The stream, turbulent and icy with spring runoff, rushes between you and the trail on the other bank. Susan, who wandered off while you considered turning back, returns with a smile. No problem, she says, a log bridges the maelstrom just upstream.
She loosens her pack straps and unfastens her hipbelt (just in case), and starts balancing her way across the log. A few steps from the opposite shore, a strip of bark
shreds away be-
neath her feet, and she plunges in. After a frantic run down your side of the river, you find her below the rapids, floating face down. You carefully drag her to shore, concerned that she might have been injured while washing over the rocks. Taking pains to move her gently so you don't risk possible head or spinal injuries, you perform an initial assessment, checking the ABCs (airway, breathing, circulation). No breathing. You begin mouth-to-mouth ventilations, better known as resuscitation. Some 9,000 Americans drown each year, and you're determined Susan won't be one of them.
Susan probably followed the near universal pattern of a drowning victim. She no doubt panicked, struggled, and fiercely held her breath. While her heart raced, her blood pressure rose and her energy quickly drained. When she finally gasped for breath, she inhaled water and vomited. Once the water entered her lungs, it crossed cell membranes and passed into her bloodstream. She then lost consciousness and stopped breathing.
As terrible as this may sound, the fact that she's unconscious makes it easier and safer for you. Rescuing a wide-eyed person from water is one of the most dangerous things you can do. Large adults have drowned trying to rescue children desperately struggling to survive. The following five words should guide your actions to help a drowning person in such situations:
Reach: Try to extend your arm, leg, or a tree limb from a safe position on shore, and then pull your friend out of the water. If possible, lie on the ground to lower your center of gravity so it's harder for your friend to pull you into the water.
Throw: If you can throw something that floats, your friend might be able to hold on and keep her head above water.
Tow: If you have a rope or line to toss, you can tow the person to shore.
Row: With some type of watercraft, you can paddle out to a victim.
Go: If the water is shallow, you may be able to wade out to the person. If the water is deep and you're a strong swimmer with proper rescue training, consider swimming out to the person. But if you're not trained, you have a statistically excellent chance of becoming a victim yourself.
But remember that Susan is unconscious, so once you've pulled her from the water, you must begin treatment immediately. If her heart has stopped she is "clinically" dead, but still might be revivable. If you haven't gotten to her quickly enough she has probably experienced brain damage from oxygen deprivation, which is irreversible and she's "biologically" dead. Since you have no way of knowing, check to see if she's breathing, and if not, start mouth-to-mouth. This can be done while in the water as long as you're on stable footing. Tip her head back to open the airway, pinch her nostrils closed, seal your mouth over hers, and blow air in until you see her chest rise, indicating that her lungs have filled. Remove your mouth and allow her to exhale. Repeat the cycle every 5 seconds for adults, every 3 seconds for children.
Once on shore or in a boat, see if her heart is beating. The best way is to check for a carotid pulse in the "valley" between the windpipe and muscles of the neck. If you can't find the pulse, start CPR (cardiopulmonary resuscitation), which is the most basic first-aid skill everyone should know. Experts estimate six out of every seven drowning victims are pulled from the water soon enough for CPR to be effective, if started immediately and kept up. Courses in CPR should be standard for everyone, so don't simply read this and think you've got it down. Contact your local hospital or Red Cross and sign up. When you do, here's a quick rundown of what they'll teach you:
- Give two full breaths and check for a pulse. If there is no pulse...
- Place the heel of one hand on the person's breastbone about two finger-widths above the lower end of the breastbone.
- Place the other hand on top of your first hand. With your arms straight, quickly compress the chest 11/2 to 2 inches and release. Each compression/ release cycle should last a second.
- If you are working alone, complete 15 compressions before giving two more full breaths. If you are working with someone, alternate 5 compressions to one full breath.
- Repeat the cycle of 15 compressions/two breaths four times, and check for a return of pulse.
- If you don't find a pulse, continue CPR until she starts breathing on her own, someone replaces you, you become physically exhausted, or a medical expert arrives.
Don't worry about water in the lungs because most of it will be rapidly absorbed into the bloodstream. She needs oxygen immediately, and you're better off trying to blow air in than trying to drain the lungs. Also, expect her to vomit. When she does, roll her on her side, clean out her mouth, then roll her back over and continue CPR until she regains consciousness.
In cold-water conditions, it's possible to mistakenly assume someone has drowned, when in fact they are still very much alive. Cold causes the blood to be shunted away from the body's periphery, and a pulse can be too weak to find. Don't start chest compressions right away because you can actually stop a cold-but-beating heart. In a hypothermic case, take your time-a minute or more is not uncommon-checking for a pulse before beginning CPR. Breathing for the victim won't hurt, even if she is doing it for herself already, so don't hesitate to start mouth-to-mouth.
Prolonged immersion victims usually suffer some degree of hypothermia. Get the victim's wet clothing off as soon as possible, and gently dry her body. She must stay warm to prevent further heat loss, so wrap her in a blanket or sleeping bag, or dress her in dry clothes. If she can drink and eat, give her warm fluids and easily digestible foods like hard candy. Once dried, dressed, watered, and fed, she might be able to walk out of the woods on her own.
Anyone who has had a brush with drowning should be hurried to a medical facility. In Susan's case, you check her pulse after two full ventilations and find it strong. After a couple of minutes, she coughs violently and begins to breathe on her own. When she's alert, you head back to the car. Susan gets a full medical check-up and enjoys complete recovery.