Medicine for the Outdoors
Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Drowning Update

A common summertime outdoor health topic is drowning. We can never do too much to prevent these tragic events. When they occur, prompt response with appropriate rescue and first aid measures can make all the difference between a tragic outcome and a happy ending. So, it’s important to keep up with current recommendations.  In a recent article in the New England Journal of Medicine (2012;366:2102-2110) entitled “Drowning,” Dr. David Szpilman and colleagues (including Dr. James Orlowski, who has been writing and teaching about drowning for decades), provided an excellent updated review of the topic. More than 500,000 deaths occur each year due to unintentional drowning. This figure does not include drowning that occur as a result of floods, tidal waves (tsunamis), and boating accidents. The latter represents a significant outdoor recreation hazard.

Drowning is an affliction of the young; it is the leading cause of death in boys ages 5 to 14 years. In the U.S., it is the second leading cause of injury-related death in children ages 1 to 4 years. When planning your education and injury prevention efforts, keep in mind the risk factors for drowning: male gender, age less than 14 years, alcohol use, seizure disorder (epilepsy), low income, poor education, rural residence, risky behavior, and very importantly, lack of supervision.

The World Health Organization adopted the following drowning definition in 2002: “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.” Thus, one does not necessarily need to die in order to drown. If someone dies, it is a fatal drowning.

Briefly, when someone is underwater, he or she swallows water or spits it out, then holds their breath, then inhales water. It is possible for spasm to occur in the larynx (throat), but this does not last for long, and when a person becomes unconscious from lack of oxygen to the brain, water passively enters the lungs. Immersion in cold water can prolong the physiological demise, because of certain protective effects of hypothermia.

Rescue techniques abound. Paramount in any attempt to assist is the admonition to not create additional victims. Thus, if the victim can be reached with an object in order to allow flotation or victim retrieval, that method should be undertaken. Call for assistance at the earliest possible moment. If a rescuer(s) reaches the victim in need of resuscitation (e.g., CPR) while both are still in the water, in-water resuscitation consisting of rescue breathing (ventilation) alone should be undertaken, because attempts at chest compression will be futile.

Injuries to the cervical spine (neck) are noted in less than 0.5% (1/200) of persons who are drowning, so immobilization of the neck while in the water is indicated only if head or neck injury is strongly suspected. Although it may be difficult, rescuers removing a victim from the water should try to maintain the victim in a vertical position while keeping the airway open, which may help to prevent vomiting and inhalation of stomach contents, as well as any further inhalation of water.

Once the drowned victim is out of the water, he should be placed on his back, with the trunk and head at the same level, and quickly checked for responsiveness and breathing. If he is unconscious but breathing, he should be placed in the “recovery position” (on his side) to allow drainage of liquid from the mouth and to avoid being on his back, which would cause aspiration in the event of vomiting. If he is not breathing, rescue ventilation is immediately begun. This intervention alone may lead to substantial improvement.

The remainder of the article reviews cardiac arrest from drowning, complications during resuscitation (for instance, do not perform the Heimlich maneuver to avoid vomiting and aspiration), advanced prehospital care, care in the emergency department, treatment in the intensive care unit, and drowning prevention. This is a very important article for rescue professionals, educators, clinicians, and anyone interested in the latest information on drowning.

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Tags: Staying Safe

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.