Support oxygenation and ventilation, assess associated trauma, and use CPAP only in the appropriate conscious patient.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
CPAP requires its own inclusion/exclusion criteria and ongoing reassessment.
Children have a separate drowning order and destination rule.
First assessment
Use spinal motion restriction for a diving or shore-break accident. Assess consciousness, airway patency, breathing, perfusion, and oxygen saturation.
For SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula at 6 L/min as tolerated. Treat arrest using the adult arrest pathway.
Ventilation and wheeze
Monitor and document rhythm. For bradycardia, clear the airway and assist ventilation with BVM and high-flow oxygen.
For wheezing, albuterol is 5 mg in 6 mL by continuous nebulization as tolerated. Reassess effort and air movement; inadequate ventilation needs ventilatory support.
Persistent respiratory distress
A conscious patient with persistent distress after suctioning/coughing to clear the airway may receive CPAP under its separate criteria. Guard against vomiting and reassess continuously.
If unconscious or unable to protect the airway, follow the advanced-airway pathway and confirm placement. Do not use the conscious-patient CPAP step in someone who cannot protect the airway.
Transport
Provide ALS escort to the nearest appropriate ERC. Contact base for suspected spinal injury, other trauma, or additional direction as needed.
Report mechanism, submersion history if known, respiratory/neurologic findings, oxygen and ventilation support, response, and any vomiting or associated trauma.