who has lately taken solo?

[flipe8]

I thought I would bring this to the top as it appears a similar incident took place in the last week or so up in Nova Scotia while an instructor friend was putting on a course. While performing a "all in" scenario, one of the students apparently became trapped in his capsized boat. From what I understand, he had a WW deck on his glass boat and forgot to leave his grab loop out. As result, he wasn't able to pop his deck. It wasn't immediately noticed with the scenario playing out until one of the instructors noticed he hadn't come up. From what I understand, the instructor performed a "Hand of God" rescue and started to perform compressions until they got the victim to shore where he was worked on until he came to. It was told to me it took about 10 minutes before the victim came around. The rescuer performing the initial compressions is a professional firefighter for the city of Halifax and is also a seakayak guide/instructor. While a near-drowning isn't a heart attack, it does show that it's is possible to perform compressions at sea(to my surprise).

I'll pass on any info about how they were positionned and what-not when it becomes available to me.

[EEL]

There is an excellent article on CPR that is somewhat focussed on kayaking in the Nov/Dec issue of the American Whitewater Journal. Many great articles in this journal and supports the view that in the USA, WW kayaking is "where it is at". Anyway, the journals are on line and you can find this issue at:

http://www.americanwhitewater.org/content/...owse_year_2007_

There is an interesting series on fear and paddling too. By someone who should know about the subject as a professional and as a paddler.

Ed Lawson

[Todd Wright]

Doing good CPR under "ideal" conditions is at best a difficult exercise. The success rate for CPR alone on pulseless and breathless (dead) patients without access to advanced cadiac care is very low. The numbers are a bit better for folks who have experienced respitory arrest (drowning leads to respirtory arrest) but are generally in good cardiac health.

So the technique question:

Rafting up boats:

This often seems like the logical choice as we do quite a bit of rafting up in sea kayaks to sort out incidents. The challenege is if you can manage to get wet dead weight (no pun inteneded) up onto the raft, get the PFD off, stradle the patient and do compressions; chances are the compressions will be fairly ineffective.

I could'nt find any data on this when developing the H2O curriculum so we gave it a go, bear in mind that this was not a proper study. Using 3 very fit college students, all of whom are competant boaters, and two of whom were EMT's with plenty of real CPR experience, in one foot seas, we attempted to resuce a unresponsive, face down, 200lb dummy (me) wearing a type IV PFD, dry suit and tow belt.

Results: It took them 4 minutes to get me onto the raft, once on the raft we substituted a standard Rescue Annie with foam legs and arms for 30 minutes of CPR (wilderness medical society guidelines recommend discontinuning CPR after 30 minutes or earlier if the scene becomes unsafe).

Lessons learned: It's really, really hard to get a dead body out of the water, CPR was clumsy and generally ineffective (the dynamic nature of the boats and water absorb too much energy, we roll folks on a backboard in the ambulance to reduce the absorbtion of the 2 inch stretcher pad), also the group is static (at the will of wind, waves and current) when the patient really needs an ambulance (on shore) and finally, water ruins rescue annie's and they are expensive to replace.

Other Technique Options: Chest compressions on a seated patient, i.e. bear hug the Patient (without PFD) in a rafted tow enroute to shore, after a Mayday call (giving a precise landing location with ambulance access). Using the same CPR land marks begin compressions. This is better but is still an unweildly task.

Take home points:

1. Every year paddlers die from imersion and submersion drowning. Often they have some comonalities NO PFD and INADEQUATE THERMAL PROTECTION. So if we're paddling in groups, dressed properly and wearing a well fitted, sport specific PFDs then our chance of having to give or recieve CPR go down dramatically.

2. Medical Emergencies and Traumatic injuries can be stabilized on the water but are magaged on shore. This has alreay been mentioned "everything is an ariway issue until the group has landed."

3. I have done CPR in the hospital, in helicopters, in ambulances, in grocery stores, in home depot, on construction sites, in living rooms etc but I have yet to do CPR in a kayak (ww, sea or surf) environment. I have had to manage hand blisters, 2 shoulder injuries, 1 brusied/broken ribs, minor sprains and strains, nausea and minor soft tissue injuries in paddling environments. Therefore, while it is useful to think about and practice the "worst care scenario" it is proably most useful to get sound training on how to manage the stuff you'll most likely see.

4. WFA and WFA H2O is useless without a proper incident managment course. A good IM course is'nt a rescue clinic but one that addresses incident avoidence, leadership, planning and implementation.

5. You are more likely to be required to do CPR in a front country setting at work (particullary if you work on Wall Street right now), while shopping etc. So take a CPR class at your local Red Cross, American Heart Association, Fire/Rescue, Hospital, YMCA etc. Redo it every year so that your skills are sharp and don't forget to call 911.

6. If you like to play outdoors or take other's onto the water or into the backcountry take a proper WFA class (SOLO, WMI, WMA) or if you are a boater take a SOLO WFA H2O course (shameless plug). If you take folks outdoors in a professional capacity take a Wilderness First Responder course.

I don't check the list's very often so if you have questions please contact me at twright@smcvt.edu.

Cheers, Todd

[Todd Wright]

Correction....Type V PFD...Than you for bringing the typo to my attention...