
Boys trapped in Thai cave were drugged for risky rescue dives - danso
https://www.latimes.com/science/sciencenow/la-sci-sn-thai-cave-rescue-boys-drugged-unconscious-20190403-story.html
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Nrbelex
This was discussed in depth in the long 1/25/19 article re the rescue:
[https://www.macleans.ca/thai-cave-rescue-
heroes/](https://www.macleans.ca/thai-cave-rescue-heroes/) (Previously
[https://news.ycombinator.com/item?id=19030307](https://news.ycombinator.com/item?id=19030307))

> 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.

~~~
penagwin
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.

~~~
iratewizard
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](https://youtube.com/watch?v=or92IMcLoIc)

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jedberg
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.

~~~
nikkwong
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.

~~~
fullsailor
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.

~~~
malandrew
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.

~~~
fullsailor
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.

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danso
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](http://www.nejm.org/doi/full/10.1056/NEJMc1900831)

~~~
if_by_whisky
Yeah, this was reported in real time while it was happening.

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penagwin
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)

~~~
russdill
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.

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bluntfang
>It had a brief career as a party drug known as “Special K.”

brief? the author must not party very much.

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dmix
> Harris told reporters that all of the rescued children “needed re-sedation
> at different times on the way out.”

Crazy. Definitely not an easy job.

~~~
sliken
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.

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jngreenlee
I think I'd want the same treatment!

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babyslothzoo
News from a year ago...

