The Diving Committee of the Undersea and Hyperbaric Medical Society (UHMS) recently released its multi-authored recommendations for rescuing a submerged unresponsive compressed-gas diver about the medical aspects, based on available evidence, and we thought it to be a worthy subject of discussion here at Scuba.com.
These recommendations result from questions from the diving community and diver training agencies that want to revise their training materials to contain the most up-to-date information on this issue. While there is certainly considerable debate as to the ideal method to be used in such cases, UHMS is a relevant and trustworthy resource for information of this nature.
Preparation for Ascent
The committee’s consensus on whether a regulator that has fallen out of the mouth of an unconscious diver should be replaced is that it should not, as manipulating the airway risks water entry.
This applies except when the dive is being conducted in an overhead environment, such as under ice or in a cave. In that case, the regulator should be purged before being replaced. If the regulator remains in the victim’s mouth, every attempt should be made to keep it in place.
The committee recommends that the diver be brought to the surface without delay, regarding victims amid the clonic phase of a seizure (wherein their muscles are rapidly contracting and relaxing) and the regulator is not in their mouth. If the regulator is in the mouth, the rescuer should do everything to keep it in place and seal the lips around the mouthpiece until the seizure has subsided, at which point the victim should be taken to the surface.
These measures prevent the inhalation of water when deep breathing resumes at the end of the clonic phase of a seizure.
Tip: If the regulator is found out of the mouth, leave it out of the mouth unless in an overhead environment. If the regulator is found in the mouth, do everything possible to keep it there.
Retrieval to the Surface
The committee’s answer to the question of what the safest ascent rate would be for this type of scenario is that there is no generic answer and that the rescuer will need to consider factors of the situation to determine this.
If the rescue diver has a decompression obligation (not a safety stop on a no-decompression dive), the committee recommends that the rescuer decide whether to take the victim to the surface. If a rescuer with a decompression obligation opts not to take the victim to the surface, the victim can be made positively buoyant and sent to the surface alone.
The victim’s head should be held in a neutral position to facilitate the escape of expanding gas from the lungs, but the committee does not recommend compressing the victim’s chest to aid exhalation during ascent. Rather, buoyancy control, positioning the head, and ensuring the regulator mouthpiece stays in the mouth should be the primary focus.
Tip: When ascending, utilize all information from your specific circumstance to surface safely while ensuring rescuer safety. Keep the head neutral, but take no additional actions with the unresponsive diver while ascending.
Surface Procedures
Once at the surface, if there is any question as to whether the victim is breathing, rescue breaths should be delivered immediately. There is an unlikely chance of harm from providing rescue breaths to a person who is, in fact, breathing, but failure to do so when the victim’s breathing is in question could be very damaging indeed.
The committee endorses the delivery of rescue breaths while still in deep water, but acknowledges that efficacy will be highly dependent on the rescuer’s prior training and regular practice of the technique. There is evidence to suggest that in-water rescue breaths may prevent progression to cardiac arrest.
Tip: If breathing is questionable upon surfacing, provide rescue breaths immediately.
Conclusion
In summary, while the committee makes these recommendations based on available evidence, execution of these recommendations is contingent on the rescuing diver’s training and abilities. If the situation is determined to pose significant harm to the rescuer, it is entirely appropriate for the rescuer to opt not to put themselves in harm’s way.
Most importantly, they acknowledge that it is difficult to provide universal guidelines for rescue situations involving a submerged, unresponsive compressed-gas diver and that their recommendations are not to be strictly adhered to in every situation.
We commend the efforts of the Diving Committee of UHMS in providing the most useful and timely information possible for this very grave yet entirely likely situation. The impact on the diving community will no doubt be one of controversy, but it cannot be refuted that these recommendations were carefully examined to the highest possible degree before their publication.
We would like to thank the Rubicon Foundation for providing this information and UHMS for releasing the paper. If you are interested in reading the recommendations, please visit this page.
