Drowning

Drowning is a type of suffocation that happens when a person's mouth and nose are submerged in liquid. This can happen in water, such as pools, lakes, or oceans, but it can also occur in other liquids. When someone drowns, they cannot breathe, which can lead to serious health problems or even death.

Most drowning accidents happen when a person is alone or when others nearby do not realize what is happening. After being rescued, people who have drowned might have trouble breathing, feel confused, or even lose consciousness. Sometimes, these problems don’t show up until several hours after rescue. Other complications can include low body temperature, breathing in water, or lung inflammation.

Drowning is more likely in places where there is a lot of water, especially if safety measures are not followed. Risk factors include not knowing how to swim well, being unsupervised—especially for children—and using alcohol or drugs. Common places where drowning happens are swimming pools, bathtubs, and natural bodies of water like lakes and rivers.

Preventing drowning is very important. Teaching children and adults to swim, recognizing unsafe water conditions, never swimming alone, and using safety devices like life jackets can help save lives. If someone is not breathing after drowning, it is crucial to open their airway and give mouth-to-mouth resuscitation. If their heart has stopped beating, cardiopulmonary resuscitation (CPR) should be started right away.

Causes

Not knowing how to swim is a big reason why people drown. Other reasons include the condition of the water, how far someone is from solid ground, physical limitations, or losing consciousness before drowning. Fear of water or drowning can also cause panic, leading to tiredness and increasing the chance of drowning.

About 90% of drowning happens in fresh water, like rivers and lakes, and a smaller number in swimming pools. The remaining 10% happens in seawater. Drowning in other liquids is uncommon and usually linked to industrial accidents. In the early history of New Zealand, many settlers died trying to cross rivers, earning drowning the nickname "the New Zealand death".

People can drown in just over an inch of water if they are face down. After someone drowns, problems can happen later because of fluid getting into the lungs. Even a small amount of fluid can cause serious issues and may lead to more health problems or death days after the drowning.

Risk factors

Many things can increase the risk of drowning:

• Not knowing how to swim well is a major risk. Taking swimming lessons, especially for children aged one to four, can help lower this risk.
• Being very tired can make swimming harder and increase the danger of drowning.
• Having easy access to water without safety measures can be risky, especially for young children.
• Not having careful supervision near water can also increase the risk, even if lifeguards are present.
• The risk of drowning changes with age and location. Young children often drown in home swimming pools, while older people are more likely to drown in natural water settings.
• Some health conditions, like seizures or heart problems, can increase the risk of drowning.

Different groups of people have different risks. In the US, young children and teenagers have higher rates of drowning. Some groups, like African Americans, have higher drowning rates than others, which may be linked to less access to swimming education.

Freediving

During freediving, some extra risks can lead to drowning:

• Ascent blackout: This happens when someone comes up from a deep dive too quickly and loses consciousness because of low oxygen levels.
• Shallow water blackout: This can occur if someone hyperventilates before diving, which reduces the carbon dioxide in the blood and can cause sudden loss of consciousness underwater without any warning.

Pathophysiology

Drowning happens in four main stages:

1. Holding your breath until you really need to breathe.
2. Swallowing fluid or it going into the airways.
3. Not being able to breathe or take in fluid anymore.
4. Permanent damage from not getting enough oxygen.

People who can't swim may struggle in the water for 20 to 60 seconds before going under. At first, someone will hold their breath to keep water out of their lungs. But when they can’t hold it any longer, even a little water can make the airway close up. If this continues, they can lose consciousness from not enough oxygen and their heart can stop.

When someone is drowning, they might panic and move a lot, using up more oxygen. The body needs oxygen from the air, but when underwater, carbon dioxide builds up. This makes the urge to breathe stronger until they can’t hold it anymore. In very cold water, holding breath is harder because of a sudden reaction that makes breathing faster. If someone hyperventilates before going in the water, they might not feel the need to breathe until it’s too late, which can be dangerous.

Not enough oxygen to the brain will make a person lose consciousness. If water gets into the airways, it can cause the airway to close up, leading to the heart stopping. Even if water doesn’t get into the lungs, not having enough oxygen can still be very harmful. The heart might stop, which stops blood from carrying oxygen to the brain. If help comes soon, there’s a chance to recover. But after about six minutes without oxygen, permanent brain damage can happen.

If water gets into the airways, the body tries to push it out or swallow it, but sometimes more water is inhaled. The airway can close up to keep water out of the lungs, but this also stops breathing. Sometimes, after losing consciousness, the airway opens and water can get into the lungs, which is called “wet drowning.” In some cases, the airway stays closed until the heart stops, called “dry drowning,” where no water enters the lungs.

Cold water can trigger a reflex that helps save energy, slowing the heart and directing blood to vital organs. However, the sudden shock of cold water can cause the heart to beat irregularly or stop, leading to drowning. Losing heat quickly in cold water is dangerous, and people can die from this shock or from not being able to move effectively in the water. Staying calm and conserving energy is important if someone is in cold water waiting for help.

Diagnosis

The World Health Organization described drowning in 2005 as happening when someone has trouble breathing because their face and nose are underwater. This definition does not mean the person has to die or even need medical help after being pulled out, nor does it mean any liquid has to get into their lungs. Experts say that people in trouble but still able to float, signal for help, and act are not yet drowning — they are just distressed. Drowning means someone is unable to breathe and could die within seconds.

Forensic doctors find it very hard to determine if someone died from drowning. Looking at the body outside and inside during an examination often does not give clear clues, and lab tests can be unclear. Doctors try to figure out if the person died because they were in water or if they were put in water after they had already passed away. Signs that might point to drowning include foam near the airway, water in the stomach, and swelling in the brain. However, these signs can also happen for other reasons.

Prevention

More than 85% of drowning cases could be prevented with the right steps. Key ways to help stop drowning include:

• Learning to swim: Knowing how to swim is one of the best ways to stay safe in water. It’s a good idea for children to start learning between ages 1 and 4, but it’s never too late to learn.
• Watching swimmers: It’s important to keep an eye on people in the water, especially children. Drowning can happen without any noise or signs. Many pools have lifeguards to watch for swimmers in trouble. Even people who know how to swim can need help sometimes.

• Learning water safety: Everyone should know basic first aid, like cardiopulmonary resuscitation (CPR), and understand how to stay safe in water. This means knowing your limits, picking safe places to swim, and following local rules and signs.
• Avoiding shallow water jumps: It’s unsafe to jump into shallow water without knowing how deep it is. Diving into shallow water or hitting hidden objects can lead to serious injuries.
• Staying away from alcohol and drugs near water: These can greatly increase the risk of drowning, especially at places like bars near water or parties on boats.

• Staying calm in water: Fear and panic in water can tire people out quickly. It’s best to stay calm, move slowly toward the shore or pool edge, and ask for help if needed. Some sea creatures can sting, but most people can get out of the water safely after a sting.
• Knowing about health conditions: Some health issues, like seizures or cramps, can make water activities risky. It’s important to understand personal limits and take extra care.
• Checking water conditions: Be aware of strong currents, bad weather, and other dangers in the water. It’s best to go with the flow of currents rather than fight against them.

• Using safety gear: Boats and pools should have safety equipment like lifejackets. Children and anyone who can’t swim well should always wear a properly fitted lifejacket. Other floating devices can also help in emergencies.

• Being careful when boating: Knowing about sea conditions and having the right safety tools, like lifejackets on boats, can prevent many accidents.

• Using rescue technology: Remote-controlled devices and drones can help reach people in trouble in water quickly.

• Swimming with a buddy: Swimming with a friend means someone is nearby to help if there’s a problem.

• Having pool fences: Fences around pools with child-proof gates help keep children out unless supervised. Many places require pools to have these fences.

• Checking pool drains: Pool drains should have covers to prevent hair or body parts from getting trapped, which could lead to drowning.

• Following warning signs: Signs, flags, and advice about water safety are there to keep everyone safe and should always be followed.

Water safety

The concept of water safety involves the procedures and policies that are directed to prevent people from drowning or from becoming injured in water.

Time limits

Further information: Drowning § Pathophysiology

How long a person can stay safely underwater depends on several things, like how active they are, how many breaths they’ve taken before going under, their health, and their age. Usually, a person can stay underwater for about one to three minutes before losing consciousness, and around ten minutes before serious harm happens. In a rare and special situation, someone was helped after being underwater for 65 minutes.

Management

Rescue

When someone is drowning or a swimmer goes missing, getting them out of the water quickly is very important. Drowning does not always make loud noises; it can happen quietly.

Rescuers should stay safe. They can help from a boat, a dock, or land nearby. The best way is to throw something that floats, like a life ring or a big branch. It is important not to aim straight at the person because even a light life ring can hurt if it hits their head. Another way is to reach the person with a rope, oar, branch, or pole and pull them out. The rescuer should stay strong and not get pulled into the water. Using vehicles to help should be done carefully to avoid hurting the person more. Modern drones can also drop life jackets to help.

Bystanders should call for help right away. If there is a lifeguard, they should be called. If not, an emergency telephone number should be called to get professional help and paramedics. Sometimes, professionals can reach the person from a boat or helicopter. Most people saved by lifeguards do not need much medical help, but it gets harder if bystanders try to rescue them.

If lifeguards or paramedics cannot be called, bystanders must help the drowning person. This can be done using small boats or even special robots that can move on water.

First aid

When helping someone who is drowning, first check if they are awake and breathing while lying on their back.

If the person is not breathing, rescue breathing is needed. For adults or children older than babies, tilt the head back and give two rescue breaths by blowing into their mouth after pinching their nose. Then, do chest compressions by pressing on the lower half of the sternum, the bone in the middle of the chest, 30 times, followed by two more rescue breaths. Keep doing this until help arrives or the person starts breathing again.

For babies, do not tilt the head back. Cover the baby’s mouth and nose with your mouth for each rescue breath. Press on the lower half of the baby’s sternum with two fingers for the chest compressions.

Defibrillators (AED) can help in some cases. They give electric shocks to help the heart start again. They are easy to use and give voice instructions. The person must be out of the water and dry before using a defibrillator. If the person is very cold, warm them up a little before trying.

Medical care

People who almost drowned but are breathing okay should be watched in a hospital for a while to make sure they are safe. Doctors will make sure their blood has enough oxygen and help them breathe better if needed. They might give medicines through a vein instead of other ways. If the heart stops, it usually stops completely or the heart acts strangely but does not beat normally. This is more common if the person already had heart problems, was very cold, or had certain medicines.

Some medicines might be used, but there is not strong proof they help. Special machines can help people breathe if normal ways do not work. Medicines to reduce swelling in the lungs are not recommended.

Prognosis

People who have drowned and arrive at a hospital breathing on their own usually recover well. Getting quick help right away makes a big difference in how well someone does.

Staying underwater for a long time makes it harder for a person to survive and can cause lasting problems with the brain. Water that is dirty or very cold can also make things worse.

Younger people, especially children, often have better chances of surviving after drowning. For example, a child who was underwater for a very long time in very cold water was able to live without serious problems right away. But even then, some problems might show up later, like trouble with memory.

Drowning is a big problem for children around the world. Many children who almost drown can have lasting effects on their brains, lungs, and kidneys. Even if they seem okay at first, problems can appear later in life. This is why it is so important to keep children safe around water.

Epidemiology

The World Health Organization says drowning causes about 300,000 deaths every year around the world. Most of these happen in countries with lower incomes. Drowning is a big reason why young children die, especially those under 12 years old. In the United States, around 1,100 people under 20 die from drowning each year.

Boys are more likely to drown than girls. This may be because boys often take more risks. In some places, like parts of Asia and Africa, many children die from drowning because they don’t have safe places to play in water. In the United States, drowning is the second biggest reason children under 12 die, after car accidents.

Society and culture

Old terminology

The word "drowning" used to mean only when someone died from being in water. But now, doctors use it to talk about both dying and almost drowning. Some old words for drowning are not used anymore. These include:

• Active drowning: when someone who can't swim or is very tired can't keep their mouth above water and is struggling to breathe.
• Dry drowning: when someone drowns but no water gets into their lungs.
• Near drowning: when someone almost drowns but survives.
• Wet drowning: when water gets into someone's lungs during drowning.
• Passive drowning: when someone suddenly sinks underwater because of an accident or health problem.
• Secondary drowning: when breathing gets worse after drowning because of liquid building up in the lungs.
• Silent drowning: when someone is drowning but isn't showing clear signs of trouble.

Dry drowning

The idea of "dry drowning" is a story that some people believe, especially in the summer. It says that children can die from drowning hours or days after being in water. But doctors say this is not true. They have agreed that drowning is when someone has trouble breathing after being in liquid. They do not use the term "dry drowning" anymore because it causes confusion and does not change how doctors treat someone who is drowning.

Capital punishment

Main article: Execution by drowning

In the past, some places in Europe used drowning as a way to punish people who were found guilty of serious crimes. This practice stopped in many countries by the 1800s. For example, England stopped in 1623, Scotland in 1685, and France briefly used it again during the French Revolution.

Experience

People who have almost drowned sometimes say that time seems to slow down, but this might just be how they remember it later. After the first struggle to hold their breath, they might feel a sharp or painful feeling when water enters their lungs. This pain does not depend on what kind of water it is.

After this pain, many people report feeling calm, peaceful, or even very happy. They might see things that aren't really there, known as hallucinations. These feelings of peace and happiness happen because the brain isn't getting enough oxygen, which changes how the brain works. These experiences can differ from person to person, depending on how quickly their oxygen levels drop.