Summer is upon is, and with it comes the season for lots of fun in and around the water. Unfortunately, water can also be deadly, especially for children and college-age males during the summer. With our discussion of the prevention, rescue, and treatment of drowning, we must all speak the same language.
Check out the recently updated drowning overview from the WHO.
There have been many media reports circulating about the dangers of "dry drowning" and "secondary drowning." These reports went viral after the "Delighted Momma" blog posted her terrifying experience. Unfortunately, there are many physicians that use the wrong terminology and perpetuate these reports. Although the Delighted Momma's experience was terrifying and fortunately had a positive outcome, discussing the case in terms of the correct terminology can actually contribute to an increased awareness and better understanding of the drowning process. Drowning is the PROCESS of respiratory impairment from submersion in water. The drowning PROCESS can only have three outcomes: 1) death, 2) survival with brain damage, or 3) survival without brain damage. Many people and media outlets use the incorrect term "near drowning" to describe a person who survives the initial drowning event.
Every year, hundreds of people are rescued who have drowned. Because they were rescued within a few minutes of drowning and receive appropriate CPR or medical treatment, most of them survive without brain damage. For every one person that drowns in the U.S., an additional four are taken to emergency departments, many of whom are sent home the same day. For those that survive with brain damage, the correct terminology is "non-fatal drowning." Older definitions that artificially say 24 hours is a "near" drowning do a disservice to the families that struggle for years taking care of their loved ones who have survived with mild-to-severe brain damage.
The fear of "delayed" or "dry" or "secondary" drowning is that a person who has drowned and is rescued gets worse up to 72 hours later. This is false. In the case of the son of the Delighted Momma, Ronin, he drowned. He experienced respiratory impairment as a result of submersion in the water, even though it was brief. Persons who have drowned should be taken to a physician for evaluation even if they are awake, talking, and have only minor breathing difficulty. The care provided by his mother was 100 percent correct.
Studies have shown that people who have drowned and have minimal symptoms will either get better or worse within 2-3 hours. Many of these people are observed in an emergency department for 4-6 hours to allow for an adequate safety margin, and then sent home. In the case of Ronin, he continued to have worsening respiratory difficulty, and required admission to the hospital and additional support before being sent home without any long term damage. From a Brazilian study of over 41,000 lifeguard rescues, we know that 0.5-5 percent of minimally symptomatic patients wound up dying. This emphasizes Delighted Momma's message that if your child has symptoms after being pulled out of the water (drowning), they need to seek medical attention. Though this sounds like semantics, understanding drowning as a process and not an outcome allows us to focus the conversation and all speak the same language.
Water safety requires multiple layers of protection. As a parent, there are several things that you can do to ensure the safety of your child around the water. Swim lessons, Coast Guard-approved life jackets, direct, uninterrupted supervision of children (arm's length if under five years old),assigning a Water Watcher or hiring certified lifeguard for parties, pool alarms, and appropriate fences to restrict access are just a few of the simple things that you can do to keep your kids safe around the water. For those traveling in the backcountry, swift water awareness, knowing upstream weather patterns, assigning trained lifeguards on guided trips, are just a few of the ways to increase your safety margins.
Whether in the city or in the backcountry, if there is a drowning incident where a person has experienced respiratory impairment as a result of being underwater, they should be evaluated immediately by a physician.
All photographs are from the Lifeguards Without Borders' recent trip to Nicaragua.