Resuscitation of the drowned person in the era of COVID-19 disease: Global consensus process for a novel approach

Abstract

Study purpose: Previous work has shown that out-of-hospital cardiac arrests (OHCA) occur more frequently in deprived areas of England. Public access defibrillation (PAD) is a key element of the early stages of the chain of survival. However, placement of automatic external defibrillators (AED) has been questioned and are not necessarily located where they would be most required for use. This study aimed to highlight discrepancies in the characteristics of areas where AEDs are located and not located in England.Materials and methods: Details of 32,844 ambulance service registered AEDs were obtained. The address of each AED location was converted to a lower super output area (LSOA), the proxy unit of neighbourhood. Neighbourhood characteristics of each LSOA were obtained from the Office for National Statistics and Government websites. Comparisons were made between LSOAs with or without an AED using chi-square and t-test.Results: AEDs were in LSOAs that were more likely to have a significantly (p < 0.01) lower residential (33.2 vs. 49.8 per hectare) but higher working (20.5 vs. 12.8) population density, have a larger white population (87.7% vs. 85.5%), be in areas with a greater proportion of groups from higher socioeconomic classifications (33.6% vs. 29.5%), and be less deprived (higher index of multiple deprivation [IMD]; Rank: 17698 vs. 15459; Decile: 5.9 vs. 5.2).Conclusions: Whilst almost 80% of all OHCAs occur in residential areas, public access AEDs are located less frequently in these areas; evidence suggests they are not clinically/cost effective in these areas. However, they are also disproportionately placed in more affluent, less deprived, areas with lower proportions of population from non-white ethnic groups. Future PAD programmes should give preference to areas where OHCA are more likely to occur and more deprived areas of the country.

Performance of Basic Life Support by Lifeboat Crewmembers While Wearing a Survival Suit and Life Vest: A Randomized Controlled Trial

“…Due to the current COVID-19 pandemic, increasing attention has been focussed on the personal protective equipment (PPE) worn by rescuers. As a consequence, aquatic rescue organizations around the world are re-evaluating their resuscitation protocols, seeking on the one hand to avoid contamination of rescuers as much as possible, while on the other hand assuring high quality resuscitation (25)(26)(27). The results of the current study may be of interest to rescue organizations, as they do not demonstrate a profound negative effect of the heavy survival suits with life jackets on BLS quality.…”

Safe On-Boat Resuscitation by Lifeguards in COVID-19 Era: A Pilot Study Comparing Three Sets of Personal Protective Equipment

“…5 - 8 However, after the appearance of COVID-19, the CPR recommendations have been updated, proposing the use of the bag-valve-mask (BVM) with a high efficiency particulate air (HEPA) filter, handled by two rescuers. 9 , 10 In addition, as an anti-contagious measure, the use of personal protective equipment (PPE) has been emphasized, including at least: polycarbonate safety glasses, gloves, and a mask filtering facepiece (FFP)/N95, 10 and for safer clinical practice, a short-sleeved apron for droplet precaution and/or a long-sleeved gown for airborne-precaution. 11…”

“…Alternatively, either due to the absence of PPE, the low economic cost, or the peculiarities of the clinical intervention, the use of plastic blankets has been experimented with as an extra or alternative protection in the intra-hospital setting, 12 - 15 and in prehospital settings, as shown by a recent pilot study with a lifeguard resuscitation simulation on the beach. 16 In this new scenario, some resuscitation procedures are currently not recommended (eg, in-water resuscitation) 10 , 11 and others are not yet certain to be applied (eg, on-boat resuscitation). For this reason and because of the health emergency, scientific societies linked to the prevention and treatment of drowning are calling for progress in research 10 in order to try to avoid deaths that are collateral to COVID-19.…”

“…16 In this new scenario, some resuscitation procedures are currently not recommended (eg, in-water resuscitation) 10 , 11 and others are not yet certain to be applied (eg, on-boat resuscitation). For this reason and because of the health emergency, scientific societies linked to the prevention and treatment of drowning are calling for progress in research 10 in order to try to avoid deaths that are collateral to COVID-19.…”