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:

 

• Oxygen
• Consider Spinal Immobilization
• Remove all wet clothing
• Re-warm

• 12-Lead EKG
• Obtain BGL

• Initiate IV

 

Respiratory distress, wheezing, rales?

 

• Yes

 

• • Consider CPAP (EMT)

 

• • Consider Albuterol (Ventolin) 5 mg via nebulizer (EMT)

 

• No

 

Hypothermia ≤ 95⁰F (35⁰C)?

 

• Yes

 

• • See Hypothermia Protocol

 

• 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.
• Regardless of water temperature - resuscitate all patients with unknown submersion time of ≤ 30 minutes.
• If submersion time ≥ 90 minutes consider moving to recovery phase instead of rescue, unless water temperature is < 43° F.
• 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), contact Divers Alert Network at 1-919-684-9111 for guidance.
• Consider hypothermia in all drownings.
• Transport should be strongly advised on all patients who's head was submerged underwater.