My last two articles focused on summer emergencies, and I would be remiss if I did not mention drowning. Most Americans are excited and grateful for summer, as it means that school is out and the kids are happy. The parents are initially delighted, but after about a month, they are prepared to send them back to school. Summer means vacations for many, and the beach is one of the favorite places to visit at this time. But summer brings its share of medical challenges: heat injuries, insect bites, Lyme disease, GI problems for those who used mayonnaise in the sandwich they ate after it had been exposed to the sun and heat for five or six hours. Summer means vacations for many, and the beach is one of the favorite places to visit at this time. But far more devastating to the family is the tragedy of drowning or serious water injury. The culprit is a lack of respect for the ocean and the lake, as well as poor decisions made by both adults and children, which, according to my grandchildren, will lead to consequences. Consequences may be as embarrassing as a bikini top pulled off by a violent wave or something much more dire, so let us move forward and discover the potential emergencies.
Approximately 5,000 deaths occur annually in the USA, with drowning representing the most common injury-related cause of death in children one to four years of age. This frightening statistic demonstrates that death from drowning can be silent and can happen in seconds. Drowning is not just a fact concerning our precious children, but can happen to anyone in any age group where there is access to a body of water. How can we improve these scenarios and preserve lives by learning basic swimming and water safety skills?. It has been confirmed that formal swimming lessons can reduce the risk of drowning, but just as important is the fact that parents should never, ever leave children unsupervised in a pool, a lake, or the ocean. Not unlike a designated driver, it should be discussed among the parents present, and shifts should be initiated to ensure that an adult is present and observing for those in the water. When I say observing, this means without a beer in their hands or a Gin and tonic. Alertness is paramount to safety.
My wife, Celia, and I had a pool in our yard from the time our children were six years old, but we did not have a fence directly around the pool. Yes, we had a five-foot wooden fence around our property, but that does nothing to protect a child from entering the pool through an open or unlocked door and playing as they usually did. It only takes seconds for an accident to occur, and this judgment error could cause a child, yours, or your friends’ children, to have a permanent disability or even to die. In many states, the law requires a four-foot-high enclosure around the pool, complete with a self-closing and self-latching gate. The CDC recommends removing all toys and floats from the pool area to prevent children from having unsupervised access to the water. The proper ratio for watching children is one-on-one without the responsible adults using alcohol, drugs, a cell phone, or reading a magazine or book. Supervision means diligent, responsible attention. If a cell phone can cause a human tragedy while driving, what could be more devastating than a young, beautiful child drowning because of a conversation? Leave the phone on your blanket or keep it in your pocket for a 911 call.
Life jackets should be used by all people in a boat on a large body of water, particularly children, regardless of their swimming abilities. Young children and weaker swimmers should also use them in a pool; however, this does not imply that an inflatable tube or toy is as reliable as a certified life vest. I recall when Celia and I had a couple from down the block come to our home for a BBQ and swimming with their kids. Unfortunately, the parents were drinking at the table and were not paying attention to their children. My wife, like a faithful lifeguard, just happened to walk to the pool’s edge and saw the 18-month-old girl who had a diaper under her swimming suit sinking into the water with bubbles coming out of her nose. Celia dove in into the pool and rescued the child in a couple of seconds, and both saved a life, a lawsuit, and a friendship. This was an error of commission, committed on our behalf, and a lesson learned forever.
Today, every parent should take a CPR course. When a loved one has a life-threatening emergency, a phone, by itself, cannot do compressions and rescue breathing, nor can it create a patent airway. It is also essential to be aware of your surroundings. Lakes lack buoyancy, are often filled with vegetation that can trap an adult foot or leg as if it were an octopus. Oceans have currents that can be extremely dangerous, and a rip tide (which I was caught in when I was fifteen) can carry a swimmer a mile from a previous location on the beach. A river can have a fast-moving current and bring a swimmer hundreds of yards from their initial spot. Thunderstorms and lightning strikes are real-life situations, which is why a community pool has regulations for exiting the water. I recall, while working at a local hospital just two minutes from the ocean, a 20-year-old man with a boom box on his shoulder walking on the beach during a lightning storm. A flash of lightning hit his antenna and seriously injured this young man. You can see the no-no in this true illustration.
I would encourage using the buddy system as I was taught at Boy Scout Camps—no buddy, no lake. I would also like to be a killjoy and say no alcohol if you are engaged in water sports such as boating, swimming, or surfing.
In conclusion, there is a time for the treatment of a drowning victim. Drowning can cause both cardiac and pulmonary arrest. Therefore, the CPR card in your pocket, or the ATLS or PALS card, indicates that you have completed a comprehensive set of lectures and were evaluated on your skill and knowledge. The reason I am mentioning this is that there comes a time when the tire must meet the road, and a card in your pocket is useless unless you immediately identify yourself and engage in the life-saving practices for which you were certified. As far as liability is concerned, I would not fret about fracturing a victim’s ribs nor would I be overly cautious of the fact that after a few breaths, preferably while still in the water, the person will split up water, mucus, vomit, or perhaps a small portion of the sandwich that had mayonnaise. But you leave that beach, having saved a life and reinforced the training of a good PA or NP. Have a safe summer, particularly if it includes water recreation.
Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor
