drowning

• UNDERSTANDS the different protocol for a drowning victim
• CAN perform CPR effectively using the drowning protocol
• KNOWLEDGE OF Acute Respiratory Distress Syndrome or secondary drowning
• CAN recognise the signs of secondary drowning
• UNDERSTANDS that immediate medical attention is required if secondary drowning is suspected 
• KNOWLEDGE that submersion duration is the strongest predictor of outcome

EXPLAIN

What is is the difference between standard CPR & CPR for drowning casualty?, Who may need it, When to do it & How an AED fits in

Understands the chain of survival & that a casualty is unlikely to recover with CPR alone. 

DEMONSTRATION

How to correctly carry out CPR for drowning (manikin) & Use an AED (training AED)

IMITATE

Get your students to practice techniques on manikin (observe throughout)

CORRECTION 

Offer advice and guidance on best practice, correct any mistakes

TRY AGAIN

Allow students additional practice to perfect technique

SUMMARY

Q & A check for understanding and emphasise important 'take aways'

CPR stands for cardiopulmonary resuscitation. It combines chest compressions and rescue breaths to give a person the best chance of survival following a cardiac arrest.

Someone who develops breathing issues caused by liquid entering the lungs and preventing the person from getting enough oxygen after being underwater or having their head underwater (this can also occur from being in the water and having spray / waves splash over the mouth/face)

Symptoms could include: confusion, abdominal swelling, chest pain, cough, shortness or lack of breath, irregular heart beat, cold/blue-ish skin, vomiting

Treatment: First Aider = Monitor for deterioration, prepare to give CPR for drowning if required. Seek medical advice as Oxygen or Medication may be required. 

Someone who is not conscious and not breathing normally or doesn't have a pulse

Anyone with training

To someone who is unconscious, not responsive and not breathing or gasping for air

If you find someone collapsed, make sure it's safe to approach, check if they respond by gently shaking their shoulders and asking them loudly are they ok. If they don't respond, shout for help and open their airway by gently tilting the casualty's head back and lifting their chin. Look, listen and feel for up to 10 seconds for normal breathing (ignore occasional, irregular gasps - these are common in the early stages of cardiac arrest). 

If they are not breathing normally, ask a helper to call 999 or 112 for an ambulance (ashore) or Mayday Distress Alert & Voice Call (afloat) while you start CPR. Ask a helper to find and bring a defibrillator / AED, if available.

If you are alone:

AFLOAT: 

• Make a Mayday Distress Alert & Voice Call before commencing CPR, ensure to emphasise that you are alone within the Mayday voice call, if you have a handheld VHF keep it with you, if a fixed set, turn the volume up enough that you can hear it. 

ASHORE:

• use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control 
• Ask your helper to put the phone on speaker and hold it out towards you
• Do not leave the casualty to look for a defibrillator yourself.  If there is someone else with you, send them to get one.  The emergency medical advisor can tell them where the nearest defibrillator/AED is.
• If you're on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control (Ashore).

Drowning is when someone has difficulty breathing because their nose and mouth are submerged in a liquid.

Check RACB once away from the water:

Responsiveness

Airway

Circulation 

Breathing

1. Do not put yourself in danger when trying to rescue a casualty.

2. When the casualty is rescued from the water, you should first perform a primary survey. If this establishes that they are unresponsive and not breathing normally, you should ask a helper to call 999 or 112 for emergency help (ashore) or Mayday Distress Alert & Voice Call (afloat) while you start CPR. Ask a helper to find and bring a defibrillator (AED), if available.

• Ashore: If you are on your own, use the hands-free speaker on a phone so you can start CPR while speaking to ambulance control. Do not leave the casualty to look for a defibrillator yourself, the ambulance will bring one.
• Afloat: Make a Mayday Distress Alert & Voice Call before commencing CPR, ensure to emphasise that you are alone within the Mayday voice call, if you have a handheld VHF keep it with you, if a fixed set, turn the volume up enough that you can hear it. 

3. Check the airway is open before giving five initial rescue breaths. This is done by placing one hand on the forehead and two fingers (of your other hand) underneath the tip of the chin. Using the hand on the forehead, pinch the casualty's nose with your finger and thumb, allowing the casualty's mouth to fall open. Take a breath and place your lips around the casualty's mouth, forming a seal. Blow into the casualty's mouth until the chest rises. 

Follow by beginning chest compressions. Kneel by the casualty and put the heel of your hand in the middle of their chest. Put your other hand on top of the first. Interlock your fingers, making sure they don't touch the ribs. Keep your arms straight and lean over the casualty. Press down hard, to a third of the depth of the chest, then allow the chest to come back up. 

After 30 chest compressions, give two rescue breaths. Repeat this at a rate of 100-120 compressions per minute.

4. Continue to perform CPR until:  

• emergency help arrives and takes over  
• the person starts showing signs of life and starts to breathe normally
• you are too exhausted to continue (if there is a helper, you can change over every one to two minutes, with minimal interruptions to chest compressions)
• or a defibrillator is ready to be used (if the helper returns with a defibrillator, ask them to switch it on and follow the voice prompts while you continue with CPR).

Beware, many casualties that drown may bring up stomach contents, so be prepared to roll them onto their side to clear their airway.

5. If the casualty shows signs of becoming responsive such as coughing, opening eyes, speaking, and starts to breathe normally, put them in the recovery position. You may also need to treat them for hypothermia by covering them with warm clothes and blankets. If possible, replace the wet clothes with dry clothes.

6. Monitor the casualty's level of response and prepare to give CPR again if necessary.

If you have used a defibrillator, leave it attached.

People who have experienced near-drowning (i.e. they have been successfully rescued, with or without the need for resuscitation) may need to be observed for a short period in hospital and medical advice should be sought, even if they appear well in the immediate aftermath.

Agonal breathing is a medical term for a person's abnormal breathing pattern when they are gasping for air and not getting enough oxygen