Drowning is defined as death caused by lack of oxygen within 24 hours of a drowning accident. The term “near-drowning” indicates a situation when someone lives for 24 hours or more after a drowning accident, whether or not the person survives. Drowning accidents are emergencies that require immediate care from a doctor.

Causes

• Drowning and near-drowning injuries are caused by a lack of oxygen because of accidental suffocation in water.

• Water in the lungs, particularly water contaminated by bacteria, algae, sand, dirt, chemicals, or vomit can cause lung injury.

• Fresh water is more dangerous than salt water because it causes more severe injury to the lungs.

Risk Factors

• Children are most often the victims of drowning. The following factors increase a child’s risk of drowning:

• • Not knowing how to swim

• • Having an unfenced pool or spa in the home

• • Among children less than one year old, the most common risk factor for drowning is being left in a bathtub unattended, even for a few minutes

• The following factors increase your risk of drowning:

• • Risk-taking behavior around pools or other bodies of water, especially combined with use of drugs and/or alcohol

• • Not knowing how to swim

Symptoms

People rescued from drowning may have symptoms ranging from anxiety to near-death. They may be alert, drowsy, or comatose. Some people may not breathe or may gasp for breath, vomit, cough, or wheeze. Breathing problems may not happen until several hours after a drowning accident. Skin may look blue (“cyanotic”) because of too little oxygen in the blood.

Diagnosis

Your doctor will diagnose a drowning injury based on the events and the person's symptoms and results of a physical examination. Tests may include the following:

• Oximetry – a test that measures the amount of oxygen in the blood.

• Chest x-rays – to find out whether and how badly the lungs are damaged.

• Additional x-rays – to look for breaks in the skull, spine, or other bones.

• Computed tomography and nuclear magnetic resonance imaging – tests that use computer images to find injuries inside the body. Doctors may use these tests to look for damage to the spine or to the brain or other organs

Treatment

Treatment options include:

• Cardiopulmonary resuscitation (CPR)

• • Note: In all unconscious people and those who have been diving, the head and neck should be supported in case of injuries to the spine

• Endotracheal intubation – For this treatment, a narrow tube is placed into the large airways of the lungs to keep them from collapsing and to allow mechanical ventilation if necessary.

• Warming treatments – This is done if the body has gotten cold due to being in cold water. This may be done slowly to avoid further injury to the body.

• A nasogastric tube – This is a narrow, flexible, plastic tube that will likely be placed through the nose into the stomach, as people with drowning injuries may have swallowed a lot of water.

Prevention

To help reduce chances that that you or someone you know will drown, take the following steps:

• Teach your children to swim but maintain constant supervision around water.

• A fence or barrier should completely enclose your pool or spa. All gates or doors leading from the house to the pool area should have a self-closing, self-latching mechanism that is above the reach of toddlers and young children.

• Remove any obstacles to allow a full view of the pool or spa from the house.

• If you use a lightweight, floating pool cover, be extra alert to the potential for drowning accidents. These covers do not keep people from falling in, and no one should ever crawl or walk on them.

• Ensure careful supervision of all guests if alcoholic beverages are served at spa- or poolside.

• Do not allow anyone of any age to swim alone.

• Always wear life vests when boating.

RESOURCES:

American Red Cross
http://www.redcross.org/index.html

CANADIAN RESOURCES:

Children’s Safety Association of Canada
http://www.safekid.org/

Safe Canada
http://www.safecanada.ca/

Canadian Red Cross
http://www.redcross.ca

References:

Driscoll TR, Harrison JA, Steenkamp M. Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev. 2004;10(2):107-113.

Drowning and near-drowning in children and adolescents: a succinct review for emergency physicians and nurses. Pediatr Emerg Care. 2005;21(9):617-619.

Harries M. Near drowning. BMJ. 2003;327(7427):1336-1338.

Salomez F, Vincent JL. Drowning: a review of epidemiology, pathophysiology, treatment and prevention. Resuscitation. 2004;63(3):261-268.

Sibert J, John N, Jenkins D, et al. Drowning of babies in bath seats: do they provide false reassurance? Child Care Health Dev. 2005;31(3):255-259.