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May 2013    Download the Entire Issue (PDF) Available to the Public Vol. 28, No. 5   RSS Feed for Undercurrent Issues
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Why Divers Should Know CPR

especially when you’re doing dive trips in the Third World

from the May, 2013 issue of Undercurrent   Subscribe Now

There are so many articles we've written stating how important it is to be prepared for worst-case scenarios while diving in Third World countries - medical issues, lost-at-sea situations - and know how to be self-reliant if they occur. Take heart issues - we wrote in March 2012 about how automated external defibrillators are a great medical tool to treat someone in cardiac arrest, but they're not available on many dive boats worldwide. In that case, it's important to know CPR --whether it's the new version or old style, it could be the difference between life and death, as divers Bill and Hilary Greenberg found out. Here is a condensed article of their story, written by Ryan Jaslow, health editor at CBS News.com.

In April 2010, the Greenbergs, from Scarsdale, NY, took their three boys to Costa Rica for a family dive trip. They thought the Catalina Islands was the perfect setting for the boys' first openwater dive and planned the boat trip for April 6. On the boat, the boys were given an instructor, while their parents were in the second group with a divemaster. The first dive went off without a hitch. The next dive was going to 35 feet, so the Greenbergs assumed it would be an easy dive. The six divers got in a single-file line to move along the rock formations; Hilary was last. While underwater, the divemaster warned that a surge was coming. To Hilary, it felt like a terrible shoving -- and that was the last thing she remembered.

"Her heart was beating, but we didn't
know anything, as far as her brain
function, what was going to happen.
What was going through my head was,
'Did I do the right thing?"

The group couldn't fight it, and could only move along with the wave as it took them 40 feet forward. When Bill turned around, he didn't see his wife. The group finned back and Bill suddenly spotted Hilary on the bottom, with her regulator out of her mouth. She had cuts on her arms and legs; the surge may have thrown her into the coral, knocking the regulator out. Bill and the divemaster lifted her toward the surface. She wasn't breathing, so Bill tried to get air to her though his regulator while the divemaster yelled for the boat, 400 feet away. It took 10 minutes from the time the surge hit until Hilary got on the dive boat. She still wasn't breathing and didn't have a pulse.

"All I can think of is, 'we've just got to do CPR'," Bill, a physician specializing in cosmetic medicine, told CBS News. He started compressions and breathing using a now-outdated method of repeating 15 compressions followed by two breaths. (The American Heart Association now recommends a fast compression-only approach, suggesting rescuers pump to the tune of the Bee Gees' disco tune "Stayin' Alive.") Hilary's pupils were fixed and dilated, and she was blue. Others on the boat told him to stop, but he refused to give up.

After 20 minutes of CPR, a small rescue boat finally arrived but the rescuers had nothing except an oxygen tank and mask. As they began to perform compressions, Bill noticed the mask was leaking air, and oxygen was going into Hilary's stomach instead of her lungs. With a language barrier, Bill had no choice but to push the technicians out of the way, and he started doing mouth to mouth again. He continued for another 10 minutes as the boat made its way to shore, where it was met by technicians with more advanced equipment, including a defibrillator. More than 40 minutes had passed since Bill last saw Hilary conscious, and during most of that time he had performed CPR (in medical training, he had never performed it for more than 10 minutes). When the emergency crew hooked up the defibrillator, they found a very weak heartbeat. While she still wasn't breathing on her own, that was the first positive sign for Bill -- Hilary's heart had hopefully started beating at some point while he was performing CPR. Bill joined Hilary for a 45-minute ambulance ride to the hospital, and called Divers Alert to arrange for her evacuation and treatment back in the United States.

DAN arranged a Learjet to transport her to a medical center in Delray, FL, where lab tests showed she was stable, but she had six broken ribs due to the CPR, was in a coma and completely unresponsive. "She was alive, her heart was beating, but we just didn't know anything as far as her brain function, what was going to happen," Bill said. "What was going through my head was, 'Did I do the right thing?'"

Hilary was then transported to New York, where all of her body was functioning normally, except for her brain. One day, Bill got a call from his sister, who said Hilary was alert, laughing and talking up a storm. She was indeed in a laughing mood, but most of her words were unintelligible. She also had no idea that anything had happened to her. She had suffered an anoxic brain injury in which cells in the oxygen- deprived brain started to die off. One of the most important parts of rehabilitation is to get the person aware of the injury. That's because the brain has to be slowed down and not overtaxed, so doctors can find ways to tap into the brain and allow it to communicate with parts of the body experiencing deficits. So doctors gave Hilary a strategy of following basic instructions, and thinking each time before she spoke, to allow her brain to slow down.

It took her days to figure out how to use a spoon, longer to learn to place it in her bowl and bring it to her mouth. She couldn't remember the days of the week or five fruits when asked, and she would forget who would come to see her. It was like being in Groundhog Day. Strangely, she was able to speak French and Spanish. Her doctors diagnosed the anoxia in her frontal lobe, the most advanced area of the brain that controls thinking, planning and higher-level reasoning skills.

Six weeks after the accident, Hilary was discharged from the hospital. By July, her long-term memory started to come back. In January, doctors told her she was "90 percent recovered." But the challenges that lie ahead are her abilities to problem-solve on her own and sequence information, problems that are magnified when she's in a social situation and trying to figure out what to say.

While no one may ever know what went on in Hilary's body after not breathing or having a measurable pulse for over 40 minutes, research suggests several factors may have worked in her favor -- starting with the CPR. Zachary D. Goldberger, a professor of medicine at the University of Washington School of Medicine in Seattle, published a study in The Lancet last September that found extending CPR for a longer time could potentially save more lives. "Her recovery is remarkable, and it's a success story," he said. Being young, and the fact that she got a long duration of effective CPR probably played a role in her recovery."

Bill adds that because Hilary was in the water colder than her body temperature, hypothermia may have bought her extra time. Doctors sometimes induce hypothermia therapeutically for patient in cardiac arrest. Mark Herceg, director of neuropsychology at the Burke Rehabilitation Center in White Plains, NY, where Hilary did rehab, said the CPR could have helped Hilary's case immensely, in that the sooner a person can get oxygen after an anoxic brain injury, the better. "He made sure nothing stood in the way," Herceg said of Bill.

Hilary herself has a goal to get back to work -- she originally trained in internal medicine and has been studying for re-certification. She's also on another mission: To make sure everyone she meets knows CPR

Divers Alert Network makes it easy for divers to find an instructor nearby that teaches CPR and first-aid courses ( www.diversalertnetwork.org/training/courses/blsfa ) -- take one before your next overseas dive trip, and be better prepared for situations where those skills mean the difference between life and death.

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