With urban and rural swiftwater rescues from flooding or other misadventures; backyard pools of all shapes, sizes and depths; inebriated persons in roadside puddles; and even toddlers upending themselves in buckets, the chances of a rescue team having to deal with a wet victim are very high. While the 'time immersed' does impact survival, the initial treatment of an immersion incident will have a significant impact on the eventual recovery of the survivor.

   If the mechanism of injury involves alcohol or other intoxicants, high-powered personal watercraft (PWC), a diving accident or a fall of more than 10 meters, complications should be expected from significant trauma to the head, face, spine or other portions of the anatomy. Another source of secondary trauma is from whitewater incidents, where the victim may be ejected from a canoe, raft or kayak.

THE DROWNING PROCESS

   In the mid 1990s, the World Health Organization and World Bank sponsored a study on the Global Burden of Disease, which found that drowning was a much underappreciated cause of death worldwide.¹ The first World Conference on Drowning, held in Amsterdam in 2002, developed a new definition of drowning to simplify reporting of injuries and deaths due to immersion. The expectation is that, by replacing many of the other terms and definitions currently associated with drowning, a more comprehensive and useful Utstein-type database can be developed.² Public health organizations can then use the data to improve prevention efforts. While most injury reporting will be the province of hospital emergency departments, Utstein-style data reporting may be required for EMS divisions of public service districts. A number of primary and supplemental criteria have been identified, including:

• Precipitating event
• Degree and duration of immersion/submersion
• Time to first resuscitation efforts (duration of untreated cardiac arrest)
• Initial response to treatment
• Adequacy and type of ventilation
• Measurement and production of blood flow during chest compressions (demonstrated by palpable pulses in the field), and the definition of return of spontaneous circulation
• Patient condition on arrival at the emergency department.

   Other criteria are also included.³ It is hoped that improved reporting of standardized information will help improve the prevention and treatment of immersion victims in the future.

STATISTICS