Chapter 19

Water Emergencies

Lesson Objectives

• Assess and manage submersion incidents.• Assess and manage scuba diving injuries,

including breathing-gas problems and decompression illnesses.

• Assess and manage marine animal stings, including those from Portuguese man-of-war, jellyfish, and sea anemone, as well as other marine organisms.

Submersion Incidents (1 of 3)

• Drowning is defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid.”

• Most submersion incidents are preventable.

Submersion Incidents (2 of 3)

• What to look for:– Victim struggling in the water.– Victim floating motionless.– Victim lying at the bottom of a body of water.

• What to do:– Assess your own resources and abilities.– Rescue the victim. Remember to reach, throw,

row, and go.

Submersion Incidents (3 of 3)

• What to do (continued):– Open victim’s airway and provide rescue

breathing, as needed.– Perform resuscitation, as needed.– Evacuate all victims who have been resuscitated.– Observe victims closely who do not require

resuscitation.

Scuba Diving Injuries (1 of 7)

• Scuba: self-contained underwater breathing apparatus

• Divers should be familiar with medical problems from their certified training course.

• Non-divers should know the basic problems that divers might face and how to provide appropriate treatment.

Scuba Diving Injuries (2 of 7)

• Breathing-gas problems– As depth and pressure increase, more gases

are able to dissolve in the blood.– Excessive oxygen in the blood can cause

visual changes, confusion, and seizures.– Increased nitrogen can cause nitrogen

narcosis.– Hypoxia occurs when breathing air is used up.

Scuba Diving Injuries (3 of 7)

• Decompression illnesses (dysbarism)– Decompression

sickness (“the bends”)

– Arterial gas embolism (AGE)

© louise murray/Alamy Images

Scuba Diving Injuries (4 of 7)

• Decompression illnesses (dysbarism)– What to look for: AGE

• Unconsciousness• Paralysis or weakness• Convulsions• Cardiac/respiratory arrest• Dizziness or visual problems

Scuba Diving Injuries (5 of 7)

• Decompression illnesses (dysbarism)– What to look for: Decompression sickness

• Joint or limb pain• Paralysis• Fatigue and weakness• Breathing difficulty• Numbness or tingling• Rash

Scuba Diving Injuries (6 of 7)

• Decompression illnesses (dysbarism)– What to do:

• Evaluate breathing and resuscitate as needed.• Give 100% oxygen.• Place victim in recovery position.• Give victim sips of water if conscious and alert.• Protect from excessive cold and heat.• Protect from injury if seizure occurs.

Scuba Diving Injuries (7 of 7)

• Decompression illnesses (dysbarism)– What to do (continued):

• Evaluate for other injuries.

• Do a neurologic exam.

• Contact local EMS and DAN (Divers Alert Network)

• Get the victim with decompression sickness to recompression therapy in a hyperbaric chamber.

Courtesy of NOAA

Marine Animal Stings (1 of 6)

• Portuguese man-of-war• Jellyfish• Sea anemone

Marine Animal Stings (2 of 6)

• What to look for:– Pain, varying in severity– Whiplike streaks on the skin– Blisters, welts, scattered red blotches

within 24 hours– In severe cases: headache, dizziness,

paralysis, and anaphylaxis– Possible coelenterate poisoning

Marine Animal Stings (3 of 6)

• What to do:– Rinse with sea water.– Do not touch tentacles with your bare hands.– Apply vinegar, rubbing alcohol, or household

ammonia for 30 minutes.– Apply shaving cream or baking soda paste and

shave the area to remove nematocysts.

Marine Animal Stings (4 of 6)

• What to do:– Reapply vinegar or alcohol and soak for

another 15 minutes.– Apply hydrocortisone cream, antihistamine

cream, or anesthetic ointment twice a day.

Marine Animal Stings (5 of 6)

• Other marine life– Stingrays– Sea urchins– Catfish– Stonefish– Scorpion fish

Marine Animal Stings (6 of 6)

• Other marine life– What to do:

• Irrigate with water.• Soak in hot water for 30 to 90 minutes.• Remove obvious pieces of barb.• Treat as a puncture wound.• Seek medical attention promptly.• Consider a tetanus booster.