Do you know life saving skills in water?

[Juan Twothree]

Just to add, lifeboats (with the exception of the three permanently manned stations on the River Thames) don't carry defibs, as they wouldn't get there in time for the defibs to be effective.

Also, in case anyone isn't already aware (and apologies if you are), a defib can't restart a stopped heart. It will only administer a shock if it detects that the heart is beating out of sync. The shock actually stops the heart, in the hope that it will then spontaneously restart in the correct rhythm.

 

[ShaneO]

I’d argue that the “stopped heart” thing is kind of just semantics; if it’s not pumping, it could be said to be stopped, regardless of whether it’s physically twitching or not. For the layperson, probably the important facts are that there are lots of reasons and a number of ways for a heart to stop pumping effectively, that’ll all manifest the same to you (collapse and not breathing and no pulse, not that you should be trying to rummage for a pulse if the first two have happened), and one of those ways is potentially reversible with a shock, and if the machine decides not to shock it’s based on it finding another of those situations.

 

[Juan Twothree]

I’d argue that the “stopped heart” thing is kind of just semantics; if it’s not pumping, it could be said to be stopped, regardless of whether it’s physically twitching or not. For the layperson, probably the important facts are that there are lots of reasons and a number of ways for a heart to stop pumping effectively, that’ll all manifest the same to you (collapse and not breathing and no pulse, not that you should be trying to rummage for a pulse if the first two have happened), and one of those ways is potentially reversible with a shock, and if the machine decides not to shock it’s based on it finding another of those situations.

That's a fair point.
I get far too carried away with this kind of stuff!

 

[ShaneO]

Musing a bit on statistics over lunch; it’s certainly the case that the survival rate of the healthcare journey that begins with CPR is completely pants, contributed to by lots of broken ribs AND most of your body having had bugger-all blood\oxygen\waste removal supply for an extended period AND you still having whatever problem that was significant enough to stop your heart in the first place… but also statistically contributed to by frail bags of bones in nursing homes, and big obese diabetics with a foot missing, and lifelong drug and alcohol abusers. While you might not feel that your knees are what they once were, anybody in the yachting community is inherently fit and well and active enough to get out on a boat, and that gives much more of a fighting chance at the recovery period, should that heart get going again. So, it’s worth having a good go at, in my opinion (which is, for what it’s worth, based on a solid professional and academic background, said the anonymous person on the internet). Just not in the water, that’s silly.

 

[RobbieW]

One of the things I remember about the chin tow is that it was easier to quieten a struggling casualty by closing the nose and mouth Still taught ?

 

[Stemar]

One of the things I remember about the chin tow is that it was easier to quieten a struggling casualty by closing the nose and mouth Still taught ?

It also makes it harder for a panicked victim to grab you and prevent you swimming...

 

[[70521]]

I have an ancient RLSS Bronze Medallion, Pool Medallion and Silver Cross, and spent a summer as a pool lifeguard when I was a student.

There is no way I, or any of my crew, would be allowed in the water to assist somebody who had gone overboard. I need everybody to be warm and dry to deal with the casualty.

If in a pool or on a beach I'd do what I could and hope the casualty survives.

Comically, as a summer lifeguard the most serious injury I delt with was a fractured radius and ulna - a poor dive from 10 metres. While my mother, a Registered General Nurse, when dropping my brother and I off at the swimming pool got involved with full CPR assisting the ambulance crew back in the early 1970's.

 

[ylop]

I'm an RNLI volunteer crew member, but not a lifeguard.
We always get people out of the water and onto the boat or beach to commence CPR.

Direct mouth to mouth is no longer used, but we have oxygen and a bag/valve/mask with a reservoir, to inflate the lungs with 100% oxygen.

Intrigued what they teach you to do if you find yourself without equipment?

There seems to be a bit of confusion about the term "rescue breaths". These are five initial breaths used before normal CPR commences, when the casualty has been deprived of oxygen.

You may be confused - but the terminology used by the resuscitation council is rescue breaths for the 30:2 ratio: Adult basic life support Guidelines that language is used by most organisations training in first aid.

In a yachting scenario, without oxygen, a face mask or BVM, current thinking is it's probably best just to do continuous chest compressions, and wait for help to arrive. Every time you stop compressions to carry out possibly ineffective lung inflations, you're losing any blood pressure that you have built up. And there will still be some oxygen transfer through movement of the chest whilst you do the compressions.

That is not actually the resuscitation council guidelines - if trained to do so and you feel happy to do so then 30:2 is the guidance. The face mask would bring no advantage to the effectiveness of the breathing, it reduces a pretty low infection risk but mostly makes a horrific experience marginally better.

 

[ylop]

Just to add, lifeboats (with the exception of the three permanently manned stations on the River Thames) don't carry defibs, as they wouldn't get there in time for the defibs to be effective.

Is that an official RNLI explanation or assumptions and Chinese whispers passed from person to person within the organisation?

Your statement is probably true for casualties who are lifeless when pulled from the water, but I would have thought lifeboats respond to medical emergencies and trauma where the casualty still has a pulse when they arrive but who declines during transport to shore? A lot is made about rescue collapse and hydrostatic squeeze which would suggest there are patients who go from satisfactory circulation to cardiac arrest after you guys turn up. If nothing else confirmation that the patient does not have a shockable rythym might help assess if there is any sense in continuing CPR.

It may be the RNLIs medical officer has analysed the data from the last however many years of shouts and determined that it really would make not difference. It may be that the challenges and risks of use, especially on inshore boats, outweigh the benefits, but it seems unlikely that the thought process is as simple as “they are usually already dead when we get there”.

 

[[70521]]

A lot is made about rescue collapse and hydrostatic squeeze which would suggest there are patients who go from satisfactory circulation to cardiac arrest after you guys turn up. If nothing else confirmation that the patient does not have a shockable rythym might help assess if there is any sense in continuing CPR.

It is a complex area.

People have survived for very long periods of time without breathing or a heart beat in very cold water.

I am not convinced that hydrostatic squeeze is relevant in lifting a casuilty into a boat. It was identified by a helecopter winchman and the height/time in the hoist is much greater. But as ever things get adopted and taught without question until some 'new' research changes thing back to the way things were done a generation ago.

From my mountain rescue days you really do know when somebody is dead, but sometimes there is a nagging feeling and you get on with CPR to give them a chance.

Quite surprised that the RNLI don't carry defibs, surely they get called out to a number of jobs where the casuilty is complaining of chest pain. Or would a helecopter be tasked with the kit?

 

[Juan Twothree]

Is that an official RNLI explanation or assumptions and Chinese whispers passed from person to person within the organisation?

It's what we're told by the trainers every three years when we do our cas care requalification.

We file an online report every time we launch, so they have the statistics to hand. I know that a quarter of all medical cas care on lifeboats is carried out by the 3 Thames stations.

Beach lifeguards have defibs, as do HM Coastguard CRVs.

We carry aspirin and GTN spray for non traumatic chest pain.

 

[The Q]

I remember being taught towing by the chin in the swimming pool while at school, that would be before 1971, never received training in that again since.
CPR, always was taught on the ground,

There is a defib at the sailing club and 2 elsewhere in the village, ( tourist village , tourists do stupid things)

Saw someone getting CPR on the public river bank, viewed from the sailing club just last year, but before I could grab the defib an ambulance arrived.. That didn't end well..

I've been taught first aid from school days, in the military, and as a rescue boat crew. The only change was the sudden change to much more compressions to less breaths a few years ago.

On rescue boat duty again every morning next week, racing myself every afternoon.

 

[Juan Twothree]

It is a complex area.

People have survived for very long periods of time without breathing or a heart beat in very cold water.

As the saying goes....... They're not dead until they're warm and dead.

Hydrostatic squeeze isn't something we worry about on inshore lifeboats, but it is on ALBs, with the extra height. Whether or not that is unnecessary I'm not qualified to say. I don't make decisions re policy, I just follow the cas care check cards.

The RNLI has worked closely for a number of years with Professor Mike Tipton, who is something of an expert on cold water survival. He was on on the RNLI First Aid and Survival committee, and I believe is still on the RNLI council, so a lot of the current practice and advice will have come from him.