Drowning History Signs and Symptoms Differential Submersion in water regardless of Unresponsive Trauma depth Mental status changes Pre-existing medical problem Possible history of trauma Decreased or absent vital signs Hypoglycemia Slammed into shore wave break Foaming / Vomiting Cardiac Dysrhythmia Duration of submersion / immersion Coughing, Wheezing, Rales, Pressure injury (SCUBA diving) Temperature of water or possibility Rhonchi, Stridor Barotrauma of hypothermia Apnea Decompression sickness Post-immersion syndrome Awake and Alert Awake but with AMS Unresponsive Supplemental Oxygen 5 Breaths via BVM / mouth-to-mouth 5 Breaths via BVM / as tolerated as tolerated mouth-to-mouth Toxic as tolerated Spinal Motions Restriction Supplemental Oxygen Procedure / Protocol TB 8 as tolerated - if indicated Section Environmental Protocol Age Appropriate Airway Remove wet clothing Protocol(s) 1-7 YES Pulse Dry / Warm Patient as indicated Monitor and Reassess Spinal Motion Restriction Procedure / NO Protocol TB 8 Encourage transport and if indicated evaluation even if Exit to asymptomatic or with Altered Mental Status Age Appropriate minimal symptoms Protocol UP 4 Cardiac Arrest Asymptomatic drowning as indicated Protocol(s) AC 3 / PC 4 patients (refusing transport) Remove wet clothing Airway should be instructed to seek Dry / Warm Patient Protocol(s) AR 1 - 7 Spinal Motion Restriction medical care/call 911 if they A IV / IO Procedure develop any symptoms within Protocol TB 8 6 hours P Cardiac Monitor as indicated IV / IO Procedure A if indicated Age Appropriate Cardiac Monitor P Airway Protocol(s) AR 1 - 7 as indicated as indicated Notify Destination or Contact Medical Control Pearls Recommended Exam: Respiratory, Mental status, Trauma Survey, Skin, Neuro Drowning is the process of experiencing respiratory impairment (any respiratory symptom) from submersion / immersion in a liquid. Begin with BVM ventilations, if patient does not tolerate then apply appropriate mode of supplemental oxygen. Ensure scene safety. Drowning is a leading cause of death among would-be rescuers. When feasible, only appropriately trained and certified rescuers should remove patients from areas of danger. Regardless of water temperature – resuscitate all patients with known submersion time of minutes. Regardless of water temperature – If submersion time hour consider moving to recovery phase instead of rescue. Foam is usually present in airway and may be copious, DO NOT waste time attempting to suction. Ventilate with BVM through foam (suction water and vomit only when present.) Cardiac arrest in drowning is caused by hypoxia, airway and ventilation are equally important to high-quality CPR. Encourage transport of all symptomatic patients (cough, foam, dyspnea, abnormal lung sounds, hypoxia) due to potential worsening over the next 6 hours. Predicting prognosis in prehospital setting is difficult and does not correlate with mental status. Unless obvious death, tra nsport. Hypothermia is often associated with drowning and submersion injuries even with warm ambient conditions. Drowning patient typically has <1 – mL/kg of water in lungs (does not require suction) Primary treatment is reversal of hypoxia. Spinal motion restriction is usually unnecessary. When indicated it should not interrupt ventilation, oxygenation and / or CPR. Revised TE 3 01/01/2017 Any local EMS System changes to this document must follow the NC OEMS Protocol Change Policy and be approved by OEMS.