Boy is OK after 45 mins under water - SailNet Community
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post #1 of 16 Old 4 Weeks Ago Thread Starter
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Boy is OK after 45 mins under water

Might be useful information for us sailors.

Don't assume it is too late for someone.

Italian boy survives being trapped underwater for 42 minutes - Europe - World - The Independent

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post #2 of 16 Old 4 Weeks Ago
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Re: Boy is OK after 45 mins under water

Like they said when I took an EMT course 25 years ago, you aren't dead until you're warm and dead. In this case, it helps to be young with an ECMO nearby too.


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post #3 of 16 Old 4 Weeks Ago
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Re: Boy is OK after 45 mins under water

They used to call this "mammalian diving reflex" and it is strongest in the youngest, especially infants. The mammalian brain can and will shut down almost all body functions when immersed in cold water, and that can keep you alive (and very much unconscious) for quite some time.

The big danger is when you are rescued, if you are improperly warmed up, THAT can create oxygen deprivation and brain damage very quickly.

The Nazis did a lot of the ground-breaking research on prisoners in WW2.
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post #4 of 16 Old 4 Weeks Ago
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Re: Boy is OK after 45 mins under water

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They used to call this "mammalian diving reflex" and it is strongest in the youngest, especially infants. The mammalian brain can and will shut down almost all body functions when immersed in cold water, and that can keep you alive (and very much unconscious) for quite some time.

The big danger is when you are rescued, if you are improperly warmed up, THAT can create oxygen deprivation and brain damage very quickly.

The Nazis did a lot of the ground-breaking research on prisoners in WW2.
Yes and apparently gets triggered more readily the colder the water and head-first immersion for some reason. There have been many documented cases just like this one so as said above, don't give up because you can't detect life signs immediately. I wonder whether CPR does more damage than just breathing for someone in those cases. CPR frequently breaks ribs and compressions interfering with a pulse that's so low you can't feel it seems to present a dilemma if you suspect the diving response has taken place. Maybe some recent AMTs or doctors can chime in on this.

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post #5 of 16 Old 4 Weeks Ago
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Re: Boy is OK after 45 mins under water

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I wonder whether CPR does more damage than just breathing for someone in those cases. CPR frequently breaks ribs and compressions interfering with a pulse that's so low you can't feel it seems to present a dilemma if you suspect the diving response has taken place. Maybe some recent AMTs or doctors can chime in on this.
There is NO alternative to CPR for Mammalian Diving Reflex Patients ... or any other pulseless (non-trauma) patient. CPR must be started promptly if there is to be 'any' chance of survival. Its very simple: NO pulse, call 911 then immediately start CPR and if possible continue CPR uninterrupted - (In the case of cold water drowning - for at least 30 minutes). The US EMS system is set up so that 80% of all people in the US 'should' (as a goal) be receiving Advanced Life Support (paramedics) within 15 minutes when 911 is activated.


Be aware that in the past few years the techniques and sequences of CPR have radically changed - and such changes have increased the survivability of pulselessness.
Dont worry about broken ribs, etc., they heal ... if and only if the patient receives CPR. Correct CPR technique vastly lessens broken ribs, etc. When was the last time YOU took a CPR or 'CPR refresher' course? ... a greater portion of CPR courses can now be done 'online', with the 'practice' the only classroom component. https://www.onlineaha.org/

Mammalian Diving Reflex - Wilderness Medicine Training Center's Blog - the Wilderness Medicine Training Center ... with write up on DMR.

Last edited by RichH; 4 Weeks Ago at 09:31 PM.
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Most current literature supports the fact that circulating the blood is way more important than oxygenating it for the survivability of a person. DO CPR. Call for help. Do not delay. Do not attempt to rewarm a drowning victim in the field. There are documented cases of survival with minimal deficits far longer than 45 mins.
We are actually inducing hypothermia on purpose in hospital in people that have neurological injury as it is protective to the brain in certain situations.
Additionally, cold water to the face can initiate an arrythmia in a subtype of long QT syndrome, which can cause loss of consciousness. This can lead to drownings. Another, albeit rare, argument for self inflating pfd.
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Re: Boy is OK after 45 mins under water

Dunno Rich. Having done hands-on CPR training with a feedback dummy, I'd have to say that CPR "from a book" must be like sex from a book.

The real experience may be somewhat shockingly different.

CPR from a book would beat nothing, the first CPR training I had was with an instructor but no dummies and no volunteers. (Igor couldn't find ay FRESH bodies.) Better than nothing, but using the dummy with feedback really helps to set muscle memory and make the process more likely to be done the same way--the right way--if it is needed.
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Re: Boy is OK after 45 mins under water

Hands on CPR with feedback dummies hasnt been done in about 8 years. The research showed that such so intimidated that the outcomes were simply dismal especially for 'non-medical' rescuers. You'll also now find that because of that research that 'rescue breathing' has all but been eliminated for non-medical rescuers, with the exception of infant child/CPR; even relegated to secondary importance with medical intervention.
Medical / rescue personnel in most areas (ie. EMS agencies) are now 'team trained' (like a well oiled pit crew) and with FAST and DEEP compressions the principal focus .... outcomes have risen proportionately due to this newer 'high value' and SIMPLER CPR methodology. When this new protocol/schema was released I was doubtful (as one of the earliest deeply involved 'pioneers' in public and medical personnel CPR training - AHA & ARC). I now clearly see/admit the difference - in outcome from the newer methods, as (until recently) a very active paramedic.
Interestingly, I learned my CPR from one of the three 'inventors' of CPR, who always quietly objected to the early until recent old rigid methodologies and who in quiet personal conversation would relate that from a physiological basis all one had to do is "push fast and hard" and that rescue breathing was not all that important during the beginning stages of CPR on a pulseless patient, except for infants and young children.

Online CPR learning with a small bit of classroom practice has proven to significantly increase the desired outcome.
The new simplified CPR methods save more lives than the old methods. Forget the harrowing precision choreography of the past. Do sign up for an online CPR course .... the newer "push FAST and push DEEP" CPR works better. ;-)
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post #9 of 16 Old 4 Weeks Ago
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Re: Boy is OK after 45 mins under water

Having been involved with a number of actual CPR cases during the years when I was a full time ski patroller, I can tell you one thing for sure; It ain't anything like the dummy. Get and carry a good face ventilator mask or even an AMBU bag and maybe learn about using an airway because in my experience, if you have to do a prolonged stint of CPR, it will be a lot less traumatic for you, as the breather. A set of different sized airways somewhat helps with inhalation of fluid (in the patient) which can be a big problem. Being on a boat, far from help is very similar to being on a mountainside in that you are not going to have an ambulance in a few minutes and are likely going to be doing CPR for a long time.

Rich, what is the new CPR method?

IS a Diving Reflex victim pulseLESS or is it so shallow as to be undetectable?

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Last edited by smurphny; 4 Weeks Ago at 10:29 AM.
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Re: Boy is OK after 45 mins under water

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Rich, what is the new CPR method?

IS a Diving Reflex victim pulseLESS or is it so shallow as to be undetectable?
Here's the re-revision of the 2005 AHA guidelines: http://www.heart.org/idc/groups/hear...ucm_317350.pdf
.... although several state EMS bureaus/agencies, for organized EMS responders, have applied even more rigorous (pit crew/extreme high quality) type of CPR on top of the general AHA standards. It 'works'; 'saves' are at a much higher success rate.

Like deep hypothermia incidents, true MDR usually has a very low to nil pulse pressure and a very low (bradycardic) rate --- can be undetectable, unless ECG, etc. is employed (but we rarely waste time in applying ECG initially). Even with electronic pulse / PO2 instruments, the feeble pulse (if any) and low body core temperature prevent appropriate monitoring. So, as with any deep hypothermic event, no one is field-pronounced as dead until "warm and dead"; obvious severe trauma cases are usually excluded due their extremely low/rare/dismal success rates.

In all non-trauma pulselessness, the key for survival is early and 'quality' CPR / early defibrillation .... followed by the quick arrival of Advanced Life Support - ALS. Its quite amazing and remarkable of the increased rate of 'code' success when such is applied early and without delay .... makes the paramedics quite happy to arrive and find a potentially viable patient to work upon. We'd rather arrive and find a 'CPR saved' patient due to 'quality CPR' being performed and have little to do than not. Such makes a BIG difference in many cases.
Most emergency response dispatch centers will even instruct over the phone on how to do the 'push fast and push hard' (compressions only) version of CPR ... definitely adds to the success rate.

:-)
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