Pigeon River Incident
We put on the Pigeon River at approximately 1:40pm on Saturday. Our group consisted of 6 very experienced kayakers, 1 SUP, and an experienced raft with a guide and 3 paddlers. The group included physicians and other CPR certified individuals. The kayakers in our group were surfing at a play spot on river left about ¾ of a mile downstream from the put-in when a swimmer floated by. His chin was barely out of the water and he was not calling out or struggling, just floating. He was still holding onto his paddle, floating on his back, and was making eye contact. His PFD was loose fitting and barely holding him up, pulling under his armpits. One of the kayakers quickly paddled over to him and offered the swimmer the tail of his boat. The swimmer was able to roll onto his stomach and grab a hold of the tail of the kayak and was pulled towards shore.
Once on shore, the swimmer did not make an attempt to pull himself out of the water. However, he did roll himself to a sitting position at water level, still holding onto his paddle. Our group got out of our boats and helped get him further out of the water. He was moving all four extremities but not able to climb up the shore independently, so we kept him seated at the river’s edge. He grumbled with response to questions and appeared to be breathing normally.
At this point, the swimmers boating partner paddled up and told us that the swimmer had swam at the very first rapid, about ¾ of a mile upstream. He had reportedly been vigorously swimming so his partner thought he was capable of getting to shore himself and went after his kayak. The swimmer’s breathing was now notably becoming more labored. We checked his pulse and it was strong but rapid. His pupils were equal and reactive and he had no obvious external signs of trauma. We removed his helmet and PFD, and cut off his spray skirt. His fingers were turning blue, indicating that he was going into shock, so we pulled him the rest of the way out of the water and elevated his feet. We asked one of our group members who had a cell phone, to call 911 for help.
The swimmer was starting to have more labored and agonal respirations. We lay him on his back and gave 2 rescue breaths. There was a lot of resistance, indicating water in his lungs. He still had a pulse though now thready. We turned him on his side to prevent aspiration and continued to give him rescue breaths, intermixed with back blows and chest thrusts in an attempt to get him to clear his airway. This was unsuccessful and he lost a pulse.
We placed him flat on a stand up paddle board and started chest compressions at a ratio of 30 compressions to 2 breaths. Due to the difficult terrain, we placed kayaks under the foot of the board to try to keep it as level as possible. CPR was continued for multiple rounds. We rotated rescuers frequently, including a raft guide, an RN from another group, and another private kayaker, in an attempt to avoid fatigue and maintain good quality CPR. After approximately 15 minutes of CPR, EMS finally arrived. It had been about 20 minutes since the swimmer was first helped ashore. The swimmer’s chest was dried and an AED was applied while CPR continued. The rhythm was non-shockable. The AED was left in place for 3 more rounds while the swimmer was transferred to a backboard and straps were applied. The swimmer remained in a non-shockable rhythm. A rope was attached to the top of the backboard and using a team system of multiple raft guides from a nearby bus, the patient was quickly pulled up the hill to the ambulance.
Once in the ambulance, CPR was continued while IO (intra-osseous) access was obtained and epinephrine was given. The swimmer was then intubated and transferred to the nearest hospital where he was pronounced dead.
Once EMS left with the swimmer, we learned more about him and the factors leading up to the day’s events.
Pushing personal limits with small group (2)
Ill-fitting/inappropriate, possibly “ski boat style” PFD
Poor general fitness level; overweight; smoker
Swam by at least 1 group that did not think he was in need of assistance