What is the first aid management for an unconscious person who dove into shallow water, struck their head against a submerged object, with a high risk of spinal injury and potential for drowning?

First Aid Management for Diving Head Injury with Unconsciousness

Immediately remove the victim from the water by the fastest means available, begin rescue breathing as soon as they are out of the water, and do NOT routinely immobilize the cervical spine unless there are obvious signs of trauma beyond the head strike. 1

Critical Safety Considerations

• Rescuer safety is paramount - ensure you can safely extract the victim without becoming a second victim yourself 2, 1
• Remove the victim from water using the fastest available method, as terminating the drowning process is essential 2

Airway and Breathing: The Absolute Priority

Use the A-B-C sequence (Airway-Breathing-Circulation), NOT the standard C-A-B sequence, because drowning-related cardiac arrest is hypoxic in nature, not a primary cardiac event 1

Immediate Ventilation Steps:

• Begin rescue breathing immediately upon removing the victim from water - this is the single most important intervention and increases survival 2, 1
• Deliver 2 initial rescue breaths that make the chest rise before checking for pulse 2, 1
• If trained and it was safe to do so, rescue breathing could have been initiated in shallow water before full extraction 2, 1

Circulation Assessment and CPR

• After delivering 2 effective breaths, check for a pulse for no more than 10 seconds 2, 1
• If no pulse is definitely felt, immediately begin chest compressions and continue with standard CPR cycles 2, 1
• The duration and severity of hypoxia is the single most important determinant of outcome, making rapid ventilation critical 2, 1

Cervical Spine Management: A Critical Pitfall to Avoid

Do NOT routinely immobilize the cervical spine in drowning victims unless specific high-risk features are present 2, 1:

Only consider spinal immobilization if:

• Obvious clinical signs of injury are present 2
• History of diving into shallow water (which applies here) 2
• Alcohol intoxication is suspected 2
• High-impact mechanism is evident 3

However, even with diving history, cervical spine immobilization should NEVER delay airway management and rescue breathing 2, 1. The incidence of cervical spine injury in drowning victims is extremely low (0.009%), and unnecessary immobilization can impede airway opening and delay critical ventilation 2, 3.

What NOT to Do: Common Dangerous Mistakes

• Never perform abdominal thrusts or the Heimlich maneuver - water is not an obstructive foreign body, and these maneuvers can cause injury, vomiting, aspiration, and dangerous delays in CPR 2, 4
• Never delay ventilation to perform cervical spine stabilization 2, 1
• Never assume the victim is stable even if they regain consciousness - all drowning victims requiring any resuscitation must be transported to hospital 2, 1

Oxygen and Advanced Care

• Administer high-concentration supplemental oxygen as soon as available, since cardiac arrest from drowning results from severe hypoxemia 1, 5
• If an AED is available and the victim remains in cardiac arrest, attach it and follow prompts for defibrillation if indicated 1

Mandatory Transport and Monitoring

ALL drowning victims who require ANY form of resuscitation (including only rescue breaths) must be transported to the emergency department, even if they appear to recover at the scene 2, 1:

• Decompensation can occur in the first 4-6 hours after the event 2, 1
• Minimum observation period is 4-6 hours for all patients requiring any resuscitation 1
• The victim may develop acute respiratory distress syndrome or other delayed complications 2, 5

Clinical Reasoning for This Specific Case

In this scenario involving a head strike from diving into shallow water:

• The hypoxic injury from drowning takes precedence over potential spinal injury in terms of immediate management 2, 1
• While diving into shallow water is a risk factor for cervical spine injury, only 0.5% of submersion victims have C-spine injuries, and all occurred with high-impact mechanisms and clinical signs of serious injury 3
• Immediate ventilation is lifesaving; delayed ventilation to immobilize the spine can be fatal 2, 1
• The unconscious state indicates severe hypoxia requiring immediate rescue breathing 1, 5