Optimal Care for the Drowning Patient


CarolinaFireJournal - James Winslow and Justin Sempsrott
James Winslow and Justin Sempsrott
08/07/2015 -

This time of year EMS personnel will likely see an increase in the number of drowning patients. It’s important for all EMS responders to review the care of the patient who has drowned. In this column we will quickly review what drowning is, the incidence of drowning, and the optimal care of the drowning patient. 

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In 2013, 4,056 people died from drowning in the United States. According to the CDC drowning is the leading cause of injury death among children between one and four years of age.

Definitions

Drowning is the process of primary respiratory impairment from submersion in a liquid. If someone is experiencing respiratory difficulty from being submerged under a liquid then they have drowned. The terms dry drowning, wet drowning, near drowning, and secondary drowning are not acceptable terms and should not be used. There can only be three outcomes from drowning; death, survival with brain damage, or survival without brain damage. 

Incidence

In 2013, 4,056 people died from drowning in the United States. According to the CDC drowning is the leading cause of injury death among children between one and four years of age. Everyday more than 10 people in the United States die from drowning.

Treatment

  • Drowning ranges from mild to moderate to severe. Everyone who drowns should receive a thorough medical evaluation and should be transported. A thorough medical evaluation is required because minimally symptomatic drowning patients can decompensate over the next several hours. 
  • Drowning is primarily a hypoxic event. Patients who have drowned who are not breathing or in full cardiac arrest should receive FIVE rescue breaths BEFORE starting chest compressions. A cardiac arrest caused by drowning is very different from a sudden cardiac arrest primarily due to ventricular fibrillation (VF) or ventricular tachycardia (VT). In sudden cardiac death from VF or VT the patient is usually not hypoxic so it’s okay to only do chest compressions. In drowning, the patient in cardiac arrest will be hypoxic so the main objective is to start with five rescue breaths before chest compressions.
  • Patients can be resuscitated from a full PEA or a systolic arrest if rescue breaths are given first.
  • Spinal immobilization should also be addressed if there is suspicion for trauma, but routine spinal immobilization is unnecessary.
  • There may be pulmonary edema (foam) coming from the patient’s airway. This can be wiped away but should not impede rescue breaths. The patient is also likely to vomit, which should be cleared from the airway.
  • Maneuvers to “push” water out of the chest such as back blows, chest thrusts, and abdominal thrusts are not indicated. Standard procedures can be utilized if the airway is obstructed. 
  • Further elaboration on the care of the drowning patient is described at the recently updated N.C. College of Emergency Physicians Drowning protocol found at http://www.ncems.org/nccepstandards/protocols/80DrowningSubmersionInjury.pdf

Summary

  • Drowning is a common cause of death and injury in the United States
  • Drowning is the only acceptable term to describe a person who suffers respiratory impairment from being submerged.
  • Five rescue breaths are the most important initial step in the treatment of the patient who has drowned. This should be done before chest compressions.

Justin Sempsrott has been an ocean lifeguard since 1996 and is the Founder and Executive Director of Lifeguards Without Borders. He is an emergency medicine and EMS physician with Wake Forest.Dr. Winslow graduated from Emergency Medicine residency from UNC-Chapel Hill in 2002 and completed his EMS Fellowship in 2003. He has worked at Baptist Hospital in Winston-Salem for the past 11 years. He was appointed as the Medical Director of the NC Office of EMS in 2011. This document contains all protocol, procedures, and policies for all EMS agencies in North Carolina.
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Issue 32.4 | Fall 2018

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