Research and practical experience shows that rescuers shouldn't give up prematurely on those that have apparently drowned in cold water. Chances for survival are much better for people inadvertently submerged in frigid waters. Statistically, drowning is the second leading cause of death in Alaska and a leading factor in most regions. The State of Alaska has been a national leader in development of guidelines for the treatment of cold related injuries and suggestions offered are based on this northern experience.
General Points - A personal flotation device (PFD) needs to worn at all times while near the water. Cold water in this context is defined as being less than 21°C (70°F). If the length of time in water is unknown, assume the best case scenario and start CPR. There is not much difference in the outcomes associated with drowning in fresh or saltwater. Treatment for drowning in warm or cold water is the same, but the colder the water, the better the odds of successful recovery.
Evaluation and Treatment - The key recommendation for rescuers is not to give up prematurely on a person that appears to have drowned in frigid water. There is a phenomenon known as the mammalian dive reflex that appears to offer us protection from drowning in cold water. This is even truer of younger children and infants who are much more resilient to harm than adults.
- Avoid moving the patient's head or neck during a rescue. A drowning could be the result of an outside factor like diving in shallow water. Use a backboard or keep the head and neck in a straight line during removal from the water
- Unless it jeopardizes the rescue, keep the patient horizontal in the water during their removal
- Call 911, activate the emergency medical system, make a Mayday call on marine VHF channel 16
- Check for signs of respiration and circulation like movement, coughing or pulse for 60 seconds before starting cardiopulmonary resuscitation
- Start CPR immediately if there are no signs of respiration or circulation
- It is important to be sure the airway is clear and open. No specific actions are necessary to expel water from the lungs. Avoid using abdominal thrusts unless it is clear that there is an object blocking the airway
- Be aware of other associated injuries that may have also occurred
- Treat appropriately for hypothermia
Some medical professionals comment that family members may give up on a drowning victim prematurely out of some sense of guilt. Don't give up on treatment in a drowning, especially if it happens in cold water. Anyone who has survived a submersion should be taken to a hospital for evaluation. Fluids (noncardiogenic pulmonary edema) in the lungs can develop up to 24 hours after the incident. Practice cold water safety skills.
