Drowning medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Medical Therapy
Many pools and designated bathing areas either have lifeguards, a pool safety camera system for local or remote monitoring, or computer aided drowning detection. However, bystanders play an important role in drowning detection and either intervention or the notification of authorities by phone or alarm. No person should attempt a rescue that is beyond his or her ability or level of training.
If a drowning occurs or a swimmer becomes missing, bystanders should immediately call for help. The lifeguard should be called if present. If not, emergency medical services and paramedics should be contacted as soon as possible.
The first step in rescuing a drowning victim is to ensure your own safety. Then bring the victim's mouth and nose above the water surface. For further treatment it is advisable to remove the victim from the water. Conscious victims may panic and thus hinder rescue efforts. Often, a victim will cling to the rescuer and try to pull himself out of the water, submerging the rescuer in the process. To avoid this, it is recommended that the rescuer approach the panicking victim with a buoyant object, or from behind, twisting the victim's arm on the back to restrict movement. If the victim pushes the rescuer under water, the rescuer should dive downwards to escape the victim.
Actively drowning victims do not usually call out for help simply because they lack the air to do so. It is necessary to breathe to yell. Human physiology does not allow the body to waste any air when starving for it. They rarely raise their hands out of the water. They use the surface of the water to push themselves up in an attempt to get their mouths out of the water. Lifting arms out of the water always pushes the head down. Head low in the water, occasionally bobbing up and down is another common sign of active drowning.
There can be splashing involved during drowning, usually a butterfly like stroke where the hands barely clear the waters surface, and sometimes victims can look like they are climbing an invisible ladder in the water.
Extenuating factors such as increased levels of stress, secondary injuries, and environmental factors can increase the likelihood of distress and/or drowning in persons who end up overboard. It is important that you recognize the behaviors associated with aquatic distress and drowning, so you can make informed decisions during emergencies.
After successfully approaching the victim, negatively buoyant objects such as a weight belt are removed. The priority is then to transport the victim to the water's edge in preparation for removal from the water. The victim is turned on his or her back. A secure grip is used to tow panicking victims from behind, with both rescuer and victim lying on their backs, and the rescuer swimming a breaststroke kick. A cooperative victim may be towed in a similar fashion held at the armpits, and the victim may assist with a breaststroke kick. An unconscious victim may be pulled in a similar fashion held at the chin and cheeks, ensuring that the mouth and nose is well above the water.
There is also the option of pushing a cooperative victim lying on his or her back with the rescuer swimming on his or her belly and pushing the feet of the victim, or both victim and rescuer lying on the belly, with the victim hanging from the shoulders of the rescuers. This has the advantage that the rescuer can use both arms and legs to swim breaststroke, but if the victim pushes his or her head above the water, the rescuer may get pushed down. This method is often used to retrieve tired swimmers. If the victim wears lifejacket, buoyancy compensator, or other flotation device that stabilizes his or her position with the face up, only one hand of the rescuer is needed to pull the victim, and the other hand may provide forward movement or may help in rescue breathing while swimming, using for example a snorkel.
Special care has to be taken for victims with suspected spinal injuries, and a back board (spinal board) may be needed for the rescue. In water, CPR is ineffective, and the goal should be to bring the victim to a stable ground quickly and then to start CPR.
If the approach to a stable ground includes the edge of a pool without steps or the edge of a boat, special techniques have been developed for moving the victim over the obstacle. For pools, the rescuer stands outside, holds the victim by his or her hands, with the victim's back to the edge. The rescuer then dips the victim into the water quickly to achieve an upward speed of the body, aiding with the lifting of the body over the edge. Lifting a victim over the side of a boat may require more than one person. Special techniques are also used by the coast guard and military for helicopter rescues.
After reaching dry ground, all victims should be referred to medical assistance, especially if unconscious or if even small amounts of water have entered the lungs. An unconscious victim may need artificial respiration or CPR.
The Heimlich manoeuver is not recommended; the technique may have relevance in situations where airways are obstructed by solids but not fluids. Performing the manoeuver on drowning victims not only delays ventilation but may induce vomiting, which if aspirated will place the patient in a far worse situation. Moreover, the use of the Heimlich manoeuvre in any choking situation, involving solids or fluids, has become controversial and is generally no longer taught. For more information on this debate refer to the article Henry Heimlich.
100% oxygen is neither recommended nor discouraged[1]. Treatment for hypothermia may also be necessary. Water in the stomach need not be removed, except in the case of paediatric drownings as a gastric distension can limit movement of the lungs. Other injuries should also be treated (see first aid). Victims that are alert, awake, and intact have nearly a 100% survival rate.
Drowning victims should be treated even if they have been submerged for a long time. The rule "no patient should be pronounced dead until warm and dead" applies. Children in particular have a good chance of survival in water up to 3 minutes, or 10 minutes in cold water (10 to 15 °C or 50 to 60 °F). Submersion in cold water can slow the metabolism drastically. There are rare but documented cases of survivable submersion for extreme lengths of time. In one case a child named Michelle Funk survived drowning after being submerged in cold water for 70 minutes. In another, an 18 year old man survived 38 minutes under water. This is known as cold water drowning.
References
- ↑ "2005 ILCOR resuscitation guidelines" (PDF). Circulation. 112 (22 supplement). 29. doi:10.1161/CIRCULATIONAHA.105.166480. Retrieved 2008-02-17.
There is insufficient evidence to recommend for or against the use of oxygen by the first aid provider.
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