Submersion Events








Yes, summer break is officially over, but it is still warm and kids like water!

Submersion Basics

  • Submersion Events are the SECOND leading cause of accidental death in children 1-19yrs. (MVC is #1, naturally)
  • Kids are different when it comes to Environmental Emergencies
    • Less mobile (can’t get out of the water)
    • Larger body surface: mass ratio (more susceptible to heat loss)
    • Curious with less understanding of the potential hazards (particularly teenagers!)

Does the Type of Water Mater?

  • The type of water is rarely clinically significant!

  • Both salt and fresh water lead to the same end points of inactivated surfactant, pulmonary edema, and hypoxia (they do so by different mechanisms… but hypoxia is still hypoxia).
  • A low hematocrit should lead to your consideration of other occult trauma… not hemoldilution!
  • In order produce a change in hematocrit a person has to aspirate >11ml/kg
  • Typically, humans aspirate 3-4ml/kg
  • In order to see significant electrolyte changes, a person has to aspirate >20ml/kg.
  • If a person were to aspirate either quantity, it would be evident clinically!!

Submersion and C-Spine Injury?

  • Routine Immobilization is not necessary solely based on the h/o submersion
  • If there was a high impact event (diving, boating accident, water sports, assault) then yes.
  • Swimming, bathing, wading, fishing, SCUBA – then no.

Submersion leads to VQ Mismatch and Pulmonary Edema…

  • Use BiPap early: If patient has respiratory distress or edema on CXR.

1. Watson, R.S., et al., Cervical spine injuries among submersion victims. J Trauma, 2001. 51(4): p. 658-62.
2. Hwang, V., et al., Prevalence of traumatic injuries in drowning and near drowning in children and adolescents. Arch Pediatr Adolesc Med, 2003. 157(1): p. 50-3.

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Sean M. Fox
I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.
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  2. […] knowing critical care topics (ex, ECMO in ED, Submersion Injuries, Optimize Chest Compressions, and Non-Invasive Ventilation) is vital to being effective in the ED, […]

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