The perfect tow
In-water rescue breathing - where does it all go wrong? Time to sharpen up your skills, with the help of John Liddiard
ADMINISTERING RESCUE BREATHING in-water is one of the trickiest diving skills to master. Plenty of divers get through basic rescue training with an adequate ability, but still with lots of little glitches that, if sorted out, would make their rescue breathing smoother, easier and far less of an effort.
The latter factor is crucial. If just giving the rescue breaths tires you out, you have less energy available for towing. Let's face it, in-water rescue breathing is only an interim measure before getting a casualty to a boat or shore, where more effective CPR can be administered.
By developing what is merely adequate technique into mastered technique, giving rescue breathing will no longer use effort that would be better spent on towing.
Nor will it interfere with towing, or slow it down. The objective is to get the casualty to the boat or shore faster, while still getting in some effective breaths that could make all the difference.
The emphasis of these tips is on the mouth-to-nose method, generally considered to be the most practical in UK conditions, but similar improvements can be made by those favouring other techniques.
But first, a digression into the photographs taken to illustrate some of the points. After so much practice getting rescue techniques up to instructor standard, my volunteer helper Elena had to work really hard to get it wrong!
Not just plain wrong, but wrong in the specific way I wanted to show with each picture, and so perfectly wrong as to make the point without all sorts of other wrongness confusing the message.
It all goes to show - once you have the technique sorted out, it's a bit like riding a bike. For convenience in the examples and to match the illustrations, I refer to the rescuer as "him" and the casualty as "her".
MY CASUALTY IS GETTING AWAY
As advised by all the training agencies, our rescue begins with a few cycles of rescue breathing while stationary. An obvious first sign of room for improvement is the casualty moving away from the rescuer - feet first!
What happens is that to get above the casualty to make a rescue breath the rescuer is finning upward, but to rise slightly out of the water takes hard finning and some strength, so the rescuer tends to push against the casualty.
In a wonderful demonstration of Newton's third law, the one about action and reaction, the casualty is pushed away from the rescuer. Compounding the problem, this causes the rescuer to tilt forwards, transferring much of the effort of finning upwards into additionally pushing the casualty away.
The solution is for the rescuer not to swim upwards at all, but to simply roll the casualty towards him.
A casualty does not have to be flat on her back for rescue breathing to work. All you need is a gentle neck extension. With this in mind, the casualty can be rolled 90° or more over to gain access to the nose without having to climb.
|My casualty is getting away: The answer is to avoid swimming upwards, but to roll the casualty towards you.|
POSITIONING TO GIVE A BREATH IS EXHAUSTING
A rescuer may think he is doing it all by rolling the casualty, but the whole process is still very tiring.
The chances are that, even if he is not aware of it, the rescuer is still getting upright in the water, and even swimming upward a little.
While our last problem was all Newton's fault, this one comes from Archimedes.
When swimming upward, a rescuer is not only lifting his own weight out of the supporting buoyancy of the water, but also the weight of the top of his cylinder and regulator.
At the same time, raising his own BC out of the water is actually throwing useful buoyancy away.
The trick is for the rescuer to enlist Archimedes' help. By leaning about 45° backwards, the rescuer's cylinder and BC stay mostly submerged, and no buoyancy is lost.
Of course, to get the casualty's nose into the rescuer's mouth now requires even more roll but, as noted earlier, there is nothing wrong with this.
While the training manuals suggest that initial rescue breaths should be given while stationary,
a bit of gentle finning backwards usually makes it easier, and helps promote good technique.
As Robert Redford says in Butch Cassidy & the Sundance Kid: "I'm better when I move."
|Positioning to give a breath is exhausting: So don't use too much effort by lifting a large amount of your body and your BC out of the supporting water - lean back about 45°.|
WHY AM I STILL DUNKING THE CASUALTY?
The beginner's problem here is simply pushing upwards against the casualty and invoking Newton again. But divers with this problem would never pass a rescue assessment; they will have learned to at least roll the casualty a bit towards them.
More insidious is the positioning of the rescuer's right elbow (assuming that he is working from the casualty's right-hand side).
The basic technique is for the rescuer's right hand to seal the casualty's mouth, while the left hand rolls the casualty by pushing up beneath the pillar-valve or left shoulder. It's so easy for a rescuer's right elbow to stray above the casualty's shoulder, and even to help with the roll by pushing down a bit. This is the root of the problem.
To keep the casualty's nose out of the water, the roll needs to be lifting her left side up, not pushing her right side down.
The best place for a rescuer's right elbow is actually under the casualty's right shoulder, as close in to the side of her head as possible. This will help to support the casualty, and keep her head out of the water while the rescuer rolls her to give a rescue breath.
It also helps the rescuer to extend the casualty's neck, but taking care not to use too much leverage.
|Why am I still dunking the casualty? Because your right elbow is straying above the casualty's right shoulder - keep it beneath that shoulder instead.|
|MY ARMS ARE IN A KNOT
Having cured the climbing problem, learned that rolling the casualty is the trick and got his right elbow under the casualty's shoulder rather than over it, the next issue encountered is that when a rescuer pulls the casualty closer and rolls her into position, his arms get in the way.
With all the clutter that many divers already have across their chests, adding a pair of arms means that it can be quite tricky getting the casualty's nose to his mouth (note the phrasing here - it's all about the roll).
Two adjustments are needed to solve this. The first is to avoid straying too far round the side of the casualty.
By staying almost in line with her body, there is room for the rescuer to move his own arms.
The second adjustment is for the rescuer to keep his arms extended while he rolls the casualty.
By getting the roll in first, he doesn't need to do anything complicated as he draws the casualty closer in for a cycle of rescue breathing.
My arms are in a knot: Not now, they aren't - don't get too far round the side of the casualty, and extend those arms.
MY LEFT ARM IS TOO WEAK
Especially if the rescuer is small and not that strong, or the casualty is big and heavy, rolling her over far enough to give a rescue breath can sometimes be almost impossible.
As with the previous problem, this usually results from pulling the casualty in too close before trying to roll her into position.
However, rather than letting her arms get in the way while rolling her, the rescuer's left elbow hooks out to the side to pull on the casualty's pillar-valve. At the same time, it is easy for the rescuer's right elbow to slip over the casualty's shoulder.
In this case, it is his left arm that is causing the rescuer's problem.
A much stronger move is to keep the elbow lower and push up and out against the casualty's pillar-valve or shoulder, rather than hooking at it from outside.
Again starting with extended arms, the rescuer needs to roll the casualty before pulling her in.
As he pulls the casualty in, the rescuer's right elbow should bend beneath the casualty's right shoulder.
At the same time, his left elbow drops towards his left side, but stays forward enough that the casualty is supported in the rolled position.
|My left arm is too weak: Hook your left elbow out to pull on the casualty's pillar valve - and don't get her too close before trying to roll her towards you.|
BUT THE CASUALTY'S BC IMPEDES MY RIGHT ELBOW
Many BCs have inflating buoyancy above the shoulders. This may be very comfortable for
leaning back and floating on the surface but, infuriatingly, this is right where a rescuer wants to put his right elbow.
The answer is simple - don't over-inflate the casualty's BC. Getting it so over-inflated as to make it rigid will not give her any extra buoyancy.
Letting out just enough air to allow her shoulder to be easily pinched in one hand will sacrifice negligible buoyancy. This does however make it so much easier to keep the rescuer's right elbow under the casualty's right shoulder when administering rescue breaths.
|But the casualty's BC impedes my right elbow: Don't overinflate the casualty's BC - let out just enough air to allow the shoulder to be easily pinched in one hand.|
|I'VE JUST GOT TOWING, AND NOW IT'S TIME FOR MORE BREATHS
Towing a casualty is obviously far harder work than swimming alone, and no amount of fancy swimming technique can change this fact or make it any easier.
However, after stopping to give a couple of rescue breaths, the very process of getting moving again takes a fair bit of effort.
The solution: don't stop. The rescuer should get his rescue breathing so slick that he can do it while continuing to tow.
This is where the practice really pays off, and the rescuer makes twice as much progress as he would with the stop-start approach.
I've just got towing and it's time to give more breaths: The solution is to avoid stopping!
MY FEET KEEP KICKING THE CASUALTY'S CYLINDER
Swimming on his back with left hand on the casualty's pillar-valve and right hand on her chin leaves a rescuer in a clumsy position for swimming, knees bumping against her cylinder or back.
The solution is simple: between breaths, the rescuer can let go with his right hand and roll onto his right side. An up-and-down kick is now rotated side to side, so his feet and knees are not obstructed and the tow becomes much more effective. He can also see where he is going.
When the time comes to give rescue breaths, the rescuer moves his right hand back to the casualty's chin and the towing may slow but not stop. It all helps to keep the rescuer at a good angle.
|My feet keep kicking the casualty's cylinder: So let go with your right hand between breaths and roll onto your right side.|