That dramatic rescue of 12 boys and their soccer coach from a flooded cave in Thailand last year was hailed as a minor miracle. But the operation might well have failed, in fact. According to recently disclosed details, the divers conducting the operation decided to drug the boys to sleep with ketamine to prevent them from panicking while they were extracted from the cave.
It was a high-risk tactic that meant exposing the boys to possible harm, and even death, but it paid off in the end.
One obvious risk was that the boys might die from hypothermia in route to safety because the ketamine would prevent them from shivering to stay warm.
Another risk was a condition known as “circum-rescue collapse.” When the body is submerged, water pressure interrupts the flow of blood which does not immediately recover once the body surfaces. Shock often sets it, blood pressure drops and there’s a risk of heart failure.
Fortunately, no such complications developed.
After the boys were put to sleep, they were placed on flexible plastic stretchers called Skeds and brought out in three phases, with medical professionals checking on their condition along the way. One of the longest and most dangerous stretches required the boys to be underwater for nearly two hours.
Two boys did end up contacting hypothermia during the rescue. However, doctors accompanying them used a warm saline solution to begin reversing their condition as the boys were being transported to a military hospital for further treatment.
The divers debated whether to make their high-risk plan known to the public at the outset. But they quickly decided that a possible outcry might prevent them from moving forward at a time when the boys were already oxygen-deprived and needed to be evacuated immediately.
With the passage of time and the demonstrated success of the rescue, the divers said they felt more comfortable revealing some formerly secret details of their operation. Discussing them openly might facilitate future rescue operations of the same kind, the divers felt.
In addition to receiving ketamine, a short-acting anesthetic, the boys were also dosed with the anti-anxiety medication Xanax and the drug atropine, which kept their heart rate steady and prevented muscle spasms. The ketamine also restricted their blood vessels, which kept their blood pressure low.
Ketamine is widely used in emergency medicine settings around the world. It is thought to be superior to a number of common opioids because it has fewer side effects, including the threat of addiction and respiratory failure.
But no one has used ketamine to sedate victims of a disaster to facilitate daring and risky underwater rescue operations with such a high potential for failure.
In fact, a lot could have gone wrong during the 6-hour extraction form the cave, divers say. While analysts described their tactic as “brilliant,” they also got lucky.
For one thing, they stumbled across the boys by accident when they’d surfaced from one of their dives to rest. A further delay would have added greatly to the risk of the extraction, and the tactics they employed.
Not everyone survived the rescue. Two of the Thai divers died as a result of the operation — one on the scene, due to a respiratory attack, and another last week due to a blood infection he contracted in the cave while rescuing the boys.
As more details of the operation emerge, the Thai cave disaster could well enter the annals of modern survival miracles.