A look at recently published medical studies and their relevance to the Swiftwater Rescue program.
Neil Newton Taylor | Swiftwater Rescue - It is over ten years ago that I remember running up the road from the Öztalerache river in Austria trying to think of the German for “not breathing” and to find a house with a phone in it. Still hearing the “and one and two …” of the guys working on our fellow boater.
He had just swum a considerable section of big volume Grade 5 whitewater and was lucky to be with boaters good enough to get him to the bank in his unconscious state. On being dragged out of the water he was blue in the face from cyanosis and to quote a friend “didn’t look good”. The kayaker regurgitated a large amount of river water during the resuscitation and started breathing by himself before the emergency services turned up. He stayed a week in hospital before he was discharged with no apparent side affects except an aversion to whitewater kayaking.
Since then I always get annoyed when I hear people say something to the effect that “Yes you can carry out CPR, but it has a less than 5% rate of success” or “Yes you can do CPR on someone but without a defibrillator their heart will not restart”. I’ve only been present one time when CPR was carried out, and it worked, so for me that was worth all the hours of training that I’ve done over the years. However saying that my “team” had a 100% success rate would be misleading as we did not have a large enough sample of resuscitation cases, and it could of just been the one in a million lucky lotto ticket that day.
Talking to students and other Swiftwater Rescue Instructors on the subject I have personally met 8 people who have successfully resuscitated a drowned person and one who has done it twice. That is quite a few lotto tickets. Sure I have also heard of many cases where it was not successful, however these were mostly where the victim was submersed for a longer period of time (45mins or more), where the victim was older or where the rescuer had arrived after the event (EMS or Rescue team).
In the last year I have read several medical studies published on the subject of CPR in Drowning cases and I though them interesting enough to bring them to your attention. Since 2003 medical studies have been standardized though the use of the ILCOR “Utstein Style” guidelines for reporting data from Drowning *.
The role of bystanders during rescue and resuscitation of drowning victims
Allart M. Venema, Johan W. Groothoff, Joost J.L.M. Bierens
Published in Resuscitation 81 (2010) 434–439
Introduction: 289 rescue reports between 1999 and 2004 were studied from the Dutch Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning) and correlated in the Utstein style of reporting.
Results: 113 victims were resuscitated however the results from 20 of these were unknown and so should be discarded. Of the 3 victims where EMS were on scene when the victim was brought ashore 3 survived. Of the 90 cases of bystander CPR by lay-persons on removal from the water 82 survived. This is a 91% survival rate.
Conclusions: Bystander rescue and resuscitation play a critical role in the survival of drowning.
Out-of-hospital cardiac arrest due to drowning: An Utstein Style report of 10 years of experience from St. Mary’s Hospital
Chun Song Youna, Seung Pill Choia, HyeonWoo Yimb, Kyu Nam Parka
Published in Resuscitation 80 (2009) 778–783
Introduction: This study was carried out in South Korea between 1998 and 2007 and covered the outcome of 131 of their patients who had been resuscitated because of drowning in the nearby Han river. This study was also presented in the Utstein format.
Results: Out of the 131 drowning victims 86 had a return of spontaneous circulation on admission to hospital. A large number of these patients developed complications such as pneumonia or respiratory distress syndrome whilst in Hospital. Only 9 patients were discharge from Hospital with a good neurological outcome (6.9%). However it was noted that 84 of the cases were suicide and that only 31 of the victims received bystander resuscitation.
Conclusions: The factors most affecting survival to discharge were: the drowning event being witnessed, a short duration of submersion, early resuscitation by EMS and rapid transportation.
The Key Role of Layperson Actions in Drowning Incidents
Jane Wigginton, MD – Dallas, Texas.
Published at the World Congress on Drowning 2002
Introduction: This study was carried out over a ten year period from 1990 to 2000 in Huston / Texas where they have an above average amount of swimming pool drownings each year mainly concerning children.
Results: The most impressive piece of information perhaps was the impact of bystander CPR. Half of the cases received CPR by bystanders and 79% of those receiving bystander CPR survived to hospital discharge (97% neurologically intact). However, most of these patients responded to bystander resuscitative efforts within a very short period of time to some degree or another and if the patient was still apneic and pulseless when the EMS rescuers arrived, only 5% were resuscitated and none remained neurologically intact.
Conclusions: Bystander CPR appears to be the definitive action for drowning victims, not any other interventions, basic or advanced.
In my eyes two of these reports are a confirmation that in a drowning event, with a short submersion time, bystander CPR is a successful rescue tool. This is one skill that we should continue to recommend that all of our students know and practice. We should also inform them that (for given parameters) in Swiftwater Rescue CPR (even without a defibrillator) has a high chance of success.
The Korean study has somewhat negative results, however with the large amount of suicides involved it is not surprising that there was an overall low success rate. Suicide victims often jump from high bridges into water causing other serious injuries and the fact remains that they do not want to live. In cases like these as well as cases of long submersion or no bystander CPR the chance of a successful, neurologically intact resuscitation are indeed very low.
For us as Swiftwater Rescue Instructors we should know that if someone is in the right place, at the right time, with the right training then they can make all the difference. When we are running our courses, as always, we want to prevent accidents from occurring, but you never know when someone may float round the corner and you could be the one to give them a lucky lotto ticket.
Neil Newton Taylor | Swiftwater Rescue- Rescue 3 Instructor Trainer – Austria & Germany
*Recommended guidelines for uniform reporting of data from drowning: the “Utstein Style”. Published in Resuscitation 2003;59:45–57.
I have used the term CPR (Cardiopulmonary resuscitation) throughout this article although many first aid manuals, especially in Europe and indeed the ILCOR guidelines use the term BLS (basic life support) to differentiate between Bystander CPR and ALS (advanced life support) where a defibrillator is used. If anyone is interested in reading the full articles or current CPR guidelines they are available through membership of the AHA or ERC.