Residual neuromuscular blockade and upper airway muscles.

We appreciate the opportunity to review and respond to the letter to the editor by Culp, Brewster, and Wernicki, in response to our review article. We thank the authors for their complimentary remarks. We are also pleased that they chose to respond and emphasize the need for prevention and rescue of drowning persons to further improve the survival rate from this disaster. They make the point that it is far more efficient and effective to prevent or interrupt the drowning process than to treat it after it renders the patient unconscious or even lifeless. We agree fully. Unfortunately, not all swimming pools have lifeguards in attendance. Further, although we believe that most lifeguards are superb in fulfilling their responsibilities, not all lifeguards are fully trained in lifesaving technique and basic cardiopulmonary resuscitation. In our experience, we have reviewed cases where some lifeguards did not give their undivided attention to their lifeguarding duties, whereas others were very lax in fulfilling their responsibilities. Still others tolerate pools with inadequate maintenance to where the pools themselves presented a hazard to swimmers. We endorse the authors concluding paragraph “Drowning is a global problem that can be dramatically reduced by teaching people how to swim, by encouraging swimming in lifeguarded areas, and by improving field resuscitation techniques. Promoting attention to the entire continuum of the drowning prevention spectrum will result in the best possible outcome.” We would add, however, that lifeguards should receive proper, extensive formal training, leading to certification as a lifesaver and in basic cardiopulmonary resuscitation. Further, lifeguards should remain conscientious and vigilant in carrying out their duties and in providing continuous attention to their responsibilities at all times.