Waterfall Accident Scenario

When a search begins for a drowning patient, when does the timer officially start?

The fire service team leader is gathering key information to determine if the operation should transition from rescue to recovery at 30 minutes. The river temperature is found to be 7°C. According to JRCALC, is this temperature cold enough to extend the rescue window to 90 minutes?

After 15 minutes, you hear shouting from a search team 50 meters downstream. They have located the patient partially trapped in a half-submerged tree. His head appears to have remained above water, but it’s unclear when he got trapped. Does the submerged person tool for aquatic rescue apply in this situation?

The search team retrieves the patient to the riverbank. He is in cardiac arrest. What is your immediate priority in managing cardiac arrest following drowning?

After suctioning visible fluid, you provide 5 rescue breaths with a BVM. The patient has obvious bilateral leg deformities but no major bleeding. No additional trauma is noted. Should you treat this as a medical or traumatic arrest?

You suspect the patient drowned due to immobility from leg injuries, not direct trauma. ALS is initiated, and the rhythm is PEA. Foam begins to build in the airway. What are your airway management priorities?

What consideration may affect your approach to intubation or SGA insertion in a drowning patient?

You successfully place and secure an ET tube. Capnography reads 3.3kPa. You delegate ventilation to a firefighter and begin preparing drug therapy. A temperature check shows 34.2°C. How does this affect your ALS drug administration?

You initiate drug therapy, adjusting dosage intervals accordingly. After the second CPR cycle, the patient achieves ROSC. What are your immediate priorities?

Initial ROSC observations: HR 85, BP 90/46, SpO₂ 100%, no respiratory effort, temp 34.5°C, BM 5.8 mmol/L, narrow complex sinus rhythm. What treatments would benefit this patient?

The patient re-arrests into PEA shortly after ROSC. HART arrives with a mechanical CPR device. Is this device appropriate in this context?

The HART leader suggests applying the mechanical CPR device and moving the patient to the ambulance. You have sufficient support to facilitate the move. Should you move the patient?

Once in the ambulance, the patient’s temperature reads 36.0°C. Can you now resume normal adrenaline dosing intervals?

The patient achieves a second ROSC after the third adrenaline dose. Helimed arrives, what key handover information should you provide?

In the drowning adult patient, you are unable to implement ROLE as a Paramedic level clinician even if they are normothermic?