Prioritize ventilation, reassess for deterioration, and obtain the required pediatric destination direction.
OCEMS source summary · Updated 2026-09-16
Key cautions & base contact
Use the pediatric destination rule and obtain base direction.
Do not apply the adult drowning CPAP step automatically to a child.
Initial care
Confirm the airway is clear and patent. Use spinal motion restriction for a diving or ocean shore-break mechanism.
For room-air SpO₂ below 95%, provide high-flow mask oxygen or nasal cannula/direct blow-by at 6 L/min as tolerated. Assess ventilatory effort, mental status, perfusion, and temperature.
Respiratory or cardiac compromise
Treat cardiopulmonary arrest using SO-P-040. Monitor and document the rhythm.
For bradycardia, assist ventilation with high-flow oxygen by BVM. Do not let a monitor task delay ventilation.
Wheezing
If wheezing is present and ventilatory effort is adequate, give albuterol 5 mg in 6 mL by continuous nebulization as tolerated.
Stop nebulization if the child continually coughs or resists treatment. Reassess air movement and effort; nebulization does not replace assisted ventilation.
Contact and transport
Base contact is required, with a pediatric-capable base preferred. SO-P-100 directs base designation to CHOC, or the nearest appropriate ERC when CHOC transport time exceeds 20 minutes.
Provide ALS escort. Report the event/mechanism, submersion history if known, airway and ventilation support, response to treatment, and any associated trauma.