By David McEvoy, Aerie Backcountry Medicine

Montana has one of the highest per-capita drowning
rates in the country. Considering we’re landlocked,
that’s sobering.

We’re one of 10 states where drowning is the most
common cause of death for people under 14. Not all of
these occur in our rivers (many happen at home), but a
number do.

This spring, we’ll read about too many people drowning
in Montana’s rivers and streams. Many of these
deaths are preventable—not in the sense of avoiding
water, but preventable because many of the events
leading to these deaths are predictable and therefore
avoidable.

Please enjoy spring on our beautiful rivers and streams.
Just do it with some caution, preparation and respect
for the power of cold, moving water. Like most things
in medicine, prevention of drowning is far more effective
than its treatment.

Here are a few basic ideas that might keep us safer this
year:

Cold water is debilitating.

The water in many of Montana’s rivers is above 70
degrees F for less than a month. Quite a few never
even reach that temperature. Seventy is the somewhat
arbitrary threshold below which many experts define
“cold water.” Immersed in this water, muscles and
brains do not function well over time. We may not
have the strength to get through a difficult rapid or
the judgment to avoid it altogether. Plan your day on
the water with adequate clothing and food in mind to
maintain your body temperature.

In addition, sudden immersion in very cold water—
like falling out of a boat or jumping in a river to rescue
a drowning person—causes unavoidable, reflexive
gasping and intense hyperventilation. If your head
is underwater when this happens, the result is often
rapid unconsciousness and death from lack of oxygen.

Moving water is relentless.

It’s difficult to appreciate the power of even slow-moving
water until it pins you against a root or log. Often
at this point, to borrow a phrase, resistance is futile.
Planning routes through the water that avoid obstructions,
particularly at high water, is critical.

Life jackets and helmets save lives.

It’s difficult to drown if your head doesn’t go underwater.
Life jackets need to fit and stay on in strong
currents; they don’t do you any good
under your seat or at home. Helmets
keep you conscious if you hit your
head, enabling you to think about
protecting yourself from further
harm.

Even capable swimmers drown.

Cold, moving water levels the playing
field. Swimming in a relatively
warm pool with no current is entirely
different than swimming for your life
in a moving, cold river.

Alcohol kills.

Many drowning victims are intoxicated.
It’s really no different than drinking
and driving. The idea of floating
the river with friends and a six-pack
appeals to many of us. However,
we need to add to that image to the
possibility of an emergency—which
with cold, moving water can happen
at any moment—when you need all
of your judgment and skill.

Drowning victims panic.

Few things are more terrifying
than being unable to breathe while
struggling against an unrelenting
force. Unsuspecting rescuers, even
close friends, will be used as a means
of escape, meaning the drowning
person will unceremoniously drag
them underwater. For this reason,
it’s far better to reach for the person from shore, throw
something to them, or row to them from a boat. In
some years, more rescuers drown than initial drowning
victims.

Drowning victims often hit their heads, injure their
spines, and vomit. Depending on how they entered
the water, drowning victims often have incapacitating
head and spinal injuries. If you’re pulling somebody
out of the water safely, do it efficiently but with as
little excess movement as possible. This is much easier
said than done and requires forethought, teamwork
and practice.

If they do vomit, turn them on their side and get the
food and water out of their mouths. There is little you
can do to get the water out of their lungs. Your job is to
keep the air heading in that direction without obstructions.

If they aren’t breathing, CPR is necessary. Realize,
however, that a drowning victim requiring CPR rarely
survives. We tend to have a false sense of the efficacy
of CPR in an outdoor setting, away from more advanced
care. While you should work to get the person
to a hospital quickly while providing the best CPR
possible, this is often futile.

David McEvoy is a paramedic and the director of Aerie,
a wilderness medicine training organization based in
Missoula. For outstanding swiftwater rescue classes in
the Bozeman area, he suggests the Whitewater Rescue
Institute.