Drowning: How you actually save a life

You might think I worried too much.  The G-Land surfer was walking and looking through pictures 8 hours after what happened. Do you really need a helicopter for that?

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If this patient was brought to a hospital he would certainly spend a few hours probably the night on an intensive care unit. First of all, he had a severe head trauma. Being unconscious for several minutes with a major loss of short term memory is enough to be monitored overnight. There might be a subdural hematoma or other kinds of brain tissue damage that will cause a deterioration hours after the incident. I certainly did not want to worry about that through the night. But this was not my main concern. When I auscultated his lungs just after the incident they were full of water. It was impressive, I have never heard anything like this. Even the worst pulmonary edema does not sound like that. Dan was a healthy man before the incident. People with a pathology leading to this amount of fluid in their lungs would not be breathing, they would most probably be dead.
Floating in the sea unconscious with his head under water he had inhaled water. The normal reaction even if unconscious is a laryngospasm in which the upper airway gets completely blocked by the vocal cords. So in the beginning only a tiny amount of water gets into the lungs. The attempt to breath under water mainly leads to water in the stomach. This was one of the reasons why he was vomiting non-stop after he had been pulled out of the water. But the laryngospasm usually does not last for long, on average about a minute. And in Dan’s case it had not lasted long enough before he got pulled out. So the vocal cords opened up and he inhaled a whole lot of sea water, still unconscious. Luckily, other surfers saved him before a cardiac arrest which would have been the next and final step. So his heart never stopped beating and once he was pulled out he did not inhale more sea water. He came back without CPR, he was able to supply himself with oxygen again even though it was only a small amount in the beginning. But this did not mean Dan was safe.

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Vomitting and coughing are both normal after a drowning incident.

He coughed up a fair bit and the rest of the inhaled water is usually reabsorbed in the lungs. But not without leaving damaged cells behind. These damaged cells can lead to an ARDS with a pulmonary edema hours after the actual drowning. This is what’s sometimes called secondary drowning because it will lead to insufficient oxygen supply. It is rare but very dangerous and difficult to treat. People, especially children can die of it even on an intensive care unit. As surfers it is crucial for us to understand those mechanisms. To take drowning incidents seriously. To be mentally prepared once it gets serious.

5 Rescue Breaths
CPR focuses on  compressions because usually when we encounter someone on land in need of CPR the problem is the heart. So statistically what we teach in first aid courses (to mainly compress) is the right thing . But in the surf numbers are different. If the reason for the cardiac arrest is a lack of oxygen compressions are secondary. What we have to do first and foremost is to get oxygen back into the body to get the heart beating again. We exhale enough oxygen in our own breath to make somebody else’s heart beat again. If  after a drowning incident first off we give 5 rescue breaths this can make all the difference. For Dan this could have made the difference had he been under water just a little longer. For him cardiac arrest through hypoxia was around the corner.
It is easy, you just have to know about it: 5 breaths through the nose or mouth of the victim as soon as possible and then compressions like you know it.

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Was the helicopter neccesary? The surfer thanked me for the view..

As for the G-Land story:  I did not save Dan. He would have been fine without me. I was there to take care of him, to organize the evacuation, to suture his wounds, knowing what to do, knowing what to say on the phone. That took the pressure off people with less experience and was convenient for everybody. But this is not how you save lives. You save lives when you react quickly and pull somebody out of the water. When you watch out for the people  around you. When you know about the rescue breaths and use your knowledge when it is needed. And when you spread the word.

So if you’ve made it to the end of this post you’ve already done a good thing. And if you make your mate read this who you usually go surfing with you have done a smart thing too. Awesome, isn’t it?

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