toxing while on ffm/gag strap

Hi

For those who might have been present, I gave a presentation at Oztek last month titled Increasing The Probability of Surviving Loss of Consciousness Underwater When Using a Rebreather. This presentation was based upon a paper I hope will be published this year in one of the diving and hyperbaric medical journals.

Resistance to Mouthpiece retaining strap use by manufactures, training agencies and instructors is I believe no longer tenable. We now have 20 years of sport rebreather diving behind us and accident data clearly demonstrates that in over 90% of rebreather diving fatalities, the actual cause of death is drowning (DAN study). This was clearly foreseen and documented at Rebreather Forum 2 (RF2) back in 1996 which was organised to address the major issues involved in bringing rebreather technology to the consumer market-place and was divided into working sessions to identify the key technology, safety, training and risk management issues. Despite the RF2 prediction regarding drowning as the most likely cause of death, the sport rebreather industry has still not addressed the matter of airway protection following LoC even though it is a design requirement of the rebreather standard EN14134:2013. The aim of my Oztek presentation was to stimulate the rebreather diving community (manufacturers, trade bodies, training agencies, instructors, divers) to re-visit the use of rebreather mouthpiece retaining strap, which has the potential to delay or limit water aspiration following loss of consciousness, thus extending the life of an unconscious diver for what might be a sufficient period of time for rescue. Rebreather divers do not die of equipment failure, human error, hypoxia, hypercapnia or hyperoxia, these are accident triggers, disabling agents or disabling injuries, in the vast majority of cases (over 90%) rebreather divers die from water aspiration and drown.

"I approached the diver and noticed the mouthpiece was out" is a common theme to rebreather fatality witness reports. I believe we as a diving community have the ability to reduce the frequency of drowned rebreather divers. However to do so will require a culture change. Thirty odd years ago legislation was proposed in the UK where the use of seat belts in cars would become law. The vehicle manufacturers opposed it, the motoring public opposed it. Thankfully this did become law and overnight vehicle accident fatality figures dropped significantly, to the point where within a few weeks there was a shortage of donor organs. Despite the original resistance, a culture change happened and how many of us would now consider driving without wearing a seatbelt. In a similar manner by which we no longer accept that being propelled face first through a glass windshield is an acceptable aspect of driving, we should no longer accept that aspirating water and drowning is the immediate effect of loosing consciousness underwater.

The vast majority of classic and contemporary military rebreathers come with a retaining strap because the potential safety benefits have long since been recognised by the original users of rebreathers - the military. Evidence from military rebreather diving demonstrates the safety benefits of using a mouthpiece retaining strap to prevent or delay water aspiration following loss of consciousness. After 20 years of sport rebreather diving, the use of a retaining strap as a standard safety feature is long overdue.

You'll find a lot of interesting discussion here on a separate posting from a couple of years back that generated over 32,000 views. It is worth while going back to review the issues discussed.

Rgds

Paul
 
I'm curious about that data. In commercial diving circles it is assumed that the airway is closed during a seizure wether from the inability to maintain it or from the sever spasms. The protocol is to stop traveling till the seizure is over. Ive witnessed an O2 seizure on a worksite and the stand by was instantly jumped due to the fact that the toxing diver has absolutely no control during the event, as well as a for a substantial time afterwards.

At any rate it's not barotrauma or drowning as your choices, it's buddy diving or drowning when it comes to O2 toxicity. IMHO

Cam
 
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Paul, thanks for the reply. Your talk was what kicked me into finally trying the gag strap.

But the fact remains, no one has a definite answer on the original q???? What happens when you tic with no own around, with the gag strap??? Do we not know?
 
In answer to your original post, if the airway is protected and water is not aspirated then you will either ascend or descend depending upon your state of buoyancy at that time (most likely descend). You will then continue to be subject to the insult resulting from what ever inappropriate gas you are breathing. If you are hypercapnic then CO2 levels will continue to rise if you are still ventilating until fatal levels are reached. PCO2 will of course rise significantly if you sink as a consequence of increasing ambient pressure where fatal PCO2 levels will be encountered sooner. If you are hypoxic, unless oxygen is added to the breathing gas, LoC from hypoxia will continue until anoxia and death arises, particularly if you ascend and ambient pressure decreases. However if you descend, PO2 may rise (loop PO2 plus any auto addition of diluent) to the level where consciousness might be regained (this has happened). If you are hyperoxic, if you ascend then PO2 will decrease to the point where the PO2 is no longer at CNS toxicity levels, i.e. at or near the surface. Consciousness will likely be regained, however the casualty will be unlikely to be lucid enough to function normally. If you descend then rising PO2 will confound the problem and you will eventually perish from CNS hyperoxia (I'm not aware of data that demonstrates the time period for this to occur in humans, however studies exposing small mammals to high PO2 levels eventually resulted in death).

Hope this has answered your question.

Rgds Paul
 
And also, burst lung.
And also, if the diver descends with a shut off ADV, he'll suffocate.
And also, if you end up on the surface with 1 hour of deco to go, you're in trouble.

There's a good reason none of this is mentioned in the military medicine french paper, or in an earlier paper (in french only, sadly) by the same authors (except burst lung). Three actually. One the victim is tethered. So he's not going anywhere. And his buddy is unlikely to not notice he's in trouble. Two, the majority of oxtox incident were on oxygen rebreathers. So no deco. Three, divers who did surface with omitted deco were preventively put in the chamber. This is in the earlier paper. They also state that they regularly practice rescue exercises with recompression in less than 3 minutes.

So they just ascend.

Anyone here usually, err... regularly, err... ever dives an O2 rebreather/3 minutes away from the pot?

The seatbelt analogy is great. I totally agree. I've been using a draeger strap for almost 2 years. After I talked about this with you, actually. But at the same time in the context of those papers it's like crashing in the A&E gate. Obviously (I counted a grand total of 0 posts arguing against gag straps in this thread) the seatbelt is key. If the driver's brains are splattered across the windshield, there's not much they can do about it.

All the same, the way most people here dive, it's more like crashing into a rock somewhere between Alice Springs and Ayers rock. A tethered buddy would be like a mate following in another car. Otherwise you'd better hope a tour bus comes quickly.

So I'm thinking it's worth talking about.. I got a strap, now what?

Cheers,

Matthieu

Incidentally, one of the takeaway message from the papers is that at least the right strap does work: 3 "moderate water aspiration" in 54 impaired consciousness events.

Link to the earlier paper: http://www.cibpl.fr/wpFichiers/1/1/...e 96 accidents répertoriés dans la Marine.pdf
 
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I have used a Gag strap for five years and find it comfortable during scootering and longer dives. The dreager gag strap also positions the teeth farther apart, which has a big impact on the WOB. That was one of the reasons I switched back from a sea cure. Given most Ox Tox convulsions last 30-60 seconds the gag strap, although not perfect does provide a better chance of survival than not having one. Plus its easier to nap on long decos. :)
 
I have a drager strap but honestly I find it hard to maintain it on the crown of my head. If I snug it up to the point where it stays put then I can't remove the mouthpiece to bail to my necklaced OC reg. If I leave it less snug so I can remove the mouthpiece then it tends to slip down onto the back of my neck. I have taken to snugging it up with it routed low across the back of my neck. Not ideal to bail and not ideal to hold the mouthpiece in my mouth either. I am thinking of adding a BOV in part to be bale to snug up the gag strap and maintain the loop in my mouth better (because I won't need to remove it to bail).
 
In answer to your original post, if the airway is protected and water is not aspirated then you will either ascend or descend depending upon your state of buoyancy at that time (most likely descend). You will then continue to be subject to the insult resulting from what ever inappropriate gas you are breathing. If you are hypercapnic then CO2 levels will continue to rise if you are still ventilating until fatal levels are reached. PCO2 will of course rise significantly if you sink as a consequence of increasing ambient pressure where fatal PCO2 levels will be encountered sooner. If you are hypoxic, unless oxygen is added to the breathing gas, LoC from hypoxia will continue until anoxia and death arises, particularly if you ascend and ambient pressure decreases. However if you descend, PO2 may rise (loop PO2 plus any auto addition of diluent) to the level where consciousness might be regained (this has happened). If you are hyperoxic, if you ascend then PO2 will decrease to the point where the PO2 is no longer at CNS toxicity levels, i.e. at or near the surface. Consciousness will likely be regained, however the casualty will be unlikely to be lucid enough to function normally. If you descend then rising PO2 will confound the problem and you will eventually perish from CNS hyperoxia (I'm not aware of data that demonstrates the time period for this to occur in humans, however studies exposing small mammals to high PO2 levels eventually resulted in death).

Hope this has answered your question.

Rgds Paul

thanks Paul, this is what I assumed. So really, to break this down - a gag strap would be most useful on deco, when tethered, unless diving as a buddy pair. Or otherwise likely to be rescued. This of course is dependent on the dive etc.
 
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