Performing CPR on a commercial diver inside the diving bell

CPR in a diving bell is difficult. It is taught by diving companies and training institutes but has not been subjected to the tenets of evidence based medicine. The diving bell lacks space as well as a flat hard surface to lay the patient on and therefore conventional methods of administering CPR are not possible. The diver is hung from a pulley tied to the diver's harness, and the bell flooded with water to reduce pooling of blood. Airway is established using a cervical collar to hyperextend the neck and inserting an appropriate oropharyngeal airway. Cardiac compressions are administered by the bellman using his head or the knee while holding the patient with his arms from behind. The bell can be recovered to surface only when spontaneous breathing and circulation have started. Diving bell offers a unique environment for management of unconscious casualties. Even though the method is at variance with the conventional method of administering CPR, it is the only method possible inside the bell. It is important that the method be scrutinized and refined so as to be more effective and efficacious inside the bell.