Pediatric Submersion Injuries

New Definitions And Protocols

Stewart, Charles MD, FAAEM, FACEP
Brown, Lance MD, MPH, FACEP
Kim, Tommy Y MD, FAAP, Attending

¹Author
²Emergency Physician—Colorado Springs, CO.
³Peer Reviewers
⁴Chief, Division of Pediatric Emergency Medicine; Associate Professor of Emergency Medicine and Pediatrics, Loma Linda University Medical Center and Children's Hospital—Loma Linda, CA.
⁵Physician, Pediatric Emergency Department; Assistant Professor of Emergency Medicine and Pediatrics, Loma Linda Medical Center and Children's Hospital, Loma Linda, CA.

Date of original release: April 30, 2006.

Date of most recent review: April 20, 2006.

See “Physician CME Information” on back page.

Pediatric Emergency Medicine Practice 3(4):p 1-18, April 2006.

It's a sultry summer evening in the ED when the EMS radio commands your attention. You overhear the charge nurse taking a report, describing an 18-monthold female who has fallen into a backyard swimming pool. The mother apparently answered a phone call leaving the child unattended. The outdoor pool is reported to be at ambient summer temperature, about 90° F. The submersion time is not known, but mother estimates “only a minute or two.” The paramedics found the child with a weak and thready pulse not breathing spontaneously. Paramedics have the child breathing by bag-valve-mask and have also achieved IV access. They report noisy breath sounds, vomitus about the mask, feeble spontaneous motions of both upper and lower extremities, and some spontaneous respiratory efforts. The paramedics report an ETA of “about 2 minutes.” You pull out your Broselow tape and ask yourself: Should I request the patient be placed in spinal precautions? Should the patient be intubated? Will steroids be helpful? Should I suspect child abuse?