Using an AED with a Diving Victim

Wilky · Post by **Wilky** » Tue Jan 30, 2007 3:07 pm

I just completed Red Cross' CPR & AED training. I asked them about using an AED with a diving victim and they did not have a direct answer. Does anyone know if there is a specific AED for diving or if the likelihood of using one is small since we are around water? I am more curious if any of the certification bodies have thought of this or have recommendations for using an AED in this type of environment.

Thanks.

CaptnJack · Post by **CaptnJack** » Tue Jan 30, 2007 3:26 pm

By the time you get them to the surface, on shore (or boat), and bare chested, I would guess they would already be brain dead. Sad, but I don't see how they could survive intact. You need a <5 minute response and that's not really plausible IMO.

GillyWeed · Post by **GillyWeed** » Tue Jan 30, 2007 4:07 pm

I think this is really something that our own Zen Diver (Valerie) should answer, but I don't know that you would want to count them out as brain dead right away. At least from my class that I took with her that was not my impression. I think having an AED is very important as basic CPR is just a holding pattern. If you are going to do CPR on the surface then why not an AED. They can be used on a wet floor or on metal, just not in standing water (so not in the pool or the ocean). Also we might concider the affects of the cold water in slowing the body down and therefore the < 5 minute time frame maybe able to be stretched a little. I hope that if I am ever in the situation there is an AED available.

Zen Diver · Post by **Zen Diver** » Tue Jan 30, 2007 4:26 pm

Well, Gillyweed, said it all. An AED can be used on a wet surface, just not in standing water. You'd have to cut off the wet/dry suit and get them bare chested, shaved if needed and apply pads etc. Of course first you'd have EMS called and on the way. Where it might be different in dive applications is on a boat. If there is a lot of vibration the AED might not be able to analyze, which means the engine may need to be stopped momentarily.

While it definitely takes time to get the victim out of the water an AED, if available, should still be used. After all, you'd still do CPR, right? Even tho it's not a great chance? The cold can help preserve brain function and you never know what the outcome will be. If you've got the tools, use them.

-Valerie

don · Post by **don** » Tue Jan 30, 2007 5:02 pm

Valerie and Gillyweed are right. As a boat captain and dive instructor working full time in the cold water for the past 5 years myself and my crew have thought a lot about cold water rescues. I've also worked as an EMT in a rural area and, at least in my area, we didn't get a lot of emphasis on diving or water related emergencies. I encourage everyone to get some training in diving related emergency management. This training will teach you how to properyly respond to a dive emergency. More importantly it will increase your awareness of potential dive emergencies and that awareness will, hopefully, help you recognize and avoid problems before they become emergencies. Train, prepare (think about emergency plans), and practice. When the vis is bad and the weather s..ks (most rescues are in less then perfect conditions) practice your rescue skills! DAN has some great courses available that focus on dive and water related emergencies. Check with Valerie for the DAN courses, or if you're in my area around "The Hood", check with me. The DAN courses will build on your basic CPR / First Aid skills and teach you about dive rescue and emergency management.

I hope you all don't misunderstand my comments. I dive with lots of people with a wide range of experience through all seasons. One (of many) things I've noticed is that sometimes people don't think ahead and plan for the unexpected. Congradulations to you that have taken CPR/First aid and other emergency management courses, and thank you for asking questions related to diving that some of those courses leave unaswered.

BTW, I've been lurking here for a while and this site is great for info and news. Thanks to everyone, inexperienced and pro, that ask and answer questions.

don

Seaslave · Post by **Seaslave** » Tue Jan 30, 2007 6:52 pm

Don, Valerie and Gillieweed are right. The AED should be applied to the stripped and towel dried victim. If the AED finds a shockable rythem it will advise a shock and if it does not find one then cpr could induce a shockable rythem. So it should be applied reguardless of duration in water and/or without air. One thing I learned in my medic training was that with an AED you can do no harm, if your putting it on then they're already "dead" (No pulse, No resperations). I think if you did not apply the AED you would be doing a disservice to the victim and if trained to use it you may be held liable for not using it.

Mathue

Sounder · Post by **Sounder** » Tue Jan 30, 2007 11:13 pm

Also consider the limitations of an AED and how you an limit these limitations. If you're on a boat, and the boat is rocking there may or may not be an accurate read for a "shockable pattern." I've found a great difference in a true shockable pattern versus when the AED advised a shock. Moral of the story is to use the device whenever possible (when situation indicates it) but, if possible, try to do it when the patient is not rocking and rolling (the back of an ambulance driving down the road causes the same problem). Even if they are moving around however, try anyway! I agree, use IN water is a problem but use on a wet patient is fine (towel dry will be helpful).

If I'm ever in trouble, PLEASE PLEASE PLEASE use the AED. Don't count me out just because all indications appear that I'm dead - especially up here where the water is cold!!! Hypothermia can be the greatist gift to people with acute emergency medical conditions as I'm sure Valerie will confirm. They're not dead until they are WARM AND DEAD - and only a qualified person should make that call anyway. As far as you should be concerned, you're saving their life, period. You should continue CPR, O2, and AED until higher medical authority arrives (or until you physically can't do it any longer). Hypothermia and AEDs have saved lives when hope was thought to be lost.

Here's the pitch for taking some of Valerie's classes and/or taking an EMT course at your local community college. It's something you'll retain and use forever - the life you save may be a total stranger or someone you love very dearly.

Zen Diver · Post by **Zen Diver** » Tue Jan 30, 2007 11:51 pm

Sounder wrote:

Here's the pitch for taking some of Valerie's classes and/or taking an EMT course at your local community college. It's something you'll retain and use forever - the life you save may be a total stranger or someone you love very dearly.

I'll be scheduling a Dive Emergency Management Provider (DEMP) class in the coming months. It includes O2, Advanced O2, AED and Hazardous Marine Life Injuries. I'll also be doing the DAN Onsite Neurological Assessment class in the next two months or so and will post details as they are available. Feel free to PM in the meantime.

-Valerie

Sounder · Post by **Sounder** » Wed Jan 31, 2007 8:12 am

Valerie, could you teach the Hazardous Marine Life Injuries portion individually? I'd really like to take that portion of the class.

Zen Diver · Post by **Zen Diver** » Wed Jan 31, 2007 8:40 am

Sounder wrote:Valerie, could you teach the Hazardous Marine Life Injuries portion individually? I'd really like to take that portion of the class.

I will probably have things set up so that you can sign up for the whole DEMP class, or, anyone who wants just the Hazardous Marine Life class can come in the afternoon for that portion. I just did HMLI on the 22nd and it was a blast!

-Valerie

Sounder · Post by **Sounder** » Wed Jan 31, 2007 9:17 am

I'd love to. They don't go into much depth (pun intended) on Marine Life injuries in medic school in Southern Arizona. The worst marine life injury there is a rattlesnake being washed down a drainage during a monsoon flash flood.

Wilky · Post by **Wilky** » Wed Jan 31, 2007 11:40 am

Thanks for all of the comments. I had asked others as well and the majority of individuals indicated to not use, because some of the things mentioned here. It is not recommended to use an AED when moving or when the victim or area is wet. However, I have ran across some information that indicates some of the newer AED's have circuitry that allows them to be used while moving and in damp conditions. The victims chest still needs to be dry.

Thanks, again.

Bryan

Sounder · Post by **Sounder** » Wed Jan 31, 2007 1:33 pm

If the circumstance calls for it and I'm the patient, PLEASE shock me several times if necessary. You're certainly not going to do any more damage. I would guess that AEDs are getting MUCH better in reading what the heart is doing while the patient is moving... technology is beautiful.

CaptnJack · Post by **CaptnJack** » Wed Jan 31, 2007 4:34 pm

Go ahead and use it, I agree it won't do any harm. But a victim in a drysuit or even a wetsuit is not going to be "cold" enough to maintain brain function for 10-15 mins. I really doubt you could get someone to the surface, aboard or ashore, and barechested - with a somewhat dry chest in <10 mins. That is alot to do in a short amount of time.

Purchasing an AED for a boat to use in diving situations is fine if you have the bucks, but sufficient O2 to use on truly treatable injuries is probably a wiser investment/prioritization IMO.

Celeus · Post by **Celeus** » Mon Feb 05, 2007 2:35 pm

Has anyone here taken, or does anyone teach this DAN class?
https://www.diversalertnetwork.org/trai ... /index.asp

GillyWeed · Post by **GillyWeed** » Mon Feb 05, 2007 2:57 pm

I believe our oun Zen Diver would be the one to teach this.. I took basic life support with her and we did the AED portion. She rocks and everyone should take one of her classes, IMHO

Zen Diver · Post by **Zen Diver** » Mon Feb 05, 2007 7:31 pm

Celeus wrote:Has anyone here taken, or does anyone teach this DAN class?
https://www.diversalertnetwork.org/trai ... /index.asp

Yes, I teach that class. I can do as a stand alone, or with BLSPRO. Not a long class and can be easily combined with O2 and/or Advanced O2. Also taught as part of the Dive Emergency Management Program, which is O2, Advanced O2, AED and Hazardous Marine Life Injuries.

Only pre-requisite for AED is current CPR.

-Valerie

Celeus · Post by **Celeus** » Wed Feb 07, 2007 7:00 pm

Zen, hope to add this as one of the ones I get before heading off to Roatan/Belize in May.

Then again, it may be one for after that when things have calmed down.