Study Notes on Submersion Incidents: Drowning and Diving Emergencies

Chapter 25: Submersion Incidents: Drowning and Diving Emergencies

Learning Readiness

  • EMS Education Standards: Reference: p. 901 in the textbook.

  • Chapter Objectives: Reference: p. 901 in the textbook.

  • Key Terms: Reference: p. 901 in the textbook.

  • Purpose of Lecture Presentation vs. Textbook Reading Assignments:

    • These aspects outline the goals and methods of education regarding emergency medical services related to drowning and diving emergencies.

Setting the Stage

  • Overview of Lesson Topics:

    • Water-Related Emergencies

    • Scuba or Deep-Water Diving Emergencies

Case Study Introduction

  • Incident Description:

    • EMTs Jacob Stilts and Lydia Huse respond to a call regarding a child drowning in a residential pool.

    • Upon arrival, they observe a woman performing CPR on a toddler.

    • Family reports that the child was missing for approximately 5 to 10 minutes before being found submerged at the pool's bottom.

    • The family member who retrieved the child from the pool began CPR immediately.

Case Study (Prevention and Survival Factors)

  • Preventative Measures Inquiry:

    • What actions could have prevented this drowning incident?

  • Survival Influencing Factors:

    • What factors affect the chances of survival for the drowned child?

Introduction to Water-Related Emergencies

  • Emergency Care Needs:

    • Patients suffering from drowning incidents require immediate medical care.

    • Medical personnel should be aware of environmental hazards that may pose risks and must have emergency medical skills while managing such cases.

Water-Related Emergencies Overview

Prevention Measures

  • Personal Flotation Devices (PFDs):

    • Could significantly reduce drowning deaths.

  • Fencing for Pools:

    • All pools should be secured with fencing to prevent access by young children.

  • Supervision:

    • Children should be constantly supervised when near any body of water or large containers of water.

  • Alcohol Avoidance:

    • Avoid using alcohol when engaging in water activities.

Definitions

  • Drowning:

    • Defined as an event where a person becomes submerged or immersed in liquid, resulting in primary respiratory impairment.

    • The liquid obstructs the patient’s ability to breathe air, potentially leading to death or survival post-event.

Incidence of Drowning

  • Statistics:

    • Drowning is a leading cause of death in children, particularly in bathtubs.

    • Causes of death statistics:

    • More children aged 1-4 years die from drowning than any other cause, other than birth defects.

    • The second most affected group is children aged 1-14 years.

    • Demographics:

    • Approximately 80% of drowning cases involve males.

    • Bathtubs are notable drowning sites particularly for individuals with seizure disorders.

    • Alcohol frequently plays a role in many drowning incidents.

Drowning Risk Factors

  • **Associated Risks: **

    • Water sports carry risks for drowning and head/spinal traumas.

    • Scuba diving incidents can result from various factors such as panic, inexperience, exertion, or poor judgment.

Panic in Drowning Situations

  • Impact of Panic:

    • Panic often exacerbates situations leading to drowning and can contribute to the death of the person who panics or loses self-control.

Prognostic Predictors for Drowning Outcomes

  • Survival Characteristics:

    • Patients with the following characteristics have higher survival chances:

    • Age 3 years or older

    • Submerged for less than 5 minutes

    • Resuscitation initiated within 10 minutes after rescue

    • Not comatose upon arrival at emergency department (ED)

    • Arterial blood pH levels >= 7.10.

Pathophysiology of Drowning

  • Mechanism of Injury:

    • Submersion leads to water aspiration or laryngeal spasms resulting in suffocation.

    • Consequences:

    • Leads to hypoxia and acidosis, which can cause irreversible brain damage and death.

Surfactant Mechanism in the Lungs

  • Function of Surfactant:

    • Surfactant helps maintain alveolar surface tension, preventing collapse.

  • Impact of Water Inhalation:

    • Water influx washes out surfactant, which causes alveolar collapse, leading to acute respiratory distress syndrome (ARDS).

Hypothermia in Drowning

  • Protective Role of Hypothermia:

    • Cold water submersion can result in hypothermia, which may protect the central nervous system (CNS).

    • Hypothermia leads to complications including hypovolemia (due to increased capillary permeability) and cardiac dysrhythmias.

Factors Influencing Drowning Severity

  • Significant Indicators:

    • Persistent cough, dyspnea/apnea, altered mental status, vomiting, and the influence of drugs/alcohol.

    • History of neurological or metabolic disorders (e.g., seizures, diabetes, neuromuscular problems) and factors like age, hypothermia, duration of oxygen deprivation, and pre-existing health conditions also impact severity.

Diving Emergencies Overview

Common Locations of Injuries

  • Diving Incidents:

    • Typically occur in shallow waters, with risks of head and spinal injuries along with extremity or rib fractures.

Safety Measures in Water-Related Emergencies

  • Rescue Guidelines:

    • Rescuers should only proceed if they satisfy the following conditions:

    • Proficient swimming skills

    • Training in water rescue techniques

    • Wearing an appropriate PFD

    • Accompanied by additional rescuers.

Rescue Strategies

  • Reach, Throw, Row, Go Strategy:

    • Utilize floating objects and ropes to safely pull patients to shore without risking the rescuer's safety.

Possible Spine Injury Indicators

  • Symptoms Indicating Potential Spine Injury:

    • Considered if:

    • Diving incident occurred

    • Struck by skis or other objects

    • Utilization of water slides

    • Suspected intoxication

    • Signs of traumatic injury are apparent.

Resuscitation Techniques

  • Mammalian Diving Reflex:

    • Triggered in cold water reduced metabolic responsiveness significantly, allowing for potential resuscitating long after submersion.

Assessment-Based Approach: Drowning and Water-Related Emergencies

Scene Size-Up

  • Safety Measures:

  • Ensure personal safety first.

  • Wear a PFD if within 10 feet of the water’s edge.

  • Standard precautions should be taken.

  • Identify relevant mechanisms of injury.

  • Call for additional resources as necessary.

Primary Assessment

  • Process:

    • Form a general impression.

    • Mental status evaluation.

    • Consider potential spinal injury.

    • Ensure patent airway.

    • Provide positive pressure ventilation if breathing inadequately.

    • Maintain oxygenation and evaluate for bleeding/hypoperfusion.

    • Determine transport priority based on findings.

Secondary Assessment

  • Actions:

    • Conduct physical examination.

    • Obtain medical history.

    • Assess for signs and symptoms including:

      • Airway obstruction

      • Inadequate or absent breathing

      • Cardiac arrest or spinal/head injuries

      • Soft tissue injuries, musculoskeletal injuries, and signs of shock.

    • Categorize patients into:

      • Asymptomatic

      • Symptomatic

      • Cardiac arrest

      • Obviously deceased.

Emergency Care Algorithm: Drowning

Patient Assessment Flowchart

  1. Identifying Mechanisms of Injury & Assessment:

    • Consider spine motion restrictions if necessary.

    • Caution: Remove patient from water while providing ventilation if needed.

  2. Mental Status Assessment:

    • Alert and obeying commands vs. altered/unresponsive.

  3. Airway Management:

    • Open airway as needed and assess breathing adequacy.

  4. Circulation and Transport Priorities:

    • Maintain pulse if present; initiate CPR and AED if absent.

    • Manage gastric distention as required.

    • Initiate transport to medical facility.

Case Study Management Steps

  • Rescuer Actions:

    • Jacob oversees CPR transition, assesses pulse absence, and identifies potential injuries.

    • Lydia gathers history from family.

Patient Management Steps

  • Care Techniques:

    • Safely remove patient from water and provide airway support.

    • Position patient accordingly for breathing effectiveness.

    • Keep an eye on additional medical conditions during transport.

Treatment Summary

  • Drowning Incidents:

    • Immediate medical intervention is crucial during drowning episodes.

    • If no pulse is detected, initiate CPR and deploy an AED when appropriate.

Summary of Drowning and Diving Emergencies

  • Prevention & Risk:

    • Awareness and education about circumstances leading to drowning to increase preventive measures.

  • Emergency Response Focus:

    • Prioritize airway, breathing, circulation, and prompt resuscitation actions including CPR for patients in arrest.

  • Understanding Diving Physiology:

    • Familiarity with gas laws related to scuba diving emergencies enhances treatment knowledge.

References and Copyright

  • Copyright Notice:

    • All materials and content provided by Pearson Education, Inc. are restricted for educational use only. The dissemination or sale of any part is prohibited.