STANDING ORDERS - ADULT & PEDIATRIC:

• 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.
• 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,
• 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 water temperature is estimated to be less than 6 Co 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 6 Co 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 AEMT/Paramedic intercept. & Assisst AEMT/Parmedic in patient care.

AEMT/Paramedic Standing Order:

• Consider High concentration of oxygen to supplement the patient’s own spontaneous respiratory effort.
• Establish IV \ IO access

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.