Wednesday, June 26, 2013

Water Safety ….. Importance Level: HIGH

by Richard Pass, RN,BS, Director, Save A Little Life, inc.

It is not unusual for us at Save A Little Life to get a call or email every so often by a parent who has actually had to try and revive a pediatric victim, for real. This, no doubt, is due to the fact that drowning events occur daily in the U.S. rating it the 5th leading cause of unintentional injury death.

Of even greater importance, drowning represents the second leading cause of accidental death in the pediatric population  -  second only to auto accidents. Parents & family members need to understand just how devastating these events can be so preparation for prevention can be improved and overall awareness heightened.

Highest Risk Individuals
Children between 1-4 years are the most vulnerable to drowning. Four out of five (a full 80%) of these children are male. In this group, the leading location for drowning is the family pool. African American children have an even higher rate of these lethal events compared to other ethnic groups. In particular, the rate of drowning for African American children between 5-14 years is nearly 3 times that of Anglo children of the same age range. Of the factors that seem to directly influence these rates, the following have been identified:

  • Lack of ability to swim
  • Inefficient barriers (fencing/ pool covers, etc.)
  • Poor adult supervision
  • Failure to wear life jackets
  • Alcohol use (in adolescence)
  • Children with seizure disorders
As we look at the higher risk issues it should become clearer as to what needs to be done to lower drowning risk in the pediatric population. 

What Does Drowning Look Like?
If you were to think of the image of someone in the process of drowning it is not unusual to anticipate someone screaming and wildly flailing about in a rather obvious way.  These images, which come from T.V. and film, are usually far from what actually occurs.  In fact, many of these are drowning events are quiet (or completely silent) with little or no noise made by the victim.  Children who have had swimming lessons can still become a victim.

In fact, one out of five of these events occurs in the presence of an adult or care provider and is not even realized until the victim is completely unresponsive. Without early recognition and quick reaction the chance of permanent brain damage or death increases.

As frightening as these images might be, the drowning victim still has a chance for survival, assuming two things occur: 1. The victim is not submerged for a prolonged period of time (no specific time frames have been provided but the quicker they are removed the better)  and 2. That CPR is initiated immediately upon removing them from the water.  In fact, this group of drowning victims has a reasonable chance of a full recovery if both of the above conditions are in effect.

Is CPR for the drowning infant or child different from dry land events?
The answer is no. Once removed from the water and deemed lifeless (no breathing or moving) we begin CPR just as we would on anyone else in that age group.  A very important concept here is that CPR for this victim is not about water extraction but rather an effort to move oxygenated blood to the victim’s brain.  This is done with immediate initiation of 30 chest compressions and 2 rescue breaths.

What about the water?
Typically, the majority of the water taken in is actually in the victim’s stomach.  Water that gets into the lungs does not come out but tends to be absorbed through the lungs into the chest cavity and dissipates from there.  If, however, there is prolonged submersion  -  and no CPR offered until paramedics arrive  -  the outcomes are almost always much worse.  Conversely, a victim who receives immediate CPR usually has a better outcome.

The water in the stomach is another issue.  It is normal for at least 80% of these victims to vomit water, even if they are otherwise lifeless.  At the instant we note vomiting, the victim must be turned on their side which will facilitate its removal.  You may swipe the mouth at that point to clear water or debris that is easily reachable.  Once this is done, turn the victim back onto their backs and, if no signs of life, resume the same 30 chest compression: 2 rescue breath format.  If spontaneous breathing or moving resumes, stop CPR and (if not yet done) call 9-1-1 immediately.

The 2 Minute Rule
Moments such as described can be emotionally devastating for the adult rescuer. As a result, judgment errors are not uncommon. We need to be very clear at this point with regard to our initial series of actions. If you are alone with a pediatric victim who appears lifeless, initiate CPR FIRST, instead of making the 9-1-1 call. Do CPR for UP TO 2 MINUTES (unless spontaneous breathing re-starts) BEFORE CALLING 9-1-1. If there is another person present, CPR and the 9-1-1 call can happen simultaneously.

Prevention remains our primary focus and should remain so.  Yet we must be ready in case these efforts fail.  Taking a current CPR course is an essential part of parental readiness.  If you have not taken a course in the last 12 months, we strongly urge you to do so.  Again, we can be reached at and/or 818 344-1442
We are expecting a long and hot summer with little ones in and out of the water in a wide variety of settings. Let’s do everything we can to reduce the risk for drowning.

Have a safe summer,

Richard Pass, RN,BS
Director, Save A Little Life, inc.

Richard is an RN with over 30 years of experience in Emergency and critical care nursing. He is currently on staff at Cedars-Sinai Medical Center and is a part-time instructor of nursing at California State University, Northridge. Richard has been a basic and advanced life support instructor with the Heart Association for more than 20 years. He also teaches Infant CPR at The Pump Station Locations and at Rosie Pope Maternity in Santa Monica.


Unknown said...

I'm so grateful for programs like this! In Tucson, AZ. water safety isn't to much of a problem other than around the pools people own. It is smart for everyone who lets their kids swim in pools to know how to administer CPR.