Technical Rescue Interface: Open Water Rescue

Technical Rescue Interface: Open Water Rescue

Andrew Schmidt

Benjamin N. Abo

Justin Sempsrott


Drowning is a leading cause of injury death worldwide. As with other injuries, prevention is key in decreasing morbidity and mortality. The prevention of drowning usually takes the form of swim lessons, proper barriers around vulnerable bodies of water, and the utilization of proper flotation devices. When these measures fail, rescue of the patient early in the drowning process becomes the next priority. This chapter will focus on the procedures and techniques necessary to complete safe and effective rescues in the open water environment.

Throughout the chapter, the safety of the rescuer is stressed. As discussed later, while the open water environment is categorized separately from “swiftwater,” conditions are often similar. (Swiftwater rescue and medical care is discussed in Chapter 26.) Well-intentioned rescuers can easily become patients if proper planning and training are not in place. The technical discussion section will be divided into “basic” and “advanced” procedures. The decision of a team leader to utilize the different levels of techniques must be made based on the team’s physical capabilities, resources, and local conditions, and not on the level of medical experience or certification. While rapid delivery of high-quality medical care is paramount to decreasing morbidity and mortality in drowning patients, it cannot take place without, first, the rescuer and patient being brought safely to shore.

Scope of Discussion

While the rescue of persons drowning in open water is pertinent to any medical responder in the wilderness setting, the actual practice of technical rescues in these environments should be restricted to those with formal training. This chapter will provide both basic principles for the lay rescuer and advanced techniques for the professional rescuer. To date, there is very little evidence describing the effectiveness of different open water rescue procedures. Rather, the equipment and techniques used in different areas are based on geography, tradition, training and certification, and financial resources.

While the term “open water” can technically refer to any part of a large body of water, including the middle of the ocean, the techniques and procedures discussed in this chapter will pertain to those used in the rescue of patients who are primarily within a recreational distance from the shore. These are patients who either swam out in the water, were pulled away from the shore by a current, or are otherwise at a distance visible from the shore, and that is achievable by a rescuer from the shore, either by swimming or by a small craft. The discussion of rescues made farther out in large bodies of water is beyond the scope of this chapter, as it often involves law enforcement, fire departments, or military participation.


Drowning and submersion injury as a medical phenomenon is discussed in more detail in Chapter 16. As discussed there, data pertaining to drowning, especially non-fatal drowning, are lacking in quantity and quality. Currently, the World Health Organization estimates that around 372,000 people die from drowning annually around the world, although this number does not take into account many important subgroups like suicides, homicides, or natural disasters, and the overall quality of data collection in many countries is very poor. More importantly, the true burden of non-fatal drowning, which can often have more devastating effects on a society, is not currently well understood.

In the United States, the location of drowning deaths varies depending primarily on age. While children less than 1 year of age most commonly fatally drown in bathtubs, and from 1 to 4 years most commonly fatally drown in pools, after 4 years of age, open water quickly becomes the most common location. This remains true throughout the rest of a life span, with some countries displaying a higher risk of bathtub death once a person reaches elderly age. In an open water environment, the subject age range a provider is most likely to perform a rescue on is 15 to 29 years. In terms of mortality, from 1999 to 2010, the Centers for Disease Control and Prevention reported a total of 20,912 drowning deaths for ages 0 to 29 years, 8,885 (42%) of which occurred in open water or while boating.1

Care Environment

The discussion of open water rescue is separate from that of swiftwater rescue. While open water refers to large bodies of water which may often be fairly stagnant, these environments can vary greatly depending on geography and weather activity. A specific phenomenon of open water environments which leads to a significant number of drownings is a rip current. Rip currents commonly occur when water on the shore preferentially flows back to a large body of water through an area of lower ground, causing a stream of deeper, faster water which may pull bathers away from the shore. These can also occur along fixed structures like rock jetties or piers. In this instance, the rescue environment may mimic a swiftwater environment, although these currents quickly abate once they reach deeper water. Open water environments can also vary greatly based on the surrounding geography. For instance, a rescue launched from a sandy beach will likely require less resources than one that requires a descent down a cliff face to reach the water. For this reason, many open water rescue teams located near steep terrain have either formal training in technical rescue or interagency agreements with another agency with the training and equipment to carry out such rescues. High and low angle rescue is discussed in more detail in Chapter 25.

Environmental Teams

The members of a team performing open water rescues will vary greatly depending on location, the structure of the responding agency, and training. This is a high-risk environment in which untrained, well-intentioned rescuers are all too often injured or killed during attempts to save drowning patients.2 For this reason, any team faced with the possibility of performing open water rescues must have members who are specifically trained in the use of rescue equipment and who possess the physical capabilities to carry out rescues in this environment. In the United States, most open water rescue operations within swimming distance from the shore are performed by open water lifeguards employed by local lifeguard agencies. Currently, all open water lifeguards who work for agencies certified by the United States Lifesaving Association (USLA) must be able to swim 500 m in 10 minutes or less.3 It is important to understand that this is a minimum standard, and does not take into account the ability to perform in rough water or handle specific rescue equipment. Any team member who will be charged with carrying out open water rescues should, at a minimum, meet this swimming requirement, and be tested in the use of any relevant equipment in both calm and rough environments.


The techniques used to perform a rescue in an open water environment are dependent on rescuer training and experience, the number of patients, and the condition of the environment at the time of rescue. An unfortunately high number of rescuer deaths are reported in the literature resulting from well-intentioned bystanders attempting rescues without the proper training or equipment.2 For this reason, the use of any techniques or equipment discussed in the following sections must be preceded by repeated training and practice in varying conditions.

Technical Discussion

This section will discuss possible techniques and equipment to be used in the event of an open water rescue. These will be divided into “basic” and “advanced” procedures. The basic procedures are meant for lay rescuers or minimally trained rescuers, and are focused on noncontact rescue techniques to ensure rescuer safety. The advanced procedures utilize equipment and techniques which require proper training and experience to master.

Oct 16, 2018 | Posted by in EMERGENCY MEDICINE | Comments Off on Technical Rescue Interface: Open Water Rescue
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