Part 10.3: Drowning

Abstract

Drowning is a leading preventable cause of unintentional morbidity and mortality. Although this chapter focuses on treatment, prevention is possible, and pool fencing has been shown to reduce drowning and submersion injury (Class I).1 The most important and detrimental consequence of submersion is hypoxia. Therefore, oxygenation, ventilation, and perfusion should be restored as rapidly as possible. This will require immediate bystander CPR plus immediate activation of the emergency medical services (EMS) system. Victims who have spontaneous circulation and breathing when they reach the hospital usually recover with a good outcome. Victims of drowning may develop primary or secondary hypothermia. If the drowning occurs in icy (<5°C [41°F]) water, hypothermia may develop rapidly and provide some protection against hypoxia. Such effects, however, have typically been reported only after submersion of young victims in icy water (see Part 10.4: “Hypothermia”).2 All victims of drowning (see definitions below) who require any form of resuscitation (including rescue breathing alone) should be transported to the hospital for evaluation and monitoring even if they appear to be alert with effective cardiorespiratory function at the scene. The hypoxic insult can produce an increase in pulmonary capillary permeability with delayed onset of pulmonary complications. A number of terms are used to describe drowning. To aid in the use of consistent terminology and the uniform reporting of data from drowning, the Utstein definition and style of data reporting are recommended3: Drowning . Drowning is a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium. Implicit in this definition is that a liquid/air interface is present at the entrance of the victim’s airway, …