teaching of AV

[johnskerry]

Heard a rumour that the teaching of AV may be stopped, has anyone else heard this, hopefully not.

[David Walker]

The recommendations for first aid training will be changing soon, as soon as BSAC review the changes and get round to publishing them. Until then we should be teaching the current syllabus.

Out of interest, the changes that are taught for general first aid (not diving specific) say (very very basically) that for suspected heart attacks CC is more important than AV, and so we don't do the rescue breaths initially, and then only 2:30 rather than the current 2:15. However, for drowning the rescue breaths are still important. There's also a lot more subtle changes in the way its taught to make things easier for people to learn - doing CC just "in the middle of the chest" rather than trying to feel the ribs for an exact point as before. No checking for circulation at all as far as I remember now. Well worth getting a refresher done with someone qualified to teach the new stuff (HSE courses I know can, I think RLSS and many others are like BSAC and waiting for the release of new materials).

David

[Rhodus Aquanaut]

No checking for circulation at all as far as I remember now.

This should be, "due to 50% of cases being mis-read, thus the use of looking for a pulse is no longer recommended or common practice".

This is because that on both sides of looking for a pulse by non-professional first aiders, they can misdiagnose either finding or not finding a pulse on a casualty.

This can be for various reasons, cold, poor positioning of the fingers to find a pulse (giving the effect of no pulse), using your thumb to locate a pulse (giving your pulse not the casualties), panic on the rescurers part due to the shear addrenalin rush. This leaves our casualty at risk, especially when you add drysuits, cramped RHIBs, other divers, waves and speeding boats, etc etc.

What we now look for, as non-proffessional first aiders, is the signs of a pulse, i.e. skin colour, cippillary refil and the blood vessels on the inside of the eye lids. There may also be other signs as well, but as divers we have added considerations over and above other landlovers.

As per always, follow the current recommendations laid down by your training agency (BSAC) until such times as the governing body (BSAC) changes the recommendations to that effect.

It is good practice to keep yourself current and up to date with all aspects surrounding diving and diving practices.

But when it comes to saving a persons life, especially if it a friend or buddy, it is better to have had some form or type of training to assist as a first aid measure and help towards their speedy recovery.

Don't forget anything we do to assist anyone will only be a first aid measure, the important thing is that the casualty gets to medical treatment ASAP to further assist in the speedy recovery.

We all await word on best practices as and when our governing body has looked at the pro's and con's of any recommendation.

Not only towards First Aid and AV, or Rescue Breaths as it may become, but also best practices towards all the skills and safety measures we require as divers.

:cool:

[Ben Thompson]

This is because that on both sides of looking for a pulse by non-professional first aiders, they can misdiagnose either finding or not finding a pulse on a casualty.

I thought it was in anaesthologists (sp?) that the original study was done? That was the worrying point- the people who do it for a living couldn't reliably find a pulse on a living person, and got false positives on non-living people :(

[PeteM]

I thought it was in anaesthologists (sp?) that the original study was done? That was the worrying point- the people who do it for a living couldn't reliably find a pulse on a living person, and got false positives on non-living people :(

I believe it was various medical professionals not just people that knock patients out (No chance of me spelling it correctly) - the orginal study involved taking the pro's into an operating theatre to check for a the pulse on someone about to under go heart surgery. When they do heart surgery they stop the heart and use an artificial heart instead, this pumps continuously and therefore does not have a pulse. The accuracy rate was only a couple of percent over 50%, i.e. just better than flipping a coin.

If the pro's do that well at checking a pulse in perfect conditions we have no chance.

[Ben Thompson]

I just found another random paper (I'm bored...) about taking pulse on people with mullered legs, in which various bits were missing- and the success rate was down around 30% for both true positives and true negatives! (not sure if the end of that sentence is an oxymoron or not!)

[PeteM]

I just found another random paper (I'm bored...) about taking pulse on people with mullered legs, in which various bits were missing- and the success rate was down around 30% for both true positives and true negatives! (not sure if the end of that sentence is an oxymoron or not!)

That is scary - less correct than a coin :eek:

[Ben Thompson]

That's what I thought!

I guess that's why signs of life are a better plan :)

[johnskerry]

Checking for a pulse disappeared a while ago for the reasons many of you mentioned. The 2:15 seems quite appropriate to the diving environment, do we need yet another change in the rates. I do wonder if there is too much emphases on the tow though.
Good to hear that we will still be teaching to give AV & CC first and looking for help second.

[David Walker]

Checking for a pulse disappeared a while ago for the reasons many of you mentioned. The 2:15 seems quite appropriate to the diving environment, do we need yet another change in the rates. I do wonder if there is too much emphases on the tow though.
Good to hear that we will still be teaching to give AV & CC first and looking for help second.

In fairness, if anything i'd expect the change to be more towards to tow and less towards the AV bit, ie get them out of the water so we can do CPR which now is acknowledged as much more important than perhaps previously. However, things like this aren't covered in the Resus Council guidelines, so everything for now on diving situations is speculation and won't be known until BSAC have reviewed them and decided how to proceed.

I don't think "yet another change" is a bad thing - a lot of the procedures are vastly simpler than before, the "rescue decision tree" thing is much smaller than it used to be (for non-diving casualties). In the end, all first aid is a compromise on doing the best we can until professional help arrives, and ideas change over time with improved knowledge and experience and so changes are inevitable. If the changes make a first aid attempt more likely to succeed, then its worth the hassle of reprinting manuals, slides, etc.

Not too sure about your last comment though - looking for help as a second priority. Going for help (if there's no one else around) is I seem to remember done sooner compared to past recommendations, since you could do CPR for hours and still be no closer to resuscitating the casualty - if its a heart attack (assumed in most cases unless the cause is obvious) then they'll need a defib for any reasonable chance of survival, and so getting help should be a very high priority.

David

[Tony Dwyer]

AV while towing a diving casualty is a bit of a 'Sacred Cow'. I have stated before on these forums that I feel that the concept is fundamentally flawed.
I suspect very strongly that most unconcious casualties on the surface do not have a pulse. The failure to resussitate casualties elements in various BSAC Incident Reports seem to indicate that I may be correct.

Where there is no pulse, AV (aka Rescue Breathing) has no value. It merely delays the casualty being beached and full CPR being applied. It also creates tremendous stress, both physical and emotional for the rescuer.

If the incident happens during a dive from a hardboat or an inflatable with a hard surface big enough to allow CPR, then AV is probably worthwhile, if only to give the rescuer something to do and occupy his/her mind.

[PeteM]

AV while towing a diving casualty is a bit of a 'Sacred Cow'. I have stated before on these forums that I feel that the concept is fundamentally flawed.

Reading the resus council documents and a few other things I think having got a casualty to the surface a couple of AV breaths are probably worth while, but then unless a boat is coming to you a better alternative is just to go for it to get the casualty to shore asap rather than tow and blow.

The reason for this is that (near) drowning is one of the few instances were someone can have circulation but not be breathing and a couple of breaths can start them again. The delay getting started with the tow is IMHO acceptable, but once started then I think keeping the momentum going gives a better chance for casualty.

[Tony Dwyer]

Reading the resus council documents and a few other things I think having got a casualty to the surface a couple of AV breaths are probably worth while, but then unless a boat is coming to you a better alternative is just to go for it to get the casualty to shore asap rather than tow and blow.

The reason for this is that (near) drowning is one of the few instances were someone can have circulation but not be breathing and a couple of breaths can start them again. The delay getting started with the tow is IMHO acceptable, but once started then I think keeping the momentum going gives a better chance for casualty.

Good and valid point, I agree.

[Gordon]

There was a study in Brazil about the effectiveness of RB and tow, and the survival rates are significantly improved if RB is started in the water.

[PeteM]

There was a study in Brazil about the effectiveness of RB and tow, and the survival rates are significantly improved if RB is started in the water.

If I remember correctly that study was predominantley concerned with swimming pool or similar incidents which tends to be significantly simpler than a rescue we might under take also it only takes into consideration drowning whereas we need to consider other problems as well. Unfortunately I can not find the report at the moment, have you got a link?

The International Life Saving Federation recommend that where a long tow is envisaged then two minutes of AV should administered prior to towing alone (for short tows they recommend one minute AV followed by a tow and blow)
http://www.ilsf.org/medical/policy_07.htm

[Tony Dwyer]

There was a study in Brazil about the effectiveness of RB and tow, and the survival rates are significantly improved if RB is started in the water.

We touched on this recently in another thread, see:

http://www.bsacforum.co.uk/forums/showthread.php?p=27642#poststop

[Gordon]

cant remember the link but think that there is one in the thread tony's recommended - will check if its the one i mean
EDIT: sounds very similiar

[johnskerry]

Thanks for your comments, our club mostly dives from boats, a boat can get to the diver quicker than a diver can get to the boat, hence my comment on the tow. However it would seem clear from the responses that although two breaths initially may make sense, the important factor is to get the casualty to a location where cc and av can be administered.

[David Walker]

Thanks for your comments, our club mostly dives from boats, a boat can get to the diver quicker than a diver can get to the boat, hence my comment on the tow. However it would seem clear from the responses that although two breaths initially may make sense, the important factor is to get the casualty to a location where cc and av can be administered.

Oh yeah obviously if there's a boat coming towards you then there's little point in trying to swim towards it to save a couple of seconds - in that case you might as well do AV or whatever else you can to help the casualty where you are... or I would anyway.

David