DCI Casualty

[Paul Oliver]

Slight conflict on advise here which has cropped up elsewhere:- YD (http://www.yorkshire-divers.co.uk/forums/showthread.php?t=32103)

Working on laying a suspected DCI Cas flat is what i teach and understand to be correct and is advised withing the BDSG Incident management flow chart:- BDSG Chart (http://www.bdsg.org/Diving%20Accident%20Management%20Procedures.pdf) also what is emphasized with BSAC on the O2 Admin Course.

However, on the DDRC flow chart they are recommending the recovery position as shown here:- DDRC Chart (http://www.ddrc.org/downloads/DDRCEmergencyFlowChart.pdf) No mention of laying the casualty flat at the start of the procedure.

Any chance of some clarification on this, as in not just the BSAC line, but why DDRC (Who i would consider the baseline authority on this) are not advising the same as BSAC and more importantly the BDSG to which they belong?

[Tristan Green]

Has anyone asked DDRC for their reasoning? It seems from your post that they are the ones that are out of kilter with the others.

Cheers,
Tristan

[Paul Oliver]

I have e-mailed the DDRC and asked for some input.

[tony J]

However, on the DDRC flow chart they are recommending the recovery position as shown here:- DDRC Chart (http://www.ddrc.org/downloads/DDRCEmergencyFlowChart.pdf) No mention of laying the casualty flat at the start of the procedure.the same as BSAC and more importantly the BDSG to which they belong?

Paul,

I do not think they use the recovery position in hospital or in amubulances, yet all first aid courses teach it.

I assume the idea is that low skilled rescuers can prevent further harm.When treatment is being given by trained rescueers (and casualty is under constant monitoring ) there are better ways.

I always assumed that the recovery position was a fall back position, which generally does no harm ( It also depends on level on conciousness if it is appropriate !)

My opinions

Tony

[PeteM]

I do not think they use the recovery position in hospital or in amubulances, yet all first aid courses teach it.

I assume the idea is that low skilled rescuers can prevent further harm.When treatment is being given by trained rescueers (and casualty is under constant monitoring ) there are better ways.

I always assumed that the recovery position was a fall back position, which generally does no harm ( It also depends on level on conciousness if it is appropriate !)

Some people seem to think that the recovery position is a form of first aid, but as you say it is just a way to prevent further damage, in particular drowning on vomit or choking.

In amubulances or hospitals a casualty is going to be monitored continuously by an experienced professional that is likely to spot these problems, this is less likely with us lot. With the professional, rapidly dealing with problems like requiring CPR takes precedence, with us the priority is to prevent further problems.

[GaryC]

[QUOTE=Paul Oliver]
However, on the DDRC flow chart they are recommending the recovery position as shown here:- DDRC Chart (http://www.ddrc.org/downloads/DDRCEmergencyFlowChart.pdf) No mention of laying the casualty flat at the start of the procedure.

QUOTE]
It was my understanding that casualties should be on their side because it aided blood flow from the heart. But that is a dim image from the past. I guess it also depends on which side you are on.

Interestingly it says/implies on the DDRC sheet that you can administer O2 on NON diving casualties. (Did I read it correctly?)

That is also an apposing view to BSAC

Gary

[Paul Oliver]

Just to try and stay on track the point i'm chasing is that we teach

1. Lay casualty down (Flat)
2. Give 100% O2
3. Give Non-Alcoholic fluids

DDRC are recommending:-

1. Administer 100% O2.
2. Administer fluids.
3. Place in recovery position.

So where is the lay casualty flat bit at the start on the DDRC chart? In the past in debates this lack of saying lay cas flat has lead to many divers believing it does not matter if the cas is flat or sitting up! Or even that it is better to keep them sitting up :eek:

As i mentioned before, to me the DDRC should be the base line for DCI treatment as many other divers will go by what they say, not by what they think a bunch of old beardies are saying.

[Adrian Kelland]

As i mentioned before, to me the DDRC should be the base line for DCI treatment as many other divers will go by what they say...
Hmm should they Paul?

I understand where you are coming from, but the DDRC is just one of many bodies treating DCI, they may not even treat the most. Do they all treat in the same way? I know when I was treated I left to sit on the bunk - we all were. Perhaps that way they know you are still conscious under the oxygen mask.

Which leads me on to my next point. IIRC the Recovery Position is for unconscious breathing casualty, if is it appropriate to move them into that position. Could also be useful if sea sickness is adding to problems.

I would not find the recovery position useful in determining the progression of any problems. It is much easier to push evenly against each leg or arm when the casualty is in a symmetric position - ie on their back.

Adrian

[Andy Nye]

BDSG Incident management flow chart:- BDSG Chart (http://www.bdsg.org/Diving%20Accident%20Management%20Procedures.pdf) also what is emphasized with BSAC on the O2 Admin Course.

However, on the DDRC flow chart they are recommending the recovery position as shown here:- DDRC Chart (http://www.ddrc.org/downloads/DDRCEmergencyFlowChart.pdf) No mention of laying the casualty flat at the start of the procedure.


Paul,

Even the BDSG flow chart states LAY THE CASUALITY DOWN ,, doesn't point out how / what position........


Food for thought

[Finless]

With a DCI wouldn't it make sense to suspend the victim by their ankles to keep bubbles away from the brain as much as possible? ......... or spin them round by their arms causing centrifugal force to ...... or is that centripetal force ...........

OK OK, I'm shutting up ...... now.

[Paul Oliver]

With a DCI wouldn't it make sense to suspend the victim by their ankles to keep bubbles away from the brain as much as possible? ......... or spin them round by their arms causing centrifugal force to ...... or is that centripetal force ...........

OK OK, I'm shutting up ...... now.

Good that will make a change ;)

[Paul Oliver]

Paul,

Even the BDSG flow chart states LAY THE CASUALTY DOWN ,, doesn't point out how / what position........


Food for thought

Not really as i understand the reasons for laying them flat and totally agree with that, and teach that on O2 admin courses. The recovery position comes in later on, and i understand that as well, and thats what i teach.

However your insistence on going straight for the recovery position based on a simplified chart is contrary to what we are teaching, although laid down is laid down and far better than sat up.

As we have seen it is hard to get possible cas to lay down at all, from my experience getting them straight into a Recovery position will be even harder.

I really don't feel this is an area where there should be much in the way of contention.

[Gordon Archer]

:cool: Me thinks you are all reading it wrong.

The Bsdg charts says lie casualty down does not state position.
Give 1 litre water or non alcoholic fluid.

DDRc says adminster 1 litre of water or non alcoholic fluid then lay into recovery position.

Ever tried giving fluids to someone in recovery position?

Anyway after 1 litre of fluid it might just be possible the casualty will throw up, especially if taken quickly. and after diving.

whats important both work, just depends who you want to subscribe to?

[Francis James]

:cool: Me thinks you are all reading it wrong.

The Bsdg charts says lie casualty down does not state position.
Give 1 litre water or non alcoholic fluid.

DDRc says adminster 1 litre of water or non alcoholic fluid then lay into recovery position.

Ever tried giving fluids to someone in recovery position?

Anyway after 1 litre of fluid it might just be possible the casualty will throw up, especially if taken quickly. and after diving.

whats important both work, just depends who you want to subscribe to?
The latest information from DAN Europe on Dive Accident Positioning is: [Quote] "An injured diver should be placed in a proper position.The diver's responsiveness and breathing status determine the best position for providing basic life support oxygen".[end quote]
So responsive breathing diver can be either on their back or recovery position depending on risk of vomiting.
Unresponsive breathing diver must be placed in recovery position but without arms or legs crossed.
Non breathing must obviously be in CPR position.
So it seems the onus is on the first aid and O2 provider to make the decision.

[IainC]

So it seems the onus is on the first aid and O2 provider to make the decision.

Indeed.

Who is this DDRC flow chart aimed at anyway? Presumably we are not the target audience as most of us hadn't seen it until now?

It looks like one of those teaching aids which distill the contents of a lecture or advice and could easily be misread out of context.

It is a general principle of first aid (at least everyhting I have been taught or teach to others) that a conscious casualty should be in the position they find most comfortable. Also recovery position is not optimal for giving O2, fluids or monitoring a responsive casualty. Stick to what you are taught, not something random you find on the internet (like this forum :-) ).

[ahar]

Earlier in the thread someone mentioned that the DDRC mentioned giving 02 to non-diving casualties. This is not a good idea. We have a doctor in the club who on the 02 course gave us a few examples of wonderful conditions that you would never know about by looking at themthat will cause a casualty to stop breathng if given 100% 02. All these conditions are complete no-no with diving so it's generally accepted that it's safe to give a diver 02, but not anyone else unless you are specifically trained.

[Francis James]

Earlier in the thread someone mentioned that the DDRC mentioned giving 02 to non-diving casualties. This is not a good idea. We have a doctor in the club who on the 02 course gave us a few examples of wonderful conditions that you would never know about by looking at themthat will cause a casualty to stop breathng if given 100% 02. All these conditions are complete no-no with diving so it's generally accepted that it's safe to give a diver 02, but not anyone else unless you are specifically trained.

Agree with you absolutely. On our course it was stressed that we can only administer O2 to divers, and only where we know the details of the dive prior to the incident.

[Paul Oliver]

Hmm The DAN First Aid book i carry on the boat don't even say lay them down!

[Francis James]

Hmm The DAN First Aid book i carry on the boat don't even say lay them down!
The DAN Oxygen Provider Flow-Chart does not mention anything about laying casualty down, but page 64 of their Oxygen First Aid for Scuba Diving Injuries goes into details about positions.

[Paul Oliver]

Got this reply from Dr Phil Bryson at the DDRC which i think covers it well enough.


Dear Paul,

Thank you for your e'mail and its various links. I do not see any differences in opinion of note. In the old days there was a thought that lying your 'DCI victim' in the head down trendelenburg position was a good idea, but this is now not the case for many reasons - one of which was, which was more important head down or giving 100% oxygen? Another problem with this was the potential for an increase in intra-cranial pressure. Thus keeping actions simple, and following the standard ABC (airway, breathing, circulation) is so important.

The international opinion now is that lying the patient down is almost certainly the best idea. The BDSG's flow chart does not say whether they should be flat on their back, or in the recovery position - all it says is "lie patient down". Our flowchart suggests the recovery position simply because divers with any form of nausea may be at risk of vomiting and putting your victim in the recovery position is sensible especially if you are inexperienced, not sitting right next to them all the time and are not able to respond appropriately immediately (and that does take some training). Clearly more experienced people may be able to make better judgements as to when the use of the recovery position is necessary - but that does depend on training and experience.

There are clearly common sense issues here and the main purpose of the flow charts is to act as an aid memoir, and they are often meant to be read as part of a small diving emergency handbook. Thus for example if the patient needs CPR you would have to lie them on their back, some people find drinking fluid difficult whilst completely flat - that should not mean that you should not 'sit them up a bit' to give oral fluids and then lie them down again. If the victim has a vestibular or cerebral bend, or they are feeling sea sick then laying them flat on their back is dangerous. Giving oral fluids to a patient who is judged to be at risk of vomiting is also dangerous.

A simple flow chart can not possibly cover the whole range of scenarios - however the key elements of administering 100% oxygen, oral fluids if appropriate and lying the patient down whilst monitoring the patients ABC's and contacting the emergency services are all vital.

Further training should always be done to enable divers to feel confident in the emergency scenarios, and it is during this training and on reading the various diving emergency books that the different scenarios can be prepared for.

Hope this makes sense and clarifies some of the issues.

Please get back to me if need be.

Regards

Dr Phil Bryson

[Andy Nye]

Got this reply from Dr Phil Bryson at the DDRC which i think covers it well enough.

So i was right ,,, doing it my way ......TFFT

[Paul Oliver]

So i was right ,,, doing it my way ......TFFT

No it does not say put them straight into a recovery position, it does however say this:-

Further training should always be done to enable divers to feel confident in the emergency scenarios, and it is during this training and on reading the various diving emergency books that the different scenarios can be prepared for

Which if you work through the scenarios on something like the O2 Admin course the recovery position comes in a bit later and when its appropriate.