Note: it’s been known for awhile that the kids were probably drugged (not necessarily with ketamine), but the news hook is that there’s a new study today. I’d link to the study but there’s a subscriber wall: http://www.nejm.org/doi/full/10.1056/NEJMc1900831
Anyone who has been a diver immediately understands why this was necessary. The last thing you want is your diver partner panicking underwater, which can happen even with certified divers. An uncertified diver in a cave is a massive liability to your own safety.
How common is it for divers to start panicking underwater? It surprises me that that's even a thing. Like, if the thought of skydiving scares you, you're probably not going to try it; so I would guess the danger of the practice itself would self-select for people who are not prone to that type of anxiety.
edit: ah yeah. potentially stupid question. obviously if something starts going wrong, even the most level headed people may panic.
You can’t always predict how you will react under pressure. If you have an equipment failure or injure yourself in a way that you have not prepared for, well...
I've seen it happen once in a hundred dives or so. Some people are more nervous than others and when something unexpected happens while they are stressed out already for some other reason it can lead to panic.
People panicking in circumstances like that is super normal. Think,all the people who loose their shit because of missing deadline, except risk is higher and level of controll lower.
An experienced diver will often times panic when, due to lack of attention or equipment failure, their air supply stops. When I was learning and practicing buddy breathing we were taught to hand the diver needing air the regulator from your mouth and then you go for your spare mouthpiece simply because they will often focus completely on the working air supply in your mouth -- to the point of just pulling it from you.
I'm usually a calm diver but I once had the combination of a slight ear infection and a speed boat passing overhead. This combination of mild pain and an ever increasing high pitched whine convinced me that my eardrum was ruptured and was rapidly getting worse. I did an emergency ascent from about 8 metres and luckily didn't have any nasty side effects.
As a diver you are usually calm and rational when dealing with expected risks (low air, bad visibility, etc.) but anything unknown or unexpected can trigger panic.
A friend of mine is a commercial diver and he has stories of seasoned co-workers panicking for extremely weird reasons.
I'm a relatively newbie diver (only 80 dives), but there have been a few times where something unexpected or new happens that can send you into at least a mild panic. Recognizing this panic and how to recover is the critical thing.
A most recent example was on my last trip I tried UV-light diving, which is when you only use UV-light with a filter on your mask to protect your eyes. You get to see some incredible new things. The divemaster stressed how important the filter was to protect your eyes. During the dive the filter on my mask came off. As instructed, I immediately closed my eyes and Waited for the divemaster to notice and tap me to let me know they had switched back to white light and it was safe to reopen my eyes. That half minute felt like an eternity.
A number of unusual situations can trigger a panic. Primary regulator failure, your mask being knocked off, unexpected fauna behavior, becoming lost, losing your group or your buddy, unexpected currents. All of this is covered in the training/certification, but not all training is equal, adequate, or regularly revisited.
Can you tell me more about the UV light diving? A cursory search doesn't seem to show up anything about the dive mask filter you mentioned. From what I found, it looks like the lights are similar to regular low-power UV-A black lights that are not a hazard to skin or eyes.
What was the model of dive light used? Was is a long-wave light like those in tanning beds or disinfecting lamps? I would imagine that any light unsafe for your eyes would also be damaging to the coral and fish.
I think you're right. I don't recall the specific equipment, we were visiting and only did a short training before. Now I've read more on it and I do feel (sheepishly) misinformed. The light may have been way less damaging than we were told. Thinking on it, I wouldn't have put it past the divemaster to troll us that way.
First, the kind of diving is more commonly referred to fluorescent diving and it doesn't use UV light, its blue (440-480nm) light. Second the filters were yellow light filters to remove the remaining light so that it didn't overwhelm the blue and you could see the fluorescence.
> How common is it for divers to start panicking underwater? It surprises me that that's even a thing.
I am a seasoned and experienced diver. I used to dive literally on a daily basis. Until that one time when without warning I totally freaked the fuck out at 20 mtr over nothing at all, with only UP UP UP UP UP on my mind. I managed to keep a lid on it and safely ascend, but that was also my last dive. I am not sure this will won't happen again, and I could endanger my buddy, group, or myself.
I agree. Especially in a cave where frantic movements could kick up sediment and block visibility. Definitely a pragmatic move but probably the right choice.
> A word about sedation. A word, too, about Dr. Harry.
> Anaesthesiology requires more training than most branches of medicine; there is always some risk that when a patient is put under, he or she will never wake up. When the patient is a child, the risks are greater. When the child is yanked along underwater for hours through a dark, cold cave, the risks are incalculable—no one has ever done anything like this before.
> Dr. Harry believes the risks of sedating the children beat the risks of not sedating the children. The lead divers believe the same, and the Thais believe the experts know best. The children cannot dive; the children will panic; the children will drown their rescuers and themselves. That is why Dr. Harry is going to do this: inject 12 kids with a sedative so powerful it will knock them out cold.
> Ketamine: a horse tranquilizer, an operating-room drug, a soon-to-be cave-rescue pharmaceutical product in its early testing stages on rock-entombed human minors.
> If only it were so simple. The children’s drugs will need to be topped up with half-doses along the way. Dr. Harry cannot dive every child out himself, but the divers are not medical doctors. Dr. Harry must give a dozen cave hobbyists and small-business owners a crash course in do-it-yourself anaesthesiology.
> If anyone dies—and many divers think they will be lucky to save two or three of the kids—Dr. Harry will bear much of the burden. He is not licensed to practice medicine in Thailand, let alone teach other foreigners to practice. Though Thailand and Australia have offered some assurance that he won’t suffer legal consequences for his young patients’ probable deaths, a conscience and a name are not so easily protected.
I'm glad Thailand and Australia offered (albeit if only verbal) protection. This is one of those circumstances were typical regulations just don't make sense and need to be shortcut for a clear emergency.
Edit: To add, all parties in this emergency agree it was necessary, so they didn't do anything without consent.
I strongly agree. This video of a cave diver describing a near death experience adds a little color to what's at stake: https://youtube.com/watch?v=or92IMcLoIc
This is my favourite tidbit about Ketamine. It is always described in a way to imply that it is a very strong tranquilizer. Though AFAIK the reason it is used for horses is that it is fairly safe to use even when you don't know exactly how much mass the body has that you are trying to sedate. This applies for small bodies as well.
The worst case turns out not to be one of the children, it was the coach. He wasn't under and caused a few problems, turns out they hadn't adjusted the dose for his increased body weight.
While an interesting read for sure, I'm not sure why people are surprised by this? Given the context, the boys are already at an elevated risk for panicking, seems like a cut and dry solution that worked as intended?
I don't view drugs as "scary" or "bad". They're tools, if used correctly they can effectively do what you need them to. There's risks with these tools of course, and those need to be considered, but in the end they're just tools. (Not talking about miss-using drugs, only talking about approved usage by professionals)
Many medical practitioners have very strong love/hate relationship with anesthesia drugs. Any patient under anesthesia requires very careful monitoring and will often have unexplained drops in blood pressure and body temperature. Usually patients first have a blood test done (out of whack liver values mean the drugs might not metabolize and the patient will never wake up) and other vitals taken, such as temperature and blood pressure.
Ketamine is much less risky than propofol, but I'm sure any doctor would understand the dangers of putting kids that young under that are already in a health danger zone and having them not be monitored.
> Not talking about miss-using drugs, only talking about approved usage by professionals
Well answer your question about why this is interesting to people. The difference between mis-use and proper use is the interesting question. This is not an approved use of ketamine, and the people administering and issuing the drugs were not licensed professionals.
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[ 4.9 ms ] story [ 70.4 ms ] threadbrief? the author must not party very much.
edit: ah yeah. potentially stupid question. obviously if something starts going wrong, even the most level headed people may panic.
To warn you, it is fairly disturbing.
As a diver you are usually calm and rational when dealing with expected risks (low air, bad visibility, etc.) but anything unknown or unexpected can trigger panic.
A friend of mine is a commercial diver and he has stories of seasoned co-workers panicking for extremely weird reasons.
A most recent example was on my last trip I tried UV-light diving, which is when you only use UV-light with a filter on your mask to protect your eyes. You get to see some incredible new things. The divemaster stressed how important the filter was to protect your eyes. During the dive the filter on my mask came off. As instructed, I immediately closed my eyes and Waited for the divemaster to notice and tap me to let me know they had switched back to white light and it was safe to reopen my eyes. That half minute felt like an eternity.
A number of unusual situations can trigger a panic. Primary regulator failure, your mask being knocked off, unexpected fauna behavior, becoming lost, losing your group or your buddy, unexpected currents. All of this is covered in the training/certification, but not all training is equal, adequate, or regularly revisited.
What was the model of dive light used? Was is a long-wave light like those in tanning beds or disinfecting lamps? I would imagine that any light unsafe for your eyes would also be damaging to the coral and fish.
First, the kind of diving is more commonly referred to fluorescent diving and it doesn't use UV light, its blue (440-480nm) light. Second the filters were yellow light filters to remove the remaining light so that it didn't overwhelm the blue and you could see the fluorescence.
I am a seasoned and experienced diver. I used to dive literally on a daily basis. Until that one time when without warning I totally freaked the fuck out at 20 mtr over nothing at all, with only UP UP UP UP UP on my mind. I managed to keep a lid on it and safely ascend, but that was also my last dive. I am not sure this will won't happen again, and I could endanger my buddy, group, or myself.
> A word about sedation. A word, too, about Dr. Harry.
> Anaesthesiology requires more training than most branches of medicine; there is always some risk that when a patient is put under, he or she will never wake up. When the patient is a child, the risks are greater. When the child is yanked along underwater for hours through a dark, cold cave, the risks are incalculable—no one has ever done anything like this before.
> Dr. Harry believes the risks of sedating the children beat the risks of not sedating the children. The lead divers believe the same, and the Thais believe the experts know best. The children cannot dive; the children will panic; the children will drown their rescuers and themselves. That is why Dr. Harry is going to do this: inject 12 kids with a sedative so powerful it will knock them out cold.
> Ketamine: a horse tranquilizer, an operating-room drug, a soon-to-be cave-rescue pharmaceutical product in its early testing stages on rock-entombed human minors.
> If only it were so simple. The children’s drugs will need to be topped up with half-doses along the way. Dr. Harry cannot dive every child out himself, but the divers are not medical doctors. Dr. Harry must give a dozen cave hobbyists and small-business owners a crash course in do-it-yourself anaesthesiology.
> If anyone dies—and many divers think they will be lucky to save two or three of the kids—Dr. Harry will bear much of the burden. He is not licensed to practice medicine in Thailand, let alone teach other foreigners to practice. Though Thailand and Australia have offered some assurance that he won’t suffer legal consequences for his young patients’ probable deaths, a conscience and a name are not so easily protected.
Edit: To add, all parties in this emergency agree it was necessary, so they didn't do anything without consent.
This is my favourite tidbit about Ketamine. It is always described in a way to imply that it is a very strong tranquilizer. Though AFAIK the reason it is used for horses is that it is fairly safe to use even when you don't know exactly how much mass the body has that you are trying to sedate. This applies for small bodies as well.
Crazy. Definitely not an easy job.
I don't view drugs as "scary" or "bad". They're tools, if used correctly they can effectively do what you need them to. There's risks with these tools of course, and those need to be considered, but in the end they're just tools. (Not talking about miss-using drugs, only talking about approved usage by professionals)
Ketamine is much less risky than propofol, but I'm sure any doctor would understand the dangers of putting kids that young under that are already in a health danger zone and having them not be monitored.
Well answer your question about why this is interesting to people. The difference between mis-use and proper use is the interesting question. This is not an approved use of ketamine, and the people administering and issuing the drugs were not licensed professionals.