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  #21  
Old 26 September 2018, 12:03
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Originally Posted by Azatty View Post
It's a 47 ninja problem, IMHO--a situation you imagine by suspending reason and probability in an effort to create a impossible problem.

1. The majority of sea life can't fuck you up badly enough to require a TQ. Sharks maybe, but the empirical research on them indicates they study humans before biting, and if your SA is so lacking that you don't notice a shark eyebanging you, you shouldn't be in the water. And only one diver fatality from a shark attack occurred in 2017, so probably not very likely to happen. Humboldt squid are a possibility, but if you're diving with them you signed a waiver and stupidly agreed to be bait on a chain in blue water so that you can see them.

2. Most diving environments don't cause the kind of injuries where a TQ is needed. If you want to dry hump a coral head until your femorals are cut, I suppose that's a case where it could happen. I suppose it could happen in wrecks, too, but I think that would involve something falling on you or slamming on you, and that is most likely a serious problem by itself.

3. Boat props are a likely cause of a TQ-worth injury, but that's a surface injury. Spearguns/punctures are also possible, but punctures generally don't require a TQ unless a big artery got nicked and the puncture is pretty big.

4. Self-applied TQs are unrealistic. No shit, there you are, underwater with 40 pounds of unwieldy kit, an exposure suit, and a massive wound quickly bleeding out, dropping your core temperature, and pushing you into shock while a cloud of blood rapidly surrounds you. But never fear, you are IuseaTQforacockringbecauseImsuchabadassdiver, so you didn't spit out your regulator while screaming in pain and panic, and you suppressed the entirely reasonable urge to un-ass the water so you could address the problem at depth and show off your skills. Oh, and you're possibly wearing 5mm neoprene gloves which kill your tactile abilities and manual dexterity. You calmly reach into your BCD pocket for your handy TQ, find nothing, realize you still have it on your dick because you had an orgy with all the Sweden Air stewardesses on the island before the dive, remove it from your dick, and expertly place it around the extremity and coolly exit the water. Right. You're probably fucked up and fighting to stay conscious if you have a life-threatening injury underwater.

I express no opinion concerning combat diver use of TQs. I can imagine one-and-a-half ninja-type problems arising in combat.

By that logic I shouldn’t carry a TQ on land either as in my decades of life I’ve never needed one applied to me, the statistics for needing one are low (for me or someone else) and certainly couldn’t use one in cold weather with gloves/heavy clothing and all, and certainly couldn’t keep calm enough to apply one (because training sides to work) let alone have a buddy help me (because I only dive solo), etc... but I can breathe on land so it’s not an issue, right?! Shit, I guess I don’t need to carry a gun either as the same can be said for that. Or homeowner’s insureance since my house won’t catch on fire...not with a FD around. Why do I pay for car insureance too if it’s statistically low that I get into an accident?!

I think that’s fallacy logic and the wrong train of thought.
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  #22  
Old 26 September 2018, 15:36
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To carry a TQ or not...a personal decision for most. I have no idea how many folks are alive today only because I put a TQ on them, but it's a lot. Usually I had to supply the TQ, either because the person needing it didn't have one or couldn't quickly convey to me where they had one, or hadn't cared for the one they carried, and it was degraded by the elements.

If you dive, and carry a TQ with you, understand that getting salt water on a TQ over time will weaken it. No point in carrying a piece of gear to have it fail when you need it most. Have a plan to inspect and replace your TQ regularly.
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  #23  
Old 26 September 2018, 16:47
Azatty Azatty is online now
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Originally Posted by 275RLTW View Post
By that logic I shouldnÂ’t carry a TQ on land either as in my decades of life IÂ’ve never needed one applied to me, the statistics for needing one are low (for me or someone else) and certainly couldnÂ’t use one in cold weather with gloves/heavy clothing and all, and certainly couldnÂ’t keep calm enough to apply one (because training sides to work) let alone have a buddy help me (because I only dive solo), etc... but I can breathe on land so itÂ’s not an issue, right?! Shit, I guess I donÂ’t need to carry a gun either as the same can be said for that. Or homeownerÂ’s insureance since my house wonÂ’t catch on fire...not with a FD around. Why do I pay for car insureance too if itÂ’s statistically low that I get into an accident?!

I think thatÂ’s fallacy logic and the wrong train of thought.
My point is that planning for every imaginable problem results in over-equipping and training the wrong things. The newbie diver shouldn't be training to apply a TQ underwater when he lacks basic skills such as buoyancy control, equipment management, and emergency management. After a couple hundred dives and solid skills, if you want to add it into the training, go for it. A situation calling for a TQ underwater is an outlier on the far tail of the curve. A diver should invest in training the basics before getting into the tacticool stuff. Not to mention that a TQ is outside of training standards of which I am aware, and imposes considerable liability on an instructor when s/he goes outside standards.

I think you'll agree that if you kit up yourself to prevent every possible injury from every possible event in combat, you can't even walk, much less fight. Rather, you plan and train for the most likely events plus a reasonable amount more for the oddball situation you'll come across. Same for diving.

The car insurance and home insurance comparisons are false analogies. Car insurance is legally required in most jurisdictions, and homeowner insurance is required by loan documents. You buy the insurance most likely because you are forced to, and someone convinces you that you "need" it because it would really suck if XX event happens and you're not insured. That's emotion, not logic.

Logically, you multiply the probability of the loss by cost of such loss, and that gets you an "expected loss." If your expected loss is greater than your insurance premium, you insure against the loss. If it's less than your premium, you don't insure against it. There's a reason that insurance companies make boatloads of money, and it IS NOT because they're paying out on loss claims; they're collecting premiums against a relatively low probability of loss. Insurance is legalized gambling, and the insurance company is the house.

In that vein, carrying a TQ on land is a far more prudent COA because the probability is much higher that one will come across a TQ-worthy injury on land--car accidents, workplace accidents, etc. I would agree that even if one hasn't run across that kind of injury personally, the probability is still high enough to warrant training and carrying a TQ.

Quote:
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Why 47?
Because I think it would take at least 45 ninjas ambushing you at once to kick your ass, and decided to throw in a couple extras for good measure.
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Last edited by Azatty; 26 September 2018 at 16:52.
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  #24  
Old 26 September 2018, 17:48
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That's valid....
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  #25  
Old 26 September 2018, 22:23
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Originally Posted by Azatty View Post
My point is that planning for every imaginable problem results in over-equipping and training the wrong things. The newbie diver shouldn't be training to apply a TQ underwater when he lacks basic skills such as buoyancy control, equipment management, and emergency management. After a couple hundred dives and solid skills, if you want to add it into the training, go for it. A situation calling for a TQ underwater is an outlier on the far tail of the curve. A diver should invest in training the basics before getting into the tacticool stuff. Not to mention that a TQ is outside of training standards of which I am aware, and imposes considerable liability on an instructor when s/he goes outside standards.

I think you'll agree that if you kit up yourself to prevent every possible injury from every possible event in combat, you can't even walk, much less fight. Rather, you plan and train for the most likely events plus a reasonable amount more for the oddball situation you'll come across. Same for diving.

In that vein, carrying a TQ on land is a far more prudent COA because the probability is much higher that one will come across a TQ-worthy injury on land--car accidents, workplace accidents, etc. I would agree that even if one hasn't run across that kind of injury personally, the probability is still high enough to warrant training and carrying a TQ:

So now there is an undefined and subjective experience level required to be concerned about ones safety when diving? No one is advocating adding a TQ to your dive bag before you get you first tanks filled, but since the OP’s username is “dive rescue” a certain amount of experience is already implied, and confirmed by his post about his experience. Additionally, this is SOCNET and. If the PADI beginners forum. Our whole careers has been planning for contingencies and being able to find solutions. Simply saying “it’s not likely [sic]” gets people killed.
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  #26  
Old 26 September 2018, 22:32
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This is a multifaceted discussion, and I'm still forming my opinion, which is why I brought it here. I appreciate the discussion from both sides.

My purpose, other than my own safety, training, and knowledge, in asking this is because it is asked of me frequently. I would be irresponsible to fire off an opinion without thoroughly considering pros, cons, and specifics.

Again, thank all of you for being actively involved in educating me.
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  #27  
Old 26 September 2018, 23:50
Shark0311 Shark0311 is offline
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I use surgical tubing to hold my octopus in place (long hose). It's not a TQ but will get someone to the boat or shore. There are so many ways to die in that situation that my main focus is on keeping the airway open on ascent.
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  #28  
Old 27 September 2018, 09:12
Azatty Azatty is online now
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Originally Posted by 275RLTW View Post
So now there is an undefined and subjective experience level required to be concerned about ones safety when diving? No one is advocating adding a TQ to your dive bag before you get you first tanks filled, but since the OP’s username is “dive rescue” a certain amount of experience is already implied, and confirmed by his post about his experience. Additionally, this is SOCNET and. If the PADI beginners forum. Our whole careers has been planning for contingencies and being able to find solutions. Simply saying “it’s not likely [sic]” gets people killed.
Sir, I didn’t say that safety should be disregard and contingencies should not be planned. My first response was actually “yet another reason to dive a long hose,” as it can be used as a makeshift TQ. I am certain that during your career you had some REMF or someone else make a suggestion that was so improbable that you facepalmed yourself.

Diverescue stated that videos showed divers in recreational equipment performing timed drills to self-apply a tourniquet—not applying one to a buddy. That suggests to me the skill is being marketed toward recreational divers—not public safety divers, combat divers, technical divers or cave divers or others who typically have a higher level of training and experience—as a cool new technique that “elite” divers know. It is not a skill presently taught by any recreational certification agency of which I am aware, which again suggests to me it’s a secret squirrel skill being pushed. I certainly have not seen any training bulletins adding the skill to any recreational rescue or dive master course.

I have seen discussions among some PSDs and instructors about whether anyone carries a TQ in a dive bag, but nothing about carrying one on a dive. I note that DAN sells a tourniquet and trainer in their store, and that DAN’s Diving First Aid for Professionals course teaches application of a TQ on land, but not underwater. So to my knowledge, there is no standardized training on the technique.

My comments are also based on the likely skill level of someone encountering the situation. SOF are highly skilled problem solvers, and while I greatly respect your experience and opinions, the average diver is not that kind of person. The typical diver is a 45-55 YO male, making more than $75,000 per year, who might have taken two certification courses, and who dives on vacation. That’s who will be attempting to self-apply a tourniquet underwater.

If Diverescue is being asked the question, the answer in my opinion in: the probability of an injury requiring a tourniquet is extremely low, and the environment does not lend itself to those kinds on injuries. There is no standardized training on the technique. Big boy rules apply.
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  #29  
Old 30 September 2018, 05:57
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Azatty- This happened today. Seems one of your 47 ninjas is alive and well and just refuted every point you suggested.

“A 13-year-old boy diving for lobster was attacked by a shark Saturday morning near Beacon’s Beach in Encinitas, leaving him with traumatic upper body wounds, authorities said.
The attack occurred just before 7 a.m. off Neptune Avenue at the foot of Leucadia Boulevard, an hour into opening day of the lobster diving season.”

http://www.latimes.com/local/lanow/l...20180929-story dot html
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  #30  
Old 30 September 2018, 09:45
Shark0311 Shark0311 is offline
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We were spear fishing off of Electric Beach in Hawaii. It was a good night for hunting. Our bags were full but it was a strange dive. My roommate, an experienced diver with thousands of dives dropped his weight belt at the surface and called it.

My dive buddy and I kept going and just slayed fish but for some reason things just seemed off. We were hunting well into the wee hours of the morning.

There was a news report later that day of what was believed to be great white that killed a spinner dolphin at Electric Beach. She was hunting with us the whole time and we never saw head or tail of her but I am damn sure that she saw us.

I've had friends get nibbled on by juvenile black tips, morays and a buddy that has a nice scar from a barracuda in FL. We are slow, ungainly blobs under the water and taking precautions is definitely the way to go. That being said I wouldn't want an open water diver focused on anything other than the basics. If shit goes south it's up to the experienced divers to save their ass. Practicing putting on a TQ while diving and possibly restricting blood flow is a no go in my book. If they want to practice on the surface then sure, go ahead.

Last edited by Shark0311; 30 September 2018 at 09:51.
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  #31  
Old 1 October 2018, 12:05
Azatty Azatty is online now
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Originally Posted by 275RLTW View Post
Azatty- This happened today. Seems one of your 47 ninjas is alive and well and just refuted every point you suggested.

“A 13-year-old boy diving for lobster was attacked by a shark Saturday morning near Beacon’s Beach in Encinitas, leaving him with traumatic upper body wounds, authorities said.
The attack occurred just before 7 a.m. off Neptune Avenue at the foot of Leucadia Boulevard, an hour into opening day of the lobster diving season.”

http://www.latimes.com/local/lanow/l...20180929-story dot html
I understand your reaction at the news, although I never said traumatic injuries do not happen and can never happen. I argued that the probability of an injury that would require a tourniquet at depth was vanishingly low. I'm still right on that point.

A few points about the California incident so we are truly comparing apples to apples:

1. He was probably not scuba diving. He was hunting bugs in 9 feet of water on opening day. This suggests that he was skin diving. Video of the beach with people surrounding the victim does not show any scuba equipment for any of the people nearby, although they are wearing wetsuits (as one would expect in cold water).

2. His injury was on the clavicle, which means a tourniquet would not be useful.

3. His injury was apparently was managed by direct pressure after loading him on a kayak and paddling 200-yards back to shore. A wound that can be controlled by direct pressure probably doesn't require a tourniquet.

As of September 24, 2018, there were 77 shark "attacks" worldwide, four of them fatal. This poor kid is number 78. The director of the Florida Program for Shark Research at the Florida Museum of Natural History stated in response to the attack in California that "“We are at a typical level of shark attacks worldwide and a little bit under for the United States this time of the year.” The trauma surgeon at the hospital where the kid was taken also stated that in the ten years he had been at the hospital, he had never seen that kind of injury.

"Attack" includes any physical contact of any kind with a shark, and an "attack" does not require an injury. Thus far in 2018, there have been four "attacks" on scuba divers this year. Only one involved an injury: a bull shark bite an Australian fish farmer's leg. So this year, there was one attack involving a shark where an underwater tourniquet may have been appropriate, but the reports indicate that he was stabilized at a local hospital and then transferred to larger hospital for reconstructive work on his tendons (so a tourniquet may not have been the solution).
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Last edited by Azatty; 1 October 2018 at 12:19.
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  #32  
Old 1 October 2018, 21:40
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Is anyone aware of research regarding bubble formation in a tourniqueted appendage? That is, tourniquet applied at depth, and Doppler or other methods to compare the affect it has on off gassing?
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Old 1 October 2018, 22:48
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Azatty: you can continue to dismiss a need for a TQ when diving all you want but there are several facts that cannot be ignored:

-in the ocean, we are not the top predator, or even close to it. If we become the prey, we don’t get to pick the time, depth, location, severity of injury, or type or predator.
-response time to medical treatment is severely increased and access is decreased when diving
-TQs stop bleeding

You seem to have the mentality that if it’s a low probability then don’t worry about it. The article above was posted to directly refute your statement that “being bit by a shark is from a lack of SA and you shouldn’t be diving [sic].” Attacks & injuries can and do happen while diving. No one is saying the Open Water noobie needs to practice TQ placement underwater but the dive professional should be carrying one. I understand you don’t think that way. You be you. I’ll keep one in my kit.
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  #34  
Old 2 October 2018, 12:51
Shark0311 Shark0311 is offline
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Is anyone aware of research regarding bubble formation in a tourniqueted appendage? That is, tourniquet applied at depth, and Doppler or other methods to compare the affect it has on off gassing?
Not that I am aware of though I bet that the Navy has tested it at some point.

I would be very careful about taking any action at depth that would restrict blood-flow unless necessary.

If it were me and I had to use a TQ at depth to prevent a person from dying then I would. I think that it would be best to leave the TQ on, explain the situation to the medical professionals and advocate that they do not remove it until a doctor can be consulted.

The doc may want to put the person in a chamber to operate on them to prevent DCS or embolism depending on the tissue damage caused during the ascent.

Again my first step would be to get them to the surface if they could survive it before placing a TQ to forestall any diving related complications.
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Old 2 October 2018, 19:20
Azatty Azatty is online now
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Originally Posted by 275RLTW View Post
Azatty: you can continue to dismiss a need for a TQ when diving all you want but there are several facts that cannot be ignored:

-in the ocean, we are not the top predator, or even close to it. If we become the prey, we don’t get to pick the time, depth, location, severity of injury, or type or predator.
-response time to medical treatment is severely increased and access is decreased when diving
-TQs stop bleeding

You seem to have the mentality that if it’s a low probability then don’t worry about it. The article above was posted to directly refute your statement that “being bit by a shark is from a lack of SA and you shouldn’t be diving [sic].” Attacks & injuries can and do happen while diving. No one is saying the Open Water noobie needs to practice TQ placement underwater but the dive professional should be carrying one. I understand you don’t think that way. You be you. I’ll keep one in my kit.
I don't disagree with your evaluation of the facts about diving, but this is SOCNET and we argue points to find the better truth. In my opinion, the probability does not by itself justify the equipment or the training as a general rule. However, the same can often be said for carrying a gun, yet we all do that. Perhaps an underwater tourniquet falls within the "unlikely but take one anyway because the marginal cost is low but the potential, though improbable, benefit is high" category. I can respect that position.

I base my actions and decisions on the probability of an event occurring and plan accordingly. I dive with a seven-foot primary hose, and I practice deploying it on every dive. It’ll work as a field expedient TQ if the need ever arises. It’s not as good as a CAT, obviously, but it’s a multi-purpose piece of kit that addresses multiple circumstances that are far more likely than a shark attack.

Also understand that over the years I have seen divers carrying all sorts of pieces of kit that are useless in anything but the most improbable diving conditions, and the more likely result of having too much kit is trouble underwater for that diver. Therefore, to me every piece of kit is a cost-benefit analysis which necessarily involves an assessment of the probability of an incident requiring such kit.

Thus, when you say that the diving professional should be carrying a tourniquet underwater in a recreational setting even though no certification agency or diving medicine organization or even the U.S. Navy (as of the 2018 revision to the 2011 U.S. Navy Diving Manual; maybe SEALs teach it but don't publish it) includes underwater TQ use in any curriculum I have found, I say “provide the quantitative basis upon which that recommendation is made.”

Regarding diving and SA, I admit that I was exaggerating a bit, although pre-attack patterns have been the source of empirical studies and the behavior I cited was present in the majority—but not all—bites. Spontaneous attacks on divers do happen, although they too are comparatively rare. Of the four attacks on scuba divers I cited, three of them occurred on designated “shark dives,” at least one of which involved baiting the sharks. Another of the three was by a shark so frequently in the AO that dive operators had given it a name.

Quote:
Originally Posted by diverescue
Is anyone aware of research regarding bubble formation in a tourniqueted appendage? That is, tourniquet applied at depth, and Doppler or other methods to compare the affect it has on off gassing?
I have not found a single instance of an underwater tourniquet being applied, so I have not found any information on the question you ask.

In 2005 and 2007, the Navy Experimental Dive Unit conducted an evaluation of 13 combat tourniquets and measured their effectiveness using an ultrasonic Doppler stethoscope, but that is the only reference to the use of Doppler and a tourniquet that I have found.

A paper from NASA referred to a study from 1943 involving the use of local compression, impairment of venous return, and an arterial tourniquet to study the intensity of pain from the "bends."

But as some professionals at DAN have noted, treatment of DCS is put ahead of scientific curiosity, so careful preservation of data is a low priority when treating DCS.

My opinion: any interruption of circulation would probably increase the risk of localized decompression sickness in the TQ'd limb because gas diffuses in to the bloodstream for elimination in the lungs. Remove or impair the bloodstream and you remove or impair the escape vector. This, of course, assumes that the injury occurred on a dive where a tissue was sufficiently saturated to cause a problem. For example, say the TQ was applied five minutes into the first dive of the week and followed by a rapid surfacing to get help. One would expect to see little, if any, occurrence of DCS with that profile, while a dive at the end of the week after a longer time at depth would more probably result in observable DCS.

But consider also that in the case of a serious injury or avulsion, the affected limb might be entirely cut off from the circulatory system anyway, so anything downstream of the TQ site might not matter much from a decompression standpoint.

I think Shark0311 is on point concerning possible embolism, although I think that the nature of the injury and dive profile will determine the course of treatment.
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Last edited by Azatty; 2 October 2018 at 19:25.
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  #36  
Old 3 October 2018, 11:41
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The US military does a fair job preparing its divers for all sorts of contingencies and that isn’t one of them. After over a century of collecting data on extremely high-risk diving evolutions, the Navy decided that such a scenario was not plausible enough to equip for, or train to. That being said, I think keeping a marine-grade TQ on you during a dive is pertinent if for no other reason than the fact that many dives involve boats and other marine hazards. I can’t really wrap my head around a credible scenario where a TQ would be needed at depth AND able to be properly applied but there are enough hazards in the maritime environment to warrant carrying an extra few ounces in a pocket, IMO. It’s like CCW insurance; wildly unlikely I will ever need it but it’s crazy cheap so why not?

Per the OPs question- I have never been involved in a diving accident involving a mechanical injury but as a military diver I was always taught to take the injured diver directly to the surface in the case of severe mechanical injuries (even when there were deco obligations). I don't remember being taught to render first aid at depth, but my memory may be fading. We left it up to the DMOs/ DMTs to decide if they needed to be pressed or not.
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  #37  
Old 3 October 2018, 14:56
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Originally Posted by DC View Post

Per the OPs question- I have never been involved in a diving accident involving a mechanical injury but as a military diver I was always taught to take the injured diver directly to the surface in the case of severe mechanical injuries (even when there were deco obligations). I don't remember being taught to render first aid at depth, but my memory may be fading. We left it up to the DMOs/ DMTs to decide if they needed to be pressed or not.
And it wasn’t that long ago that we considered TQs as a last ditch effort and that they caused permanent damage. Times and knowledge change.

I fully agree that subsurface TQ usage would be very rare. However, if it can take 4-10 min to surface with massive hemmoraging, then 30 sec of TQ application at depth gives you more options at a successful patient recovery. Even on the surface, being a few minutes from the boat or shore can be fatal without any means to stop bleeding.
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