Not long ago, I was reading the news online as I do most days. There was a story that chilled me to the core, and one that I’m sure nearly all parents would relate to. I read about the drowning death of a 3 year old boy on the Gold Coast. What makes this story especially sad, is that it isn’t a one-off event and it’s something that we will continually read about into the future. Because even though Australia is the driest inhabited continent in the world, we have one of the highest reported incidences of drowning in the developed world. Another article I read late last year basically said that if the number of people who drowned in rip currents were the same as people being attacked by sharks, there would be a national outcry for a shark cull. Yet drownings continue to happen.
Want some more scary statistics? OK, brace yourself… In the 2016/17 financial year, there were 291 deaths in Australia due to drowning in aquatic locations. From my interpretation of the Royal Lifesaving Society report, this also includes drownings in bath tubs and inside the home. On average, that’s a bit over 5 people a week drowning. Males, at 75% of the total deaths, are the biggest culprit when it comes to drowning. Now whilst these numbers are bad, it gets worse – there were an estimated 685 people who were involved in non-fatal drowning incidents that required hospitalisation. I could go on, but there’s just so much data out there it’s kind of depressing…
So, what is drowning? The World Health Organization define drowning as the process of experiencing respiratory impairment from submersion/immersion in liquid. In other words, unless you’re Kevin Costner in Waterworld, we can’t breathe underwater. The process of drowning when you look at it from a pathophysiological perspective is actually quite fascinating. It occurs in the following stages:
1. Initial submersion in water leads to apnoea (the person stops breathing), unless the person suffers a catastrophic illness or injury that renders them unconscious. Now if that person submerges involuntarily, most adult victims begin to panic and struggle. This then leads to an increase in blood pressure and heart rate.
2. Now, after an interval that depends on pre-submersion oxygenation (i.e. how much oxygen you had on board before you went under), physical fitness, intoxication, injury or illness and the degree of panic/struggle, the combined effects of hypercapnia (elevated levels of carbon dioxide in the blood) and hypoxia (lack of oxygen in the tissues) lead to the person taking an involuntary breath. This is known as the ‘breaking point’. It’s at this stage that large volumes of water are often swallowed/inhaled.
3. After the initial inhalation of fluid, the patient will experience bronchoconstriction (airways tighten up), increased pressure in the lungs, as well as other effects such as laryngospasm (constriction of the larynx).
4. Secondary apnoea occurs, closely followed by total loss of consciousness. Vomiting or regurgitation of swallowed fluid is common, which leads to aspiration of the stomach contents into the lungs.
5. Involuntary gasping respirations cause flooding of the lungs, causing damage.
6. Hypoxia leads to bradycardia (very slow heart rate), hypotension (very low blood pressure) and irreversible brain injury within 3 – 10 minutes.
As a trainer, I am often asked, at least once a week, ‘why can’t we just do compressions?’ Knowing how drowning happens might at first seem somewhat morbid, however this knowledge can greatly increase our understanding of why the first aid techniques we teach during our courses are so important. It’s with this knowledge that we can see why compression only resuscitation techniques are somewhat useless. First up, let’s refresh what needs to be done if you encounter a person drowning.
Drowning First Aid
• Remove the casualty from the water ASAP. DO NOT ENDANGER YOURSELF. Throw a rope or use a buoyancy aid to affect the rescue. Call for help.
• In minor incidents, following removal from the water, coughing may occur followed by spontaneous breathing.
• In serious incidents, if the patient is unconscious and not breathing, follow your Emergency Action Plan of DRSABCD.
• Assess the patient with their head level with the rest of their body. This decreases the chances of vomiting or regurgitation.
• The airway of the patient can be assessed whilst they are lying on their back. The exception to this is if there is obvious water, blood, vomit or sand in their mouth. If this were the case, the patient should be promptly rolled to their side and the airway cleared.
• If CPR is required, carry out as per training. If clear or frothy fluid accumulates in the upper airway during resuscitation, continue CPR and do not attempt to drain fluid.
• Continually monitor patient if successfully resuscitated. Patient should be transported to hospital.
So why are compressions only CPR so useless? The primary cause of cardiac arrest in drowning is lack of breathing. This then results in no oxygen in the blood and an increase in carbon dioxide. By doing compressions only, all we are doing is circulating oxygen poor blood around the body. This is pointless and doesn’t assist the patient at all. If done at all, it should only be done briefly prior to the arrival of a barrier device, face mask or bag valve mask. The use of oxygen is beneficial, however resuscitation should not be delayed awaiting the arrival of oxygen equipment. As always, the use of an Automated External Defibrillator (AED) is highly recommended. Most times, the patient who drowns will not be in a shockable rhythm, however if the drowning occurs due to a pre-existing medical condition, the use of a defibrillator will be advantageous.
How do we slow down the number of drownings? The simple answer is prevention. Teach your kids to swim. Don’t wait until they’re in school to learn, get them in the water and comfortable with it as babies. Keep in contact with them when they’re young, keep a close eye on them when they’re older. Always swim between the red and yellow flags when at the beach. Always empty the bath of water. Never leave buckets of water lying around the house (nappy or clothes soaking buckets). If you have to soak something, put the bucket in the laundry tub. Keep pool fences and gates maintained. Establish some ground rules around pool for kids.
The best thing you can do is prepare for the worst by doing a first aid course. Provide first aid covers CPR, teaching you how to effectively and efficiently perform compressions and rescue breaths. We can do this at either of our two training locations in Helensvale or Mermaid Beach, or we can come to you onsite. Stay safe folks.
Information sourced from the following:
Australian Resuscitation Guideline 9.3.2 – Resuscitation of the drowning victim
Royal Life Saving National Drowning Report 2017
Emergency and Trauma Care for Nurses and Paramedics (Curtis and Ramsden, 2011)