Drowning

Table of Contents

Importance of Water Safety

Drowning occurs quickly and silently.

Drowning is a leading cause of accidental death in young children, making water safety a critical concern for parents and caregivers. Understanding the risks and implementing safety measures can significantly reduce the likelihood of drowning incidents.

Statistics.

According to the World Health Organization (WHO), drowning is the third leading cause of unintentional injury death worldwide, claiming about 236,000 lives each year.

In Australia drowning is the second most common cause of accidental death in children, with boys being 5 times more likely to drown than girls as the drowning ration is for every 6 drowning incidents 5 are boys and 1 is a girl. Statistics state children in the age range of 0 to 4 years of age are the most at risk from drowning. Most urban drownings occur in private back yard swimming pools with 20% of urban drownings occurring in bathtubs.

In many countries, drowning rates are higher in rural areas compared to urban areas due to lower access to swimming lessons and safety equipment.

Unfortunately, as the children get older and as parents, we start to think they are safe. Then they turn 18 and alcohol comes into play, which is one of the biggest risk factors for teenagers.

Preventing Drowning.

Preventing drowning involves a combination of supervision, education, and safety measures. Constant supervision is essential whenever children are near water, including bathtubs, pools, ponds, and even small containers of water.

Swimming Lessons: Enrolling children in swimming lessons can provide them with essential skills to help prevent drowning. Lessons should be age-appropriate and taught by certified instructors.

Life Jackets: Ensure children wear properly fitted life jackets when boating or near open water. Even strong swimmers should use life jackets in unpredictable water conditions.

Pool Safety: Install four-sided fencing with self-latching gates around pools to prevent unsupervised access. Keep pool covers and alarms in place as additional safety measures.

Supervision and Safety Measures

Effective supervision means maintaining constant visual and auditory contact with children around water. Avoid distractions such as phone calls or socializing when supervising swimming or water play.

Water Safety Rules: Establish and enforce water safety rules, such as no running near the pool, no diving in shallow water, and always swimming with a buddy. Educate children about the dangers of water and the importance of following safety rules.

Emergency Preparedness: Learn CPR and basic water rescue techniques. Keep emergency equipment, such as a life ring and a reaching pole, near the pool. Ensure that a phone is readily accessible to call for help if needed.

Activity.

Please watch these videos with caution as each videos shows a child drowning. In the next three videos all the children survive, but there are many videos on the web that show drowning incidents where the child does not survive.

 

These videos demonstrate how easily and quickly drowning can happen. In all three incidents the child are in a pool with other adults and children around them yet they are still pulled from the pools unconscious and requiring CPR. 

Drowning is silent.

What Drowning Look Like.

signs of drowning

As we have seen from the videos, drowning can look like a young child playing in the water bopping up and down but there are some signs to look out for.  In general the mouth is at water level with the head tilted back as they fight to grasp for air. Their body is in a vertical position and if you look under the water it can look like they are climbing a ladder as they panic to grasp onto anything. Do you think you could recognise a child drowning?

Drowning, Secondary Drowning, and Dry Drowning

When a baby / child or adult is under the water the person will start to panic, and struggle as they are unable to take a breath. They will hold their breath and will eventually either aspirate or go into laryngospasm.

There are 3 different types of drowning:

  • Wet Drowning: is basically when water enters the airways and lungs preventing babies from effective breathing.
  • Secondary Drowning: Secondary drowning happens when a little bit of water gets into the lungs, resulting in inflammation or swelling. The body struggles to exchange air properly through the lungs, which can lead to a build-up of carbon dioxide and dangerously low levels of oxygen. With secondary drowning, there can be a delay of up to 24 hours before the baby shows signs of distress.
  • Dry Drowning: refers to complications that can arise after a person takes in water through their nose and/or mouth, but not into their lungs, causing a spasm that closes the airway.
  • Previously, the term “near drowning” was used to indicate patients that survived for > 24 hours following a drowning event. Whilst this term is still commonly used, it has been replaced by the term “non-fatal drowning”.

Wet and dry drowning.

This can also be placed into two categories of wet drowning or dry drowning, with statistics showing wet drowning accounting for 85% of cases and dry drowning 15% of cases.

However, more recent autopsy studies of drownings have shown at least some level of increased fluid in the lungs in over 98% of victims, suggesting that aspiration (breathing) occurs in almost all cases.

 

Most deaths in hospital are due to lack of oxygen to the brain (hypoxic brain injury), rather than from wet drowning (pulmonary oedema or lung injury) from the initial drowning incident.

Information Medical Staff will Require.

With a drowning incident it is also important to take notice of:

  • Length of time under the water.
  • The type of water it is including if it is contaminated, dirty, chlorine, beach or bath water.
  • Take notice of the water temperature, cold, lukewarm, warm or hot.
  • Did the baby/child receive any other injuries or was there an incident for example did they fall and hit their head, was it a boating accident, did they slip in the bath.
  • Does the baby/child have any underlaying medical conditions such as epilepsy.
  • What care was giving to the child/baby prior to them being handed over to medical staff. Was CPR preformed and for how long.

This will be what medical staff will need to know at the hospital to be able to provide the best possible care for the best outcome.

What to do when faced with a drowning situation.

Let’s look at what to do if you are in this situation involving a drowning incident.

We will start with the easiest of situation but always remember your DRSABCD first, in all situations.

First Incident.

If an incident has occurred in the water and there seems to be no need for emergency assistant. Over the next 24 hours you will need to monitor your baby, toddler or child for these symptoms.

  • Shallow or laboured breathing: Rapid and shallow breathing, nostril flaring, or seeing the space between the child’s ribs or the gap above their collarbone when they breathe means your child is working harder than normal to breathe. If you notice these symptoms, you should seek medical help immediately.
  • Coughing: Persistent coughing—or coughing associated with increased work of breathing—needs to be evaluated.
  • Vomiting: Vomiting is a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen, and also from persistent coughing and gagging.
  • Fatigue or excessive sleepiness: A day of water fun can tucker kids out, Water play can be exhausting for babies, children and adults, making us feel fatigued and tired. If a child is showing signs of excessive fatigued, it could mean they aren’t getting enough oxygen into their blood.
  • Behavioural changes: If your child is acting more forgetful or just not acting like themselves, it could indicate there has been a change in their oxygen status. Similarly, a dip in oxygen level could make your child feel sick or woozy.

If your baby/child is unable to speak or express themselves, it may be hard to know exactly how they feel. Monitor them closely to ensure they’re breathing freely and keep an eye out for any of the other mentioned symptoms.

Second Incident.

If a water incident has occurred and you have gone through the DRSABCD and the Baby / Child is awake with no need for CPR, take into consideration other injury including spinal injury that may have occurred. Keep the child calm and comfortable, and if possible, place them in the recovery position on their side until help arrives. Once taken to the hospital to be checked over by medical staff. Expect to remain at the hospital for a minimum of 6 hours for observation to ensure hypoxia and pulmonary oedema don’t develop from fluid on the lungs. After being discharged continue to look out for the symptoms listed above for 24 hours after the incident.

Third Incident.

The baby/child is unresponsive and been underwater for a length of time.

 

DRSABCD

D – Danger to yourself or others (do not go near water if there is electricity going through it).

R – Response to stimulation

S – Send for help

A – Airways

B – Breathing

C – Circulation

D – Defibrillation

E – Exposure in cooler climates, drowning is associated with hypothermia

 

Continue CPR till an ambulance arrives and continue checking for a pulse on every fifth round.

Expected Outcomes.

No single clinical score accurately predicts which patients will survive from a drowning event. Some studies show a link between time under the water with no oxygen and survival and other factors include water temperature, time to CPR and time to first spontaneous respiratory effort.

The Orlowski scale is commonly used to predict outcomes from drowning – based upon the following features:

  • Age under 3 yrs.
  • Estimated time under the water is greater than 5 minutes.
  • No attempted resuscitation in the first 10 minutes after rescue.
  • Unconscious on arrival in ED
  • Metabolic acidosis on arrival in ED with pH < 7.1

It is estimated that there is a 90% chance of good recovery if less than 3 of these are present and a 5% chance of recovery if more than 3 of these factors are present.

How Do We Prevent a Drowning Incident.

Preventing drowning involves a combination of supervision, education, and safety measures. Constant supervision is essential whenever children are near water, including bathtubs, pools, ponds, and even small containers of water.

 

Learn basic swimming and water safety skills.

Enrol into the free splash classes and then formal swimming lessons.

There is also a learn to swim app for parents and careers who have access to a pool. This will help with building confidence around water.

 

Pool Safety.

Appropriate fencing that fully enclose the pool. The fencing needs to be at least four feet in

height and separate the house from the pool with a self-closing and self-latching gates.

Remove all toys from the pool area that might attract children to the pool when the pool in not in use.

Don’t leave furniture or toys against the fence that babies can use to climb the fence.

 

Water Safety Rules: Establish and enforce water safety rules, such as no running near the pool, no diving in shallow water, and always swimming with a buddy. Educate children about the dangers of water and the importance of following safety rules.

 

Supervise closely.

Designate a responsible adult to supervise closely and constantly when children are in or near water (including bathtubs). You can assign a specific adult to supervise each child when they have access to water. Adults watching kids in or near water should avoid distracting activities like reading, using the phone, and consuming alcohol or drugs, because drowning happens quickly and quietly.

After swim time is over, shut and lock doors that give access to water. Be proactive and learn about any risks when visiting another home or unfamiliar location. Adults should supervise children closely even when lifeguards are present.

 

Wear a life jacket.

Life jackets reduce the risk of drowning while boating for people of all ages and swimming abilities. Life jackets should be used by children for all activities while in and around natural water.

Life jackets can also be used by weaker swimmers of all ages in and around natural water and swimming pools. Do not rely on air-filled or foam toys, as these are not safety devices.

 

Learn CPR & Emergency Preparedness.

Your CPR skills could save someone’s life in the time it takes for paramedics to arrive.

Keep emergency equipment, such as a life ring and a reaching pole, near the pool. Ensure that a phone is readily accessible to call for help if needed.

Know the risks of natural waters.

Know the beach.

Beaches are very hazardous with moving sand banks and rips that can pull a person out to sea. Play it safe at the beach swim between the flags, listen to lifeguards and not drink alcohol. Surf life saving has more information available on there web page.

 

Conditions

Lakes, rivers, and oceans have hidden hazards such as dangerous currents or waves, rocks or vegetation, and limited visibility. Check the forecast before activities in, on, or near water. Local weather conditions can change quickly and cause dangerous flash floods, strong winds, and thunderstorms with lightning strikes.

 

Avoid alcohol.

Avoid drinking alcohol before or during swimming, boating, or other water activities. Alcohol impairs judgment, balance, and coordination.9 Do not drink alcohol while supervising children.

 

Use the buddy system.

Always swim with a buddy. Choose swimming sites that have lifeguards when possible. The buddy system is especially beneficial for people with seizure disorders or other medical conditions that increase their risk of drowning.

 

Take additional precautions for medical conditions.

Know if your medical condition or those of others you are swimming with might increase the risk for drowning and take extra care. For example, if you or a family member have a seizure disorder like epilepsy, have one-on-one supervision around water. People with seizure disorders can also consider taking a shower rather than a bath. Take extra precaution around water if you or a family member has other medical conditions that can increase drowning risk, like heart conditions or autism.

 

Consider the effects of medications.

Avoid swimming if you take medications that impair your balance, coordination, or judgement. These side effects increase the risk of drowning. Several medications can produce these side effects, such as those used for anxiety and other mental health conditions.

 

Don’t hyperventilate or hold your breath for a long time.

Do not hyperventilate before swimming underwater or try to hold your breath underwater for long periods of time. This can cause you to pass out and drown. This is sometimes called “hypoxic blackout” or “shallow water blackout”.

Quiz.

A male child between the age of 0 to 4 years living in Australia in a back yard swimming pool.

There mouth is at water level and the head is tilted backwards.

There body is in a vertical position and their body is doing a climbing motion

Wet Drowning – Water enters the airways and lungs preventing breathing.

Secondary Drowning  – a small amount enters the lungs resulting in inflammation or swelling.

Dry Drowning – water taken in but not entering the lungs, causing a spasm that closes the airway.

  • time under water.
  • type of water or fluid.
  • water temperature.
  • other injuries.
  • underlying medical conditions.
  • What first aid did you render.
  • Shallow or laboured breathing: Rapid and shallow breathing, nostril flaring, or seeing the space between the child’s ribs or the gap above their collarbone when they breathe means your child is working harder than normal to breathe. If you notice these symptoms, you should seek medical help immediately.
  • Coughing: Persistent coughing—or coughing associated with increased work of breathing—needs to be evaluated.
  • Vomiting: Vomiting is a sign of stress from the body as a result of the inflammation and sometimes a lack of oxygen, and also from persistent coughing and gagging.
  • Fatigue or excessive sleepiness: A day of water fun can tucker kids out, Water play can be exhausting for babies, children and adults, making us feel fatigued and tired. If a child is showing signs of excessive fatigued, it could mean they aren’t getting enough oxygen into their blood.
  • Behavioural changes: If your child is acting more forgetful or just not acting like themselves, it could indicate there has been a change in their oxygen status. Similarly, a dip in oxygen level could make your child feel sick or woozy.

Learn basic swimming and water safety skills.

Closely Supervise children.

Wear a life jacket

Learn CPR

Don’t drink alcohol if you are supervising or swimming.

Know the risk of natural water.

Know the beach.

Know the weather conditions.

Use a buddy system.

Take additional precautions for medical conditions.

Don’t hyperventilate or hold your breath for a long time.