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Matt: [00:00:00] We'd like to take a moment to remember all those who lost their lives in the floods here in Texas this month. We will continue to keep the families, friends, and everyone affected by this tragedy in our thoughts and prayers. We would also like to say thank you to all the first responders from Texas and around the country that came together to help.

We know this was an extremely difficult assignment for you and your dedication to saving lives and community service doesn't go unnoticed and is greatly appreciated.[00:00:30]

Narrator: You're listening to EMS with your hosts, Erik Axene and Matt Ball.

Matt: What's our topic?

Erik: There's actually I have no idea what we're talking about. I'm just kidding. It's summertime yes. 

Matt: We just, we talked about hyperthermia recently. 

Erik: Submersion injuries. That's right.

So submersion injuries is another important topic, especially for the summer. Mm-hmm. And something that's deadly. Yep. Something that can really, you know, responsible parents. [00:01:00] Just one second of just, I thought dad was watching kid. Dad thought mom was watching kid. Yes. Oh, just disaster. I've seen some of the saddest stories in the ER.

Matt: You should be on scene with those calls. They are horrific. And the screams of a mother like that are something you, 

Erik: It can happen to any of us. Anybody. It happens so fast. It. Hard because sometimes kids get into the situation because of neglect and CPS does need to be involved.

Yeah. And I know at our hospital, CPS gets involved in [00:01:30] all submersion injury cases. 

Matt: They at least investigate it. 

Erik: At least investigate it. And so sometimes parents are like this adds insult to injury. Oh yeah. Had friend of mine that was involved in something like this, and they called me and said, why are they doing this to us?

Yeah. You have to explain, Hey, listen, it's just a protocol. They have to do it. They gotta do this. Yes. But anyway, submersion injuries. Yes. Sometimes people call it near drownings or drownings. Drowning is dead, so we're not really covering the dead people. We're talking about the submersion injuries.

And there are variations to how [00:02:00] sick you can be based on what we find. But it's pretty obvious that we need to breathe. Yeah. An important thing. Important thing. And if you're underwater and you're a little kid or you somehow you're in a river rafting accident.

You aspirate water. That's right. It doesn't take long to have a bad outcome. Yeah. It does not take long. 

Matt: Floods out Your OV light inhibits gas exchange. That's exactly right. And it just Yeah. Causes

Erik: the blood's flowing great.

Matt: Yeah. You've got blood in your body.

Erik: In fact, it's probably going really fast. 

Matt: [00:02:30] Yeah. There exactly's just no air, which is exchange, expediting the problem. Yeah, exactly. Your organs are, like I say, they're flooded out. You're washing out all the oxygen. And you can't perfuse your vital organs. 

Erik: And then on top of that, when you aspirate, you increase risk of infection. 

Matt: Yep. Another thing that people don't think about. That's right. They prophylactically, don't they usually put these patients on antibiotics? 

Erik: Yes. Yes. In the hospital. The other thing that I think is worth talking are some of the risk factors. We're not gonna cover all of them, but alcohol's a huge one.

Matt: Yes. We recently had a tragic case here in the Dallas [00:03:00] area. Yeah.

Where don't know. I don't know if alcohol was a factor. I'm not saying that, but uhhuh, multiple times a year in our area with all the lakes that we have every year, having a 

good time. On the boats. Water ski, good friends and family drinking, having a couple of drinks, be careful. It's a recipe for disaster. Yeah. It happens every year and it's so sad when these things happen to anybody, kids, adults,

Erik: I lost a, one of my best friends to a boating accident because of something like that. I don't know necessarily if [00:03:30] alcohol was involved. But it was a boating accident.

Thought he drowned. Never found the body.

Matt: That's the other tragedy. We just recently had a case just north of us. 

Erik: Oh yeah. 

Matt: Where I don't know, it was a father and daughter went down River. I know they found the father's body, but I don't know if they ever found the girl. I know there was several weeks 

Erik: You got this. I'm gonna keep laughing. You got, I'm sorry to interrupt our podcast, but you got a string hanging down right. 

Matt: I'm like, you're laughing at the story as I'm telling this. There it is. I'm so sorry. This [00:04:00] distracting this. I, and sometimes you gotta laugh when you're talking about deep stuff, right?

Erik: That's one thing I love about our podcast.

Matt: I thought you were gonna tell me I had a bat in the cave. 

Erik: No. You look great. It just had this long string hanging down between your eyes. I. 

Matt: That's funny. Oh, you gotta live, live studio. 

Erik: No, we do. We have a good time on this show. Yes. But you're, this is a serious issue.

Matt: Yes. We're not laughing about the seriousness of these issues. They're tragic for families. Tragic. But they happen every year and they're, and a lot of times they're preventable. 

Erik: They are. 

Matt: [00:04:30] Just being a little bit smart, not getting too crazy. We're not saying don't go have a good time, but be smart.

Erik: Yeah. Be smart. And when you're out there at the pool or whatever with your kids Yeah. It's, you've really gotta keep. Your eye on 'em. 

Matt: If you have a pool at home. I know, like in the neighborhood I live in, I actually, in the city I live in, it's required that if you have any pool, you have to have a fence around your backyard.

Erik: Yeah. 

Matt: So somebody can't come in or, if they jump their, your fence, you're not liable. But, if you have a pool and you have small children, have some sort of alerting system [00:05:00] Yep. Put a gate around the pool itself with some sort of an alerting system that, somebody gets out and opens up that door and you're in the house doing whatever.

Being just a good parent cooking dinner or something, and your kid walks out. These are not, malicious things on the parents. No. They're doing their thing and the kid gets careful. Yeah. Be careful. Take precautions. Teach your kids about pool safety. 

Erik: And it's not just the pools, it's the bathtubs.

Even buckets with little kids. That's right. You fall into a bucket of water or whatever. It might be head first. It doesn't take [00:05:30] long. That's right. It's essentially, you're drowning. 

Matt: Yeah. 

Erik: You don't need a pool. You don't need to be fully immersed to drown. So That's Right. Something that's really important.

You have a seizure disorder or you, whatever it might be. Think about mean, you can really be careful

Matt: diabetes, low blood sugar, and get altered. Yeah.

Erik: If you have a seizure disorder, you should not be bathing the kids. 

Matt: Oh, I never thought about, that's good. Yeah. Alone. Be careful. Yeah. Be careful alone, so that's a good point.

Erik: Something to think about, things to just be careful. Yep. And just so many things that can [00:06:00] happen. Nobody intends to hurt a kid, obviously.

Matt: Let's hope that's the case.

Erik: Yeah. Yes. But you just gotta be careful. It happens to the best of parents, like I said at the beginning.

I thought dad was watching. Dad thought mom was watching. Exactly. It happens. And then they find baby, and

Matt: I think every parent probably at some point in their parenthood, has had a moment where I thought you were watching the kids. I thought you were watching the kids. Yeah. Oh yeah. And we all just got lucky for the most part that something bad didn't happen.

Yeah. So first responder or you're a nurse doctor in a hospital and you get that [00:06:30] drowning patient.

So obviously if you're pre-hospital, first thing is gotta get 'em outta that environment, right? That's right. Get 'em outta the water. Get him outta the water. Get 'em outta the water. Right?

Erik: What's the first thing we should do? I think once you get 'em outta the water repeat, I think is the way we taught this in our lecture before, right? Check for responsiveness is the first thing we should do. Patient you get called, they were in the pool obviously. Hopefully by the time you get there, they've been removed.

Okay. And the first thing you wanna do is to see if they're responsive. Yeah. And if they're responsive that means at least [00:07:00] a 78% at the minimum, a 78% chance of survival based on data. 

Matt: And that's when you say responsiveness, we're not talking about alert and oriented. Yeah. We're just saying if they're awake and even looking at you talking at all.

Yes. They don't have to have a GCs of 15 necessarily. No. But if they are alert and responding to you, that's a good sign. 

Erik: Yes. That's a good sign. Now, if you get to that patient and they're not responsive it's not necessary that you just immediately check pulses and start chest compressions potentially.

The first thing you want to do, if the patient is [00:07:30] unresponsive, is to give them five rescue breaths. That's our protocol. Now, if your protocols are different and you're listening to this follow your protocol, 

Matt: that's based on data. 

Erik: It is, yes. And when you oftentimes breathing into these folks will restart the heart, like a kickstart, a motorbike, right?

Matt: Because typically these are younger, healthy people. That's right. For the most part, they don't have comorbidities. That's right. They're not on a ton of meds. That's right. But the problem is they've got fluid blocking. 

Erik: Correct. Yeah. So getting the rescue breaths can oftentimes be what really Yeah.

Gets them going again.

Matt: Be ready for them to start puking. 

Erik: Now if after [00:08:00] rescue breaths, obviously they don't come around, they're still unresponsive. We gonna check pulses. That's right. So if they do have. Pulses. Now we're getting down to 56. I think the 59% mortality rates here is starting to get ugly.

Yeah. That's not good. They've probably been down for a little while if you get to that point. Yeah. Now if they don't have pulses and you're there then you gotta look for time. Yeah. So pulses, time of suber. Responsiveness is the R, P is for pulses. T is time. You get to that patient that doesn't have [00:08:30] pulses.

How long were they down? If it's more than an hour? The, unless it's hypothermia really cold, right? Maybe there are cases of folks CPR for 24, like long time, whole, hours and hours, right? And you can survive because you're so cold. That's right. But if you don't have pulses, excuse me, and you've been down for longer than an hour, but if you've been down for less than an hour.

Now you're getting down pretty high mortality rates. We do everything we can. Yep. [00:09:00] And I've had many patients like this where we sent 'em up to the pediatric ICU. Yep. And we just pray that when we've turned the sedation off, they've got brain activity. Yeah. 

Matt: And the biggest thing I would say is, these are terrible calls.

Obviously we've said it for the families, these are also terrible calls for the responders. Oh yeah. But it's important to remember. Don't be in a rush, right? Yeah. If you get that kid at the pool, any patient really, there is no reason to, rush to the back of the ambulance right away. Start [00:09:30] working the problem there.

We know what the problem is, right? Yep. Get 'em. Start ventilating. Yeah. Start, ventilating. Start if they're not responsive, right. If they're, yeah. If they're not responsive, that's, or if they're pulseless. Yeah. You've got to start ventilating these patients. Get a tube if you're allowed to do that.

Erik: Yeah. 

Matt: Get an, get a definitive airway in there that's gonna help 'cause their aspirations is a huge risk again. Yep. Start oxygen don't be, especially with these pediatric patients, so often first responders their go-to is get him in the back of the ambulance and let's just go, no, there's nothing you're [00:10:00] gonna do in the er.

We say this over and over again. There's nothing you're gonna do for the most part in the ER in this situation that I can't do pre- hospitally. Yeah. If you're allowed to intubate, RSI, things like that. If you can do those things, do them. Yeah. Don't be in a rush to rush off to the hospital 

Erik: and, if those rescue breasts, like we talked about, can turn these kiddos around real quick so you follow your protocols.

But remember rescue breaths. Rescue breaths. If that's not responsive, that can turn 'em around right there. That's right. And then check those pulses, doing. [00:10:30] Following your protocols with CPR if necessary. And, airway protection. 

Matt: Remember if you're going intubate or defibrillate, dry them off.

Yep. Get them out. If they're laying, get 'em out of that wet environment. Dry 'em off before you, stick the pads on 'em. Go to defibrillate. Something that in the fog of war, you forget. You don't think about it. But remember those kind of things. That's good. Very important stuff. So get 'em out of the environment.

Uhhuh, start treating the problem. Rescue breaths, ventilations are key. 

Erik: Yeah. 

Matt: If they're in cardiac [00:11:00] arrest, start working your cardiac arrest protocols. Chest compressions. 

Erik: Yeah. 

Matt: Defibrillation, if that's indicated. Throw the Lucas device on 'em, if they can fit in the Lucas device get in the airway, whether it's a supraglottic airway and these situations.

I would say that these are patients I want to intubate. 

Erik: Yeah. 

Matt: Super Glottic airways. A lot of times in a normal medical CPR, that's probably that we've talked about. The data isn't really beneficial for innovation. 

Erik: Cardiac arrest. Even BVM, it's, yeah. If you're getting good compliance doesn't show [00:11:30] any outta hospital mortality benefit to ha based on the data that I've read and the cocoran review that I read.

Matt: Yep. So would you say in these patients, would you agree that you would probably want to get a tube? I, these patients you always wanna 

Erik: shoot for the definitive airway. Sure. You always wanna shoot for that. And to me there are many situations where the IGEL could be a great temporary airway. Yeah. And I think in these patients getting the ETT. Was ideal. Yeah. 

Matt: And that's, that's been, I've seen that a lot on social media now. People talking about, intubating and [00:12:00] cardiac arrest and we've talked about this before, but it's all based on the patient presentation, right?

Yeah. If I've got a patient that's maybe in V-fib, not a drowning patient, medical patient in V-fib and I'm trying to work that problem and I've got a superlo airway in and I'm getting good compliance on my bag and I'm able to ventilate, keep it, I'm not worried abouting that patient right now, I'm worried about converting that rhythm.

So meds, electricity, that's what I'm trying to focus on. I might intubate them down the road, but it's all about prioritizing. And I guess what I'm saying is [00:12:30] in the drowning patient, I am prioritizing getting a tube higher than other patients is my point.

Erik: I see what you're saying. Yeah. Yeah. The ventilation is key, especially in kids.

And we gotta and similar to a trauma situation, right? You gotta, once you've got, once you're through your algorithm, you've got this sick patient that was a submersion injury, less than an hour underwater. You gotta treat the sickest things first. That's right. So yeah. 

Matt: Another thing too, when you are going to intubate these patients, think about suction, salad, technique, obviously [00:13:00] they've got fluid.

Yeah. A lot of contaminants. You're, especially if you're doing chest compressions, oh yeah. That's gonna be coming out. So be prepared for that. As a first responder, it's screw the key S suction. And I again, learn that salad technique because again, in these cardiac arrest situations, you're gonna have a lot of fluid coming out.

So be ready for that when you go to tube. 

Erik: Yeah. A lot of fluid. You know the other thing. You might wanna think about too, is oftentimes when we see these patients and we get there on scene it can be a party situation with a lot of people. It can be a family situation in the backyard pool.

It can be a [00:13:30] lot of dynamics. Yes. And sometimes chaotic. I've been in situations on ride outs where we've had to just use the ambulance just to separate. Sure, sure. Patient care. 

Matt: Sometimes you do have to get in the back of the ambulance to keep ourselves safe. 

Erik: Yeah. 

Matt: And that brings up another point, and I think we've talked about this, is that.

There's always the controversy of if it is a kid do we let mom and dad watch, the resuscitation of efforts of us or of the staff. Yeah. And studies have shown that it's actually better for them in the long [00:14:00] run. To watch us as long as they're being safe. They're not interrupting us, they're not obstructing us from doing our job if they're safe.

Erik: In the ideal situation, in the ideal situation, certain situations I could see 

Matt: PD. Yeah. If they're being chaotic. And they're, it's, then yeah, you gotta get 'em outta that situation. But if mom and dad, obviously they're gonna be upset. They're gonna be emotional. There's no getting over that. 

Erik: Of course they will.

Yeah. 

Matt: But if PD has them, or maybe the officer has them off to the side Hey, and explaining to the parents, Hey, this is what we're doing. He's doing chest compressions to kind, [00:14:30] to circulate the blood. This guy, he's ventilating, he's oxygenating your baby's body, he's getting an iv, he's gonna give him medications to try to, whatever the case may be, 

Erik: Right.

Matt: That is shown to be good if the worst happens. 

Erik: Yeah. 

Matt: It. The parents realized I watched them, they did everything that they could to try to save my child. And not that they're probably ever gonna get over that, but maybe in some small sense it can give them a little bit of peace that 

Erik: Yeah, 

Matt: we didn't just blow it off and we didn't try.

We really tried. 

Erik: Yeah. 

Matt: We tried to do [00:15:00] everything that we can see. 

Erik: I could see how that would be helpful. 

Matt: Yeah. Something to think about. 

Erik: There's just to back it up a little bit with the, what's killing these patients? It's the anoxic brain injury. Yes. We get the heart started.

And, you bring in a submersion injury to me in the ER. Okay. Maybe we will, who knows, stabilize them a little bit more get the IV, maybe another IV in start these antibiotics or whatever it might be, right? Yeah. But really the answers come the next day. Yeah. So when they're in the ICU and we're [00:15:30] extubating or turning the sedation down to see what brain activity we have, right?

So that's the key. So if you do have that patient that's pulseless and you did the rescue breast and it's not working and it's, and it's a 20 minute whatever, 10 minute or whatever in their pulse list, transport time, whatever, 

Matt: or Oh yes. Time. Yeah. 

Erik: Submersion time. The brain cells are what we're trying to save.

Matt: Yeah. It's the same thing in a medical cardiac arrest. It's exactly the same. It's the same thing. Yeah. Yeah. That's what we're trying to say. Because we can probably get the heart to start beating with enough epi, right? That's right. That's right. Why have we [00:16:00] gone from doing 10 rounds of epi to three rounds of epi uhhuh, because the vasoconstriction in the brain, because Yeah, we get the heart beating, but you've just killed the brain because there's no circulation up there. 

Erik: And that's why time is so important too with stroke. It's the same thing with stroke. It's all the same pathophysiology. It's we're, we have blocked blood flow or somehow we've, we're not getting oxygen to the brain.

That's right. And the brain cells are so sensitive to the lack of oxygen. Yep. And they don't live long. That's right. And it's irreversible. Yep. And what. I think it's interesting. Even as [00:16:30] a in the pre-hospital environment, I like to see the pathophysiology of how things progress.

So it's really interesting. This is how it happens is that when you have impoverished the brain cells from oxygen they die. And then when they die, they swell. And it's that pressure. It's the swelling. It's the pressure. When you increase the pressure, you're not getting blood flow to the brain, the blood can't get in. 

Matt: That's right.

Erik: Cause that that brain bucket just like in A TBI. That's exactly right. That's what we wait for in the hospital. We wait and we [00:17:00] pray to see what the responsiveness will be, if there's any brain activity at all. Yeah. That's the name of the game.

Matt: Yeah. So let's talk about, if somebody they turn around and they see their kid in the pool and they jump in, they get 'em outta the pool, and the kid's awake and alert, should they call 9 1 1 ambulance. Great question. What should they be thinking about as far as, oh, I, I think he's fine.

He's acting fine now. I don't think we need to go to the hospital. Should they transport? What's, I, we talk about, up to 72 hours. You can still just him checked. Yeah. 

Erik: Get him, [00:17:30] gotta get him checked. 

Matt: That's, I agree. 

Erik: I'm no fun to have at a party. I'm gonna tell you right now I'm it's, nobody wants to take their kid.

It's scary sometimes to take your kid to the ER because they had a submersion injury. What's gonna happen? Who the CPS, all this stuff. 

Matt: And I think more than that, honestly, I think being on some of these calls, a lot of times it's oh, they're fine. Yeah, they were underwater for a few minutes, but they're fine.

They're awake, they're running around and they're talking. 

Erik: That's really dangerous, potentially. Exactly. That's the good message. They, we need to get the vitals, we need to get that. Oftentimes the chest [00:18:00] x-rays indicated there are certain medical standard of care procedures and protocols that we follow based on the data 

Matt: that we can't do pre hospitally.

No. That's why they need to go. That's what I'm saying. 

Erik: Yeah, that's right. So get to the to the er. There are certain situations where I've told families that, oh, you know what? Based on your story, there's no risk here. 

Matt: Yeah. 

Erik: Let's just check a couple things. Watch 'em for a couple hours. We sent 'em fine home.

Probably gonna be fine. But there are those situations, those real situations where the kiddo seemed [00:18:30] fine talking to me. What you starts, oh yeah. You can really cause some serious injury with depending upon how much, liquid you had aspirated. 

Matt: There's no way to know that. No, you don't know. You have no idea.

And especially those situations where how long were they under? I don't know. Yeah. We just went out and we found 'em out there it might've been 30 seconds, it might've been. Five minutes. And yeah. I think that's important for first responders to realize that you get called out to one of these near drowning calls or a drowning call.

And [00:19:00] you get there and mom and dad are out with the kid. And the kid seems fine. Fine. He's got good color, he's responding to you. That doesn't necessarily mean he's out of the woods. A hundred percent. 

Erik: That's correct. 

Matt: And it's always best to encourage mom and dad, look, I know he looks fine now Uhhuh.

But I think it's probably best because there's, we're limited with what we can do here pre hospitally. I think it would be best. And you know what, just some verbal judo mom and dad are, I don't wanna, I don't think we need to go by ambulance. Okay, fine. You understand the risks. [00:19:30] Obviously we want to cover ourselves from a liability standpoint.

Point. Yeah. But then tell them like, look, please. Then you drive them to the er. If you don't want to go with us, please take them into the ER and get them checked out. Yeah. We would prefer that you go with us because we can monitor a route in case anything bad happens. 

Erik: Yeah. 

Matt: But encouraging them to go is important.

Erik: And man, you in these cases, you've got to document. 

Matt: Yeah, 

Erik: you've got to document quotes Yes. Of what you've said and what they said and they, you're explaining the risks. Yes. They accepting the risks. That's the thing is you've gotta disclose the [00:20:00] risks so mom and dad or whoever's taking care of this patient Yes.

Can then verbalize and communicate their understanding of the risks and benefit. And you've documented all of it. In court it will not stand up if you can say, oh, mom and dad were there and they said that, they didn't want to go to the er. And then in court they're gonna say gosh, I don't know.

You're the medical expert. They let me go. I assumed it was okay. I'm not a paramedic. I don't know medicine. 

Matt: Yeah. Especially if there's a bad outcome and they're looking for somebody to [00:20:30] scapegoat. 

Erik: To who are they gonna pick. It's not all about, this, we've talked about this before.

It's not all about CYA and all that stuff, and defensive. 

Matt: We wanna do what's best for our patients. 

Erik: Always do best for,

Matt: That's the main thing.

Erik: The key though, is on these situations, you wanna make sure that you have communicated, disclosed. All risks and benefits and then it's all communicated back to you after they have legal and mental capacity.

That's right. We don't really want to get into a refusal thing now. But when you're trying to determine whether or not a parent can have, make an [00:21:00] autonomous decision for that kid it's not good enough to just say, Hey, it's the mom and dad, they have legal, custody here.

Yeah. And they can make the decision what they want to do. Yeah. No, that's not the case actually. 

Matt: Had mom and dad been drinking all day at the pool party, maybe, and they're a little inebriated and they. Don't, they're not. That's right. And what are they gonna do in court? They, were drunk or, yeah.

I know. Some systems not, again, not to get off on refusals, but some systems are starting to video. Yeah. And take video evidence that the paramedic or the EMT is explaining the results or the explaining the [00:21:30] consequences of not going and getting. Yeah. Okay. You understand what I just told you? Yeah, I understand.

Yeah. We could die if he doesn't go or whatever. 

Erik: I think this is really appropriate to talk about here because in this situation you have so many kids. Look great. Yep. Same thing with head traumas too. Sometimes the baseball bat to the side of the head, big kid looks great for a little while.

Wakes back up. Yeah, that's right. So knowing the medicine, knowing the pathophysiology of some of these diseases can really be important in doing that communication, that disclosure of [00:22:00] information to the parents so they can make an educated decision. That's right. And then in, in court, God forbid, you know it's, it says here in the patient care report, actually, you know what, if you do a really good job, the lawyer will say right away.

Don't have a case here. 'cause they told you everything.

Matt: Yeah. It's documented right here that Yeah. Yeah. They told you everything and you signed it. 

Erik: That's right. Yeah. 

Matt: Yeah. But yeah, so I think we talked about assessment, we talked about number one, we talked about prevention. Yeah. That's the best thing we can do.

To prevent these type of calls, these type of injuries, these type of deaths. [00:22:30] You do get these calls we've talked about. Get 'em out of the environment. Start treating them on scene. Don't be in a rush unless it's an unsafe scene. Yep. Talked about what you need to do. 

Erik: Yep. And I would say too, for your kids, as the summer starts out here, there, there are free swim lessons you can get through your city call your, city municipality where you are.

And oftentimes they offer free community swimming lessons. There are ways to be safe out there. 

Matt: Have you seen the thing where they put the babies in the pool and they teach 'em to flip over? Yeah. And then they just float. [00:23:00] It's amazing. It is amazing. It's, and it's crazy when they go test them, they take this little tiny baby and they put him in the water and he just whoop and he flips over. That's right. And it just sits there just hanging out until Oh my gosh. That is amazing. Yeah. So it's very, that's another part of prevention. Yeah. You get some swim lessons. Yeah. Anyway. 

Erik: Yeah. Having a, lifeguards, there are certain places where it's safe to swim, you're diving into a pool and you can't see, 

Matt: that's another thing that we talked about is, swimming in the ocean or open water swimming.

That's right. Know your limitations. [00:23:30] Riptides if you don't live, if you're from Texas, and you're going out to wherever the coast and you're going to the ocean and you're not used to looking for riptides and things and you're thinking, oh, I'm a big bad swimmer. 

Erik: I told you what happened to me. And remember that embarrassing story where I got my pants ripped off? 

Matt: Pants ripped off, had to walk up naked. Oh my Gods parking lot. So embarrassing. It's, yeah, but you're swimming like in a pool and you think you're a swimmer. Yeah. Okay. There's no current in a pool. Now you're in the ocean and it is unforgiving.

That's right. It will at sea. Or a river, it will suck you out to [00:24:00] sea and you're in big trouble. 

Erik: And then lakes, you got the water sports, you've got potential jet skiers that don't see that kid. That's right. That whatever. Yeah. Make sure you have life preservers in your boat.

Using the, all the flags if you're doing water sports following the rules of the of the lake Yeah. Of whatever you're doing. And the alcohol too, obviously that's just can't, you can't say that enough that's, you just drink a little too much. Yeah. And just, you're not making the right decision.

Matt: No. You're doing, yeah, you're doing dumb things you shouldn't be doing. I think it's good to [00:24:30] mention salt water versus fresh water. Yeah. There's, they used to teach, oh, salt water was worse. No, they did that study on dogs. There's no real, no difference between a salt water drowning and a fresh water drowning.

Erik: The bugs are different. The bugs might be different, as far as one being worse than other. 

Matt: The pathophysiology of, yeah, exactly. That study was done on dogs, if I remember right, with the salt water? I don't know. 

Erik: That's a good question. I don't remember. 

Matt: It's what I recall. Yeah. When they changed it, that was why. That data wasn't very good data. 

Erik: Yeah. But I remember when we did our submersion injury lecture not too long ago a couple years [00:25:00] ago, I think. I remember reading that. Yeah. It's like the whole freshwater salt water thing, it's not worth spending time on that.

Yes. Yeah. It's the liquid in the lung that's not supposed to be there. 

Matt: That's, doesn't matter if it's salt or not unsalted or salted, 

Erik: it may change the antibiotic choices in the emergency department. No. That does not change the management. 

Matt: Yeah. And I think the biggest takeaway is for first responders is.

Again, if the patient's unconscious, we're working them. Obviously those patients are getting transported. It's that difficult call you get to and the kid looks fine, and mom and dad don't want to [00:25:30] go. You need to strongly advise Mom and dad, look, they need to go to the hospital. We gotta get 'em checked out.

Yeah, hopefully they'll just be there for a couple hours. Everything's good, you come home, but God forbid something does go wrong. And now we're further down the line of them getting treatment. Always encourage transport to the hospital with these patients. Very important. 

Erik: Said, this is a great summer message on our podcast.

Matt: And go have fun. Go swim. Go have a good time. Careful. There's nothing wrong with that. Just be careful and be smart. 

Erik: Don't invite [00:26:00] me 'cause I'm not fun to have at the party. 

Matt: You are if your pants get ripped off. My gosh. See? See, on the next one.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.