What
is the difference between drowning and “near drowning”? In
drowning you are dead. In near-drowning you are not dead — yet…

Prevention
is by far the best treatment for both. Start with common sense. Good
pre-trip screening for medical problems, equipment that is in good
condition (proper clothing for the weather, participants that are at
the skill level for the challenge of the day, and each participant
wearing their PFD. All participants need to be sober, not hung over
from the night before. The omission

of
any of the above can contribute to drowning.

Most drownings
occur within a short distance of safety. So always be prepared to
self rescue or to rescue someone else. Carry your throw bag with you
when you scout rapids, not just when someone is running them.

When
someone swims in white water, there is the potential for other
injuries as well as drowning or near drowning. While they are in that
hole being worked, or on that rocky, bony swim, they could be
injured. They could swallow water while attempting to get to the
surface or to that eddy. And, if they are unresponsive when you get
to them, their stomach could be full of water. But suppose “it”
happens. What do you do?

The
first thing you need to do is protect the airway, while remembering
that the victim may also have a spinal injury from the swim. The best
way to open the airway is the “jaw thrust” method. This
method does not extend the neck. Therefore, it keeps the potential
for spinal cord damage to a minimum. Remember, if the victim’s
stomach is full of water, they may vomit. Log roll them as a unit. DO
NOT turn their head if there is any chance they have a spinal injury.
Also, be sure to have your pocket mask and gloves available. This is
messy business.

When
someone drowns, they run out of oxygen and lose consciousness. How
long can you hold your breath? Quite awhile? Your heart keeps on
beating, even after you lose consciousness, until all of the oxygen
is used. If you start rescue breathing QUICKLY, as soon as you safely
can, you have a good chance of reviving the victim. You may catch the
heart before it runs out of groceries (i.e.,

when
all it needs is more oxygen).

This
is one time when CPR and rescue breathing have a high chance of
success. But, you must be QUICK in your rescue, and QUICK in your
attempts to breathe for the victim. The brain can only go for about 4
minutes before brain cells begin to die. ACT QUICKLY, but safely.

The victim may not be in respiratory arrest. Instead, they
may be coughing and sputtering. This person needs time to rest.
Assess them to see if they have any injuries, and get them out of the
water to a safe place. Here we are talking about the person who took
a swim and is now not able to carry on as normal. They are short of
breath at rest, or cannot catch their breath. This person needs to be
taken off the river and to safety, with the minimum of exertion on
their part.

Evacuate
them as quickly and safely as possible. Carry them out; put them in a
tandem canoe; build a cata-kayak. Do whatever it takes, but keep
their exertion to a minimum. Do not let them walk out, as this may
further stress the body and put them in respiratory distress or
respiratory arrest. (If that happens, you may need to rescue breathe
for the victim.)

If
someone takes a hard swim, they can appear OK even if they have
aspirated a small amount water into their lungs. Water will irritate
and/or damage the lung tissue. This tissue will swell just like any
injured tissue, and may leak fluid for up to 24 hours after the
injury. This leaking fluid will build up in the alveoli of the lungs,
and decrease the efficiency of the lungs as they try to exchange

oxygen
and carbon dioxide. This can lead to respiratory distress or
respiratory arrest (death).

After
a near-drowning, the lungs can fill with fluid from the damaged
tissue for up to 24 hours after the event. This is known as “parking
lot drowning”, and is why a person who has had a near-drowning
needs to be seen at a medical facility for evaluation. You’ve
probably taken a hard swim with no ill effects, but then had a cold
or cough the next day. You may have had a mild case of “parking
lot drowning”, or pulmonary edema, and just didn’t know it.

Points
to take home:


Prevention is the
easiest treatment.

Be
prepared to self rescue or rescue someone else quickly.

If
someone is not breathing, QUICKLY do a jaw thrust maneuver to open
the airway but not damage the spinal cord. (This is taught in CPR and
is part of being prepared).

If
someone is not breathing after the jaw thrust, QUICKLY breathe for
them as soon as is safely possible


These people will
vomit, so wear your gloves and pocket mask.

If
necessary, log roll the victim as a unit. DO NOT roll their head to
the side. You could damage the spinal cord if they have a spinal
column injury.

If
someone has taken a serious swim and is short of breath at rest,
evacuate them quickly, and with minimal exertion on their part.

If
someone takes a serious swim, they should be monitored or checked out
by an MD, even if they

appear
to be OK. Fluid can build up in their lungs for the next 24 hours.

Planning
and prevention are the best treatment.

by
Lonny McBride
From The Eddy Line, April 1998