It's late April. The weather is warming up. Time to have "the talk"
"There are two times in your life when you are at the greatest risk of drowning. The first is when you are 5 years old or younger." The second time in your life when you are at greatest risk is when you are between 15 and 25 years old and are male.
Young children die because they are left unattended or are poorly supervised near a swimming pool or a bathtub. Those males who are 15 to 25 years old tend to drown during recreational activities such as social events at rivers, lakes and beaches. "Alcohol or illegal drugs are often involved. More than 50% of adult drowning deaths are believed to be alcohol-related."
Yes, no matter how often and how intensely parents are warned about the dangers of drowning, our kids still suffer tragedies every single year.
Let's look at some basic information and the stats before we go into the talk about drownings and near drownings and secondary drownings. I want to make sure that you understand that the effects of near drownings and secondary drownings can be life-long and debilitating although most kids do "just fine". And, if you're unaware of secondary drownings, you are certainly exposing your child to serious consequences.
What happens during drowning? What happens after the initial gasp? When the drowning process "begins, a part of the air passage (larynx) closes involuntarily, preventing both air and water from entering the lung. In 10-20% of cases, hypoxemia (low level of oxygen in the blood) results because the larynx spasms and stays closed". This is called "dry drowning" because no water gets into the lungs. "Hypoxemia also occurs in "wet drowning" when the larynx relaxes and water enters the lungs." Vomiting can occur and the stomach contents can be breathed into the lungs.
- Within 3 minutes of submersion, most people are unconscious and within 5 minutes, the brain begins to suffer from the effects of no oxygen. An abnormal heart rhythm begins and culminates in cardiac arrest where the heart stops beating. Those who have near-drowning experiences, often suffer from heart rhythm cardiac issues
- Whether "dry" or "wet" drownings occur can depend on whether the event took place in fresh or salt water. Only a small amount of water, in either condition, is necessary to damage the lungs. [Medical authorities make a great distinction between salt and fresh water ingestion.]
- When water is taken into the lungs, it washes away the thin coating which bathes the inside of the lungs creating breathing problems which causes acute respiratory distress and impacts the lungs, heart, brain and nervous system.
- Low flow of air into the lungs leads to loss of blood to extremities and the brain. The brain swells. Brain swelling leads to about 20% of near-drowning victims causing neurological damage. It's the number 1 reason why near drowning victims cannot be revived after rescue.
- Between 2005 and 2014, there were an average of 3,536 fatal, unintentional drownings (not boating related) ANNUALLY in the US...about 10 deaths per day. This is about the same number as deaths related to Sudden Infant Death Syndrome (SIDS). Additionally, 332 people die each year in boating accidents. Fully 20% of those who die from drowning are kids 14 years and younger.
- Like SIDS, drowning is a quiet death.
- 350 kids under the age of 5 drown in pools nationwide every year.
- In California, Florida and Arizona, drowning is the leading cause of accidental death in children under the age of 5.
- Most deaths of all ages occur in June, July and August and happen in backyard pools.
- An additional 2600 kids are treated in hospital ERs for near drowning incidents, some of which lead to permanent brain damage.
- The costs? Submersion victims have an initial hospitalization cost that ranges from $2000 for a person who fully recovers to $80,000 for a person with severe brain damage. It is not unusual for a severely brain damaged victim to have initial hospital stays of more than 120 days (that's 4 months) with expenses nearing $200,000. This is only the initial hospitalization, the costs for lifelong care for severely brain damaged near-drowning victim are incalculable.
For those who I call the "Teeny Weeny Jelly Beanies", the under 5 set, the situation is especially dangerous. Here's what we know:
- About 75% of the submersion victims were between 1 and 3 years old.
- About 65% of the submersion victims were boys.
- Toddlers are at particular risk. Why? They often do the "unexpected because their capabilities change daily". Don't trust them ever ever ever...they are rascals.
- Most were being watched by parents. At the time of the incident, most victims were being watched by one or both parents.
25% were seen in the yard or porch or patio.
31% were in or around the pool before the accident.
- A whopping 69% of the kids who went under were NOT expected to be in or at the pool, but were found in the water.
Most accidents happen fast. A child can drown in the amount of time it takes to answer a phone. 77% of the victims had been missing from sight for 5 minutes or less.
Seconds count. Survival depends on how quickly the child is rescued and the breathing process can be started. Restarting the breathing should take place while the child is still in the water in order to reduce the impact of brain damage.
Drowning is quiet. Like Sudden Infant Death Syndrome, drowning is a quiet event. There's no splashing to alert anyone that the child is in trouble
Of those millions of residential swimming pools, 35% had diving boards, 8% had pool alarms (WHHHAATTT??), 25% had safety cover and only 3% of the above-ground pools had pool alarms. I guess folks value "fun with diving board" than they do safety. Let's re-work these priorities...
Near-drowning is described as "almost dying from suffocating under water. It is the last stage before fatal drowning". It is the case that "near-drowning victims still required medical attention to prevent health-related complications". This kind of incident can be referred to as "wet" or "dry" drowning and some forms of "secondary drowning".
"During near-drowning, your body is cut off form oxygen to the point where major body systems can begin to shut down from the lack of oxygen flow." For children, this can take seconds and usually takes longer in adults.
Someone who has experienced near-drowning may be unresponsive. They may also have cold or bluish skin, abdominal swelling, chest pain, cough, vomiting and of course, shortness or lack of breath.
If you encounter this situation, it is recommended to do the following:
Because hypothermia (being very cold) makes it difficult to detect a pulse, look for one for 1 minute before starting CPR. Start chest compressions (CPR) for one minute before calling 911 if you are the only one on the scene. If there are two of you, start CPR while the other person is calling 911.
They may have suffered a spinal cord or neck injury so be careful. Remove their wet clothing and cover them with a blanket to avoid hyperthermia. The Heimlich maneuver does not help.
Those who are "doing well" 8 hours "after rescue can be safety sent home with nothing more than a follow-up call or evaluation visit".
I won't go into the ER treatment but it is aggressive and very invasive, as you can imagine. ER staff face issues related to respiratory arrest, cardiac arrest, respiratory failure, seizure activity, incident-related injuries such as bleeding and broken bones as well as head trauma, hypothermia, and maintenance of blood sugar levels. It's all hands on deck when a near-drowning victim is brought in due to the many body systems failures that happen simultaneously.
"Neurocognitive outcomes of children after drowning incidents cannot be accurately predicted in the early course of treatment."
Near-drowning victims are likely to have a poor outcome if:
- They have spent more than 10 minutes under water (30-45 seconds yields the optimal outcome
- It has taken more than 10 minutes to give them basic life support. (Delays in EMTs/ambulances, etc.)
- They have a score on the Glasgow coma scale of 5 or lower. (You can't be given a score lower than 3. Obviously, a 5 represents very severe impairment.)
- They are younger than 3 years.
- They have persistent arrested breathing (stop breathing) or require frequent CPR in the ER.
- The water in which they were immersed was warmer than 50 degrees Fahrenheit.
The reason the water temperature is an issue is because cold water can actually reduce the more dangerous effects of near drowning by preventing or delaying hypoxia (lack of oxygen) and setting off the "diving reflex" which "is a primitive bodily reflex (especially in children) that shunts blood from the extremities to the vital organs".
If they arrive at the hospital without a heartbeat, 35% to 60% will die in the emergency department and all of those survivors have permanent disabilities.
Early rescue (within 5 minutes of submersion) and prompt CPR (within less than 10 minutes of submersion) is the best guarantee of a full recovery.
The long term issues are those consistent with anyone, whatever the cause, who experiences severe brain injury. Here are the issues:
- Paralysis: quadriplegia, hemiplegia
- Difficulty with reflexes including swallowing and needing to have a feeding tube and likely, a catheter to urinate.
- Seizure activity
- Frequent infections
- Orthopedic injuries
- Permanent vegetative state.
Long-term care, possibly requiring out-of-home placement, costing $350,000 for round-the-clock care is likely. State facilities have an average expense of $150,000 a year.
It doesn't look like "regular drowning", so parents are not alarmed. Here are the warning signs to look for even hours after you've left the beach or pool:
- "Difficulty breathing, coughing, chest pain, or throwing up. Look for rapid and shallow breaths, nostril flaring, or a pronounced gap in the ribs when breathing. These are all signs a child is working too hard to get oxygen.
- Extreme tiredness. Big-time fatigue can be a sign that the brain isn't getting enough oxygen. [And no, it's just not because the kid has been in the water all day and had that scare!]
- Any odd changes in behavior. Kids in the beginning stages of delayed drowning may be really cranky, argumentative or combative.
- Odd physical changes. Look out for blue lips or pale skin.
Very few, perhaps 1%-2% result in a drowning death. When in doubt, listen to your instincts and get to an ER fast.
- Stay within arm's reach of your child at all times in a pool or spa or whatever body of water you are bobbing around in.
- Have a pool cover, pool alarm or a fence. Fences should be at least 4 feet high.
- Never leave a child alone in a bathtub. Babies drown in bath seats.
- Never leave toys in a pools as they can attract children to them.
- Keep kids away from wells, creeks, ponds, streams, landscape features.
- Don't drive on flooded roadways.
- Don't drink alcohol and swim.
- Teach everyone how to swim! USA Swimming has a Make a Splash Campaign. Check it out to see where your child can take swimming lessons.
- Empty inflatable or plastic kiddie pools and turn them over after each use to keep rain from collecting,
- Install alarms around windows and doors if you have a pool or live near water.
- Keep toilets seat and tops down.
- Have rescue materials and a phone nearby when swimming.
- If a child is missing, look in the pool first.
- Take CPR classes
- Don't use flotation devices as a substitute for supervision. They're not. Those little wings, floating duckies or other pool toys aren't a substitute for you being there.
- Store buckets out of the way of young children.
- Don't put a bath seat in tubs with slip-prevention strips as the suction cups can detach unexpectedly.
- Teach grandparents or other caregivers about the consequences of "secondary" drowning.
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