Every day in the United States, an average of 13 people drown, compared to nine who die from fire. Drowning is one of the leading causes of accidental death in the United States. About 4,000 people of all ages die every year from it, and that number doesn't include the 700 who die from drowning in boating accidents, because the Centers for Disease Control and Prevention classifies them differently. Drowning also is the second-leading cause of accidental death in children ages 1 to 15, after motor-vehicle accidents.

Water operations long were the sole responsibility of police agencies; for fire departments, they were considered primarily recovery operations. This was the case until emerging data showed cold-water near-drowning victims could survive extended periods of time underwater. After that, dedicated and well-trained dive-rescue units emerged in fire-service agencies across the country.

Dive-Rescue Developments

In the 1970s, the few fire departments capable of responding to open-water drowning events were mostly ill-equipped and trained only to civilian open-water SCUBA certifications. Last-seen points (LSPs), zero-visibility environments, swiftwater diving and specialized search equipment use weren't even considered. Predictably, a high number of public-safety personnel, both police and fire, became casualties of poorly planned and executed recoveries. And operations truly were recoveries, because it was rare for resuscitation efforts to be initiated for someone who had been submerged for any length of time.

One seminal event helped change how the public looked at near-drowning victims and the possibility of resuscitating them — and it happened to be televised.

During the winter, a young boy had been riding on the back of his father's motorcycle when they lost control and went into a roadside pond. The water was mostly frozen over and very cold, and the boy was underwater for more than an hour. Chicago Fire Department divers entered the icy water and found the boy, and aggressive EMTs restored his cardiac and respiratory function. At the hospital, emergency-room staff worked quickly to resuscitate the boy, who eventually made a full recovery.

While some called it a miracle, clearly there was some scientific reason the victim recovered without profound brain damage or other debilitating medical problems. Now we know the effects of cold on the body and how it reacts even after breathing and cardiac activity have ceased. In fact, cold environments are now used in clinical situations to assist medical personnel in preserving and sustaining patients undergoing long, complex operations.

Studies show near-drowning victims have the best chance of being revived if the water is cold, fresh (i.e., non-saltwater), and not polluted. There are other key factors. Significant trauma, from a motor-vehicle accident for example, is a contraindication of successful resuscitation. Also, the younger the victim, the better the chance for survival. And if the “Mammalian diving reflex” kicks in or the submersion is considered a dry-lung drowning, the statistics become more favorable.

Successful Teams

The assistance and expertise the fire service already provides in several technical-rescue disciplines make it a pretty good fit for water rescue.

While there are very successful volunteer and non-fire-service dive-rescue teams, the large majority of 24/7/365-capable units are either dedicated rescue companies, such as those in New York City, Los Angeles County and Seattle, or use the automatic-aid model employed by a large number of suburban and rural departments.

Those fire departments already operating technical water-rescue units, or with automatic-aid agreements in place for that purpose know that the three most important elements to success from an administrative perspective are:

1. Managing the unit administratively and strategically, including the on-scene deployment and decision-making process. Many departments have incorporated a special operations division into their organization, and it is an efficient way to provide structure, leadership and responsibility for the folks who will be doing the actual work.

   Any technical-rescue unit that is allowed to operate independently of the command structure is a house of cards waiting to fall. It either will fail from lack of attention and support or it will breed a lack of responsibility in its members regarding the larger picture and how that unit fits into it. Initiative is a key element of successful leadership, and all great on-scene emergency operators have it. But there's a fine line between freelancing and initiative. Most fire departments wouldn't think of allowing a ladder company to engage without a command structure in place, but they allow so-called “specialty units” to do just that. Water rescue must be part of an overall strategy to mitigate an incident, not an independent entity with little or no command support and strategic oversight. Indeed if the unit is part of the mainstream — even if under the umbrella of special operations — it will have someone to manage a budget, arrange for documentation of training, and provide the necessary clout and leadership to continue procuring better equipment and newer technology.

2. Preplanning for underwater rescue and recovery so the organization is aware of the potential for open-water near-drowning and what type of water exists in the response area. Preplanning for dive-rescue operations is a critical element of success, just as it is for any other emergency response. Open-water near-drowning occurs in lakes, rivers, streams, ponds, stormwater retention pools, saltwater bays and harbors, and more. Taking a close look at what exists will govern the level of response capability necessary. Will you need a 24/7/365 unit, or can you use callback or mutual/automatic aid? Is there dangerous moving water that will necessitate specialized swiftwater dive training? Is the water considered zero-visibility, or can divers widen search patterns because the water is clear? Is access for equipment and personnel limited and will they need the support of technical rope teams, all-terrain vehicles and additional personnel to move all the equipment into position.

   There are a couple of terms I learned decades ago from a Marine gunnery sergeant that apply directly to these missions — KISS (keep it simple, stupid) and the 7 Ps (prior, proper, planning prevents pretty poor performance). Plan for contingencies and failures. Plan for inebriated and hysterical witnesses. In dive-rescue operations, success isn't always measured by whether we're able to resuscitate a victim, but rather by how we deal with family, friends and the media. Plan and train for that, too.

3. Training to nationally recognized standards. If a water-rescue unit is part of a department's deployment model, it should be extremely well-trained and superbly led. Training is the key to operational success and the continued good health of our divers. It has to be the cornerstone of the unit's activities and it must be realistic, difficult and continuous.

   Training shouldn't be fatal, however, and the 7 Ps say that divers must first be drilled and practiced in every piece of gear they may use. That means repetition and being able to instantly react to malfunctions or unexpected circumstances.

   The water most dive rescuers operate in won't be clear, warm and obstacle-free. And water isn't human beings' natural environment. Training needs to include diver entanglement, out-of-air emergencies, loss of hardline communications and immediate action drills for all of these. It starts on dry land with equipment familiarity and continues into the pool for confidence training. This is the sort of activity that should stress the diver in a controlled environment so he has to react and problem-solve. Be aware that there are instructors who push the envelope a bit too far in these confidence drills. Good management and leadership will legislate that sort of thing out of the training program.

   Most dive-rescue operations don't use the buddy system underwater in zero visibility. That's contrary to military and civilian dive procedures, but I became a convert after spending more time worried about my partner than I did doing an effective pattern. The diver has to know whether surfacing is the default action when something goes wrong, but also how to stay calm and attempt to troubleshoot an equipment problem underwater with little or no visibility.

   Another consideration is training for — and at — the depth to which divers may descend. Most near-drowning victims are found in fairly shallow water (less than 60 feet), but there are times when it may be necessary to extend the search into deeper waters. A diver should go no deeper than the depth at which he has done an emergency out-of-air ascent drill.

Know the Risks

Cold-water near-drownings — those that occur in a water temperature less than 65°F — have the potential for victim resuscitation. Understanding what makes up a successful response, whether a department is at the technical level or just responsible for commanding the incident, is critically important for the safety of responders and the potential for locating and resuscitating victims. Those in command and administrative roles must know what is required to deploy and manage these operations so responders and technicians can understand their limits.

Risk/benefit analysis is part of everything the fire service does. Preplanning for the incident, training to the highest standard, and then strategically and tactically managing operations will give commanders the ability to recognize and employ risk/benefit analysis so the scale always tips in the operators' favor.

---

Tom Marino is a 30-year veteran of the fire service and a captain with the Valley Regional Fire Authority in the Seattle area. He has commanded the technical rescue portion of the special operations division for 12 years. He also has been a military, recreational and public-safety diver and instructor since 1988 and is currently an advanced swiftwater-rescue instructor and a squad officer with FEMA WATF-1.

Related Stories

• Got water?
• Water Rescue