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George -
Thanks as ever for the polite response.
I'm surprised though, since you usually have a well-reasoned answer as to
why one method is better than another. Simply referring to one anecdote
where your method worked isn't enough (it'd be like my referring to my
anecdote that my shoulder QR harnesses have never failed ... yet). I'm
convinced of your (and other) arguments that a good shear is better than a
broken QR. I'm wondering why you're responding with an anecdotal response
and no logic behind your argument in this case.
What I fail to understand is why, if you had the proper equipment (ie, a
medical O2 regulator and mask), you used the PURGE VALVE on a scuba deco
(pure O2) regulator to rescucitate the victim. If you had the proper
equipment, use it properly.
My suggestion (which you didn't comment on) was that if all you had (for
some unthinkably stupid reason) was:
* an O2 deco bottle with scuba regulator
then the best thing to do would *NOT* be to stick that reg in the victim's
mouth and push on the purge valve. There would simply be no easy way to
gauge how much air was going into the victim, whether or not the air was
going into the lung, and stopping at the appropriate time. A purge valve is
not a bag. If you can give me the name of the doctor/medic who actually
*ADVISES* this method, please let me know. I'd like to call them up and ask
them who their malpractice insurance company is (since they must be pretty
good).
If a deco bottle is all the equipment you were stuck with (again, if this
was the case, then DIR/WKPP is perhaps not as well-thought out as I had
thought), then the best method would be for the rescucitator to take the
breath from the pure O2 and then rescue breathe into the victim. The breath
will be about 96% pure O2 and you would have all the benefits of not
overinflating the victim. I'm not saying this would be easy, but I don't
think you would find a medic/doctor who would advise *against* this.
Now, legalities aside. In a rescue situation, I wouldn't feel bound to only
use the techniques that the Good Samaritan law would restrict me to using.
I'd rather have someone alive and suing me than to risk having them die
because of inaction. For example, when mountain climbing, I carry an Epi-pen
and I *will* stab a bee sting victim going into anaphylactic shock with it,
even though protocol doesn't allow it and I could be sued by the victim's
estate for practicing medicine without a license. Screw protocol in those
circumstances.
But I wouldn't do something that is patently hazardous when a simpler and
safer solution exists. Isn't that the real meaning of DIR? We argue with
reasoned responses. Let's think about this again:
Situation: non-breathing victim (likely cause: drowning with possible AGE)
Method 1: Using purge valve on a non-medical, scuba regulator with pure 02:
+ Delivers 100% pure O2
+ Low risk of infection to/by rescuer
- Very imprecise control of volume of gas delivered
- Hard to control gas blowing out exhaust vents, covering them increases
inflation pressure to very hazardous levels (IP=150psi~)
- Difficult to sense if victim is vomiting; airway situation
- DIfficult to close victim's mouth around regulator airpiece, open up
victim's airway,
cover the exhaust vents of the reg; and purge it at the same time.
Method 2: Using proper equipment (pocket mask with O2 inlet; or bag-mask)
+ Delivers ~40% O2 with pocket-mask with O2 inlet; 100% if you have a bag
+ Proper amount of air delivered to patient
+Low risk of infection to/by rescuer
+ Resistance (caused by possible closure of airway, diversion to stomach,
or vomiting) is easily sensed
Method 3: Rescuer breathes off O2/Nitrox demand regulator during normal
mouth-to-mouth
+ Delivers 96% O2 (for O2 deco; 28-32% O2 if you're on Nitrox I/II)
+ Proper amount of air delivered
+ Resistance (caused by possible closure of airway, diversion to
stomach, or vomiting) is easily sensed
- Risk of infection to/by rescuer (NA if rescuer has pocket mask)
- Cumbersome for rescuer
DIR (ie, thinking about your equipment choices) would say to use method 2 if
possible, method 3 if you don't have the equipment; and method 1.... never,
wouldn't it?
If you can give me reasons why Method 1 is actually a good idea, please let
me know.
Just because method #1 worked once doesn't mean it will always work or will
always be the best. Like Mr. Sutton, just because you can dive dry without a
BC doesn't mean it's smart. I'll be ordering my next harness without QRs.
Thanks again (as always) for your time,
Karen
ps. have you looked at respirators in hospitals. they use mechanically
operated bellows as well, so that the amount of air/o2 inspired by the
patient is never more than they can handle and the pressure is very
carefully regulated.
At 10:26 PM -0500 11/11/99, kirvine@sa*.ne* wrote:
> Karen, this is the kind of thinking that we boot out of our
> organization. By the way, we DO have the REAL equipment,not the DAN
> garbage, we do have real parmedics using it, real doctors and real
> knowledge of how to do these things that was gained from real
> instruction by professiionals, not some dive moron in a five minute
> session.
>
> We have had the shit the fan, and we have solved it correctly. Next time
> I am looking at a dead guy, I will wait and ask you what to do first.
> Right.
>
> One more time, the difference between BEEN THERE DONE THAT AND BULLSHIT.
>
--
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