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March 25, 2010 11:52 AM Pacific (GMT -8)
 

Rescuing an Unconscious Diver
by Bob Ramsay, Director, DAN South East Asia-Pacific

It was a great dive, the vis at the wreck was better than I'd ever seen it, and the marlin we saw at the five-meter (15-foot) mark was a one-of-a-kind experience.

My buddy and I were biding our time on the safety stop, and everything seemed fine. I made a final time check and turned to my buddy to give the thumbs-up, but discovered she had already left. Looking up, I could see her on the surface.

Strange. I surfaced and shouted. No response.

She was, I now noticed, floating face down. No!

I shouted to the boat, gave a distress signal, raced to her and turned her over.

Nothing.

For a second my brain didn't register, and then POW-I was in overload.

The skipper reacted immediately. Thank god the boat was only 4 meters (12 feet) away. I got her to the side, and the skipper reached over to haul her in, straight up. But he couldn't.

I remembered the weight belt and I pulled it off. I should have done that first.

We tried again, but the side was too high.

Take her to the back, pull her up the ladder.

She was just too heavy. I began to panic.

Get a rope. Yes, that should work. The mooring rope was spliced to the bollard and didn't reach.

Get a knife. It wasn't sharp enough.

Get another bloody rope. We managed to get the "mermaid line" around her chest, under the arms. Heave and push-and finally she was on the deck.

After that, it was automatic. We stretched her out and initiated the ABC First Aid assessment. She had a good chance now.

At the Hospital

Later, I sat at the hospital like a stunned mullet, playing the scene over and over. I tried to work out what I could have done differently. What exactly might have made a difference to my buddy?

I relived the event: from surfacing to seeing something was wrong was only a few seconds, no delay, that was OK. She was fine at the 5-meter (15-foot) safety stop-what could have happened? I managed to get her to the boat quickly, but getting on the boat?

That's where it had all fallen apart.

I had forgotten to dump the weights. So stupid. How could I forget that? We couldn't lift her out! My god, it was pathetic, two grown men unable to get an unconscious diver out of the water. Why didn't it work?

The helpful hands coming over the side? But things seem to go all wrong: the first and second lifts failed. I towed her to the back, more delay. The ladder was too high, even with lots of hands. Finally the rope and more hands had gotten her out of the water. How long did it all take?

More to the point, when exactly did she stop breathing?

I painfully counted the minutes on one hand. When a person stops breathing, it only takes four minutes before the brain starts to die.

So was this a successful rescue? Yes, the diver was removed from the water, resuscitation was successful, breathing was started soon after getting on board. Let's have a look at what could be improved.

PRACTICE!

In some rescue courses, removal from the water into the boat is discussed, but not practiced. If it is practiced, then the scenario is often very different from the typical club or private boat dive situation.

Another important consideration is that in reality, an unconscious patient is a complete dead weight, not one jot of help. So, however well you think you have managed in practice, it will be much harder in a real-life crisis.

A simple practice of the system to be used to remove a victim from the water into the boat would probably have made all the difference. A few minutes de-bugging the perceived plan in the above scenario would definitely have been of great benefit.

Practice is the best thing to save the dying brain cells: time is of the essence.

All dives vary: the number of divers, the ratio of large to smaller divers, the type of diving (boat, shore or jetty) and the size of the boat. Is the shore dive a beach or rocky entry? What if you are at the end of a jetty with no reasonable access except back to shore? How do you control the situation and perform the rescue with no skilled rescuers to assist?

Remembering the potential diversity of situations, let's look at some ways that may assist your planning or help you to practice within a class, your club or group of regular divers.

Inflatables

If using an inflatable boat, the perception is to simply pull the diver over the side. What tends to happen, however, is that the legs float under the hull and can act as a very secure stop to the lift.

The Surf Life Saving Society of Australia members do not halt their inflatables during a rescue but keep "way on," to prevent the legs stopping the lift. The forward movement of the boat also sweeps the legs back and assists in rolling the body into the boat. Be aware of the moving motor blades if you chose this method, though.

A typical dive situation will have the boat anchored, not underway. A direct lift may seem easy, but try facing the diver away from you or turning him side on: then the legs will not catch around the inflation tube. Or alternatively, pull him alongside flat on the surface, and lift and roll him onto the boat. Try these and other methods to see what works for your inflatable and your typical crew.

Small Rigid Boats (4-7 meters / 12-21 feet)

Smaller rigid boats often require other methods, but the inflatable suggestions may, in fact, work. Legs, encased in rubber, float very well and can cause trouble by locking themselves and, consequently, the rest of the unconscious diver's body, to the hard chine (the intersection of the bottom and sides of a flat- or v-bottomed boat). Displacement vessels tend to have nice curves on the hull and therefore do not have this problem.

Small boats may tip when two or more rescuers stand on one side: add to this the weight of the unconscious diver, and you may all be swimming.

Here's a real-life account of just how difficult a rescue can be without prior planning. I interviewed the persons involved in an incident that occurred when diving from a small four-meter (12-foot) boat.

The divers, two males, left a non-diving female partner in the boat. An out-of-air situation ended in a buddy-breathing disaster: the rescuer ended up with no air and made a rapid ascent. On the surface, the diver was paralyzed on one side of his body. The buddy towed him to the boat, where he exited the water and, along with his partner, who was waiting in the boat, pulled the unconscious diver over the transom next to the outboard. (This was the normal-and only-way you could enter this small boat without tipping it over).

The effort to get the injured diver up over the stern, head-down-bum-up, legs still in the water, was long and intense. At this point, the rescuers collapsed into the boat in an exhausted, heaving mess. It was some minutes before the diver could be pulled the rest of the way into the boat.

Fortunately, the diver was breathing at all times - a non-breathing diver may have died. The rescuers admitted they could not have done another thing at the point when they stopped. They had wanted to continue but could not.

Small unstable boats present special problems. Sitting down to keep the center of gravity low, and lifting and rolling the unconscious diver over the side may work. Yes, some water may also come in, but it should be possible to lower the side enough to get the diver inboard before the boat founders.

Another possible method may be to have a seat that can also act as a lifting board or a see-saw over the gunwale or the transom, to lift and slide the diver in.

The bottom line, however, is again that the trial (practice) of an idea will quickly lead to a solution. This evolution of a "system that works" for your dive boat is usually not hard to figure out. Practice this trial when time is available, not when precious seconds may save a life.

The slightly larger boats in the 4-7 meter range-5.5 meters plus-have better stability but, usually, higher sides. Vessels of this size may still have three- or four-person crews, but they are beginning to be large enough to have a rescue system stowed on board.

RESCUE SYSTEMS

Aids to removing divers from the water offer many advantages. Often fewer crewmembers are needed to use a good rescue system, but do not get seduced by technology-speed and ease of use are the most important features.

Lifting Stretchers

Lifting stretchers that float can be placed under unconscious divers and offer many handholds to rescuers as the diver is brought on board. This type of lift means the victim can be held horizontal during the rescue. Keeping the diver flat has been traditionally regarded as an important element of the rescue. However, diving doctors generally now agree that speed in getting the diver onboard is of a higher priority. The stretcher system, then, may still be effective, but holding a diver in the horizontal position during the lift is now not regarded as essential.

Rigging Systems

If the vessel has a mast, then a rigging system using the boom and pulleys may be the way to go. Again, remember simplicity: a system that uses one hand to accomplish the lift may look elegant, but if it takes 10 minutes to rig, it is useless.

I have seen books advising the use of nets or ropes to roll the diver up the side. After trying some of these methods, I suggest you try them as well. It provides an afternoon of fun and some hazard, but is very enlightening.

WORKSHOPPING THE SYSTEMS

The South Australian Police Water Response Group assisted with workshopping the following techniques.

Knotted Ropes

One technique spotted in textbooks was the use of two knotted ropes, with the loops hanging in the water. You stand on the knotted ends and hold the other. The unconscious diver is theoretically placed over the loops.

We tried this and found (amongst much hilarity and not a little concern!) that placing the unconscious diver into the loops was almost impossible without two people. Then, when you try to lift the patient, the chest rope becomes a neck rope! Not very good. No matter how we tried this, it didn't work.

(Incidentally, for the system to work-even to the point of strangulation-our "injured diver" had to hold himself rigidly straight. He suggested that if he was fit enough to hold himself in this manner, he was sure he could have climbed up the jetty, never mind the ladder!) So even with textbook suggestions, the message is clear: rescue systems must still be attempted beforehand. As we discovered, nice pictures do not necessarily make a good rescue.

Netted Ropes

Of course, not all ideas in rescue books are poor-far from it. One suggestion uses the same principle as the looped ropes but has a net to fill the gap. This system is much better, but diving gear tends to catch in the net at all stages of the exercise, so we suggest canvas or some other strong material to replace the netting. Watch for water catchment. One end of the material is fixed to the gunwale, and the other has a pole attached to keep the material at a similar tension during the lift. It also spreads the load at the rope attachment points.

Netting with Plastic Segments

Some manufactured products are available. One company has a commercial system based on the "net" principle. It uses plastic segments to form the lifting surface and has the advantage of not crushing the diver as he is being rolled up. The sections form a minimum radius that protects the diver. The system can also be used as the normal diving ladder. This unit rolls up for minimal storage space.

Dive Platforms

Bigger boats have higher freeboards, but generally, they have fewer problems. If divers are to enter or exit large boats, marlin boards or dive platforms are often fitted. Larger boats often have bigger crews, so the problem may be solved by brute strength alone.

TESTING THE WATERS

The South Australian government divers attended a day of practice sessions in diver rescue. Many had different but effective plans to suit their various operational platforms. The SA Police Water Response Group also has many operational needs, but just one plan: Police dive teams are usually at least five or six persons. The divers are usually tethered by safety line or surface-supply umbilical, so pulling the diver alongside is easily accomplished.

They also have a standby diver who is always "ready to jump." After that, it is just many-hands-make-light-work.

Big Crews

I tested them by picking the highest part of the 15-meter (45-foot) vessel's side and saying, "I'm unconscious, rescue me." They simply jumped one diver in to hold my arms up to the three or four divers on deck, and presto! There I was, on deck.

So big boats with big crews ("big" as in many of them, but also the size of the individuals) can get by with brute strength. I think the strength and fitness of the police team would mean the rescue would be a success.

Big Brains

There are other, smaller teams with members of all sizes. The female divers who attended this practice day all had a go at pulling, lifting or dragging-usually the largest person they could find-into the boat. As one suggested, "Being female, we need to feel we cannot rely on brute strength alone. But as part of a dive team, we need to be confident that if the time came, we would be an effective member of the rescue team."

After watching the women perform, I'm sure a clever, effective system will beat brawn every time. While the "police" approach works for some, it should be noted that other solutions are just as effective.

In all cases, the following principle may be effective: the effort required to perform a lift from the water with a person stationary is enormous. If the body is moving in the direction you require, the initial effort is very much reduced. The "bouncing" of the unconscious diver will allow him to be pulled higher with each bounce. Finally, he can be pulled well up into the boat.

Good Coordination

Coordination is required if two rescuers are involved and the subject must be held "locked" into position, using their arms and your legs. From this position, a lump of wetsuit is grabbed and the victim bundled into the boat-not very elegant, but effective. This method may allow the head to drop below the surface: it must be balanced by the extreme urgency of removal from the water.

SUMMING IT UP

The message is simple: Plan first, then practice. The objective is rapid, safe removal from the water of an unconscious person by the available crew.

Some suggestions in this article differ from accepted practice and advice. If a rescue can be performed quickly with the head supported clear of the water and the unconscious diver's body kept horizontal, this is the optimal preferred method. However, the realities of achieving this excellent advice in small boats is far removed from the textbook situation. The suggestions offered should be worked through until your dive group is comfortable with the method that evolves.

Also, keep in mind this advice is for scuba diving situations, where back and neck injuries are rare. If spinal injury is suspected, universal standards dictate that the airway take precedence.

Take Action

On your next dive, talk through and practice your plan. After the dive, take a few minutes to practice the plan again. Practice at sea in real dive conditions, if you can. The weather may not be kind when a real-life emergency happens.

Have you practiced your plan?

Bob Ramsay, a member of the Board of Directors of DAN South East Asia-Pacific, has been diving for 30-plus years, both commercially and recreationally. An instructor for 15 years, Bob now works at the Royal Adelaide Hospital (RAH) Hyperbaric Medicine Unit (HMU) as a Senior Hyperbaric Technician. Always interested in diving safety, Bob works with many groups to study diver rescue.


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