June 17, 2013

CPR and Summer Drowning Injuries

iStock 000017311306SmallNow that the weather is warming up, our kids are making a beeline to the pool. With all the fun of water sports comes the serious reality of water-related injuries. According to the Centers for Disease Control:

“Children ages 1 to 4 have the highest drowning rates. In 2009, among children 1 to 4 years old who died from an unintentional injury, more than 30% died from drowning. Among children ages 1 to 4, most drownings occur in home swimming pools. Drowning is responsible for more deaths among children 1-4 than any other cause except congenital anomalies (birth defects). Among those 1-14, fatal drowning remains the second-leading cause of unintentional injury-related death behind motor vehicle crashes.”

The very first step in avoiding this tragedy is to recognize when a person is drowning. It doesn’t quite look like what you might think. US Coast Guard Aviation Survival Technician First Class Mario Vittone, in an article he co-contributed to On Scene, The Journal of US Coast Guard Search and Rescue and in a blog article recently reposted at, shares the following description from Francesco A. Pia, Ph.D, about what Dr. Pia calls “the instinctive drowning response”:

Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface.

  1. Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.
  2. Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.
  3. Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
  4. Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
  5. From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Both articles are well worth a read, and Technician Vittone makes an important observation when he talks about a bystander’s assessment of a potential drowning:

“Ask [the potential victim], “Are you all right?” If they can answer at all—they probably are. If they return a blank stare, you may have less than 30 seconds to get to them. And parents—children playing in the water make noise. When they get quiet, you get to them and find out why.

In addition to understanding how to recognize drowning, CPR is a “must know” for any day at the beach, lakeshore, or aquatic center. I want to share with you a section from our pediatric emergency care programs that addresses the appropriate response to this life-threatening situation:

Due to the nature of drowning and the effective treatment of rescue breaths, the initial approach for a child who has drowned focuses on getting rescue breaths initiated as rapidly as possible. To care for a suspected drowning:

    • With personal safety as a priority, get the child out of the water as soon as possible
    • Do not attempt to remove water from the airway or lungs using abdominal thrusts.
    • Once a drowning child is removed from the water, quickly look at the face and chest for normal breathing. If breathing is gasping or absent, provide two rescue breaths that each make the chest visibly rise. Then begin chest compressions Provide continuous cycles of 30 compressions and 2 rescue breaths.
    • If a drowning child is out of the water and remains unresponsive and not breathing after the initial two breaths and follow-up care, attach an AED as soon as one is available. Dry the chest before applying pads.
    • Be prepared for vomiting when caring for a child who has drowned. If vomiting occurs quickly roll the child on to her/his side to drain fluid from the mouth. Sweep solid matter out with your gloved finger.

Let the summer of 2013 begin with safety. Take a CPR class today!

Find A Class, ASHI, MEDIC First Aid


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