Drowning & Dive Rescue Emergencies
Graig Temple, NREMT-P
Dive Rescue Specialist
Objectives
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Students shall be able to differentiate
between an Active and Passive Drowning.
 Students shall be able to explain the
difference between a Near Drowning verses
an actual Drowning including signs and
symptoms.
 Students will be able to compare and
contrast a fresh water drowning verses a salt
water drowning.
Objectives
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Students shall be able to identify a RipCurrents in typical surf conditions
 Students will obtain a basic knowledge of
Yell - Reach – Throw – Row – GO
Objectives
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Students shall be able to identify various
types of dive related emergencies along
with their associated signs, symptoms and
immediate treatments.
 Students will be able to describe basic scene
management of a dive emergency
 Students will be able to identify basic
components of SCUBA gear including
Drowning

Definition - Die by immersion in water: to
die by immersion and usually suffocation in
water or other liquid, or kill a person or
animal in this way. Death occurs either
from lack of oxygen or as a result of cardiac
arrest from the lowered body temperature.
Active Drowning
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Conscious Victim
Thrashing
Vertical in water
Unable to call for help
Body may be low in
the water
Passive Drowning
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Unable to stay afloat
Unable to fight on the
surface
Submerges
Becomes apneic
Body floats on surface
or could sink
Cardiac Arrest
imminent
Near Drowning

Definition – a person who nearly drowns
from suffocation in a liquid: Injury occurs
as of a direct result of the suffocation but
does not result in death.
Near Drowning
Signs and Symptoms
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Abdominal distention
Bluish skin of the
face, especially around
the lips
Chest pain
Cold skin and pale
appearance
Confusion
Cough with pink,
frothy sputum
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Irritability
Lethargy
No breathing
Restlessness
Shallow or gasping
respirations
Unconsciousness
Vomiting
Fresh Water Drowning

A type of drowning in which hypo-osmolar
water compromises the surface tension of
alveolar surfactant, causing an imbalance in
the ventilation-perfusion–V/Q ratio, with a
collapse of some alveoli, and both true–
absolute, and relative–intrapulmonary
shunting
Fresh Water cont.

If the drowning or near drowning occurs in fresh
water and water enters the lungs, that water is
quickly absorbed into the blood stream. Fresh
water has a lower solute concentration than the
plasma in the pulmonary capillaries; therefore,
the fresh water is absorbed across the alveolar
membrane into the bloodstream.
Fresh Water cont.

Once in the bloodstream, this fresh water
dilutes the blood and changes the blood
chemistry. Fresh water also affects blood
cells and tissue membranes causing
hemolysis which is destruction of the blood
cells. The chemical change in the blood can
result in cardiac dysrhythmias
Salt Water Drowning

Sea water aspiration results in fluid-filled
but perfused alveoli, accompanied by a V/Q
abnormality due to pulmonary edema; the
shifts of fluids and electrolytes in salt water
drowning result in hemoconcentration,
CHF, and hypernatremia
Rip Currents

A strong, narrow surface current that flows rapidly
away from the shore, returning the water carried
landward by waves.
 Occurs when waves break heavily in one area and
weaker in others.
 Current in the Rip is “jet like” and will carry the
victim typically from several feet to a 100 yards
before the current stops.
 Majority of Near Drownings occur as a result of
being caught in Rip Currents
How to Escape the Rip
Surface Rescue
YELL – Reach – Throw – Row – GO
Yell for Help
Reach for the victim (with an object if possible)
Throw a Life ring, Rope bag or Floatation Device
to the victim
Row or Paddle to the victim if possible
GO yourself by swimming to their aid.
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KNOW YOUR LIMITATIONS!!
Useful Tools
Public Safety Divers
Responses

Drowning
 MVC’s with submersion
 Boating and PWC accidents
 Off Shore SCUBA accidents
 Ice Rescues
 Mutual Aid
Training

Due to the various types of incidents that
public safety divers respond to, it is
necessary to be trained in multiple
disciplines including;
– Basic and Advanced Open Water
– Rescue, Dry Suit, Wreck and Night Diving
– Public Safety Diving
– CPR/AED/EMT/Paramedic
Dive Emergencies
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Heat Exposure
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Soft Tissue Injuries
– Hyperthermia
– Lacerations
– Heat Exhaustion
– Abrasions
– Heat Stroke
– Contusions
Cold Exposure
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Stress
– Hypothermia
– Increased Heart Rate
– Frostbite
– Elevated B/P
Dehydration
– Elevated R/R
– Psychological
Medical Monitoring
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BLS/ALS Crew equipped to assess
– Vitals Pre and Post dive
– SpO2 and EtCO2
– Cardiac Monitoring and 12 Lead EKG
– Mental Status and Neuro Exam
– Secondary physical exam
Dive Emergencies

Oxygen Toxicity
 Nitrogen Narcosis
 Free Diving and Shallow water blackout
 Carbon Dioxide Retention
 Decompression Sickness and Illness
Oxygen Toxicity

Works off of Daltons Law on Partial
Pressures.
– The result is an elevated pO2 and convulsions.
This is the direct cause of Nitrogen Narcosis
which eventually leads to DCS.
SIGNS and SYMPTOMS
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Muscle spasms
Nausea/Vomiting
Dizziness
Tunnel vision
Tinnitus
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Irritability
Anxiety
Trouble Breathing
Unusual fatigue
Loss of coordination
Convulsions
Nitrogen Narcosis
Often referred to as the “Raptures of the Deep”
occurs when divers dive below 100 feet.
 This condition happens due to two laws. Dalton’s
law states that the total pressure exerted by a
mixture of gases is equal to the sum of the total
pressure of each gas in the mixture as if it were
occupying the same space.
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Narcosis cont.
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Boyle’s Law states that it is these same
gases when rapidly reduced that causes
decompression sickness. That is why
Nitrogen is the gas that determines
decompression schedules.
Suffering from Nitrogen Narcosis
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Contributing factors
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Signs and Symptoms
– Cold
– Complex reasoning
– Stress
decreases by 33%.
– Manual dexterity
decreases 7.3%.
– Diver appears “drunk”.
– Example; diver appears
to have drank 1
Martinis per every 50
feet.
– Heavy work and
fatigue
– CO2 retention.
Treatments

Immediate CONTROLLED ascent with
constant monitoring by buddy/dive master
or Dive-medic.
 100% O2
 Cessation of diving, no further 100ft plus
dives.
 Monitor and transport.
Free Diving/Shallow Water
Blackout

Shallow water blackout (SWB) is a sudden
loss of consciousness caused by oxygen
starvation following a breath holding dive.
 About 7000 drownings a year occur as a
result of this occurrence.
 Free divers use hyperventilation to reduce
CO2 build up to extend the breath holding
time.
Shallow Water Blackout cont..
Effects divers that use “closed circuit”
breathing apparatus.
 Occurs commonly within 15 feet of the
surface.
 Loss of oxygen to the starved lungs causes
rapid loss of consciousness.
 Occurs insidiously without warning.
 Victims don’t know what hit them.
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Signs and Symptoms
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Altered Mental Status secondary to hypoxia
 Sudden onset of unconsciousness
 Respiratory Arrest – Near Drowning
 Cardiac Arrest
CO2 Retention
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Primary concern due to skipped breathing.
 Breath holding
 Closed system diving
 Diving with contaminated air.
Signs and Symptoms
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Tachycardia
 Tachypnea
 Shortness of Breath
 Seizures/Convulsions
 AMS/Unconsciousness
 Headache
 Sweating
Treatment

100% O2 via Non-Rebreather
 Monitor Vital Signs, SpO2, EtCO2
 ALS Assessment – Cardiac Monitor, 12
Lead EKG, Stroke Assessment
 Transport if needed
Decompression Sickness
“the bends”
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Discovered in 1841 by sport divers.
 Caused by the production of Nitrogen that
leaks into blood circulation and accumulates
in the joints.
 Severity is determined by the depth and
time of a dive, along with the rate in which
the diver ascends.
Types of DCS
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Type I– Cutaneous manifestations and minor joint pain.
Referred to as “pain only”.
– Caused by bubbles, intravascular and
extravascular with large gas stores in the fatty
bone marrow.
– Cause of Dysbaric Osteonecrosis.
Types of DCS cont.
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Type II
– Includes severe symptoms related to
cardiopulmonary and neurological systems.
– Usually involves extensive damage to the spinal
cord.
Types of DCS cont.
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Type III
– Commonly a combination of an Arterial gas
embolism and Decompression Sickness.
– Involves neurological symptoms.
– Generally termed the worse form of
Decompression Sickness.
Signs and Symptoms
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Signs– Blotchy Rash
– Paralysis or weakness
– Coughing Spasms
– Staggering gate or instability
– Unconsciousness
Signs and Symptoms cont.
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Symptoms– Tired feeling
– Itching
– Pain in arms, legs or thorax
– Dizziness
– Numbness, tingling or paralysis
– Chest compression or Shortness of Breath
Treatments

Immediate 100% oxygen breathing even if a
marked improvement is noted.
 Stabilize the same as you would for an Air
Embolism.
 Recompression
 Rapid Air Transport to a medical facility
with re-compression abilities.
Accident Management
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Rescue – Removal from the water as quickly as possible.
– Diver must be made positively buoyant by
removing their weight belt.
– Wait until the diver is aboard a vessel (diving
bell, platform, boat) before resuscitation is
preformed.
Treatments
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Cardiopulmonary Resuscitation should not
be altered for the patient who is involved in
a diving accident.
 Keep in mind that water temperatures are
colder at depth than on the surface. The
chances that the diver may be hypothermic
are high. “They are not dead until they are
warm and dead”
Positioning
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If any form of Decompression Sickness is
suspected the diver must be kept in a supine
position and not allowed to sit up or stand.
 Sitting up or standing may cause bubbles to
distribute from the left ventricle and aorta to
the brain.
 Trendelenburg is NOT recommended.
BLS Treatment
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Baseline Assessment, Vitals and Injury
Management
 Oxygen - is the definitive treatment of
patients with salt water aspiration syndrome
and most pulmonary barotrauma.
 Consider CPAP for near-drownings
 Reassessment every 5 minutes
ALS Treatments
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Aggressive IV rehydration is a benefit to
divers.
 Use an Isotonic fluid with large bore
catheter if possible.
 DO NOT use any solutions which are
composed of glucose. It has been shown
that these solutions may increase
neurological trauma.
ALS Treatments cont.
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No drugs have been shown to be a benefit in
the treatment of Decompression Illnesses.
 Aspirin may be ordered by a physician to
lessen the chances of blood clots.
 Diazepam or Versed to control and prevent
convulsions.
 Analgesics as needed (Morphine/Fentanyl)
Transport
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Stabilization of the diver must precede
transportation. Resuscitation, O2
administration, IV access, hemorrhage
control and passive re-warming of the
hypothermic patient.
 Transport should be rapid and to an
appropriate Trauma Center with the
capability of recompression.
Transport cont.
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Special transport considerations – Must stay below 1000 feet.
– Road transportation may be inappropriate
depending on the roads altitude, contour and
surface. (Mountains, Valleys etc.)
HYPERBARICS
How does it work?

When the body is pressurized free gases that
are in the body decrease as the pressure
increases.
 Gas Wash Out- If the body has been
flooded by large amounts of one type of
gas, the pressurization causes the gas to
wash out.
Monoplace
Local Chambers for Divers
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Maryland
– GBMC, Baltimore
– MIEMSS (Shock Trauma),
Baltimore
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Delaware, none
New Jersey
– Ocean County Med. Ctr,
Atlantic City
– Comprehensive Wound
Treatment Ctr., Hackensack
– Morristown Memorial,
Morristown
– Seachrist Clinical Services,
Kearny
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Virginia
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Mount Vernon Hospital,
Alexandria
US Army, Fort Eustis
Metropolitan Hospital,
Richmond
DePaul Medical Center,
Norfolk
Sentara Leigh Hospital,
Norfolk
Naval Medical Center,
Portsmouth
Important Phone Numbers
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USCG, Ocean City (410) 289-7457
 USCG, Indian River (302) 227-2121
 Divers Alert Network 1-919-684-4DAN
LODD