by Lynn Taylor (Phd)
Water activities such as boating, fishing, swimming, surfing, scuba diving and freediving are a Kiwi way of life and pleasures that many of us enjoy. Whilst most days end happily, these activities do expose us to potential risks such as drowning. Last year, drownings in New Zealand were at an all time low since records began in 1980, but still with a total toll of 104.(1). Many of us will be able to recall stories of near misses, or successes of rescue by friends, family, trained surf life savers, or the Westpac Trust rescue helicopter.
An unconscious person who has been recovered after time submerged underwater should be treated as a victim of ânear drowningâ. This article aims to cover the practical, salient points for a member of the general public to follow, to give the victim the best possible chance for survival. It is not meant to substitute for proper training.
How should I get them out of the water?
Ideally it requires at least two adults to lift a person from the water into a boat as they should be lifted out in the prone position (lying horizontal, face downwards). (Head-out upright removal of a person from the water can cause circulatory collapse and is believed to be the cause of death in individuals found conscious in cold water but who perish within minutes of the rescue(2)). If you are alone on the boat, do the best you can. Priority is to get the victim out of the water.
What should I do once the diver is onboard?
Follow the ABC rule:
Lie the victim down. Tilt the victimâs head back and support the jaw by lifting the chin to carefully open the airway. Ensure their airway is unobstructed.
Check for breathing. Lean down, place one ear near the victimâs mouth and look towards the chest. Look for movement of the chest, listen and feel for breathing. If the victim is breathing place them on their side in a ârecoveryâ position with the head tilted backwards and the mouth slightly downwards. If not breathing, lay them on their back and initiate rescue breathing, also called expired air resuscitation (think of your own safety and use a âbarrierâ before commencing mouth-to-mouth resuscitation). In the case of a victim of submersion, the airway has been compromised and therefore five initial rescue breaths may be more appropriate than the two initial rescue breaths recommended in first aid courses in most countries (apart from Australia where the Australian Resuscitation Council recommend five initial breaths as standard). (3)
Check for signs of circulation. Look for movement such as swallowing or coughing. Check for a pulse. In the case of person rescued after some time in cold water, take up to 30-45 seconds to really check for a pulse, as the carotid (and other) pulse may not be palpable with severe hypothermia. If you canât feel a pulse after 30-45 seconds go ahead and start CPR. The recommendations for the ratio of number of chest compressions to rescue breaths, the depth and the frequency of compressions varies according to whether adult, child, or infant and (previously) whether performed by a single person or two persons. Due to recent changes in guideline protocols for adult basic life support CPR by a layperson is now identical for any number of operators. Compression:Ventilation ratio is recommended at 15:2 (15 compressions for two breaths) for all adult patients and remains at 5:1 for infants(4). Technique is most important and hence the recommendation for professional training. For an adult, use a compression rate of 100/minute and a compression depth of approx 1Â½-2 inches (4-5cm). For a child (1-8 yrs) use the same rate but a depth of 1-1Â½ inches (2.5-4cm). Check for a pulse (10 second check) every minute.
Who should I contact?
Call the emergency services immediately. However, if you are a lone rescuer, it is recommended that, for a case of submersion/near drowning, a sole rescuer provides approximately one minute of CPR (if required) before activating the Emergency Medical Services(3).
For a diving incident it is advisable to contact the Diver Emergency Service, however, contacting any of the Emergency Services by any method will initiate the rescue procedure as they will liaise with the necessary services involved. Be sure to mention it is a diving incident (even if the rescued victim appears to be okay).
Diver Emergency Services New Zealand 0800 4 DES 111 (0800 â 4 â 337 111). Australia 1800 088 200. International +61-8-8212 9242.
Coastguard on VHF Radio Channel 16 (or 2182kHz)
General Emergency Services cell phone 111
If your initial contact is with the Coastguard or 111 Emergency Services, request that contact is made with the Diver Emergency Services and await further advice.
Be sure to give them the following information(3):
â¢ Location of the emergency
â¢ How to contact you
â¢ The nature of the incident
â¢ How many people need help
â¢ Condition of the victim(s)
â¢ What aid is being provided
â¢ Any other information requested
Should I give them oxygen to breathe?
Yes. Water in the lungs inflames and damages the alveoli and reduces the effectiveness of the lungs, reducing oxygen uptake and leading to hypoxia. Hypoxia is an inevitable and most important consequence of submersion. It can progress for many minutes after successful rescue, even in a victim that appears to be recovering.Breathing elevated concentrations of oxygen helps to increase the blood oxygen levels and so reduce symptoms of hypoxia(3). If you own a boat you should consider carrying oxygen and receiving training in how (and when) to use it.
Should I warm them?
Attempts to re-warm patients with deep hypothermia outside the hospital setting are inappropriate, but measures to prevent further heat loss are important. Wet clothing should be removed before wrapping victim in thick blankets. Shivering is a good prognostic sign(2).
Should I give them a hot drink?
Hot drinks do not help prevent heat loss and should be avoided(2).
What should I do whilst waiting for the emergency medical services?
Make sure someone stays with the diver at all times as victims of near drowning can deteriorate rapidly without warning. The diver should be lying down, in a lateral ârecoveryâ type position. Continue to monitor the ABCs. If breathing stops, lay them on their back and initiate rescue breathing. If CPR is required, continue chest compressions until rendezvous with the EMS (or a pulse returns).
Where can I get appropriate training?
Professional dive training agencies have courses which teach you techniques in diver rescue and also courses in providing first aid. Contact your dive centre for details.Divers Alert Network have specialized courses in oxygen administration and first aid. Contact the DAN offices for your nearest instructor New Zealand (09) 445 5036 (North Island), (03) 364 0045 South Island, Australia 03-9886 9166, email firstname.lastname@example.org Many organisations run courses in general first aid and resuscitation techniques.
Useful resources: New Zealand Underwater produces the Dive Safe book which is packed with practical information and tips on safety and is available free of charge. Contact phone (09) 623 3252 or visit www.nzunderwater.org.nz. The launch of a new section on the website covering medical and educational topics is planned in 2004. Water Safety New Zealand have an array of excellent resources available on topics such as safe boating, beach safety, pool safety, safe fishing, child safety, river safety. Many booklets are available free of charge and some can be downloaded from their website. Contact phone (04) 801 9600 or visit www.watersafety.org.nz
Summary actions for victims of near drowning:
â¢ Remove the victim from the water in the prone (horizontal) position.
â¢ Call the Divers Emergency Services New Zealand 0800 4 DES 111, Aust. 1800 088 200
â¢ Assess airway, breathing, and circulation of victim and respond as required.
â¢ Give the diver 100% oxygen to breathe.
â¢ Prevent further heat loss by removing wet clothes and wrapping in blankets
â¢ Have someone stay with the diver.
â¢ Continue to monitor the ABCs.
Your knowledge and actions could save a life. Consider getting proper training and carrying oxygen aboard your boat.
References: 1. Water Safety New Zealand statistics www.watersafety.org.nz. 2. Harris M (2003) ABC of resuscitation. Near drowning. BMJ Vol 327. 3. Lippmann J (2002) Oxygen First Aid available through Dive New Zealand/Pacific mail order shop.