Patient presentation of history of being submerged under water for an excessive period of time resulting in potential cardiopulmonary compromise. Concomitant injuries such as cervical spine trauma should be suspected and treated accordingly.

1. Perform patient assessment and ABC's. Pay special attention to clearing the upper airway using appropriate suction device.
2. Be prepared to assist ventilations as necessary (do not hyperventilate an unconscious patient or one suspected of closed head trauma). Administer oxygen via a device, which will insure adequate oxygenation. Apply pulse oximetry device and record oxygen saturation levels.
3. Stabilize neck prior to moving from water if any suggestion of a potential neck injury exists. Remove patient on LSB. Ventilations can be initiated prior to removing from water; closed chest compressions can be started as soon as removal from water is completed.
4. Obtain patient and event history. Try to determine:
   1. How long was patient submerged?
   2. Fresh or salt water? Polluted or 'clean'?
   3. Diving accident? (Spinal precautions)
   4. Water temperature?
5. Evaluate for potential hypothermia and treat per HYPOTHERMIA protocol.
6. Monitor vitals signs in accordance with S.O.P. protocol.
7. Transport patient exeditiously based on patient condition and circumstances.
8. All patients of near drowning should be transported. Latent pulmonary complications are frequent and commonly severe.

INTERMEDIATE LIFE SUPPORT

Establish IV access using an isotonic solution. Titrate infusion rate to support patient vital signs and condition. (Do not hydrate unconscious patient; just avoid hypotension).

ADVANCED LIFE SUPPORT

• Attach and monitor ECG
• Monitor pulmonary status closely; consult with MCEP about dyspnea associated with immersion incident. Administer Albuterol 2.5 mg via SVN for bronchospasm. Intubate if indicated.
• If cardiac arrest occurs, treat as you would any other medical arrest.