Because yachties lead their lives on the water, it's good practice occasionally to review the proper procedures for addressing the life-and-death scenario of attempting to rescue a person who has nearly drowned or appears to have died from drowning.
Worldwide, it is estimated that about 150,000 people drown annually. Though statistical information regarding near-drowning is not as reliable, some experts estimate that there may be as many a 600 near-drowning incidents for every reported death.
Before rendering aid, it is important to carefully evaluate the victim’s condition. There are times when people may simply lose consciousness due to an in-water incident. Be sure to check diligently for breathing and a pulse. Keep in mind that in a near-drowning scenario, breathing may be shallow and if the person is cold, a pulse may be hard to find. It is recommended that a careful search for a pulse be done for at least 10 seconds on a warm person and for one minute if the victim is cold before beginning chest compressions and CPR.
If you have completed a thorough assessment of the victim and determined that he/she is not breathing then it's time to begin CPR. Let’s review the ABC’s for drowning:
Airway
The idea that lungs fill completely with water in a drowning incident is a bit of a misconception. Ginger Bartos, RN, of MedAire/MedLink says, “Most often, there is a small amount of water inhaled and an involuntary spasm of the epiglottis that prevents the lungs from being completely filled.” Therefore, attempting to execute a Heimlich or other maneuver to rid the lungs of water is not recommended; instead, it is important to assist the victim in breathing as soon as possible. Lift the neck and tilt the head backward. Open the victim’s mouth to check for any noticeable obstruction.
Breathing
If the airway is clear and the victim is still not breathing, keep the head positioned with the neck up and head back, pinch the nose and deliver two full breaths. Each breath should take one second. If the victim is a child, use a shallower breath.
Circulation
If the victim is still not breathing, coughing or showing signs of resuscitation and you cannot find a pulse, then begin chest compressions. Hands can be quickly positioned by placing them in the center between the two nipples. Push down on the chest from 1.5 to 2 inches 30 times at the rate of 100 times per minute (which is faster than once per second – count one-and-two-and-three…). Check for breathing and a pulse and repeat the 30-to-two, compressions-to-breaths as necessary.
Nurse Bartos says, “There are many stories of miraculous survival for drowning victims. Whatever the mechanisms influencing survival, rescuers are trained that every patient is potentially recoverable however gloomy things first appear. [They] are trained to continue resuscitation efforts without interruption for at least one hour on drowning victims [before giving up on reviving the person].”
Regarding the use of AEDs for a water incident, Nurse Bartos says, “Drowning victims should be removed from the water to a dry area if possible prior to resuscitation attempts…. An AED is a valuable assessment tool, however it should NEVER be used on someone who is wet. You must ensure that your victim is dry and the area around the victim is dry as well…. Most typically, a drowning victim will have a heart with no electrical activity, which does not require a shock to be delivered by an AED. But, a few will drown exactly because they were swimming when they underwent ventricular fibrillation and will definitely benefit from [an AED].”
An interesting fact to keep in mind: Illegal drugs and/or alcohol are believed to be a factor in over 50 percent of adult drowning deaths. If someone becomes unconscious in the water, it is important that aid be rendered right away. About 75 percent of near-drowning victims who receive immediate treatment will survive; however after about 10 minutes without life support in the form of CPR, the prognosis for survival is poor.
According to an article published by Dipak Chandy, MD, assistant professor of medicine at New York Medical College, “If you were to rank, by importance, the risk factors that contribute to drowning and near-drowning, the list would look like this:
- Inability to swim or overestimation of swimming capabilities
- Risk-taking behavior, including the use of alcohol and illicit drugs
- Inadequate adult supervision of children
- Trauma (such as a physical injury), seizures, stroke, heart attack or heart arrhythmia
- “Shallow water blackout” in which swimmers hyperventilate in order to swim longer under water. This can lead to a lack of oxygen in the brain and loss of consciousness.
- Hypothermia, or lowered body temperature. This can lead to heart arrhythmia and rapid exhaustion.”
Ultimately it is every crewmember’s responsibility to be aware of your mates’ and guests’ habits and limitations. Make sure you review the necessary steps in order to be prepared should you ever be expected to come to the aid to someone who has become unconscious in the water.