|Title:||Emergency hospital management of drowning victims|
|Document ID:||Operational Circular OP 1982/05|
|Date of issue:||Thursday, 11 August 2005|
|Status:||NO LONGER APPLICABLE|
|Description:||This Operational Circular provides advice to hospitals and health services on the emergency management of drowning victims.|
|Applicable to:||Clinical and administrative staff of the Department of Health|
|Period of effect:||from 5 August 2005|
|Authorised by:||Dr Simon Towler, Executive Director, Health Reform and Clinical Policy, 01-Aug-2005|
|Print version:||View print version|
Emergency hospital management of drowning victims
The World Congress on Drowning 2002 and the International Life Saving Federation (2004) have defined drowning as “the process of experiencing respiratory impairment by immersion in liquid”.
Drowning interrupts the oxygen supply to the brain and therefore the major factors affecting survival are early rescue and resuscitation.
In Western Australia in 2001/02, accidental drowning resulted in 27 fatalities, 52 cases who were admitted to hospital and survived, and 97 cases that attended an emergency department and were discharged. Of the hospitalised cases, 49 cases were estimated to have recovered fully and the remaining three cases to have had moderate or severe disability as a result of the drowning incident 1.
The highest rates of drowning occur in children under 5 years of age and in young adults. At all ages, males are over represented.
Co-morbidities may worsen the effects of drowning and should be actively sought:
Hypothermia is more likely in children and more likely following drowning in cold water (<15°C). Drowning in cold water may afford a degree of cerebral protection against hypoxia, but in Western Australia the water is not normally cold enough to provide such protection. Most reports of survival after prolonged submersion are of children who drown in water colder than 5°C and who have residual cardiac activity (such as electromechanical dissociation) when taken from the water.
Maximal resuscitation should be provided for up to 30 minutes during which rewarming should be provided as necessary. If spontaneous circulation does not return during this period, resuscitation may be ceased regardless of the core temperature. Intrahospital transfer is inappropriate unless spontaneous circulation has been re-established.
In patients where the circulation is restored, neurological assessment should not be undertaken until the patient has been fully rewarmed.
The principal physiologic consequences of immersion injury are prolonged hypoxemia and acidosis which must be corrected to ensure survival. Where there is significant concern, early consultation with a tertiary centre is advised.
The following treatments should be routine for all drowning victims:
Unless there are no symptoms on presentation to the hospital, drowning victims should be observed for a minimum of 6 hours, with pulse oximetry monitoring. Severe cases may require ward or ICU admission.
Resuscitation of the Drowning Victim. Guideline No 8.7. Australian Resuscitation Council. February 2005.
Statements on In Water Resuscitation. Policy No 7.0. International Lifesaving Federation. September 2001.
Dr Simon Towler
This circular last updated: Thursday, 11 August 2005 at 3:36pm