Drowning Resuscitation Class Pays Off in North Carolina
For Suzi Carstensen of Cedar Rapids, Iowa, July 23, 2014, was no day at the beach.
Vacationing along North Carolina’s south shore with her family, Carstensen thought it odd when her 10-year-old daughter, Courtney, marched out of the surf at Brunswick County’s Ocean Isle Beach and announced that Grandpa had left her.
“She said he’d been sitting in the water with her, then rolled over and floated farther and farther away,” Carstensen remembers. “At first, we thought he might have gone for a swim, but Tim, my husband, figured he’d better check it out. He asked Courtney to show him where Grandpa had been.”
A few minutes later, Tim found his 75-year-old father-in-law, Phil Torticill, face-down in chest-deep water. Waves and a rip current had knocked him off his feet. Suzi estimates he was underwater for five to ten minutes. When Tim and other family members dragged him to shore, “He looked dead,” she says.
And that might have been the end of this story if not for some timely training and a truckload of rescuers determined to put it into practice.
A Special Case
The summer of 2013 had been a bad one for beachgoers in Brunswick County. Rich Burns, a paramedic and training officer at Brunswick County EMS, says his agency handled seven drownings.
“We had three fatalities in one day,” he says.
Burns was wondering how to improve those odds in 2014.
“One of our guys had just seen a presentation on drowning by Justin Sempsrott, an ED doc in Winston-Salem. He said Justin was an amazing speaker, so I looked into it and got him here in mid-July.”
Sempsrott is executive director of Lifeguards Without Borders (www.lifeguardswithoutborders.org), a non-profit group dedicated to lessening “the global impact of drowning.”
“We’ve spent a lot of time over the last few years speaking nationally and internationally to EMS agencies on drowning resuscitation,” says Sempsrott. “We have different versions of our presentation. The two-hour one seems to work best for EMS.”
Sempsrott gave that talk in Brunswick County to about 100 paramedics, EMTs, doctors and nurses six days before the Torticill drowning. The 34-year-old physician stressed that the C-A-B algorithm, introduced by the American Heart Association in 2010, doesn’t fit special cases like drowning (see The ABCs of Drowning Care sidebar below).
“What people don’t realize is that the AHA guidelines really apply to witnessed, out-of-hospital vfib/vtach arrests,” Sempsrott explains. “For those people, defibrillation and compressions are the priorities.
“Drowning is different; the ABCs haven’t changed. Most of those patients go through PEA (pulseless electrical activity) on their way to asystole. If they do stop in vfib or vtach–about 10% of drowning patients–the reason is global cardiac hypoxia, not focal hypoxia like in an MI. The AED won’t be effective if you don’t also reverse the hypoxia.”
Sempsrott tells rescuers not to worry about water in the lungs during drowning resuscitations.
“We have this idea that you have to treat drowning by draining all the water from the lungs when, in reality, you just have to get oxygen into the brain. Typically, very little water gets inhaled–less than 30 ml, if any.
“The first person out of the bus should have a BVM. If it’s attached to oxygen, great. If not, just start on room air. Find the patient and oxygenate them as quickly as possible.
“If you bring them to the hospital with dry lungs and a dead brain, there’s nothing we can do.”
Run For a Life
One of the EMTs at Sempsrott’s class was Jimmy Yates, a captain with Ocean Isle Beach Fire Department and the first rescuer to reach the patient. Burns was right behind him, only two minutes after the 9-1-1 call came in.
“Jimmy was like a gazelle. He came out of the truck with a BVM in one hand and an OPA in the other. He ran right to the patient. Bystanders were doing compressions, but that’s not what was needed. All they were doing was circulating oxygen-deficient blood.
“So Jimmy slides up to the patient, puts the OPA in there and starts going to town with the BVM. The next guy comes with just an O2 bottle. That goes against everything we teach these guys about making sure you got all the gear with you, but they remembered the class and remembered this guy is low on oxygen.”
Burns found Torticill pulseless in a junctional rhythm. He was being ventilated through a King airway during CPR.
“All of a sudden I see his rhythm start to change,” Burns recalls. “Then it was like someone flipped a switch on this guy; his color improved and the pulse ox skyrocketed from 50 to the low 80s very quickly. We got him in the back of a pickup truck to take him to the ambulance, and I’m watching Justin’s presentation unfold right in front of me.”
By the time Torticill arrived at Brunswick Medical Center, he had regained consciousness and was tugging at his tube.
“He was confused but very purposeful,” says Dr. William Sherrod, Brunswick’s chief of emergency medicine. “He just continued to improve the whole time there. His oxygen levels were good and he required minimal supportive care.”
Sherrod, who is also BCEMS’s medical director, says North Carolina is changing its drowning protocol to reflect Sempsrott’s guidance. “We’re trying to get the message out–that’s the biggest thing. We have lots of beaches and pools here.”
Four days after drowning, Phil Torticill was discharged neurologically intact and healthy enough to drive 1,200 miles with his family back to Cedar Rapids.
“Dr. Sherrod and all of the paramedics on the beach–they just did a wonderful job,” Carstensen gushes. “My dad wouldn’t be here if it weren’t for their hard work and training.”
“They interrupted the drowning process,” concludes Sempsrott.
And that was as easy as A-B-C.
Sidebar: The ABCs of Drowning Care
- Insert OPA and/or NPA(s) for unresponsive patients
- Clear vomitus, ignore foam
- Give five breaths immediately via BVM or mouth-to-mouth
- Add oxygen if available
- Continue rescue breathing
- Switch to advanced airway only if BVM unsuccessful with OPA and NPAs
- Assess rhythm of pulseless patients
- Defibrillate if indicated (rare)
- Don’t delay ventilations for spinal immobilization (rarely needed)
- Transport all symptomatic patients
- Warm to 94°F en route
The author wishes to thank the Torticill family for their considerable assistance with this story and its outcome: Phil, Ann, Suzi, Tim, Courtney, Michael, Christine, Will and Sophia.
Mike Rubin, BS, NREMT-P is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at firstname.lastname@example.org.