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New Guidelines For Drowning Resuscitation In The COVID-19 Era

The Covid pandemic has prompted first responder groups, including surf lifeguards, to reassess the risks of resuscitation to rescuers and patients.

Ventilations, also known as rescue breaths, are critical for the resuscitation of drowned patients. However, these can be risky procedures for lifeguards in the new COVID era.

To minimise the risks to lifeguards and to the beach-goers they protect, a working group drawn from the International Drowning Researchers’ Alliance (IDRA), the International Life Saving Federation Medical Committee (ILS-MC) and the International Maritime Rescue Federation (IMRF) have prepared a set of new guidelines for drowning resuscitation.

IDRA Co-Founder and ILS-MC Secretary Dr Jonathon Webber says the working group consulted with representatives of resuscitation councils and aquatic rescue organisations from 17 countries - Argentina, Australia, Belgium, Brazil, Canada, Denmark, Greece, Italy, Ireland, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, UK, and USA. Through multiple rounds of commenting, 86 individuals contributed to the guidelines.

The guidelines include an easily read and understood COVID (Compression-only Or Ventilations In Drowning) CPR algorithm that walks surf lifeguards through the steps they should take when a drowned person is removed from the water unconscious.

The algorithm asks a series of questions to guide the lifeguard in how to effectively treat the person and minimise the risk of infection. The CPR algorithm and the guideline summary document can be found at

Surf Life Saving New Zealand Medical Director and ILS-MC Chair Dr Gary Payinda said the guideline document looks at all the options for minimising the risk of COVID-19 infection including:

  • Prevention of drowning: Ranging from forbidding or reducing all water activities in some areas to media strategies to spread drowning and COVID-19 prevention messages.
  • Infection risk mitigation: Screening patrons entering facilities; ensuring rescuers belonging to high-risk groups for developing COVID- 19 are not assigned to duties; and ensuring organisations adhere to national guidelines for return to work safety.
  • Personal Protective Equipment (PPE): For all resuscitations, rescuers should wear gloves, a face mask and eye protection and follow proper hand hygiene procedures. Organisations must ensure adequate PPE is available.
  • Resuscitation of drowned persons during COVID-19 era: The COVID CPR algorithm provides details on which interventions should occur during the resuscitation of a drowned person depending on the circumstances.
  • Education and training programmes: Before any implementation of the proposed resuscitation techniques with equipment, rescuers should receive appropriate training on their use and the underlying new protocols.
  • Responsibilities of aquatic rescue organisations and other ethical aspects: Organisations and employers have an ethical obligation to act in the interest of the rescuer’s safety.

Dr Webber said the guidelines were intended for lifeguards and first responders rather than the general public.

“In the spirit of ‘hands across the ocean’, agencies may use the basic framework to inform and guide their local protocols” he says.

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