Rescue When a person is<unk>  or a swimmer becomes missing, a fast water rescue is needed to take that person out of the water as soon as possible.<unk>  is not necessarily violent, with splashing and cries; it can be silent. Rescuers should avoid endangering themselves unnecessarily. So, whenever it is possible, they should assist from a safe ground position, such as a boat, a pier, or any patch of land near the victim. The fastest way to assist is to throw a buoyant object (such as a lifebuoy). It is very important to avoid aiming directly at the victim, since even the lightest lifebuoys weight over 2 kilograms, and can stun, injure or even render a person unconscious if they impact on the head. Alternatively, one could try to pull the victim out of the water by holding out an object to grasp. Some examples include: ropes, oars, poles, one's own arm, a hand, etc. This carries the risk of the rescuer being pulled into the water by the victim, so the rescuer must take a firm stand, lying down, as well as securing to some stable point. Bystanders should immediately call for help. A lifeguard should be called, if present. If not, emergency medical services and paramedics should be contacted as soon as possible. Less than 6% of people rescued by lifeguards need medical attention, and only 0.5% need CPR. The statistics are not so good when rescues are made by bystanders. Water rescue (simulation). The rescuer has already controlled the position of an anxious victim and then begins the towing to shore choosing a backstroke style. The victim's nose and mouth are kept above the water. The next option would be that anyone gets into the water and takes the victim out (the right manner to do this is using a towing maneuver). However, it carries a risk for the rescuer, who could be drowned. It can happen because of the water conditions, the instinctive<unk>  response of the victim, the required physical effort, and other problems. The rescuer must swim until reaching the victim. Then, the first contact between them is important. A<unk>  person in distress is likely to cling to the rescuer in an attempt to stay above the water surface, which could submerge the rescuer in the process. To avoid this, it is recommended that the rescuer approaches the panicking person with a buoyant object or extending a hand, so the victim has something to grasp. It can even be appropriate to approach from behind, taking one of the victim's arms, and pressing it against the victim's back to restrict unnecessary movement. Communication can also be important. If the victim clings to the rescuer, and the rescuer cannot control the situation, a possibility is to dive underwater (as<unk>  people tend to move in the opposite direction, seeking the water surface) and consider a different approach to help the<unk>  victim. It can happen that the victim has already sunk beneath the water surface. In shallow waters the rescue requires caution as the victim could be conscious and cling to the rescuer underwater; on the plus side however, the lack of depth allows the rescuer to bring the victim to the surface simply by grabbing one of the victim's arms and swimming upward, which entices the victim's entire body in the same direction, thus making the task easier, especially in the case of an unconscious victim. Should the victim be located in deeper waters (or simply complicates matters too much) the rescuer should dive, take the victim from behind, and ascend vertically to the water surface holding the victim. After a successful contact with the victim, any ballast (such as the weight belt) should be discarded. Finally, the victim must be taken out of the water, which is achieved by a towing maneuver. This is commonly done placing the victim body in a face-up horizontal position, passing one hand under the victim's armpit to then grab the jaw with it, and towing by swimming backwards. The victim's mouth and nose must be kept above the water surface. If the person is cooperative, the towing may be done in a similar fashion with the hands going under the victim's armpits. Other styles of towing are possible, but all of them keeping the victim's mouth and nose above the water. Unconscious people may be pulled in an easier way: pulling on a wrist or on the shirt while they are in a face-up horizontal position. Victims with suspected spinal injuries can require a more specific grip and special care, and a backboard (spinal board) may be needed for their rescue. For unconscious people, an in-water resuscitation could increase the chances of survival by a factor of about three, but this procedure requires both medical and swimming skills, and only the breaths of the rescue ventilation are practicable in the water. Chest compressions require a suitable platform, so an in-water assessment of circulation is pointless. If the person does not respond after a few breaths, cardiac arrest may be assumed, and getting them out of the water becomes the priority. First aid The checks for responsiveness and breathing are carried out with the person horizontally supine. If unconscious but breathing, the recovery position is appropriate.Rescue breathsIf not breathing, rescue ventilation is necessary.<unk>  can produce a gasping pattern of apnea while the heart is still beating, and ventilation alone may be sufficient. The airway-breathing-circulation (ABC) sequence should be followed, rather than starting with compressions as is typical in cardiac arrest, because the basic problem is lack of oxygen. If the victim is not a baby, it is recommended to start with 5 normal rescue breaths, as the initial ventilation may be difficult because of water in the airways, which can interfere with effective alveolar inflation. Thereafter, a continual sequence of 2 rescue breaths and 30 chest compressions is applied. This alternation is repeated until vital signs are re-established, the rescuers are unable to continue, or advanced life support is available.Chest compressionsFor babies (very small sized infants), the procedure is slightly modified. In each sequence of rescue breaths (the 5 initial breaths, and the further series of 2 breaths), the rescuer's mouth covers the baby's mouth and nose simultaneously (because a baby's face is too small). Besides, the intercalated series of 30 chest compressions are applied by pressing with only two fingers (due to the body of the babies is more fragile) on the chest bone (approximately on the lower part). Attempts to actively expel water from the airway by abdominal thrusts, Heimlich maneuver or positioning head downwards should be avoided as there is no obstruction by solids, and they delay the start of ventilation and increase the risk of vomiting, with a significantly increased risk of death, as the aspiration of stomach contents is a common complication of resuscitation efforts. Treatment for hypothermia may also be necessary. However, in those who are unconscious, it is recommended their temperature not be increased above 34 degrees C. Because of the diving reflex, people submerged in cold water and apparently drowned may revive after a relatively long period of immersion. Rescuers retrieving a child from water significantly below body temperature should attempt resuscitation even after protracted immersion. Medical care People with a near-drowning experience who have normal oxygen levels and no respiratory symptoms should be observed in a hospital environment for a period of time to ensure there are no delayed complications. The target of ventilation is to achieve 92% to 96% arterial saturation and adequate chest rise. Positive end-expiratory pressure will generally improve oxygenation. Drug administration via peripheral veins is preferred over endotracheal administration. Hypotension remaining after oxygenation may be treated by rapid crystalloid infusion. Cardiac arrest in<unk>  usually presents as asystole or pulseless electrical activity. Ventricular fibrillation is more likely to be associated with complications of pre-existing coronary artery disease, severe hypothermia, or the use of epinephrine or norepinephrine. While surfactant may be used, no high-quality evidence exist that looks at this practice. Extracorporeal membrane oxygenation may be used in those who cannot be oxygenated otherwise. Steroids are not recommended.
Drowning
Arrhythmia
Heat stroke
Hypoglycemia
Sudden wealth syndrome
Murder
Heat exhaustion
Seizure