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During an ill-conceived packrafting trip in the Wind River Range a few years ago, a buddy of mine got strained under a fallen log. His raft flipped and wedged itself against the debris, and he went under. I saw his panicked face clearly as he emerged for a moment, took a huge gulp of air, and quickly slipped away. Miraculously, he fought his way to the surface and scrambled to safety. In the midst of that remote emptiness, the risk of sudden, deadly events in the water became instantly real.
Drowning has been the leading cause of death in US National Parks since 2007, representing about a third of unintentional fatalities. That number could grow as increasing numbers of new visitors head outdoors. While 85 percent of Americans say they can swim, only 56 percent can do it well enough to self-rescue themselves if their boat flips or a river sweeps them off their feet. For generations, the opportunity to learn how to swim has been skewed along racial, social, and economic lines.
From a physiological standpoint, drowning is simple to understand: A submerged human can hold their breath for a short time, but a gasp reflex ultimately kicks in, and they suck in liquid. Oxygen no longer effectively enters the bloodstream from their lungs, and the thin layer of special fluid that helps keep them inflated washes away. Oxygen deprivation leads to unconsciousness, and, without rescue, cardiac arrest and death.
Rescue breathing can restart gas exchange and buy precious time, maybe even coaxing the heart back into motion. Given the respiratory source of the problem, we’ve always taught that, along with chest compressions, rescue breathing is the cornerstone of drowning resuscitation, whether with specialized devices or old fashioned “mouth-to-mouth.” Nonetheless, some rescuers may be untrained, uncomfortable, or unable to start rescue breathing.
As it turns out, chest compressions even without ventilation may be equally effective. A 2019 study of more than 5,000 patients with cardiac arrest after drowning observed similar outcomes in those who received conventional CPR with rescue breathing compared with “compressions only” CPR, which is commonly taught to the general public. The lesson for first responders is that high quality chest compressions alone can save lives.
Drowning deaths are always tragic, and often preventable. Outdoor leaders and rescue professionals alike should focus on universal swimming competency, prevention strategies addressing swift water and rip current risks, and the development of effective strategies for field resuscitation. A coordinated effort will make the water safer for everyone.
Christopher Tedeschi teaches and writes about wilderness and disaster medicine. He is associate professor of emergency medicine at Columbia University and an editorial board member for the journal Wilderness and Environmental Medicine. He enjoys hiking and biking near his home in the lower Hudson Valley.
Key Skill: Hands-Only CPR
The best way to learn CPR is to take a class; over the course of an hour or two, you’ll have the chance to practice basic life support skills under the watchful eye of an instructor. Untrained and in an emergency situation? After calling for help, move the victim to a flat surface, kneel next to them, and find the center of the victim’s chest. Put one hand over the other, center your shoulders above your hands, and push hard and fast. The ideal speed is 100 to 120 compressions per minute, or roughly the beat of the Bee Gee’s hit “Stayin’ Alive.” —Adam Roy
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