By Mark Phillips
Are you ready for a challenge? This is not a challenge to train or accomplish a specific task. You don’t get a coin if you finish. This challenge issued to you is much more than that.
The questions have no right answer. No action you take will be the right one. Nothing you do, including nothing at all, will prevent someone from dying.
But, doing nothing could save a life.
Perhaps challenge is too specific. Perhaps dilemma is more appropriate.
How do we protect ourselves from harm or death while doing everything possible to prevent someone else from being harmed or dying?
Consider this: A 911 call comes in and you and your team are dispatched to a car in the water. The location is 3 minutes away. You arrive and the crew that is with you are members of your water response team. You grab a mask, snorkel and fins and jump into the water heading for the vehicle that is underwater hoping for a quick rescue or situational assessment while your crew begins setting up the limited dive gear on board.
You take a quick breath and dive down to the 12 foot deep car and find you are on the driver’s side. Visibility is minimal at best. A quick feel around tells you that all the driver’s side windows are down. You reach in and feel the driver. It is a woman and she is not moving. You quickly cut her seatbelt and have to make a quick ascent for another gulp of air. A quick breath and down you go to extract the woman. Once on the surface you swim her to shore and your crew drags her out of the water diverting their efforts to CPR.
Breathing heavily with adrenaline pumping through your veins, you take a moment to see that your team has the situation under control. Another breath and you dive back down to the car.
As you reach the car you realize you did not get a good breath and have to make a quick ascent. You take a moment to regroup, get your breathing under some control, take a gulp of air and go back down.
This time you reach inside the rear window and feel a child seat, it’s occupied. Before you can react, something brushes against your hand and you realize it is the hair of someone else.
Do you take time to save the baby? Do you take time to search the other side of the car to see if there are even more passengers? Your time frame for a realistic and viable rescue is slipping away. Who do you save? Taking time to search potentially takes life from the infant but could give you valuable information you can share on the surface where you could get a teammate in the water to assist, possibly rescuing someone else.
Either decision, either action is likely to result in a fatality. But if you take the time and everything works out perfectly you may save a family.
You choose to take the chance and search. Back to the surface for another breath and a quick shout to the team letting them know there are two more victims.
Deep breath and back down.
The adrenaline rushing through your body is demanding that you breathe; the exertion of the swim is having a dramatic effect on your ability to hold your breath for even a short time. How long can you hold your breath? In the moment, will you be able to control your breathing? Will you be able to be effective? Maybe, but probably not.
Each ascent without a victim is another nail in their coffin.
You make it to the passenger side of the car and determine that both windows are down and discover a child in the front passenger seat and another in the back seat. Now you have three victims. Who can you save? Who do you try to save?
Save one and two die? Save none and rush to the surface to report and scream for help? Maybe all of them die because of the delay. Maybe the additional help is there and together you save one of the three… or two… or all of them.
Which is the better choice? How can you possibly know? How do you make that decision?
As a water response team we strive for rescue. We want more than just a victim out of the water and breathing on their own, we want them to fully recover and resume their normal lives.
One of the sad realities is that we cannot save everyone and by the time the divers arrive, the chances of rescue have diminished to close to zero. We know this. We understand this. But even knowing and understanding that there is virtually no chance of a rescue, we still try.
We like to say we have a “Golden Hour” which allows us to work in rescue mode for an hour before transitioning to recovery mode. We even fudge this 60 minute time frame past the intent. The “Golden Hour” was originally(?) an hour of rescue efforts from the time of submersion but we’ve skewed that to be an hour from the time we start. Some teams have even extended the time frame to 90 minutes.
Our GOAL, our training, planning and purpose is to save lives. So we sometimes fudge a number that we already consider to be overly generous. Miracles do happen and we should help one along when we can.
However, we also train, plan and prepare for the risk we assume and the known hazards we will face in and under the water: depth, current, zero visibility, debris, sharp metal and broken glass, rising gasoline columns and more. We do this because our other goal is to ensure our own people live through the incident. We typically use and refer to an analysis done on site called “Risk / Benefit.”
Is the RISK to our people worth the BENEFIT of saving someone else’s life? We want to be heroes and say yes, absolutely, you bet! But the reality is that we are not going to purposefully place one of our own in a situation that we know has a high possibility of killing them for the chance we might save someone else.
In the previous scenario, the car was in a shallow body of water. Now use that same scenario and make the depth just 30 feet. How much more risk does that create? How does that affect the survival possibility of the victims? Can you perform a breath hold dive to 30 feet and still have time to do any searching or work? Is there even a marginal possibility that the attempt could be made? What is your limit? If you do not know your limits or those of your team, who has to die during the onsite / on scene discovery of those limits? You? One of your team members? One or more victims?
We live in a lawsuit happy society. There are public expectations of us regarding our skills, talents and abilities as Emergency First Responders. When we show up to a scene, regardless of what it is, we are expected to overcome the obstacles and save lives.
We are EXPECTED to put our lives at risk. That may not be a realistic expectation. We train and equip ourselves very purposefully to reduce our risk. WE know what we do but the public watching does not know all we had to do to prepare ourselves or our teams to do the jobs we do.
Most of the time we do our job well and without injury or major incident. If it is not a contract year, they call us heroes and praise our hard work and dedication. Unless we do something wrong and someone gets hurt or killed. Then the gloves come off and everyone waits to see whose heads will roll.
What if someone was hurt, or died, and we did nothing wrong? The public expectation of us is so high that when someone gets hurt or dies, it MUST be our fault. And again, everyone waits to see whose head will roll.
Is it fair? Of course not but it is how we are perceived and if we do not recognize this we are deceiving ourselves.
You respond to a Not Breathing call from a frantic elderly woman who found her husband sleeping on the couch when she woke up this morning. When you arrive you immediately recognize lividity and a quick touch confirms rigor mortis. Before you can speak, the wife tells you that she saw him breathing just a few minutes before she called 911. In a heart-wrenching sobbing voice she can barely whisper, “please save him.”
We know the outcome already. There is nothing we can do that will bring him back to life.
“Why won’t you help him?”
“PLEASE, PLEASE HELP HIM!”
Do you say, “Sorry for your loss” and pack your gear and leave? Do you wait for EMS or a Justice of the Peace(?) to show up before you leave? While you are waiting are you talking and joking around? Does your crew step outside to have a smoke? Do you get on your cell phone and have an unrelated and public conversation?
Hopefully your response to all the above is NO.
If you have been on the job for even a little while you have seen death. You have seen the grief of the survivors. You have seen the mechanism of fatality on more than one occasion.
You already know if there is family or friends present. Your patient is dead. Don’t you have a responsibility to the survivors? If it is nothing more than showing a little human compassion and respect, we should do it. On some occasions, we take time to discuss what our procedures are and what can be expected to occur over the next hour or two. We give them information that includes the truth. Information shared with family members who are on your scene, regardless if it is above or below water, should be truthful, accurate and respectful.
But what do we do when our victim is still alive and under the influence of drugs or alcohol and has decided to commit suicide?
What do we do if our victim is perfectly sober and is trying to commit suicide? What if they are successful and we are present when it occurs?
A gunshot through the head is usually pretty final. A drug overdose, while daunting, can sometimes be mitigated. A bridge jumper, depending on the height of the bridge and/or the depth of the water could survive the impact and might be saved.
What do we do if someone is determined to commit suicide by drowning? What if they are successful and you witness the event?
If they are in the water and are trying to kill themselves, your ability to assess risk is limited to what you can see and what you can determine from witnesses. What you cannot see is the possible weapon in their hand or pocket, their mental state of mind (other than the obvious) or their capacity for violence if approached or interfered with. Do you train for this? Do you have an Operational Guideline for this kind of emergency?
What if they are successful? What is the public perception of your team or department now?
There are no right answers. There are no right procedures to follow. It is a dilemma that will result in one of three outcomes:
- The victim is prevented from being successful.
- The victim is successful and you perform a possible rescue or a body recovery.
- The victim is or is not successful and injures or kills one or more of the potential rescuers.
If you are part of an active water rescue and / or work as an Emergency First Responder in any form, there will be numerous incidents in your career where you will be placed in possible jeopardy. The ability to breath normally, to walk or run, to see what is coming at you ends when you submerge.
Our risk goes up. The ability to be fatally injured goes up. Why are we doing it? Why would we take on and accept that level of risk? There is no right answer for that question either. We just do. Or primary goal is to save lives. It is who we are and how we are wired.
We CAN mitigate and lessen the risks through training, equipment maintenance and awareness of our own physical and mental conditioning. When we are expected to put our lives in jeopardy, we should know when the expectation exceeds reality. But our reality is usually much more than that seen by the public. We accept the risk and take on the challenges but we do so having trained and equipped ourselves properly. Our goal is to save lives without losing ours or one of our own. In extreme incidents, we do sometimes have to rely on a miracle.
Nothing says we can’t help it along.
About the author
Mark Philips is a 33 year career firefighter who just recently retired and has been an active diver since 1979. Mark holds instructor credentials from 5 scuba agencies and specializes in Underwater Crime Scene Investigation. He has taught from Hawaii to North Carolina and been a consultant for numerous organizations, institutions and manufacturers in the field of Public Safety Diving. He is the author of PSDiver – A Textbook for Public Safety Diving and the Editor / Publisher of the free E-Zine, PSDiver Monthly. He is also a member of International Training, Training Advisory Panel.
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