Epidemiology and clinical characteristics of drowning patients presenting to a pediatric emergency department from 2017 to 2020.

BACKGROUND: Drowning is a common mechanism of injury in the pediatric population that often requires hospitalization. The primary objective of this study was to describe the epidemiology and clinical characteristics of pediatric drowning patients evaluated in a pediatric emergency department (PED), including the clinical interventions and outcomes of this patient population. METHODS: A retrospective cohort study was conducted of pediatric patients evaluated in a mid-Atlantic urban pediatric emergency department from January 2017 to December 2020 after a drowning event. RESULTS: Eighty patients ages 0-18 were identified, representing 57 79 unintentional events and 1 intentional self-injury event. The majority of patients (50%) were 1-4 years of age. The majority (65%) of patients 4 years of age or younger were White, whereas racial/ethnic minority patients accounted for the majority (73%) of patients 5 years of age or older. Most drowning events (74%) occurred in a pool, on Friday through Saturday (66%) and during the summer (73%). Oxygen was used in 54% of admitted patients and only in 9% of discharged patients. Cardiopulmonary resuscitation (CPR) was performed in 74% of admitted patients and 33% of discharged patients. CONCLUSIONS: Drowning can be an intentional or unintentional source of injury in pediatric patients. Among the patients who presented to the emergency department for drowning, more than half received CPR and/or were admitted, suggesting high acuity and severity of these events. In this study population, outdoor pools, summer season and weekends are potential high yield targets for drowning prevention efforts.

Unintentional Drownings in Pediatric Populations: Injury Prevention in the Post-COVID-19 Era.

Unintentional injuries are one of the leading causes of death in Americans. A large proportion of these deaths are attributable to accidental drownings and falls, both of which oftentimes take place in or around swimming pools and swimming pool-related apparatuses such as diving boards. The American Academy of Family Physicians (AAFP) has reported drowning incidents as the most common injury-related cause of death in children ages one to four years. Although the AAFP has outlined steps to take to prevent drownings, there has not been a current large-scale study illustrating the effectiveness of these strategies with regard to their effect on the prevalence of swimming pool drowning cases in the last 10 years. Thus, we aim to utilize the National Electronic Injury Surveillance System (NEISS) database to uncover these rates, which can ultimately help aid in the reevaluation of current recommended guidelines.

A Traumatic Pandemic: High Acuity Pediatric Trauma in the Covid-19 Era

Purpose of study COVID-19 has shifted the utilization of health care resources. Gaps remain in our understanding on how COVID-19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. We identified trends in the numbers and types of traumas presenting to a Level 1 Pediatric Trauma Center during the COVID-19 pandemic compared to prior years. Methods used We compared high acuity trauma visits (defined as traumas requiring admission, emergent surgical intervention or resulting in a fatality) presenting between January 1st and August 31st, 2020 to corresponding months in 2017-2019. We also evaluated the changes in mechanisms of injury during this time period. Data were analyzed using longitudinal time series analyses and t-tests. Summary of results Of 480 traumas presenting from January to August 2020, 227 (47.3%, 95%CI 42.7%-51.9%) were high acuity traumas. High acuity traumas declined significantly, as a state of emergency was declared, to a nadir of 16 in April 2020 (compared to the 2017-2019 mean of 38.3, p<0.001). As restrictions were lifted, high acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 (2017-2019 mean 35.7, p<0.001). High acuity traumas as a proportion of total Emergency Department visits were higher from March to August 2020 compared to prior years (figure 1). There were more visits for high acuity assaults and child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 compared to prior years, while visits for animal attacks remained stable Conclusions This analysis provides insight into how the COVID-19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues and further restrictions are debated. (Figure Presented).

Evaluation of the First Lap learn to swim voucher programme: protocol.

INTRODUCTION: Swimming skills are an evidence-based component of drowning prevention. However, in Australia, many children miss out on learn to swim education. Voucher programmes may reduce swimming lesson cost and increase participation, especially among priority populations. The First Lap voucher programme provides two New South Wales state government-funded $100 vouchers for parents/carers of preschool children to contribute to swimming lesson costs. This evaluation aims to determine the effectiveness of the programme in meeting objectives of increasing preschool-aged children participating in learn to swim programmes and building parent/carer knowledge and awareness of the importance of preschool-aged children learning to swim. METHODS AND ANALYSIS: A programme logic model was developed to explain the inputs, activities and intended outputs, and outcomes, which guided this mixed-methods evaluation design of quantitative and qualitative analysis within an impact/outcome evaluation. Baseline sociodemographic registration data will be provided by the parent/carer of each child participant and linked to swim school provider data on voucher redemption. Data will be collected on voucher use, knowledge, and attitudes to swimming lessons at registration and across two surveys. An economic evaluation will assess programme cost-effectiveness. CONCLUSION: This evaluation will determine impacts on participation rates in learn to swim programmes, particularly within priority populations. It will examine whether the programme has influenced attitudes and motivations of parents and carers toward learn to swim programmes and water safety, whether the programme has impacted or enhanced the ability of the aquatics sector to deliver learn to swim programmes and assess its cost-effectiveness.

Planning and executing a health fair to bridge accessibility gaps and language barriers for the Hispanic community in Mobile County, Alabama

Purpose of Study: Community health fairs have been developed to address the unmet needs for disease prevention and health education among underserved communities. Hispanic communities experience significant non-financial barriers (e.g., cultural and linguistic) that also contribute to lower rates of access and utilization of health care services, including important preventive screening services. Around 3% of Mobile County's population is Hispanic. The aim of this event was: (1) To perform basic health screening, provide health education, and administer COVID-19 and Influenza vaccines to children under the age of 18 years. (2) To act as a bridge between the Hispanic families in the community and the available resources to help them overcome barriers to accessing quality care. Methods Used: We started by identifying and finalizing the location and the date for the health fair with help from the Guadalupe Center (a faith-based organization). We planned to divide the health fair into three specialized zones: Health Screening, Health Education, and Vaccination. The Health Screening zone would include anthropometry, developmental screening, and vision screening. The Health Education zone would educate the families on asthma care, breastfeeding, drowning prevention, road safety, safe sleep practices, oral hygiene, adverse childhood experiences, and healthy lifestyle. The Vaccination Zone would administer COVID-19 and Influenza vaccines. We designed and printed brochures for all health education topics in English and in Spanish. Age and gender appropriate 'Health Passports' with growth charts and other key parameters to record the child's health status were also created. Resident and medical student volunteers were trained regarding documentation, health screening, health education, and referrals to early intervention or specialist services that accepted uninsured or Medicaid patients. Summary of Results: A total of 49 children underwent health screening and health education. Each child's health status was documented in age and gender appropriate 'Health Passport'. In addition to this, these children and their parents were educated at the various health education stations and provided with brochures. Around 40% of the children that were screened had an abnormal vision screen, the parents of these children were given a list of available resources for further follow-up. Six children with developmental delay were identified and early intervention forms were filled out for two and more information regarding the Individualized Education Program (IEP) was given to the other four families. Eight children were vaccinated for COVID-19 and five were vaccinated for Influenza. Conclusion(s): The Hispanic community has persistently faced barriers to access healthcare due to literacy and socioeconomic status. Academic institutions and community- based organizations must work to develop and sustain culturally relevant health education and outreach events to reduce these disparities. Copyright © 2023 Southern Society for Clinical Investigation.

Evaluation of post-drowning rescue missions in the pre-hospital emergency of Mazandaran during 5 Years...The Fifth National Conference on Drowning Prevention, 27-28 July 2022, Guilan Road Trauma Research Center, Rasht, Guilan, Iran

Background: Every year, many people die due to drowning and its complications as a severe health problem in Northern provinces. The first step in planning health problems in any society is to prioritize problems based on epidemiological trends. This is an epidemiological study on drowning missions performed by Mazandaran Emergency Medical Services for 5 years. Methods: This retrospective cross-sectional study was conducted on mission forms of all drowning victims in Mazandaran pre-hospital emergency from the beginning of 2017 to August 1400. The data of age, gender, drowning place, mission result (dispatch, mission cancellation, outpatient treatment, and death), and accident time and date were collected and analyzed using SPSS Software (Version 19) and the chi-square test. Results: Out of the 1127 rescued drowning cases, most incidents occurred between 10:00 AM and 12:00 PM and between 5:00 PM and 8:00 PM. A total of 720 cases (63.9%) were men and the remaining 407 cases (36.1%) were women. In addition, 506 (44.9%) cases were dispatched, 167 (14.8%) died, 341 (30.3%) were treated on-site, and the remaining 10% of missions were canceled. Most cases of drowning were in the age group of 20-30 years old. The most common place of drowning was in the unpatrolled area of the beach with 891 cases (79%). Following the COVID-19 spread and lockdown in 2020-2021, the drowning cases in the river and water channels increased so that 9 cases in 2017 reached 101 cases in August 2021. Conclusion: Most of the drowning cases occurred in unpatrolled areas among the young and productive age group of society. Development and maintenance of protected swimming beaches, as well as public education on first aid for drowning victims, seem necessary. Further, public warning and relief systems should be strengthened to make people aware of the dangers of swimming in unpatrolled and unsafe areas.

SHEWANELLA SEPTIC SHOCK COMPLICATING COVID-19 SURVIVORSHIP FOLLOWING EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO) RECOVERY

SESSION TITLE: Critical Care in Chest Infections Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Shewanella are gram-negative bacteria that inhabit salt and brackish watery environments, rarely causing skin and soft tissue infections. We report a case of septic shock, bacteremia, and empyema due to Shewanella in a COVID-ARDS survivor who previously received ECMO. CASE PRESENTATION: A 67-year-old man with a medical history of hypertension, diabetes, recent COVID-ARDS illness complicated with STEMI, leading to a VT/VF arrest requiring 21-days of VV-ECMO support presented three weeks after discharge due to worsening oxygen needs. The patient was hypotensive, febrile, tachycardic, tachypneic, with SatO2 92% on HFNC> 50%FIO2. Labs showed leukocytosis, lactic acidosis, and acute kidney injury. Chest x-ray showed a loculated left pleural effusion. Broad spectrum antibiotics were started. Blood cultures grew Shewanella species in aerobic and anaerobic bottles. A CT of the chest is shown (Figure 1). Thoracentesis was performed with findings consistent with empyema (Table 1). The empyema was managed with pigtail catheters and TPAse-DNAse. Pleural fluid cultures had no growth. The patient improved and was discharged on 6-week course of IV ceftazidime. DISCUSSION: Shewanella is a rare cause of skin and soft tissue infections, following traumatic injuries in association with exposure to salt or brackish water. It has also been associated with pneumonia, in the setting of near drownings, in both fresh and saltwater. Individuals with underlying liver disease and immunocompromising conditions are at the highest risk of contracting the pathogen and manifesting illness. Shewanella algae and putrefaciens may manifest as deep ulcers with hemorrhagic bullae, bacteremia, endocarditis, and meningitis (1). In addition, biliary tract infections and peritonitis can occur (2). Our patient had no epidemiologic risk factors for Shewanella infection. Although nosocomial transmission is possible, we are not aware of any previous reports of such exposure in association with this infection. Given negative pleural fluid culture with positive blood culture, we hypothesize our patient's empyema is due to Shewanella given no other apparent infectious etiology. Studies have shown that approximately 40% of pleural infection are culture negative. It is possible that antibiotic therapy started before fluid collection lowered the diagnostic yield of thoracentesis. The prevalence of bloodstream infections during ECMO ranges from 3 to 18%, with coagulase-negative staphylococcus as the most frequent cause, followed by Candida spp., Pseudomonas aeruginosa, Enterobacteriaceae, Staphylococcus aureus and Enterococcus spp. (3) with no known reports of Shewanella per the ELSO registry. CONCLUSIONS: This case may confer possible healthcare-related acquirement of Shewanella. Our case adds awareness to clinicians about potential routes of inoculation, predisposing factors, and the wide clinical manifestations of Shewanellosis. Reference #1: Weiss TJ, Barranco-Trabi JJ, Brown A, Oommen TT, Mank V, Ryan C. Case Report: Shewanella Algae Pneumonia and Bacteremia in an Elderly Male Living at a Long-Term Care Facility. Am J Trop Med Hyg. 2021;106(1):60-61. Published 2021 Nov 15. doi:10.4269/ajtmh.21-0614 Reference #2: Savini V, Marrollo R, Nigro R, Fazii P. Chapter 6-Skin and Soft Tissue Infections Following Marine Injuries. In: The Microbiology of Skin, Soft Tissue, Bone and Joint Infections. Vol 2.;2017:93-103. Reference #3: S. Biffi et al. / International Journal of Antimicrobial Agents 50 (2017) 9–16 DISCLOSURES: No relevant relationships by Akram Alkrekshi No relevant relationships by Robert Kalayjian No relevant relationships by Ismini Kourouni No relevant relationships by Srinivasa Potla No relevant relationships by Zahra Zia

BENIGN PARTIAL ROLANDIC EPILEPSY FOLLOWING SARS-COV-2 INFECTION AND NEUROCOVID-19 EXPERIENCE: A CASE STUDY

Background Early evidence described by a number of scholars worldwide suggests that neu-roCOVID-19 has both mild [e.g. loss of smell (anosmia), loss of taste (ageusia), neurological tics (heterophilia), visual disturbances, headaches, dizziness, disorien-tation] and more severe sequelae (e.g. cognitive impairment, seizures, delirium, psychosis, strokes). Long-term neurological problems or neurological deficits may also occur. The aim of this study was to describe the examination and neurother-apy of a boy following SARS-CoV-2 infection and NeuroCOVID-19 in whom neurological tics and motor automatisms as well as cognitive impairment, particularly attention deficit disorder, developed as a consequence. Case study: We present a boy K.S., 7 years old, without any neurodevelopmental disorders, following a SARS-CoV-2 infection in May 2021 and the contraction of neuro-COVID-19 confirmed by a genetic test for the quantitative detection of neutralising antibodies (responsible for immunity) in the IgG class against SARS-CoV-2. The boy had relatively mild pseudomonal symptoms of the illness: temperature 38.5, runny nose, cough, muscle aches, headaches and general weakness. He was treated symptomatically and recovered after 2 weeks. Two months later, at the beginning of July 2021, neurological tics consisting of an upward turning of the eyeballs to the left appeared. These tics intensified in August 2021 and were accompanied by motor automatisms consisting of the left hand stiffening in salute-like position, while at the same time there was an inclination of the head to the left. In September 2021, after exertion in the swimming pool, an epileptic seizure occurred which caused the boy to start drowning. In the days that fol-lowed the above described tics and motor automatisms increased. He also developed sleep disorders, which consisted of him waking up several times during the night, during which time neurological tics and motor automatisms also ap-peared. Gradually, cognitive dysfunctions, especially attention deficits and behavioural changes, joined in, making it impossible for the boy to function independently at school and in many situations of daily life. Neurophysiological examination: qEEG, ERPs and sLORETA tomography performed on 11.09.2021 using automatic seizure activity detection software showed the pres-ence of the neuromarker benign partial rolandic epilepsy (BPERS) and neurocog-nitive disturbances resembling the symptoms of attention deficit hyperactivity disorder (ADHD), compared with the neuromarkers of children with this condition (n=100) from the normative database of the Human Brain Index (HBI) in Switzer-land. Detection of the neuromarkerBPERS was helpful in selecting an individu-alised neurostimulation protocol. The patient participated in 20 neurofeedback sessions using (1) SMR reinforcement, theta inhibition;(2) theta inhibition, B1 reinforcement (15-18 Hz);(3) qEEG-guided neurofeedback. Neurostimulation with neurofeedback was conducted twice a week, for 15-20 minutes gradually increasing to 30-40 minutes per session. The patient also received individual goal-directed psychotherapy After successive sessions of neurofeedback, a gradual reduction neurological symptoms was observed. By the end of neu-rotherapy, neurological tics, motor automatisms, neurocognitive disorders and behavioural disturbances had completely disappeared. The patient functions well in school and achieves very good results. Conclusions: HBI methodology was helpful in finding functional neuromarkers of benign partial Rolandic epilepsy and disturbed cognitive control. Therefore, it was possible to offer more effective neurorehabilitation of the disorders, which contribute to a better quality of life for the patient.

Drowning: A practical review of prehospital intervention

Despite a recent decrease in drowning deaths, the number of drownings in Australia remains too high. Being reminded of key considerations for a drowning emergency is helpful preparation for health professionals who may take control at the scene © 2021 Medicine Today Pty Ltd. All rights reserved.

Suicides During the Pandemic: A Retrospective Study

Suicide is defined as a fatal self-injurious act with some evidence of intent to die.1 Suicide occurs more often in older than in younger people, but is still one of the leading causes of death in the late childhood and adolescence. Every year, more than 1,00,000 people commit suicide in our country.1 Suicide accounts for 1.4% of all deaths, and is the 15th leading cause of death globally.2,3 Suicide is associated with an impulsive nature. Several risk factors concerning family structure and interactions have been linked to a suicidal behaviour. Direct conflicts with parents and siblings, Occupational status and social acceptance have a great impact, but so do the absence of communication and a lack of empathy.12 Interpersonal losses are also strongly associated with suicide cases. But in developing countries one of the major reason always remains unemployment and poverty. There are different rates of suicides and suicidal behaviour between males and females (among both adults and adolescents). While females more often have suicidal thoughts, males die by suicide more frequently.5 Hence, this study was planned with a purpose to know the magnitude and the socio-cultural factors of the problem of suicides, so that a sound prevention program could be suggested, planned and implemented for reducing the incidence of suicides.

Increased unintentional drowning deaths in 2020 by age, race/ethnicity, sex, and location, United States.

INTRODUCTION: During the COVID-19 pandemic, one study in Australia showed an increase in drowning deaths in certain settings, while a study in China showed a decrease in drowning deaths. The impact of the COVID-19 pandemic on drowning deaths in the United States is unknown. OBJECTIVE: To report on unintentional drowning deaths among U.S. persons aged ≤29 years by demographic characteristics and compare 2020 fatal drowning rates with rates from 2010 to 2019. METHODS: Data from CDC WONDER were analyzed to calculate unintentional drowning death rates among persons aged ≤29 years by age group, sex, race/ethnicity, and location of drowning. These rates were compared to drowning death rates for the previous 10 years (2010-2019). RESULTS: In 2020, 1.26 per 100,000 persons aged ≤29 years died from unintentional drowning, a 16.79% increase from 2019. Drowning death rates decreased 1.81% per year on average (95% CI: -3.02%, -0.59%) from 2010 to 2019. The largest increases in unintentional drowning deaths from 2019 to 2020 occurred among young adults aged 20 to 24 years (44.12%), Black or African American persons (23.73%), and males (19.55%). The location with the largest increase in drowning was natural water (26.44%). CONCLUSION: Drowning death rates among persons aged ≤29 years significantly increased from 2019 to 2020. Further research is needed to understand the impacts of the COVID-19 pandemic on drowning and identify how drowning prevention strategies can be adapted and strengthened. PRACTICAL APPLICATIONS: Drowning remains a leading cause of injury death among persons aged ≤29 years. However, drowning is preventable. Interventions such as learning basic swimming and water safety skills, and consistent use of lifejackets on boats and among weaker swimmers in natural water, have the potential to reduce drowning deaths. Developing strategies that ensure equitable access to these interventions may prevent future drowning.

Occupational health recommendations for lifeguards in aquatic emergencies in the COVID-19 era: prevention, rescue and resuscitation

Severe acute respiratory syndrome (SARS-CoV-2), which causes coronavirus disease 2019 (Covid-19), is highly contagious. Lifeguards are the first line of response in aquatic emergencies and they will suffer a strong exposure to risk this first summer of the Covid-19 era, so their occupational health must be rethought in their professional practice during the new normal. The main public health measure to prevent drowning is prevention, but when this fails and assistance or rescue is required, in most interventions, distancing will not be possible. The limitation of personal protective equipment (PPE) for rescue is a reality that must be known and that can affect the health of the lifeguard. A review of the current literature aimed at avoiding or minimizing the risk of contagion in the interventions carried out by rescuers in the Covid-19 era was performed. This article provides structured information on the prevention of contagion in lifeguards, the potential risks, the available PPE, and the recommendations for its proper use during rescue or prehospital care in aquatic settings.

Extreme Winter Storms: Environmental Impacts of Public Utility Policies on Vulnerable Populations

Winter Storm Uri, one of the coldest in decades, brought snow and ice to Texas along with record subfreezing temperatures for 5 days February 13-17, 2021, and was followed by Winter Storm Viola, which brought more of the same February 18-19, 2021. Millions of Texans lost electricity and clean, running water for several days, which some suggest was due in part to a state-regulated energy market. Many Texas schools shut down for the entire week, as the death toll rose from these storms due to hypothermia and exposure, carbon monoxide poisoning, fire, drowning, and poor road conditions. Not only were COVID-19 vaccinations halted due to impassable roads but also Texas hospitals struggled to provide electricity and water pressure needed to perform life-saving medical treatments for their patients. The purpose of this article is to provide an overview of the historic winter storm event, identify vulnerable populations and key public health policies, and highlight the potential environmental public health risks associated with the storms.

A study into the development of a light weight smart life buoy prototype (LWSLB)

Life Buoy, also known as a life preserver, is a crucial safety tool on board any marine ships. The most common and conventional lifesaver is operated manually to save people from drowning, yet this method poses a risk for both the victim and rescuer. Hence, with the help of current technology, a smart lifebuoy has been developed, whereby the rescuer just operates the lifebuoy using remote control. Yet, the existing smart life buoy system has been found heavy and hard to be operated, especially for women, children, and other people with disabilities.This paper focuses on the development of a lightweight smart life buoy system and its characteristics. Arduino Uno R3, Arduino Nano, DC motor 775, Transmitter and Receiver kit were the main components used in the development of the lightweight smart life buoy system (LWSLB). The developed LWSLB system was tested at the National Defence University of Malaysia’ swimming pool due to Covid-19 lockdown, and data such as speed, range of remote connection and battery endurance were obtained. It has been found out that the developed LWSLB weighs just 3.5kg overall compared to Brand S which weighs 13.75kg. However, in terms of speed, Brand S proves to be faster at 4.17m/s compared to LWSLB which exhibits a speed of 1.25m/s. © 2021, Faculty of Maritime Studies. All rights reserved.

When Natural Hazards Intersect with Public Health: A Preliminary Exploration of the Impact of Bushfires and the COVID-19 Pandemic on Australian Coastal Drowning Fatalities.

Natural hazards combined with the COVID-19 pandemic have had significant global impacts to the community and the environment. This study explores the impact of the Australian 2019/20 bushfires followed by the COVID-19 pandemic on unintentional coastal drowning fatalities. Fatality data were collated using triangulation methodology. Percentage change in coastal drowning fatalities between 2019/20 financial year (FY) and the 15FY annual average (2004/5-2018/19) were calculated for the dominant bushfire period (August 2019-February 2020 inclusive) and COVID-19 restrictions in place for 2019/20FY (March-June 2020 inclusive). Relative risk (RR; with 95% confidence intervals [CI]) of coastal drowning was calculated against the average for overall, bushfire and COVID-19 periods, using coastal participation data as the denominator, weighted for the predicted decrease in the use of outdoor coastal areas due to these widespread events. Coastal drowning fatalities increased in 2019/20FY by 9% overall (bushfires: 6%; COVID-19: 9%). Swimming/wading drowning fatalities increased during the bushfire period (RR = 2.02; 95% CI: 1.13-3.63), while boating and personal watercraft (PWC)-related fatalities increased during both the bushfire (RR = 2.92; 95% CI: 1.41-6.05) and COVID-19 period (RR = 3.86; 95% CI: 1.64-9.11). Rock fishing fatalities also increased across both the bushfire (RR = 4.19; 95% CI: 1.45-12.07; p = 0.008) and COVID-19 (RR = 3.8;95% CI: 1.24-11.62; p = 0.027) periods. Findings indicate the activity patterns leading to coastal drowning fatalities changed despite significant public health events impacting freedom of movement and thus opportunity for coastal participation. Understanding, and preparing for, the impacts of natural hazards on drowning risk is vital for future preventive efforts.

Safe On-Boat Resuscitation by Lifeguards in COVID-19 Era: A Pilot Study Comparing Three Sets of Personal Protective Equipment.

INTRODUCTION: On-boat resuscitation can be applied by lifeguards in an inflatable rescue boat (IRB). Due to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-COV-2) and recommendations for the use of personal protective equipment (PPE), prehospital care procedures need to be re-evaluated. The objective of this study was to determine how the use of PPE influences the amount of preparation time needed before beginning actual resuscitation and the quality of cardiopulmonary resuscitation (CPR; QCPR) on an IRB. METHODS: Three CPR tests were performed by 14 lifeguards, in teams of two, wearing different PPE: (1) Basic PPE (B-PPE): gloves, a mask, and protective glasses; (2) Full PPE (F-PPE): B-PPE + a waterproof apron; and (3) Basic PPE + plastic blanket (B+PPE). On-boat resuscitation using a bag-valve-mask (BVM) and high efficiency particulate air (HEPA) filter was performed sailing at 20km/hour. RESULTS: Using B-PPE takes less time and is significantly faster than F-PPE (B-PPE 17 [SD = 2] seconds versus F-PPE 69 [SD = 17] seconds; P = .001), and the use of B+PPE is slightly higher (B-PPE 17 [SD = 2] seconds versus B+PPE 34 [SD = 6] seconds; P = .002). The QCPR remained similar in all three scenarios (P >.05), reaching values over 79%. CONCLUSION: The use of PPE during on-board resuscitation is feasible and does not interfere with quality when performed by trained lifeguards. The use of a plastic blanket could be a quick and easy alternative to offer extra protection to lifeguards during CPR on an IRB.

Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. A pilot study.

OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The first step consisted of washing hands, putting on safety glasses and gloves as the first personal protection equipment (PPE) and then covering the victim with an assembled plastic blanket. The second step consisted of 10 min of cardiopulmonary resuscitation (CPR) with PPE and plastic blanket, following the technical recommendations for ventilation during COVID-19. RESULTS: Ten rescuers took part in the pilot study. The average time to wear PPE and place the pre-assembly kit on the victim was 82 s [IC 58-105]. After 10 min the quality of the resuscitation (QCPR) was 91% [87-94]. Quality chest compressions (CC) were 22% better than ventilations (V). Most of the rescuers (60%) thought that placing the plastic blanket on the victim on the beach was somewhat simple or very simple. CONCLUSIONS: Resuscitation techniques in COVID-19 era at the beach have added complexities for the correct use of PPE. Plastic blanket plus basic ventilations equipment resource could be a new alternative to be considered for lifeguards to keep ventilation on use while reducing risk transmission.