Not all drowning is fatalJonathon Webber

The drowning problem

A snapshot

• Drowning claims the life of one person every 1.5s

• Where lifeguard services operate, <6% of persons rescued require

medical attention and only 0.5% require CPR

• Where bystanders are involved, almost 30% of persons rescued

require CPR

• Epidemiologic data lacks reports for >94% of non-fatal incidents

• The highest burden of drowning is in low/middle-income countries

Drowning in New Zealand

Drowning hospitalisations

Possible explanations

• Increased awareness amongst parents/caregivers to seek

medical attention

• Lower threshold for ambulance staff to transport to hospital

• Consequence of fatal drownings declining

• Something else??

Framework

Drowning Chain of Survival

https://1drv.ms/f/s!AiPJvRcAPrGjsBZgEQTbz1v_yUCg

Back to basics

Drowning definitions

Drowning is the process of experiencing respiratory impairment from

submersion/immersion in liquid

• Drowning outcomes are fatal or non-fatal

• Non-fatal drowning is then further classified as with or without

morbidity (injury)

• Obsolete terms include: near, dry, wet, delayed and secondary

drowning

WHO draft position statement

https://www.who.int/violence_injury_prevention/drowning/non-fatal-drowning/en/

Types of respiratory impairment

Respiration was impaired due to submersion/immersion in liquid, and

immediately after the drowning process stopped the person was:

1. Breathing, experiencing involuntary distressed coughing, and was

fully alert (Mild – 1)

2. Having difficulty breathing and/or was disoriented but conscious

(Moderate – 2)

3. Not breathing and/or had become unconscious (Severe – 3)

Case study one

A survey respondent indicates that their child was in distress in the water and

had difficulty breathing immediately after they were pulled out of the water.

The respondent states that their child has more difficulty completing daily

activities such as school work than prior to the drowning incident.

Case one is a non-fatal drowning. The correct categorisation of case one is

having had moderate respiratory impairment at the moment that the

drowning process stopped, and some morbidity at the time of measurement.

Category: 2B

Case study two

The respondent indicates that they experienced distress in the water and

were told they were not breathing and were unconscious immediately after

the drowning process stopped. At the time of measurement, the respondent

indicated that their functional capacity was the same as prior to the incident.

Case two is a non-fatal drowning. The correct categorization of case two is

having had severe respiratory impairment at the time the drowning process

stopped, and no morbidity at the time of measurement.

Category: 3A

https://www.notoutofthewater.com/

Red flags

Further advice

If you notice behaviour changes up to 4 hours after a child has

left the water, seek medical help immediately

• There have been no recorded cases of normal, healthy

children who suddenly die because they went swimming

days earlier

• Symptoms that appear unexpectedly, much later, are likely

unrelated to the drowning episode and should be

evaluated as such

First aid management

Considerations

• Patients often froth. Do not

suction; apply the mask and

leave the froth to go in and out

with the oxygen

• Be prepared for vomiting

• Most post-drowning "collapse" is

due to physical exhaustion

• Hypothermia occurs in summer

Dead heroes cant save lives

Bystander rescue

• In many case reports it is the person in distress that survives, and the rescuer

that fatally drowns

• Avoid entering the water if possible. Only enter the water with some form

of flotation

• Always use non-contact tows. Remember, you are a source of buoyancy to a

drowning victim

• In most cases, providing flotation to the patient will interrupt or stop the

drowning process

Drowning resuscitation

General principles

• Start CPR on any person located within

60min of being reported missing*

• Prompt initiation of rescue breathing

and basic life support is more

important than defibrillation

• Regurgitation occurs in >40% of cases;

be prepared for it

• Submersion time is the most powerful

predictor of outcome

Drowning resuscitation

Initial assessment

• Assess patients in a supine position

• Perform CPR for ~1min and then attach an AED if resources

are limited

• If regurgitation occurs, quickly roll the patient onto their side

and allow the water to drain out. Resume CPR without delay

• Chest compression-only CPR is not recommended

Conclusions

Take home messages

• The drowning toll is heading in the right direction, but we can do better

• Seek medical help immediately for any non-fatal drowning patient

displaying any of the warning signs: www.NotOutOfTheWater.com

• People who have drowned and showed minimal symptoms after leaving

the water either get better or worse within 2-4hrs

• Chest compression-only CPR does not address hypoxia

• The prevention of drowning will always be a better cure than

resuscitation from it

www.surflifesaving.org.nz