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4.1            Drowning/Submersion - Adult & Pediatric                                

     = cross reference       = information      = drug information

SUBMERSION: When a patient goes under the water immediately, has a hypoxic cardiac arrest and then cools down. Prognosis considered dismal.
IMMERSION: Patients are in the water with head above water and they continue to breathe while they cool down before they eventually arrest. Prognosis can be good with patients surviving after prolonged CPR.




  • Routine Patient Care.

  • Consider spinal motion restriction for suspected spinal injury, see Spinal Injury Protocol 4.5.

  • If unresponsive, obtain esophageal or rectal temperature.

  • Consider NOT initiating resuscitation efforts with:

    • A clear history of prolonged submersion prior to cooling and/or cardiac arrest prior to submersion, OR

    • If esophageal or rectal temperature greater than 32oC (89.6o F) with asystole documented in 2 leads.

  • Obtain specific history.

  • Consider hypothermia. (Refer to table below)

  • Remove wet clothes and warm the patient.

  • Conscious patients with submersion injuries should be transported to the hospital.



  • Consider CPAP to supplement the patient’s own respiratory effort.

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  • Patients with Stage III or IV hypothermia may benefit from treatment at a facility capable of ExtraCorporeal Membrane Oxygenation (ECMO) or CardioPulmonary Bypass (CPB). Provide a list of these facilities.

Protocol Performance Standards

Performance / Documentation Standards

  • Was the patient's weight determined via weight-based resuscitation tape (unless weight definitively known)

  • Documentation of pre- and post-treatment blood glucometry

  • Assessment of patient's mental status.

Protocol Bibliography


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