Emergency Treatment: Drowning Incidents

Drowning is a significant public health concern, causing death and disability, especially in children. It is important to know how to swim and to never leave a child unattended near water. First responders, including EMS personnel and lifeguards, should be well-versed in advanced interventions such as airway management and CPR. Hospitals play a crucial role in treating drowning victims by providing critical care, monitoring, and therapeutic interventions to improve patient outcomes. This involves addressing respiratory distress, fluid and electrolyte imbalances, neck and spine injuries, and potential neurological complications.

Assessing the situation: Knowing the signs of drowning and how to respond

Drowning is a significant public health concern and a major cause of death and disability, especially in children. It is important to know how to identify and respond to a drowning person, as immediate action and first aid can prevent death.

A person who is drowning may not always exhibit the distressed call for help that is typically associated with drowning. They may not be able to shout for help at all and can go unnoticed, even if people are nearby. Be alert for signs of drowning, such as uneven swimming motions, which could indicate that the swimmer is getting tired. Often, only the person's head may be visible above the water as their body sinks.

If you suspect someone is drowning, do not put yourself in danger. Extend a long pole, tree branch, or throw a rope attached to a buoyant object like a life jacket to reach them. Call for emergency medical help as soon as possible, even if you are trained and able to rescue the person yourself.

Once the person has been rescued from the water, perform a primary survey. If they are unresponsive and not breathing, start CPR. If there is a helper, ask them to call for emergency services and bring a defibrillator if available. If you are alone, use a hands-free speaker on your phone to call for help while performing CPR.

If the person shows signs of responsiveness, such as coughing, opening their eyes, speaking, or breathing normally, place them in the recovery position. Monitor their level of response and be prepared to administer CPR again if necessary.

First aid: Performing CPR, rescue breathing, and other immediate treatments

Immediate first aid can prevent death in drowning cases. When someone is drowning, they may not always call out for help, so it is important to be vigilant for other signs of distress, such as uneven swimming motions.

If someone is drowning, and you are trained and able to do so, attempt a rescue. However, do not put yourself in danger. Try to extend a long pole or tree branch, or throw a rope attached to a buoyant object to the person. Once the person is out of the water, perform a primary survey. If they are unresponsive and not breathing, start CPR. Ask someone else to call emergency services and bring a defibrillator, if available. If you are alone, use the hands-free speaker on your phone to call for help so that you can continue CPR while speaking to emergency services.

If you are trained in CPR, open the person's airway and begin rescue breathing (mouth-to-mouth or mouth-to-nose) after 30 chest compressions. Place one palm on their forehead and tilt their head back, then use your other hand to gently lift their chin. Pinch their nose closed, cover their mouth with yours, and breathe into their mouth for one second. Watch to see if their chest rises. If it does, give another breath. If not, tilt their head back and lift their chin again before repeating your breath. Give 30 more chest compressions, then two rescue breaths. Repeat this pattern until the person begins to move or help arrives.

If you do not feel comfortable giving rescue breaths, continue performing chest compressions until help arrives. Keep in mind that chest compressions alone may not be enough to resuscitate the person. If two people are able to perform CPR, give one to two rescue breaths after 15 chest compressions, then trade off.

If the person shows signs of responsiveness, such as coughing, opening their eyes, speaking, or breathing normally, place them in the recovery position. You may also need to treat them for hypothermia by covering them with warm clothes and blankets, and replacing wet clothes with dry ones. Monitor their level of response and be prepared to give CPR again if necessary. If a defibrillator is used, leave it attached.

Even if the person seems alert with good breathing and a strong pulse, seek medical attention. Lung complications, fluid and body chemical imbalances, irregular heart rhythms, and other injuries may be present after a drowning incident.

Hospital care: Monitoring core temperature, providing neurological examinations, and managing complications

Hospital care for drowning victims involves several critical steps, including monitoring core temperature, providing neurological examinations, and managing various complications.

Monitoring Core Temperature:

Maintaining an optimal core temperature is crucial for drowning victims. Therapeutic hypothermia, or controlled cooling, has been suggested to provide neuroprotection and improve recovery chances. Continuous monitoring of core temperature is mandatory in the emergency department and intensive care unit. This monitoring should also be extended to the pre-hospital setting whenever possible.

Providing Neurological Examinations:

Neurological examinations are essential for assessing brain function and identifying any potential neurological sequelae from drowning. Frequent examinations can help detect any deterioration in brainstem function, which could indicate a poor prognosis. Additionally, continuous EEG monitoring may be employed to detect subclinical seizures.

Managing Complications:

Drowning victims often experience lung complications, including fluid and electrolyte imbalances. Irregular heart rhythms are also common, and resuscitation efforts may be required. In cases of near-drowning, observation in a hospital setting is recommended, even if the person appears to be recovering well. This is due to the potential for delayed onset of complications. Neck and spine injuries may also occur, particularly if the person dove into shallow water, and require careful management to facilitate rescue breathing.

Therapeutic hypothermia: Using controlled cooling to potentially improve neurological outcomes

Drowning is a significant public health concern, causing death and disability, especially in children. Therapeutic hypothermia (TH) is a promising treatment that has been shown to improve neurological outcomes in drowning victims.

TH is a neuroprotective therapy that has been used to improve outcomes for neonates with neonatal encephalopathy (NE), a syndrome of disturbed neurological function in infants. NE is often caused by hypoxic-ischemic encephalopathy (HIE), which occurs when there is a decrease in cerebral blood flow and oxygenation, leading to brain injury. TH has been shown to improve outcomes in motor, cognitive, behavioural, and neurological domains in children with HIE.

The use of TH in drowning victims is based on the idea of controlled cooling to reduce brain injury and improve neurological outcomes. The goal is to lower the core body temperature to less than 35°C within six hours of hospitalization. This can be achieved through surface cooling or endovascular cooling methods. Endovascular cooling can reach target temperatures faster but requires expertise and training for catheter insertion.

The benefits of TH have been observed in adults who experienced out-of-hospital cardiac arrest, with improved survival and neurological outcomes in clinical trials. TH has also been shown to reduce mortality and unfavorable outcomes, such as severe disability, in patients with traumatic head injuries.

While TH shows promise, it is not without side effects, and further research is needed to optimize its use. Some combined treatments, such as argon-augmented TH, have not shown synergistic effects, and TH has been associated with higher rates of pneumonia. Additionally, there are barriers to implementation, including a lack of awareness of effective techniques and controversies over the best methods to reach target temperatures.

Prevention: Educating the public about water safety and drowning prevention measures

Drowning is a significant public health concern, causing death and disability, especially in children. It is the number one cause of death for children aged 1 to 4 years and the leading cause of death for people with autism.

To prevent drowning incidents and educate the public about water safety, several measures can be implemented:

• Swimming lessons: Teach children and adults how to swim. Swimming lessons offered by organizations like the American Red Cross can help individuals of all ages develop swimming skills and water safety awareness.
• Water safety education: Promote water safety education through free online courses, videos, and activities provided by organizations like the American Red Cross. These resources teach important concepts such as avoiding common dangers, fundamental water safety skills, and recognizing and responding to drowning emergencies.
• Close supervision: Parents and caregivers should provide close and constant supervision when children are in or around water. This includes pools, bathtubs, decorative ponds, and other water sources. Even good swimmers can drown, so it is crucial never to leave a child unattended.
• Life jackets: Encourage the use of U.S. Coast Guard-approved life jackets for children, inexperienced swimmers, and boaters. This simple precaution can significantly reduce the risk of drowning.
• Safe swimming practices: Teach individuals to always swim in lifeguarded areas. Emphasize the importance of seeking permission before going near water and checking for potential hazards in the water environment, such as fencing around pools and spas.
• Emergency response training: Educate parents, caregivers, and community members on how to respond in a water emergency. This includes recognizing the signs of someone in distress, such as splashing, waving their arms, or trying to stay afloat. Knowing how to perform CPR, rescue breathing, and basic first aid can be life-saving.
• Public awareness campaigns: Collaborate with local authorities, emergency responders, and swimming organizations to develop and disseminate drowning risk statistics and prevention guidelines. Raise awareness about the dangers of drowning and provide accessible resources for individuals and families to stay safe.
• Fencing and barriers: Implement physical barriers, such as four-sided fencing, to separate water sources like pools and spas from the immediate surroundings. This prevents unsupervised access, especially by young children.

By implementing these prevention measures and educational initiatives, the public can be better equipped with the knowledge and skills to stay safe in and around water, ultimately reducing the incidence of drowning.

Frequently asked questions