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Background[]

  • Drowning is not always a fatal event. Some people die as a result of drowning, while others survive with serious, life-long injuries, or none at all. Thus, the term “drowning” should not be used to imply death.
  • According to the World Health Organization: Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes are classified as death, morbidity and no morbidity. Agreed terminology is essential to describe the problem and to allow effective comparisons of drowning trends. Thus, this definition of drowning adopted by the 2002 World Congress on Drowning should be widely used.


Links[]

Media[]

  • http://www.bbc.com/news/health-31008206 Every year, nearly 400,000 people round the globe die by drowning, making it one of the world's most common causes of accidental death. From BBC in 2015.
  • EMRAP_DROWNING Podcast of a story of an emergency room visit concerning a child accident.

Insights[]

Misconception. No such thing as dry-drowning.[]

Silent epeidimic[]

From the Washington Post, By Editorial Board:

IN AN AGE of ethnic conflict, fatal disease and chronic malnutrition, it seems strange to stumble across figures such as this: 388,000 people die every year from drowning, according to the World Health Organization . To put this number in perspective, drowning accounts for nearly 1 in 14 injury-related deaths worldwide. It is the third-leading cause of unintentional death. It is also the greatest cause of injury and unintentional death among children younger than 5 in both the United States (also known as USA) Flag of the United States and Asia. This is a problem that traverses the developed and developing worlds.

Predictably, however, those from poorer countries are at higher risk: The rate of death by drowning in Asia is 30 times higher than in the United States. In Bangladesh (also known as BAN) Flag of Bangladesh, Cambodia (also known as CAM) Flag of Cambodia, Vietnam (also known as VIE) Flag of Vietnam and Thailand (also known as THA) Flag of Thailand, drowning is responsible for 1 in 4 child deaths — more than the number who die from measles, polio, whooping cough, tetanus, diphtheria and tuberculosis combined.

What makes this public health crisis particularly problematic is that, unlike fatal disease and chronic malnutrition, drowning is not an issue at the forefront of humanitarian aid efforts. Drowning has gone largely unnoticed as a serious health matter because death counts, which rely primarily on hospital reports, fail to take drowning into account. Michael Linnan , technical director at the Alliance for Safe Children , told the Integrated Regional Information Networks that “the child drowning epidemic has been invisible.”

The Alliance for Safe Children and UNICEF’s Office of Research released a report in May that found that nearly all drowning-induced deaths are preventable. Instead of allowing this problem to languish unaddressed, governments should mobilize support for demonstrably effective and low-cost prevention strategies. The report emphasized the long-term value of teaching children over the age of 4 SwimSafe techniques — swimming and rescue training — a program that reduced drowning rates by 90 percent in a research program in Bangladesh. Building low-cost bridges and other barriers is also an effective way to protect unsupervised children from water hazards.

Gordon Alexander, director of UNICEF’s Office of Research, said that such “affordable interventions” could “save hundreds of thousands of children’s lives.” When the data are so clear and the solutions so straightforward, it is time to address what Mr. Alexander correctly termed this “hidden killer.”

Details[]

source: https://docs.google.com/file/d/0B3Ylak5R8rxwU2FyMWVtSGNTVGc/edit

Statistics[]

  • Approximately 10 people drown every day in the United States (also known as USA) Flag of the United States, according to the Centers for Disease Control and Prevention (CDC), with nearly 25 percent children younger than 14.
  • 70 percent of African-American and 60 percent of Hispanic/Latino children cannot swim, according to a national research study by the USA Swimming Foundation and the University of Memphis.
  • Only 13 percent of kids who come from a non-swimming household will ever learn to swim, the USA Swimming Foundation found.
  • African-American children drown at a rate nearly three times higher than their Caucasian peers, the CDC reports.
  • Drowning is a silent killer. Most young children who drowned in pools were last seen in the home, had been out of sight less than five minutes, and were in the care of one or both parents at the time, according to the Present P. Child Drowning study.

Terms: Near Drowning, Dry Downng, Delayed Drowning and Secondary Drowning[]

Before 2002, there were 33 different published definitions of drowning and near drowning. Some of these definitions and terms were confusing and made tracking of drowning patients very difficult. For example, if someone was rescued from the water and taken to the hospital as a “near drowning” and they died a few days later as a result of complications, cause of death may be listed as “respiratory failure” and not as drowning. From a medical and public health standpoint, the initial event that caused death was drowning, but the fatality was never listed as being caused by drowning.

To standardize and understand the reporting of drowning, the 2002 World Congress on Drowning, accepted by the World Health Organization (WHO), American Heart Association (AHA), International Liaison Committee on Resuscitation (ILCOR) and many other lifesaving, lifeguarding.

Drowning is defined as “the PROCESS of experiencing respiratory impairment from submersion/immersion in a liquid. If someone has difficulty breathing as a result of being liquid. If someone has difficulty breathing as a result of being underwater, then they have drowned.

Drowning doesn’t always end in death. Thousands of people, adults and children, drown every year and survive without any additional complications. There are also a significant number of people who suffer non-fatal drowning and as a result have severe, moderate or mild brain damage. You can think of this situation as similar to that of heart attacks or strokes. Some people who experience a heart attack will die, some will survive without complications, and some will survive with some amount of complications. The same is true with drowning.

Wrong[]

Incorrect and confusing drowning terminology includes:

  • near drowning
  • dry drowning
  • delayed drowning
  • secondary drowning

The above terms are bogus. There is no such thing as “dry” or “wet”, “delayed”, or “secondary” drowning.

There is no such thing as “near” drowning. A person who does not die from a drowning incident has suffered a non-fatal drowning and survives with either no complications or brain or other organ damage ranging from mild, to moderate to severe.

It is so important for the media and everyone else to speak the same language. With universal words and understandings, everyone can get a better understanding of the scope of the drowning problem and learn to better prevent and treat it.

To better understand the scope of the non-fatal drowning problem, use correct terminology when speaking to clients, the media, each other, and through social media.

Correct Summary of Drowning[]

Any person - adult or child - who has been in or under the water and has symptoms of difficulty breathing, excessive cough, foam or froth in the mouth, or aren’t acting right that occur immediately or within a few hours of being in the water had a non-fatal drowning and should seek care from a doctor. Symptoms usually appear immediately, but may be delayed by a few hours or get progressively worse. Onset or worsening of symptoms usually occurs within the first 8 hours of submersion.

Anyone with respiratory impairment, not acting right, excessive cough, foam, or lethargy after being underwater, even briefly, should be taken to a hospital for further evaluation.

Drowning is a spectrum ranging from mild to moderate to severe.

[]

There are numerous sources online, some from doctors and other medical professionals, which refer to outdated materials and incorrect information. In addition to incorrect use of the term “secondary” drowning, some of these sources also use other incorrect terminology such as “dry”, “wet”, or “delayed” drowning, none of which have a clear, accepted definition. Someone who has been underwater, even briefly, and has difficulty breathing, excessive coughing, is not acting right or has any other abnormal symptoms has drowned and should be taken to a hospital for further evaluation.

Position on the term[]

Links[]

NDPA.org says[]

Drowning is a leading cause of injury death for young children ages 1 to 4, and the fifth leading cause of unintentional injury death for people of all ages. For every child less than 15 years old who dies from drowning in a pool, another 10 receive emergency department care for nonfatal submersion injuries. Nonfatal drowning can cause brain damage that may result in long-term disabilities including memory problems, learning disabilities, and permanent loss of basic functions. The good news is that drowning can be prevented.

While rates of fatal drowning in a swimming pool vary with age, gender, and race, the highest rates are among children ages 1 to 4. Males are at higher risk than females at all ages.

Drowning accounts for about 10 deaths per day in the United States.[]

Exact data on non-fatal drowning is more difficult to obtain, but it is estimated that for every fatal drowning incident, there are 3 to 7 non-fatal drowning incidents. These non-fatal incidents are usually incorrectly identified as a “near drowning.” That is an additional 30 to 70 persons per day in the United States who drown and survive, some with brain damage, some without. Instead of talking about “secondary” or “dry” or “near” drowning, we should be discussing the fact that ALL drowning is drowning and the entire process needs to be better understood and studied.

Big Data[]

Our understanding of the scope of the drowning problem is complicated by additional difficulties with data collection. When collecting data, he United States Centers for Disease Control and Prevention (CDC) and WHO do not include drowning (fatal or non-fatal) incidents that occur on boats, during floods or natural disasters or by suicide or homicide. The numbers presented are simply the best estimates they can make.

In 2010, there were 12,900 visits to emergency departments (EDs) in the U.S. for drowning, which presumably excludes boating and natural disasters. Only 2,600 were admitted to the same hospital. The remaining 10,300 were either sent home or transferred to another hospital. During that same time frame, there were 3,782 drowning deaths (excluding boating, natural disasters and suicides or homicides), many of which occurred before reaching a hospital and therefore are not included in the 12,900 ED visits. This means that, conservatively, there are 6,000 to 10,000 non-fatal drowning incidents in the U.S. every year. There are likely many more, but we do not have adequate data to support such claims.

Szpilman D, Bierens J, Handley A, Orlowski J. Drowning. N Engl J Med, 2012;366:2102-2110.

Bowman SM, Aitken ME, Robbins JM, Baker S P. Trends in US pediatric drowning hospitalizations, 1993-

Villaveces A, Mutter R, Owens PL, Barrett ML. Causes of injuries teated in the Emergency Department,

2010: Statistical Brief #156, May 2013. Available at www.hcup-us.ahrq.gov/reports/statbriefs/sb156.jsp.

International Liaison Committee on Resuscitation (ILCOR). Advisory Statement: Recommended

guidelines for uniform reporting of data from drowning. Circulation. 2003;108:2565-2574.

White J. StarGuard: Best Practices for Lifeguards. Champaign, IL: Human Kinetics, 2012.

Witman D. Invited Review: U.S. adoption of the uniform definition of drowning. International Journal of

Aquatic Research and Education, 2008;2(4).

Justin Sempsrott, MD; Medical Director for SAI

Seth C. Hawkins, MD; Medical Director for SAI

See Starfish Aquatic Institute for more insights.

Insights from New Zealand (also known as NZL) Flag of New Zealand about modern Drowning Terms[]

source, 22nd November 2013, Volume 126 Number 1386 by Peter Jones, Kevin Moran, Jonathon Webber

With the New Zealand summer soon upon us, health professionals may be called upon to assist at the scene of a drowning incident. This letter seeks to update readers on current internationally accepted drowning terminology.

Drowning is a leading cause of unintentional injury resulting in death in New Zealand. Despite a declining drowning toll (n = 98 in 2012), New Zealand’s drowning rate is still higher than Australia (2.3 vs. 1.27 per 100,000), the United States and Great Britain. In 2012, 176 patients required hospitalisation (>24hrs) for drowning.2-4 On New Zealand beaches last year, surf lifeguards performed 1,645 rescues and almost 350,000 other safety interventions.5

In 2002, the World Congress on Drowning was held in the Netherlands. This meeting involved a wide range of experts in the fields of water safety, lifesaving, and resuscitation (both pre and in-hospital basic and advanced life support). Several taskforces were formed with the aim of developing an international consensus on a number of issues around the management of drowning.

Prior to this conference there was no real agreement on terminology between countries or organisations, making it difficult to interpret research or compare data. The first of the 13 major recommendations of this group was that there should be a single universal definition for drowning.

This recommendation was subsequently adopted by the International Liaison Committee on Resuscitation (ILCOR) and in 2003 a glossary of terms and definitions for a revised Utstein template, along with guidelines for the uniform reporting of data from drowning was published.6 Although endorsed by the World Health Organisation in 2005, this terminology has yet to be fully adopted by all health professionals, academics, researchers, those working in the aquatic safety field and mainstream media.7-10


Current (accepted) terminology Drowning Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid. Non-fatal drowning Survival after drowning. This is further classified as non-fatal drowning with morbidity or no morbidity. Fatal drowning Death due to drowning Other (accepted) terminology Submersion The whole body is under water. Immersion Part of the body is covered in water (for drowning to occur the face and airway would have to be immersed). Witnessed Drowning episode is observed from the onset of immersion or submersion. Unwitnessed Victim found in water, no-one saw the event. Old (abandoned) terminology Dry and wet drowning As all drownings occur in liquid, they are by definition wet. It is impossible to tell at the scene whether water has been aspirated into the lungs (and in most drowning incidents it has anyway); these terms are redundant. Active or passive drowning Replaced by Witnessed or Unwitnessed. Secondary drowning Used previously to describe both the events precipitating a drowning episode and the development of post drowning effects on the lung. Now descriptions of such events are to be explicit and this term has become redundant. Near-drowning This term has been used for both survivors of drowning and for those that died at some point in time after initial resuscitation was successful, creating confusion. This term should not be used as people either survive the drowning episode or they do not (see above). The international drowning prevention community have regarded this term as obsolete for over 10 years since drowning was defined as a process rather than a product. Just as you wouldn’t say someone had a ‘near-asthma attack’, so too with drowning.


Implications for clinical practice/recommendations—As healthcare professionals we have a responsibility to promote the use of internationally agreed terminology to the public, in our practice, in medical reports and through the media. Part of this is demonstrating that we are up to date with current international thinking. This will also help to improve the quality of the data we are able to collect about drowning and our ability to contribute to improvements in resuscitation techniques through research. We strongly encourage all healthcare professionals to start using the current terminology.

Peter Jones Director of Emergency Medicine Research Adult Emergency Department, Auckland City Hospital Auckland, New Zealand

Kevin Moran Principal Lecturer in Health and Physical Education Faculty of Education, The University of Auckland Auckland, New Zealand k.moran@auckland.ac.nz

Jonathon Webber Honorary Senior Clinical Tutor Department of Anaesthesiology, The University of Auckland Auckland, New Zealand


References:

1.University of Otago IPRU. Causes of injury by age [Fact sheet 42]. 2009. Cited 12/11/13. Available from: https://blogs.otago.ac.nz/ipru/publications/fact-sheets

2.Water Safety New Zealand. Report on drowning 2012. Wellington: Water Safety New Zealand; 2013.

3.Royal Life Saving Society Australia. National Drowning Report. 2013. Cited 12/11/13. Available from: http://www.royallifesaving.com.au/facts-and-figures/research-and-reports/drowning-reports

4.International Life Saving Federation. World Drowning Report. Int J Aquat Res Educ 2007;1:381–401.

5.Surf Life Saving New Zealand. Annual Report 2012/13. Cited 11/11/2013. Available from: http://www.surflifesaving.org.nz/organisation/about-us/annual-reports/

6.ILCOR Advisory Statement. Recommended Guidelines for Uniform Reporting of Data From Drowning: The “Utstein Style”. Resuscitation 2003;59:45–57.

7.Van Beeck EF, Branch CM, Szpilman D, Modell JH, Bierens JJLM. A new definition of drowning: towards documentation and prevention of a global health problem. Bulletin of the World Health Organization 2005;83:853–856. Cited 12/11/13. Available from: http://www.who.int/bulletin/volumes/83/11/vanbeeck1105abstract/en/

8.New Zealand Herald. 2013. Cited 12/11/13. Available from: http://www.nzherald.co.nz/near2ddrowning/search/results.cfm?kw1=near-drowning&kw2=&st=gsa

9.Langley J. New Zealand Injury Prevention Strategy: significant shortcomings after 5 years. N Z Med J 2010;123(1327). http://journal.nzma.org.nz/journal/123-1327/4466/content.pdf

10.Al-Shaqsi S. Better be prepared than sorry: what should the New Zealand healthcare system learn from the 2009 Pacific Tsunami? N Z Med J 2011;124(1333). http://journal.nzma.org.nz/journal/124-1333/4632/content.pdf

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