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Environmental exposures lead to numerous emergency calls throughout the United States and beyond each year and result in potentially devastating conditions. Appropriate prehospital care may make the difference for patients experiencing these serious, and sometimes fatal, exposures. By knowing the risks and recognizing the signs, early detection and proper intervention can be instituted.


  1. Define and differentiate between the terms: drowning and near drowning.

  2. Describe the signs and symptoms that occur during the drowning process and the prognosis of individuals who have undergone this process.

  3. Describe the general management of drowning victims.

  4. Comment on the inherent risks associated with water operations (covered in greater detail in Chapter 72).

  5. Describe the cardiovascular and neurological findings of severe hypothermia.

  6. Detail the initial management of life-threatening hypothermia and list deviations from usual ACLS during cardiac arrest or periarrest scenarios.

  7. Describe the cardiovascular and neurological findings of severe hyperthermia.

  8. Detail the management of life-threatening hyperthermia.



Although substantial efforts have been taken by health care advocates and public health providers to develop appropriate prevention strategies, drowning remains a significant cause of morbidity and mortality in not only the United States, but also worldwide. The global statistics vary widely on the annual number of deaths from submersion injuries, but depending on sources cited, annual death rates range from 150,000 to 500,000 deaths per year.1,2,35 For each death that occurs, there are two to four other related water-related injuries that require hospitalization.6

In the United States, drowning is the second leading cause of death in children only surpassed by deaths from motor vehicle accidents.2 Of those who survive the drowning episode, one-third will suffer from significant morbidity due to irreversible anoxic brain injuries.7 The populations most at risk for submersion injuries are infants and toddlers aged 1 to 4 years. Children in this age bracket account for approximately 27% of all deaths due to submersion.1 Of those patients, males are more apt to suffer from drowning injuries when compared to their female counterparts.7

Most submersion injuries occur in freshwater, even in states with large areas of coastal access. The sites of drowning also vary with age. In the young infant population (<1 year), 55% of drownings occur in the bathtub.1 In older children, up to 50% occur in local swimming pools, followed by freshwater bodies of water (lakes, rivers, and streams).1,2,6,7 It is important to note in older children and adults that greater than 50% of submersion injuries are associated with the concurrent use of alcohol and drugs.1,6,7

For many years, the specific definitions of the types of submersion injuries have been blurred. In 2002, the First World ...

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