Drowning

Some facts

Drowning is important: 1,000 people drown every day, 2 every 3 minutes, 41 per hour. It is the world’s 3rd leading cause of accidental death: 3.6 million people over 10 years.

Disease of youth

  • 64% < 30 years old
  • 43% < 15 years old
  • 25% < 5 years old

Male: female ratio 2:1

In 40%, alcohol is on board

4 stages of Immersion associated with particular risk in drowning

Initial Responses/Sudden Death (first 3-5 min)

  • Skin cooling

Short-Term Responses (5-30 min)

  • Superficial Nerve and Muscle Cooling

Long-Term Responses (30 min +)

  • Cooling of deep tissues

Post-immersion (during rescue)

  • Collapse of arterial pressure
  • Continued cooling

Fresh versus salt water drowning

Lethal aspiration of salt water 22ml/kg (approx 1.5 litre), fresh water 44ml/kg

Be aware that drowning can take up to 4 hours – observe and watch for 6!

Prognostication

Better outcomes:

  • Rescued and BLS commenced < 5-10 min
  • Children
  • Those who have not aspirated
  • Water temperature < 10 oC, core body temperature 33-35 oC
  • Neurologically intact on arrival at hospital
  • Minimum blood pH > 7.1, blood glucose < 11.2mmol/L
  • ROSC on scene
  • Spontaneous ventilation in ED

Worse prognosis

  • Risk of death or severe neurological impairment after hospital discharge is reported to be nearly 100% when the duration of submersion exceeds 25 min
  • Following 30 mins resuscitation, if no signs of life, resuscitation is futile -> stop

It is important to remember that casualties who have entered water sometimes have access to a “bubble” of air – particularly if they had entered the water following a boating incident or were in a car at the point they entered the water. In these circumstances it is impossible to judge the point at which submersion has occurred. 

What about cold water???

This is a regular point of discussion and concern. Water temperature is a key determinant: icy versus not. In the UK sea water is very unlikely to be icy or cold enough – however, small areas of water may well be, particularly in the winter months. 

References

  • Szpilman D, Bierens JJ, Handley AJ, Orlowski JP (2012) Drowning. New Engl J Med. 366: 2102–10. 
  • Tipton & Golden (2011). Decision making guide for immersion incidents involving total (head under) submersion. Resuscitation. 82: 819-824.
  • Golden & Hervey, 1981 
  • Oakley & Pethybridge, 1997
  • Tipton 2016
  • Bierens 2014. Handbook of Drowning.