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Creating a Universal Drowning Chain of Survival

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Creating a Universal Drowning Chain of Survival Creating a Universal Drowning Chain of Survival: Need and Evaluation Proposal format: Panel Discussion and Brainstorming Session – 105 minutes Members: David Szpilman, Bo Løfgren, Jonathon Webber, Linda Quan, Joost Bierens, Luiz Morizot-Leite, and Stephen J. Langendorfer. David Szpilman, Bo Løfgren, Jonathon Webber, Linda Quan, Joost Bierens, Luiz Morizot-Leite, and Stephen J. Langendorfer. DROWNING CHAIN OF SURVIVAL – Workshop – World Conference on Drowning Prevention, Potsdam - Germany 2013, Book of Abstracts, P123. www.wcdp2013.org Abstract: Drowning involves principles and interventions that are not found in other emergency medical situations. Preventative behaviors as well as critical response steps can be part of an effective educational strategy.One such educational strategy in emergency response medicine has involved promoting icons in the form of a “chain of survival.” The relevance of a specific drowning chain of survival was first debated during the World Congress on Drowning(Netherlands,2002).The recognition that drowning education had several unique characteristics resulted in “survival chain”(figure1) formed by 6 links. Since then, the “drowning chain of survival” have been used successfully around the world to guide education, and actions to take among lay, rescue and health professionals(Wilson-Saliba & Szpilman,2007;Szpilman,2011).More recently, similar initiatives have been proposed that include separate preventative and response sets of icons(Quan,et al.,2012). The objective of this session is to: 1.Examine conceptual, practical, and educational values associated with chain(s) of survival especially for drowning prevention and response; 2.Discuss the benefits and detriments to a standardized/universal drowning prevention and response chain of 3.survival that meets International Organization for Standardization(ISO) compliance; 4.Discuss how one or more final drowning chain of survival could be comprised;and 5.Identify ways to evaluate whether proposed drowning chain(s) of survival meet the needs of all layers of prevention and response as well as comply with ISO. Drowning principles and interventions that are not found in other emergency medical situations. First aid and advanced life support in the aquatic environment often requires specific skills and knowledge that were not taught in regular first aid/CPR education. The target group needing drowning education included all lay and professionals persons playing, living, or working around the water(Szpilman,2007;Deakin,2012).It has been estimated that 85% of drownings may be prevented by adequate supervision, swimming instruction, water safety education and awareness, availability of water safety equipment including life jackets, CPR training, presence of lifeguards, and appropriate water safety legislation and regulations(Quan,2007;Moran,2011).When preventative measures fail, potential responders need to be able to perform necessary hierarchic steps to interrupt the drowning process. The first challenge is to recognize someone in the water at risk of drowning and appreciate the need and how to activate the lifeguard and emergency medical system(EMS) appropriately. It is critical that lay persons take precautions not to become another casualty by engaging in inappropriate or dangerous rescue responses(Venema,2010;Orlowski,2001). If not initially recognized and a successful rescue performed, then basic life support may need to be initiated on the drowning while still in water.In those cases, immediate in-water resuscitation provides the greatest benefit if provided safely and effectively(Szpilman,2004). Cervical spine injuries are much less frequently associated with drowning than other trauma.Transporting drowning casualty from the water and positioning them on land require unique adaptations.Upper airway management is always challenging in drowning due to vomiting and the amount of water that has been aspirated.In most drownings the heart tissue is healthy and stops beating only due to hypoxia after a period of apnea (Szpilman,1997;Orlowski,2001).It is imperative that cardiopulmonary resuscitation follows the “traditional” mnemonic of Airway–Breathing–Circulation(ABC) rather than the more-recently proposed CAB sequence(Kitamura,2010).Initial ventilation breaths may be ineffective in drowning due to the presence of water in upper airways(Baker,2011).The ERC has recommended five initial ventilations to increase oxygenation and minimize hypoxia prior to initiating compressions.The most common cardiac rhythm in cardiac arrest following drowning is asystole instead of ventricular fibrillation. Recommendations for when to start and stop resuscitation are different from non-drowning-related cardiac arrest and the rate of success for reviving child drowning is potentially higher than for other causes(Grmec,2009). Since 2002, much new and important information has arisen.This “discussion and brainstorming session” intends to identify additional information as well as to obtain feedback from drowning prevention experts. Table 1 shows the Discussion/Brainstorming session organization proposal for the WCDP2013. .
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