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Wilderness Medical Society - snowmass 2005 (Page 186)

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Wilderness Medical Society - snowmass 2005
16
Chapter 3
SUBMERSION INJURIES

Recommendations are considered Category 1B by the WMS Panel of Expert Reviewers.


I. GENERAL INFORMATION
Rescue of a near drowning victim is inherently dangerous. The following guidelines are
suggested for getting the victim safely out of the water:
1) Reach for the victim, if possible, with an extended arm or leg, clothing, a stick
or paddle, or anything that allows the rescuer to stay safely on land or in a boat.
2) When reaching is not possible, throw something that floats to the victim.
3) Throw a line to the victim and tow the victim to safety.
4) Row or paddle out to drowning victims, in a boat, wearing a personal flotation
device.
5) Swimming rescues are extremely dangerous and are not recommended unless
the rescuer has been trained and fully understands the risk involved. Do not
attempt underwater searches for missing victims.
All rescuers should wear personal flotation devices (PFDs).

II. GUIDELINES FOR ASSESSMENT AND TREATMENT
Assess unconscious patients immediately for adequate respiration. This can sometimes be
done in the water, if the rescuer is a strong swimmer and/or if the rescuer can stand in
shallow water. Begin rescue breathing as soon as possible. There is no value in
attempting to clear the patient's lungs of water, but be prepared to roll the patient and
clear the airway should water fill the airway during the rescue, or if the patient vomits.
Dependent positioning to drain lungs of water is of no proven benefit. Protect the spine in
unconscious patients and in diving or surfing accidents. In the absence of a pulse, begin
chest compressions as soon as possible. Continue CPR while pulseless, but terminate in
30 minutes if pulse has not recovered. Evaluate all drowning and near-drowning patients
for hypothermia. Hypothermic submersion patients cannot be presumed dead until they
are "warm and dead." If they have been submersed for more than 60 minutes, or have not
recovered a pulse after 30 minutes of CPR, they are dead.
Urgently evacuate all submersion patients to definitive medical care. Even if the victim
feels "ok," it is possible to develop delayed respiratory, renal, or other problems, so that
evacuation is still indicated; and the patient's vital signs should be monitored for 24 to 48
hours after submersion. Immediate treatment primarily by ventilation at the scene is the
most important factor in determining survival. If the victim is unconscious or
experiencing respiratory distress during transport, high-flow oxygen should be
administered if available.

III. CONTROVERSIES
A. Should all victims of accidental submersion be evacuated? Someone who is
unexpectedly submersed and who comes up coughing but never loses

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