Spinal Injury in Shallow Water
You are lifeguarding at a lake beach. The water is murky, and the bottom is uneven. A 16-year-old boy runs down the beach and dives headfirst into the water near the swimming area boundary. You see him immediately surface face down and floating motionless. You are about 20 yards away. You activate the emergency action plan by blowing your whistle and signaling to the other guard to call 911. You enter the water with a stride jump and approach the victim. When you reach him, he is face down, unresponsive, and not breathing. You suspect a spinal injury because of the mechanism of injury (headfirst dive into shallow water). The water is about 4 feet deep here.
1. How should you manage this victim in the water, considering the suspected spinal injury and the fact that he is not breathing?
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The victim has a suspected spinal injury and is unresponsive and not breathing. The priority is to maintain an open airway and provide ventilations while minimizing movement of the spine. In the water, you should immediately stabilize the head and neck in line with the body. Since the victim is face down, you need to rotate him to a face-up position while maintaining spinal alignment. Use a technique like the head splint: place your hands on the sides of his head, and with the help of another rescuer if available, rotate him face up. Once face up, maintain manual in-line stabilization and check for breathing. Since he is not breathing, you should begin rescue breaths immediately. If you are alone, you can use a buoyant aid to support the victim while you provide ventilations. Do not attempt to remove him from the water without proper spinal precautions. The goal is to provide ventilations and get him to a backboard for extrication as soon as possible, while awaiting EMS.
2. What equipment and techniques should you use to extricate this victim from the water, and what should you do once he is on the deck?
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For a suspected spinal injury in the water, you should use a backboard for extrication. With the help of other rescuers (at least two others), you should carefully log-roll the victim onto the backboard while maintaining spinal alignment. The backboard should be positioned under the victim, and he should be secured with straps. Then, lift the backboard out of the water and place it on a flat surface. Once on the deck, continue to maintain spinal stabilization and monitor breathing. If the victim is still not breathing, continue rescue breaths or CPR as needed. Keep the victim's head and neck immobilized until EMS arrives. The backboard should be used to transport the victim to the ambulance. Remember to minimize movement of the spine throughout the process.