Ambulance UK October 2021

FEATURE
Rescue
• Avoid entry into the water whenever possible. If entry into the water is
essential, use a buoyant rescue aid or flotation device.
• Remove the victim from the water and start resuscitation as quickly
and safely as possible.
• Cervical spine injury is uncommon in drowning victims (approximately
0.5%). Spinal immobilisation is difficult in the water and delays
removal from the water and adequate resuscitation of the victim.
• Consider cervical spine immobilisation if there is a history of diving,
water slide use, signs of severe injury, or signs of alcohol intoxication.
• Despite potential spinal injury, if the victim is pulseless and apnoeic
remove them from the water as quickly as possible (even if a back
support device is not available) whilst attempting to limit neck flexion
and extension.
• Try to remove the victim from the water in a horizontal position to
minimise the risks of post-immersion hypotension and cardiovascular
collapse.
Ventilation (3)
• Prompt initiation of rescue breathing or positive pressure ventilation
increases survival. If possible supplement ventilation with oxygen.
• Give five initial ventilations as soon as possible.
• Rescue breathing can be initiated whilst the victim is still in shallow
water provided the safety of the rescuer is not compromised.
• If the victim is in deep water, open their airway and if there is no
spontaneous breathing start in-water rescue breathing if trained to do so.
• In-water resuscitation is possible, but should ideally be performed
with the support of a buoyant rescue aid.
• If normal breathing does not start spontaneously, and the victim is <
5 min from land, continue rescue breaths while towing. If more than
an estimated 5 min from land, give rescue breaths over 1 min, then
bring the victim to land as quickly as possible without further attempts
at ventilation.
Regurgitation (3)
• Expect the casualty to vomit.
• If regurgitation occurs, turn the victim’s mouth to the side and remove
the regurgitated material
• There is no need to clear the airway of aspirated water as this is
absorbed rapidly into the central circulation.
• Do not use abdominal thrusts or tip the victim head down to remove
water from the lungs or stomach.
Chest compressions (3)
• As soon as the victim is removed from the water, check for breathing.
If the victim is not breathing (or is making agonal gasps), start chest
compressions immediately.
• Continue CPR in a ratio of 30 compressions to 2 ventilations.
• Most drowning victims will have sustained cardiac arrest secondary to
hypoxia. In these patients, compression-only CPR is likely to be less
effective and standard CPR should be used.
Post Rescue Care
After Drop
A phenomena known as “After Drop” can occur as a result of aggressive
rewarming; peripheral vasodilation can lead to a redistribution of blood
and a drop in core temperature. This can occur during treatment or
even after recovery. This can be prevented by moderated warming
techniques; If the casualty has vital signs, is insulated and immobile,
there is no rush to actively warm them.
Curcum Rescue Collapse
Particularly evident in immersion hypothermia casualties, ‘Curcum
Rescue Collapse’ has been attributed to the aggressive repositioning
of the casualty from a floating horizontal position to vertical as they
were winched out of the sea using a hoist. Standing up quickly can
cause orthostatic hypotension; a drop in blood pressure as the vascular
system cannot constrict fast enough in the lower limbs and abdomen
to squeeze oxygenated blood up to the brain; this is noticeable by the
‘head rush’ or feeling of light-headedness as the brain is momentarily
deprived of oxygen.
Combined with the immediate loss of hydrostatic pressure which was
being exerted on the body whilst the casualty was immersed, this
drop in blood pressure can reduce cerebral perfusion to the point of
unconsciousness and cardiac perfusion to the point of cardiac arrest.
Both immersion and severely hypothermic casualties are now rescued
horizontally and as such, should remain in this position until rescue.
References
1. Hawkings JC, Sempsrott J and Schmidt A (2016) “Drowning in a Sea of
Misinformation: Dry Drowning and Secondary Drowning” Emergency medicine
News. https://journals.lww.com/em-news/blog/BreakingNews/pages/post.
aspx?PostID=377 Accessed 19th January 2021
2. https://www.who.int/en/news-room/fact-sheets/detail/drowning
3. UK Resuscitation Council (2019) “Cardiac Arrest in Special Circumstances” in
Advanced Life Support Guidelines. Ch 12. 113:142
4. Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM et al (2003)
“Recommended Guidelines for Uniform Reporting of Data From Drowning”.
Circulation. 108[20]:2565
5. Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Cushing TA, Auerbach PS. (2016)
“Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of
Drowning”. Wilderness and Environmental Medicine. June;27(2):236-51.
6. Szpilman D, Pearn J, Queiroga AC (2019) “Medical Position Statement MPS
22 – Research Needs for Drowning”. International Lifesaving Fderation Rescue
Commission 28/08/2019. https://www.ilsf.org/wp-content/uploads/2020/01/
MPS-22-2019-Research-Needs-for-Drowning.pdf Accessed 19th January 2021
7. American Heart Association (2005) “Drowning”. Circulation. 112(2) Supp. 13.
IV-133-IV-135.
8. International Lifesaving (2015) “World Conference on Drowning Prevention 2015
– Malaysia: Program and Proceedings”. ILS. https://www.ilsf.org/wp-content/
uploads/2018/11/WCDP2015_ProgramProceedingsLR.pdf Accessed 19th
January 2021
9. Datta A and Tipton M (2006) “Respiratory responses to cold water immersion:
neural pathways, interactions, and clinical consequences awake and asleep”.
Journal of Applied Physiology. 100:6, 2057-2064
10. Giesbrecht G. (2000) “Cold stress, near drowning and accidental hypothermia: A
review”. Aviation, Space, and Environmental Medicine. 71. 733-52.
11. Matthew JA. (2016) “Submersion and Diving-Related Illnesses”. In: David S.
(eds) Clinical Pathways in Emergency Medicine. Springer, New Delhi.
12. Schmidt AC, Sempsrott JR, Hawkins SC, Arastu AS, Cushing TA, Auerbach PS. (2016)
“Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of
Drowning”. Wilderness and Environmental Medicine. Jun;27(2):236-51.
13. Vittone M and Francesco A. (2006) “Drowning doesn’t look like drowning”.
On Scene – the Journal of of U. S. Coast Guard Search and Rescue. Fall. P.14.
https://mariovittone.com/wp-content/uploads/2010/05/OSFall06.pdf Accessed
19th January 2021
14. National operational Guidance: Water Rescue and Flooding”. National Central
Programme Office. https://www.ukfrs.com/pdf/print/node%3A20802 Accessed
on 9th January 2021
15. Tipton MJ, Golden FS. (2011) “A proposed decision-making guide for the
search, rescue and resuscitation of submersion (head under) victims based on
expert opinion”. Resuscitation. Jul;82(7):819-24
AMBULANCE UK - OCTOBER
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