NON-FATAL DROWNING: MORE THAN IT SEEMS

Contrary to popular belief, drowning doesn’t stop when a casualty is out of the water. NSRI’s head of Lifeguarding, Stewart Seini, tells us more.

EARLIER THIS YEAR I went to dinner at friends. There were numerous couples there, all with small kids, and I was talking about my work at Sea Rescue, as well as the medical drowning research I do with the International Drowning Research Alliance (IDRA).

One of the parents who was listening told me about an incident that happened a few months before, at a child’s pool party. ‘One of the children had a near drowning. They pulled the child out of the water – he was coughing, he was incredibly tired, but after about an hour he was himself again and back to having fun!’ By this time, some of the other parents had started listening to our conversation.

I turned to the person and said, ‘You know that child was still drowning for that full hour after he was pulled from the water?’

The room went quiet and the conversations in the background stopped – understandably so, it was quite the statement. The parents that had been chatting around us were now looking at me, a bit shocked. Some may not have been quite convinced by what I said. I later found out that most of them had had a similar experience in the recent past.

‘But the child was alive and, apart from being tired and having a cough, he was fine. Isn’t drowning when you die?’ the parent responded.

This is not the first time I’ve heard this.

COMMON MISCONCEPTIONS

When it comes to drowning, it is important to understand that drowning is not the outcome, but the process the patient goes through that ends up either being fatal or non-fatal. This process starts with respiratory impairment from submersion or immersion in water and the outcomes are simple. You either drown and survive with or without a degree of brain injury, which is referred to as a non-fatal drowning. Or you drown and die, which is referred to as a fatal drowning.

Think about anyone you know who has had a heart attack or a stroke and survived. We don’t say the person had a near heart attack or a near stroke. The same applies to drowning. There’s nothing ‘near’ about what has happened to that child at the pool party, or to anyone else who has had a drowning incident and was conscious afterwards. In simple terms, the child drowned and survived. The misconception tends to be that once the person is out of the water and they seem okay, the drowning incident has stopped, and we mistakenly call such an incident a near drowning.

If we look at what was happening to that child, he had a small amount of water in his lungs that was causing irritation and alveolar damage. This resulted in a decrease of oxygen absorption, which in turn, deprived the brain of oxygen. Consequently, the child had a cough, and was irritable and tired. What the child really needed was supplemental oxygen.

WHAT REALLY HAPPENS

Drowning is a lack of oxygen to the brain, with lung complications. We don’t use the terms near drowning, dry drowning, delayed drowning or secondary drowning any longer, because the drowning process begins when there is respiratory impairment, no matter how small, and doesn’t stop until the drowning process has ended by the brain receiving a sufficient amount of oxygen. Secondary to this, high-flow supplemental oxygen allows the surfactant in the lungs to regenerate, enabling the lungs to transfer oxygenated blood to the brain and vital organs.

Because the term near drowning or secondary drowning has been used so often in the past, the misconception has been created that the drowning incident is over when the person is out of the water, is conscious and seems fine. The assumption is that the person is probably acting differently because it was a traumatic event, and that they simply need some time to ‘walk it off’ or rest. But the reality is that the person needs supplemental oxygen to re-oxygenate the brain. We always teach our rescuers that the patient doesn’t stop drowning when they are on the boat or on dry land – the patient stops drowning when they get oxygen to the brain.

The other misconception is that the lungs fill up with water. But we typically see very little water in the lungs. Yes, that small amount of water that enter the lungs does cause problems. Oxygen uptake is decreased due to the alveolar damage, and this causes a lack of oxygen to be delivered to the brain. So when the paramedics arrive or you take the child to hospital, the immediate treatment is supplemental medical oxygen – and it’s not only to treat the injury to the lungs, but also to get oxygen to the brain as quickly as possible. That’s why when the child I mentioned at the beginning of this article was coughing and feeling incredibly tired, he had a lack of oxygen to the brain, causing him to be tired and irritable. He was in fact in need of additional medical treatment.

Luckily, in his case, the incident wasn’t too severe: he was pulled out of the water quickly having very little water enter his lungs and after an hour of being able to get sufficient oxygen to the brain, he was fine, although the surfactant in his lungs damaged by the water probably took about a day to regenerate fully. But many people aren’t this fortunate, and the injury to the brain can be severe enough to last a lifetime.

THE TRUE PICTURE

With summer around the corner, children will be attending pool parties; families will be having braais at the poolside, camping next to a river/dam, or going to the beach. It’s so vital that, when they do, there is a dedicated person to watch the kids in the water and know the signs of a person that is drowning.

We are so used to the movies, where someone who is drowning would be splashing on the surface of the water and calling for help, generally making a big scene – but in most cases drowning is silent and there is no splashing or calling for help. The person usually looks like they are treading water but making no headway, their body would be vertical in the water, mostly, with their head tilted back. The brain would go into survival mode by prioritising muscle movements to keep the body and head above water – the person won’t always be able to call for help and might not even respond to you if they are in trouble, because their brain is focusing on the task at hand, which is to keep the head above water. After a certain amount of time, usually 20-60 seconds, the person’s head would start dipping below the surface. It is a common occurrence for drownings to happen among groups of people without others being aware of it, because the individual in trouble does not act like drowning victims we see on TV and in films. That’s why simply being near the pool when kids are in the water is not the best prevention method – it is much more effective to have a dedicated person (even taking turns to supervise in shifts), because they can watch out for those silent signs of drowning.

If you suspect a child has had a drowning incident, look out for the following common signs. If they display any of these signs or if you are unsure, call an ambulance or get the child to hospital as soon as possible:

▶ Coughing

▶ Vomiting

▶ A small or large amount of foam from the nose or mouth

▶ Shortness of breath

▶ Chest pain

▶ Dizziness

▶ Behaving out of character

▶ Tired

▶ Confused

▶ Irritable

▶ Aggressive

The story about the child who had a non-fatal drowning is all too familiar; we all know someone, ‘a friend of friend’, who has experienced a similar situation. Some children have survived and some have not. The purpose of this article is not to scare parents from letting their children swim, attend pool parties or enjoy a beach day, but to increase awareness and understanding, and to help identify the symptoms of non-fatal drownings.

It’s what we do.