If I'm ever in trouble, I damned sure hope you're around.  You did more than
anybody I know could have, and I dive with the head of a police dive team
and a paramedic.  I'm both impressed and humbled.

Could you have done more?  Hell, how would I know.  I couldn't have come
close to what you did.  All I can say is that I'm proud to know somebody
that tried so much, so hard.  Nice try.  Sorry it didn't work out.

Lee

----- Original Message -----
From: "Mike Wallace" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, April 10, 2003 12:22 PM
Subject: [SCUBA-SE] (Fwd) [divingaccidents] Death in Palau


> Got this from another list.
>
>
> ------- Forwarded message follows -------
>
>
> "Ya'll know I went to Palau and Yap for a dive vacation. I was on a Peter
> Hughes live-aboard in Palau. It was the 2nd day, and there were 17 guests.
>
> We dove a site called Pelilieu Cut. It starts out as a wall dive with a
> current similar to Cozumel. No big deal. The plateau ends in a point so
the
> current meets, and it's high velocity. But it's where all the big stuff
> hangs out. (I swam with a marlin on my safety stop when I repeated this
> site, and there were a ton of shark). So the plan was to get dropped off
in
> the blue by a tender, dive the wall for a bit (10 min or so), ascend to
the
> crest of the plateau (40 feet) and hook the reef. My dive was all good. I
> was comfortable on the wall, and I had my hook out for the crest. But once
> I went over it, the current was ripping. One of my buddies (I dove with 2
> guys all week--that's a whole other novel in itself.... I essentially was
a
> solo diver the whole vacation.) grabbed me as I came over the crest
because
> I was having trouble hooking. I hooked, but our combined body weight broke
> his hook, and he went downstream. The coral head I was hooked on promptly
> broke off, and I scrambled to hook again. Moments later, I was getting
> oriented. I noticed a female guest was next to me, and her mask was off. I

> thought it'd be scary for her to be blind and not know if anyone was
> around, so I grabbed her hand to reassure her. It was limp. I further
> assessed her and noted that her weight belt was off, 6 feet behind her.
Her
> BCD was open with the hook on her right shoulder (it should be centrally
> located so you can disconnect it easily). Her eyes were closed, there were
> no exhaust bubbles (the reg was in her mouth), and she had plenty of air
in
> her tank according to her gauge.
>
> I tried to grab her with my right arm and disengage her hook with my left
> hand. I had a hard time fighting the current. I was reaching for my knife
> when the divemaster swam up and he cut the line and took her to the
> surface. I couldn't even unhook myself! I cut my own line and ascended to
> the surface.
>
> I waited 18 min. at the surface. I was alone, but swam up to 2 buddy
groups
> (they were 2 instructors and 2 new divers with only 12 dives each). They
> weren't dropped off in the blue, but on the plateau so they did a drift
> dive at 20 feet in the ripping current, and aborted the dive. They had no
> idea of what I'd seen at depth.
>
> The tender had taken the victim to the big boat. There were 13 divers in
> the water that had to be picked up by the tender, so that's why I was on
> the surface for 18 min. There were 6 feet swells, and I had to breathe off
> my reg.
>
> When I got on the tender, the husband was on board, and he had no idea. He
> thought she had only lost her fin.
>
> We pull up along side the big boat, and I see a couple of guests
performing
> CPR on the woman. I hopped on board and assessed the situation. They were
> doing effective CPR and were bagging her with 100% O2. In the meantime, we
> got an AED and a med box from the Aggressor. So I consolidated everything
> and evaluated what to do. There was one endotracheal tube, one IV
catheter,
> 2 liter bags of saline, 3 cardiac bristojets (epi, NaCO3, atropine) and a
> bunch of epi pens (like what people use if they're allergic to bee
stings).
>
> Her mouth was full of water, so I did a finger sweep and removed the food
> particles and rubber bands off her braces. We tilted her in recovery
> position briefly to "drain" her, and then she was intubated. I gave the
epi
> down the OET and bagged her. It wasn't effective in stimulating her heart.
> I put the IV in and ran the fluids wide open, and gave the bicarb and
> atropine. I consolidated a couple of the epi pens and gave them.
>
> CPR had been going on for about an hour, and she miraculously regained her
> heart rate and spontaneous respirations. (It was agonal; therefore, no
> effective alone, so she was continued to be ventilated by hand with the
> ambu-bag on 100% O2.)
>
> Timeframe check: We started the dive around 0800. Her heart rate came back
> at 0925, so she was down for approx. and hour and 1/2. That translates
into
> poor perfusion of her brain=anoxic injury. (She wasn't fully "brain dead"
> because she was spontaneously breathing, although it was agonal,
indicative
> of brain stem injury.)
>
> We cut her wet suit off and applied dry blankets to warm her up. (the
water
> temp was 84*F, air temp in the mid-80s) We strapped her to a back board,
> and lifted her to the tender. It's a faster boat, but it still took an
hour
> to get to town.
>
> I had 4 male guests help put her in the boat, and put them to work. One
> ventilated, one held the IV bag, and another continuously monitored her
> radial pulse. During the boat ride, 3 times the victim became bradycardic,
> and I gave her an epi pen. (I only had 3 left.) Her heart rate would tach
> away for a short while, and then slow down as the drug wore off. I
supposed
> she was hypotensive, although I used up almost all the IV fluid and had no
> vasopressors. (Her nose and finger tips were showing lividity from lack of
> perfusion, whether from being hypotensive or clamping down from the epi is
> unclear.) Her pupils were mid-sized and fixed and she wasn't spontaneously
> moving any of her extremities or opening her eyes. (these indicate
> significant brain injury)
>
> Once we got to the hospital, it was almost as bad as the boat. The crazy
> white girl went on a rampage. They knew we were coming, yet had no vent,
no
> EKG, no pressors,.... I had an AED (but she was bradycardic or asystolic
so
> I couldn't use it), but I hooked them up to their defibrillator and got an
> EKG reading. She was tachy in the 110s, with a significant ST elevation.
> Her BP was 70 palp. I requested some dopamine (a common pressor) and they
> didn't know what it was. So I put in 2 more IVs and hooked up some fluids
> at wide open to augment her BP.
>
> Did I mention there was no vent? It took almost 1/2 hour for it to arrive,
> so she was bagged on 100% O2. Her pulse ox was 82% (normal=>95%). She more
> than likely wasn't oxygenating because of the near-drowning injury. I
> didn't have suction on the boat, and they didn't have it in the ER either.
>
> I wanted to do an arterial blood gas (a common test that measures the gas
> levels in the blood) and they couldn't perform it. They didn't have the
> machinery.
>
> I was in combat mode, bossing everyone. The MD in charge escorted me out
to
> debrief. He was only a family practice doctor, but he was an American.
>
> She ended up being "stabilized" and airlifted to Guam the next day. She
> died 3 days after the accident. (I don't know if her husband withdrew life
> support, or if she went into ARDS/pneumonia which lead to cardiac arrest.)
>
> The fact that she "came back" after >1 hour of CPR is nothing short of
> miraculous. In the hospital, if a patient is in asystole for > 1/2 hour,
> everything is stopped. If you don't get a rhythm or any response after
that
> long, it's not going to happen. (We call that "being dead" or "being
really
> dead". A person with v-fib or v-tach has no pulse so is technically dead,
> but there's some electrical/physical activity still present, so it's
> possible to "reset" the heart by shocking it and augmenting the strength
of
> the contractions with pressors. In asystole, there's nothing. So no oxygen
> is getting to the heart and brain, even though CPR may be in progress. The
> person is "really dead." It's not enough to perfuse the organs, so the
> person just becomes deader and deader. Does that make sense? So the fact
> that she was "dead" for > 1 hour, and had a heart rate is, again,
miraculous.)
>
> Back on the boat, we all "debriefed". Piecing the story together, the
> scenario goes as follows: The victim hooked on the reef. She lost a fin in
> the current, perhaps looked back to assess the situation, and lost her
mask
> in the process. She panicked, dropped her weight belt, and tried to remove
> her BCD. What follows next, no one knows. She may have panicked,
> hyperventilated, and became unconscious. She had an abrasion on her
> forehead, so she may have hit her head in the current and became
> unconscious. The end result was that she was unconscious and drown.
> Although the reg was in her mouth, her nose was exposed, and the current
> was high velocity, and sea water likely could've entered and filled her
lungs.
>
> The time I hooked, discovered her, and the divemaster unhooking her was
> brief. I sensed no one around me. After the dive, my buddy said he was
> downstream, and she was released before he was able to get to us. He went
> to the surface with the DM, and assisted getting her on the tender and
> starting early CPR. He told me that everyone was downstream and was
hooked.
> Everything that occurred was clearly visible, but no one did anything to
> help. Her husband was nowhere around, and witnessed nothing.
>
> In my own personal debrief, I considered if there was anything I could've
> done differently. Rescuing her could've been quicker, I suppose, if I
> would've grabbed my knife in the first place. But, again, it was pretty
> quick, the time frame between once I discovered her and when she went to
> the surface.
>
> An airlift would've been nice, but it wouldn't have changed the outcome.
>
> As far as the drugs.... What good is having them or specialty items (like
> the OET, IV catheter, etc.) if no one is around that is trained/qualified
> to use them? This is a vacation live-aboard, not an ICU.
>
> I filled out a bunch of incident reports and sent copies of it to DAN and
> PADI. Undoubtably the husband will sue Peter Hughes. The claim could be
> made that the dive site was for an expert diver, and there were many
novice
> divers. There were 17 divers in the water, and one divemaster. Panic
> situations wern't mentioned in the briefing (for instance, I knew that if
I
> didn't hook in the beginning, it wasn't a big deal. I had plenty of air on
> my back, and it would've been a longer drift dive.) Perhaps the victim
felt
> obligated to remain hooked, or to hook in even though she wasn't
> comfortable (instead of just aborting the dive) which exacerbated the
> situation."
>
>
>
> ------- End of forwarded message -------
> __
> Mike Wallace
> 34 47.534
> 086 34.132
>