Most rescues in which the victim is saved are surface rescues. How the victim is handled, depends on the type of victim he is. There are four basic responses the victim will exhibit, these classify the type of victim. The person will either be rational, passive, panicky, or unconscious. Be aware that the victim can be a combination of any, or slip from one to the other easily, and frequently. A victim can be rational to his situation, but passive in dealing with it. Most of the problems of the rational or panicky can be solved by providing positive buoyant support. When unsure about any victim, assume the worst. When dealing with any victim in the water continual assessment is imperative.
First priority is establishing buoyancy, underwater or above, and determining if the victim is breathing. Breaths in water, on the surface or below, are hard to detect. Buoyancy above water is best accomplished by bringing a life ring or other PFD out with you for the victim. If the victim is a diver, have him inflate his BCD. If it is already inflated, have him do it until the over pressure valve goes off thus insuring full inflation. Keep in mind that if the diver is wearing a back mounted BC it may tend to push the wearer face down. Their stress or panic could be caused by their fighting the BC trying to keep their head out of water. For these people have them deflate the BC partially. This is because the pushing forward of the BC comes from over inflating, by releasing a little air, the diver will come more up right, and the feeling of being pushed forward will be relived.
Determine the victim’s state of mind. As long as he is calm, the rescuer can work close. Always reassure the person, enlisting his help as much as possible. The reason for this is it forces the victim to think about something other than his predicament, thereby calming him down.
Watch for any objects the victim may be carrying. Ask him if he has anything in his hands, and to hand it to you. The logic behind not asking him to drop what he has is because it may be part of the problem. In his state of mind, keeping what he has is very meaningful to him, and dropping it is beyond his comprehension. Some divers have very heavy and valuable camera equipment, or spearguns, dropping something like that would never be done. Most victims will however hand over whatever is asked for. Take what he has, and hand it to one of your fellow rescuers, do not take it from the victim and drop it. By doing that you forfeit his trust. Only jettison gear or other objects that must be for life threatening situations.
Get him to drop his weights. Talk him through each step. Divers will drop weight belts when told to do so, because unlike other things, he is taught to jettison this piece of gear. Only if he refuses should you ask for it, and then drop it yourself. Get him to relax and let the water support him.
When the victim is unable to do anything (unconscious or injured) or wont (passive) you will have to do it for him. Never jeopardize your safety. When there is any doubt about handling a victim without endangering yourself, do not get to close.
The victim should have the impression that you are in complete control of the situation, this only comes from countless hours of training in both pool, and open water. A rescuer who is not confidant in himself will never convince a victim that he is in control, and may hinder rescue efforts.
It is always best to have two rescuers in the water, especially with a panicky victim. Approach the victim cautiously, and when a diver, go to him from the left side. The reason being, the left side has the BCD inflator hose.
Never make contact until you have evaluated:
Victim’s degree of stress (panic).
Degree of fatigue (Rescuer’s)
Rescuer’s experience (training).
Your relative sizes.
Upon reaching the victim and the determination has been made to grab him, support can quickly be given by placing a hand under the armpit, or grabbing a gear strap. This manuever facilitates lifting the head out of the water. Be cautious, he can put you in numerous hand holds, or try to use you for a personal flotation device. Getting the victim buoyant and breathing easy is the primary in water goal. Once this is achieved you may have to tow the victim to safety. However if the victim is breathing easy has no injures this can be done in a slow calm manner. Rushing someone to shore after calming him down may trigger a panic response.
Anyone who remain motionless on the surface for a long time should be checked. They could be victims of passive panic. This type of panic occurs when the victim is frozen with fear, or just gives up. These people will do nothing, they wont fight and they wont try to save themselves. As with any victim approach with caution. An unconscious, non-buoyant victim, will sink quickly. When a victim is floating face down in the water your first step is to get him face up. Do this from the victim’s side, by place a hand on each side of the lateral chest, at the base of the ribs, about nipple line. Then rotate the victim towards you. Once he is on his back, place one of your hands about the point where the T and L spines join, this will stabilize almost any size victim in the water. Do not lift the victim up out of the water, it is maintaining axial alinement similar to the way a waterbed floats a person. Do not hesitate to roll a victim face up in the water, HE NEEDS AIR.
Some rescuers want to wait for two people to roll a victim over, in case of head injury. The two man roll involves one man holding the head while the other rolls. It is hoped the two do it together. It takes time and practice. The victim needs air now. The chest roll is quick and easy, it can be taught to anyone in a few minutes. The spine is not manipulated because it is not touched. The water maintains an even balance on the body. In the two man roll the spine in manipulated because at least one rescuer is holding the head. Treading water and holding C-spine traction is almost impossible. When rolling someone over use the chest roll, when you suspect a C-spine injury apply a C- collar in the water, after the roll. All face down in the water victims have airway as there number one problem.
A near drowning victim is considered a panicked victim while still in the water and conscious. A panicked person always presents a potentially lethal threat to the rescuer. He does not care about any injury he may have, or your safety, he just wants out of the water. Do not think that you as a rescuer can cause a drowning person enough pain to let go of you. Air hungry people do not feel pain.
A diver however, does not present as many problems to the rescuer as the non-diver in a near drowning, or panicked situation. The reason being is that establishing buoyancy on the diver only requires reaching the BCD inflator. If the tank is empty the diver may be controlled by garbing the tank valve.
When going after a panicked victim and you get caught from the front, push down on the victim’s elbows, and climb up on him, then push off quickly. Put your chin to your chest to avoid grabs, or kicks to your throat. When a wrist is grabbed, grab your hand and pull it up toward your head. When wearing SCUBA gear you can dump your BCD and sink, or you can pull yourself down his body. Do not inflate your BC until you have the victim buoyant.
The most common cause of diving and swimming fatalities is exhaustion. It makes a diver or swimmer more susceptible to the environment, cramps, hypoglycemia, hypoxia, decompression sickness, and nitrogen narcosis. Factors leading to exhaustion are over working, poor physical condition, smoking, drinking, lack of rest, swimming in surf or currents, treading water, swimming on surface in SCUBA gear, trying to catch up with someone who swims to fast, and so on. It can be seen that almost everything leads to exhaustion, which leads to the bigger problems of decompression sickness, drowning, or mistakes resulting in arterial gas embolism or other over expansion injuries. The only cure is prevention.
Divers should say when they are too tired to continue. Macho attitudes have no place in diving or rescue work. Learn to use the water not conquer it. If you experience fatigue, stop and rest. Buoyancy can solve most problems in water. When too tired to continue, fully inflate your BC and float, resting on the surface. If needed, signal the Divemaster for assistance.
When heavy exertion is necessary, conserve energy and change teams frequently. Do not neglect a rescuer who has been working. He has expended a tremendous amount of energy and may be exhausted, help him out of the water and off with his gear. Practice problem prevention.