To Do Today:
- PT – 2 hours cross-train/team or individual sport.
- CPR/First Aid certification should be scheduled or completed NLT 15NOV.
- Review Mosbys Paramedic Textbook, pp. 1262–1266, by McKenna, Kim D. (2011)
- Review “It Doesn’t Look Like They’re Drowning” by Vittone, Mario and Pia, Francesco Ph.D. (2006).
- Review Recognizing Distressed Swimmers, Lifesaving Magazine.
Drowning is suffocation by liquid. It can lead to death and ongoing health problems. A drowning victim inhales water into the lungs or the throat closes by reflex so that little or no water can enter the windpipe. In either case, a victim can no longer breathe.
Drowning itself is quick and silent, although it may be preceded by distress which is more visible. A person drowning is unable to shout or call for help, or seek attention, as they cannot obtain enough air. The “instinctive drowning response” is the final set of autonomic reactions in the 20 – 60 seconds before sinking underwater, and to the untrained eye can look similar to calm or safe behavior. Persons trained in rescue learn to recognize drowning people by watching for instinctive movements in two categories:
Distress: People in trouble, but who still have the ability to keep afloat, signal for help and take actions.
Drowning: People suffocating and in imminent danger of death within seconds. This includes:
- Passive drowning: People who suddenly sink or have sunk due to a change in their circumstances. Examples include people who drown in an accident, or due to sudden loss of consciousness or sudden medical condition.
- Active drowning: People such as non-swimmers and the exhausted or hypothermic at the surface, who are unable to hold their mouth above water and are suffocating due to lack of air. Instinctively, people in such cases perform well known behaviors in the last 20–60 seconds before being submerged, representing the body’s last efforts to obtain air. Notably such people are unable to call for help, talk, reach for rescue equipment, or alert swimmers even feet away, and they may drown quickly and silently close to other swimmers or safety.
Drowning begins at the point a person is unable to keep their mouth above water; inhalation of water takes place at a later stage. As mentioned, drowning can be quick and unspectacular and media depictions as a loud, violent struggle have much more in common with distressed non-swimmers who may well drown but have not yet begun. In particular, an asphyxiating person is seldom able to call for help. The Instinctive Drowning Response covers many signs or behaviors associated with drowning or near-drowning:
- Head low in the water, mouth at water level
- Head tilted back with mouth open
- Eyes glassy and empty, unable to focus
- Eyes open, with fear evident on the face
- Hyperventilating or gasping
- Trying to swim in a particular direction but not making headway
- Trying to roll over on the back to float
- Uncontrollable movement of arms and legs, rarely out of the water.
Other warning signs drowning is that the victim may call for help and has an expression of dread or panic. But typically a victim that is active and drowning may not call for help because he is trying to conserve his air and will not speak. Another symptom of drowning is when the victim thrashes at the water’s surface. If the victim stops or grows calmer, he has likely been overcome by fatigue, hypothermia, or a lack of air. At this stage, the victim usually has 20 to 60 seconds before going under the water’s surface.
Drowning can also happen in ways that are less well known:
- Deep Water Blackout. Caused by latent hypoxia upon ascent from depth, where the partial pressure of oxygen in the lungs under pressure at the bottom of a deep free-dive is adequate to support consciousness but drops below the blackout threshold as the water pressure decreases on the ascent. It usually strikes upon arriving near the surface as the pressure approaches normal atmospheric pressure.
- Shallow Water Blackout. Caused by hyperventilation prior to swimming or diving. The primary urge to breathe (more precisely: to exhale) is triggered by rising carbon dioxide (CO2) levels in the bloodstream. The body detects CO2 levels very accurately and relies on this to control breathing. Hyperventilation artificially depletes this, but leaves the diver susceptible to sudden loss of consciousness without warning from hypoxia. There is no bodily sensation that warns a diver of an impending blackout, and victims (often capable swimmers swimming under the surface in shallow water) become unconscious and drown quietly without alerting anyone to the fact that there is a problem; they are typically found on the bottom.
- Secondary drowning. Inhaled fluid can act as an irritant inside the lungs. Physiological responses to even small quantities include the extrusion of liquid into the lungs (pulmonary edema) over the following hours, but this reduces the ability to exchange air and can lead to a person “drowning in their own body fluid.” Certain poisonous vapors or gases (i.e., burning fuel, toxic materials, or chemical vapor on/near the water surface), or vomit can have a similar effect. The reaction can take place up to 72 hours after a near drowning incident, and may lead to a serious condition or death.
If the victim is not breathing, begin rescue breathing. Place the victim on his back, tilt head back to open airway, pinch the nose, and give two full breaths. If the victim does not inhale during the first two breaths, reposition his head and attempt two more breaths. Check for a pulse. If a pulse is present, but the victim is still not breathing, continue rescue breathing. If a pulse is not present, begin CPR. WARNING: If the victim has no pulse and is not breathing, administer CPR immediately. If the victim does have a pulse but is not breathing, give rescue breathing only. If the victim has a pulse and is breathing, DO NOT give CPR—CPR could prove fatal. Continue first aid until medical help arrives. A victim who is not breathing and has no pulse may appear dead. DO NOT decide that death has occurred. Continue with the prescribed treatment.
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