RESCUE AND IN-WATER RESUSCITATION

**Please note this is placed as an appendix based on standard international recommendations. This does not take the place of standard unit military training.**

- Identify and locate the victim (ask if there are more than one).1-2
- Victims are often seen motionless, sinking slightly below the surface.
- They may submerge into the water and never surface.

GOALS

- Initially the type of water does NOT matter (salt, fresh, clean, dirty).1-2
- Alert advanced life support as soon as possible.
- Accurately record environmental conditions including time of submersion, type and temperature of water and air, scuba diver (depth, time at depth, type of dive rig).
- As a clinical provider, if you find yourself being a rescuer, don’t become a victim. If you are being deployed on a Naval vessel – ensure you have taken all the courses about rescue swimming. Rescuer safety is a priority. Untrained rescuers or weaker swimmers should utilize alternative means of rescue such as the use of flotation devices, ropes, or paddles. Options for rescue include but are not limited to the following: 1-2,10

1. 1. Reach with an object from the safety of the shore or ship.
   2. Throw an object like a rope or flotation devices (this may help the victim stay afloat or the search and rescue team locate the victim.)
   3. Row (or paddle) a smaller craft to the victim if they are too far from shore to reach or have a floatation device thrown. The rescuer should ideally stay out of the water.
   4. Tow them into shore or away from danger in the water (i.e. swift water rescue).
   5. Go into the water (as a last resort) to rescue the victim if this is within the rescuer’s skill set.

- In water rescue, breaths should only be done when rapid extraction is NOT feasible. In water, chest compressions are NOT effective and should not be attempted. 1,11,12,16,
- Cervical spine injury in drowning victims is low (0.009%). Unnecessary cervical spine immobilization can impede delivery of rescue breaths via time of application and reduced airway opening. Routine stabilization of the cervical spine in the absence of circumstances that suggest a spinal injury (diving, boat accident, and fall from height) is not recommended. If suspected, protect cervical spine by assuming neck injury (use jaw thrust to open the airway and utilize C-Collar when feasible).1-3,9,17
- Hypothermic patients rescued from cold water are prone to lethal dysrhythmias (ventricular fibrillation). Patients should be handled as gently as possible to include the performance of life saving procedures (e.g., intubations) as these may precipitate dysrhythmias. Priority remains oxygenation, ventilation, and restoring circulation. 13