Water Safety - Summer Is Coming part 1


Robert Barnwell, MD 

Summer is fast approaching here in Central and South Texas and with it come extreme temperatures. Every year the blazing Texas heat prompts droves of people to flock to nearby waterways, hoping to enjoy a lazy float down the river under the shady Live Oaks. But while floating the river is a great way to beat the Texas heat, there are several notable dangers that all whom partake should be aware of. This will be a four-part series describing some of these dangers, how to prevent them and what to do if they should occur.


Drowning is the result of submersion in water and tends to result in death by water gaining passage into the lungs. The amount of water inhaled and the length of time one goes without oxygen are the most important factors when determining the severity of injury from drowning. If the amount of water inhaled is great enough, it can lead to a lack of oxygen and a loss of consciousness that can lead to significant brain damage and eventually death. 

The best way to avoid tragic injury while enjoying the river this season is to understand the risks and take care to avoid them.

Secondary drowning is a rare phenomenon, and the result of a delayed reaction to a near drowning event. If one inhales even a small amount of water, it can result in significant irritation and swelling of the lungs and limit the ability of the lungs to pass oxygen to the bloodstream. Symptoms of secondary drowning may begin within an hour and up to 72 hours after the event and may include shortness of breath, chest pain, extreme exhaustion, ongoing cough and fevers. If someone you know has experienced a near drowning and is exhibiting these symptoms, they should be evaluated by a medical professional immediately.

Per the CDC (Center of Disease Control), drowning ranks 5th among the leading causes of unintentional injury death in the United States. Among the top risk factors for drowning are being of male gender (80% of drowning victims are male), lack of swimming ability, not wearing a life jacket, and alcohol/substance abuse. Since many float the river do so on some type of floatation device (raft, inner tube), those who cannot swim may get the false sense that they are safe and do not require a life jacket. But the truth is that if a person is separated from their flotation device for any reason and does not have the ability to swim back to it, they are at risk for drowning.  While we recommend that all who float the river wear a personal life vest, it is especially crucial for non/poor swimmers.

Alcohol is involved in roughly 70% of deaths due to drowning and is known to effect decision making and coordination.  When mixed with other drugs (prescription or recreational) these effects are often heightened. To reduce your risk of being a victim of drowning, limiting or avoiding alcohol is highly encouraged.

What should I do if I’ve witnessing someone drowning?

Immediately call 911 for help and remove the victim from the water. In doing so, it is important that you are mindful of your surroundings and any potential dangers that might exist, to avoid becoming a victim yourself. As you move the victim, be sure to control and stabilize their head to avoid potential further injury. While waiting for EMS to arrive, start CPR as soon as possible if indicated (victim is not responding, not breathing, or has no pulse).  Once EMS arrives, allow them to take over all medical interventions. 

Once the patient arrives to the Emergency Department, the Physician and Nurses, will secure the patient’s airway, continue oxygen therapy and begin to treat any associated injuries.  Depending on the length of submersion the treatment course may vary. Those with mild symptoms, requiring few interventions will usually be observed for 4-6 hours and if their condition doesn’t worsen, will be discharged home safely.  If the patient’s injury is more severe, requiring more intervention, they will be transferred to an Intensive care unit for further management.

The best way to avoid tragic injury while enjoying the river this season is to understand the risks and take care to avoid them. If you cannot swim, consider taking lessons (it is an important life skill) and when you are on the river remember to wear your life jacket, avoid alcohol and drugs and watch out for your buddies. And if you want to go the extra mile, consider taking a CPR course (you never know when it could come in handy). 

Please be sure to check back for Part 2: Heat injuries. 


Dr. Barnwell is the current medical director at our San Marcos location.  Prior to joining Premier, He served as chief of Emergency Medicine Service at the Army’s only Level 1 trauma center, San Antonio Military Medical Center.  Dr. Barnwell is board certified in Emergency Medicine and attended medical school at the Uniformed Services University of the Health Sciences.  

Signs and Symptoms of Meningitis

Meningitis is the medical term for inflammation of the tissue (meninges) that surrounds the brain and spinal cord.  Most frequently, this is from a variety of viruses that we can commonly encounter in the community.  Occasionally, the inflammation can come from a bacteria instead of a virus.  The difference between these two types of meningitis is very important in determining the diagnosis, treatment and prevention of the disease.

Should We Be Worried About Measles?

Should We Be Worried About Measles?

Measles is an incredibly contagious viral disease and is spread through the air.  Sharing the same airspace, such as a classroom, airplane, home or clinic waiting room, with a person infectious with measles may be enough to spread the disease to others.  The disease can even be spread to others that enter the area up to 1-2 hours after the infectious person left the area. 

Our 2019 New Year’s Resolution

Every 2 years, the Texas Legislature meets to pass new policies and legislation that affects all Texans.  One of the most important topics this session is healthcare. We want to highly encourage every Texan to be informed of these issues. Below is a snapshot of the issues we believe are among the biggest concern, how Premier is addressing them, and what we believe can be done to remedy these issues for Texas as a whole.

Why Is The Flu Shot So Important?

Why Is The Flu Shot So Important?

Though the flu virus can be detected all year-round, it usually starts in October and peaks between December and February. Every year, 5 to 20 percent of the population across the U.S are affected by the flu virus, presenting most severe repercussions in young children, pregnant women, the elderly, and people who suffer from certain health conditions, like asthma and heart disease.



Joshua Strommen MD, FACEP


Firework Related Injuries


Fireworks maintain a nostalgic part of our hearts. We all have grown old with wonderful memories of 4th of July fireworks alongside all its companion foods and drinks. However, we are also familiar with the dangers of fireworks if not careful. On a yearly basis, the Consumer Product Safety Commission accumulates data on firework-related deaths and injuries. The CPSC (https://www.cpsc.gov/Research--Statistics/Injury-Statistics) does this for many products to include ATV’s, appliances, pools, and nursery products to name just a few.  As of 2016, the most recent report, here are some notable facts on firework injuries:


·       There were 11,100 injuries and 4 deaths nationwide.

·       Ages 20-24 had the highest incidence of injuries.

·       Of the patients who came in - 

  • Hands and fingers were injured the most at 33% of the time
  • Head/face/ears at 20%
  • Eyes at 9% of the time

·       Burns caused 69% of all injuries.

  • Sparklers can burn at temperatures up to 2000 degrees Fahrenheit!

·       Sparklers and reloadable shells are most associated with injuries.

·       Malfunction (tipping over, errant flight path, and short fuses) of the firework was more common as the cause of injury than misuse (improper placement, mischief, or holding in the hand).

·       About 10% of the injuries will end up in hospitalization and/or a surgical procedure.


A few pointers to remember for safety:


·       Never allow young children to ignite fireworks.

·       Sparklers burn at blistering hot temperatures.

·       Never place your body over a firework that is intended to shoot up or out.

·       Never re-light a firework that didn’t ignite fully initially.

·       Keep a bucket of water or a hose handy when you are shooting fireworks.