Distinction between BOed and "normally" drown person

[sheepeck]

Imagine

You will spot some freediver lying on the bottom.
You will pull him-her out of water and what to do now? How one could distinguish if the person is in BO or has already water in lungs?

Petr

[BennyB]

Either way you should start rescusitation immediately.

I was reading in an Australian newspaper that they are implementing a new rescue standard - instead of arriving at the scene, checking vital signs (pulse etc,) then administering 5 quick breaths, then starting CPR, they are arriving at the scene and immediately starting CPR but at a quicker speed (can't recall the exact ratio). The idea is to start to pump the blood around the body as this may be more important than the first few breaths.

I don't think this would work with freediving. Even many lifeguards have said it's dangerous and they would not be doing it. Imagine if someone was just unconscious and you ran up and started chest compressions on them...

[sheepeck]

Originally Posted by BennyB

Either way you should start rescusitation immediately.

But how?
In case he/she is in BO - then I would take mask off and blow on face. In case on drawning, I would try to get the water out of the lungs and start mouth to mouth breath and heart massage if needed.

But - the question is - WHAT kind of rescue to choose? How to decide?

[BennyB]

Sorry, i'll clarify what I meant. I thought you were meaning that if you just saw someone lying on the bottom of the pool (someone that you hadn't been spotting).

If you see someone blacking out during a dynamic, you should immediately get the person's airway out of the water, support their head (make sure they can't hurt themselves on pool edges etc), take their mask off, gently (not yelling) say their name, and gently blow on their face. If they do not come back within a few moments, say around 30 seconds then you should give a couple of breaths mouth to mouth. This will serve 2 purposes - firstly to pop the glottis open (a laryngospasm will close this off for a small period of time, the breath helps open it again), and secondly to provide air to the victim.

Usually if they have just BO'd and you got them quickly, then this is probably enough and they will regain consciousness. If they haven't come to within a minute, check their vital signs (breathing, pulse at neck) and start administering full EAR (mouth to mouth) or CPR as necessary.

If it was me and I was walking near the pool and found a freediver at the bottom, I would skip the blowing/name calling bit and assume they had drowned, going straight into resuscitation - give 2 quick breaths, check vitals and perform EAR/CPR as necessary.

Either way (BO or drowned), you can't make things worse by giving them a couple of quick rescue breaths. In fact some freedivers give one or 2 breaths as soon as someone blacks out as they believe this helps speed the process up and get them breathing quickly.


I'd like others to chime in here, i've not done a rescue course in years and haven't done a specific freedive resuscitation course, just picked up bits from various dive courses, talking to other freedivers and just common sense.

Cheers,
Ben

[iceselkie]

Yes, it's a perfectly good idea to breathe for them ASAP, even if it's assisted breathing. Get that O2 out quick if you have access to it too. Here, we give two slow breaths at first, (2 second length, 3 second spacing)check pulse and then continue 1:5, O2 at 10L/min. (& Call the Ambulance!)
The question as if they've BO'd and no aspiration vs Aspiration, is likely a matter of timing/airway protection- if they come to, they can still experience dry-drowning. read http://pedsccm.wustl.edu/All-Net/eng...ct/drown-2.htm
Chest compressions can be done on a weak pulse, but definitly use caution, keep on top of the vital signs so you know which way they are progressing.

[sheepeck]

OK, I see - apparantely there is no visible difference in BOed and drowned person, right?

[immerlustig]

the difference is that a bo'd person is alive, a drowned person is dead. big difference.

near drowning: http://www.emedicine.com/ped/topic2570.htm

there is also the possibility of secondary drowning where a person had water entering the lungs during immersion but was regaining consciousness later on. this water, if not clinicly removed, will over time increeasingly inhibit gas exchange as the water moves around inside the lungs. eventually the person dies from not enough o2. if there is any possibility of water in the lungs, even if the diver doesn't feel it see immediate medical attention. secondary drowning can occur mayn hours after the event.

http://en.wikipedia.org/wiki/Drowning

[Skywalker]

Just my two cents to the topic. Never ever bother trying to remove water out of somebodys lungs. first you never know how much is in there anyway second the water is absorbed by the alveols in the lungs in a matter of seconds not minutes. Secondary Drowning yes be carefull with that and seek medical check up.

And please no do not ever attempt chest compression on any person older then a new born as long as there is a pulse even if very weak. Even the best CPR is propably just almost as efective as a weak Pulse produced by the heart itself (especialy if the pulse is strong enough to be felt on wrist).

I can recomment the source of the European Resuscitation Council (I am sure there is a compareable institution in the states) They publish Guidelines for almot every possible medical Emergency which are based on lots of studies and a lot of people braking their brains thinking about the best possibility for the patient.
They obviously do not feature how to treat a bo freediver but for example feature a special part about drowning incidents.

Rob

Edited to add a link to the ERC: http://www.erc.edu/index.php/doclibrary/en/12/1/

[samdive]

The resuscitation guideline changes that Benny refers to have an exception for drowning so would not apply in this instance - for non drowning victims, you now go straight into chest compressions (30:2) but for drowning you do up to 5 breaths first (European Resusc Council).

[naiad]

Originally Posted by BennyB

Either way (BO or drowned), you can't make things worse by giving them a couple of quick rescue breaths. In fact some freedivers give one or 2 breaths as soon as someone blacks out as they believe this helps speed the process up and get them breathing quickly.

I'd like others to chime in here, i've not done a rescue course in years and haven't done a specific freedive resuscitation course, just picked up bits from various dive courses, talking to other freedivers and just common sense.

I thought it was best to try and get the person to breathe before giving rescue breaths. I have seen quite a few blackouts and sambas in pool training, and they have all recovered quickly without rescue breaths. They were rescued within a few seconds of having blacked out.

Lucia

[sheepeck]

Originally Posted by BennyB

In fact some freedivers give one or 2 breaths as soon as someone blacks out as they believe this helps speed the process up and get them breathing quickly.

Yes - but is it true?
Why I asked - I was wondering if giving rescue breath to BOed person doesn't act contraproductivelly since I was taught to act calmly, just to speak to that person and blow on face. It was said that for ex. patting on face would not help and I thought that giving rescue breath would also could be felt like something what couldn't happen and that person would stay in BO state longer.
The larrynx is closed anyway so I don't know if you would be able to push the air through.

Petr

[henjon]

I would like to add a comment, on the question wether to give a person a cpr blow right away, or first try to get the person breathing by using the btt. At the nordic deep site, you can read about a discussion simular to this one. Here the conclusion is that you may risk blowing air into the victims stomach because of the sealed airways. This may cause the victim to begin vomitting, which in the end will help to further complicate the situation.

And then i have a question.. have any of you ever experienced a person having a samba or BO after short sessions in a pool? i.e. after an 25 meter dynamic? or 30 second dive for instance? Or is it only when people push themselves that they risk BO and Samba?

Kind regards

[BennyB]

I think the breath helps pop the larynx open earlier, which in turn triggers the rest of the body responses that tell the unconscious person that they are ok, as well as supplying air a little bit earlier.

This is what I heard at the comp in Nice earlier this year from the French guys. I can't see any reason why it would either not work or make the situation worse (besides the diver waking up to someone kissing them... which could work both ways!). All the things you've mentioned (talking calmly, blowing on face etc) are all part of an overall response to regain consciousness, as I imagine the quick breath is.

Cheers,
Ben

[BennyB]

Keep in mind that CPR is Cardio Pulmonary Resuscitation, which is the chest compressions. EAR is Expired Air Resuscitation which is mouth to mouth. What do you mean by BTT? I haven't heard this term before.

Interesting point you raise Henjon about flowing air into the stomach instead of the lungs. We were always taught in the life saving club when I was a teenager to tilt the head back fully when giving mouth to mouth otherwise the air goes straight into the stomach. This can be a bit hard if you're in the pool or open ocean and you're having trouble balancing. We were taught Mouth to Nose as well, which sounds gross but is a bit easier to maintain a head tilt if you haven't got your balance because you're in deeper water.

I think it's entirely possible for somebody to BO or Samba after short distances/times underwater. Think if somebody tried to sprint 25m no-fins or did back to back laps without a proper rest in-between. A guy I used to train with had another dive buddy that would nearly always BO at 48m no-fins, yet this guy was athletic and could easily do a 4+min static.

Cheers,
Ben

[henjon]

Hi Ben.

In the army we learned to always and only, blow through the nose, and with the head tilted backwards.. Tilting the head opens the airways just like you said. But the problem is doing this properly while in the water as you also mention.

Often the thoath can become blocked by the victims tongue, or the thoath is sealed. theese things are common with BO´ed people. and hence blowing through the nose will be far more effective. I have been on 3 first aid courses. And each and every time we learned mouth to nose.

About BO or samba in a pool, i guess it is VERY important to allow one self plenty of recovery time, and only do dynamic dives that are very short and only designed to train technique rather than indurence.