Posted by Rebecca Wear Robinson on July 7, 2014 · 55 Comments
The news has been full of stories of secondary drowning lately. I’ve had a number of parents ask me about secondary drowning, and finally was asked the big question, ‘so what is drowning?’
Today I’m going to talk about what drowning really means, how to recognize if someone is drowning, and I’m going to explain why drowning is one of the most preventable causes of death and injury and what you can do to keep your child safer around water for their entire life. It’s a long article, but probably the most important article I’ve written on the subject, so please stick with me.
There are a number of terms out there for drowning, including: secondary drowning; dry drowning; near drowning. The number of terms is misleading and has even led to confusion amongst medical professionals, but officially* there is only one term that should be used and only one term you need to know – drowning.
Drowning is a process. One outcome of the process of drowning is death, but during the approximately 10 minutes it takes for someone to die from drowning, the brain is being deprived of oxygen and permanent damage can occur. Brain damage starts to occur within 5 minutes of the brain not receiving oxygen.
Contrary to common opinion, the most severe complications or death from drowning are not caused by water filling the lungs. The biggest problem in drowning is oxygen not getting to the brain.
Think of it this way – being under water is the same as being in outer space. If you can’t breathe oxygen, you will die.
The process of drowning is serious and should be taken seriously by parents, lifeguards, and communities. In minor drowning cases, even just small amounts (less than a tablespoon) of water getting into the lungs can cause problems. If someone has had their mouth or nose covered by water, either being under water or just having water forced into the mouth, like on a water slide, and they are now having trouble breathing, they should go to the emergency department. Most of these patients are going to survive and be fine. Many of us have had the experience of “choking” or “gagging” on water that goes down the wrong pipe while drinking something. These protective reflexes are the same as what we see in someone who is drowning.
If the coughing or choking or gagging on water is present more than a couple minutes after your child exits the water, they should be taken to the emergency department. If your child is choking, has foam coming out of their mouth or ANY difficulty breathing up to 3 hours after exiting the water, they should be taken to the emergency department immediately. And remember, when you go to the emergency department, make sure you tell the doctor that your child’s breathing trouble started after they were in or around water, because even a small amount of water can be the trigger for the breathing problem and is an indication of drowning.
IMPORTANT: If a child’s (or adult’s) mouth or nose was covered in water and they are having trouble breathing or are coughing for more than a few minutes, you need to get them to the emergency department immediately, because they are drowning.
There are two primary ways to recognize if someone is drowning.
- The first is continuous coughing, foam at the mouth, or any difficulty breathing if the mouth or nose was covered by water at any point. This sign of drowning occurs when the face is no longer in the water.
- When someone is still in the water, the most immediate way of recognizing they are drowning is that they may look like they are climbing a ladder. Their head is just below the surface, they are vertical in the water, they are probably looking upright and their arms may be moving as if they are climbing a ladder. It is silent. No yelling. If someone is yelling for help, they may be out of their depth and you should call a lifeguard for help, but it’s the silent ones who are in the most trouble and need immediate aid. (see: Parents…Do You Know What Drowning Looks Like?? ) If someone is pulled from the water in this situation, always get them to the emergency department immediately.
What about the children who do not die of drowning immediately?
First the good news – if your child is having trouble breathing and you take them to the emergency department, especially within the first 2-3 hours, one large study shows that only only 20% of those children needed additional hospitalization and the death rate of those children was only 1:200,000. If you act fast and get medical help as soon as possible, there is a good chance your child will recover completely.
Now the scary news – According to the Center for Disease Control (CDC), for every child that dies from drowning, another five need emergency medical care and 50% of those children need additional care. Many suffer some degree of permanent brain damage, like Samuel Morris. Brain damage can occur after only five minutes without oxygen. Again, drowning is very serious, so if your child was in or around water and is having trouble breathing, get them to the emergency department immediately and make sure you tell the hospital staff that the breathing difficulty started after your child was in or around water.
The best news I have is that drowning is almost always preventable. Teaching water safety and swimming can be lifetime vaccines against drowning.
The most important things you can do in the short-term are:
- Learn basic water safety – how to act safely around water and how to recognize dangers;
- Be aware of the dangers;
- Watch your child whenever they are around water, if they are young or not strong swimmers, be in the water with them within arm’s reach, and never leave them alone in the bath. You are your child’s primary lifeguard.;
- Install an approved pool fence
- Empty buckets, decorative ponds and wading pools when they aren’t in use;
- Never rely on inflatable devices to keep your child safe; and
- Learn CPR. Not hands-only CPR to the Staying Alive song, but child CPR, because every child and every drowning victim needs oxygen, and only traditional breathing-and-compression CPR will deliver the necessary oxygen.
To provide your child with lifelong protection from drowning:
- Start teaching your child about water safety from the time they are babies, and don’t stop talking about water safety until they are grown;
- Teach your children to swim from a very early age. The American Red Cross starts infants (and their parents) in parent-and-me classes at 6 months. A number of organizations provide swimming lessons at no or reduced cost, so don’t let economics keep you from protecting your child; and
- Don’t avoid being near water with your child or teach your child to be afraid water. Fear leads to panic, which can lead to poor decisions or walking into danger unknowingly. Knowledge leads to respect and safe actions. Knowledge is power. Empower your child to make the right decisions around water.
Thanks for sticking with me to the end. Now, I have one favor. Please share this information. If you learned even one new thing in this article, share the link on your social media or with your friends and relatives. Ask your local newspaper or TV station to spread the word. Drowning is greatly misunderstood and is still a hidden global epidemic, but if we all work together to spread accurate information, we can make all of our children safer. It takes a village.
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* Since 2005, it was agreed upon by all major agencies, including the World Health Organization, American Red Cross, American Heart Association and the American Academy of Pediatrics, that there is only one term that should be used, drowning. Again, drowning is a process. One possible outcome of drowning is ‘fatal drowning’ or death, which can happen in as little as 10 minutes. Another possible outcome of drowning is referred to as ‘non-fatal drowning’, and can encompass the full range of injury from mild and temporary complications to severe and permanent brain damage. This brain damage can begin in as little as 5 minutes. The last possible outcome from the process of drowning is, unofficially, ‘no lasting damage’, which is the best possible outcome and more likely if you know the signs and take basic precautions.
Many thanks to:
- Dr. Justin Sempsrott who provided invaluable expertise and assistance for today’s article. Dr. Sempsrott is the Executive Director of Lifeguards Without Borders, Medical Director of Starfish Aquatics Institute, and is a Clinical Instructor in Emergency Medicine at Wake Forest University.
- Dr. Linda Quan, Seattle Children’s Hospital for reviewing and validating the facts included in this article. Dr. Quan is a Member of Aquatics Subcouncil and Vice-Chair of Scientific Advisory Council of the American Red Cross
As a SAR responder, this excellent article helps me know how to better assess and respond to drowning subjects. Thank you!
Thank you and thank you for your excellent and important work in SAR – MUCH appreciated!