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Lots of interesting responses to my earlier message! Bill VanderClock (WVANDERC@BE*.ED*) writes: Such a regulator is certainly possible, but unfortunately in the hands of the untrained, a lethal weapon. [ ... ] The regulator you describe would require a great deal of training to avoid doing damage. Absolutely true, no doubt about it -- I would envision such a regulator to only be appropriate equipment for divers trained in ventilation techniques. (As an aside, I think that this training should be mandatory for dive resuce training, but that's another story.) Dan Grimm (dan@ba*.en*.mo*.ed*.au*) writes: Here in Australia, the Australian Resuscitation Council has just ruled out Positive Pressure valves. From Jan. 1st, you won't be able to buy a resus. unit with a 'purge' button, and the first aid courses will teach you not to use it; They feel it is to easy to overinflate (lungs, stomach etc). [I just did a one day Advanced Cardio Pulmanory resus. course and it is amazing how much easier it is to use a bag-mask to ordinary cpr....] I am surprised about this -- does this apply to paramedic and hospital usage also? Yes, ventilation with a bag is much easier than by breath; Positive Pressure Ventilation is even easier, and can make airway management easier as only one hand is needed to hold the mask and control the ventilation. Tracey Baker (tab@pa*.co* / tab@go*.ho*.at*.co*) writes: [...] A problem with incorporating this into a scuba regulator would be that in order for PP artificial ventilation to work, you need some sort of seal on the airway -- either a tight-fitting mask or an endotracheal (ET) tube. This might be possible with a scuba mouthpiece on the reg, but I'd imagine it would be *very* difficult (it's tough enough just to keep a seal & open airway with a mask designed for that purpose!). I think it would be easier with a scuba reg, as the reg can be controlled with one hand, leaving the other hand free for manipulating the victim's head/neck. I find that operating a bag unit solo is very difficult -- sealing the mask, squeezing the bag, and maintaining the airway always seems to take three hands. During paramedic training, I prefered positive pressure ventilation for the time while setting up to intubate the victim (one rescuer sets up while the other manages the victim). After intubation, the bag is a better approach, as the airway no longer needs to be actively managed, and there is also no mask to worry about. [...] The PP/demand system is almost *too* easy for an untrained person to (mis-)use -- I've seen many cases of police officers using the ones they carry and doing nothing but filling the patient's stomach up with oxygen... I've seen this often also -- and I find it disturbing, as the Officers are trained in the proper use. However, they (aparently, though I am not certain) probably do not have continuing education/recert requirements in this area. An even more disturbing thing is when an MD does it wrong...(Personal Opinion: Dentists are the ones to be wary of!) [...] In my personal jump kit, which travels with me, I carry a disposable BVM (cost < $50), a pocket mask with oxygen inlet (cost ~$25), and I hope to add an O2 reg as described above soon (cost ???, probably not more than a few hundred $s). Also, the boat I dive on has oxygen on board (K-bottle), with a standard pin-index valve and flow-control reg, so all I'd really need there is the tubing (which I also carry). I also carry similar equipment, but my idea with a ventilation regulator would be to provide recusitation capability right where it is needed. Once a victim is on shore or on board the dive boat, recusitation is relatively straight forward -- there are also usually lots of people available to help with the mechanics. However, valuable time is wasted between the time the victim surfaces to the time when recusitation can be started on a firm surface (boat or shore). In-water recusitation by breath is extremely difficult to do effectively, especially in any sort of chop. Even in calm water, just managing the airway is very difficult. Hence, the idea for a positive pressure ventilation regulator. Establishing and managing the airway becomes easier, as the rescuer can now position themselves behind the victim's head. A nose clip could be used to eliminate that task, though it is not essential. Also, if the jaw can be opened, the scuba reg will keep it open, and will prevent the entry of water -- in fact, I would think that this aspect would make it safe enough to use a hard airway while still in the water (which I do not think is very safe, b/c of the opportunity for entry of water, when using in-water recusitation by breath). Alternatively, I could see the reg having a connection inside the mouthpiece frame for a standard pocket mask. O2 is not essential to this idea, though that would seem the logical place to employ such a regulator (there are fewer demands on the reg, the switch is more controlled). Just a thought, -frank -- fhd@pa*.co* | A common fallacy is to equate a limitation of knowledge 1 917 992 2248 | with a knowledge of limitations. 1 718 746 7061 | -- Foster Morrison
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