Blackout! Now what?
Reprinted from Freediver Magazine Issue #10
Over the last summer teaching the Performance Freediving clinic, I've had the opportunity to work with a lot of great freedivers, spear fishermen, and apniest from around the world. At each one of these clinics, Brett and I have always found the most rewarding aspect is the response of the participants to a portion of our clinic that is quite often overlooked when learning to freedive. Safety and rescue-skills.
Most freedivers learn by teaching themselves, reading books or by their buddy who usually did the same. These aspects of learning cover only the basics of equipment use, surface dives, equalizing and ascending and usually never cover important issues like how to take care of your buddy should they blackout or what to look for.
The most important rule when freediving is always freedive with a buddy. Nothing simpler could be more important to your safety, yet some people ignore it because they assume they know when to stop or insist they don't push their depth or times. This isn't always the case though and an individual's daily variation in hydration levels, lack of sleep, sickness or competitive ego, can lead us to be more susceptible. Most all blackout fatalities could have been easily avoided if this one simple common sense rule had been followed.
But does freediving with a buddy mean bringing your non-freediving friend out to tend your boat while you enjoy the reefs and marine life below? Or is it same ocean, same day and that's your idea of a buddy? Your freediving partner should be experienced and capable of assisting you in the most crucial depth ranges during your ascent, understand what to look for should you require any assistance while ascending and know how to properly assist and take care of you should you blackout. Most importantly they should be keenly observant of you and your body language and BE THERE to assist you. They're no use to you if they're off chasing a fish or have already started their own descent.
The most common problem experienced by freedivers is usually when reaching the surface and experiencing a near-blackout or 'samba'. Near-blackout or 'samba' is the point where varying degrees of lack of oxygen, 'hypoxia', may make you feel light-headed, dizzy, confused, euphoric, experience lack of muscle control, convulsions and a difficulty in breathing. Sometimes you may receive the 'ok' signal from your partner upon them reaching the surface, but ten seconds later they blackout, even though they appear 'ok'. Funny thing is, most divers continue to give the 'ok' signal even as they sink back under the water. Always observe your buddy for at least a thirty second period on the surface before making your freedive. It's during this time that most all of the 'sambas' or blackout problems will occur and where they are easily handled.
What should you do if your buddy begins to blackout upon reaching the surface? Insuring their airway remains out to the water is the most important thing. Support them under the arm and back and be prepared to protect the airway and not let it re-submerge. Move them onto their back to keep the face, mouth and nose above the water, while supporting and controlling the head and keeping it tilted back to open the airway to assist in breathing. In trying to help your buddy in this situation, you'll probably find them hard to manage because of convulsions and muscle rigidity blacking out divers may experience. That or they'll be limp as a noodle and hard to control.
Now you have them supported, you need to assist them in regaining consciousness. First off, if water conditions allow, remove their mask to open up the mouth and nasal airways, this will allow an easier and faster recovery. If sea states are bumpy and waves might wash over your head, leaving the mask on will help protect the nose, while covering their mouth with your hands will keep water from entering the airway.
Once the mask is removed and the airway is open, blow across their face to stimulate their facial sensors. This will help spontaneous breathing resume and in most cases within ten seconds. Pediatric physicians often use this technique when dealing with infants who are suffering from sleep apnea.
Even though the airway may be open, a laryngospasm may make them sound like their choking while their attempting to breath. Laryngospasm is a protective reflex that protects the airway by closing off the vocal cords in the throat preventing water from entering the lungs. In drowning with swimmers this is usually stimulated when water hits the back of the throat. With freediving, this reflex is usually automatic when blackout happens on or under the water and although this protective mechanism occurs, it will eventually relax after several minutes and breathing will resume.
Breathing may initially be effected by the diaphragmatic muscle as it spasm. As long as sounds of air are heard, maintain the airway and support them, normal breathing will resume shortly. If within the first 10 seconds of being on the surface, respirations are hampered by a laryngospasm and breathing is seen in the chest and stomach, but no air sounds are heard, then the initiation of the first of two breaths of rescue breathing can help relieve or break the laryngospasm and the airway should open and spontaneous breathing begin. If breathing doesn't begin then continue rescue breathing by giving a breath every five seconds. Basic life support or first aid / CPR courses teach rescue breathing and it should be a priority of all freedivers to get the proper training in these valuable skills. The need for any rescue breathing is very rare in most freediving blackouts as long as proper buddy procedures are followed.
Now we want to talk our buddy back by using encouraging phrases such as "It's ok, breath, breath, you're on the surface, breath". Our hearing is one of the first senses to come around from a blackout and positive reinforcement is the best key. One mistake some freedivers make is they assume that you have to shout, shake and slap the freediver back to consciousness. In a blackout, the body has decided to shut the diver down to conserve valuable oxygen when it recognizes it's running low. By attempting to 'shock' them back, you send a signal to the body that it is still in danger and this may cause them to remain unconscious longer. Another negative point of this type of rescue is that most victims awake very aggressive, defensive and confused and usually fight and struggle against their safety divers. A more gentle and encouraging approach is best utilized.
This short article can't cover every aspect of rescue skills for freediving, but awareness of the potential problems is the first step. Receiving proper, professional instruction is important to gain the necessary experience when dealing with these emergency situations. In future article I'll cover other rescue topics such as basic buddy procedures and how to assist your buddy blacking out during ascent
Safe and fun freediving to all.