Drowning and diving emergencies SOP

Question 1

Outline the contents of the drowning and diving SOP

Answer 1

Scene safety
Water rescue operations

Drowning:
- mechanism
- management
Diving:
- gas embolus vs decompression
- management

Question 2

Describe the particulars of scene safety when treating a drowned casualty

Answer 2

Dynamic risk assessment
We don’t rescue people from water
Should be >3m from waters edge and not on vessel/pontoon

Question 3

Describe the nature of rescue operations that may be encountered

Answer 3

Water rescue by HART/FRS/RNLI
Rescue operations determined by the survivability model

Use start clock time - most reliable time when patient thought to have been submerged

Unlikely to survive submersion beyond 60 mins unless a child or water is <6 degrees (ice cold)

Beyond 90mins move to recovery operations

Question 4

Describe the mechanism of drowning

Answer 4

Multiple causes:
- Cold water shock
- Gasp/inability to hold breath
- Arrhythmias
- Swim failure
- Water aspiration
- Hypothermia

Question 5

Describe the management of the drowned patient

Answer 5

Extrication
- Horizontally via backboard
- Remove wet clothes and dry
- Immobilise C-spine if mechanism consistent with injury

If conscious:
- Actively warm
- O2 if required
- PHEA if ventilatory failure

If unconsicous/arrested:
- Prioritise oxygenation and ventilation
- Measure core temp and modify ALS if hypothermic
- Warm IVI
- Decompress stomach with orogastric tube
- Lung protective ventilation
- Consider prolonged resus/eCPR

Question 6

What are the factors predictive of a good outcome following drowning?

Answer 6

• Cold before wet
• Short time in the water
• Witnessed arrest
• VF/PEA
• <65
• Temp <28

Question 7

What are the symptoms of arterial gas embolism?

Answer 7

Chest pain
Blurred vision
Stroke symptoms
Seizures
Low GCS
Arrest

Question 8

What are the symptoms of decompression sickness?

Answer 8

Joint pain
Limb paraesthesia
Muscle weakness
Urinary retention
Confusion
Pulmonary oedema

Question 9

Describe the management of a patient with diving related illness?

Answer 9

• Lie flat
• High flow O2/PHEA
• Rule out alternative diagnosis/concurrent illness
• IV fluids

Question 10

Which patients may benefit from hyperbaric treatment?

Answer 10

Decompression within 72 hours
And
Rule out other cause as able
And
Symptomatic

Fly them at 500ft or less