Aquatic Emergencies for EMS: From Rescue to Resuscitation
Aquatic emergencies present a unique and often unpredictable challenge for EMS providers, requiring rapid decision-making in dynamic, high-risk environments. Unlike traditional medical calls, water-related incidents frequently involve unstable scenes, environmental hazards, and critically ill patients suffering from hypoxia, hypothermia, trauma, or a combination of these factors. Drowning remains a leading cause of unintentional death in the United States, particularly among children and high-risk populations, emphasizing the need for EMS professionals to possess a strong understanding of both prevention and prehospital management strategies. This course provides a comprehensive, evidence-based review of aquatic emergencies, focusing on the pathophysiology of drowning, risk factors, and the critical importance of early oxygenation and resuscitation.
Learners will explore the physiological mechanisms underlying drowning, including hypoxia, pulmonary dysfunction, and the role of hypothermia in both injury and potential survival. Special emphasis is placed on the unique resuscitation priorities in drowning patients, including the importance of airway and ventilation management over traditional cardiac-first approaches. The course also examines environmental considerations such as cold-water immersion, the mammalian dive reflex, and the concept that patients are “not dead until warm and dead,” reinforcing the need for cautious and prolonged resuscitation efforts in hypothermic patients. In addition, providers will review best practices for scene safety, rescue operations, and patient assessment in aquatic environments.
Beyond drowning, this course addresses a broad spectrum of aquatic-related emergencies, including diving injuries and watercraft trauma. EMS providers will gain a working understanding of gas laws and how they contribute to conditions such as decompression sickness, arterial gas embolism, and barotrauma. Practical, scenario-based content reinforces clinical decision-making, transport considerations, and coordination with specialty resources such as hyperbaric facilities. By the end of this course, participants will be equipped with the knowledge and confidence to safely manage aquatic emergencies, prioritize life-saving interventions, and improve patient outcomes in these complex and often time-sensitive situations.
Learners will explore the physiological mechanisms underlying drowning, including hypoxia, pulmonary dysfunction, and the role of hypothermia in both injury and potential survival. Special emphasis is placed on the unique resuscitation priorities in drowning patients, including the importance of airway and ventilation management over traditional cardiac-first approaches. The course also examines environmental considerations such as cold-water immersion, the mammalian dive reflex, and the concept that patients are “not dead until warm and dead,” reinforcing the need for cautious and prolonged resuscitation efforts in hypothermic patients. In addition, providers will review best practices for scene safety, rescue operations, and patient assessment in aquatic environments.
Beyond drowning, this course addresses a broad spectrum of aquatic-related emergencies, including diving injuries and watercraft trauma. EMS providers will gain a working understanding of gas laws and how they contribute to conditions such as decompression sickness, arterial gas embolism, and barotrauma. Practical, scenario-based content reinforces clinical decision-making, transport considerations, and coordination with specialty resources such as hyperbaric facilities. By the end of this course, participants will be equipped with the knowledge and confidence to safely manage aquatic emergencies, prioritize life-saving interventions, and improve patient outcomes in these complex and often time-sensitive situations.
Objectives
Upon completion of this course, the participant will be able to:
- Identify key risk factors, populations, and epidemiologic trends associated with aquatic emergencies.
- Describe the pathophysiology of drowning, including hypoxia, aspiration, and gas exchange impairment.
- Differentiate the stages of hypothermia and the physiologic effects of cold-water immersion.
- Select appropriate scene safety strategies and rescue methods for aquatic environments.
- Determine appropriate assessment priorities and interventions for aquatic patients, including airway, breathing, and circulation management.
- Distinguish between diving-related gas laws and associated injuries, including decompression sickness and arterial gas embolism.
- Recognize mechanisms of aquatic trauma and special considerations for high-risk populations.
Curriculum
Chapter 1: Epidemiology, Definitions, and Risk Factors
- Introduction to Aquatic Emergencies
- Modern Definition of Drowning (ILCOR/AHA)
- Scope of the Problem (U.S. Statistics & Trends)
- High-Risk Populations and Disparities
- Environmental and Behavioral Risk Factors
- Prevention Strategies and Public Health Implications
- The Drowning Process and Hypoxia Cascade
- Airway Responses and Laryngospasm
- Pulmonary Effects and Gas Exchange Failure
- Freshwater vs. Saltwater Physiology
- Neurologic and Cardiovascular Effects
- Delayed Complications (ARDS, Secondary Injury)
- Heat Loss in Water vs. Air
- Stages of Hypothermia
- Mammalian Dive Reflex and Survival
- “Not Dead Until Warm and Dead” Concept
- Prehospital Hypothermia Management
- Rewarming Strategies and Complications
- Scene Size-Up and Hazard Identification
- Rescuer Safety and AVIR (Aquatic Victim Instead of Rescuer)
- Reach, Throw, Row, Go Rescue Model
- Swift Water and Environmental Hazards
- Personal Protective Equipment and Flotation
- Multi-Rescuer Coordination and Incident Command
- Primary Assessment in Aquatic Emergencies
- Airway and Breathing Considerations
- Circulation and Shock Assessment
- Neurologic Evaluation and GCS
- Spinal Injury Considerations
- Focused History (SAMPLE + Event Details)
- Airway Management and Oxygenation
- Ventilation vs. Compressions in Drowning (ABC vs CAB)
- Cardiac Arrest in Drowning Patients
- Advanced Airway and Ventilatory Support
- Transport Decisions and Destination Planning
- Post-Resuscitation Care and Monitoring
- Introduction to SCUBA and Pressure Physiology
- Boyle’s Law and Volume Changes
- Dalton’s Law and Gas Mixtures
- Henry’s Law and Gas Dissolution
- Effects of Pressure During Descent and Ascent
- Clinical Relevance for EMS Providers
- Barotrauma (Ear, Sinus, Pulmonary)
- Pulmonary Overpressurization Syndrome (POPS)
- Arterial Gas Embolism (AGE)
- Decompression Sickness (Type I & II)
- Nitrogen Narcosis and Oxygen Toxicity
- Prehospital Treatment and Hyperbaric Considerations
- Watercraft and Boating Injuries
- Blunt and Penetrating Trauma in Water
- Spinal Injuries in Diving Incidents
- Special Populations (Pediatrics, Seizure Disorders)
- Alcohol, Drugs, and Behavioral Factors
- Multi-System Trauma with Drowning
- Pediatric Pool Drowning Case
- Cold Water Submersion Survival Case
- Boating Trauma with Drowning
- SCUBA Diver with Decompression Illness
- Delayed Respiratory Distress Case
- Scene Safety Failure (AVIR Case)
Price: $18.00
Contact Hours: 1.5
Course Author
Brad Moore
Brad Moore is a dedicated public safety professional with over 18 years of service in emergency response. He has been a firefighter since 2021 and became a licensed paramedic in 2023, providing critical care in high-pressure situations. Before transitioning to Fire and EMS, Brad served for 12 years as a police officer, where he developed strong skills in leadership, crisis management, public safety, and community service. He is also a licensed EMS Instructor through the Texas Department of State Health Services, further extending his expertise in training and education for emergency responders.
Course Accreditation
Provider approved by the Texas Department of State Health Services, course provides 1.50 contact hour(s). CE Program Approval Number #: 601011.