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Comment by gjm11 | Hacker News Reader

Someone who may or may not be btilly posted exactly the above to Mario Vittone's blog, and got a response from Vittone saying, inter alia, "Your four points contain some good as well as some dangerous advice. There are often too many variables for lists of possible rescue techniques - but waiting for unconsciousness is a very (very) bad idea."

(Emphasis mine.)

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It was not I who posted that there.

I fully agree that waiting for unconsciousness is a very bad idea. Obviously it is an option of last resort. However from my training, I believe it to be a better idea than getting killed. And in my training it was suggested as an option of last resort if we had no other options and didn't feel comfortable making a rescue.

And yes, there are a lot of variables that come into play. For example my instructor once saw 3 people drowning in a river. She rescued 2 and let the third drown because she was developing hypothermia. (The story is that one broke through thin ice, the other two tried to rescue the first. The one who died was one of the would-be rescuers.)

However in general if you have the knowledge and experience to properly judge those factors for yourself, you should know more about drowning than my brief blog post.

I grew up near a lake and always used to hearing those drowning stories. One of the guy I met told me about a similar story. He was trying to rescue a kid who was drowning and he started to grab/climb him as soon as he reached him. He said he had to punch him into unconscious then rescued him.

Obviously it is an option of last resort.

Not obviously, since you listed it third of four and fourth was roughly "swim where they can't grab you, and drag them back to shore while avoiding their grasp", which sounds pretty straightforward to an untrained reader.

It sounds pretty straightforward when you hear it, but execution is the real challenge. And if you execute it incorrectly, you run a serious risk of death.

To give an example of what can go wrong, your description suggests that you just hold the person where they can't reach you and drag them. But if you try that you'll find out the hard way that there is no good way to drag the person while they are still panicking without getting grabbed.

To give another problem, can you swim in place for a minute with your hands out of the water? Try it before confidently asserting that you can. And that is substantially easier than swimming in place, holding a struggling, panicked person up.

Those are among the reasons why I've so strongly recommended that untrained people avoid option #4. If you can stand on the bottom, fine. Otherwise, not so fine.

As a former lifeguard (certification has expired), I agree with btilly. Treading water without your hands was part of the test for this reason. Part of the training also involved being grabbed underwater by fellow trainees. Until you've actually been grabbed in a bear hug underwater, you can't really prepare yourself for what it feels like. And this is with someone who isn't panicking, and that you know will let go if you can't break their hold after a while.

Another important thing that they brought up in my training: the first thing to check for before going in to save someone (land or sea) is if the conditions are safe. As far as I know, every trained rescuer is told to put their own safety above the person or people they are trying to save. While I don't fault anyone that sacrifices themselves to save others, it doesn't make sense to add another death to what is already a tragedy.

I'm not a lifeguard -- I'm not even much of a swimmer -- but I am trained in First Aid. One of the things we were taught is not to just rush to be a hero when you come upon an apparent trouble situation. You first need to assess the situation and area with respect to the safety of yourself, and any bystanders.

Example scenario (based on a real life occurrence, as related by my instructor): You approach an indoor pool, and see what looks to be a child floating face down in the water, and an adult also floating similarly nearby. Your first instinct might be to dive in to save one or both of them, but a subtle clue is present: while the child is in swimming attire, the adult is in street clothes. In actual fact, a live wire has somehow come to be in contact with the water -- the adult had dived in to try to save the child, but was electrocuted.

What you said about people bear hugging you underwater reminds me of when I was on a swim team and we played a game called "Sharks and Minnows."

The lone shark starts at one end of a 25 meter pool, all the minnows at the other. The coach blows the whistle and all the minnows have to try to reach the other end without getting caught at the surface. Any minnows caught at the surface immediately become sharks. Repeat until there are no minnows.

I wasn't the fastest swimmer, but I could easily hold my breath from one end of the pool to the other, including wrestling underwater with sharks. If Sharks and Minnows were an Olympic sport I would have been competitive. Of course, that was when I was twelve ;-) At this point, I think I'd carefully consider how to approach an obviously drowning person.

I remember playing that.

My strategy was to breast-stroke as fast as I could while not quite scraping the bottom of the pool with my chest.

I usually came out pretty well in the end :)

We would also do exercises in the diving pool of treading water for a half hour+ at a time. Good times.

(I was also around 12)

I absolutely love the mechanics of that game. First of all it's a blast. But the cool part is that the game mechanics themselves ensure that everybody is safe. The minnows want to stay underwater to win the game, which is a secondary goal to wanting to breathe. And the sharks want to get the minnows to the surface to win the game. So fight it out as much as you want, but the minnows have to TRY to not breathe.

As a former Bronze Cross I also agree with btilly. I practiced swimming for thousands (training, competitively, and pleasure) of hours before having to save my first drowning victim. If you don't have the experience you are going to put yourself and the other person at great risk.

"Another important thing that they brought up in my training: the first thing to check for before going in to save someone (land or sea) is if the conditions are safe. As far as I know, every trained rescuer is told to put their own safety above the person or people they are trying to save."

Absolutely.

NOLS and the Sierra Club tell you the same thing, as well -- if you lead a hike for the Sierra Club and someone gets hurt, the FIRST thing you do is make sure the situation is safe. It doesn't do anyone any good if someone gets hurt and you get yourself hurt trying to get to them -- because now there are TWO victims.

I understand it once explained, I just said you should watch yourself before calling it obvious in future, because as someone untrained in lifeguarding or swimming - it isn't.

Or more specifically, watch yourself before deciding not to mention it because it's "obvious".

Why isn't it obvious that you don't really want to let someone drown almost to death? In any case I really didn't want to put too big a warning against #3 because I don't want to scare people away from that option if it is a choice between that and #4. Seriously, I don't.

As for you understanding the risks of #4 when explained, if you had understand it when it was first explained you shouldn't have responded as you did. Go back and re-read my original post. I said not once, but twice, that this was for trained people only. I further gave as two reasons the inability of untrained people to properly support a struggling person in the water, and the speed with which a mistake gets you killed. Yet your reaction was that #4 didn't look so bad.

I described #4 in the amount of detail I did because I thought people would be curious about it. But if people are going to misread my attempt to satisfy curiosity as a howto, it would have been much better for me to say no more than that going after a person drowning in water over your head is a recipe for suicide unless you have specialized training.

> which sounds pretty straightforward to an untrained reader.

Precisely why 3 was before 4. 4 is only an option if you know you're capable of it, and know why. If you think you are, you're wrong.

4 is an option until you know why it's not as simple as it looks, then it's not. It becomes an option again when you know you're capable of it.

Unskilled and unaware of it. Deadly unk-unks.

If you are in the middle of a lake and not a fairly well trained swimmer - it is really dangerous advice to try to drag them to shore and avoid their grasp. The swimmer could easily grab on to you and drown you both.

Don't underestimate a drowning swimmers ability to grab and hold you under the water - they are fighting for their life. It sounds ridiculous, but I have seen a small child do so to a large adult many times.

Don't think of this as lifeguard training,but you've basically got to get them over one shoulder or under an arm, then across the torso, while using your hip and a strong kick to basically pin them against your side so they have the least possible leverage to twist around and hug/climb you. Then you have to figure out how to swim them back with one arm. Sometimes it takes a couple tries. While a passive victim is closer to death the situation is usually safer for the rescuer, especially if inexperienced or untrained.

Waiting for unconsciousness is neither a bad idea nor should it be considered a last resort. Thinking of it as such is exactly how you get yourself in trouble yourself. It's amazing how quickly you can get incapacitated in the water, you might think you can hold your breath for 30 seconds with no problem, but that doesn't work when you start with empty lungs and a kick to the stomach. Then you're oxygen deprived from the very beginning and within 15 seconds your survival instincts have taken over. Now there are two drowning people which means the next person who wants to try and make the rescue will have two people jumping on him. No one in his right mind is going to try that so the only option is to wait for unconsciousness. Unfortunately by the time the second person is unconscious the first person may well be dead.

As btilly points out very aptly the first step to the rescue always has to be getting the person to calm down. However the moment they start to climb you, you need to go under to get them off. If you do manage to get a grip behind them and they start to struggle their sometimes lifeguards will arch their backs pulling both the rescuer and the victim's heads under water, this hopefully gets them to calm down.

One point that isn't mentioned is that this is an entirely different situation if you have a flotation device buoyant enough to hold both of you. Lifeguard tubes are ideal for of course ideal but fun noodles or kickboards can be used in a pinch. With such a device, your goal is to get a hold of the person without losing your float. With Lifeguard tubes you want to approach the person (ideally from behind) with the tube across your chest underneath your arms and grab them underneath their arms once you have them try to get as much of their weight onto the tube. If the tube is supporting their weight then they can't put any unexpected pressure on you, and they'll calm down very quickly when they feel the stability.

How throwing them the noodle, without getting close enough to endanger yourself? Or can't they climb the noodle?

Edit: Having read the article--a noodle probably won't help somebody who's past aquatic distress and has started drowning.

It sounds cold, but if you are not a trained professional, they are in deep water, and you cannot throw them something, you run the very (very) real risk of having you BOTH drown and die if you try to save them while conscious. In case you didn't read the article, if they get a hand on you they will climb you like a tree and have the strength of a million doses of adrenaline.

What solution do you propose instead?

It's not unprecedented either. In CPR training, you are taught the Heimlich. You are also taught that you have to ask someone who is choking if they want help (or you will be sued, regardless if you save them). If they say no, they don't want help, you can either leave them to die, do it anyway and get sued for all you are worth (don't count on mercy, the law is 1000% against you), or wait until they pass out and then do it anyway (you are then protected by the Good Samaritan law)

Unless you are a medical professional (and you are acting in that capacity (a 3 hour CPR course doesn't count)), you don't need to obtain "consent to treat." And even if you are a medical professional, Implied Consent would be a pretty easy argument to make in the case of a non-verbal patient.

Good Samaritan laws are 1000% in favor of the rescuer (especially if that rescuer is a lay person).

TL;DR; If you are familiar with the Heimlich Maneuver, and you see someone who is choking (can't speak or cough, clutching their throat, etc), _please_ don't hesitate to act.

If someone can say no, they do not need the Heimlich -- at worst, they have a partially occluded airway, in which case using a finger to try to sweep the object out, or turning the person face down so the object falls out, is the correct course of action. (of course, if someone is non-verbally communicating no, then what you say applies, but I'd still be getting into position, and gesturing either sweep the mouth themselves, or use a convenient chair to do it.)

I was referring to when they are using non-verbal communication. Of course you do not do the Heimlich when they can still talk, that is Heimlich 101.

I was under the impression that you were taught to ask if they wanted help to determine if they were legitimately choking to death or not. Is it possible for someone who is truly choking to respond to a question about if they want help or not?

That's part of it -- if they're able to respond, or if they're coughing, they're still breathing.

My wife was taught in her lifeguard training to swim towards the person but as you get closer extend your feet towards them as if you were sitting in a lazy-boy facing them. Then if they try to pull you under you can kick them in the face and knock them out.

Is this common advice?

Kicking someone in the face will damage them, might stun them and keep them off you, but probably won't knock them out. Knockouts come from moving the brain within the skull, and a blow to the face isn't the best way to do it (too soft).

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