|Stop. Breathe. Think. Only then should you act. Rushing into a rescue can make you both victims.|
His mask pushed back, his reg out of his mouth, the victim flails the surface with his arms, staring wildly in all directions. "Diver!" I call out. "Are you in trouble? I can help you!"
No answer, no eye contact. Clearly, this guy is in panic. I approach cautiously and stop outside his reach, as I've been taught. A panicky diver only wants to climb out of the water, and he'll crawl up your chest and stand on your head if he can. The cardinal rule of rescue is to save yourself first; otherwise, there will be two victims.To take control of this diver, I'll need to get behind him and grip his tank between my knees, then give him buoyancy--inflate his BC or dump his weights. If the victim were smaller, I might try grabbing an arm and spinning him around to get to his tank, but this guy is huge, a man-mountain churning the water around him into Class 5 rapids. So I submerge to approach from below and behind, because whatever else happens, a panicky diver won't go deeper to grab me.
This is my first mistake. The victim is on the surface and breathing, and I should wait for him to calm down through exhaustion. But his alarm is infectious and I feel the need to do something now.Under water, the victim is invisible in a roiling cloud of bubbles. I approach and suddenly my head is smacked backward, my mask and reg wiped off my face. Instead of his tank, I've found one of the victim's massive pumping knees. I push off and reach the surface, gasping.
"Are you all right?" instructor Ned Branch calls from poolside."Yeah, I'm OK, but he can drown now."
That earns a rueful laugh from my "victim," Joe Martin, a skilled divemaster in danger of nothing more than overacting. Joe then confirms my mistake: I should have waited. "I was about beat when you approached," he says. "I would have had to quit thrashing in another minute."
Stress and Panic
This was my most vivid lesson in the first full day of a Rescue Diver course I took recently in Southern California. It started with classroom work last night and will finish with two full days in the ocean. Before it's over, I will drown at least two of the "victims" I'm trying to save, but emerge feeling more confident in my dive skills than I have in 23 years of diving.
My fellow students are new divers looking to improve their skills. Two, Jason Hoge and Ryan Chromy, have 18 dives each in their log books. Carr Brown has 50. All of them see the rescue course as basic skill development.
Me? As training editor for Scuba Diving with oh-so-many dives behind me, I've covered this material many times before, so the class should be easy. Or so I think.
The classroom sessions covered how to assess an emergency, organize a rescue effort, treat for drowning and administer oxygen for DCI, among other things (independent first aid and CPR certification will be required before we finish the course).Then we hit the pool at Ventura Dive and Sport and practice skills like towing a tired diver and air-sharing. We practice each until we get it right, then add another. Running through each drill is a common thread; besides meeting the victim's immediate need (for air, a tow), we have to treat what's almost always his real problem: too much stress.
Stress has physical causes ("I'm cold, I'm tired") and psychological causes ("I'm confused, I'm worried") that can feed one another and grow to anxiety and then panic if not controlled. Many dive emergencies, like avalanches, start with a minor problem--a leaky mask, say, or a sticky power inflator. The minor problem causes stress, which impairs judgment, which leads to a bigger problem, more stress, worse judgment, and so on.
A major goal of the rescue diver is to stop the avalanche to disaster early, before it gains power and speed, by reducing and managing stress. And stress, as I found out, attacks both victims and rescuers.
The Rescue Diver course teaches that the best medicine for stress is what Ned calls "solution thinking." Basically, it's the classic formula: Stop. Breathe. Think. Act. "You've got to break the instinctive fight-or-flight response, because your instinctive reaction is usually the wrong reaction," he says. "The first thing to do is stop."
The next step, taking a slow, deep breath, also requires no thinking. Both steps calm you down, allowing your brain to engage for step three, thinking through a rational course of action. Only then do you act. "Solution thinking doesn't start with 'Act,' it ends with it," Ned explains.For our next pool drill, something new. Suppose you see a diver lying face-down on the bottom, not moving. What should you do?
First, Ned says, nudge him to make sure he's really unconscious. If he doesn't respond, you need to get him to the surface before you can do anything else. The basic consideration is to keep his reg in his mouth if it's still there (don't waste time fumbling for it if it's not) and ascend at a normal rate. Assuming he's lying on the bottom on his stomach, approach his left side, put your right arm under his left armpit, reach for his reg and hold it in place while also supporting his head in a normal position so expanding air can escape from his lungs. That leaves your left hand free to vent your BC and, if necessary, the victim's BC. But if the victim gets uncontrollably buoyant, let him go to the surface alone and ascend safely yourself. Michelle Tomillo acts as my "victim" this time and all goes pretty well. My confidence soars, just in time to for me to commit another homicide.
The Kiss of Death
Once you've brought the victim to the surface you'll need to decide if he's breathing and, if he's not, give artificial respiration. Likewise, if you just happen across an unresponsive diver floating at the surface. That's our next exercise.
Four volunteers act the parts of unconscious victims lying on the surface, face-down. We students are supposed to approach, calling "Diver! Are you in trouble?" and splashing water at our victim to verify that he is unconscious. If he doesn't respond, we call out "Diver needs help!" then turn our victim onto his back, check for breathing and give artificial respiration by both mouth-to-mouth and mouth-to-pocket-mask methods. Each student gets a victim. Joe--massive, a sleeping whale--is mine again.To roll a face-down victim onto his back, you approach him head-to-head with your arms crossed. Grab the victim's wrists, and by uncrossing your arms you should be able to roll him over. That's what the book says, anyway. But Joe's arms are spread so far I can't reach both his wrists with my arms crossed. Somehow I capsize him. Next: My weight belt off, victim's weight belt off. My mask off, victim's mask off. My reg out, victim's reg out. My hood off, then support his head to open his airway and look, listen and feel for breath on my cheek. No problem so far.
Now the hard part. Mouth-to-mouth is sometimes called "the kiss of life," but the victims--especially the guys--had warned us to not take that literally (the least necessary instruction of the day). Instead, we would simulate mouth-to-mouth by breathing into the back of the hand that pinches the victim's nose. First, two long breaths, then one every five seconds.The drill calls for the rescuer, who's on one side of the victim, to reach under him with the hand nearest the victim's feet and support his head with it, while his other hand reaches over the victim's head to pinch his nose. For example, if you're on the victim's right side as he floats face-up, you should reach under and support his head with your right hand while your left hand comes over his forehead and pinches his nose.
My brain understands what to do, but my hands confuse their roles twice--my right hand pinches Joe's nose while my left hand supports his head. That means the palm of my right hand smothers Joe's mouth.Rescue breathing with a pocket mask goes even worse. I'm supposed to position myself at Joe's head, place the mask over his mouth and nose, hold it firmly in place with fingers and thumbs of both hands, then arch my head over his face and blow into the mask. I try twice, but can't get high enough over Joe's buoy-sized head. Instead, I just push him under water. It's Joe's turn to come up gasping and choking. But Ned is a patient instructor, and I get as many chances as I need to get it right.
We next add gear removal for both rescuer and victim while maintaining the rhythm of rescue breathing--one breath every five seconds. The trick here is to be patient; unfasten only one buckle or strap after each breath. That I can do, but maintaining a steady breathing rhythm at the same time is tough. Basically, I leave my "victim" to asphyxiate while I slowly unsnap buckles. And what's worse, Jason and Ryan finish long before I do. "You guys are naturals!" Ned tells them as I stumble on. I'm embarrassed, discouraged and confident of little except that I could undress a corpse pretty well.
Tomorrow we'll repeat all these exercises in the ocean and add a few more, like searching for a missing diver and helping a tired or unconscious diver to shore. Right now, it seems impossible.
A Brighter Day
Diving conditions off the beach the next morning aren't ideal--cold water, zero vis and a little surface chop. Ned wants us to combine several drills into one rescue sequence: we'll surface an unconscious diver, give rescue breathing and remove gear.
Given the conditions and my track record, it sounds tough, but when I begin the rescue, everything starts to go well. Somehow, overnight, my hands have learned where to go. Almost by themselves they bring Michelle to the surface, supporting her head properly. They inflate BCs, drop weights, take off regs and masks and start unbuckling our other gear. I feel relaxed now and more confident. I've stopped punishing my victims and started helping them.I finish the class a more competent diver. Not only have I learned important skills, but I've also gained confidence that if faced with a real emergency I'd be able to help. It's a common epiphany among students in the rescue course. Ned tells me that his first rescue diver class "did more to increase my confidence level and my personal skills level than virtually any other course since I got certified."
Then he asked me to consider the alternative. "What if somebody were in trouble and you could have helped but didn't know how? How are you going to deal with that for the rest of your life?"
10 Tricks I Learned in Rescue Class
1. When towing a tired diver, ask him to help by finning a little, even if you don't need the help. By making him a co-rescuer instead of a helpless victim, you may restore his confidence and head off stress.
2. As you approach a surfaced diver looking distressed, asking a question like "Are you OK?" gives a clue to his state of mind. If he doesn't answer or if he acts like he didn't hear, he may be approaching panic.
3. Say, "I can help" as you approach. The words give surprising comfort to a panicky diver.
4. If a panicky diver on the surface rushes toward you, back up toward the boat or shore. That leads him closer to safety.
5. The best first aid for a tired diver at the surface is more buoyancy. Fatigue means stress and fear of sinking, and he may be closer to panic than either of you realizes. If he inflates his BC or dumps his weights (or you do it for him), he'll relax almost instantly.
6. While towing a tired diver, keep up the cheery, optimistic chat ("We're doing great, we're almost there," etc.) to keep down his anxiety level. Make eye contact if you can.
7. Finally, there's a use for a snorkel: extend it, instead of your hand, to a tired, panicky diver. If he takes it in a death grip, you can let go if you have to.
8. After passing your octopus to a diver who's low on air, don't start ascending immediately. Pause a moment for both of you to establish a breathing rhythm, get used to the situation, make sure you've got a grip on each other (with right hands) and calm down. Only then start up.
9. Giving one rescue breath every five seconds means counting to "one thousand four," not five, between them. You're giving the breath on "five."
10. "Bounce" an unconscious or helpless diver to get him onto the dive platform. First, dump all his gear. Put one of his hands on the edge of the platform, the other on top of the first, and one of your hands on top of both to hold them there. Climb out yourself, then grab his wrists and bounce him up and down in the water, higher and higher. At the top of a bounce, jerk him onto the platform.