diver removal from water

[haydn leaker]

In a rescue situation, practiced in the pool or from a RIB, what is the current thinking regarding straight arm lifts and should the subject be lifted on their back or on their front?

[john williams]

In a rescue situation, practiced in the pool or from a RIB, what is the current thinking regarding straight arm lifts and should the subject be lifted on their back or on their front?

If you lift them onto their back - you'd better be VERY sure that you are going to be able to lift them beyond their buttocks so that they bend the way God intended!

I couldn't guarantee to do that - so would always choose to lift then over the edge and onto their stomach. If I go too far - I can let them slip back a little (or I bruise thighs)

If I don't go far enough I can drape them over the tube and hold them there whilst someone else gets a better grip and drags their bum in sideways (not dignified - but also not bad for their back).

Poolside - I might bruise a few ribs - but if I'm still mastering the technique then perhaps I should have a spongy mat over the edge to solve that one! (or try one of those padded waistcoat type surfcar buoyancy aids to protect the casualty)

Note:
This is just my opinion - and not one officially endorsed anywhere.

The BSAC perspective will be -
"As long as it works - what works best for you?"

John

[Andy Wade]

In a rescue situation, practiced in the pool or from a RIB, what is the current thinking regarding straight arm lifts and should the subject be lifted on their back or on their front?

Yes, I'd agree with John.
I wouldn't want to risk a spinal injury on the side of the pool by pulling them up with their back towards me. Of course the men amongst us will wince a bit if you hit a certain part of our anatomy on the pool edge when you lift us facing you.
I'd recommend aiming to get their waist about level with the pool edge where they will naturally bend anyway, making sure you support their head carefully as you lay their upper body down, then swing their legs up from one side, up on to the side of the pool. If necessary, roll them away from the pool egde, applying either the recovery positon and/or ABC depending on their condition. Watch their head on the pool floor at all times.
Be careful not to let go of them altogether when changing your hand position from their arms to their legs. last thing you want is them falling back into the water.

Out on the RhIB it's a bit different, you can also (if you like) pull them straight out onto their back and into the boat - removing the need to turn them over in the limited space available, which may save vital seconds. Be firm and positive about the lift, but not too rough with them of course.

I think that about covers it.
Others may be able to add more?

[TerryH]

In a rescue situation, practiced in the pool or from a RIB, what is the current thinking regarding straight arm lifts and should the subject be lifted on their back or on their front?

Front, especially in pools.

If they havnt got a rubber matt around, go for one of those
roll-up exercise mats. Tiles and parts of the anatomy dont
like each other.

Same for a RIB. Worse case is the divers are tired and the
skipper is busy. Much easier for you to be around the
diver and push up from beneath adding to there "pull".

Casualty naturally folds round the contours of the tube, so if
there is a problem on the lift you are less likely to drop
him, just fall backwards while holding on to his/her
arms/armpit.

Using this method, quite slight females can get big blokes
in the RIB, so it is preferable to the other method.

TerryH

[Nevil Adkins]

In a rescue situation, practiced in the pool or from a RIB, what is the current thinking regarding straight arm lifts and should the subject be lifted on their back or on their front?

This is what I was taught lots of years ago doing RLSS lifesaving:

1) When finishing the tow to the pool edge, bring the casualty in front of you, facing the pool edge. Place your arms under their armpits and grasp the side. Bring your knee up between their legs. The casualty is now secured against the side with you as the 'basket'.

2) Push the casualty's arms forward until they are straight out and lying along the pool side. Remove your arms from under the casualty's armpits and hold the casualty as far down their arms as you can reach, pushing down to keep the casualty's arms on the floor and therefore stop them sliding down into the water. Climb out around the side of the casualty.

3) Cross your arms and take hold so that your right hand is holding their right wrist. Lift the casualty out of the water until the top of their thighs are level with the pool edge. Bringing your hands apart will now turn them so that they are sitting on the side. Carefully lower the casualty to the ground, using your feet as a cushion to protect their head from hitting the ground too hard.

As usual with these things it takes longer to describe it than to do it!

This method has the advantage that if you are strong enough to successfully make the lift, you are left with the casualty face-up ready to receive CPR. If you have to abort the lift you are not left with the casualty trying to bend the wrong way over the pool edge. Try it and see how you get on.

Regards
Nevil

[haydn leaker]

This is broadly what I teach in the pool, with the addition of not using a straight arm lift but turning them so their back is to you and bend your knees (maybe half kneel) and get your arms under their armpits, preferably grabbing their wrists so they are very secure, keep back straight and lift them out". One on each side being preferred if someone else available. Your can then easily protect head with your body. On a RIB I think I would bring them in on their stomach.

Am I right in considering that straight arm lifts are not a good idea? 2 reasons - you could injure them (or you) and it's very hard to get them high enough, facing front or back.

Haydn

[iain Paul]

Can I point out a number of points with regard to current (for a considerable number of years) RLSS lifting, which eminates from the manual handling regulations, safe lifting techniques and concertn for spinal injury but are just as appropriate to in this case Divers. (Dare I mention risk assessments?)

Most important is that there is within RLSS no teaching of single person lifts allowed, minimum being 2 person with this being adaptable for more to assist if required. (1 each arm / 1 each arm + 1 pusing from water/1 each arm + 2 pushing from water)

Secondly the only lift which should be taught is the casualty facing poolside at all times, rescuer on each side with one hand on wrist other hand on upper arm with the lift being done using the legs and not the back. Once out of the water one person then supports the head whilst the other secures the lower body. If they are not sufficiently secure (ie not far enough onto poolside ) turn them parallel to the poolside with one person caring/lifting for head and arms and the other the legs whilst doing so. There should be no problems getting at least the casualties torso onto poolside in this manner following which the "spin" and roll will get them well clear of the water. (Before anyone tears this to pieces I fully accept that this is an over simplification of the description)

Obviously the freeboard in different pools will have an effect on how far someone is onto poolside as will apply with the freeboard in boats. Equally teamwork is paramount with someone taking charge and agreeing who takes the head". In a RIB the scene will be similar with the exception that there will be a need to control the further "slither" off the tube onto the floor again with particular attention to the head.

Though I agree with the idea of padding to prevent injury in training, I would caution putting this on poolside unless non slip as it can cause additional slip risks. It is important to remember and teach that the lift is as it says a lift (followed by draping onto/over poolside) and not as some folk think a "pull up and (scrape)over" poolside! (Yes Ive been there done that & had the bruises and scratches to prove it.)
Simplest solution in our scenario is actually for folk to do it with their own personal padding in the form of a wetsuit.

Iain
RLSS NTA /BSAC AI

[haydn leaker]

Thanks Iain, that's good stuff. Do you have any specific comment about straight arm lifts - I was taught they were not very safe and that you should hold the diver under the arms.

[TerryH]

Can I point out a number of points with regard to current (for a considerable number of years) RLSS lifting, which eminates from the manual handling regulations, safe lifting techniques and concertn for spinal injury but are just as appropriate to in this case Divers. (Dare I mention risk assessments?)

Most important is that there is within RLSS no teaching of single person lifts allowed, minimum being 2 person with this being adaptable for more to assist if required. (1 each arm / 1 each arm + 1 pusing from water/1 each arm + 2 pushing from water)

Secondly the only lift which should be taught is the casualty facing poolside at all times, rescuer on each side with one hand on wrist other hand on upper arm with the lift being done using the legs and not the back. Once out of the water one person then supports the head whilst the other secures the lower body. If they are not sufficiently secure (ie not far enough onto poolside ) turn them parallel to the poolside with one person caring/lifting for head and arms and the other the legs whilst doing so. There should be no problems getting at least the casualties torso onto poolside in this manner following which the "spin" and roll will get them well clear of the water. (Before anyone tears this to pieces I fully accept that this is an over simplification of the description)

Obviously the freeboard in different pools will have an effect on how far someone is onto poolside as will apply with the freeboard in boats. Equally teamwork is paramount with someone taking charge and agreeing who takes the head". In a RIB the scene will be similar with the exception that there will be a need to control the further "slither" off the tube onto the floor again with particular attention to the head.

Though I agree with the idea of padding to prevent injury in training, I would caution putting this on poolside unless non slip as it can cause additional slip risks. It is important to remember and teach that the lift is as it says a lift (followed by draping onto/over poolside) and not as some folk think a "pull up and (scrape)over" poolside! (Yes Ive been there done that & had the bruises and scratches to prove it.)
Simplest solution in our scenario is actually for folk to do it with their own personal padding in the form of a wetsuit.

Iain
RLSS NTA /BSAC AI

Got a bit of a problem with this.

While all of it is right for basic pool training, it doesnt
translate well to rescue scenarios involving boats.
It would be nigh on impossible to not pull somebody over a
tube of a RIB. So bearing in mind the reflex link between
training and a real scenario, is it right to lift rather
than drag?

Next the assumption must always be worse case. That's the
boat handler in the RIB and you + buddy casualty in the water.
So that means one person in the boat to lift. How do you
practice this if you must use 2 people?

Not knocking RLSS stuff, that's obviously right for pool etc,
but maybe not so good for scuba.

TerryH

[matts]

Next the assumption must always be worse case. That's the
boat handler in the RIB and you + buddy casualty in the water.
So that means one person in the boat to lift. How do you
practice this if you must use 2 people?

Ever tried a par-buckle Terry. You can ususally find a bit of rope lieing around a rib. Once you have the cas tied off the buddy could get in the boat and help with the lift.

Just a thought.

[TerryH]

:=Next the assumption must always be worse case. That's the
:=boat handler in the RIB and you + buddy casualty in the water.
:=So that means one person in the boat to lift. How do you
:=practice this if you must use 2 people?

Ever tried a par-buckle Terry. You can ususally find a bit of rope lieing around a rib. Once you have the cas tied off the buddy could get in the boat and help with the lift.

Just a thought.

Yep we practice that and even have a stretcher cradle in the
pool as well as a load of other ways. We try and get
students to think outside the box and use what's around.

Par-buckle assumes your rescuer is fit and not exhausted.
He may struggle to even lift himself in, let alone the
casualty.

TerryH

[matts]

Par-buckle assumes your rescuer is fit and not exhausted.
He may struggle to even lift himself in, let alone the
casualty.

Yes and the cas could be double the bodyweight of the Cox.
I doubt you are going to find a perfect answer. You could agree not to leave a Cox alone on the boat, or only dive off boats with lifts/deck winch. Otherwise you have to accept that rescues are made on a best efforts basis.

[sebsaccoach]

I havent read all the links, however have you though about deflating a RIB tube to get them into a boat. The valves on ribs will let a tube down very quickly (especially if you sit on it) the RIB can still be driven safely with one tube deflated.

[sebsaccoach]

I havent read all the links, however have you though about deflating a RIB tube to get them into a boat. The valves on ribs will let a tube down very quickly (especially if you sit on it) the RIB can still be driven safely with one tube deflated.

[TerryH]

I havent read all the links, however have you though about deflating a RIB tube to get them into a boat. The valves on ribs will let a tube down very quickly (especially if you sit on it) the RIB can still be driven safely with one tube deflated.

No I havnt and it's a good point. Will add that to the list
of options in PRM scenarios.

TerryH

[matts]

I havent read all the links, however have you though about deflating a RIB tube to get them into a boat.

Nope. Consider it added to my armoury of best efforts.

The valves on ribs will let a tube down very quickly (especially if you sit on it) the RIB can still be driven safely with one tube deflated.

It is one of those things I would probably get to in desperation when faced with the problem. It will now get a mention in my rescue lectures.

Thanks for that.

[richard2338]

Yes and the cas could be double the bodyweight of the Cox.
I doubt you are going to find a perfect answer. You could agree not to leave a Cox alone on the boat, or only dive off boats with lifts/deck winch. Otherwise you have to accept that rescues are made on a best efforts basis.

Having attempted to pull an unconscious casualty into a low-sided inflatable boat on my own, I can most heartily recommend leaving two people in the boat at all times.
However, it was surprising to discover the semi-bionic effects of a bit of adrenaline... even on a total weed like me!
Once you get started, theres a fair bit of slither effect, although i regret to say that supporting the casualty's head probably wasn't considered during the process. Non-breathing casualty survived however. Fortunately some help came along at the critical moment...

Always try and drive our little boat with a deck-hand nowadays, despite the space they take up! And always worry about the time taken to get a casualty into a hardboat with no tail-lift/winch etc when I look at one.

(The casualty wasn't one of my divers by the way - they were all happily submerged at the time!)

[Andy Wade]

I havent read all the links, however have you though about deflating a RIB tube to get them into a boat. The valves on ribs will let a tube down very quickly (especially if you sit on it) the RIB can still be driven safely with one tube deflated.

Nice idea.
And if you knock together a couple of bits of tubing, you can blow the partially deflated tube back up pretty quickly with a direct feed 'blow gun'.
This can be carried in the boat kit for emergencies.


.

[Philip Smith]

Next the assumption must always be worse case. That's the
boat handler in the RIB and you + buddy casualty in the water.
So that means one person in the boat to lift. How do you
practice this if you must use 2 people?

Howabout: Cox holds casualty at side of boat (giving AV if necessary), rescuer quickly jettisons casualty's and own kit and climbs into boat, cox and rescuer pull casualty into boat. However, this is one of a number of reasons why single-handed boat handling should be avoided, if possible.

Partially deflating a tube is a nice example of lateral thinking, but often more than one thing goes wrong at a time (weather could deteriorate), so I wouldn't want to compromise the performance of the boat unless it was the last resort to get the casualty in.

Phil S

[steve swift]

I did some research into this when I worked at a dive school that used RIBs all the time. In a rescue scenario the cas was brought into the RIB face out. At first I noted this as wrong, but when we actually analysed it, it was obvious that the cas didn't bend backwards because the buoyancy of his feet (ie suit or booties) lifts up his legs.

We then practised this each way quite a few times and found that we thought this way (face out) was better for a number of reasons;

1 The cas was the right way up for a continuing AV. Turning someone over in the back of a RIB is not easy
2. If you had to stop halfway you could do a quick breath or two of AV.
3. The cas tended to be lifted out further in the frst lift ( I think IIRC this was because you tended to grab under the armpits rather that the grabbing the arms - but I can't remember exactly)

I admit that this was not highly scientifically done and had a relatively small sample, but it was so obvious to us that the face out was better (from both the cas and rescuer's perspective) that we didn't need to try it any more.

Thereafter, every time I had a rescue scenario and the rescue was carried out with cas face in, I got them to repeat face out and asked them which they found better. 100% said face out.

I don't think that deflating the tubes is a good idea, unless perhaps it is a very calm day, as you are likely to get a lot of water into the boat (I have experiece of non deliberate tube deflation here!) What heppens if you find that you can't re-inflate? (I don't like epople switching the engin off either for the same reason). I actually found that the weight of the rescuers on the side of the RIB brought the tube on that side low enough.

In the pool might be a different proposition. I don't know, I haven't tried.

Just my 2pworth, which was my little hobby horse when I worked there.
Steve

[mark allen]

I did some research into this when I worked at a dive school that used RIBs all the time. In a rescue scenario the cas was brought into the RIB face out. At first I noted this as wrong, but when we actually analysed it, it was obvious that the cas didn't bend backwards because the buoyancy of his feet (ie suit or booties) lifts up his legs.

We then practised this each way quite a few times and found that we thought this way (face out) was better for a number of reasons;

1 The cas was the right way up for a continuing AV. Turning someone over in the back of a RIB is not easy
2. If you had to stop halfway you could do a quick breath or two of AV.
3. The cas tended to be lifted out further in the frst lift ( I think IIRC this was because you tended to grab under the armpits rather that the grabbing the arms - but I can't remember exactly)

I admit that this was not highly scientifically done and had a relatively small sample, but it was so obvious to us that the face out was better (from both the cas and rescuer's perspective) that we didn't need to try it any more.

Thereafter, every time I had a rescue scenario and the rescue was carried out with cas face in, I got them to repeat face out and asked them which they found better. 100% said face out.

I don't think that deflating the tubes is a good idea, unless perhaps it is a very calm day, as you are likely to get a lot of water into the boat (I have experiece of non deliberate tube deflation here!) What heppens if you find that you can't re-inflate? (I don't like epople switching the engin off either for the same reason). I actually found that the weight of the rescuers on the side of the RIB brought the tube on that side low enough.

In the pool might be a different proposition. I don't know, I haven't tried.

Just my 2pworth, which was my little hobby horse when I worked there.
Steve

Would advocated Steve?s point here about not deflating the tube of the boat or turning the engine off. The first point of first aid in not to put the rescuer in danger and by doing both of these things you start to put yourself in danger and that is a no no.. Tube might not be able to be reflected and engine my not start. When I was on my own in a rib I have also had to pull someone out of the water on my own and the diver was 6? 4? tall and was 17 stone and we used parbuckling to get him in the boat with the head being supported by his buddy. One person can do it, but it depends on the person in the boat using brains not brawn to do it. The amount of weight on the rope is minimal and even the smallest person can do it as I have also shown on many a PRM course. I had the pervious south west regional coach lift up one of her 6' Area coaches.
Mark Allen

[patrick]

:=I did some research into this when I worked at a dive school that used RIBs all the time. In a rescue scenario the cas was brought into the RIB face out. At first I noted this as wrong, but when we actually analysed it, it was obvious that the cas didn't bend backwards because the buoyancy of his feet (ie suit or booties) lifts up his legs.
:=
:=We then practised this each way quite a few times and found that we thought this way (face out) was better for a number of reasons;
:=
:=1 The cas was the right way up for a continuing AV. Turning someone over in the back of a RIB is not easy
:=2. If you had to stop halfway you could do a quick breath or two of AV.
:=3. The cas tended to be lifted out further in the frst lift ( I think IIRC this was because you tended to grab under the armpits rather that the grabbing the arms - but I can't remember exactly)
:=
:=I admit that this was not highly scientifically done and had a relatively small sample, but it was so obvious to us that the face out was better (from both the cas and rescuer's perspective) that we didn't need to try it any more.
:=
:=Thereafter, every time I had a rescue scenario and the rescue was carried out with cas face in, I got them to repeat face out and asked them which they found better. 100% said face out.
:=
:=I don't think that deflating the tubes is a good idea, unless perhaps it is a very calm day, as you are likely to get a lot of water into the boat (I have experiece of non deliberate tube deflation here!) What heppens if you find that you can't re-inflate? (I don't like epople switching the engin off either for the same reason). I actually found that the weight of the rescuers on the side of the RIB brought the tube on that side low enough.
:=
:=In the pool might be a different proposition. I don't know, I haven't tried.
:=
:=Just my 2pworth, which was my little hobby horse when I worked there.
:=Steve

Would advocated Steve?s point here about not deflating the tube of the boat or turning the engine off. The first point of first aid in not to put the rescuer in danger and by doing both of these things you start to put yourself in danger and that is a no no.. Tube might not be able to be reflected and engine my not start. When I was on my own in a rib I have also had to pull someone out of the water on my own and the diver was 6? 4? tall and was 17 stone and we used parbuckling to get him in the boat with the head being supported by his buddy. One person can do it, but it depends on the person in the boat using brains not brawn to do it. The amount of weight on the rope is minimal and even the smallest person can do it as I have also shown on many a PRM course. I had the pervious south west regional coach lift up one of her 6' Area coaches.
Mark Allen

We do not use RIB's where I live in Mauritius and some of our boats have 3ft freeboard. The parbuckle is the answer and we have had some made up by our local sailmaker with a bolt rope down each side. One end can be fixed to the boat with carabiners and the other has handles that can be grasped by the boatman and pulled. Because of the mechanical advantage 2:1 even a fairly frail person can lift almost anyone with full control. Patrick