MountainView Hospital - July 03, 2020

As the weather starts to warm up, swimming is a common activity sought to stay active and keep cool. However, without being careful and knowing the ways to practice safe swimming, any adult or child can fall victim to downing.

“Drowning and near-drowning experiences are serious problems this time of year,” says Dr. Alexa Lewis, Sunrise Health Graduate Medical Education Consortium PGY-3 Emergency Medicine Resident. “Our body’s basic functions and survival mode kick in when there is lack of oxygen, which contributes to how the body responds during a drowning.”

But what are the different types of drownings, and do we really need to worry about them?

Understanding terms about drowning

You may hear doctors or media use the terms such as wet, dry, delayed, and near to describe drowning incidents of patients who have some degree of respiratory difficulty after being in the water, but are still alive. Dr. Lewis helps us understand what the different terms may mean.

  • Wet drowning: Wet drowning, as Dr. Lewis says, occurs when a person is pulled out of the water after the lungs have filled with water and accounts for approximately 90% of drownings.
  • Dry drowning: You may have heard this term used to incorrectly describe a drowning on dry land that occurs sometime after being immersed in water. Dr. Lewis explains dry drowning occurs when a person is pulled out of the water after laryngospasm, which is when vocal cords involuntarily snap shut, sealing off the lungs from air exchange and water. Thus, there is no water in the lungs. Dry Drowning accounts for approximately 10% of drownings.
  • Near drowning: Because drowning is typically associated with death, “near drowning” has been used to describe a drowning incident that the person survived.

The World Health Organization (WHO), International Liaison Committee on Resuscitation (ILCOR), American Heart Association (AHA) and all other major resuscitation bodies define drowning as the process of respiratory impairment after submersion of immersion in liquid, with outcomes ranging from no injury to death. Drowning is a process, not an outcome.

Most importantly, drowning is caused by lack of oxygen, not the amount of water entering the lungs, as is often believed. The medically accurate term for these misnamed cases is “non-fatal drowning.”

“Unfortunately, depending on how long each patient’s brain was starved of oxygen, there can be different long term consequences even if a person has not died,” says Dr. Lewis.

What is non-fatal drowning?

Although there are approximately 4,000 fatal drownings in the United States each year, non-fatal drownings are far more common. It’s estimated that for every fatal drowning, there are at least five non-fatal drownings that require medical care.

“Non-fatal drowning occurs to someone who has had a submersion injury but did not die,” says Dr. Lewis. Drowning is commonly thought to happen when completely under the water (submersion), but drowning can also occur if there is respiratory impairment from water splashing in the face (immersion). Drowning incidents can happen during whitewater rafting, as well as in heavy ocean surf, wave pools or waterslides, where the person takes in water even though their head is above the water.

After someone is rescued from the water, look out for the following symptoms:

  • Coughing
  • Wheezing
  • Lightheadedness

Seek emergency medical care if you begin to notice more severe symptoms like:

  • Irritability
  • Confusion
  • Headache
  • Lethargy
  • Vomiting
  • Respiratory difficulties or unconsciousness

Respiratory or neurologic symptoms will be present as soon as one gets out of the water, and will either get better or worse over the next few hours. If there is concern, it is always appropriate to seek medical attention.

“Regardless of whether a patient has suffered “dry” or “wet” drowning, the same measures are taken once patients arrive in the Emergency Room,” says Dr. Lewis. “Non-fatal drowning is treated similarly in the ED and represents a less severe presentation along a spectrum of severity.”

Water safety tips to avoid drowning

According to the Centers for Disease Control and Prevention (CDC), drowning is the leading cause of accidental death in children age 1 to 4. It’s also the second leading cause of unintentional injury-related death in children age 1 to 14. But it can occur at any age, due to a variety of risk factors.

Some ways to reduce drowning risk include:

  • Supervising your child at all times: Children younger than 5 should be under constant supervision around any amount of water, not just places like bathtubs and pools. Toilets, sinks, buckets, puddles, coolers with melted ice, trash cans and wading pools can all pose a drowning threat. Containers filled with water should be emptied immediately. Young kids should be under “touch supervision,” or within reach at all times. Older kids should be under uninterrupted supervision, meaning adults shouldn’t be reading, napping, looking at their phone, eating or performing any other distracting activities while their child is swimming.
  • Creating barriers: Using secure pool fencing, load-bearing pool covers and locks on pool access points can prevent unsupervised access.
  • Enrolling your child in swimming lessons: Formal swimming lessons have been linked to reduced downing risk in children age 1 to 4.
  • Learning CPR: Parents should enroll in a CPR class and encourage family members, babysitters or anyone else who may supervise their child to do so, as well. Kids age 1 to 4 are at the highest risk for drowning when they’re not being supervised by their primary care provider.
  • Wear a lifejacket: Even if you have strong swimming skills, life jackets can reduce the risk of open-water and boating drownings.
  • Stay alert in open water settings: There is a risk of drowning in lakes, rivers and oceans for both children and adults, often due to inability to predict currents in open water. If waves look too rough or water is moving too quickly, don’t swim. Obey all beach flags, especially when they advise against going into the water.
  • Avoid alcohol when swimming: A cold beer at the beach may sound relaxing, but drinking before swimming, boating or participating in water sports increases the risk of drowning. Adults supervising kids around water should never consume alcohol.
  • Supervise elderly family members in the bathtub: Rates of elderly drownings are rising due to the sedative effects of certain medications. It’s important to supervise elderly family members while they’re in the bathtub or pool. Use similar care with people who have seizure disorders or other medical conditions where loss of consciousness can occur.

Prevention and education are the most important steps you can take in treating drowning. Dr. Lewis advises you remain vigilant and take the proper steps to reduce the risk of drowning and protect you and your loved ones from both fatal and not fatal drowning.

Your healthcare needs, especially any emergency-related symptoms, should not be ignored. If you are experiencing any life-threatening symptoms as mentioned by Dr. Lewis or any other experiences, immediately call 9-1-1 and seek medical attention.