At the beginning of a dive day no one expects to get hurt.
My group of 30 San Diego divers woke to find our liveaboard at its destination: San Clemente Island off the California coast. We wolfed down breakfast, held our safety briefings and set about kitting up. As the trip’s leader, I had chosen our first site, Outside Boiler, for its impressive structure, walls and arches.
One of the divers, “Al,” told his buddy and a crew member he wanted to enter the water off the swim step at the stern, rather than use the higher side entry, due to a minor medical procedure he underwent a few months prior to the trip. He climbed down the 4-foot ladder to the swim step as his buddy continued to don his gear on the main deck above.
No one saw exactly what happened next, but a splash was heard. Someone yelled that Al was in the water going down and looked like he was “in trouble.” I rushed to the stern and looked over the railing, but he had already disappeared from view.
I queried those at the back of the boat about whether Al had gone into the water on purpose, fallen in by accident or something else. No one could say. Confusion threatened to overtake the situation. I asked a couple of divers on the surface near the boat to go down and get him. Despite the initial outcry, it still wasn’t clear in my mind if he was truly in trouble or had simply chosen to ignore common sense and etiquette and was awaiting his buddy on the bottom.
The fog of the accident has clouded my ability to exactly remember the events of that morning. I think I asked his buddy why Al might have chosen to go down by himself. Unknown to me at the time, two divers were already in mid-descent and saw Al as he fell. (The visibility was excellent at more than 60 feet.) One of these divers later shared that Al initially looked like he was “doing a happy dance.” But this impression quickly changed as he saw Al stop moving, adopt a head-down position and continue descending limply. (He now believes he saw Al in the act of drowning.)
Two more witnesses were already on the bottom at 82 feet. They stated they both saw Al falling “like a rag doll” and strike the bottom head first. They quickly kicked over to him, and one of the two divers from higher in the water column arrived just a few seconds later. Al’s regulator was out of his mouth, his eyes were wide and staring, and no response was discernable. The other divers partially inflated Al’s empty BC and swam him up to the surface at an aggressive speed.
Standing on the boat, not more than three minutes after Al splashed into the water, I heard a cry off the port stern, “Help, help! This is not a drill!” I called for oxygen, an automated external defibrillator (AED) and the first aid kit as well as someone who could begin writing down the events.
I went to the boat’s swim step and, with the help of Al’s dive buddy, grabbed Al and hoisted him aboard. An anguished cry escaped the buddy’s lips as we lifted Al. He was limp, his lips were blue, and blood was streaming from his nose and mouth. I’ll never forget the blank look in his eyes.
We muscled Al up onto the main deck and laid him out flat. I quickly determined he was unresponsive and not breathing. I gave him two rescue breaths, got his wetsuit open, called for shears to cut it off and began CPR. I also called for the captain to notify the Coast Guard.
I honestly don’t know for how long I performed CPR. It couldn’t have been more than two or three minutes; we had just gotten the AED pads applied when I took a moment to reassess the victim and heard a ragged gasp escape his throat.
“I think he’s breathing,” I murmured. I almost didn’t dare to believe it, yet as I watched and listened, Al took another, somewhat stronger breath. I quickly instructed those who were helping with the oxygen to trade out the CPR mask for a nonrebreather mask and gently slipped it onto his face.
Al’s breaths became a bit sturdier (though by no means strong) over the next couple of minutes, and weak groans began to emanate from him. I continued to talk to him, urging him to fight and to breathe as
I had been doing since we got him onto the deck.
The heavy, emotion-laden air on that back deck began to lessen somewhat as Al’s groans and then whimpers of hurt became stronger. Oddly, those pain-wracked cries were the sweetest sounds I’ve
ever heard.
There was an obstetrician/gynecologist aboard, and I turned over care of Al to her. Several minutes later Al was able to open his eyes, and he remained semiconscious until the Coast Guard helicopter arrived to transport him to the emergency department.
Amazingly, Al walked out of the hospital 36 hours later after a battery of tests and a chamber ride. A fortunate combination of people in exactly the right places and many trained divers onboard led to this successful outcome.
Why Hyperbaric Treatment?
The doctor at the hospital where Al was taken did not know whether or not Al had breathed compressed gas. Because it could not be ruled out, the doctor chose to treat Al in a hyperbaric chamber due to the risk of arterial gas embolism (AGE). Eventually it became clear that Al had not breathed compressed gas, and the doctor diagnosed nonfatal drowning. The reason Al fell in the water remains unclear; Al’s own memory of the event is incomplete.
© Alert Diver — Q3 Summer 2014