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updated corrected 25 aug after input from Stig Severinsen
In 2001 I filmed Hubert Myer blacking out at 10-15 meters in the Ibiza world cup. I remember his twisting body with air flowing out of him - the safetydivers lifting up his limp lifeless body on to the boat and the pink foam coming out of his mouth. He had been down to70 meters.
 Wolle after BO at Triple depth 2005 |
In those days we didn´t use lifelines. In the coming years we learnt that these things look much worse than they are. The epioglottis actually closes when the brain shuts of due to lack of oxygen. A reflex to stop water entering the lungs. Hubert was actually up and laughing some three minutes later. In the first Triple depth I remember Wolle and Alex doing real deep blackouts - more scary for the safetydivers than for the actual divers - I would say. In the clear blue Red sea it was all visible from the surface. |
 Still holding her breath - not reacting to BTT |
Now in the third Nordic Deep it happened againg in front of my eyes. I was judging a CWT/CNF/FIM competition in the green waters of the west coast of Sweden. We were anchored inbetween cliffs with 85 meters of water under us. We had two afetydivers and a "jellyfishchaser" at the rope, one man ready with the antiballast and a first aid medic with oxygen 3 meters from the rope beside a low plattform. Klara Hansson from Sweden is attempting a national record, CNF 42 meters. Nordic Deep 2006. A depth she has never done before. |
1.53. Safety diver returns without seeing the athlete, signals upwards from 5 meters
1.55 Judge in water goes down directly.
2.00 Second safety goes down.
2.08 Athlete goes unconcious, I see her as it happens.
2.12 I grab Athlete at 21 meter
2.16 Second safety helps at 17 meters. He holds from behind, I hold head and block airways.
2.30 Removes mask just before surfacing and start BTT
2.42 I try 3 blows into mouth but fail due to bad position of headand maybe laryngospams.
3.02 First safety manages to blow into lungs*.
3.08 Athlete opens eyes.
1 minut of unconciousness! *If it was the blow into lungs that made her concious or if the laryngospasm let go before the blow we can not say.
Regarding the safetysystem we can note that the third safetydiver was never needed, neither was the antiballast system. Another blackout story during a training session here.
| Conclusions In the evening all athletes gather in a meeting and we see the video and discuss rescue operations. Soon we have two opinions against each other. Stig Severinsen thinks the BTT phase is unecessary and ask for more action - "Go for a quick blow into the lungs". Wolle gets very emotional and search for english words and say that this is not a useful approach. "It is impossible to blow air into the lungs of a blacked out freediver". At the meeting are a biologist specializing on diving mammals (such as us), Johan Andersson, a hyperbardoctor and scientist (Mats Linér) and a first aid medic (Daniel Fjojt). They explain to us that it is difficult to blow passed a laryngospasm (that blocks the airway). They support Wolles´claim that you might blow air into the stomach instead - which might lead to a throw up and the problem is even worse. |
below: At last a tag. Klara at the 2005 Nordic Deep after a two year battle with her eardrums. |
1. Do not try blowing into the lungs with the victim in the water. Water might get into mouth and down to the epiglottis and it might seal even more. If land is far a way of course you have to do something and a blow into the lungs might be what is needed.
Now the medical people says something that is news for most of us. YOU CAN NOT OPEN A laryngospasm - it will open when the oxygen for that muscle has run out - or when the victim is persuaded to wake up.
Stig mentions that the brain listens even if you are uncouncious, and others suggest how important it is to make the victim feel safe. Safe enough to dare to start breathing again since the brain is actually trying to "save the lungs" from the water.
2. The conclusion could be that the BTT (Blow tap talk) is the right first approach, and...
3. Get the victim as fast as possible on to dry land if BTT does not work.
Since the new standards for CPR tells us that blowing into the lung is not the essential part of the CPR, the pumping of the heart is the most important thing. One blow into the lungs is enough and then you need 30 heartsqueezes to pump the blood up to the brain and back down to the heart and the lungs. So swimming to land stoping to do an inblow several times might not be the right approach. You waste your time and you might get water down to the epiglottis. We also are told that the head has to really be bent backwards in order to open up the throat for a blow into the lungs.
Stig writes: "I have done "lungblow" MANY times...(blown directly after BO in sea and pool) and EVERYTIME the diver has woken up JUST after the blow. I feel quite sure that FIRST the epiglottis closes (reflex)...maybe because of water in mouth, maybe because of low body oxygen level or maybe because of a "vacuum" from the lungs..that is...the person is fighting to HOLD breath...and the epiglottis gets sucked down towards the lungs (closes)..this OPENS when air is blown in and the body starts to breath again."
Is this an indication that we have "breathing reactors" not only in the face but maybe also in the mouth/throat.
Stig comtinues: "I think the larynx goes into cramps at a later state...after epiglottis closes...but not necessarily because of this...I am not saying the epiglottis HAS to be closed for a laryngospasm to happen....Note taht 10-15% maintain the laryngospasm/seal until cardiac arrest…(dry drowning)"
And finishes with: "DO SOMETHING...and use your common SENCE...and remember that all situations are always DIFFERENT".
Sebastian
The reaction to water inhalation
If water enters the airways of a conscious victim the victim will try to cough up the water or swallow it thus inhaling more water involuntarily. Upon water entering the airways, both conscious and unconscious victims experience laryngospasm, that is the Larynx or the vocal cords in the throat constrict and seal the air tube. This prevents water from entering the lungs. Due to this laryngospasm, water enters the stomach in the initial phase of drowning and very little water enters the lungs. Unfortunately, this can prevent air from entering the lungs, too. In most victims, the laryngospasm relaxes some time after unconsciousness and water can enter the lungs causing a wet drowning. However, about 10-15% of victims maintain this seal until cardiac arrest, this is called dry drowning as no water enters the lungs. In forensic pathology water in the lungs indicates that the victim was still alive at the point of submersion; the absence of water in the lungs may be either a dry drowning or indicates a death before submersion.