Diving into shallow water can drive the head into the bottom and break the neck, often injuring the spinal cord in young, healthy people. Rescuers must protect the airway and breathing while keeping the head and neck in line during removal from the water.
Key symptoms
- Neck pain or tenderness after hitting the bottom
- Weakness or paralysis of the arms and legs
- Numbness, tingling or burning in the limbs
- Trouble breathing from weak chest muscles
- Floating face down or unable to swim after the dive
What you find on exam
- Primary survey; airway and breathing first
- Motor and sensory exam in all four limbs
- Spinal tenderness and deformity
- Signs of neurogenic shock: low blood pressure with a slow pulse and warm skin
- Drowning signs: cough, crackles, low oxygen
Tests
- Validated spinal assessment criteria to decide on motion restriction
- Oxygen saturation and waveform capnography
- Repeat neuro checks during transport
- Hospital: CT and MRI of the spine
Treatment basics
- Manual in-line stabilization in the water; float the patient onto a backboard
- Spinal motion restriction with a cervical collar; scoop stretcher or vacuum mattress for transport
- Open the airway with a jaw thrust; assist breathing with a bag-valve mask if needed
- Treat neurogenic shock with IV fluids, then a vasopressor such as norepinephrine
- Transport to a trauma center with spine care
Red flags
- Breathing failure or a weak cough
- Low blood pressure with a slow heart rate
- Loss of movement or feeling in the limbs
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Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NREMT psychomotor skill sheets (EMT and Paramedic); National EMS Education Standards (2021). Written by Making Synapses. Making Synapses is not affiliated with these organizations.