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The inside surface of our lungs are made up of tiny sacs. Each sac is about as wide as 4 human hairs. The walls of these sacs is where one of the wonders of life takes place. We breath in and the oxygen crosses over from our lungs into the blood stream. Then waste carbon dioxide crosses back over the other way, from the bloodstream into the lungs and we breath out. These little sacs inflate and deflate as we breath.

Our lungs also have a light fluid that prevents them from drying out. The problem is that the weight of the fluid, the fragile nature of the sacs and us breathing means that, ordinarily, the sacs would collapse.

Fortunately, our body has another trick up its sleeve; surfactant.

We use surfactants every day in our washing machine. Surfactant reduces the surface tension of the water and clothes release their dirt and grime. If you’ve ever watched the washing machine, you’ll know that the other property of a surfactant is that it makes water foam when agitated.

So if a drowning person breathes in a small amount of water then it mixes with the surfactant in their lungs. Then, if you now lay them down and start pressing on their chest, and blowing air down their lungs guess what happens… foam! Sometimes lots of it, and it just keeps on coming. If you’ve got a strong stomach head to the foam section of the Lifeguards Love YouTube website. There you’ll see real foam in real people who have drowned. Be aware, some of these videos may show people who did not survive or who survived with significant injuries.

Drowning is an oxygen emergency. The person’s brain is dying because they have dangerously low levels of oxygen in their blood. You can reverse the process by getting oxygen into the lungs and pumping it around the body. Good quality cpr does this. Even better if you can introduce an oxygen resuscitator and a skilled set of hands.

So what do we do about foam? Instinctively we’d be inclined to roll them and try and clear the airway. In fact, that’s exactly what we used to do. Unfortunately, it doesn’t provide the best chance of survival for the casualty. Anything that interrupts cpr, interrupts the reversal of the oxygen emergency. Foam is a lung product, send it back where it came from.

The Australian and New Zealand Resuscitation Councils supports this. Their guideline (Mar 2014) for the Resuscitation of the Drowning Victim says that if after removing the person from the water and determining that they are unconscious, inspect the airway. If anything, including water, is seen then roll the person and let gravity do its stuff.

It then states;

“Do not attempt to expel or drain clear water or frothy fluid that may re-accumulate in the upper airway during resuscitation.”

Send it back down. Doctors will tell you “I can fix damaged lungs… I can’t fix a damaged brain. Bring me a viable brain”.

Vomit is another matter. Vomit is the chunky stuff that comes from the stomach. It can block an airway and you need to roll them and clear the airway if this occurs.

Vomit becomes more prevalent as pressure increases in the stomach. Check your head tilt, check your chin lift, reduce the amount of air you apply so that you only get chest inflation. Blow too much and the excess air has to go somewhere. If the stomach is swelling (distension) don’t press on the stomach in an attempt to alleviate the symptom. If the person lives, it’ll pass tomorrow, probably in a noisier fashion than it went in.

Foam and vomit are not nice. They’re bodily fluids, they smell, they’re slippery they make performing cpr more difficult. As a professional lifeguard, you need your pocket mask and your gloves.

For the drowned casualty oxygen is the key ,and interruptions to cpr should be minimised. Lifeguards should be prepared for foam and ignore it.