PILLOLE DI PRIMO SOCCORSO/10 – L’ANNEGAMENTO.
Finalmente estate, o almeno lo speriamo, e finalmente la spiaggia, il sole e il mare, ovvero l’acqua, questo elemento a cui siamo indissolubilmente legati. L’acqua è un ambiente da sempre legato all’uomo, in primis perché è fonte di vita. Ma l’acqua è anche legata ad avvenimenti fatali, sia per tragici eventi di carattere naturale, sia per nostra disattenzione o per un approccio sbagliato, irrispettoso. Ed è proprio su questo punto, vista la stagione che ci approcciamo a vivere, che vorremmo fare un po’ di chiarezza. L’approccio sbagliato, il poco rispetto per l’elemento acqua ci porta a subire un solo tragico evento importante: l’annegamento. L’annegamento può essere raggruppato in tre tipi di cause: malore in acqua, inabilità al nuoto e difficoltà a ritornare. Il malore in acqua prescinde come causa all’elemento liquido, quindi né dalla capacità al nuoto né dalla profondità. Infatti, alcuni malori possono manifestarsi anche senza gravi episodi a secco; e gli stessi possono aggravarsi o potrebbero essere fatali nell’elemento acqua. Eventi come sincopi (perdita improvvisa e temporanea di coscienza di breve durata e recupero completo e spontaneo), eventi traumatici che impediscono movimenti, cause degli effetti di alcol e/o droghe, non sono malori di per sé che mettono in pericolo di vita l’infortunato. Ma, se un evento del genere accade in acqua, questo può causare anche la morte poiché le vie respiratorie, bocca e naso, potrebbero essere immerse facendo mancare l’apporto di aria, e quindi di ossigeno, al nostro sistema respiratorio. Va da sé che anche altri malori potrebbero essere causa di tragici eventi, come ad esempio un arresto cardiorespiratorio che già per esso potrebbe essere un evento mortale. Abbiamo invece, inabilità al nuoto quando il soggetto è incapace di galleggiare e finisce per qualche motivo in acqua fonda. In questi casi, soprattutto se si tratta di bambini, l’annegamento è silenzioso. La vittima non è in grado di segnalare il pericolo, ma annaspa sull’acqua e le vie aeree non emergono per un tempo adeguato per poter tossire, inspirare e/o usare anche la voce per richiamare l’attenzione. L’atto di “sbracciare” è solo un mito, legato a cinema e racconti. Un soggetto che non sa nuotare non è in grado di spostarsi orizzontalmente in acqua e pertanto è capace di annegare anche a pochi metri di distanza da una zona di acqua bassa o dal bordo vasca. Per cui potrebbe essere fatale una caduta accidentale in acqua da barca o bordo vasca o argine; una rottura del supporto galleggiante (braccioli, materassino) o un naufragio; che un bagnante nuotando a cagnolino finisce dove non tocca; ad un bimbo piccolo che inciampa nella piscinetta gonfiabile. La prevenzione in questi casi si svolge educando la popolazione all’importanza della scuola-nuoto, che in primis deve essere vista come “un luogo dove acquisire un’abilità motoria essenziale all’autoprotezione dell’individuo” e soltanto in un secondo momento come attività o impegno sportivo. L’intervento di salvataggio in acqua in questi casi è quasi sempre semplice. La difficoltà non è soccorrere un pericolante in acqua piatta, ma rendersi conto in tempo della persona che sta annegando. Nel ritorno impedito il soggetto è capace di nuotare, però non riesce ad uscire dall’acqua per una motivazione esterna che glielo impedisce. In questi casi è evidente la situazione di pericolo, tuttavia, anche qualora fossero presenti astanti o soccorritori, l’intervento tecnico potrebbe essere complesso. Sui nostri litorali il ritorno impedito è spesso causa di eventi nefasti. La conformazione della costa crea alternanza di acqua bassa e canaloni profondi di ritorno che bisogna saper riconoscere. Questi ultimi provocano onde e correnti verso il largo che impediscono il rientro. La prevenzione si effettua educando la cittadinanza, anche attraverso programmi scolastici, su quelli che sono i rischi legati agli ambienti acquatici e sulle norme per una balneazione corretta e sicura. Inoltre, è importante che gli addetti al salvamento compiano un’efficace attività di sorveglianza e che i bagnanti seguano le loro indicazioni. L’intervento di soccorso deve essere precoce poiché il paziente necessita quanto prima del supporto vitale di base-BLS. Quest’ultimo, in caso di annegamento, differenzia leggermente dal protocollo BLS standard. Infatti, in caso di arresto cardiorespiratorio le manovre di rianimazione cominciano con cinque insufflazioni, a differenza del protocollo standard che prevede l’inizio delle manovre con le compressioni toraciche esterne. Rispetto ai tempi, e quindi alla gravità, con cui viene soccorsa la vittima generalmente vengono effettuate due distinzioni: il pre-annegamento, atto iniziale del processo in cui il soggetto comincia ad inalare o ingoiare il liquido, condizione che potrebbe in ogni caso già portare a diverse e gravi lesioni che possono perdurare; l’annegamento, vero e proprio, che concerne una catena di passaggi fisiopatologici, che non è detto che porti al decesso. In tutti e due i casi l’infortunato necessita di ricovero ospedaliero per controlli mirati e approfonditi. Come sempre, il salvataggio e il Primo Soccorso non si improvvisano. È molto importante non effettuare interventi che potrebbero aggravare la propria condizione e quella dell’infortunato. E comunque prima di intervenire, se soli, effettuare sempre la chiamata di soccorso. Intanto, come sempre, Vi invito a frequentare i nostri Corsi di Primo Soccorso e Manovre Salvavita e Corsi Rescue in acqua per imparare le tecniche e le procedure corrette. Alla prossima. Un ringraziamento al lifeguard trainer Davide Gaeta per il prezioso contributo a questo articolo.
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