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

Purpose: Early reversal of hypoxia through ventilations is the most effective measure to reduce mortality for the drowned person In the COVID-19 era, there is a movement away from this intervention for out-of-hospital providers as resuscitation organisations update protocols and individuals become concerned about potential risk Aquatic rescuers face a dilemma and as a result, required updated guidance Methods: Three international organisations representing aquatic rescuers requested input from their membership and a working group was formed to draft the statement Elements were identified from the responses and for each, three features were discussed: recommendations for rescuers, interventions to improve safety, and data needed to inform practices Consensus was achieved through an iterative process whereby an updated statement was sent to the larger membership for feedback until no major revisions were identified Results: 56 individuals with expertise in drowning resuscitation research, policy and implementation contributed from 17 countries Eight elements were highlighted, which included development of a COVID-19 drowning resuscitation algorithm (Fig 1), and strategies for risk mitigation, protective equipment, education and research Data gaps identified included the rescuer\u0027s risk of becoming infected, efficacy of alternative ventilation techniques and ability of organisations to urgently implement new training programmes [Formula presented] The process highlighted global differences in rescuer knowledge, skill and access to equipment which were exacerbated by region-specific pandemic concerns Despite these, agreement was reached by generating recommendations with levels of risk that were aimed towards organisations instead of the individual rescuer Conclusion: We describe the first urgent, global consensus process by the drowning community Through this, a resuscitation algorithm for use by aquatic organisations has been developed describing adaptations in the COVID-19 era Although the viral threat may subside in the future, the consensus process has revealed important insights to improve the safety of rescuers who perform resuscitation in aquatic environments