Elsevier

Resuscitation

Volume 81, Issue 4, April 2010, Pages 434-439
Resuscitation

Clinical paper
The role of bystanders during rescue and resuscitation of drowning victims

https://doi.org/10.1016/j.resuscitation.2010.01.005Get rights and content

Abstract

Background

Bystanders make a critical difference in the survival of drowning victims. Little information on their role before arrival of the Emergency Medical Services (EMS) is available in the scientific literature. In a descriptive study, this role is investigated.

Methods and results

We studied 289 rescue reports (1999–2004) available from the Dutch Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning), an organisation that, since 1767, acknowledges awards to bystanders who have contributed to the survival of a drowning victim. There were 138 variables retrieved from these reports. The Utstein Style for Drowning (USFD) was used as a guideline. Of the 26 USFD parameters on victim and scene information, 21 were available for analysis. Eight non-USFD parameters, defined by the authors of this research, were available in >60% of the cases. There were 343 victims, rescued by 503 rescuers. 109 victims were resuscitated by bystanders. Of the 18 victims who first received resuscitation from bystanders and then consequently from pre-hospital professionals, 14 survived. Rescues often occurred in dangerous circumstances: multiple victims (n = 90/343), cold or ice-cold water (n = 295/341), deep water (n = 316/334), swimming to the victims (n = 262/376), young age of rescuers (the youngest rescuer was 5 years of age).

Conclusions

Bystander rescue and resuscitation of drowning victims seems to contribute to a positive outcome. Bystanders are prepared to take responsibility to rescue a drowning victim in spite of significant dangers. The USFD is helpful in understanding the role of bystanders in drowning situations, but may need modification to become more instrumental.

Introduction

Some recent studies have concluded that drowning victims have a good chance of survival when bystander resuscitation has already been started before the arrival of the emergency medical services (EMS). Outcome is poor if rescue or resuscitation is delayed.1, 2, 3, 4, 5, 6, 7 Unfortunately, little data on what exactly happens during the rescue and resuscitation of drowning victims by bystanders is available. This information is important to provide input in training courses, aimed at the rescue and resuscitation of drowning victims.

Unique sources of data on how bystanders respond to drowning incidents are the rescue reports of the Dutch Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning). Since 1767, this organisation has given awards to bystanders who have performed the rescue, and also in many cases the resuscitation, of a drowning victim.8, 9 Each year, several bystanders are rewarded, depending on the actions of the bystanders. These actions vary from heroic and lifesaving actions (in which case a gold, silver, or bronze medal is awarded) to simple assistance (in which case a written certificate is awarded). The archives of the Maatschappij tot Redding van Drenkelingen cover more than 240 years and more than 7000 reports.

In 2002, by means of a painstaking multidisciplinary process, international consensus has been reached about the uniform dataset that should be used to register and study drownings: The Utstein Style for Drowning (USFD).10 The USFD includes sets of parameters related to victim information, scene information, emergency department evaluation and treatment, hospital course, and disposition. Since then, the USFD has been applied in two articles related to out-of-hospital resuscitation and in-hospital cardiopulmonary bypass.1, 5

In this study, USFD parameters related to victim and scene information (Table 1, Table 2), as well as other potentially relevant parameters to study the involvement of bystanders, have been retrieved from 289 consecutive rescue reports of the Maatschappij tot Redding van Drenkelingen on accidental drowning cases in the period 1999–2004. At the same time, the feasibility of the USFD parameters was tested.

Section snippets

Methods

The information in the rescue reports of the Maatschappij tot Redding van Drenkelingen is based on the three data sources that are used for the decision to reward a rescuer: registration forms of the Maatschappij tot Redding van Drenkelingen, formal police or fire-fighter reports, and newspapers and magazines. The registration forms of the Maatschappij tot Redding van Drenkelingen consist of 13 questions with the objective to determine the category of reward in accordance with formal criteria.

Results

Between 1999 and 2004, during 289 rescue events (minimum per year 29, maximum 63, mean 48), 343 drowning victims were rescued by 503 bystanders: 253 victims (73.8%) were alone (single victim rescues), another 90 victims (26.2%) were together with one or more others (multiple victim rescues).

The availability and data of the USFD parameters, and USFD parameters by proxy, on victim and scene information are summarised in Table 1, Table 2. Table 3 shows the non-USFD parameters, including their

Discussion

The behaviour of bystanders is seen as one of the most important factors in the survival of drowning.1, 2, 3, 4, 5, 6, 7, 10, 17, 18, 19 As far as we know, this is the first study based on a large population, that points out how bystanders deal with the rescue and resuscitation of drowning victims before the arrival of the EMS.

Analysis of our data provided descriptive data on scenes and participants in drowning situations. Some of the data also show that bystanders, when confronted with a life

Conclusions

This is the first study in a large cohort of drowning victims that uses USFD parameters to study the behaviour of bystanders in the rescue and resuscitation of drowning victims, before the arrival of the EMS. Our data suggest that bystander rescue and resuscitation play a critical role in the survival of drowning. The interventions of bystanders occur in dangerous situations. Adaptation and expansion of the current USFD parameters should be considered.

Conflict of interest statement

Joost Bierens is an honorary advisory consultant of the Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning). The Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning) provided partial funding (travel expenses, software) for Allart Venema. This had no influence on the contents of the manuscript in any way. This research was not otherwise funded.

Acknowledgements

This research was supported by the Maatschappij tot Redding van Drenkelingen (Society to Rescue People from Drowning) who generously provided the data. The authors also thank B. Chris Brewster, President, United States Lifesaving Association, for his comments on a prior version of this manuscript.

References (39)

  • P. Suominen et al.

    Impact of age, submersion time and water temperature on outcome in near-drowning

    Resuscitation

    (2002)
  • T. Vassal et al.

    Severe accidental hypothermia treated in an ICU: prognosis and outcome

    Chest

    (2001)
  • G.A. Jelinek et al.

    Community attitudes towards performing cardiopulmonary resuscitation in Western Australia

    Resuscitation

    (2001)
  • S. Grmec et al.

    Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest

    Int J Emerg Med

    (2009)
  • J. Marchant et al.

    Bystander basic life support: an important link in the chain of survival for children suffering a drowning or near-drowning episode

    Med J Aust

    (2008)
  • J.G. Wigginton et al.

    The critical role of lay persons and their actions in drowning incidents

  • D.N. Kyriacou et al.

    Effect of immediate resuscitation on children with submersion injury

    Pediatrics

    (1994)
  • Brokken HM, Frijhoff WThM. Idealen op leven en dood: gedenkboek van de Maatschappij tot Redding van Drenkelingen,...
  • Cited by (92)

    • Lay-rescuers in drowning incidents: A scoping review

      2021, American Journal of Emergency Medicine
      Citation Excerpt :

      Literature shows a human tendency towards altruism when helping drowning victims [15,19,21]. This altruistic behaviour is reinforced when the rescuer has a close bond with the victim [7,9,13,14,21], although in many cases, witnesses take risks impulsively [6,7,17], based on the principles of the Good Samaritan and the desire to do the right thing [10]. In water rescues, the basic ability to swim (regardless of the true level of water skills, age, or experience) can motivate laypeople to attempt the rescue due to emotional factors that override the objective risk analysis [18].

    View all citing articles on Scopus

    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.01.005.

    View full text