Drowning/Submersion 

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg

□ Airway and ventilation is a priority

□ Consider transport to pediatric trauma hospital as these patients may need admission for observation		□ Unresponsive 
□ Mental status changes 
□ Decreased or absent vital signs 
□ Vomiting 
□ Coughing 		□ Trauma 
□ Pre-existing medical problem 
□ Pressure injury (diving) 
□ Barotrauma 
□ Decompression sickness 
□ Duration of immersion 
□ Temperature of water 

Clinical Management Options

EMT-B
• Scene safety & decontaminate patient as needed 
• Evaluate for Cardiac Arrest 
• Oxygen, Target SpO2: 92-94% 
• BLS airway management as needed 
• Evaluate for spinal motion restriction if neuro deficits present 
• Keep patient warm
Paramedic
• If conscious and with wheezing, Albuterol & Ipratropium Bromide nebulizer 
• If conscious and with rales/rhonchi, CPAP 
• Vascular access 
• Evaluate ECG and EtCO2 
• Advance airway maneuvers and management as needed 
Consult Online Medical Control as Needed

Pearls

  • Do not attempt a water rescue unless trained.
  • Criteria for resuscitation includes: 
    • Suspected arrest from cause other than submersion 
    • Patient submersion time less than 20 minutes from witness of person going underwater or from arrival of the first Public Safety entity until the patient is in a position for resuscitative efforts to be initiated.  
  • On- scene rescuers should consider conversion from rescue to recovery at 20 minutes unless the patient is a diver with an air source, or a patient trapped with a potential air source.  
  • Final decision for transition from rescue to recovery mode rests with on-scene command. 
  • SMR should be used when a suspected or known traumatic mechanism preceded the drowning. 
  • All victims should be transported for evaluation due to potential for worsening over the next several hours. 
  • Drowning is a leading cause of death among would-be rescuers. Allow appropriately trained rescuers to remove victims from areas of danger. 
  • With pressure injuries (decompression / barotrauma), if possible, transport dive computer and/or dive logs with patient. 
  • Consider CPAP early if respiratory distress for any age if adequate mask seal can be established and patient alert. 
  • Assess water temperature (< 10◦ C / < 50◦ F) defines cold water.