Wilderness and Rescue Medicine 8th Edition

Wilderness and Rescue Medicine 168

Risk Versus Benefit Water is a high-risk environment for the injured and the rescuers, especially if it is moving and cold. Water rescue offers an almost unlimited opportunity to create more patients and increase the scale of disaster. Mitigating the risks is the first step in rescue and resuscitation. Considerable training and practice are required. Unskilled res- cuers should remain ashore. A patient in the water is an unstable scene. In all but the most desperate situations, removal of the patient from the water comes before assessment and treatment. In-the-water spine stabilization, for example, is appropriate only in a heated pool with enough rescuers and scene control to ensure the safety of all involved, including the patient.

Ear Pain and Mask Squeeze Middle ear barotraumas can affect SCUBA and free divers alike. The tympanic membrane (ear drum) in the ear is particularly susceptible to injury from changes in water or air pressure. As the diver descends, they must force air into the middle ear behind the ear drum to counter the water pressure pushing in from the outside. If the air pressure inside matches the water pres- sure outside, the ear drumwill remain uninjured. If either becomes excessive, the membrane will rupture and allow water to enter the middle ear. Middle ear barotrauma is usually not an emer- gency, but it carries the anticipated problem of middle ear infection. The patient should not be permitted to swim or dive until the ear drum has healed. This usually takes several weeks to months. Serious problems can develop when the injury involves the inner ear or facial nerves. Early evacuation to medical care is indicated since there is no real field treatment.

General Principles

Middle Ear Barotrauma

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Signs and Symptoms: • Pain • Impaired hearing • Congestion Serious : • Facial paralysis • Hearing loss

Inner ear

TM

• Tinnitis • Vertigo • Fever

Middle ear sinus

© 2018 WMA

Mask squeeze develops from a failure to pressur- ize the air space in the face mask during descent. The relative increase in pressure in the vascular system and soft tissue under the mask can cause the rupture of small blood vessels in the con- junctiva of the eye and skin of the face and nose. Although scary looking, it is usually not serious. Treatment is directed at relieving symptoms.

Beware that your treatment does not inhibit your patient’s ability to survive in and around water. A patient immobilized on a backboard or litter is completely helpless. Allowing your patient freedom of movement may risk exacerbating an injury but will be of substantial benefit if the raft or small boat capsizes.