Drowning

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Scene 1 · Opening

22.20, the leisure lake, closed six hours ago. A sign with a red bar across it says the swimming here is not supervised.

You were walking past on the path. Well out from the bank, thirty metres or so, something is moving.

An arm goes up, then drops. Nobody else around.

Scene 2 · The instinct

She is a long way out. You swim well enough, you did lessons, it is dark and the water must be about sixteen degrees.

Your whole body is telling you to go.

Thirty metres of black water. What do you do?

• Right move : I do not go into the water. I call 18 and I do not take my eyes off her.
  This is the hardest move there is, and it is the right one : The guidance is explicit where nobody is on duty: call for help on 18 or 112, never lose sight of the casualty so you can guide the crew in and point out where she is, and do not go in yourself unless you are sure you can help her without risking your own life. Thirty metres in the dark at sixteen degrees does not meet that condition.
• Mistake : I dive in, thirty metres is nothing, I will be there in thirty seconds.
  That is how there end up being two bodies instead of one : The fire and rescue services put it in plain words: it happens often that the people who went in to help drown themselves. Rescuing somebody in the water calls for real physical fitness and excellent swimming ability, because you have to be able to CARRY the casualty in the water.
• Not the best choice : I empty my pockets onto the low wall first: keys, wallet, phone.
  You have just put down the one useful object of the evening : Of those three things, one is any use at all, and you have set it on the ground. Pick it back up.

Scene 3 · The lifebuoy

18 has been called, you gave the name of the site and the way in. They say six minutes.

At the end of the jetty there is a lifebuoy on its bracket. It is four metres from you, and the water is at nought.

Six minutes to hold. What do you do with those four metres?

• Right move : I go and get the lifebuoy and throw it to her, without putting a foot in the water.
  Help, without putting yourself in danger : The condition the guidance sets is that one and no other: do not go in yourself unless you are sure you can help without risking your own life. Throwing a lifebuoy from the jetty meets it completely; swimming out to her does not. And you can keep watching her at the same time.
• Mistake : I wade in to my waist and hold my hand out: from there I am risking nothing.
  The bottom of a lake drops away without warning : This is not a swimming pool: the edges of a lake are uneven, the silt is slippery, and it is dark. The guidance talks not about depth but about risk: do not go in yourself unless you are sure you can help without risking your own life. From the bank you meet the condition; waist deep you no longer do.
• Mistake : I wait and do nothing, I was told not to go into the water.
  Not going in is not the same as doing nothing : The guidance also asks you never to lose sight of the casualty so you can guide the crew in and give the best account of where she is and how she is doing. And the condition of not risking your own life allows everything that can be done from the bank. The lifebuoy is four metres from you, on a bracket put there for this.

Scene 4 · She is holding on

She caught the lifebuoy on the third throw. She is not coming back towards the bank, she is floating and coughing.

You can see her, you can hear her, and there are four minutes left.

What do you shout to her?

• Right move : Not to fight it, to let herself be carried, and to keep hold of the buoy.
  Do not fight it, do not burn yourself out : The guidance for the person in the water is precisely that: do not try to fight the current, so as not to burn yourself out, let yourself be carried, float on your back if you get tired because it lets you breathe better, and try to stay calm until help arrives.
• Mistake : To swim towards me, she has a buoy now.
  She fights the water and burns herself out : The official instruction is the opposite: do not try to fight the current, so as not to burn yourself out, let yourself be carried, and float on your back if you get tired. Somebody who has just swallowed water has no thirty metres left in her, and a buoy is for floating, not for moving.
• Mistake : I run to the campsite three hundred metres away to fetch people.
  When you get back, you no longer know where she was : Never lose sight of the casualty so you can guide the crew in and give the best account of where she is and how she is doing. On thirty metres of black water, a lost bearing does not come back, and the crew arrives with a search on their hands.

Scene 5 · Out of the water

Two firefighters in drysuits brought her in inside a minute. They laid her on the bank beside you, and went back for her bag in the water.

She is not responding. Her chest is not rising.

She is here, in front of you, and she is not breathing.

• Right move : I tilt her head back and start with five rescue breaths, then move on to compressions.
  Air first: her heart stopped for lack of oxygen : Cardiac arrest after drowning is arrest by hypoxia, and the national guidance says it plainly: give five initial rescue breaths immediately, before starting chest compressions. The Red Cross teaches the same opening, five mouth-to-mouth breaths, then the sets of compressions and breaths.
• Valid move, there is better : I start chest compressions right away, in the middle of the chest.
  Compressions are a good action, and they are prescribed : The guidance says so: failing that, start with chest compressions until you are able to give rescue breaths. And the Red Cross prescribes it for a bystander who has not been trained in mouth-to-mouth: without training, compressions alone are worth far more than nothing. Drowning does have one specificity, and it is the one this case makes you repeat: the water is what caused the asphyxia, her heart stopped for lack of oxygen, so air comes first. If you feel able to, five initial rescue breaths first, then compressions.
• Mistake : I turn her upside down to get the water out of her lungs.
  Nothing comes out, and she is still waiting for air : The guidance rules these manoeuvres out: the amount of water breathed in is usually small, and airway-clearing techniques are dangerous on a drowned person, they delay resuscitation. The time spent turning her over is time without air: five rescue breaths, then compressions.

Scene 6 · She is breathing

Five rescue breaths, then compressions. After thirty or so, she coughs, at length, and her chest starts rising again.

She does not speak, she does not open her eyes, she is soaked and it is fourteen degrees.

She is breathing and not responding. What do you do?

• Right move : I take her wet clothes off, I cover her, and I roll her onto her side.
  In that order, and until help arrives : The guidance runs exactly like that: take her wet clothes off and cover her, then, if she is unconscious, meaning she is breathing but does not speak, does not move and does not open her eyes, put her in the recovery position.
• Mistake : I leave the wet clothes on, she will warm up by herself.
  Soaked clothing cools you faster than the air does : The guidance asks for it explicitly: take her wet clothes off and cover her. This is not about comfort, it is the next part of the rescue: somebody brought out of the water goes on losing heat as long as she stays in wet clothes.
• Mistake : I leave her on her back and go up to the car for a blanket.
  She stayed on her back, alone, after bringing water up : An unconscious person who is breathing goes onto her side, and that comes before the blanket. She has just brought water back up: on her back with nobody there, she is exposed to what she brings up. The blanket can wait thirty seconds, the position cannot.

Scene 7 · The crew

The blue light comes up the dirt track and reflects off the water. They wrap her in a silver blanket and take her away.

One of the crew asks you exactly where she was when you saw her. You point to the spot, because you never took your eyes off it.

You never put a foot in the water. That is why two of you are going home tonight.