The Management of Drowning: Advanced Life Support and Transport

A regional organized emergency medical service (e.g. paramedics) that carries specialized apparatus such as oxygen, endotracheal tubes, suction and intravenous equipment should be activated, if available. In any case, the patient should be transferred to hospital as soon as possible. The early administration of oxygen by suitable positive pressure apparatus, by personnel trained in its use, may be the critical factor in saving lives. For this reason, oxygen administration equipment should be carried on all dive boats. Patients who regain consciousness or who remain conscious after drowning events may have significant pulmonary venous admixture with resultant hypoxaemia. All such patients should receive supplementary oxygen and be further assessed in hospital. Respiratory and cardiac arrests have occurred after apparently successful rescue.

Although endotracheal intubation remains the best method for securing an airway and achieving adequate ventilation, the necessary expertise may not be available until the victim is transferred to hospital. In such cases, the use of airway devices such as the laryngeal mask airway may improve ventilation while the patient is being transported to hospital. Other airways such as the pharyngo-tracheal lumen airway and the Combitube tube are alternatives, but they require more training and have their own problems. One potential problem with all supraglottic devices, and with mouth-to-mouth and bag-mask ventilation techniques for that matter, is that the airway pressures required to inflate a ‘wet’, non-compliant lung may be very high and not easily achieved with these devices or methods. Endotracheal intubation may the only way to achieve adequate tidal volumes in such patients.

Properly trained and equipped personnel attending a case in the field may be able to invoke advanced resuscitation techniques such as the airway interventions mentioned earlier and the monitoring methods, drug administration strategies and arrhythmia treatments specified in Figure 23.3.

Advanced life support algorithm. CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; ETT, endotracheal tube; IV, intravenous; IO, intra-osseous; LMA, laryngeal mask airway. (From the Australian Resuscitation Council.)
Advanced life support algorithm. CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; ETT, endotracheal tube; IV, intravenous; IO, intra-osseous; LMA, laryngeal mask airway. (From the Australian Resuscitation Council.)

Advanced life support algorithm. CPR, cardiopulmonary resuscitation; ECG, electrocardiogram; ETT, endotracheal tube; IV, intravenous; IO, intra-osseous; LMA, laryngeal mask airway. (From the Australian Resuscitation Council.)