Toxic-Environmental Protocol Section oxia. R. nsport. NO Pulse Exit to Airway ypoxia) due to potential as tolerated mouth-to-mouth as indicated Protocol TB 8 Cardiac Arrest Unresponsive 5 / Breaths via BVM 1-919-684-9111 Age Appropriate Protocol(s) AR 1 - 7 from submersion / immersion Divers Alert Network Decompression sickness Barotrauma y phase instead of rescue. Protocol(s) AC 3 / PC 4

Hypoglycemia Cardiac Dysrhythmia Spinal Motion Restriction Restriction Motion Spinal     Dive Accident / Barotrauma ry treatment is reversal of hyp s from areas of danger. YES Post-immersion syndrome Trauma Pre-existing medical problem Pressure injury(SCUBA diving)

 Differential    2 kin, Neuro ste time attempting to suction. Ventilate with BVM would-be rescuers. tilation are equally important to high-quality CPR. yspnea, abnormal lung sounds, h (any respiratory symptom) onsider to recover moving known submersion time of ≤ 25 minutes. s should remove patient apply appropriate mode of supplemental oxygen. njuries even with warm ambient conditions. ambient warm with even njuries ed it should not interrupt ventilation, oxygenation and / or CP (does not require suction) Prima suction) require not (does TE 3 oes not correlate with mental status. Unless obvious death, tra as tolerated as tolerated as indicated as indicated Protocol UP 4 if indicated Age Appropriate IV / IO Procedure as indicated Protocol TB 8 Dry / Warm Patient Protocol(s) 1-7 Remove wet clothing Supplemental Oxygen Altered Mental Status Cardiac Monitor & ETCO Awake but withAMS Drowning Airway Protocol(s) 1 AR - 7 Age Appropriate Airway Notify Destination or Notify Destination Contact Medical Control 5 Breaths via BVM / mouth-to-mouth Unresponsive Mental status changes signs vital absent or Decreased Foaming / Vomiting Coughing, Wheezing, Rales, Apnea

Spinal Motion Restriction Procedure / / Procedure Restriction Motion Spinal Signs and Symptoms Signs and      Rhonchi, Stridor  ental status, Trauma Survey, S P A encing respiratory impairment omatic patients (cough, foam, d – If submersion time ≥1 hour c atient does not tolerate then 2 This protocol has been altered from the original NCCEP Protocol by the Johnston County EMS Medical Director Medical EMS County Johnston the by Protocol NCCEP original the from altered been has protocol This 6 hours if indicated if indicated as tolerated as indicated IV / IO Procedure evaluation even if Dry / Warm Patient minimal symptoms Remove wet clothing Awake andAlert Supplemental Oxygen Monitor and Reassess and Monitor asymptomatic or with Asymptomatic drowning drowning Asymptomatic Cardiac Monitor & ETCO Procedure / Protocol TB 8 SpinalMotions Restriction Encourage transport and patients (refusing transport) medical care/call 911 if they should be instructed to seek develop any symptoms within Encourage transport of all sympt Cardiac arrest in drowning is caused by hypoxia, airway and ven Foam is usually present in airway and may be copious, DO NOT wa Regardless of water temperature Regardless of water temperature – resuscitate all patients with When feasible, only appropriately trained and certified rescuer Ensure scene safety. Drowning is a leading cause of death among Begin with BVM ventilations, if p Drowning is of experi the process Recommended Exam: Respiratory, M Consider CPAP for Spinal motion restriction is usually unnecessary. When indicat When unnecessary. usually is restriction motion Spinal Hypothermia is often associated with drowning and submersion i Drowningpatient typically has <1 3 – mL/kg of water in lungs Predicting prognosis in prehospital setting is difficult and d

Temperature of water or possibility of Duration of submersion / immersion

Possiblehistory of trauma; slammed

Submersion in water regardless of regardless water in Submersion

Respiratory Distress Respiratory    worsening over next 6 the hours.   through foam(suction water and vomit only when present.)       hypothermia in liquid.a   into shore wave break   depth  Pearls  History  P A