In his article for Fire Engineering, Mike Hudson, an experienced ocean lifeguard-paramedic, discusses the complex and risky nature of in-water mouth-to-mouth ventilations in water rescue scenarios. Hudson highlights that, while traditional lifeguard training emphasizes immediate ventilation for drowning victims, this approach is increasingly scrutinized for potential health risks, particularly exposure to infectious diseases and chemical contaminants. Key points include:
- Historical Context and Lifeguard Practices: For decades, lifeguard protocols have focused on rapid, in-water ventilations to increase drowning victims’ survival. However, Hudson notes that these protocols are largely based on outdated or limited studies. He points to one study from over 25 years ago, often referenced by organizations such as the American Heart Association (AHA), that suggested in-water ventilation without delay could benefit victims. Hudson critiques this study, which was conducted on cases mainly involving young children in shallow water, for its limited scope and applicability to varied water rescue environments.
- Health and Safety Risks: According to Hudson, administering mouth-to-mouth ventilation poses significant risks to rescuers, especially given the realities of drowning events. He explains that drowning victims often aspirate water and emesis, which can lead to chaotic and contaminated airways during resuscitation. He emphasizes that OSHA has taken a strong stance against mouth-to-mouth procedures in professional healthcare due to cross-contamination risks, a view he believes should extend to water rescues. Pathogens like Hepatitis B, TB, HIV, and COVID-19 are highlighted as major concerns, especially given the high exposure rates among healthcare workers in recent years.
- Chemical Contamination Hazards: Another serious risk, Hudson argues, is the potential for rescuers to encounter victims who have ingested or been exposed to harmful substances, such as fentanyl. Hudson references incidents where rescuers have accidentally ingested or absorbed chemicals, resulting in poisoning and severe illness. He emphasizes the need for rescuer awareness and protective measures to minimize such risks, particularly as narcotics-related incidents become more common in water rescue cases.
- Reevaluation of Training Protocols: Hudson calls for a shift away from in-water ventilations toward alternative resuscitation techniques that better protect rescuers. He advocates for the use of bag-valve-mask (BVM) devices for out-of-water resuscitation, which offer a safer approach by reducing direct contact with victims’ bodily fluids. Hudson proposes specific steps for improving water rescue protocols, such as focusing on rapid removal of the victim from the water, prioritizing on-land resuscitation, and ensuring equipment like BVMs and AEDs are easily accessible.
- Rescuer Preparedness and Alternative Techniques: Hudson recommends extensive training and fitness for rescuers, emphasizing that rescues of incapacitated individuals in high-risk environments require careful planning and skill. Instead of mouth-based ventilations, he suggests implementing compression-only CPR to maintain circulation until proper ventilation equipment is available, a practice he believes aligns better with modern resuscitation science. He also encourages lifeguard training programs to enhance protocols for quick victim extrication and shore-based care.
Hudson urges a paradigm shift in water rescue training. He advocates for safer, evidence-based resuscitation techniques that prioritize rescuer health while still aiming to save lives. Hudson’s insights challenge traditional approaches, highlighting the need for adaptation in response to evolving safety standards and risks in water rescue settings.