How Not to Do A Rescue

[dwashbur]

We've been to Monterey, and more specifically the Breakwater, several times now, but our re-introduction this past Saturday, 6-7-08, was a bit jarring. Just as we pulled up, a diver was pulled out of the water in serious distress.

She was probably in her 50's; we gleaned that she and her buddy had been down to about 40 feet with no problems, but by the time they reached about 6 fsw making their way in, she popped to the surface complaining that she couldn't breathe. Her buddy did the right thing, got her buoyant and dragged her to shore while calling for help. As we arrived, some guy was running back and forth on the breakwater shouting for someone to call 911. (Aside: he was also a diver, apparently, but he was about as much help as a sore foot. We had serious problems with him later over an unrelated matter. In a word, he was a twit. But that's another story.)

My wife and I are both rescue divers and she's also a registered nurse, so when I saw someone calling both 911 and DAN, I stayed up on the breakwater to direct traffic and wait for EMS while she went down the steps to the beach to try and help. It was a good thing she did, because those people didn't have a clue what they were doing. More precisely, the phrase "cluster-f***" comes to mind. There were 5 people kneeling around her and nobody seemed to know what to do. Somebody nearby got out a DAN oxygen kit and started trying to put it together. My wife pushed a couple of guys out of the way and knelt beside the victim, and noticed several things at once. First, she was conscious. Second, she was breathing. Third, she was blue. So even though she was breathing, she wasn't getting enough oxygen. My wife called for oxygen, and some nitwit handed her a mouth-to-mouth mask. Huh???? She stared at it for a second and tossed it aside. At last someone got the O2 tank down there. She set up the nonrebreather mask, hooked it up, and put it on the woman, only to discover that none of these geniuses had turned the tank on.

At that moment someone produced a second O2 kit, and this one actually was turned on (what a concept). She got the mask in place and cranked the oxygen up, but even with full-bore 100% O2, the woman was still blue and saying she couldn't breathe. But she was conscious and had a clear airway, so my wife said "Let's get her in the rescue position." The woman's buddy flatly refused. He insisted she stay on her back. My wife tried to point out that if this was a cardiac event and the woman vomited in that position, it could kill her. He was having none of it, so the woman stayed on her back.

About that time, EMS arrived and I directed them to the scene. Three paramedics came down to the victim, and no less than 3 of the clowns who thought they were helping refused to move out of the way. The paramedics actually had to physically move one guy so they could get in to take care of business. My wife and I had already gone back up the steps and were keeping out of the way of the ambulance team. These other guys didn't seem to understand why they needed to move.

As it turned out, it was apparently a case of serious exhaustion. The lady is out of the hospital and seems to be doing well; the doctor just wants her checked out by a dive-savvy physician before she goes back in the water. So it turned out all right, but it sure wasn't thanks to all her "helpers."

If there's a better argument for continuous diver training, and especially rescue training, I don't know what it is...

[nwscubamom]

Wow, this is a perfect example of what I teach my students in my CPR classes about why you must ask for permission before helping someone, and why some folks may refuse your help. Frankly, if I was that lady, and those clowns were asking permission to work on me - I'd flat out refuse them!!!

So I'm curious, why use the non-rebreather mask if she was conscious and breathing? Why not use the demand valve with an oronasal mask?

- Janna

[Sounder]

So I'm curious, why use the non-rebreather mask if she was conscious and breathing? Why not use the demand valve with an oronasal mask?

- Janna

How common are the demand valve masks?

If it were me, I would have used a non-rebreather mask too... but only because I don't have a demand valve mask. That's a few scuba units I don't have to spend on an O2 kit right now. Instead I carry a couple non-rebreathers and a bag-valve mask should it be a bad day.

[nwscubamom]

Don't confuse the mask with the method. Using the demand valve with either an oronasal mask (sometimes called a TruFit mask) or using it with an oronasal resuscitation mask (aka pocket mask - with the demand valve plugged into the oronasal hole on the top) is THE #1 method for delivering the highest concentration of O2 to a breathing diver.

But the key is you're using the Demand valve (works just like a scuba regulator and delivers 100% O2 on demand).

Using the non-rebreather mask is a surefire way to go through your O2 supply much faster, as well as not delivering 100% O2 (due to mask leaks) to the diver in distress.

[nwscubamom]

So I'm curious, why use the non-rebreather mask if she was conscious and breathing? Why not use the demand valve with an oronasal mask?

- Janna

How common are the demand valve masks?

If it were me, I would have used a non-rebreather mask too... but only because I don't have a demand valve mask. That's a few scuba units I don't have to spend on an O2 kit right now. Instead I carry a couple non-rebreathers and a bag-valve mask should it be a bad day.

The demand valve masks are as common as a 'pocket mask', which should be standard in every single first aid or O2 kit. Or you can buy a silicone 'trufit' mask for about $30-$40 I think.

So I bet you DO have a demand valve mask.

- Janna

[Sounder]

So I'm curious, why use the non-rebreather mask if she was conscious and breathing? Why not use the demand valve with an oronasal mask?

- Janna

How common are the demand valve masks?

If it were me, I would have used a non-rebreather mask too... but only because I don't have a demand valve mask. That's a few scuba units I don't have to spend on an O2 kit right now. Instead I carry a couple non-rebreathers and a bag-valve mask should it be a bad day.

The demand valve masks are as common as a 'pocket mask', which should be standard in every single first aid or O2 kit. Or you can buy a silicone 'trufit' mask for about $30-$40 I think.

So I bet you DO have a demand valve mask.

- Janna

Sorry, yes you are correct... I do have the (common) mask... it's on my bag-valve system. I have another one in the bag too as a back-up. What I don't have is the demand valve so I run both my bag-valve and non-rebreather off the "christmas tree" fitting on the oxygen regulator.

You're very correct in saying that the demand valve plugged into an appropriate mask is the #1 way for delivering 100% O2 without (much) waste. Someday I'll get one of these, but I need a scootie, more sets of doubles, tech training, deco bottles, etc... before I get a O2 demand system.

The waste with my delivery options is why I bring an extra bottle, even when close to EMS. It's not optimum, but if someone wants/needs O2, and I'm the only guy around with a kit, it's what they're stuck with.


Dave - do you know whether they had a demand system at your scene in either of the kits? Sounds like you definitely watched quite the cluster-f. Glad everything came out ok.

[Grateful Diver]

As it turned out, it was apparently a case of serious exhaustion. The lady is out of the hospital and seems to be doing well; the doctor just wants her checked out by a dive-savvy physician before she goes back in the water.

... to what end ... so it can happen again?

Given what you've told us, I would wonder if she's physically fit to dive at all. I hope that's something the doctor is prepared to consider ...

... Bob (Grateful Diver)

[dwashbur]

Wow, a lot to answer. Janna, she hooked up the rebreather because that was what they handed her. Actually, first they handed her the pocket mask - without an O2 source - as if she was supposed to give a breathing person artificial respiration. Kathy knew the woman needed oxygen, and the rebreather was there so she hooked it up. But as it turned out it was all pointless because the guy with the tank never turned the blasted thing on. When she got the second tank, she did in fact hook up a demand valve. I only just this moment learned that part of it (I was up topside directing EMS to the scene).

Bob, I don't know the particulars of the person or the accident. From the way her buddy was talking, they have been diving a lot, and initially everyone thought it was a heart attack. My wife didn't agree because there was no chest pain, but I guess that was one of the things the hospital had to rule out. As for why she needs to get checked out by a dive physician, that I don't know. It's just what the owner of the nearby shop told us when we asked the next day how the woman was doing. You now know as much as I do, which obviously ain't much