Sunday, 25 November 2018

Drowning First Aid


As my blog promotes swimming, underwater photography and the aquatic lifestyle, it would be irresponsible of me if I didn't post something about first aid for drowning.
    This will be one of the most serious blog posts that I will ever write and I'm sure that much of the information here will seem like common sense. However, in an emergency situation, it is very easy for adrenaline and the fight/flight/freeze response to block rational thought. Simple and memorable instructions can help make a difference between life or death. And since 400 people in the UK (4000 in the USA) die from drowning each year, it's worth reading and then re-reading all the information presented here.

Starting with this infographic:

Some images from Pixabay.

D - Danger 

  • Before swimming anywhere, think about potential risks to yourselves and others. Does the sea look too rough? How deep is the water? What is the water temperature? How good is the visibility?
  • If your instincts tell you that it looks too dangerous, why risk it? Wait for a while or postpone your swim or dive for another day.
  • If everything looks safe or you're comfortable with the conditions, do take precautions to limit the risk. The water may change from safe to unsafe whilst you're mid dive.
  • Our relationship with the sea can be as complex as that with other humans. If you find yourself in a destructive situation that can't be solved with a cup of tea and a rational discussion, you have every right to leave the environment. 

The same is true with the sea - there's no harm in getting out, chilling on a rock and waiting for your 'loved one' to calm down. If you have the option to keep safe, it's a much better choice than trying to 'tough it out' and harming yourself in the process

  • If you go diving, it's always best to do so with a trained and competent buddy. It's usually more fun that way anyway. 
  • If solitude is your necessity, or you think there is a risk you could lose your buddy, take a brightly coloured surface float, marker buoy or inflatable boat. This will make it easier for buddies to re-unite, for rescuers to locate you and for boat users to be on the look-out for re-surfacing divers. 

A surface float with a flag and pockets to store your phone in a waterproof case is even better

  • And finally, if you're not a confident swimmer but like to hang out near water (or with your water-loving friends), you may not know what to do if you think that someone is drowning. It's best to alert a life guard, someone who can swim or who has access to a boat. If you can't find someone, try to find a life ring or line that you can throw to them. If you cannot swim confidently, do not try to rescue your buddy.

Left: A 15m throwline. Right: A 72cm life ring.

  • Don't take unnecessary risks. Some people may be daredevils (like these puffins), but it doesn't mean that you should be as well. One person drowning is already bad enough. Two people drowning can end in tragedy. 

R - Response

  • One of the best ways to prevent drowning in the first place is to make sure you keep regular communication with your buddy. 
  • Verbal communication at surface intervals, eye contact when underwater and habitual hand signalling will enable you to check your buddy's consciousness and awareness.

The universal diving hand signal for 'OK'. 
Image from Pixabay.

  • If you're on the shore whilst your buddy is in the water, call to them if you spot any potential dangers such as approaching storms, speed boats, tidal waves, sharks or this swan
  • If your buddy is unresponsive, they may be staying still and silent so as not to startle a turtle they're filming for their next YouTube video. Or, they may be experiencing Shallow Water Blackout, which is a loss of consciousness resulting from a lack of oxygen to the brain after a breath-hold dive (and they are at risk of drowning).

W - Watch

  • Watch your buddy. Drowning never looks as dramatic as it does in the movies. A drowning person may spasm but more likely they will stop swimming, stop responding and possibly begin to sink.

If you need prescription glasses on-land, you should also invest in prescription goggles and/or a prescription diving mask. Good vision will make it easier to spot subtle signs that a person is drowning.

  • Check for bubbles in front of their face, caused by an unwanted exhalation after becoming unconscious.
  • Observe their movements. If your buddy seems conscious but is moving erratically, they may be experiencing Loss of Motor Control (LMC, also known as 'Samba'). LMC is caused by dangerously low oxygen levels in their body. You will need to help them hold their head above the water since they may not be able to do so.    

It may seem like your buddy is head-banging, blowing bubbles and playing underwater air-guitar, but there's a good chance they may have Loss of Motor Control and are at risk of drowning. Only incredibly silly people play aquatic air-guitar anyway.

A - Airway

  • If your buddy is not responding and seems to be experiencing drowning, LMC or black-out, your first priority will be to protect and open their airway
  • Approach them from behind if you can and assist them to the water's surface if they have sunk. Support your buddy's head whilst doing so. If they have exhaled air whilst underwater, cover their mouth with their hand to stop them from potentially breathing in more water until you are at the surface. 
  • At the water's surface and whilst supporting their neck and head, tilt their head back to open their airway. Remove their mask to help them breathe through their nose.

Support your buddy's head and neck and tilt their head backwards to open their airway. 
Photo from Cliff Etzel at

  • Remove any weights they may be carrying. You want to prevent any chances of them sinking back underwater (and re-obstructing their airway).
  • If the water is very unpredictable or there are other aquatic hazards, prioritize getting out of the water. You can't maintain your buddy's airway if you are both in Danger.

T - Talk  

  • Talk calmly to your buddy whilst maintaining their airway at the surface. Unconscious people are usually still able to hear. Encourage them to breathe, use their name, ask them to talk to you. 

Communicating with your casualty is an often forgotten but very important aspect of first aid. 
Image from Pixabay.

  • You can also gently tap their shoulders and breathe softly across their face. Engaging their senses may bring them back to consciousness - the feeling of air across their face can also encourage them to breathe.  

E - Exit the Water

  • If you're still in the water at this point, your buddy is at risk of breathing in water and both of you are at risk of suffering from hypothermia, especially if the water temperature is low. 
  • Whilst maintaining your buddy's airway, do your best to get the both of you out of the water. If you are not near a shore, hopefully you will be near a boat or a platform. 

A boat is better than rocks, but rocks are better than nothing. 
Image from Pixabay.

  • If you're far away from the shore and don't have access to a boat, hopefully you will be near a surface float or marker buoy. Be near anything that can help you to steady yourself whilst you're supporting your buddy and importantly, to make you more visible to rescuers. 

R - Rescue Breaths

  • If your buddy is still unconscious and not breathing, administer five rescue breaths.
  • It can be difficult to tell whether someone is breathing or not whilst they are unconscious. Watch their chest to see if it is rising and falling as they inhale and exhale. You can place the back of your hand in front of their mouth to feel whether or not any air is being exhaled. 
  • It's much easier to apply rescue breaths outside of the water but if you are still in the ocean and waiting for help, administer them anyway. Sometimes you have to work with the situation at hand.

Tilt your casualty's head back with one hand on their forehead, lift their chin with your other hand, pinch their nose and breathe into their open mouth. Do this five times. 
Image from Alpha Outpost.

  • If you're still in the water, administer a rescue breath every five seconds if they are not breathing. 

A - Airway (Assistance/Ambulance)

  • After applying rescue breaths, it is very likely that your casualty will cough up water. Monitor your buddy's airway and make sure it is not blocked by water or vomit. 
  • You may want to briefly lie the casualty so that their head is lower than their body to help drain any water from their mouth.
  • Put your ear to your casualty's mouth to check for breathing.

Keep their airway open with one hand on their forehead, and the other underneath their chin.
Image from Pixabay.

  • If there are other people around, call to them for help. Ask them to call for an ambulance (999 in the UK, 112 in the EU, 911 in the USA).
  • If you're out of the water but there's no one to help you and your casualty is still unconscious and not breathing, administer CPR (see below) for one minute before attempting to call for emergency help. 

B - Breathing

  • If you are still supporting your casualty in the water and waiting for help, keep administering one rescue breath for every 5 seconds and continuously monitor their airway for signs of breathing and/or airway obstruction.
  • If your casualty starts breathing but they are still unconscious, place them in the recovery position.

 This is what the recovery position looks like.
Image from Pixabay.

  • Even if your casualty regains consciousness, is breathing normally and they assure you that they're OK, they will still need medical attention. If any water has entered their lungs it can irritate their air passages and call them to swell (this is known as secondary drowning).   

C - Circulation (CPR)

  • If you are out of the water and your casualty is still not conscious and not breathing, administer CPR (cardio-pulmonary resuscitation).

Place one hand on your casualty's chest, interlock your other hand and with straight arms press down 30 times (these are chest compressions). A first aid training manikin can help you understand how much force is needed when carrying out chest compressions.
Image from Pixabay

  • Carry out 30 chest compressions and then 2 rescue breaths. Repeat until emergency services arrive.
  • How fast should you carry out the chest compressions? Bring to mind 'Staying Alive' by the Bee Gees. It has the perfect tempo and the subject matter is very relevant. 
  • If you have bystanders nearby and you're tired from carrying out CPR for a while, instruct helpers on how to administer it.
  • Depending on how well funded the emergency services are in your area, you may want to keep track of how long it will take for an ambulance to reach you whilst others are helping you with the CPR.
  • If it is available, use a defibrillator and follow the instructions and voice prompts. Be careful not to be in contact with the casualty whilst the defibrillator sends a shock.

Additional Considerations

  • If your casualty has recovered, there is a good chance they will need to be treated for hypothermia. If possible, replace wet clothing with dry clothes and use warm coats or blankets to cover them.
  • If they are conscious, a warm drink may help them. Make sure to keep monitoring their response levels, breathing and pulse. 

To reward you for reading this rather serious post, here is a photo of a dog wrapped in a blanket to illustrate how to take care of someone who is showing signs of hypothermia.
Image from Negative Space.

  • The preceding sections can be summarized as the acronym DR WATER ABC (like DR ABC, but for the WATER) in order to help you keep in mind the order of first aid priorities. 
  • However, the circumstances can dictate the order in which first aid steps are taken or how many times they need to be repeated.
  • The Drowning First Aid Infographic at the top of the page can also be illustrated with seals and sea lions:

Some images from Pixabay.
Image of the sea lion giving CPR is from this video.

  • You can also learn basic first aid from taking workshops and courses at the Red Cross and/or St John's Ambulance. Both are fantastic organisations who do incredible life-saving work all over the world. 

And finally, stay safe and dive with friends. Thank you for reading!