Water Emergencies

  1. Submersion Incidents
    1. Drowning
      1. Definition
      2. Incidence
      3. Predictors of morbidity and mortality
    2. Types
      1. Freshwater
      2. Saltwater
    3. Pathophysiology
      1. Little difference in patient lungs regardless of what type of water submersion occurred
      2. Submersion in cold water results in better survival than warm water
      3. Age is a factor due to cardiovascular health
      4. Duration underwater effects outcome
      5. Submersion in very cold water can produce cardiac disturbances
      6. Hypoxia from submersion is major factor in death
      7. Diving in shallow water can cause spinal trauma
      8. Prolonged hypoxia causes death of brain tissue
    4. Unique Signs and Symptoms
      1. Airway – obstructed with water immediately after rescue
      2. Breathing
        1. May be coughing if early rescue
        2. Agonal breaths if prolonged submersion
        3. Respiratory arrest if very prolonged submersion
      3. Circulation
        1. May be in cardiac arrest
        2. Skin is cyanotic
        3. Skin may be cold
    5. Assessment Considerations
      1. Airway, ventilation, and oxygenation
        1. Oxygen saturation may be difficult to obtain if patient is cold
        2. Use spinal precautions when opening airway to assess if risk of spinal trauma is possible
        3. Auscultate breath sounds
      2. Assess for presence of other injuries
      3. Obtain past medical history
    6. Management Considerations
      1. Airway, ventilation, and oxygenation
        1. Suction and maintain open airway
          1. anticipate vomiting
          2. position lateral recumbent if no risk of spinal injury
        2. Ventilate with bag-mask if impaired ventilation or respiratory arrest
        3. Administer oxygen by non-rebreather mask if breathing is adequate
      2. Circulation
        1. If cardiac arrest is present, refer to current American Heart Association guidelines
        2. Defibrillate with AED if indicated (refer to current American Heart Association guidelines)
      3. Transport Considerations
        1. Transport to appropriate facility
        2. All patients who had submersion injury with any report of signs and symptoms during or after submersion need transport to the hospital

Content Creator: Joyce Lockwood
CAPCE Course Number: 21-EMTP-F3-2207
Total CE Hours: 1
Level: Advanced
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.