With the lazy days of summer upon us, outdoor activities will be ramping up. Along with the sunscreen and the mosquito repellent, remember to bring those life preservers and other water safety equipment for the kiddos if you will be around water. Drownings are 100% preventable, and are the second leading cause of unintentional death in children 1 to 4 years of age (Szpilman, Bierens, & Orlowski, 2012). The purpose of this article is four fold: 1) explore the terminology surrounding drowning, especially the term “dry drowning”, 2) understand the pathophysiology of drowning, 3) realize what actions need to be taken if you see someone you think may be drowning, and finally, 4) know what you can do to prevent drowning accidents from occurring.
Terminology
First, let us address the term “dry drowning.” In order to put your minds at ease, this term is used incorrectly and is actually a myth. It is not uncommon to see links to pages on social media sites that recount tragic stories of “dry drowning” incidences. These stories tell of children who have died suddenly a day or two after having a near drowning incident. These stories have caused many parents to become hyper vigilant at pool sides and water fronts across the nation. However, what is not disclosed to the public is the autopsy results of the child who died, revealing a totally unrelated cause of death.
To be quite honest and clear, the terms “dry drowning,” “secondary drowning,” “active drowning,” “passive drowning,” “near drowning,” or even “wet drowning,” should all be avoided (Szpilman, et al, 2012). They leave too much to the interpretation of the condition for lay person and professional alike. Drowning was defined by the World Health Organization (WHO) in 2002 as: “…the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes are classified as death, morbidity and no morbidity. Agreed terminology is essential to describe the problem and to allow effective comparisons of drowning trends.” So there you have it, the myth has been demystified. Drowning does actually involve liquid, and is not in any way dry as the incorrect term of “dry drowning” implies.
Pathophysiology
The actual pathophysiology of drowning needs to be addressed just to help clarify how drowning actually occurs. When a person is drowning, they cannot keep their airway clear because water is rapidly entering airway passages. They try to spit out the water, but are unable to do so, causing them to hold their breath. This lasts for about a minute, or until the respiratory drive is too high, then some water is aspirated and the coughing reflex follows along with a laryngospasm response. Hypoxemia (decreased oxygen) leads to loss of consciousness. A sudden drop in oxygen causes the heart to slow then eventually stop. The whole process from submersion, to cardiac arrest can take seconds, to as long as an hour, depending upon the temperature of the water. This being said, a person drowning in a colder body of water will usually have a greater chance of survival due to the decreased metabolic demands of the body. (Szpilman, et al 2012)
Responding to a Drowning Emergency
Typically, public beaches, lakes, or community swimming pools tend to be very busy, often over crowded with enthusiastic swimmers. Along with 
overcrowding conditions, comes a high volume of noise as these swimmers are often splashing and screeching as they enjoy cooling off in the summer sun. Though, rising above this noise level is an unexpected, yet but distinct scream; a mother’s scream as she cries out for help. In her panic, she yells “he can’t swim, someone help!” The child is located in the deep end of the pool, and is seen thrashing about as he struggles to swim. What is your next action? Do you attempt to be the superhero and jump in and save him?
You know the clock is ticking, you have about 60 seconds. First, look for the lifeguard. Make sure that the lifeguard has been alerted, and is responding to the emergency. If there is no lifeguard available, you must be prepared to intervene as their rescuer. A quick little saying can be readily used to help you remember the steps involved in rescuing a drowning victim; it goes like this: REACH, THROW, ROW, & GO. First in the line of rescuing steps is, “reach” – Try to “reach” them by laying on the side of the deck, while extending an object to them such as a pool noodle or “reach” a branch or a paddle from the shore if at a lake or beach. It’s important that you do not jump in to rescue them. Often in drowning, the victims are panicked, causing them to hang on to you in a great level of desperation, and they quite possibly might try to push you under the water in an attempt to save themselves. This could result in you as the rescuer becoming the next drowning victim. The next step in the rescue process is “throw.” – If unable to “reach” the victim and this method is obviously out of the question, throw them a line, rope, lifesaver, life jacket, or any other flotation device they can securely hold onto. By doing so, this will help to keep both you and the victim safe. The third step is “Row” – If the victim is too far and cannot be reached using the methods described above, quickly locate a canoe, or a boat, and get to the victim and pull them out of the water into the boat or canoe. When you are close enough to the victim, use the reach and throw maneuvers described in the first two steps. Be especially cautious if you are in a small boat, as they can be easily capsized, and of course always remember to wear your own life jacket! The last step in the rescuing the drowning victim is “Go”- If the first three interventions are not feasible, effective, or timely, quickly swim, or get to the victim directly. Please be aware that this can be very risky, and your heroic life-saving measures may be compromised. Thus, it’s important to be aware of the risks of rescuing a drowning victim, and it is also important that you receive training on water safety and first aid rescue. If you are not confident or certified in these lifesaving skills, it is better to leave this to emergency responders, who are highly trained in these kind of emergencies. Most importantly, immediately alert the lifeguard, and/or dial 9-1-1. Wait for help to arrive, and standby for further instruction.
Once the person has been rescued and is brought to the shore or the pool side, then what’s the next step? First,, it’s critical that you have verified that a 9-1-1 call has been placed, and that emergency responders are on their way. Second, it is important to determine whether the victim is conscious or alert. If they appear to be stable and without distress, they should still be evaluated by their medical provider as soon as possible, because it is likely that they might have choked on quite a bit of water which places them at risk for secondary injury. However, if they are not alert, conscious, and/or not breathing start CPR and first aid immediately!
Prevention
Pescatore and Hawkins (2018), advise the dangers of drowning are real, and not just something that happens to others. We owe it to our children to consider the risks involved in swimming and other water activities. All persons must be made aware of the possible drowning hazards, and be mindful to avoid jeopardizing their safety while in the water. Armed with this knowledge will help to reduce fears about swimming, while also increasing the swimmer’s competency and knowledge on how to reduce their personal safety risks. Finally, it’s important to remember that prevention remains key. Preventing drowning is easy, and can be done by considering the following basic prevention measures: supervision, instruction, and education. The American Academy of Pediatrics (2015) recommends “touch supervision”, meaning children should be within reach. Other recommendations include teaching children to swim and learning the steps of CPR. Educating children about basic water safety is the central element to reducing the occurrence of drownings. Understanding the importance of the use of life jackets when they are around water or on water crafts, never swimming alone, swimming in an area with a lifeguard on duty, and obeying the safety signs and warning flags, are just a few of these basic safety concepts. These fundamental measures, along with other drowning prevention techniques should be well considered. For more information regarding drowning prevention techniques see Table 3 below.
Conclusion
It is known that “dry drowning” is a myth. But regardless of what it’s called or even labeled, drowning is drowning, and is a real and dangerous reality that can be prevented. By using proper supervision, water safety practices, and education, we can eliminate the number of drownings and safely enjoy staying cool in the sun this upcoming summer season.
Author
Mary Beth Larsen, MSN, RNC-NIC &
Jason Major, AS, BS, MS, PhD
References
Drowning (2018) World Health Organization. Retrieved from http://www.who.int/violence_injury_prevention/other_injury/drowning/en/
Pescatore, R., Hawkins, S. C., (2018, May) Two er doctors explain the real swimming danger kids face. The Inquirer. Retrieved from http://www.philly.com/philly/health/kids-families/drowning-is-never-dry-two-er-doctors-explain-the-real-swimming-danger-kids-face-20180503.html
Szpilman, D., Bierens, J. J. L.M., Orlowski, J. P. (2012) Drowning. The New England Journal of Medicine 366 (22) Retrieved from https://nv-ezproxy.roseman.edu:2787/doi/full/10.1056/NEJMra1013317
Water safety for older children (2015) American Academy of Pediatrics Retrieved from https://www.healthychildren.org/English/safety-prevention/at-play/Pages/Water-Safety-for-Older-Children.aspx