DAN Provider Award Program
Program Overview : Incidents Resulting in DAN Provider Awards
Many of the details from these incidents have been removed to protect privacy.
We pulled the guy out of the water. He seemed to be suffering from severe sea sickness. We took off all of his scuba gear and sat him down. After he was sick a few more times, he appeared to go into shock and black out. During this time the oxygen kit was brought out and put into use. I started with the demand inhalator valve and he was unable to activate it so we switched to the non rebreather mask, set on 15 LPM. After getting him on to a backboard, his pulse weakened and the decision was made to assist with rescue breaths using the pocket mask and additional oxygen until the Coast Guard took him.
The rescuer left work on Friday around 4 in the afternoon on his way to our dive center where he was scheduled to assist in a PADI Open Water Course that evening.
At one of the subway terminals where he was in the process of changing trains, he saw in a corridor a small gathering and made his way there to see what was happening. He saw a 65 to 70 years old lady sitting in a chair being talked to by two Transit cops. He saw that something was definitely wrong. He identified himself as a CPR/First Aid Instructor and offered his help which was gladly accepted.
Neither of the officers seemed to know how to respond to the unfolding situation.
The rescuer first tried to communicate verbally with the patient. She did not respond but seemed peaceful with her head resting on her chest in a sitting position. She was very pale. The rescuer immediately applied the protocol he has learned and that he teaches. Look, listen and feel for 10 seconds and seeing no response, immediately started CPR. He told one of the cops to make sure EMS was on its way. It was evident at this point in time that the patient was in full cardiac arrest. This was one of the few times the rescuer did not have his pocket mask with him, but he did have a face shield. He did ask the cops if they had pocket masks, gloves or shields and was told that they were not part of their service issue. After a few minutes of providing CPR, one of the cops offered to help and was instructed to ventilate and he would continue chest compressions. The officer was visibly upset with the situation and ill-prepared to deal with it.
A few minutes later, another passer-by identified himself as a Red Cross CPR/First Aid Instructor and relieved the transit cop. They re-evaluated the victim and continued CPR while waiting for EMS arrival. Because of a snow storm outside and the sheer distance between the location of the incident in the subway system and the surface, both rescuers estimate that it took approximately 20 minutes before EMS personnel showed up and took over. When the rescuer left, EMS was in the process of using their AED to try and revive the victim.
Of his experience, the rescuer had this to say: “While CPR is a very tough and demanding thing to do in real life, that type of intervention really calls on all of our training as first responders and on everything we learn in various CPR/First Aid and related courses. The most difficult thing to deal with is not to know what happens to the victim eventually. This incident is nothing out of the ordinary. I simply applied my training as I have practiced and rehearsed and taught in DAN and EFR courses. Everybody should get that type of training because you never know when you will be called to act in an urgent situation.”
At approximately 11:00 am, I had 17 snorkelers in the water on a nice sunny day with light winds producing no more than a one or two foot sea. A few feet behind the back of the boat the victim’s daughter yelled, “My mom’s not moving!” She was trying to pull her to the boat. The victim was wearing a snorkel floatation vest and her head was above the water. A crew member jumped into the water to assist. She discovered that the victim was not breathing and initiated mouth to mouth resuscitation.
Another crew member immediately helped to pull the victim on board the vessel where the three of us alternated mouth to mouth resuscitation for about 20 minutes until the Coast Guard Rescue Boat arrived. Within 30 seconds of initiation of mouth to mouth, I was on the phone to the Coast Guard Station and they dispatched a boat immediately. Two minutes after we began artificial respiration we began to administer oxygen along with the rescue breaths via a pocket mask with continuous flow.
The patient had a pulse the entire time she was on my vessel. When the Coast Guard boat arrived, two Coast Guard medical personnel came aboard and took charge of the victim. They hooked up a monitor to the victim and I heard one of them say, “She has a pulse.” The Coast Guard men put her on a backboard and she was transferred to the Coast Guard boat and taken to shore. During the time the victim was being artificially respirated, although unconscious, it appeared like she might start breathing on her own from time to time but then it would stop.
That afternoon I was informed by the Coast Guard Station that the victim had passed away later on. The victim’s daughter informed me that the victim had a history of cardiovascular disease as well as being 75 years old.
I heard a distressed lady running past me as I was packing up to go home. She was looking for a lifeguard. I told her the lifeguards were gone for the day. She said a man was drowning.
The conditions that day were “like Christmas in July”. We were all marveling at the rather large westerly swell during the summer months. The surf was breaking outside at about 6 feet on the sets. Currents were strong, surf were ugly at best, the beach crowded with visitors and locals alike.
I ran around the rocks (the north boundary for County Lifeguards) to discover several people dragging a very large man (6’4”, 250lbs.) haphazardly up the beach. This vision sent a wave of shock and adrenaline up my spine as I suspected a spinal injury.
Once away from the surge, they laid him down. I asked if anyone knew CPR. Two “rescuers” said they did. So I told them to get busy. Only seconds after viewing their technique, I made the judgment call that they didn’t understand the process of CPR. I told bystanders to call 911 and jumped into the rescue. It was anything but “textbook” because bystanders and well-intentioned “rescuers” were frantic. I assessed the victim to be unconscious, not breathing without a pulse. One man helped with compressions, I carefully opened the airway to administer rescue breaths without a mask. I requested through a girl who was making the “play by play” on a cell phone that they deliver oxygen. CPR continued.
Lifeguards came running over. Much to my dismay, empty handed. I told them we needed oxygen immediately! They ran back.
The victim had an obstructed airway with second stage drowning symptoms. His color was blue. No one knew the latest protocol for obstructed airway. At one point, my “assistant” stopped completely and I had to do compressions, check for obstructions, and breathing all by myself. I encouraged everyone to not give up. After what seemed like minutes, my “assistant” came back to help. We continued two man CPR for more than 20 minutes when I noticed a pulse and very labored painful breathing. I said, “I have a pulse.” We assessed the victim to be breathing laboriously. We turned him in the recovery position and oxygen finally arrived with the beach personnel.
The tide was rising to a high level that day so I started to build a berm around the victim. Many people chipped in to build a sand berm to block the surge from the victim and rescuers. The berm was huge because all the people chipped in.
I believe the oxygen made the big difference in recovery for the victim. Once the oxygen was administered, the paramedics arrived for assessment. The victim answered questions. A neurological survey indicated absolutely no feeling. The victim was transported on a backboard via helicopter to the hospital. The whole rescue took more than one hour.
The next day I followed up with phone calls to the Hospital to inquire about the victim. No information was given. A few days later, I did a Water Safety presentation to a group of teenagers (with County Lifeguards, Fire and Paramedics). I told my story to the Fire/Paramedics. I got the word that the victim was transported to another hospital alive with feeling and movement in his upper body. I was stoked to hear the good news.
I am so glad for the training I had in CPR, oxygen administration, and lifeguarding. The training paid off because I had no fear and went right in to do what I was trained to do. It was scary and ugly. Yet, we did the best we could to save a life. I believe CPR made the difference in favor for life for this person.