Drowning and near Drowning

Medical Definition:

“Drowning is death within 24hrs from suffocation by submersion in a liquid, normally fresh water or sea water.

Near Drowning is survival more than 24hrs from suffocation by submersion.

Secondary drowning is a non-specific term for death after 24hrs from complications of submersion.”

Source Patient UK article Drowning and Near Drowning www.patient.co.uk

The Drowning Process

“The Coastal and inland water of the United Kingdom remain cold throughout the year, even during the warmest summer months. These waters are often deep and frequently have strong currents. The survival time is limited for anyone who gets into difficulties in such water. Weak or non-swimmers may survive for only a few seconds in cold, deep or fast flowing water. Competent swimmers or those acclimatised to cold may be more able to get out alive, although they may simply take longer to drown.”

“Rescue should never be relied upon. Successful rescue usually depends on the presence and quick response of a skilled rescuer with some form of rescue equipment, and the ability of the victim to co – operate and not struggle.”

“Optimum conditions for rescue are seldom found, especially in those first few vital seconds before drowning occurs.”

Source: ROSPA www.rospa.com

Most drowning victims are taken by surprise and are in a state of shock, often silent and missing the shouting and arm waving as seen on TV.

There Are Typically Five Stages To Drowning:

1. Surprise

In this stage the victim recognises danger and becomes afraid. The victim assumes a near-vertical position in the water, with little or no leg movement. The arms will be at or near the water’s surface, making random grasping or flipping motions. The head will be tilted back with the face turned up. Victims rarely make any sounds; they are struggling just to breath.

2. Involuntary Breath Holding

The victim has now dropped below the static water line and the body in an attempt to protect itself, Initiates involuntary breath holding. This occurs because water has entered the mouth and causes the epiglottis to close over the airway. Though the victim may continue to struggle, he/she will not usually make any sounds as he/she cannot breathe. Without Oxygen, the victim will lose consciousness.

3. Unconsciousness

Because the victim has been without oxygen, the body shuts itself down as unconsciousness results. In this stage the victim will be motionless. Because breathing has stopped, he/she is in respiratory arrest. There is no chest movement or breathing sounds. At this point the victim sinks to the bottom of the water, either slowly or rapidly, depending on factors such as the amount of air trapped in the lungs, body weight and muscle mass. The victim will remain unconscious (and die) unless breathing is re-established.

4. Hypoxic Convulsions

Due to the lack of oxygen in the brain, the victim may look as if he/she is having a convulsion……… the victim’s skin turns blue, especially in the lips and fingernail beds………..

5. Clinical Death

The final stage in the drowning process is death……..both breathing and circulation stop. The victim is in cardiac arrest. The heart stops pumping blood. The vital organs are no longer receiving oxygen rich blood. The lack of oxygen causes the skin to turn blue.

The earlier the lifesaver begins……. (CPR)…… after the heart stops and provides defibrillation (if needed) the better the victim’s chance of surviving the incident…………After Four minutes without oxygen, brain cells begin to die, and irreversible damage occurs. This is called biological death.


Jeff Ellis & Associates www.Poseidon-tech.com

ROSPA Drowning in the UK 2002/ 427 people

39% rivers, streams

20% coastal

12% lakes and reservoirs

“The most important point that emerges from any examination of drowning is that there must be an intervention in the drowning process before the victim gets into difficulties.”

A Preventative Strategy

“The most positive way of countering drowning is to prevent entry into the water in the first place. It is essential to counter one of the factors which contributes to drowning as soon as possible and certainly before the stage of possible rescue is reached. These factors form links on what we refer to as ‘The Drowning Chain’, i.e. the possible combination of events which lead to drowning.

Any plan to prevent drowning must aim to break one of these links and so avoid the ultimate fate.

The Drowning Chain

  1. Ignorance, disregard or misjudgement of danger

An intervention is most successful if it breaks this first link in the drowning chain. Through education comes recognition and therefore avoidance of danger. The danger is then recognised, respected and avoided.

  1. Unrestricted access to hazards

The counter to the second link in the drowning chain is to deny access to the hazard. This may be done by warning of danger or by otherwise preventing potential casualties from entering into danger e.g. fencing.

  1. Absence of adequate supervision

Absence of adequate supervision can only be countered by more competent training and application. Those who guard the lives of others can only ever be totally vigilant.

  1. Inability to save yourself, or to be rescued

If the drowning chain is still intact and the victim has not been ‘saved’ while still out of the hazard, only the fourth and final link remains! Now only self rescue, or rescue by another person can avoid the worst consequences.

Although rescue is a poor option in any preventive plan, this does not mean that it should not be considered and encouraged where appropriate. Other options should have a greater priority because they have more chance of success.”

Source: ROSPA Water Safety Fact sheet August 2004