• Resuscitation efforts should start at the scene if the casualty is to have the best chance of survival and full neurological recovery (AHA & ILCOR 2000). Basic life support should be commenced (refer to Chapter 5). It makes no difference if the accident occurred in fresh or salt water.
• It is important to be aware of personal safety and minimise danger when reaching and recovering the casualty. Attempt to keep the casualty horizontal. Vertical removal from water may cause circulatory collapse (AHA & ILCOR 2000).
• Resuscitation should start unless there are obvious lethal injuries, putrefaction or rigor mortis.
• If there is a possibility of spinal cord injury, such as after diving into shallow water, the spine should be immobilised during recovery. The jaw thrust should be used to open the airway, rather than head tilt, chin lift.
• Rescue breathing should begin as quickly as possible. It can be attempted once the rescuer can stand in the water or the casualty is on land. If it is difficult to perform mouth-to-mouth ventilation while supporting the casualty's head in the water, mouth-to-nose ventilation is an acceptable alternative.
• The airway should be inspected and any debris removed. It is not necessary to remove water from the airway before starting BLS. Attempting to tip the casualty head down will not help remove water and may cause vomiting and aspiration.
• Vomiting is a common occurrence in submersion events. The person's head should be turned to the side. Suction should be used to remove vomitus. Early tracheal intubation will help prevent aspiration of vomit.
• It may be difficult to palpate a pulse if the casualty is cold. If no signs of circulation are present, chest compressions should be started as soon as possible. Do not attempt chest compressions while the casualty is still in water.
• Successful resuscitation with full neurological recovery has been reported in casualties with prolonged submersion in cold water therefore life support should continue for a longer period than usual (AHA & ILCOR 2000).
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