In warm weather, many folks head to the waterfront for recreation. As humans can’t survive underwater for very long, significant risks exist for those who aren’t careful. Drowning is the most harrowing and heartbreaking water-related injury; it is the third leading cause of death from unintentional trauma behind motor vehicle accidents and falls. About 90 percent of drownings take place in fresh water venues like rivers, lakes and swimming pools, with the rest occurring in sea water.
According to a 2004 report from the World Health Organization, drowning is the 3rd leading cause of death from unintentional injury. From 2005-2009, there were an average of close to 4000 drownings annually in the United States; the number of non-fatal water submersion injuries, many involving brain damage, were much greater.
WHO DROWNS?
There are a number of factors which increase the risk of drowning. They include:
Poor swimming ability: Face it: If you can’t swim, your chances of drowning increase. Failure to recognize physical limitations can exhaust even decent swimmers and cause their demise.
Poor supervision: Drowning can happen relatively quickly and without a lot of noise. Even when lifeguards are present, they may not notice that you’re in distress. Unsupervised Small children could die even in a bathtub.
Age: Drowning is the second leading cause of death in children 1-14 years of age, surpassed only by motor vehicle accidents. Those under five tend to drown in swimming pools. In natural water settings, drowning deaths occur most often in teenagers and young adults.
Sex: Most drowning deaths (80 percent) occur in males.
Location: Although home swimming pools are the most likely places that young children drown, most adult drowning events occur in natural, boating, or wilderness settings.
Lack of Barriers: Easy access can be a recipe for disaster in young children. Pool fences that separate the pool from the yard reduce a child’s risk of drowning by 83%.
No Life jackets: In the year 2010, 88% of boating deaths by drowning involved people who weren’t wearing life vests.
Alcohol: Fully half of deaths by drowning in adolescents and adults involve impaired judgment and coordination caused by drinking.
HOW YOU DROWN
The primary urge to breathe is triggered by rising blood carbon dioxide (CO2) levels. The human body is very good at detecting small changes in CO2 and controls breathing to facilitate “gas exchange”: Oxygen in, carbon dioxide out.
Drowning begins at the point a person is unable to keep their head (nose and mouth) above water. The actual inhalation of water into the lungs happens later on.
Once a person is unable to keep their mouth above water, a cascade of events takes place that leads to a fatality. You may be surprised to know that symptoms considered to be classic for drownings, like flailing and screaming, often aren’t apparent. Involuntary movements of arms and legs may occur underwater and not “splash”. Lack of air prevents screaming for help loud enough to be heard. From a distance, it may not be obvious that the victim is in trouble even to those directly observing them.
It’s important, therefore, to look for the following behaviors seen in near-drowning individuals:
- Mouth and nose below the level of the water
- Eyes unfocused or wide with fear
- Head tilted back with mouth open
- Obvious gasping for air
- Attempting to swim to shore without making progress
- Uncontrollable movement of extremities (may be underwater)
FOUR STAGES OF DROWNING
There are thought to be four stages of drowning:
1)The victim holds their breath voluntarily underwater as long as possible. This lasts only until carbon dioxide in the body reaches too high a level.
2)Water enters the airways as the urge to breathe becomes impossible to suppress. Although the trachea goes into spasm to prevent aspirating more water, panic ensues. This consumes more oxygen and speeds the loss of consciousness. Having said that, an unconscious victim rescued with a sealed airway due to spasm still stands a good chance of recovery.
3)Once unconscious, the open trachea allows free movement of water into the lungs. Fluid in the lungs prevents oxygenation, leading to cardiac arrest and deterioration of brain cells.
4)Injury to the brain becomes irreversible after several minutes without oxygen. Near-drownings are usually found within two minutes, while fatal events are seen after ten minutes or more. The younger the person, the better their chances: In one instance, a child submerged in water just above freezing for 66 minutes survived without apparent neurological damage. It’s thought that hypothermia in these types of events slows the metabolism, which allows for a longer period of time before the development of severe brain damage.
When a death occurs in water, it is usually evaluated by autopsy. Water in the lungs indicates a victim was still alive at the point of submersion. Absence of water in the lungs may occasionally be seen when airway spasm persists until cardiac arrest. This is known as a “dry” drowning. The more likely,scenario, however, is someone who died before the immersion event.
STAYING SAFE IN THE WATER
In summer weather, Beating the heat often means a dunk in the pool or lake. Here are some things you should know to keep your family and yourself safe from drowning:
- Take Swimming lessons: Don’t go into swimming-depth water if you don’t know how to swim. Swimming lessons are provided by many municipalities throughout the country. Believe it or not, the best time to teach children to swim is between the ages of one and four.
- Take CPR classes: Understanding resuscitation is very important when it comes to aiding drowning victims.
- Strictly supervise youngsters in the water: Whenever children are involved, strict attention must be given by a responsible, sober adult. For preschool children, the adult should be close enough to touch the child and not involved in any other activity.
- Utilize the “Buddy System”: Everyone, even adults, should always swim with another person or persons.
- On the beach, beware rip currents: Know the meaning of flags on supervised beaches. High waves, discolored water, debris, and channels of water moving away from shore are signs of dangerous conditions. If caught in a rip current, swim parallel to shore until free, then diagonally back towards the beach.
- Foam or inflatable toys don’t take the place of life jackets: Noodles and water wings aren’t acceptable as substitutes for life vests, especially on boating trips. Be firm about using the right equipment, even for adults.
- Pool fencing saves lives: Four-sided fencing 4 feet high with a high latch is the safest way to prevent small children from falling or jumping into the pool and getting into trouble. Don’t leave toys near the pool after swimming.
- Be aware of the weather: Thundershowers often whip up the water with strong winds, increasing the risk of drowning.
- Be physically fit: Swimming involves exertion, so make sure you’re up to the challenge.
- Don’t drink alcohol: Any water activity becomes more dangerous, both to you and children you supervise, if you’re drinking.
- Don’t hyperventilate: Professional deep divers often hyperventilate to decrease carbon dioxide and depress the urge to breathe. Taking rapid deep breaths to see who can stay underwater longest, however, may cause a blackout and lead to drowning.
- If you suffer from a seizure disorder, use the shower, not the bathtub. Avoid situations where the head is immersed. Anyone with a history of convulsions should undertake swimming activities only with one-on-one supervision.
- In the wilderness, be wary of river crossings. Fast moving water may knock you off your feet, even if less than a foot deep.
REACH, THROW, ROW, GO
At the beach or in the wilderness, you might encounter a distressed person in the water. Your first response will be to jump in and help, but remember that the hazards that are causing the problem are probably still there. Also, the person in question will likely be panicked and flailing around. First, you should call others to help if possible.
Your goal is to help the person in distress while avoiding injury and reducing the risk that you’ll become the next victim. To accomplish this, remember four words: “Reach, Throw, Row, Go”.
REACH out to the person with a stick or oar.
THROW the person a lifeline, life preserver, or other floating object.
ROW out to the person in a canoe or other boat if available.
GO into the water only when there is no other option.
If you must go into the water, recovery must be done in such a way that doesn’t wind up submerging the rescuer due to the victim’s desperate attempt to stay above water. A buoyant object is helpful, but approaching from behind or offering one hand can work as well. Once the victim is in hand, any objects weighing them down should be removed. Then, towing the patient from behind with the face well above water can be accomplished.
Once out of the water, put the individual in supine position and check for breathing. If unconscious but breathing, place in the standard recovery position.
Cardio-Pulmonary Resuscitation (CPR) is required if the victim isn’t breathing. Unlike in a typical cardiac arrest, five initial rescue breaths are recommended and then chest compressions. This is because the basic issue is lack of oxygen. not cardiac malfunction. After the initial breaths, cycles of 30 chest compressions and 2 rescue breaths are performed until help arrives.
Some believe in attempting to expel water with Heimlich-like maneuvers. These should be avoided because there is no solid object obstructing the airway, and these motions could delay the start of ventilatory actions. Also, abdominal thrusts raise the chance of vomiting stomach contents into open airways, increasing the risk of death.
Victims who arrive at a medical facility with a regular heartbeat and spontaneously breathing usually recover with good outcomes. Those requiring resuscitation will require intensive care and may end up with long-term handicaps related to brain damage from lack of oxygen.
Joe Alton MD
Read the full article here