AV rates

[Iain McDhonnchaidh]

what are the recommended AV breathing rates when doing a diver tow? and in general what is the recognised drill?

[David Walker]

what are the recommended AV breathing rates when doing a diver tow? and in general what is the recognised drill?

Two breaths every 15 seconds while towing, when dekitting usually either keep the 2:15 pattern or move to one breath for every clip you undo. As long as you keep roughly to that sort of pattern it should be effective (assuming of course they are effective AV breaths - remember that its no good rushing to get a breath in on time if you aren't getting air into the lungs).
And then when you're out of the water if you're doing CPR its usually recommended to do 2 breaths, 15 compressions, 2 breaths, etc, etc, etc....

Think thats most of them, hope that helps - its all in the course notes / instructor manuals if you want more details.

David

[Steve Walker]

Two breaths every 15 seconds while towing, when dekitting usually either keep the 2:15 pattern or move to one breath for every clip you undo.

Since the move to 2:15 I've been encouraging trainees to use the same for the dekitting, but of necessity you have to go through the 1:5 just so that if the trainee encounters another instructor who is sticking to the older version, they won't be unprepared. Although I do this, and bearing in mind the shift to 2:15 was a deliberate bid to improve the efficiency of AV, I still feel it is a bit unecessary and a PITA when pool time is very limited.

Out of interest, how many Instructors actually _are_ still using the 1:5 for dekitting ?

Cheers
Steve

[petesmith]

:=Two breaths every 15 seconds while towing, when dekitting usually either keep the 2:15 pattern or move to one breath for every clip you undo.

Since the move to 2:15 I've been encouraging trainees to use the same for the dekitting, but of necessity you have to go through the 1:5 just so that if the trainee encounters another instructor who is sticking to the older version, they won't be unprepared. Although I do this, and bearing in mind the shift to 2:15 was a deliberate bid to improve the efficiency of AV, I still feel it is a bit unecessary and a PITA when pool time is very limited.

Out of interest, how many Instructors actually _are_ still using the 1:5 for dekitting ?

Cheers
Steve

Just a point to note - static AV rates were never 1:5 it was 1:6 (10 breaths / min) - not that that mattered much!

Whats important is that the breaths are effective!

Pete

[David Walker]

Out of interest, how many Instructors actually _are_ still using the 1:5 for dekitting ?

Our club's main instructors have always said do whichever is more convenient / comfortable. Probably quicker to get them dekitted if you keep to 2:15, since you can probably get the whole kit off in 15 seconds, or maybe 30, where as if you stop 3 times as often to give AV then its going to be slower overall. Not significantly, and as has been mentioned the quality of AV is definately still most important, but still you want them out of the water as soon as possible.

David

[Steve Walker]

Just a point to note - static AV rates were never 1:5 it was 1:6 (10 breaths / min) - not that that mattered much!


I stand corrected, my typo.
But while we're on the topic as the CC rate was 80 ccpm (now 100 ccpm) there's very little chance that it would have equated to the desired 6 breaths per min quoted in the training literature

Whats important is that the breaths are effective!

Pete

Exactomundo!

[Martin]

The UK resuscitation council recommends that that 2breaths:15compressions ratio is used in all adult incidents. This is inline with the recommendations of the europeans resus council, and also the american resus council guidlines. (see <a href="http://www.resus.org.uk" >http://www.resus.org.uk</a> for more info). If there are signs of circulation, and chest compressions are not necessary, then rescue breathing should be continuous at the recommended rate.

Obviously, in water, we are faced with a dilemma. We have two objectives;
1. To provide AV.
2. To remove the casualty from the water.

Performing 2 breaths every 15 seconds (usually taught, in my experience, as 12 fin kicks, breath, break, breath) takes the breathing rate from the full BLS algorith, and therefore we hope it is effective. It also provides a reasonable rate of movement in getting the casualty out of the water.

Interestingly, the resuscitation councils recently changed the recommended training structure for BLS, and instead of teaching new first aiders chest compressions, they only teach AV. The reason for this is that it has been well demonstrated that AV is the most important part of the resuscitation attempt.

In terms of what instructors are teaching, then any instructor who teaches anything other than 15:2 should be very wary of their liabilities. It is the duty of each and every instructor to ensure that they are teaching the latest recommendations, and if they are not teaching the latest recomendations then they NEED to have a very good reason for teaching something different!

How would you feel if you taught a student CPR incorrectly, then when they were involved in a resuscitation the patient died? What if you had taught them what you *SHOULD* have taught them?? The patient might have had a better chance.

[Dave]

In terms of what instructors are teaching, then any instructor who teaches anything other than 15:2 should be very wary of their liabilities. It is the duty of each and every instructor to ensure that they are teaching the latest recommendations, and if they are not teaching the latest recomendations then they NEED to have a very good reason for teaching something different!

How about because they credit their students with having brain cells and being able to remember it. The information I was given for the shift away is not that 15/2 is better, but that it doesnt require thought to change and that it is easier to perform, whilst 6/1 is a more effective rate

Dave

[Philip Smith]

Interestingly, the resuscitation councils recently changed the recommended training structure for BLS, and instead of teaching new first aiders chest compressions, they only teach AV. The reason for this is that it has been well demonstrated that AV is the most important part of the resuscitation attempt.

Yes, but this is because most cardiac arrests in everyday life are due to heart attack or other causes which require defibrillation to restore a rythm. In diving incidents, cardiac arrest is more likely to have followed respiratory arrest due to near-drowning, choking or trauma, in which case cardiac compressions may be effective.

Philip Smith

[Andy Wade]

The UK resuscitation council recommends that that 2breaths:15compressions ratio is used in all adult incidents. This is inline with the recommendations of the europeans resus council, and also the american resus council guidlines. (see <a href="http://www.resus.org.uk" >http://www.resus.org.uk</a> for more info). If there are signs of circulation, and chest compressions are not necessary, then rescue breathing should be continuous at the recommended rate.

Obviously, in water, we are faced with a dilemma. We have two objectives;
1. To provide AV.
2. To remove the casualty from the water.

Performing 2 breaths every 15 seconds (usually taught, in my experience, as 12 fin kicks, breath, break, breath) takes the breathing rate from the full BLS algorith, and therefore we hope it is effective. It also provides a reasonable rate of movement in getting the casualty out of the water.

Interestingly, the resuscitation councils recently changed the recommended training structure for BLS, and instead of teaching new first aiders chest compressions, they only teach AV. The reason for this is that it has been well demonstrated that AV is the most important part of the resuscitation attempt.

In terms of what instructors are teaching, then any instructor who teaches anything other than 15:2 should be very wary of their liabilities. It is the duty of each and every instructor to ensure that they are teaching the latest recommendations, and if they are not teaching the latest recomendations then they NEED to have a very good reason for teaching something different!

How would you feel if you taught a student CPR incorrectly, then when they were involved in a resuscitation the patient died? What if you had taught them what you *SHOULD* have taught them?? The patient might have had a better chance.

Am I alone in finding this last statement really disturbing?
Why should I worry about having taught a slightly different rate to someone? IME these rates have changed at least 3 or 4 times over recent years, so does that mean that someone who uses an 'old' rate is liable because the casualty died? I reckon they'd have a hard time proving that there was a liability on the part of the person applying CPR because the rate was wrong.
People have had their lives saved many many times using all these different rates over the years. Just because current thinking says that we now use a different rate, doesn't mean that the old rate is suddenly dangerous.
At the end of the day, the main concern lies in the technique and it's efficiency. Rather than following a strict rate, get as much air into them as possible in the most efficient manner, to hell with rates and timings, in principle you just wait until they have breathed out and stick another breath into them, and compressions are pretty much as fast as anyone can give them anyway, if you try to follow the prescribed rate to the letter, you'll find that you can't actually go any faster than that. It's very diffcult and tiring as it is.
15:2 means bu**er all if half of them didn't actually get air in or compress properly because you were concentrating too much on rates rather than effectiveness, I have never followed the rates strictly to the letter when I have taught or examined because effectiveness is key.
Rates are guides for people to aim for, not rules to be strictly adhered to.
To sow seeds of doubt into anyone attempting CPR is likely to result in them not trying in the first place just in case they get it wrong.... and IMO that can't be a good idea.
If the ambulance chasers start to see potential money in this, it will only result in lots of perfectly capable people not even bothering to try CPR for fear of prosecution, including myself.

[John Bantin]

I am one hundred percent with Andy on this one. You can only do your best and that means keeping the circulation going and oxygenating the lungs until the casualty can be defibrillated.
Please God, none of you ever have to do it.

[ric morte]

:=Out of interest, how many Instructors actually _are_ still using the 1:5 for dekitting ?

Our club's main instructors have always said do whichever is more convenient / comfortable. Probably quicker to get them dekitted if you keep to 2:15, since you can probably get the whole kit off in 15 seconds, or maybe 30, where as if you stop 3 times as often to give AV then its going to be slower overall. Not significantly, and as has been mentioned the quality of AV is definately still most important, but still you want them out of the water as soon as possible.

David

I was taught that when doing any activity whilst giving AV the rate should be 15:2 (2 AV every 15 sec). This allows a single rate to be learnt for AV whilst towing, dekitting, recovering etc. 15:2 is also the optimum CC:AV rate. When AV is on land/boat and no other activity, it can fall back to the 5:1 (or 6:1) rate.

I believe (but haven't seen any hard evidence) that dekitting a diver at 15:2 is more efficient since there is less swapping of tasks. Priority is to get the casualty out of the water and recovered for full AV/O2.

Is this most people's understanding?

[Martin]

I am one hundred percent with Andy on this one. You can only do your best and that means keeping the circulation going and oxygenating the lungs until the casualty can be defibrillated.
Please God, none of you ever have to do it.

yes, I completely agree, you can only do your best.

As a person in attendance at an incident, that is most certainly the case, and our best at the time is indeed our best, and no-one is going to criticise us for trying. When it does, however, hit fan, you cannot possibly prepared for your first experience. And this is amplified all the more when you may be attempting a resuscitation on a boat which could be a significant distance from any help! (have you been there?? I also hope to god you never have to be, as it is truly an awful experience).

It is important, therefore, that the each of us knows exactly what should be done, and we practise it regularly. It is also important that a consistent message is delivered, and hence as instructors we have an obligation to deliver the same set of guidelines. The governing body for resuscitation, in our case the rescuscitation council, provides the latest guidelines in a readily accessible format, and there is no excuse for an instructor not having referenced them recently to ensure they are teaching the most up to date guidlines. The BSAC also provide bulletin's on changes.

The resuscitation councils are well informed groups of highly experienced and knowledgable individuals.
They issue there guidlines not so we can pick and choose what we think they are correct in recomending, but because the current evidence in the medical literature suggests that the guideines are the most effective method of providing CPR.

It is not about crediting students with intelligence, or anything else. I see your point of view. Even the most intelligent person, however, might be very paniced should they encounter an incident. The current simple algorithm is ideal, easy to follow and easy to remember. There is no sense whatsoever in an instructor complicating the situation further.

There are, of course, already some complications in the algorithm which are very relevant to divers - there is a change for in cases of drowning or near drowning, where a cycle of CPR should be employed before going for help. WHen there is a large dive team however, this becomes irrelevant as there are plenty of peole to delegate to.

[John Bantin]

Of course training agencies must come up with guidelines but I have seen people ?practising? CPR and completely obsessed with counting but without due regard to efficacy.

I have been involved for real. As Andy says 80 compressions a minute is about as fast as anyone can go and very tiring. It was mentioned in this week?s Sunday Times that a man died of a heart-attack while giving CPR to a drowned person on a beach in the Caribbean.

Lung inflations have to be effective. It is important to see the chest rise. (No-one prepares the trainee for the dramatic consequences as the chest falls and the casualty becomes grotesquely animated during exhalation.)
But you do your best.
Sometimes it was 10:1 at others 15:2 and at others everything in between. You lose count after a bit.
As for delegating, you will surprised at how many normally intelligent people just run round like chickens without heads!
My successful attempts to keep a deceased person in good shape resulted in him looking very pink and healthy instead of dead and green but in fact he was not revived. He was a journalist and there were attempts by his friends to pillory me in the Telegraph, the Guardian and even Private Eye, such was their gratitude for my efforts!

[iainmsmith]

:=In terms of what instructors are teaching, then any instructor who teaches anything other than 15:2 should be very wary of their liabilities. It is the duty of each and every instructor to ensure that they are teaching the latest recommendations, and if they are not teaching the latest recomendations then they NEED to have a very good reason for teaching something different!

How about because they credit their students with having brain cells and being able to remember it. The information I was given for the shift away is not that 15/2 is better, but that it doesnt require thought to change and that it is easier to perform, whilst 6/1 is a more effective rate

Dave,

Are you talking about in-water AV rates or CPR?

Iain

[Martin]

John,

The attempts to pillory you in various media outlets is obviously an unacceptable situation. These journalists should perhaps consider their professionalism.

I agree completely with you that once in the field, you simply do your best.

I think you have agreed here with my principle point, that instructors teaching BLS should be teaching the current recomendations of the resusucitation councils/BSAC/governing body. They should not be modifying this to their own thoughts.

An instructor my impart their experience on a student, but this should not interfere with teaching the core prescribed content, which should be delivered in line with governing body recomendations.

--
Martin

[John Bantin]

There is a simple reason that I am against hard and fast numbers given by training agencies as against recommendations:
Imagine a real emergency if you can.
We live in a litigious society. If a governing body offers hard rules for something like this you might have to be prepared to face a legal action with an expert witness (a trainer) who says that the prescribed rate is say 15:2 and you will have to admit that sometimes you only managed 14:2 or lost count and did say 16:2 or 17:2 or maybe even 10:1 or even some other number. What if you only manage 77 compressions in a minute?
So if you cannot do it exactly as prescribed, and in the circumstances no-one can, believe me, you might be vulnerable to legal action against you. There will always be someone ready to say you did it wrong. So then the best course is to not get involved - which is already how so many people see it.

[ric morte]

There is a simple reason that I am against hard and fast numbers given by training agencies as against recommendations:
Imagine a real emergency if you can.
We live in a litigious society. If a governing body offers hard rules for something like this you might have to be prepared to face a legal action with an expert witness (a trainer) who says that the prescribed rate is say 15:2 and you will have to admit that sometimes you only managed 14:2 or lost count and did say 16:2 or 17:2 or maybe even 10:1 or even some other number. What if you only manage 77 compressions in a minute?
So if you cannot do it exactly as prescribed, and in the circumstances no-one can, believe me, you might be vulnerable to legal action against you. There will always be someone ready to say you did it wrong. So then the best course is to not get involved - which is already how so many people see it.

In one sense I am with you all the way - hard and fast rules all too easily make for unthinking people. Since no emergency is 'text-book' there will always be other factors that present themselves to a rescuer - and it is here that the rescuer needs to be able to assess the situation, show flexibility when required and optimise the situation in favour of a succesful outcome.

However - and this is a BIG however - when training students it is no good being flexible to the point that the student has no framework upon which to fall back. When confronted with a rescue scenario it will probably be as much as the rescuer can manage just to remember the basics. In a stressful situation the rescuer desperately needs a simple set of guidelines to follow. If they have presence of mind they may indeed be able to think the situation through and adapt what they have been taught to the immediate situation and show flexibilty. If so, good for them!

To me it is clear - get the basic drill right every time, repeat it and then when it's been done correctly, repeat it again until it becomes second nature - and yes, use the numbers. Only then should the trainee be challenged with other 'what-ifs' and hopefully see the ways in which they can adapt what they have learnt. I think you will find that no BSAC trainer instructs their students to restrict themselves slavishly to the numbers, but that the AV/CC must be effective. That is the idea that must be etched into the mind of the trainee. Effective.

As to those who are only too ready to say "you did it wrong" or to those who choose never to get involved, my only comment is quite unprintable..... I agree, it seems to be the way things are going. I wonder if they too could be shipped off the planet along with the telephone sanitisers :)

Ric

[John Bantin]

Take part in our online survey, and you could win a Luxfer pony cylinder worth ?106. This month's question - Would the threat of litigation put you off training divers? ?

Bear in mind that a teachers union recommends that its teachers no longer participate in school trips for the same reason.

[ric morte]

Take part in our online survey, and you could win a Luxfer pony cylinder worth ?106. This month's question - Would the threat of litigation put you off training divers? ?

Hmmmm... not sure.... but the thought of litigation sure puts me off lawyers.

Ric