Drowning

Drowning happens when you can’t breathe because your nose and mouth are completely covered or surrounded by water. When you can’t breathe, your body can’t take in any oxygen. When your body doesn’t get enough oxygen (asphyxiation), it can lead to brain damage, cardiac arrest and death.

Drowning can happen to anyone — even people who are good swimmers. It’s the No. 1 cause of death for children ages 1 to 4. Every year, more than 260,000 people die of drowning worldwide.

The good news is 90% of drownings are preventable. It’s important to learn about ways to reduce your risk. You can keep yourself and your family safe from drowning.

What are the main types of drowning?

You may hear terms like “near drowning” or “dry drowning.” But due to a better understanding of the drowning process, providers no longer use them to describe any condition.

The process of drowning can have three outcomes:

• Fatal drowning: That means the victim died. It’s also called “drowning with mortality.”
• Nonfatal drowning without injury: That means you survived, and you don’t have any breathing issues or other health concerns.
• Nonfatal drowning with injury: That means you survived, but you experience breathing problems or other issues after you’re rescued.

Healthcare providers further divide “nonfatal drowning with injury” by how severe your breathing issues are:

• Mild: You’re fully alert and breathing, but you can’t control a severe cough.
• Moderate: You’re conscious, but you’re having trouble breathing and might be confused.
• Severe: You’re unconscious and not breathing.

What are the six stages of drowning?

Drowning deaths all follow the same process that leads to cardiac arrest. There are six stages in the process.

1. Struggle to keep the airway clear of the water

Your first instinct will be to panic. You’ll try to swim, but exhaustion will take over, and your muscles will give out. You’ll become more upright in the water, and you’ll start treading instead of swimming. You may repeatedly go under the water and come back up. Eventually, you’ll start struggling to keep your airway clear of the water. This stage may last 30 to 60 seconds.

2. Initial submersion and breath-holding

After you go under, you’ll try to hold your breath. Your breath-hold time (BHT) will depend on several factors, including water temperature, what type of clothing you’re wearing and how physically active you are. If you’re in warm water, you may be able to hold your breath for up to one minute. In cold water, your BHT is much shorter. Eventually, you’ll reach your breaking point and gasp for air.

3. Aspiration of water

When you gasp for air, you’ll take in water. You may swallow some water, but as your reflexes tell you to breathe, water may also enter your lungs (aspiration). If you aspirate water, you may feel a painful, burning sensation in your lungs. If you don’t aspirate any water, you may not feel any pain. After 30 to 60 seconds, any sensations of panic or pain will give way to feelings of peace and calm.

4. Time to unconsciousness

With time, water in your airway will result in low levels of oxygen in your blood (hypoxemia). Eventually, your brain won’t get enough oxygen. This will cause a decline in brain function and lead to a loss of consciousness. The time it takes to become unconscious depends on your available oxygen stores and how fast your body uses those reserves.

5. Time to cardio-respiratory arrest

After you lose consciousness, your blood pressure will quickly fall. Your breathing may stop, or your breaths may become irregular. Your blood pressure will eventually reach 0. Your body may continue to gasp for air as you go into cardiac arrest. Most people will go into cardiac arrest within five minutes of going under the water.

6. Death — inability to revive

For every 1.8 degrees Fahrenheit (1 degree Celsius) your body temperature drops, your brain activity, energy use and oxygen demand fall by 6% to 7%. This percentage plunges when your brain temperature reaches 71.6 degrees F (22 degrees C). The sooner you’re removed from the water and basic life support is started, the better the outcome. In one study of people who survived drowning, 88% were underwater for less than six minutes.

Is drowning painful?

It can be hard to explain what drowning feels like. People who’ve survived drowning have had unique experiences. But most people who aspirated (had water enter their lungs) used words like “painful” or “burning” to describe what they felt. Most people who didn’t aspirate said they didn’t feel any pain.

But as they slipped into unconsciousness, people from both groups often felt an overwhelming sense of peace. After the pain, they felt calm and relaxed. They had no fear. Some people described seeing bright colors, and others experienced hallucinations. These sensations may occur due to low levels of oxygen and chemical changes in the brain.

Signs of drowning

People who are rescued have a wide range of signs and symptoms. It depends on how long you were underwater. You may be alert, confused or unconscious. You may or may not be breathing. Symptoms of drowning may include:

• Coughing
• Wheezing
• Vomiting
• Fatigue
• Shallow breathing
• Blue or pale skin (cyanosis)

Drowning causes

Drowning doesn’t always look like you’d expect. Scenes of people thrashing in the water and screaming for help in the movies don’t typically happen. Instead, drowning usually occurs quickly and quietly. Most people drown within two minutes. Accidental drowning can affect anyone. The causes can vary based on age and other factors.

Infants often drown in bathtubs, sinks and bath seats. They can also drown in buckets, wells and decorative ponds. Babies can drown in as little as 1 to 2 inches of water. Most infant drowning deaths happen within five minutes of an adult taking their eyes off them.

Toddlers and children frequently drown in swimming pools. They may gain access to a pool when a gate has been left open, or there’s no fence at all. Even children who’ve taken swimming lessons may jump in and drown.

Adults tend to drown in natural bodies of water, like lakes, rivers and oceans. They may underestimate the danger or overestimate their ability to swim in these waters. Drowning may also occur after an injury, like diving in shallow water and hitting their heads.

Risk factors

Males are more than twice as likely as females to drown. This may be because males tend to engage in riskier behaviors. They may swim in unsafe areas. Or they may use drugs or drink alcohol before swimming, which can impair their judgement.

People who are less experienced swimmers are also more likely to drown. This includes those who haven’t had swimming lessons. Some of these differences may be related to culture. For example, Black children and teenagers ages 5 to 19 drown at a rate of 5.5 times higher than white children and teens the same age.

In children, certain health conditions — like autism and epilepsy — increase the risk of drowning. In people 65 and older, heart conditions and dementia increase the risk.

Other risk factors include:

• Living in a household with a low income
• Living in a rural area
• Living in a high flood-risk zone
• Having limited access to swimming lessons
• Working in a job involving water, like commercial fishing

Complications of drowning

People who survive drowning may have serious injuries and other complications. These include:

• Severe brain injury
• Permanent brain damage
• Long-term disability
• Aspiration pneumonia
• Acute respiratory distress syndrome (ARDS)

How is drowning treated?

The sooner you’re rescued, the better the outcome. Bystanders should call for help and provide a flotation device. If it’s safe to do so, they should pull you out of the water.

If they’re able, a bystander should immediately begin cardiopulmonary resuscitation (CPR). They should start with five rescue breaths to get air into your lungs. Then, they should check your pulse and start alternating rescue breaths with chest compressions.

If an automated external defibrillator (AED) is available, the bystander should remove your wet clothing and/or life jacket, place AED pads on your chest and apply a shock. They should keep you warm until help arrives.

On the way to the hospital, EMTs will provide additional lifesaving treatment, including supplemental oxygen.

Once at the hospital, healthcare providers will continue to perform rescue efforts if necessary. They may use artificial life support (ECMO) or other treatment methods.

A provider will determine the severity of your condition based on how long you were underwater and your symptoms. They may take your body temperature and measure your blood oxygen level. Additional tests may include:

• Blood tests, like a basic metabolic panel (BMP)
• Chest X-ray, to see how much lung damage you have
• CT scan, to diagnose head or spinal injuries
• Electrocardiogram, to check for heart conditions

What is the outlook (prognosis)?

Your outcome depends on several factors, including:

• Age
• Water temperature
• Time underwater
• How quickly rescue efforts were started

If you’re alert and no more than mildly confused after you’re rescued, your prognosis is good. If you aren’t breathing and/or aren’t conscious at the time of rescue, your prognosis is poorer.

If you’re unconscious when you’re rescued, you have a higher risk of developing a severe brain injury. If alcohol was involved, you’re more likely to die or have brain or lung damage. At least 3 out of every 10 children with brain damage will need long-term rehabilitation.

Can drowning be prevented?

Yes. You can prevent most drownings by following some simple water safety tips. You and/or your children can:

• Learn basic CPR and water safety skills
• Take swimming lessons
• Wear life jackets
• Install a fence that fully encloses your pool
• Swim with a buddy
• Supervise children closely when they’re in or near water