Drowning occurs when an individual is immersed in water and takes water into their lungs, subsequently not being able to breath. Drowning is divided into delayed drowning or secondary drawing and immersion incidents. For Survive Outdoors, we are going to limit this to drowning and dry drowning incidents.
There are about ten drowning deaths per day in the United States. Approximately one in five deaths from drowning are children less than 14 years of age. An additional 613 people die yearly from boating-related incidents.
There is a large difference from fresh water drowning and saltwater drowning. For more involved patho-phisiology of drowning, I advise reading, Wilderness Medicine by Auerbach. In general, saltwater drowning has a higher mortality than fresh water incidents. The reason for this is that sea water has a osmolarity ( A higher concentration of dissolved particles ie sodium in the case of saltwater ) 4 times higher than fresh water. This will cause a transfer of plasma into the small sacs of your lungs call alveoli. This results in lung swelling or pulmonary edema.
Shallow water blackout is an event where an individual hyperventilates before they enter the water or they hold their breath for a period of time. This is common among snorkelers, spear fishing enthusiasts, etc. Hyperventilation reduces arterial carbon dioxide pressure without increasing oxygen storage. During swimming activity, the body starts using stored oxygen in muscles before the classic carbon dioxide stimulus tells you to breathe, causing one to return to the surface to breathe. When this occurs, the victim usually blacks out and a drowning episode occurs. It is never advisable to hyperventilate before swimming. How many times have you seen teenagers and children compete with how far they can swim underwater? This is exactly the scenario that could exacerbate a shallow water blackout and death.
The statistics are sketchy on this scenario, but approximately 15-20% of individuals who drown have what is called, “dry drowning”. This is specifically a laryngospasm in response to water just starting to be taken into the lungs. It is a natural physiological mechanism for the larynx to spasm, stopping the water from entering the lungs.Treatment for these individuals is the exact same for those drowning victims that do have water in their lungs. Always implement the ABC’s of the unconscious person. – Airway first, then Breathing and Circulation.
In any medical emergency, it would be awesome to be able to predict the outcome. Unfortunately, in the majority of cases, this cannot be done. Many physicians and statisticians have looked at large groups and have been able to pull some prognostic factors that impact outcome. Those factors are:
Near drowning victims who are alert, show good pupillary reflex and are not in coma should do well. Individuals who have been submerged greater than ten minutes and have treatment resuscitation lasting longer than 25 minutes have usually less than a 5% chance of recovery.
Administering CPR and assisting an individual in breathing are clearly the most important treatment interventions in victims of near drowning episodes. Mouth-to-mouth ventilation is still the treatment of choice. Attempting cardiac compressions in the water is also possible, although very difficult. I have done this on two occasions. One victim survived. Unfortunately, the other did not.
There are really no available studies to show good circulation with compressions in the water. Still, the attempt should be made if you cannot reach the shore or a boat. If you cannot implement compressions, mouth-to-mouth MUST continue.
The following treatment discussion is based on having next to nothing in the outdoors. Most of us will not have float boards. However, if you can improvise, use anything hard as that can be placed on the victims back. This can be a paddle, a boat seat, even a log that is floating around. If the victims belly is distended from swallowing too much water, expelling that is very helpful. Laying the patient on their back, head turned to the side and pushing on their belly will help. It is important to do this technique before mouth-to-mouth, as the fluid could interfere and the victim could vomit during resuscitation. This may happen anyway, however, it could be beneficial to try.
Important to note – The American Heart Association discourages the Heimlich maneuver in drowning victims unless there is a known or perceived blockage.