Water Emergencies and EMS Safety
Water-related emergencies occur at beaches, pools, rivers, lakes, and flood zones. These incidents present unique hazards that make them among the most dangerous calls for EMS providers. Drowning is the third leading cause of unintentional injury death worldwide, and would-be rescuers frequently become victims themselves. Understanding water rescue principles, knowing your limitations, and coordinating effectively with trained water rescue teams keeps both you and your patients safer.
The fundamental rule of water rescue is that untrained rescuers must not enter the water. Every year, bystanders and first responders drown while attempting to rescue someone from the water. A panicking drowning victim will climb on top of a rescuer, pushing them underwater. Moving water exerts tremendous force; even knee-deep flowing water can knock an adult off their feet. Cold water causes rapid incapacitation, reducing swimming ability within minutes.
The Reach-Throw-Row-Go Hierarchy
Water rescue follows a hierarchy of methods, from safest to most dangerous:
- Reach: Extend a pole, branch, towel, or your arm (while anchored) to the victim from a stable position. This is the safest method and should always be attempted first when the victim is close to shore.
- Throw: Throw a rope, ring buoy, life jacket, or any floating object to the victim. Practice throwing rescue devices accurately; under stress, most people throw short of the target.
- Row: Use a boat, raft, surfboard, or other watercraft to reach the victim. This keeps you on a stable platform above the water and allows you to reach victims farther from shore.
- Go: Swimming to the victim is the last resort and should only be attempted by trained water rescue swimmers wearing appropriate personal flotation devices and with backup personnel watching. Even trained swimmers use an approach technique that keeps them at arm's length from the victim, extending a flotation device rather than making direct body contact.
Moving Water Hazards
Rivers and flood waters present hazards beyond drowning. Hydraulics (recirculating currents at the base of dams or waterfalls) can trap swimmers indefinitely. Strainers (objects like fences, trees, or grates that allow water through but trap people and debris) can pin a person underwater with enormous force. Undercut banks and submerged obstacles create entrapment hazards. Water temperature in rivers is often much colder than air temperature, accelerating hypothermia. Never enter moving water without specialized swift water rescue training and equipment.
EMS Role in Water Emergencies
As an EMS provider at a water emergency, your primary roles are coordinating with water rescue teams, preparing for patient reception once the victim is out of the water, and initiating resuscitation. Stage your ambulance with clear access for patient loading. Prepare warm blankets, dry clothing, and suction equipment. Brief your crew on the drowning resuscitation protocol: airway management is the priority, followed by ventilation and CPR as needed. All submersion victims require hospital evaluation, even those who appear asymptomatic, because delayed pulmonary complications can develop hours after the event. If a water rescue team is not available and the victim is accessible from shore, use the reach and throw methods while awaiting specialized resources.