Treatment and Prevention of Drowning
Rescue of the Drowning Patient
Reaching the Patient
PATIENTS IN SUBMERGED VEHICLES
CARDIOPULMONARY RESUSCITATION AND PRIORITIZATION OF AIRWAY
AUTOMATED EXTERNAL DEFIBRILLATOR
CERVICAL SPINE PRECAUTIONS
Noninvasive positive pressure ventilation (NIPPV)
Disposition in the Wilderness
DECISION TO EVACUATE
- Any patient with abnormal lung sounds, severe cough, frothy sputum, foamy material in the airway, depressed mentation, or hypotension warrants immediate evacuation to advanced medical care if risks of evacuation do not outweigh potential benefit.
- Any patient who is asymptomatic (other than a mild cough) and displays normal lung auscultation may be considered for release from the scene. Ideally, another individual should be with them for the next 4 to 6 h to monitor for symptom development or the patient should be advised to seek medical assistance if symptoms develop.
- If evacuation is difficult or may compromise the overall expedition, patients with mild symptoms and normal mentation should be observed for 4 to 6 h. Any evidence of decompensation warrants prompt evacuation if the risks of evacuation do not outweigh the potential benefit.
- If evacuation of a mildly symptomatic patient has begun and the patient becomes asymptomatic for 4 to 6 h, canceling further evacuation and continuing previous activity may be appropriate.
CEASING WATER-BASED RESCUE AND RESUSCITATION EFFORTS
- Based on resources, it might be reasonable to cease rescue and resuscitation efforts when there is a known submersion time of greater than 30 min in water >6°C (43°F), or greater than 90 min in water <6°C (43°F), or after 25 min of continuous cardiopulmonary resuscitation.
- If at any point during search and rescue efforts the safety of the rescue team becomes threatened, rescue efforts should be ceased.
- If resources are available and recovery team safety is maintained, body recovery efforts may continue beyond the search and rescue period with the understanding that resuscitation attempts will likely be futile.
Disposition in the Emergency Department
PERSONAL FLOTATION DEVICES
COLD WATER SURVIVAL
- Upon falling into cold water, distance oneself from any immediate life threats (eg, fire, sinking vehicle, whitewater, hazardous waves, rocks). Then, remain calm and focused and control breathing by taking slow deep breaths.
- Consider physical capabilities, location, resources, and chances of rescue to determine whether to swim to safety.
- If a decision is made to swim to safety, this should be done as soon as possible before physical capabilities deteriorate from the effects of cold stress.
- If a decision is made to await rescue, an attempt should be made to remove as much of the body from the water as possible. All clothing should remain on, unless it hampers buoyancy. Most clothing does not compromise buoyancy and will not pull one down, although the water within the garment may impede movement. If the person remains immersed and has a flotation garment on, the heat escape lessening position should be maintained if possible. In a group, the huddle position may be used.
- If prolonged rescue is expected, it might be beneficial to attach oneself to a buoyant object or to a surface out of the water to improve the chance for survival.
Treatment and Prevention of Drowning
December 1, 2019
Last Updated Month/Year
April 13, 2023
Supplemental Implementation Tools
External Publication Status
Country of Publication
Female, Male, Adolescent, Adult, Older adult
Health Care Settings
Paramedic emt, nurse, nurse practitioner, physician, physician assistant
Prevention, Management, Treatment
D004332 - Drowning
hypothermia, Drowning, submersion, immersion, cold water submersion