With Memorial Day weekend and peak drowning season upon us, there is no better time than the present to debunk some myths about how we drown.
And, it isn’t how you would think.
An average of 3,536 fatal unintentional (non-boating) drownings occur each year in the United States inflicting anguish that could, in many cases, be prevented. Add on to this the 332 who succumb annually to boating-related incidents. Since over half of drowning victims get admitted to the hospital or transferred for comprehensive care, the often long-term devastating consequences of nonfatal drowning events will be elucidated here as well. (1)
Buzzwords abound these days even in the drowning arena. It seems the topic has gotten branded. Terms like “silent drowning,” “secondary drowning” or “dry drowning” may complicate the picture. The important word to emphasize is “drowning.” The concept of greatest import is the realization that precautions and awareness should dominate when any body of water is in close proximity albeit a frozen lake, the bathtub or residential pool.
Drowning can impact all ages, ethnicities, genders and health status. Those sick or well can be affected. Due to the tremendous variability of water safety, activities, environments (e.g. pool or open water) and conditions (e.g. inclement weather, currents, salt vs fresh water), even an excellent swimmer shouldn’t have a false sense of immunity from the subject. That said, knowing how to swim is a crucial benefit and important whether adult or child. As is knowledge of CPR (cardiopulmonary resuscitation) and its rapid initiation—the earlier it is received the better one’s chances.
Here are some U.S. statistics on drowning (2,3):
- Roughly 1 in 5 people who die from drowning are children 14 or younger— 2nd leading cause of unintentional injury-related death in ages 1-14 behind motor vehicle accidents
- Almost 80% of people who die are male
- Highest rate in children ages 1-4. Top cause of death in this population behind congenital anomalies— most take place in residential swimming pools, for infants <1 bathtubs rank highest and buckets remain a hazard
- 5th leading cause of death by unintentional injury for ALL ages
- African-American children (ages 5-19) are 5.5 times more likely to drown in pools than peers (4)
Primary and secondary causes of drowning put people at risk. For instance, a primary drowning incident would entail drowning of a healthy toddler in a pool. A secondary culprit would be one prompted by the effects of trauma, substance abuse or drug use, a disease or its treatment.
Illnesses or the like that impair the physical mobility, consciousness, or mentation of a person like an undiagnosed cardiac arrhythmia or intractable seizures require special restrictions and surveillance. Clearly, those with specific medical conditions and on therapies that can impede their cognition or level of consciousness are imperiled. Anyone at risk of fainting (See Why We Faint), seizing or prone to low blood sugars (hypoglycemia) are in jeopardy. Suicide or self-harm can be another etiology.
Throughout the span of the life cycle, there are occupational, situational, and recreational differences that contribute to your risk. In early infancy and childhood, a momentary lapse of adult supervision is all that is required while mopping the floor to answering a phone call when bathing a little one. As we age, there is a rise in drownings in natural waters. Adolescents might partake in riskier endeavors like diving under dangerous conditions with shallow water, while intoxicated or via extreme water sports. Adults and the elderly can have heart attacks and key medical conditions, abuse substances and can also sustain head or other traumas.
Work-related risks are tied to certain professions while hurricanes represent one of many of nature’s unpredictable hazards.
How We Drown
Hollywood routinely depicts a drowning victim as a person shouting for help, flailing and thrashing about in the water. When someone can shout and speak, this actually implies they are getting the oxygen they need. By no means should you ignore this person as they are in apparent distress—they might be injured, be panicking and not know how to swim or be at risk of imminent drowning.
More often, in the actual drowning person silence is the deafening factor. It happens quickly, quietly and without warning. As the person is gasping for every breath and concentrating on getting air, they will typically not speak, fatigue and be in a vertical position with their head bobbing in and out of water. Their effort to swim falls short and traditionally keeps them stationary. The mouth is usually open and the head tilted back as they attempt to leverage the water beneath by extending their arms outward and pushing downward.
By the time it is noticed, the individual can be unconscious from hypoxia and submerged. Depending on body size, age, clinical and environmental factors, the rate of drowning can be quite quick between seconds to under a minute. (See this instructional video (5))
When Do We Drown
Though it is prevalent this season (May to August), the issue is a year-round one that warrants diligence to avoid. For example, in the cold weather adverse events arise from playing or landing on frozen bodies of water that make you vulnerable to falling through cracks and weakened areas. Hypothermia can threaten survival and occurs even in more moderate weather that exists the majority of the year. This consequence is not exclusive to winter. In general, drowning is an indoor and outdoor concern. We worsen our chances of survival when we do not know how to swim. Due to size, younger children need even less volume of exposure to demonstrate symptoms of drowning.
What Happens When We Survive Drowning or Submersion
With near drowning or submersion comes morbidity or no morbidity. Ideally, the patient is discovered before loss of consciousness while alert and minimally impaired. This is your best shot at no morbidity from the event. If CPR needs to be initiated, the outcomes are worse. With greater delay in CPR often comes a more ominous result. In severe cases, brain damage, learning and memory problems and a persistent vegetative state is possible.
It is very important for you or your child to be evaluated by a trained medical professional and emergency services after a near drowning or submersion incident. Symptoms can evolve, progress and pose great risk hours after the inciting event. You may think your child appears well, but there can be a lag before untoward effects come to light and when they do the decline can be fast.
Multi-organ failure, chemical aspiration, pulmonary edema, acute respiratory distress, metabolic disturbances, and hypoxic injury to the brain are a mere few examples of serious health consequences. Remember, there are many variables in the mix that guide the extent of damage.
Though there is much we can do today with medical advances, avoidance of drowning is in yours and your loved one’s best interest.
Take Home Messages
- Exercise good judgement and be proactive—e.g. know yours and your child’s limitations, alcohol and illicit substances add danger to water activities, avoid diving into the shallow end or where there are many rocks, don’t leave a child unattended around any body of water, wear life jackets when boating, boat safely
- Be a responsible pool owner—e.g. have essential barriers around pool. Pool safely, see here.
- Take swim lessons and learn CPR— early bystander CPR makes a world of difference! Make prevention a family affair— it is never too late to learn to swim.
- Be partners with lifeguards—keep your eyes on your child at all times and don’t swim alone
- Seek emergency medical services when an incident arises, as time is of the essence. Submersion injuries can evolve and worsen, so don’t miss the window where help can be crucial in improving an outcome. A medical professional can discern the difference.
- Be aware of your surroundings and the signs of a person in trouble
- Encourage close observation of children
- With some simple steps to ensure summer and water safety, you will enjoy the holidays and season creating a lifetime of wonderful memories! (see Notes section, 6)
(1) (2) The Centers for Disease Control and Prevention (CDC)— Unintentional Drowning: Get the Facts, see here.
(4) To review the CDC morbidity and mortality report, see “Racial/Ethnic Disparities in Fatal Unintentional Drowning Among Persons Aged Less Than or Equal to 29 Years—United States, 1999-2010."
(5) I urge you to look at posted videos of active drowning on youtube as there are many. They underscore that people can be swimming close by and be unaware of the struggle taking place within arm’s length. Knowing what to look for is crucial to early identification of drowning. This is the difference between life and death and a life without disabilities as a result of delayed intervention. Always be aware of what is going on around you.