Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning

Abstract

The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.

Update on drowning

“…[5] However, application of international guidelines within a resource-limited setting must be carefully weighed. In SA, the WMS guidelines are undergoing review by the Wilderness and Expedition Medicine Society of Southern Africa to ensure relevance in the SA context.…”

“…Rescues attempted by people who do not fulfil these criteria place the potential rescuers at risk. [5] Individuals without appropriate training should try to reach out to victims, while ensuring that they have secured themselves to a fixed point. If this is unsuccessful, throwing a buoyant device to the victim is an alternative.…”

“…There is little evidence to suggest that anything more than ventilation is beneficial for a victim of drowning who is still in the water. [5] Once out of the water, and as soon as possible after addressing immediate threats to life, the victim should be actively and passively warmed, depending on available means. Once it is established that the patient has a pulse, the immediate priorities for resuscitation are airway management, oxygenation and ventilation.…”

“…[13,14] The incidence of associated cervical spine injuries in drowning incidents is ˂5%, and is usually associated with diving from a height. [5] Spinal protection is therefore not a concern in drowning unless there is a significant mechanism for cervical spine injury, significant distracting injuries, a focal neurological deficit, anatomical disruption, abnormalities in the cervical spine causing concern or an altered mental status. [15] Unless there is an immediate threat to life or active CPR, there should not be delays in transferring the drowning patient to hospital for assessment and further management.…”

“…[5] Criteria for admission include severe cough, abnormal lung sounds, frothy sputum or foamy material in the airway, hypotension (systolic blood pressure <90 mmHg or mean arterial pressure <60 mmHg) and altered mental status. [5] Several prognostic tools have been suggested to assist with predicting outcomes from drowning. Submersion time has an exponentially negative relationship with survival.…”