Appeared in DIVER October 2012
Recovering a stricken diver from depth involves some big decisions, and it helps to think ahead. Seven of the UK’s leading technical-diving instructors discuss what they would do in such an emergency with JOHN LIDDIARD
FOR NORMAL SPORTS DIVERS, rescuing another diver is just a technique we learn during our training, to be applied at some random point in the future should we ever be unlucky enough to have an incapacitated buddy.
At this point, unless it is a skill regularly practised, we make a messy but successful controlled buoyant lift. “Successful” in that at least both rescuer and victim end up on the surface, even if there is some loss of control in the process.
Keeping our rescue skills practised and up-to-date will of course lead to better rescues, with less risk of injury from the ascent.
For most divers, depth and decompression are never so great that side-effects of a rescue ascent can’t have a good chance of being resolved later in a recompression chamber.
But as depth and decompression increase and we get into the technical-diving realm, so the difficulty of making a rescue increases, as do the risk and severity of consequent injury to the rescuer and further injury to the victim.
Making a controlled buoyant lift in technical-diving kit is largely an extension of the techniques we already know. What can’t be practised is the psychological aspect of the rescue and decisions that need to be made in the process. There is no single right answer.
This summer’s Vobster Tek-Camp provided an opportunity to ask some of the country’s top technical instructors. These are their personal thoughts, and don’t necessarily reflect the official position of the training agencies they represent.
ONE CASUALTY IS BETTER THAN TWO
PHIL SHORT: “There are a lot of people out there, very competently technical diving, who have not really considered what will happen if something goes wrong.”
PAUL TOOMER: “The first thing anyone is taught is, never put yourself at risk. But also, we never leave anyone down there.”
KEVIN GURR: “Make time to think about it first. Look ahead and decide how to go about doing it. Is it worth coming to the surface? Is it worth trying to do the lift at all? How long has this guy been here? But to make a decision you need that time. It could make the difference between life and death of one or two people.”
VIKKI BATTEN: “You are relying on people using their judgment, and that is based on their own comfort zone, the environment, experience and a whole load of factors. I’d hate to advise somebody else to do what I might decide to do.”
MARK POWELL: “Every option is open to criticism. Sending them up from the bottom is probably best for you, but potentially worst for the casualty. Bringing them straight to the surface and missing decompression is probably best for the casualty, but worst for you.”
NOT BREATHING, REGULATOR OUT
RICH WALKER: “I need to work out how long they’ve been there. Am I looking at a rescue
or a body recovery? If they were in my team, chances are they haven’t been like that for long.”
MARTIN ROBSON: “If someone loses consciousness under water and loses a regulator, unfortunately they’re going to pass away, regardless of how short a time they’ve been under water. It’s not a very forgiving environment. More often than not the lifting of a person to the surface is a body recovery.”
MARK POWELL: “You only have a few minutes before they’re dead. The chances of actually saving them are pretty slim. Doing any stops on the way up will guarantee that they’re dead.”
VIKKI BATTEN: “Their best chance of assistance is on the surface. Unless you know they’ve been there for hours, there’s still a chance. But they are not alive, so their safety comes second to those who are. I would still try to bring them up at a controlled rate if I could. I don’t want to lose another person from my team for the sake of somebody who may not be recoverable anyway.”
PHIL SHORT: “In a physical overhead, it ceases to be a rescue and becomes a recovery, because the penetration distance and time without breathing means that there is no chance of survival. It can only be a rescue in open water.”
PAUL TOOMER: If they aren’t breathing, they’re going up. If it’s a small amount of deco, I’ll go with them. If it’s a long amount of deco, they’re going up on a bag.”
REGULATOR IN, STILL BREATHING
PAUL TOOMER: “How many divers are found unconscious, but with a regulator still in their mouth? I’d like to see some numbers on that.”
VIKKI BATTEN: “You have someone who is alive, and I would want to do everything I could to maintain that.”
MARK POWELL: “If they’re unconscious, all the muscles of the face go limp. They may not be making a good seal on the mouthpiece. Even if they’re breathing, they may not be breathing for very long, even if you’re holding the mouthpiece in place. The only time where it has a high chance of success is with a full-face mask or a rebreather with a gag-strap.”
PHIL SHORT: “One scenario is an oxygen convulsion, which is a grand mal seizure. It’s a violent thrashing action. If you’re not waiting for it to stop, you need to approach from the back. If a regulator is in, you make the effort to hold it in. If the regulator is out, there’s no point putting it back.”
PAUL TOOMER: “Once you’re off the bottom and on the way up, it becomes harder. You need
to keep the airway open. You need to keep the regulator in their mouth. It’s not just the technique but the decisions you have to make.
At about 30 minutes of decompression I may be prepared to do a bounce to the surface and head back down for an interrupted decompression. When we have an hour of deco overhead, there’s a good chance I’d never see my family again if I brought that diver straight to the surface. Or I could be totally lucky, miss my decompression, bring them to the surface and walk away from it.”
PHIL SHORT: “With modern decompression algorithms, the stops start way deeper and the profile is more gradual. If you miss out those stops, you’ve now introduced enough bubbles to induce a bubble that will evolve. So now you’re an injured diver attempting to rescue an unconscious diver. Get them to the principal stop, the stop that if you miss you’ll end up badly injured yourself, then send them up to the surface and continue your deco.”
MARTIN ROBSON: “If you choose to take them to the surface and then immediately descend to make a profile based on omitted decompression, there are standard protocols that allow you to do that. Included in any technical training syllabus will be what to do if you omit some deco. Choosing to do that really is a personal decision.”
RICH WALKER: “I’d try to do as much of the deep section of my deco as possible, and a nice slow ascent. Then something like 3m per minute from my 21m gas-switch to bring them to the surface, make sure they’re stable, hand them off to surface support, then go back down as fast as I could and do an interrupted deco procedure. My real concern is getting to the surface in a condition in which I’m not incapacitated myself.”
KEVIN GURR: “If that means you end up violating decompression big time, 10, 20, 30 minutes, as long as you can get them to the surface and you think there’s a chance of getting the boat over, you have the option to do an interrupted decompression, certainly in a holding pattern.
In a situation like that I would probably still come to the surface if I thought I could bring the person round.”
DECOMPRESSING THE CASUALTY
VIKKI BATTEN: “If they’re breathing, I’d need to judge whether they could miss some decompression. If you’ve got long decompression, I don’t know if that would be effective on someone who is unconscious.
I don’t think anyone has any data on that. Controlling a decompression stop over any period of time is going to be difficult. Perhaps I would have to send them up.”
PHIL SHORT: “There’s a theory among medical people that when someone experiences an oxygen convulsion, the effect of that high dose of oxygen in the system gives them a longer interval of survival without brain damage and potentially does something to the deco strategy, in that the few people who’ve been rescued at depth following ox-tox have not got bent. Nobody knows why, because it can’t be properly researched. But that obviously doesn’t apply to the rescuer. If you can get them up to 6m and hold them at that stop, they may come round and manage the rest of their own ascent. But don’t lift them while they’re convulsing, because it’s likely that the airway is closed.”
RICH WALKER: “If they had a regulator in, you still need to manage gas-switches for yourself.
It’s not something you can do for victims unless they’re conscious. If I had a capacity to manage my own deco and they had a regulator in, that could give them some deco.”
PHIL SHORT: “Being pragmatic, a breathing diver with an embolism on the surface is better than one underwater and dead. So whatever state they’re in, alive but injured on the surface is better than dead.”
REACHING THE SURFACE
MARTIN ROBSON: “What are you going to do when you get to the surface? You’ve done a shore dive and now you’re miles from anywhere. Which dive-boat are you on, how will they handle emergencies? If you draw back and look at the bigger picture, that will help you make decisions.”
KEVIN GURR: “The problem with just sending them up is they can’t flap their arms around and attract the boat. You’re no longer in control”
MARK POWELL: “You have to consider what surface cover you have. Will a single person on a boat be able to do anything if you just send them to the surface? Can they get them onto the boat? Some skippers never go out without at least two people on board.”
PAUL TOOMER: “If you were doing an emergency ascent, it wouldn’t necessarily be back up a shot-line to a decompression and support station. The dive needs to be planned, but during the dive we flex to the environment. Conditions can change.”
PHIL SHORT: “In a perfect scenario a yellow buoy calls the safety diver, who descends to take over the rescue. In reality, it’s just a bunch of divers bagging up in pairs to be picked up by the boat. When you get to the principal deco depth you stabilise and clip a reel to the diver to control his ascent. Once he’s gone, you clip your SMBs and send them up on the same line.”
MARTIN ROBSON: “If someone sends up a yellow SMB, the surface team are either going to send in a support diver, in which case you have someone to partner your distressed diver with and take them to the surface, or they’re going to lower some gas. In either case you now have a way of delivering this diver to the surface without you having to abandon your decompression.”
KEVIN GURR: “A lot depends on the surface team and protocols. Knowing that support is available makes my decision a lot easier.”
WOULD YOU TAKE A BIGGER RISK?
PAUL TOOMER: “I ask divers if they would risk themselves. Then I ask, if it was someone that you loved, your father, son, daughter, wife, now what would you do? It’s suddenly a different story. Honestly, I’ve looked and searched and I cannot find anyone to give me the answers on what to do. I know what I will break personally.
I also know that if it were someone I loved I’d probably break all of it. But that’s down to human nature. I’ve just done two weeks in Bikini. If there’d been a problem I’d have come straight to the surface, because there was a chamber on the boat and Simon Mitchell was on the team.”
WHEN DOES THE RISK BECOME IMPOSSIBLE?
PHIL SHORT: “For a professional instructor who is training all the time, helping the casualty while not risking the rescuer is possible. For what is basically a hobbyist technical diver, to cope with all those things at once might be unmanageable.”
BE HONEST WITH EVERYONE INVOLVED
VIKKI BATTEN: “We need to get away from the idea that it’s always someone else’s fault when a diver dies. Divers must accept responsibility. Often, the loved ones of those involved in incidents didn’t know that the diving they were doing had a risk. People reassure families that diving is safe. While it is safe, they should also inform them that there is a risk, as with any sport or activity. The family should accept the risk and understand what it is you’re doing. If they don’t, it’s very difficult for them to deal with the loss of a loved one anyway, but a lot of people find it hard to understand that their loved one made a mistake. Most diver deaths are due to diver error. They think their loved one was perfect; the loved one had reassured them that it wasn’t a problem because they didn’t want to worry them.”
MARTIN ROBSON: “The traditional recreational approaches still have validity, but they need adapting to deal with the extra equipment. Coupled with physical size, this means that there are people I wouldn’t be able to rescue with a back- lift and would need to rescue face to face.”
VIKKI BATTEN: “I prefer to lift people from the front. If they’re neutrally buoyant that doesn’t put a great strain on me, other than controlling their buoyancy, and I have at least one hand for my own equipment.”
KEVIN GURR: “I prefer to lift face to face. All their controls are on the front. If they come round,
I can reassure them rather than have them panic with me behind. If they’re carrying multiple stages, maybe some of that kit won’t be needed during the ascent, even if they come round, so get rid of it as soon as you can – anything that makes the overall rescue simpler.”
MARK POWELL: “Inside a wreck or cave, you need to get out before you can go up. A back-
lift is good for swimming them out horizontally. A back-lift can keep you comfortably horizontal. You use their buoyancy and then just ride them. But if you need clear access to their equipment, or if they’re breathing but unconscious, then a front-lift may be better.”
PAUL TOOMER: “I prefer to lift from behind if they have gas, or from the front if they don’t and I’m using my buoyancy. I find using their gas is very controllable, especially if I’m lying them flat on their back and in perfect trim.”
PHIL SHORT: “The key is to get trained in one of those methods and practise it to as close as possible to making it a reflex. Don’t jump and change between two methods, because then neither will become a reflex.”
KEVIN GURR: “Close the loop if it’s out of the mouth, to preserve evidence and prevent a flooded loop becoming a buoyancy problem, but you also need to be able to vent the loop to prevent it becoming a buoyancy problem. If the mouthpiece is still in and there is a BOV [bail-out open-circuit valve] and you know what it’s connected to, then maybe switch the BOV. But then you can’t do gas-switches. So keeping them on the loop would give them the right gas all the way up. On the other hand, if CO2 is the issue, keeping them on the loop isn’t going to help. It’s a tough judgment call, which is why it’s so important to stop and assess the situation.”
MARTIN ROBSON: “Make sure lung over-pressure valves are fully open and switch a BOV to a known open-circuit gas. It’s the same exercise with a lot of new techniques that are predominantly equipment-driven.”
KEVIN GURR: “I had to lift someone after an oxygen convulsion at 50m. Fortunately there was only about five minutes of deco, so I brought him all the way to the surface. I skipped the deco. On the bottom I watched him convulse and waited for him to stop fitting, which gave me about 15 seconds to think about it and get mentally prepared. He was on a rebreather, off the loop and basically drowning. He wasn’t already using his BC so I lifted him on his drysuit. I knew that would be my worst buoyancy problem. Initially it was face to face because I wanted to control as much as possible. What I actually did, and to this day I’m not exactly sure why I did it, was to invert him. About halfway up he started to go anyway, his drysuit feet filling up, so I let him continue rather than correct it. I was thinking that maybe there’s a chance when the gas inside him expands it will purge water from him. At 10m, we drifted across the shotline and I managed to get my leg round it. That slowed us down and I punched him and made him burp air. When he was at the hospital after we’d resuscitated him, he had no lung damage at all.”
MARTIN ROBSON: “I was involved in what turned out to be a body recovery and a rescue. There was a missing cave-diver. The first people to commit to look for and possibly rescue the cave-diver were a couple of divers who weren’t sufficiently qualified, were under-equipped, and ended up making the task more difficult for the cave-diving rescue team that followed. When they were discovered, neither diver would have had enough gas to get out by themselves.”
PAUL TOOMER: “I took a guy who was partially conscious through a full ascent. I took him through all his decompression and gas-switches. The lights were on, but no-one was home. I took the reg out of his mouth and put the next one in and purged it for him.”
PHIL SHORT: “A diver had an ox-tox from breathing 80% at 50m, and I and another diver lifted him all the way to the surface. Every 3m we hit him in the middle of the chest to see bubbles come out of his mouth. This happened as the whole team arrived on the bottom. We missed deco, got him to the surface and on the boat. He was in intensive care overnight but perfectly OK and diving again in a month. In all he was without air for about seven minutes.”
|MARTIN ROBSON: “Rescue under water is first aid, and subject to the same principles. Don’t be so instantly reactive that you put yourself in a position of danger. Remove the casualty from danger. For most people the moral sense of helping someone in distress is very difficult to temper against not
hurting yourself in the process.”
“If there is no chance of resuscitation because you know he has been drowned for 10 minutes, then
all you could do is make two casualties instead of one. But if there is a chance he will come round, attempting to save a life is obviously the primary thing that you do.”
VIKKI BATTEN: “Having suffered decompression sickness, I wouldn’t miss my deco for someone else. Environment has a lot to do with it. If you have safety and support divers and you know that
you just have to control this diver through a couple of fairly short stops, then that’s what you’re going to do.”
“If they’re unconscious and breathing, but have a huge decompression penalty, that’s the one that needs addressing most. Do we keep them in the water and take them through the decompression? If it were a small deco dive I’d bring him to the surface. If it were a bigger deco dive, I have a real conundrum.”
“After you pass serious bottom time beyond 80m or anything at all beyond 100m, you need to look
at it similarly to an overhead environment. It’s so far from home, it’s such a complex ascent, and it could do so much damage to the rescuer if he starts missing that sort of deco. There comes a point where you analyse the whole situation and go: this guy cannot be revived by the time we get him where he needs to be.”
“I’d lie them face-down, lie on top of them and do all the buoyancy on their wing in a flat trim position. One hand on their wing control, one hand extending their neck to keep the airway open and hold their regulator in. I could swim them out and make an ascent in a flat trim position.”
“A friend came up to the surface and saw his buddy sinking down again, and his buddy was his wife. He went back down after her and he said there is no depth he wouldn’t have gone to, to rescue her. He said whatever it took he was going to go and get her. Even if it turned into a double fatality, he wasn’t going to leave her. He brought her back up, and as he was ascending his next thought was:
‘What about the kids?’ She made a complete recovery. They decided that for technical diving they wouldn’t dive together, just in case. It was their risk assessment to make sure they wouldn’t both be lost in one incident.”
TekCamp: www.tekcamp.co.uk; Vobster: www.vobster.com
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