Drowning and Submersion

 

History:

 

  • Submersion in water regardless of depth
  • Possible trauma to C-spine
  • Possible history of trauma (i.e., diving board)
  • Duration of immersion
  • Temperature of water or possibility of hypothermia

 

Significant Findings:

 

  • Unresponsive
  • Mental status changes
  • Decreased/absent vital signs
  • Vomiting
  • Coughing
  • Apnea
  • Stridor
  • Wheezing
  • Rales

 

Differential:

 

  • Trauma
  • Pre-existing medical problem
  • Pressure injury (i.e., diving)
  • Barotrauma
  • Decompression sickness
  • Post-immersion syndrome
  • Hypothermia

 

Treatment:

 

 

 

 

  • 12-Lead EKG
  • Obtain BGL

 

 

  • Initiate IV

 

Respiratory distress, wheezing, rales?

 

  • Yes

 

 

 

 

 

  • No

 

Hypothermia ≤ 95⁰F (35⁰C)?

 

  • Yes

 

 

  • No

 

    • See appropriate protocol based on symptoms

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Drownings have a high index of suspicion for possible spinal injuries.
  • When water temperature is less than 70⁰F (21⁰C) there is no time limit; resuscitate all.  These patients have an increased chance of survival.
  • Some patients may develop delayed respiratory distress.
  • All victims should be transported for evaluation due to potential for worsening over the next several hours.
  • Drowning is a leading cause of death among would-be rescuers.
  • Allow appropriately trained and certified rescuers to remove victims from areas of danger.
  • With pressure injuries (decompression/barotrauma), consider transport to a hyperbaric chamber located at Greenville Memorial.
  • Consider hypothermia in all drownings.

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRAEMT

National Registry Advance Emergency Technician