Understanding Fatal and Non-Fatal Drowning

No, you can’t drown days after a water incident, but the risks of nonfatal drownings are very real. Here’s how to stay safe.

Every summer, it seems like new—and frightening—cases of “dry drowning” or “secondary” drowning pop up on TV shows, news reports and social media. These accounts are often accompanied by claims that a child can die days or even weeks after a scary water-related incident.

But what are dry and secondary drowning? And do we really need to worry about them?

“There is no such thing as dry drowning or secondary drowning, and neither term has any medically accepted or published definition. It’s all just drowning,” says Justin Sempsrott, MD, Medical Director of the Emergency Department, West Valley Medical Center in Caldwell, Idaho and Executive Director of Lifeguards Without Borders. “Most cases are advertised as a child being pulled out of the water and they were 100 percent normal, then mysteriously became ill later. But there haven’t been any published cases of that.”

Unpacking misleading terms about drowning

Although they lack a medical definition, the terms “dry,” “delayed,” “secondary,” “near,” “wet,” “active,” and “passive” drowning are frequently used both by providers and the lay media to describe patients who have some degree of respiratory difficulty after being in the water, but are still alive. Here are some of the commonly used terms:

  • Dry drowning: You may have heard this term used to incorrectly describe a drowning on dry land that occurs sometime after being immersed in water. Although that process is incorrect and does not occur, dry drowning was actually a medical term once used to describe drownings where a person is underwater, but liquid does not enter the lungs. It was thought that, in these cases, the airway would close (a condition called laryngospasm) and a person would suffocate. However, laryngospasm rarely is the primary cause of drowning—when a person loses consciousness while drowning, the airway opens up again. Plus, regardless of whether water enters the lungs or not, it is still considered drowning, because it was caused by water immersion.
  • Secondary drowning: Sometimes also referred to as “delayed drowning,” this term is used to describe water entering the lungs with symptoms of drowning worsening over time. Some stories claim symptoms can appear days later, but in those cases, they’re likely due to another cause. This term is also confusing because it incorrectly implies that drowning victims have gone through a second immersion under water.
  • Near drowning: Because drowning is typically associated with death, “near drowning” has been used to describe a drowning incident that the person survived.

The World Health Organization (WHO), International Liaison Committee on Resuscitation (ILCOR), American Heart Association (AHA), and all other major resuscitation bodies define drowning as the process of respiratory impairment after submersion or immersion in liquid, with outcomes ranging from no injury to death. Drowning is a process, not an outcome.

Most importantly, drowning is caused by lack of oxygen, not the amount of water entering the lungs, as is often believed. In other words, these terms miss the point and simply don’t make any medical sense, Dr. Sempsrott explains: “I frequently give the example of someone who had a stroke or a heart attack and survived. You wouldn’t say they had a delayed heart attack or a near stroke."

So, why are these misnomers so widely used? In common use, we equate the term “drowning” with death and struggle to describe the scenario in which someone drowns but does not die. But there is a medically accurate term for these cases: “non-fatal drowning.”

What is non-fatal drowning?

Although there are approximately 4,000 fatal drownings in the United States each year, non-fatal drownings are far more common. In fact, it’s estimated that for every fatal drowning, there are at least five non-fatal drownings that require medical care. According to Sempsrott, some international studies report as many as 10 non-fatal drownings for every fatal drowning.

Though we commonly think of all drowning persons as having been completely under the water (submersion), drowning can also occur if there is respiratory impairment from water splashing in the face (immersion). Drowning incidents happen during whitewater rafting, as well as in heavy ocean surf, wave pools, or waterslides, where the person takes in water even though their head is above the water.

After someone is rescued from the water, look out for symptoms like coughing, wheezing, or lightheadedness. If you also begin to notice more severe ones like irritability, confusion, headache, lethargy, vomiting, respiratory difficulties or unconsciousness, seek emergency medical care.

“If there are any symptoms, the person has drowned. It might be a mild drowning, but they should go to the emergency room or doctor where they’ll be observed for a few hours,” says Sempsrott. “An easy rule of thumb is to take them for further evaluation if they have more of a cough or respiratory difficulty than you would expect from water ‘going down the wrong pipe’ at the dinner table.”

Keep in mind: A drowning victim’s condition will not deteriorate days or weeks later without any symptoms. Respiratory or neurologic symptoms will be present as soon as they get out of the water and will either get better or worse over the next few hours. There are no published cases of someone being 100 percent normal, then later having a deterioration. If someone develops symptoms days or weeks after swimming, seek medical care. But, as Sempsrott notes, “Those symptoms aren’t from drowning—it’s something else that needs to be investigated.”

If concerning symptoms develop more than 8 hours after leaving the water, then you should still seek care, even though it was not caused by the drowning event.

Water safety tips to avoid drowning

According to the Centers for Disease Control and Prevention (CDC), drowning is the leading cause of death in children age 1 to 4, aside from birth defects. It’s also the second leading cause of unintentional injury-related death in children age 1 to 14. But it can occur at any age, due to a variety of risk factors.

Some ways to reduce drowning risk include:

  • Supervising your child at all times: Children younger than 5 should be under constant supervision around any amount of water, not just places like bathtubs and pools. Toilets, sinks, buckets, puddles, coolers with melted ice, trash cans, and wading pools can all pose a drowning threat. Containers filled with water should be emptied immediately. Young kids should be under “touch supervision,” or within reach at all times. Older kids should be under uninterrupted supervision, meaning adults shouldn’t be reading, napping, looking at their phone, eating, or performing any other distracting activities while their child is swimming.
  • Creating barriers: Using secure pool fencing, load-bearing pool covers, and locks on pool access points can prevent unsupervised access.
  • Enrolling your child in swim lessons: Formal swimming lessons have been linked to reduced downing risk in children age 1 to 4.
  • Learning CPR: Parents should enroll in a CPR class and encourage family members, babysitters, or anyone else who may supervise their child to do so, as well. Kids age 1 to 4 are at the highest risk for drowning when they’re not being supervised by their primary care provider, according to Sempsrott.
  • Wear a lifejacket: Even if you have strong swimming skills, life jackets can reduce the risk of open-water and boating drownings.
  • Stay alert in open water settings. There is a risk of drowning in lakes, rivers, and oceans for both children and adults, often due to inability to predict currents in open water. If waves look too rough or water is moving too quickly, don’t swim. Obey all beach flags, especially when they advise against going into the water.
  • Avoid alcohol when swimming: A cold beer at the beach may sound relaxing, but drinking before swimming, boating, or participating in water sports increases the risk of drowning. Adults supervising kids around water should never consume alcohol.
  • Supervise elderly family members in the bathtub: Rates of elderly drownings are rising due to the sedative effects of certain medications, according to Sempsrott. It’s important to supervise elderly family members while they’re in the bathtub or pool. Use similar care with people who have seizure disorders or other medical conditions where loss of consciousness can occur.

“Prevention is the most important treatment for drowning,” says Sempsrott. Remaining vigilant and taking the proper steps to reduce the risk of drowning can protect you and your loved ones from both fatal and non-fatal drowning.

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