As the summer wanes, and kids return to school, you, as an emergency responder, may be lulled into believing that the risk of drowning has subsided or at least diminished significantly. As the fall approaches, fewer people are engaged in water sports, vacations are winding down, and swimming is less of a focus.
But the reality is quite different. Not only is drowning a significant year-round threat across the United States, but it is also a lethal worldwide phenomenon.
A GLOBAL THREAT
According to the World Health Organization (WHO), drowning is now the third leading cause of unintentional injury death around the world, with an estimated 360,000 drownings occurring each year. Not surprising, children are at highest risk, as are males and individuals with increased access to water. Here are some frightening statistics (2014) from WHO’s Media Centre Report on Drowning¹:
- Drowning is one of the top five causes of death of people aged one to 14 years for 48 of 85 countries with data meeting inclusion criteria.
- In Australia, drowning is the leading cause of unintentional injury death in children aged one to three years.
- In Bangladesh, drowning accounts for 43 percent of all deaths in children aged one to four years.
- In China, drowning is the leading cause of injury death in children aged one to 14 years.
- In the United States, drowning is the second leading cause of unintentional injury death in children aged one to 14 years.
Other factors associated with an increased risk of drowning include:
- Those occupying lower socioeconomic classes
- Members of ethnic minorities
- Those lacking higher education
- Individuals living in rural populations
- Infants left unsupervised or alone with another child around water
- Alcohol use, near or in the water
- Certain medical conditions, such as epilepsy
- Tourists unfamiliar with local water risks
DROWNING DEFINED
The 2002 meeting of the World Congress on Drowning did away with the term “near-drowning,” instead defining drowning as any process of respiratory impairment caused by submersion or immersion in liquid.² In conjunction, the International Life Saving Federation has produced a list of safety recommendations for various water environments, to reduce the number of drownings globally. They are:
Beach Safety
- Check the water conditions before entering.
- Swim at a beach patrolled by lifeguards.
- Swim between the red and yellow flags.
- Swim with a friend.
- Read and follow instructions on safety signs.
- Never swim after consuming alcohol.
- Surfers and swimmers should not use the same water area at the same time.
- Float with a rip current; do not try to swim against it.
Inland Water Safety
- Swim at an area supervised by lifeguards.
- Check water conditions before entering.
- Swim only in designated swimming areas.
- Swim with a friend.
- Read and follow instructions on safety signs.
- Do not dive into water of unknown depth; beware of submerged objects.
- Never swim after consuming alcohol.
- Float with a current; do not try to swim against it.
Home Water Safety
- Home pools should be fenced.
- Ensure the pool gate is closed and latched at all times.
- Keep watch and supervise children at all times.
- Never swim alone.
- Never leave buckets or pails of water accessible to children.
- Install mesh over ponds.
- Empty baths when not in use.
- Learn water safety and CPR.
Safe Boating
- Take a boating safety course before boating.
- Ensure the boat is in good condition before use.
- Ensure all safety equipment is available and in working condition.
- Wear life jackets.
- Let someone know where you are going.
- Never overload the boat with people or equipment.
- Keep a watch on the weather conditions.
- Stay clear of swimmers.
TREATING THE DROWNED PATIENT
The initial assessment of the drowned patient is critical to aggressive treatment. Assessment should include³:
- Preventing injuries to patient and responders
- Initiating plans early for water extraction and rapid transport
- Conducting a safe water rescue and recognizing need for spinal immobilization
- Assessing ABCs
- Reversing hypoxia and acidosis
- Restoring or maintaining cardiovascular stability
- Preventing further loss of body heat and initiating rewarming in the hypothermic patient
Drowning scenarios are primarily respiratory emergencies. If alcohol was involved or the patient was seen diving into the water, treat for spinal injury via immediate immobilization before removing the patient from the water. Your main priority: rescuer safety!
THE ROLE OF MEDICAL SUCTION FOR DROWNING
Like any respiratory emergency, your main objective is to support oxygenation, reverse hypoxia, and maintain a patent airway. You’ll need your portable suction unit for each stage of this process. Begin by:
- Providing supplemental oxygen as soon as possible
- Performing endotracheal intubation
- Providing positive end-expiratory pressure
- Performing CPR if the patient is in full arrest
Each of these steps may require intermittent medical suction. The patient may expel water, which will need to be evacuated via suction. If intubation is performed, suction may be necessary to visualize the cords, especially in the presence of trauma. Cardiac compressions may force water from the patient’s lungs and stomach, so keep the portable suction unit nearby.
Drowning is a common threat, and like any respiratory emergency, it requires immediate action and effective treatment. And a crucial piece of equipment is your portable suction unit.
¹ 2017, World Health Organization, Media Centre Report on Drowning, http://www.who.int/mediacentre/factsheets/fs347/en/
² 2011, Pollak, A., Ed.
Critical Care Transport, American College of Emergency Physicians, Jones and Bartlett.
³ 2011
Prehospital Trauma Life Support, American College of Surgeons, Committee on Trauma, MOSBY JEMS, Elsevier.