Because Miracles Happen
By: Mark Phillips
You are a trained, experienced member of your departments dive team. You keep a small “go bag” of gear with you on the apparatus you are assigned to. In your mind, you have had thoughts concerning how you might react in a water emergency if you were alone.
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 your finish. This challenge 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 your unit is dispatched to a car in the water. You know the spot. Poor to no visibility, muddy bottom but only 12’ deep.
The location is 3 minutes away. You arrive and one of the other crew members with you are members of your water response team. You open your go bag and grab a mask, snorkel and fins and jump into the water. You swim as fast as you can to where the bubbles are indicating the vehicle that has submerged. You plan is to make a quick breath hold dive to the vehicle, hoping for a quick rescue or situational assessment while your crew begins setting up the limited dive gear carried on you unit.
You take a quick breath and dive down. You make it just a couple of feet and are already out of breath and are forced back to the surface. You know you have to take a moment or two to get your breathing under control. Seconds seem like hours and you try to regain your breath. Finally you make a decent to 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 seat belt and have to make a quick assent for another gulp of air. Quick breath and you go back down and extract the woman.
Once on the surface you swim her to shore and your crew drags her out of the water and diverts their efforts to CPR.
Breathing heavily and with adrenaline pumping through your veins, you take a moment to see that they have the situation under control and swim back out to the car. Another breath and you dive back down to the car.
You reach the car and realize that you did not get a good breath and have to make a quick assent. You take another moment to regroup, get your breathing under some control, take a gulp of air and go back down.
This time you feel inside the rear window and feel a child seat and it is 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 more passengers? Your time frame for a realistic and viable rescue is slipping away. Who do you save? Taking time to search takes away potential life from the infant but could give you information that you can share on the surface that would get someone else in the water to assist with a possible rescue of someone else.
Either decision, either action is likely to result in a fatality.
If you take the time and everything works out perfectly your actions 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 in the car.
Deep breath and back down.
The adrenaline rushing through your body is demanding that you breathe; you can feel your heartbeat in your ears, and your chest is burning inside. 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 assent 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 you need has arrived 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? (h3)
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 divers are needed, 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.
The “Golden Hour”
We like to say we have a “Golden Hour” rule that allows us work in a 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 an hour rescue mode efforts from the point of submersion but we 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.
We also train, plan and prepare for the risk we assume and the know 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.” We use this phrase incorrectly.
It is supposed to be a ratio of “Risk vs. Benefit” that goes like this: “Does the risk of this action outweigh the benefit of the desired result”. This is the way most of us were taught to measure risk. If we were honest we could say something like:
“Does risking our lives looking for a piece of evidence that may or not be where we think it is worth the potential negative outcome of death, even if we are successful?”
Unless we had perfect conditions, including visibility, manpower and equipment or possibly had the potential to save a life, our honest answer would have to be, “No”.
A more concise test would be:
Instead of Risk vs Benefit, we are actually comparing Hazard Assessment vs. Consequence of Risk.
Does the assessment we make of known and unknown hazards justify the potentially fatal consequences of our actions if we have a chance to save a 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 to kill them for the CHANCE we MIGHT save someone else.
In the previous scenario, we quantified the depth as a shallow, 12 foot depth, body of water. Now use that same scenario and make the depth just 20 or even 30 feet.
How much more risk does that create? How does that affect the survival possibility of the victims? Will visibility be a deciding factor? Can you PERFORM a breath hold dive to 20 or 30 feet and still have time to do any searching or work? How do you know?
Is there even a marginal possibility that the attempt would even be made? What IS your limit? How do you know?
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?
When does our skill or lack of skills become the deciding factor to negate a rescue attempt when there is a high possibility of saving a life?
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 obstacle and save life and property.
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 the consequences of our actions. 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 and watches for whose head will roll.
What if someone was hurt or died and we did nothing wrong?
The public expectation of us is high. If someone gets hurt or dies, it MUST be our fault and everyone waits and watches for whose head will roll.
Is it fair? Of course not but it is how we are perceived and if we do not recognize that we are deceiving ourselves.
You respond to a “not breathing” call from a frantic elderly woman who found her husband on the couch sleeping 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!”
The wife says she saw him breathing. Knowing that the man is already in rigor and there is no way she saw him breathing, do you work him anyway? 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 was NO.
Protocols may require us to work him based on the witness information but we already know the outcome.
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 likely have seen the mechanism of fatality on more than one occasion.
You already know if there is family or friends on the scene. 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 but 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, angle of entry 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 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? If someone gets hurt or dies, it MUST be our fault and everyone waits and watches for whose head will roll.
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 jeopardy. The ability to breath normally, to walk or run, to see what is coming at you ends when you submerge in a low visibility or zero visibility environment.
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 risk 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 and in doing so, without losing ours or one of our own.
What training do you do that helps prepare you for a worst case scenario when civilian lives or your own are at risk? Are you willing to put the time in, to keep an open mind and seek out additional training? Are you willing to challenge yourself to constantly improve and grow your knowledge and skills?
In extreme incidents, we do sometimes have to rely on a miracle.
Nothing says we can’t help it along.