It is a warm summer day; outdoor activities for the citizens of your fire district are in full swing. You’re just finishing some apparatus cleaning when the radio opens….Engine 1, Medic 1 respond to a reported drowning 123 Main St. at Main St. Apartments. You are familiar with this apartment complex, as you have been there many times. As you make the block, you see people jumping and waving. You park the rig; as you approach the scene, you see no lifeguard on duty, and a body facedown in the pool.
In communities all across America, the above scenario plays out quite often. While not commonly thought of as a major problem, drowning accounts for approximately 4,000 infant and pediatric deaths annually, leaving an estimated 12,000 with varying degrees of brain injury.1 When adults are included in these statistics, the numbers increase to 7,000 drowning deaths each year.2 Despite these numbers, more than half of all parents and guardians feel that drowning is not a threat to their child.1
A quick ride around your response district will show the huge potential for drowning and pool-related injuries, not to mention other static and dynamic water sources such as rivers, lakes, and ponds. When responding to water emergencies, you begin the process just as at any emergency scene: perform a size-up, determine resources needed, and develop an action plan from the information gathered.
Active patients are conscious, but may be injured or disoriented. 3 Active patient removal can be complex or simple, depending on the nature of the injury or the situation encountered. If the patient is simply injured and cannot make it out of the pool, normal patient-removal procedures and stabilization measures ordinarily suffice. However, if the patient is actively drowning, rescue will become increasingly more difficult. The procedure, “Reach, Throw, Row, Go” has been around for decades and still applies to active rescue situations.3 Using this technique, you try to reach a patient with an object (i.e., pole, rope, or boat) before you make an aggressive entry into the water. If you have to make entry into the water, you must remain aware that the victim will be very excited and could unintentionally injure rescuers. Wear a personal flotation device (PFD);
if you have a second one, bring it with you to act as a “rescue tube” for the victim.3 Maintain eye contact and talk to the victim the entire time. Once you reach the victim, immediately head for shallower water. NEVER attempt an in-water rescue with boots on or if you are unsure of your swimming ability.
Unlike an active victim rescue, rescue of the passive victim takes multiple rescuers and will more than likely present difficultly in removing the victim from the water. At this point, we are at the “Go” option of our rescue procedure, and an in-water rescue is the only available option. One of the biggest mistakes rescuers make is diving in the pool and grabbing the victim. Whenever you see a passive (unconscious) victim, act as you do in normal patient-care situations and assume that C-spine is compromised, taking appropriate precautions.3 Along with maintaining C-spine immobilization, the goal is also to get the victim’s nose above water and assess breathing.3 If the victim is breathing, take your time and carefully remove the patient. However, if airway or breathing is compromised, rapidly remove the victim while taking appropriate C-spine precautions. This includes using slow, gentle movements while entering the water (no diving or jumping in) so as not to move the water or victim.
Location of the victim on arrival will impact steps for C-Spine immobilization. If the victim is on the surface, approach from the feet and grasp the patient at the elbows; gently move the victim’s arms up toward the head, using the arms as makeshift head blocks for C-spine immobilization.3 Next, rotate the patient so the nose and mouth are out of the water. If they are already face up, rotation is unnecessary. If the patient is subsurface (underwater), the approach to achieve the greatest success is a feet-first subsurface dive using the same C-spine stabilization technique previously mentioned. 3 Again, if you are not sure of your swimming ability, do not attempt a dive.
Once the victim is face up, the next consideration is to remove the victim from the water. Place a backboard under the patient and let it float into place underneath him; this will take several rescuers to accomplish because of the buoyancy of the water, and backboard.3 Once on the backboard, resuscitation measures can begin, although it may be easier to start them on the side of the pool. On removal of the victim from the pool, follow standard assessment and resuscitation procedures. Remember to dry the victim off if you intend to attach an automated external defibrillator or a manual defibrillator.
It is recommended that you use a pool to practice these procedures so that you will feel comfortable using them in an emergency situation. Also, conduct preincident planning at all of your aquatic facilities to understand the potential they have for an incident and their characteristics and resources should an incident occur. Like anything else in the fire service and life, preparation is the key to success. Are you prepared?