By Dr Penny Fraser
Our bodies are about 50-60% water, 70% of our world’s surface is covered by water and we all need to drink about 2-3 litres of the stuff per day. And here in Switzerland, we have some of the most beautiful lakes, rivers and thermal baths to enjoy.
Yet, despite its life-giving, restful, rejuvenating, fun and sporting aspects, water must be approached with caution – always.
Sadly, the World Health Organisation recently reported that 372,000 people lose their lives worldwide per year from a variety of water immersion episodes – these include falls into ponds, fountains, hot tubs, baths, buckets, as well as during water sports such as swimming, canoeing, sailing etc.
In Switzerland, 9 out of 10 cases occur in open waters (lake, rivers etc.), 7% occur in public pools and perhaps surprisingly, only 2% happen in private swimming pools. In children, drowning is the second most common cause of accidental death, with a large peak in preschool children 0-5 years old and another peak in males aged 15-24 years.
What happens when someone drowns?
Unlike the dramatic movie scenes of noisy splashing and arm waving, drowning is usually a silent, unobserved event. The reality is that a child can slip under water and drown in less than 20 seconds.
A person underwater will initially hold their breath but this will progress to involuntary gasping leading to large amounts of water being inhaled into the lungs (“wet drowning”) and swallowed into the stomach.
Alternatively, the larynx may close up (laryngospasm) and stop water going into the lungs (“dry drowning”). The larynx (the voice box) is made of cartilage and muscle and sits in the windpipe where the Adam’s apple is. It normally controls the voice and breathing and also prevents swallowed food or water from entering the lungs. In dry drowning cases, there may be no water in the lungs, but there is no oxygen going in or carbon dioxide coming out either.
In either circumstance, if the person is not quickly rescued from the water, the lack of oxygen and rising levels of carbon dioxide means that the heart will slow down and stop, i.e. a cardiac arrest.
This might all seem scary but the good news is that you can do something to save someone who is drowning. Cardiopulmonary resuscitation (CPR) is a practical skill that anyone can learn, that anyone can use to save a child or adult’s life.
“Correction of hypoxaemia (lack of oxygen in the blood) cannot wait for the arrival of trained staff…… bystander resuscitation….is the biggest single determinant of survival in….children once they are rescued”
– British Medical Journal – 14th Feb 2015
How do you give CPR to someone who has drowned?
Note: CPR is only given to someone who is unresponsive and NOT breathing. If the person is unresponsive yet IS breathing, put them into the recovery position and monitor their breathing until the Emergency Services arrive.
Check for DANGER to yourself
Do not enter the water if there is a risk to your own life.
Get the person OUT OF THE WATER
Only if you can do so safely. Use a life-ring or other equipment if available.
Check for a RESPONSE
Are you ok? Can you hear me?
Shout for HELP
Can someone phone 144 or 112 for an ambulance, please?
Open their AIRWAY
Open their mouth and tilt their head back
Are they breathing?
No? Give 2 RESCUE BREATHS
Seal your mouth round their mouth and breathe out gently for 2 seconds.
Give 30 CHEST COMPRESSIONS
Put your hands in the centre of their chest and push down hard at a rate of 100 compressions per minute
Continue giving 2 rescue breaths and then 30 chest compressions NON STOP until the Emergency Services arrive and are ready to take over, i.e. their hands are hovering over yours, prepared to perform the next chest compression.
Even if the person is very cold, blue and has no signs of life, carry on – there is evidence that drowning in cold water (0-8 °C) will cool the brain and other tissues and therefore increase their chances of survival – this is called the ‘neuroprotective effect’.
What else do I need to know?
Sometimes accidents and illnesses can be interrelated. Remember that someone might have been taken ill near, or in, the water. This might cause them to become unconscious and then drown. Examples include a heart attack, stroke, fainting, seizure, diabetic hypoglycaemia, head injury, excess alcohol intake, drug abuse and deliberate self-harm (suicide). When the Emergency Services arrive, give them as much information you can about the person’s health and circumstances.
If someone seems to be fine after a near-drowning incidence, do they still need to go to hospital?
Yes, they do. A doctor will need to check them for associated injuries and potential complications. The checks may be done just once and then the person allowed home. Alternatively, they may be required to stay in hospital for several hours, or sometimes days, to be sure that the body has recovered completely.
What complications might occur?
- Brain damage and swelling.
- Head or spinal injuries from a dive or fall.
- Infections in the bloodstream, sinuses, skin, brain, lungs etc.
- Kidney damage.
- Dilution of the blood due to absorption of excess water via the stomach or lungs.
What is “secondary drowning”?
This condition has been in the media quite a lot recently. It can occur between one to 48 hours after a near-drowning episode and is slightly more common after freshwater immersion. When water is inhaled, the normal secretions of the lungs are lost or inactivated. This means the lungs can’t exchange oxygen and carbon dioxide properly and breathing difficulties can start. A child may be short of breath, coughing, have chest pain, become drowsy or unconscious. If this happens, ensure that the child is breathing, put them into the recovery position and call the Emergency Services.
All this information might seem a little shocking but I hope it equips you with some knowledge of what might happen and how to recognize primary and secondary drowning. If you want to know more about CPR and the recovery position, take the time to attend a HealthFirst First Aid course and practice these simple steps that you can take to save someone’s life.
Dr Penny Fraser MB BS BSc(Hons) MRCS (Eng) is a British-trained Emergency Medicine doctor working at the Hôpitaux Universitaires de Genève as well as the mother of two little swimmers aged 8 and 10. She is one of the Medical Directors of HealthFirst Sàrl, who deliver unique, practical First Aid Training and Health Education in English throughout Switzerland. Contact HealthFirst for more details about how the team can come to your home, school or business to train you in these important life-saving skills. www.healthfirst.ch.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. All reasonable care has been taken in compiling the information but there is no legal warranty made as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. HealthFirst and Dr Penny Fraser are not responsible or liable, directly or indirectly, for any form or damages whatsoever resulting from the use of information contained in or implied in this article.