ATS - submersion and diving emergencies

Emergency Medical Technician
18 – Submersion & Diving Emergencies
© 2014
• Water-related incidents
occur year-round & pose
a safety risk for both
patients and responders
• Environmental conditions
that can further
complicate scene
management include:
– Current
– Water depth
– Hidden hazards
– Temperature
3

© 2014
• Understanding the risks
and knowing how to
quickly provide
emergency care in
water-related
emergencies are crucial
to success
4

© 2014
1. Submersion Emergencies
2. Spinal Injuries in Water
3. Diving Emergencies

© 2014
• Never enter the water if
you do not have the
training or equipment
for a water rescue
• Factors that can
contribute to water-
related incidents or
submersion
emergencies include:
– Weather conditions
– Alcohol use
– Medical emergencies
7

© 2014
• The World Health
Organization, defines
drowning as:
– “The process of
experiencing
respiratory impairment
from submersion or
immersion in liquid”

© 2014
• Four categories:
– Asymptomatic
– Symptomatic
– Cardiac arrest
– Obviously dead
9

© 2014
• The asymptomatic
patient displays no
signs or symptoms
of drowning
10

© 2014
• The symptomatic
patient will exhibit
some of the signs &
symptoms
commonly
associated with
drowning
11

© 2014
• Signs & symptoms of
drowning include:
– An altered mental status
– Respiratory distress or
arrest
– Unusual vital signs
– O2 saturation below
95%
– Persistent cough,
wheezing crackles
– Hypothermia
– Cyanosis
– Shock
– Vomiting or diarrhea
12

© 2014
• The cardiac arrest
patient presents
with apnea & no
pulse
13

© 2014
• The obviously dead patient will often
exhibit rigor mortis & lividity
– Lividity: The pooling of blood in the lowest,
or underside parts of the body
14

© 2014
• Perform scene-size up
• Assess ABC’s
• Perform rapid trauma
exam
• It is not unusual for a
drowning patient to
suffer from other
injuries
• Assess carefully
15

© 2014
• Ensure a patent airway
• Look for obstructing
foreign objects
• Be prepared to suction -
vomiting is common
• Assist ventilations with
supplemental oxygen
16

© 2014
• Evaluate for other
injuries or medical
conditions
• Protect from
hypothermia & shock:
– Remove surplus wet
clothing, cover patient,
keep warm
• Transport
• Monitor for changes
• Prepare for cardiac
arrest
17

© 2014
• A patient involved in a
water-related incident
may have a spinal
injury
• The patient may be
responsive but unable
to move
• The patient may be
unconscious
• These incidents often
occur in very shallow
water
19

© 2014
• Perform a water rescue
only if you are properly
trained & have the right
equipment
• Your safety is your first
priority
• If you suspect a spinal
injury:
– Maintain in-line
stabilization
– Secure the patient to a
backboard before
removing him from the
water
20

© 2014
• Procedures to manually
stabilize the neck &
spine of a patient who
is face-down in the
water include:
– The “head-splint”
procedure
– The “head-chin
support” technique
21

© 2014
• The head-splint support
technique uses the
patient’s upper arms to
stabilize the head &
neck
• Perform head-splint
procedure for a patient
that is in shallow water
22

© 2014
• Position yourself
alongside the patient
• Brace the patient’s arms
up against the sides of
the head to keep the
head stable
• Rotate the patient by
pushing down the
shoulder nearest you &
raising the shoulder
farthest from you
23

© 2014
• Once the patient is face
up, stabilize the head by
pressing the upper arms
inward & using your
arm to provide support
underneath
24

© 2014
• Used in deep water &
only if the responder is
fully trained to perform
a water rescue
25

© 2014
• Position yourself
alongside the patient
• Place one hand at the
base of the skull to
support the head and
neck
26

© 2014
• Place the other hand
across the front of the
mandible
• Hold your forearms to
the patient’s torso
• Duck under the water &
under the patient,
rotating him as you do
this
• As you surface on the
other side, continue to
maintain manual
stabilization
27

© 2014
• Once the patient is
rotated, ensure a patent
airway:
– Begin rescue breathing
if indicated
• Other responders will
slide a backboard
underneath the patient
• Continue to maintain
manual stabilization
28

© 2014
• Continue to maintain
manual stabilization
• Apply a c-collar
• Secure the patient &
remove from the water
• Continue emergency
care for drowning
29

© 2014
• SCUBA = Self-contained
Underwater Breathing
Apparatus
• SCUBA diving is
popular, especially
along shoreline areas
• When done properly it
is a safe activity, but
several life-threatening
conditions can occur
31

© 2014
• Drowning injuries
• Injuries or
complications from pre-
existing medical
conditions
• Medical emergencies
– Air embolism
– Decompression
sickness
32

© 2014
• A collection of gas
bubbles that develop in
blood vessels
• On submersion, the
combined pressure of the
atmosphere & water
compresses gases, such
as the air, in the lungs
• When surfacing the air in
the lungs expands &
forces expanding bubbles
into the blood
• These bubbles block
blood flow & compromise
perfusion
33

© 2014
• The signs and symptoms of air embolism
occur upon surfacing and include the
following:
– Blurred vision
– Chest pain
– Numbness & tingling in the extremities
– Weakness or paralysis
– Frothy blood in the mouth or nose
– Convulsions
– Rapid lapse into unconsciousness
– Respiratory & cardiac arrest

© 2014
• Caused by surfacing too
quickly from a deep,
prolonged dive
• Dissolved gases in the
blood expand, creating
bubbles
• Bubbles act as emboli in
the vessels, blocking
blood flow to vital
organs
35

© 2014
• Decompression sickness
(DCS) can:
– Come on suddenly,
within 15 minutes
– Be delayed up to 24
hours
• There are two types or
classifications:
– Type 1
– Type 11
36

© 2014
• Type 1 is a mild DCS
• The hallmark symptom
is a dull, aching pain
that causes the diver to
bend over in pain
• Refered to as “the
bends”
• A mild pain commonly
begins in the shoulder
then gradually worsens
37

© 2014
• Type II is a more
serious condition
• Significantly affects the
nervous, respiratory &
circulatory systems
• Onset is rapid, though
many signs & symptoms
can be delayed for
many hours
39

© 2014
• Signs & symptoms on
the nervous system
include:
– Lower back &
abdominal pain,
numbness or tingling
– Headache
– Dizziness
– Vision & auditory
disturbances
40

© 2014
• Signs & symptoms
continued:
– Altered mental status
including confusion &
agitation, progressing
to coma
– Nausea & vomiting
– Uncoordinated
movement
– Motor & sensory
deficits
41

© 2014
• Signs & Symptoms on the
respiratory system
include:
– Lower back & abdominal
pain, numbness or
tingling
– Burning sensation on
inhalation
– Nonproductive cough
– Respiratory distress
– Burning sensation
typically localized
behind sternum
– Nasal flaring &
accessory muscle use
42

© 2014
• Signs & Symptoms on
the circulatory system
include:
– Hypovolemic shock
signs, including
tachycardia &
hypotension
– Thrombus (blood clot)
caused by coagulation
43

© 2014
• Obtain detailed dive
history:
– How deep?
– How long?
– Rate of ascent?
• Look at preplanned dive
chart or computer
records:
– Transport information
with patient
44

© 2014
• Ask questions about:
– Issues with equipment
or marine animals
– What kind of gas is in
air tank
– Use of medications or
intoxicants prior to
diving
• Travel history within
the last 72 hours:
– In an airplane or to a
higher elevation?
45

© 2014
• Ask if:
– Any first aid was
administered after the
dive
– If the patient has
experienced any sinus
or ear pain
– Has any fluid drained
from nose, mouth or
eyes (barotrauma)
46

© 2014
• Place the patient in the
recovery position:
– Use supine position &
manual in-line
stabilization if you
suspect spinal injury &
the patient is alert
• Maintain the airway &
administer high-flow
oxygen
• Document the exact time
you began oxygen
delivery
• Transport the patient
immediately
47

© 2014
• Contact medical
direction to locate a
facility with a
hyperbaric chamber
• Monitor the ABCs &
keep the patient warm
• DAN – Divers Alert
Network – 24/7
assistance for SCUBA
emergencies
48

© 2014
• Your first responsibility is to keep yourself
safe
• Never enter the water unless you have the
equipment & training required
• Water-related emergencies can occur in
any season & in many environments,
indoors & out
• By evaluating the scene & quickly
recognizing signs & symptoms of various
water related emergencies, you will be able
to provide the best care possible

ATS - submersion and diving emergencies

ATS - submersion and diving emergencies

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