EMT Standing Order:

• Routine Patient Care.
• Victims with only respiratory arrest usually respond after a few artificial breaths are given.
  • Give a few breaths and check for a pulse.
    • Anticipate vomiting
• For patients in cardiac arrest, provide immediate CPR.
  • Utilize the sequence ABC, not CAB, i.e. start with airway and breathing before compressions.
• Routine stabilization of the cervical spine in the absence of circumstances that suggest a spinal injury is not recommended.
  • If c-spine injury is suspected, see Advanced Spinal Assessment Procedure and Spinal Motion Restriction Protocol.
• Obtain specific history: time, temperature, associated trauma, etc.
• Begin resuscitation efforts while removing the patient from the water.
• Consider hypothermia. (See Hypothermia Protocol - Adult & Pediatric).
• Remove wet clothes and warm the patient.
• All patients with a history of submersion should be transported to the hospital.
• Reassure anxious patient.
• If the water temperature is estimated to be less than 6o C and submerged:
  • Less than 90 minutes: Initiate full resuscitation
  • Greater than 90 minutes: Consider not initiating resuscitation or termination of efforts. Contact Medical Direction for guidance.
• If water temperature is estimated to be greater than 6o C and submerged:
  • Less than 30 minutes: Initiate full resuscitation
  • Greater than 30 minutes: Consider not initiating resuscitation or termination of efforts. Contact Medical Direction for guidance.
• Call for Paramedic intercept, if available. If not available, call for AEMT intercept.

AEMT/PARAMEDIC Standing Order:

• Consider CPAP to supplement the patient’s own spontaneous respiratory effort.
• Establish IV/IO access.

  Do not attempt water rescues unless properly trained and equipped. When operating on scenes involving water, use extreme caution and wear a Personal Flotation Device (PFD).

PEARLS:

• There is no need to clear the airway of aspirated water; only a modest amount of water is aspirated by most drowning victims, and aspirated water is rapidly absorbed into the central circulation.
• Unnecessary cervical spine immobilization can impede adequate opening of the airway and delay delivery of rescue breaths.
• SCUBA Diving related injuries: for patients presenting with suspected diving-related emergencies, a thorough assessment should include obtaining the patient’s dive computer and/or dive plan. The major types of dive-related illnesses include Pulmonary Over-Pressurization Syndromes (POPS) and Decompression Sickness (DCS). Seriously ill patients may present with any combination of altered mental status, respiratory distress or shock. After recognition of a suspected diving related emergency, treatment should focus on supplemental oxygen and rapid transport. ED staff should be fully briefed on the patient’s dive history.

* Consider to transport to a hospital with Hyperbaric Chamber management.