Drowning remains a significant worldwide public health concern. It ranks as the third leading cause of unintentional injury death, accounting for 7 per cent of all injury-related fatalities.

It is a particularly major cause of disability and mortality in children. At least one third of survivors sustain moderate to severe neurologic consequences.

According to the Centres for Disease Control, from 2005 until 2014 there was an annual average of about 3,500 fatal drownings (non-boating related) in the United States, or about ten deaths per day.

An additional 332 people died each year from drowning in boating-related incidents.

A 2014 national survey found that more than half of all Americans could not swim or perform basic swim safety skills.

Definitions

Exact definitions of drowning varied widely until 2002, when a group of experts at the World Congress on Drowning in Amsterdam suggested the following: drowning is a process resulting in primary respiratory impairment from submersion in a liquid medium.

Implicit in this definition is that a liquid-air interface is present at the entrance to the victim’s airway, which prevents the individual from breathing oxygen.

Terms such as wet drowning, dry drowning and near-drowning may be noted in historical references and may still be presently used, yet they have been abandoned in medical literature in favour of the general term “drowning”.

Additional classification of drowning may include the type of water in which the submersion occurred, such as freshwater and saltwater or natural bodies of water versus man-made ones.

Although initial treatment is not affected by the type of water, blood electrolyte derangements may be related to the salinity of the water and infectious complications are primarily related to whether the victim was submersed in a natural or a man-made body of water.

Consequences

In drowning, the classic image of a victim helplessly gasping and thrashing in the water is infrequently reported. The more ominous scenario of a motionless individual floating in the water or quietly disappearing beneath the surface is more typical.

Immediate threats of drowning include effects on the nervous and cardiovascular systems.

Long-term neurological sequels may vary from minor memory problems to different degrees of learning disabilities, to stroke-like deficits to a permanent vegetative state.

Cardiac complications include a slow heart rate, heart attack, damaged heart muscle and cardiac arrest. The above degree of injury depends on the severity and duration of a low oxygen level.

Thus, the most critical action in the immediate management of drowning victims includes a prompt correction of that and the associated build-up of acid in the blood and tissues.

Prevention

Prevention is key for reducing death and long-term disability from drowning. Community education is vital in promoting water safety, injury prevention and CPR initiatives.

Unfortunately, community activism often occurs only after a tragic death or injury. Here are some recommendations by different medical organisations:

• Toddlers must not be allowed near bathrooms or buckets of water without immediate adult supervision.

• Children must never swim alone or unsupervised. Adults must be well aware of their own and their children’s swimming limitations. Most pool-related drowning cases occur within the first six months of pool exposure.

• Children must be taught safe conduct around water and during boating and jet-skiing or water-skiing.

• Appropriate barriers must be used around pools and other water-containing devices at home. The absence of proper pool fencing is reported to increase the odds of pool-related drowning by three to fivefold.

• Large, inflatable, above-ground pools can contain thousands of gallons of water but because they are considered “portable”, these pools often are exempt from local building codes requiring pool fencing. Because some of these pools have soft sides, it is very easy for a child to lean over and fall headfirst into the water.

• People using a swimming facility must know CPR and have immediate access to a phone.

• Use of excess alcohol or any recreational drugs by adults is not appropriate when swimming or engaging in water sports, or when operating or riding in motorised watercraft. Appropriate boating equipment should be used, including personal flotation devices, and all boaters must understand weather and water conditions.

• Adult patients with advanced cardiac, respiratory or neurologic conditions should be closely monitored when swimming for recreational or therapeutic purposes.

•Joe Yammine is a cardiologist at Bermuda Hospitals Board. He trained at the State University of New York, Brown University and Brigham and Women’s Hospital. He holds five American Board certifications. He was in academic practice between 2007 and 2014, when he joined BHB. During his career in the US, he was awarded multiple teaching and patients’ care recognition awards. The information herein is not intended as medical advice nor as a substitute for professional medical opinion. Always seek the advice of your physician. You should never delay seeking medical advice, disregard medical advice or discontinue treatment because of any information in this article.