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Paramedic’s Corner: Helping prevent drowning deaths and near-drownings
Paramedic’s Corner: Helping prevent drowning deaths and near-drownings

Ambulance Director Gary Carmack
PULASKI COUNTY, Mo. (July 7, 2010) — How many readers have ever experienced a near-drowning event?

Medically defined, drowning is death by asphyxiation resulting from submersion in a liquid. A near-drowning indicates that death either did not occur or occurred more than 24 hours after submersion.

About 4,500 people die each year in the United States from drowning. Drowning is the second highest cause of death in the 1-14-year-old age group; only motor vehicle crashes kill more of our kids. World-wide drowning is the fourth-highest cause in the 5-14-year-old group and tenth in the 15-44-year-old age group.

Drownings occur in a variety of places and settings, including oceans, lakes, reservoirs, bays, Jacuzzis, bathtubs, swimming pools, and buckets. Yes, even buckets. I always remember when growing up my mother would worry about buckets of water sitting around. She was afraid a baby would fall in and drown. I always thought to myself, “Can this really happen?” When I grew older and worked as a paramedic and later as the county coroner, sadly I learned she was so very right, as mothers usually are.

Home pools, often referred to as backyard swimming pools, are the location of somewhere between 38 and 60 percent of all child drowning accidents. Home pool drowning usually occurs on weekends and usually in the late afternoon and evening from about 4 p.m. to 6 p.m. Frequently, the pools are fenced and the drowning occurs in the family's own pool. Interestingly, the scenario often goes like this: a child is discovered to be missing. One or both parents are home. Surprisingly, the pool is one of the last places searched and the child is found floating face down on the top or the bottom of the pool. Often efforts are made to remove the child from the pool and resuscitation is started at the same time the paramedics are called.

What happens when a human drowns? What causes the event to happen in the first place?

Usually something goes wrong, such as swallowing of water, panic, fatigue, inability to cope with currents, injuries, or cold. A person could have a seizure in a bathtub and drown. After something goes wrong, there is intense panic and loss of control, inefficient breathing, decreased buoyancy, exhaustion, and cardiac or respiratory arrest.

A few comments on the pathophysiology of drowning are needed to understand what happens. Following submersion, if drowning people are conscious, they will go through a period of apnea (temporary absence of breathing) for a few minutes as an involuntary reflex as they struggle to keep their head above water. During this period of time, the blood is shunted to the heart and brain because of a naturally occurring process called the mammalian diving reflex. This reflex is a complex cardiovascular response to the nose and mouth being submersed in the water. This reflex causes the heart to beat slowly and allows the brain and heart to be maintained. This is where the common saying in emergency medicine comes from: “The cold-water drowning victim is not dead until warm and dead.” In other words, a person who has been submerged in cold water may only appear to be dead. However, due to the extra supply of oxygen supplied to the heart and brain, the person may indeed still be alive. However, in a disquieting warning for parents, tragically 20 percent of children who do survive have devastating and permanent neurological disability.

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