b'Chapter hapter Do not apply external pressure over a distended stomach as it could result in further vomiting / regurgitation. Do not attempt to expel or drain clear water or frothy fluid that may re-accumulate in the upper airway during resuscitation. Oxygen administration (if you are trained in its use) is beneficial during resuscitation, however efforts should not be delayed while waiting for oxygen equipment to become available. A successfully rescued and resuscitated patient requires close monitoring to detect a relapse into cardiac arrest. This can occur in the minutes or hours following return of spontaneous circulation and breathing, due to persisting lung damage and hypoxic injury to the heart.Call an ambulance for all patients resulting from of an immersion event, even if seemingly minor or they appear recovered. Special Problems Influencing Rescue and ResuscitationMedical Conditions Not all water related deaths are primary drowning. Sudden incapacitation can be caused by a heart attack, cardiac rhythm disturbances, seizure, hyperventilation, drugs & alcohol, dementia, frailty and other conditions causing loss of consciousness, e.g. low blood sugar in a diabetic. These conditions should be suspected in known competent swimmers found drowned unexpectedly. In some victims these medical conditions can be aggravated by the shock of sudden immersion in cold water. Spinal injury in waterSpinal injury occurring concurrently (at the same time) with drowning is rare, estimated at less than 0.5% but should be suspected if the patient dived into shallow water, was dumped in the surf, on rocks or after an accident involving a boat or other aquatic craft. Remove the patient from the water taking care to keep the airway clear of wave splash while minimising movement of the spine in any direction. Care of the airway takes precedence over a suspected spinal injury and an unconscious, non-breathing patient should be removed immediately from the water by whatever means possible. Medical Emergencies 211'