Drowning

Drowning is when a person's mouth and nose get stuck under liquid and they can't breathe. This can happen in water like pools, lakes, or oceans, but it can also happen in other liquids. Not being able to breathe can cause big health problems or even death.

Most drowning accidents happen when a person is alone or when others do not know what is happening. After being saved, someone who has drowned might have trouble breathing, feel confused, or even pass out. Sometimes, these problems start many hours after they are saved. Other issues can include feeling very cold, having water in their lungs, or lung swelling.

Drowning happens more in places with lots of water, especially if safety rules are not followed. It is more likely if someone cannot swim well, is not being watched—especially children—or if they use alcohol or drugs. Places where drowning often happens are swimming pools, bathtubs, lakes, and rivers.

Stopping drowning is very important. Teaching children and adults to swim, watching for unsafe water, never swimming alone, and using safety tools like life jackets can help save lives. If someone is not breathing after drowning, it is important to open their airway and give mouth-to-mouth resuscitation. If their heart has stopped, start cardiopulmonary resuscitation (CPR) 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, or losing consciousness before drowning. Fear of water or drowning can cause panic, leading to tiredness and increasing the chance of drowning.

Most drowning happens in fresh water, like rivers and lakes, and a smaller number in swimming pools. A small amount happens in seawater. Drowning in other liquids is uncommon and usually linked to industrial accidents.

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.

Risk factors

Many things can increase the risk of drowning:

• Not knowing how to swim well is a major risk. Taking swimming lessons 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.
• 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 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.

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 a short time 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.

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.

If water gets into the airways, the body tries to push it out or swallow it. 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 slows the heart. 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. Staying calm and conserving energy is important if someone is in cold water waiting for help.

Diagnosis

The World Health Organization says drowning happens when someone can't breathe because their face and nose are underwater. This does not mean the person died or needs medical help after being pulled out. It also does not mean any water got into their lungs. Experts say that if someone is in trouble but can still float, signal for help, and act, they are not drowning yet — they are just distressed. Drowning means someone is unable to breathe and could die very quickly.

Forensic doctors find it hard to tell if someone died from drowning. Looking at the body 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 stopped with the right steps. Here are some important ways to help prevent drowning:

• Learning to swim: Knowing how to swim is a great way 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.
• Knowing about health conditions: Some health issues 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.
• Following warning signs: Signs, flags, and advice about water safety are there to keep everyone safe and should always be followed.

Water safety

Water safety means doing things to stop people from drowning or getting hurt in water.

Time limits

Further information: Drowning § Pathophysiology

How long a person can stay underwater safely depends on many things. These include how active they are, how many breaths they took before going under, their health, and their age. Usually, a person can stay underwater for about one to three minutes before losing consciousness. Around ten minutes, serious harm can happen. In a very rare case, someone was helped after being underwater for 65 minutes.

Management

Rescue

Getting someone out of the water fast is very important if they are drowning or missing. Drowning can happen quietly without loud noises.

Rescuers should stay safe. They can help from a boat, dock, or land nearby. The best way is to throw something that floats, like a life ring or big branch. Do not 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.

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 can breathe on their own when they reach the hospital usually get better. Getting help quickly helps people recover well.

Staying underwater for a long time makes it harder to survive and can cause problems with the brain. Dirty or very cold water can also make things worse.

Younger people, like 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 sometimes, problems like trouble with memory might show up later.

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 many deaths each year around the world. Most of these happen in countries with fewer resources. Drowning is a common reason why young children die, especially those under 12 years old. In the United States, many people under 20 die from drowning each year.

Boys are more likely to drown than girls. This may be because boys sometimes 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 one of the biggest reasons 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. 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.
• Near drowning: when someone almost drowns but survives.
• Passive drowning: when someone suddenly sinks underwater because of an accident or health problem.

Dry drowning

Some people believe that children can die from drowning hours or days after being in water. But doctors say this is not true. They say drowning is when someone has trouble breathing after being in liquid. They no longer use the term "dry drowning" because it causes confusion.

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 feels slower. After trying to hold their breath, they might feel pain when water gets into their lungs. This pain can happen no matter what kind of water it is.

After the pain, many people feel calm, peaceful, or even happy. They might see things that are not really there. These feelings happen because the brain is not getting enough oxygen, which changes how the brain works. These experiences can be different for each person, depending on how fast their oxygen levels drop.