By AMERICAN HEART ASSOCIATION NEWS
Hundreds of thousands of people worldwide die every year from drowning. Yet efforts to figure out the best way to save them have been hindered by inconsistencies and confusion about how to report the details of these tragic occurrences and their eventual outcomes.
Those much-needed instructions were provided Monday by the International Liaison Committee on Resuscitation, a global coalition of health organizations that includes the American Heart Association, the European Resuscitation Council and the Heart and Stroke Foundation of Canada, among others.
The new guidelines specify what information should be collected from lifeguards, paramedics and hospital staff when an incident occurs. For example, knowing when someone’s face first went underwater, how long they were submerged, and when CPR began are some of the precise details that have been lacking.
Such data will help researchers better synchronize their findings and build on subsequent studies, said Ahamed Idris, M.D., the advisory’s lead author and a professor of emergency medicine at UT Southwestern Medical Center in Dallas.
ILCOR issued the first set of guidelines in 2003, but a lot has changed in resuscitation medicine and more is known about where gaps exist in the reporting of drownings. For instance, the new guidelines add an entire section about the lifeguard’s role.
Idris said lifeguards have the best information to report and frequently resuscitate people who never go to the hospital, which provides more evidence about the actual burden of drowning.
About 3,500 people in the United States die each year from unintentional drownings, according to the Centers for Disease Control and Prevention. Roughly 300 additional drowning deaths are boating-related.
Despite the statistics, there’s a shortage of drowning research, Idris said. He hopes the new advisory will remedy that.
“We’ll know how successful this report is when people start using it,” he said.
Increasing the study and understanding of drowning will save lives in the long run, Idris said. “We hope the new statement stimulates more and better reporting of the science of drowning, and that better reporting will lead to better treatments,” he said.
Michael Sayre, M.D., a professor of emergency medicine at the University of Washington in Seattle, said the heart may still be beating even after a drowning victim stops breathing. Mouth-to-mouth rescue breaths might bring them right back, said Sayre, who was not involved in writing the advisory.
But if someone is underwater for more than 10 minutes, “things are getting grim,” he said. Even so, some still survive.
For drowning victims, the AHA recommends immediate CPR with chest compressions and rescue breaths. Anyone who requires CPR or is injured during a drowning event should get checked by a healthcare professional, Sayre said.
The quality of care received by lifeguards or bystanders, paramedics and doctors also makes a difference in survival, Idris said.
“Since 2003 there’s been an explosion of information about what factors represent quality of resuscitation,” he said.
For hospitals, the advisory recommends tracking whether CPR was being given when victims reached the hospital, when it was stopped and why. In addition, hospitals should track whether a patient went to intensive care and if the hospital cooled the body to limit damage to the brain and organs, a treatment known as therapeutic hypothermia.
Drowning conservatively claims about 372,000 lives a year worldwide, and 90 percent of those deaths are in low- and middle-income countries, according to the World Health Organization. In those countries, emergency response and hospital treatment “may be immature, rare or absent,” the advisory authors wrote. The WHO works with some of those nations on drowning prevention programs.
In the United States, children under 14 represent about one in every five drowning deaths, according to the CDC. One- to 4-year-olds have the highest drowning rates, with most drownings taking place in home swimming pools.
Prevention is the best way to save lives, said Sayre.
Place a barrier between the house and pool and learn to swim, he said. While boating, he suggests wearing a life jacket and avoiding alcohol.
“It’s a bad idea to drink and boat,” Sayre said.
Alcohol is involved in up to 70 percent of drowning deaths associated with water sports in adolescents and adults, according to the CDC.
The drowning advisory was published in the AHA’s journal Circulation and the European journal Resuscitation.