Statements on who needs further medical help after rescue from the water

Background

At its meeting in April, 2000, the Medical Commission considered the need for lifeguards, following rescue of persons from the water, to make decisions on which persons should be sent to hospital or advised to seek further medical advice. In some instances, the decision will need little thought but especially in less serious cases, the likelihood of delayed complications may not be appreciated by those without medical or extensive lifeguarding training. There are also clearly legal implications which will vary from country to country and these are not specifically addressed. The original 1978 advice from the Medical Commission of the World Lifesaving organization has been used as the basis for the present Statement.
Introduction

Lifeguards are the front line in prevention of drowning and rescue of citizens in difficulty in the water. Resuscitation may or may not be necessary but following every rescue, the lifeguard must decide whether hospital or medical follow-up is either necessary or advisable. This Statement provides guidelines for the assistance of Lifeguards.

Statement

(a) The following persons should be sent to hospital in most cases:

• Any Patient who lost consciousness even for a brief period.
• Any Patient who required Expired Air Resuscitation (Rescue Breathing).
• Any Patient who required cardiopulmonary resuscitation.
• Any Patient in whom a serious condition is suspected such as heart attack, spinal injury, other injury, asthma, epilepsy, stinger, intoxication, delirium etc.

(b) The following persons may be considered for release from care at the scene if, after 10-15 minutes of careful observation, while being warmed with blankets or other coverings as required, the Patient has ALL of the following. In such cases, it is unwise for the Patient to drive a vehicle and the Patient should be so advised. If any of these conditions do not apply or if the lifesaver has any doubt, then the Patient should be advised to seek early medical attention.

• No cough.
• Normal rate of breathing.
• Normal circulation as measured by pulse in strength and rate and blood pressure (if available).
• Normal colour and skin perfusion.
• No shivering.
• Is fully conscious, awake and alert.

(c) There is always a risk of delayed lung complications. All immersion victims should therefore be warned that if they later develop cough, breathlessness, fever or any other worrying symptom, they should seek medical advice immediately. It is preferable that these persons not return to a home environment where they are alone for the next 24 hours. Special care and observation should be given to child victims.