 I don’t know her name, and I’ll probably never know what eventually happened to her. But I do know that I’ll never forget the day our paths crossed in the most dire of circumstances.
Just a warning in advance that this blog post contains some fairly graphic depictions of a real-life emergency scenario which may be disturbing to some readers. During a recent holiday, my husband and I took a day trip to snorkel off a small and fairly remote island. After a 30 minute drive then a 1 hour boat trip, we arrived on the tiny 0.5 square kilometre island where the only facilities were some tables and chairs and long drop toilets - not even running water. While we took a break from snorkelling and sat down at the far end of the beach, we noticed a group of people gathering up the other end of the beach as a person was dragged from the ocean. Despite both knowing first aid and being confident around the water, we still hesitated before making the decision to go and help. Firstly (as I’m sure many other junior health professionals will relate to) there is the feeling of self-doubt - ‘yes, I’m a doctor but I’m not that experienced, I would probably just be getting in the way’, and secondly there were at least 30-40 people now standing around a person on the sand. We assumed that surely someone was performing some immediate first aid. In the few minutes it took us to walk over to the scene, we weren’t able to get a view of the person due to the surrounding crowd, however the atmosphere was noticeably void of panic or hysteria. Subsequently, we assumed everything must have been under control. It was only when my husband stood on top of a table to try and see what was happening that he noticed that despite the amount of bystanders, no first aid was actually being administered. He yelled out to me and indicated that I would need to offer my help. While the surrounding onlookers didn’t seem to understand the severity of the victim’s condition, my stomach dropped as the seriousness of the situation became clear and I realised that I would need to manage it. I pushed through the surrounding onlookers and my own pulse quickened when I finally was able to lay eyes on the limp, grey and clearly unconscious young woman who lay on the sand, not moving and quite obviously not being attended to by anyone who knew first aid. What had looked from a distance like a person who had been placed in the recovery position was actually a person who had been dragged from the water and left on the sand haphazardly, with her face laying in a puddle of her own regurgitated sea-water on the sand. I still feel queasy thinking about what lay before me in that moment. As I approached the victim, a staff member from one of the snorkel boat companies also came over and I asked if they needed help. He said yes, before going back to his boat to arrange for transport to hospital, so for what felt like much longer than the 5-10 minutes it probably was, I was a lone first responder. Prior to that moment, the only out-of-hospital first aid events I’ve had to assist in have involved minor sporting injuries, insect bites or cuts and scrapes… nothing where I had the potential to actually be the sole difference between life and death, or at the very least between life and terrible morbidity. The realisation that these potential consequences depend on your actions, on an island more than an hour from the nearest hospital or basic first aid resources is absolutely terrifying. As soon as I reached the victim I started the familiar DRS ABCD of basic life support that to many of us with basic first-aid awareness is second nature, and perhaps we take for granted that the average lay person doesn’t immediately think of these things. In a perfect world I would have cleared away non-useful bystanders, donned a pair of gloves and called for an ambulance but unfortunately on a remote island without fresh water, soap or mobile phone signal, sometimes the best available option is far from best practice. I immediately called to the woman, squeezed her hand and yelled in her ear without a response. At the same time, I lifted the woman’s head out of the sand and had some assistance to roll her properly over onto her side as she had clearly been vomiting or regurgitating water. She began bringing up large amounts of sea water and as I continued to apply head tilt keep the airway open, she started taking regular breaths. I’m not sure if she was breathing at all up to this point, owing to her position and the fact her mouth and nose were directly in sand and water; but I don't think I have ever felt as relieved as when those first spluttery breaths occurred. She continued breathing, at first with short rapid breaths with increased effort, but her colour changed from the terrifying blue-grey to pale but with some pink returning. I knew this woman was by no means out of the woods, this was a sign things were heading in the right direction. The woman kept breathing but remained unresponsive and unconscious during the eternity it seemed to take to arrange the boat to transfer her to hospital. When a stretcher finally arrived on the beach and the woman was moved onto it, I felt so helpless as I tried to communicate with the boat staff who were to take her. There was no “1, 2, 3, roll” or careful consideration of possible spinal injuries. The woman was placed onto her back despite that if she stayed lying supine for any length of time it was likely she would choke on the sea water she continued to bring up. As much as I tried to signal, instruct and move her myself, it took me yelling repeatedly before another person understood and helped me to roll her over. At the time I didn’t even think about the fact those people probably didn’t speak very much English, I was just determined to try and do what I knew was best. I felt even more helpless as the boat staff carried the young woman onto the waiting boat, almost dropping the stretcher and the woman in the process. It made me feel sick to my stomach. It seemed to take so long for them to get her back on her side and leave the beach to get her to a hospital. Just as shockingly, many tourists in the water seemed to ignore my husband and others who were trying to clear them from the water so the boat would be able to load the woman on and transport her away. It felt so frustrating not being able to do more, or to know that I had done enough. After the woman was on the getaway boat, I turned around and burst into tears. I don’t know whether it was the confronting nature of what I’d been involved in, the inaction of the dozens of other bystanders before we arrived or the frustration of it taking so long to get this woman to proper medical assistance, but the whole situation was just incredibly overwhelming and quite traumatic. It was shocking that of the 8-10 boats who had brought tourists to the island that day, only one staff member came to assist. Especially considering we were in a country where many tourists don’t swim regularly at home, and aren’t confident in the water, I would have thought that all tour companies would have to train their staff in first aid at the very least. I would like to think that if a similar thing was to happen in Australia then there would be plenty of bystanders who would at least have some knowledge of what to do if someone is pulled from the water and sufficient resources to appropriately respond. However, on arriving home from our holiday and hearing news of a huge number of drownings in NSW over the Christmas period, maybe we all need a refresher on water safety and what to do when something goes wrong. I held my bronze medallion and lifeguarding certification for a number of years before I completed my medical training, so somewhere in the depths of my memory I had plenty of knowledge about assisting in drownings, even if I hadn’t yet had to put it into practice. These potentially life-saving courses don't take very long to complete but could prevent one or your children, one of your friends or even a stranger from suffering terribly. Royal Lifesaving Australia runs courses in basic first aid & CPR, lifesaving techniques in the Bronze Medallion, and a swim and survive program for school-aged children and even have a course in water safety for older people. I would highly recommend checking out the Royal Lifesaving website (http://www.royallifesaving.com.au) for details of these courses. As Australians we spend much of the warmer months around the water and you never know when you will witness a person in distress. According to Royal Lifesaving, 280 people drowned in Australian waterways last year, a 5% increase on the year before. Here are their top tips to keep yourself and your family and friends safe when enjoying our beautiful waterways:
The following advice DOES NOT replace completing a first aid or lifesaving course (which I would strongly suggest everyone considers booking in for and regularly re-doing), but if tomorrow you came across a drowning person, what should you do? (Adapted from the Australian Resuscitation Council Guidelines: http://www.resus.org.au/policy/guidelines).
When looking back over my experience in assisting with a drowning victim, I am left with many questions, to most of which I’ll never have an answer. Was there something more I could have done to have given the woman a better chance at a full recovery? Did she make it to hospital ok, and did she in fact recover? What caused her to drown in calm and fairly shallow water? Did all those bystanders have no idea what to do, or was there a cultural reason for not jumping straight in to help? Regular searches of the local news have not turned up any reported drowning deaths at the island where the incident occurred, but other drownings were reported in the months prior - so I have to maintain hope that this means the small actions I took on that beach might have enabled that woman to not be another statistic. We can all learn from this, especially my fellow junior health professionals, not to doubt yourself in a stressful situation; and to always offer your help in an emergency, even if it looks to be under water-tight control. Finally it is a harsh reminder that our beloved oceans (and pools, lakes, rivers!) can be dangerous places, and if we all made an effort to gain skills and knowledge to keep ourselves and each other safe, then many tragic drowning deaths could be prevented. References: Royal Lifesaving Australia: http://www.royallifesaving.com.au Australian Resus Council guidelines: http://www.resus.org.au/policy/guidelines
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