Emergency Medicine Medicine & Health

Cardiac arrest in drowning stems from lack of oxygen, so on-scene care differs slightly from ordinary arrest: once the scene is safe, check response and breathing immediately and, if breathing is absent or abnormal, give rescue breaths first, then continue cycles of compressions and breaths while emergency help is summoned. Do not perform abdominal thrusts or hold the person upside down to “drain water” - this delays resuscitation and increases the risk of vomiting and aspiration. Every drowning victim needs medical assessment even if they seem to recover, and should be kept warm to prevent further hypothermia.

Move a hypothermic person to a warm, sheltered place, remove wet clothing and wrap the trunk in blankets to rewarm the core; if fully alert they may sip a warm sweet drink, but handle them gently - rough movement in severe hypothermia can trigger fatal arrhythmias - and never give alcohol. Frostbitten tissue should not be rubbed, held near a fire or scrubbed with snow; rewarm it slowly in water at 37-39 degrees Celsius, and if refreezing is possible, leave it frozen and get to medical care fast. Both conditions warrant professional treatment as early as possible.

After a spinal fracture the vertebrae may already be unstable, and twisting, bending or dragging can let bone fragments press or cut into the spinal cord, turning a recoverable injury into permanent paralysis. Suspect it strongly after falls from height, road crashes or diving injuries, or when there is severe neck pain, numbness or limb weakness. Keep the person where they are, steady the head and neck with your hands so head, neck and trunk stay in line, and wait for trained rescuers; move them as a unit only if there is immediate danger such as fire or water. If the airway is blocked or breathing has stopped, however, restoring breathing and circulation takes priority.

A tourniquet is for life-threatening limb bleeding - spurting blood, or bleeding that direct pressure cannot control. Apply it about 5-7 cm above the wound, never over a joint, tighten until bleeding stops, and note the time so medical staff know. Do not loosen it intermittently to “let blood flow”, as that worsens blood loss; bleeding from the trunk or neck cannot be tourniqueted and needs wound packing with firm pressure instead. Stopping catastrophic bleeding is often more urgent than waiting for an ambulance, which is why many countries now train the public to do it.