Skills assessment in drowning incidents by rescuers

Abstract

Background and purpose Drowning is one of the leading causes of unintentional death worldwide. Prevention is the best strategy but it is not always sufficient to avoid the incident. When a person starts drowning, survival and prognosis will depend largely on the assistance of a rescuer. The objectives of this thesis were to analyze the interventions that both bystanders and professional rescuers have been known to use until now, in order to study the different strategies for the improvement of physiological conditions on the basis of simulation-controlled studies and to evaluate the optimization of resuscitation techniques on board rescue boats, both before and during the COVID-19 pandemic. Material and methods Six scientific publications make up this thesis. The first two papers are conceptual and descriptive, namely: a systematic literature review (PRISMA) and an expert consensus guide based on the COVID-19 literature review. The remaining 4 articles are controlled simulation studies with lifeguards, innovative in methodology, in which physiological, perceptual and skill aspects were analyzed during cardiopulmonary resuscitation (CPR) in case of drowning. Results Four profiles of lay rescuers have been identified, with different skill levels, and risk gradation has been established according to the rescue technique used. In professional lifeguards, the effect of electrostimulation (ES) on the recovery process after a rescue was found to be better than passive recovery. The feasibility of cardiopulmonary resuscitation maneuvers has been verified by navigating on a rescue water craft (RWC). In situations with risk of airborne transmission of aerosols containing infectious agents, the use of plastic blankets improves intervention start times without reducing the quality of CPR. Conclusions The conclusions related to the hypotheses are summarized in the following three paragraphs: There are different profiles of lay-rescuers. There is no scientific description of recommended water rescue techniques for lay-people; therefore in general the lay-rescuer should not enter the water to attempt a rescue. However, lay-rescuers with aquatic experience who are in the water (e.g. surfers) can be a great asset in drowning mitigation. In relation to professional lifeguards, initiating CPR of the drowning victim early is possible on land and on a rescue vessel by adapting known techniques to the space, rescuer position and sea conditions. The use of personal protective equipment (PPE) has a number of advantages as well as limitations in aquatic environments. The use of a plastic blanket may be an alternative to delay the start of maneuvers without diminishing the CPR quality. Active recovery methods designed for professional rescuers promote faster physiological readjustment. Electrostimulation may be an alternative for recovery after a physically demanding rescue.