P KZN DROWNING

Prehospital management

• At drownings outside of the home, for example, quarries, open water, it is paramount that the victim should be removed from the water only after ensuring it is safe for the rescuer to do so. All possible ways to rescue the victim without entering the water should be considered. This is to avoid the rescuer becoming a second victim.
• Early effective basic life support (BLS) is likely to be the most important factor for survival. In the majority of circumstances, a standard ABC approach should be followed.
• Rescue breaths can begin in shallow water, delivering mouth to nose breaths may be easiest in this situation.
• Record a temperature and begin the process of maintaining or re-establishing normothermia. This can begin on the scene by removing wet clothes, drying the victim and covering them with blankets or dry clothes.
• There is no evidence to support the use of positioning manoeuvres or abdominal thrusts to remove aspirated water from the lungs.8
• Immobilisation of the cervical spine should be performed where appropriate, specifically in the adolescent age group or with a history of traumatic injury. Cervical spine injuries are rarely associated with drownings in younger children. Hwang et al looked at 10 years of drowning presentations to a tertiary paediatric centre and determined that out of 143 patients, only seven had cervical spine injuries. The youngest child was 9 years old. All injuries occurred in a swimming pool, six having a history of diving.5
• A nasogastric or orogastric tube should be inserted and definitive airway established early to minimise the risk of vomiting and aspiration.9
• The victim’s chest should be dried prior to applying defibrillator pads.9