UHMS Rescue Paper – Recommendations for rescue of a submerged unresponsive compressed-gas diver

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In January 2013, the Underwater Hyperbaric Medical Society gave permission to The Dive Forum to host a recently published paper by leading hyperbaric doctors and medical staff (1) concerning the rescue of an unconscious diver and covered three phases:

Phase 1, preparation for ascent: If the regulator is out of the mouth, should it be replaced? If the diver is in the tonic or clonic phase of a seizure, should the ascent be delayed until the clonic phase has subsided? Are there any special considerations for rescuing rebreather divers?

Phase 2, retrieval to the surface: What is a “safe” ascent rate? If the rescuer has a decompression obligation, should they take the victim to the surface? If the regulator is in the mouth and the victim is breathing, does this change the ascent procedures? If the regulator is in the mouth, the victim is breathing, and the victim has a decompression obligation, does this change the ascent procedures? Is it necessary to hold the victim’s head in a particular position? Is it necessary to press on the victim’s chest to ensure exhalation? Are there any special considerations for rescuing rebreather divers?

Phase 3, procedure at the surface: Is it possible to make an assessment of breathing in the water? Can effective rescue breaths be delivered in the water? What is the
likelihood of persistent circulation after respiratory arrest? Does the recent advocacy for “compression only resuscitation” suggest that rescue breaths should not be administered to a non-breathing diver? What rules should guide the relative priority of in-water rescue breaths over accessing surface support where definitive CPR can be started?

The article certainly spurned significant discussion on and off the forum, but more importantly, provided some robust baseline information for the whole community against which divers could use and practice with.  (GUE have already amended their procedures following this advice).  

Prior to this publication there was much conjecture about what to do with an unconscious diver, especially what to do when encountering a diver suffering from an oxygen toxicity event. This paper has provided that clarity. Importantly, it identifies that doing something is better than doing nothing; a DCS event is potentially treatable, drowning is not.  

Dr Simon Mitchell presented this subject at the European technical diving conference (Eurotek 2012) and following the publication of the article in January 2013, it prompted a group of GUE UK divers to undertake a rescue weekend in Plymouth in March 2013.  This weekend was aimed at conducting basic skills such as a lift from 15m or so followed by a surface recovery and then CPR on the boat which was returning to port at high speed. The rescue weekend was success, if only because it identified the challenges faced when conducting a rescue and as such, anything you can do to prevent the incident from occurring in the first place, has got to be a good thing. Undertaking a rescue with a deco overhead or toxing patient is going to be very difficult; as such make sure that you understand your own limitations, and if need be send the casualty up rather than create two casualties.  

I would like to thank the editorial staff at the UHMS for allowing publication of the article which is also hosted on the excellent source of hyperbaric and diving information, the Rubicon Repository

(1) S.J. Mitchell, M.H. Bennett, N. Bird 1,4, D.J. Doolette 1,5, G.W. Hobbs 1,6,7, E. Kay 1,8, R.E. Moon 1,6, T.S. Neuman 1,9, R.D. Vann 1,4, R. Walker 1,6,7, H.A. Wyatt 1,10 

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