8.2 Drowning Resuscitation & The Drowning Chain of Survival

8.2 Drowning Resuscitation & The Drowning Chain of Survival

Drowning is a process in which submersion or immersion causes respiratory impairment. The initial problem is lack of oxygen, so effective breaths are central to resuscitation. The rescuer must also avoid becoming a second victim: safe recognition, flotation, and removal come before patient-side CPR.

The Drowning Chain of Survival

The AHA drowning chain organizes the response into five linked actions:

1. Prevent drowning. Use barriers, attentive supervision, life jackets, swimming and water-safety skills, and risk awareness.
2. Recognize distress and call for help. Drowning can be quiet. Activate lifeguards or emergency response as soon as trouble is recognized.
3. Provide flotation. Reach or throw a buoyant object when possible so the person can keep the airway above water.
4. Remove the person from the water safely. Use trained rescuers and appropriate equipment. An untrained person should not make a hazardous entry.
5. Provide care as needed. Assess breathing and pulse, provide ventilations or CPR, and use an AED according to the findings.

These links begin before cardiac arrest. Prevention and early flotation can stop the hypoxic process before resuscitation is required.

Safe removal and in-water breathing

Activate professional water rescue early. A reach assist, thrown flotation device, rescue pole, boat, or trained lifeguard is safer than an impulsive entry. Spinal motion restriction is not performed routinely for every drowning victim; use it when the circumstances suggest trauma and it can be provided without compromising airway and breathing care.

Trained rescuers may provide rescue breaths in the water when it is safe, they are able to support the person, and their training permits it. This is not an instruction for an untrained rescuer to remain in dangerous water. Chest compressions cannot be delivered effectively while a person is floating; remove the person to a firm surface as quickly and safely as possible.

Assessment after removal

Once the person is on a safe surface:

1. Check responsiveness and breathing.
2. Activate emergency response and send for an AED if not already done.
3. A healthcare provider checks breathing and a pulse simultaneously for no more than 10 seconds.
4. If a definite pulse is present but breathing is absent or inadequate, provide age-appropriate rescue breaths and reassess about every 2 minutes.
5. If no definite pulse is felt, begin high-quality CPR with rescue breaths.

The AHA recommends CPR with breaths after drowning because the arrest generally follows hypoxia. A trained rescuer may begin the drowning resuscitation sequence with breaths followed by compressions according to current training, but do not create a long delay by debating a fixed number of initial breaths. Continue conventional CPR with breaths and compressions.

If a rescuer is unwilling, unable, or not trained to provide breaths, compression-only CPR is preferable to doing nothing until help arrives. For a trained BLS provider, however, breaths are an important part of drowning resuscitation.

Ventilation and airway practical points

Open the airway and give each breath over about 1 second, using only enough volume for visible chest rise. If the chest does not rise, reposition the airway and improve the mask seal. Do not press on the abdomen in an attempt to expel water. That delays ventilation and can cause vomiting and aspiration.

Vomiting may occur. If it does, turn the patient only as much as needed to clear the airway, suction if equipment and training are available, and resume breaths and compressions promptly. Water does not need to be drained from the lungs before CPR begins.

AED use near water

Use an AED as soon as it is available. Move the patient out of standing water and quickly dry the chest where the pads will attach. The rest of the body does not need to be completely dry. Apply the pads, make sure no one is touching the patient during analysis or shock, deliver a shock if advised, and resume CPR immediately.

Common errors

• Entering dangerous water without training or equipment.
• Delaying breaths and compressions to try to drain water.
• Performing abdominal thrusts when no foreign-body airway obstruction is present.
• Withholding CPR because the person feels cold.
• Delaying AED use to dry the entire body.
• Assuming that a person who resumes breathing no longer needs evaluation and monitoring.

The exam pattern is straightforward: protect the rescuer, activate help, remove safely, and provide care driven by breathing and pulse findings. In drowning cardiac arrest, select ventilation-inclusive CPR and rapid AED use.