June 14, 2013

Drowning Victims Don’t Look Like They’re in Trouble

It’s summer, and time for a reminder that drowning is the No. 2 cause of accidental death in children 15 and younger (No. 1 is vehicle accidents). Astonishingly, about half the children who will drown in a year, according to a story on Slate.com reprinted from a blog by Mario Vittone, will do so within 25 yards of a parent or other adult.

How is this possible? Isn’t it obvious when someone is in trouble in the water? Doesn’t he or she thrash, struggle and yell for help?

Actually, no; as the story says, “Drowning is almost always a deceptively quiet event. The waving, splashing and yelling that dramatic conditioning (television) prepares us to look for is rarely seen in real life.”

The reason is physiology. The instinctive drowning response, a term coined by Francesco A. Pia, Ph.D., is how people respond when they are suffocating in the water. As Pia describes in an article in On Scene: The Journal of the U.S. Coast Guard Search and Rescue, it looks like this:

1. Except in rare circumstances, drowning people are unable to yell for help. The respiratory system was designed for breathing, and if you can’t breathe, your body makes speech a secondary concern. You have to breathe before you can talk.

2. Drowning people’s mouths alternately sink below and reappear above the surface of the water. Your mouth is not above the surface of the water long enough for you to exhale, inhale and yell for help. You have time only to exhale and inhale before your mouth starts to sink below the surface of the water.

3. Drowning people can’t wave for help. Instinct forces you to extend your arms laterally and press down on the water’s surface to leverage your body so you can lift your mouth out of the water to breathe.

4. During the instinctive drowning response, you can’t voluntarily control your arm movements. If you’re struggling on the surface, you can’t wave for help, move toward a rescuer or reach out for a piece of rescue equipment.

5. From beginning to end of the instinctive drowning response your body remains upright in the water, with no evidence of a supporting leg kick. Unless rescued by a trained person, you can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Children are particularly at risk, because they generally last only as long as 20 or 30 seconds in the instinctive drowning response.

Someone in the water who is yelling for help and thrashing probably is in real trouble, just not usually the end stages of it. They might be in aquatic distress, which doesn’t always precede the instinctive drowning response, and also doesn’t last long. Unlike true drowning, Vittone writes, these victims still can assist in their own rescue by grabbing grab lifelines, for example. But people nearby have to pay attention—there isn’t much time to help.

Other signs that people in the water are in danger of drowning:


  • head low in the water, mouth at water level

  • head tilted back with mouth open

  • eyes glassy and empty, unable to focus

  • eyes closed

  • hair over forehead or eyes

  • not using legs; vertical body position

  • hyperventilating or gasping

  • trying unsuccessfully to swim in a particular direction

  • trying to roll over on the back

  • appear to be climbing an invisible ladder

So vigilance is key—drowning people don’t usually look like they’re in trouble. They might just look like they are treading water. To find out, ask the person, “Are you all right?” If you get a vocal response, it’s probably OK. If you get a blank stare, you might have fewer than 30 seconds to get to them. Parents should remember that children playing in the water make noise. If they go quiet, get to them quickly.

For other pool safety tips, see our blog, “Surviving the Drowning Season.”

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May 30, 2012

Surviving the Drowning Season

We’re on the cusp of summer, and, unfortunately, on the brink of the drowning season.

According to the Centers for Disease Control and Prevention (CDC), drowning is a leading cause of death worldwide, and the highest rates are among children. In the U.S., drowning is the leading cause of “injury death” among children ages 1 to 4. At least half of those victims drowned in swimming pools.

Drowning death rates are higher than the rates for all other causes of death in young children except for congenital disorders.

From 2005 to 2009, nearly 6,000 people were treated annually in U.S. emergency rooms for nonfatal misadventures in the water. More than half were children younger than 4, and more than 17 in 100 were children from 5 to 14. (Among people older than 15, more than 1 in 5 water accidents were associated with alcohol use.) Half of all those emergency patients required hospitalization or were transferred to another facility for further care.

To prevent drowning, all parents and children should learn survival swimming skills—the ability to right oneself after falling into water, to swim a short distance and float or tread water. In addition:


  • The swimming environment should be protected by lifeguards, and pools should have fencing on four sides that separates the pool from the house and yard.

  • Avoid consuming alcohol when swimming, boating, water-skiing or supervising children.

  • All boaters and weaker swimmers should wear life jackets.

  • Caregivers/supervisors should be trained in cardiopulmonary resuscitation.


For additional information about drowning risk factors and prevention strategies, visit the CDC’s website about water-related injuries.

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June 16, 2011

Swimming pool safety advocates say law isn’t working

A federal law designed to prevent children – and sometimes, even adults – from being sucked in and trapped by a pool or spa drain isn’t working, pool safety advocates say.

The Virginia Graeme Baker Pool and Spa Safety Act, named for the 7-year-old granddaughter of former secretary of State James Baker, who died in a hot tub in Northern Virginia in 2002 after getting trapped by the drain, was passed by Congress in 2007. But a recent recall of more than 1 million pool drain covers designed to fix the problem – just the latest of many setbacks - highlights how difficult the implementation of the law has become, the law's backers say.

Nancy Baker, the mother whose lobbying efforts helped get the law passed, says the implementation of the law has been “botched.” The law was supposed to award more than $4 million in grants for states to bring their pool safety codes up to federal standards. Not one state has done so.

Members of Congress who supported the law complain that the Consumer Product Safety Commission (CPSC) undermined it by eliminating the requirement for automatic drain shut-off switches as an added layer of protection in some pools. Industry groups argued that the switches were unnecessary.

That decision "runs counter to both the spirit and letter" of the law, say five senators led by Mark Pryor (D-Ark), who sponsored the 2007 law in the Senate. "In single drain pools, no drain cover — no matter how large or unblockable — can protect a child from entrapment if the drain cover is improperly installed or inadvertently removed," the senators wrote in a 2010 letter to the CPSC.

CPSC enforcement of the law has also been problematic. The commission could not provide precise statistics on how many inspections have been done, but estimated that since 2009, it has contracted out with 16 state and local health departments to do more than 2,800 inspections. Those contracts cover fewer than 1% of the 300,000 commercial pools in the U.S., not including residential pools and spas, which number more than 16 million, according to industry data.

In addition, a CPSC investigation found that the testing laboratories that certified drain covers as meeting safety standards applied those standards inconsistently and incorrectly, meaning many of the covers may be unsafe for the pools they're installed in.

Source: USA Today

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November 10, 2010

Tracking sports injuries to make athletics safer

Fred Mueller is not your casual weekend sports fan. The retired 74-year-old former professor from the University of North Carolina continues to run – almost single-handedly – the National Center for Catastrophic Injury Research (NCCIR) at UNC, tracking, logging and analyzing catastrophic injuries in football and other sports.

Over a 30-year span, Mueller has analyzed more than 1,000 fatal, paralytic or otherwise severe injuries to young athletes, looking for and identifying patterns that result in rule or other changes that increase athlete safety.

The data compiled by the NCCIR has its genesis in the “football death log” begun in 1931 by the American Football Coaches Association. In the 1960s, UNC began to oversee the log. After Mueller became director of the NCCIR in 1980, he expanded it to include catastrophic injuries in all sports, among boys and girls.

Almost immediately, Mueller noted a previously hidden cluster of injuries among polevaulters and swimmers. As a result, polevaulting pits were expanded and surrounded with softer padding, while minimum depths were established for diving into swimming pools.

And after he noted the high number of injuries among cheerleaders, specifically those who are thrown up to 25 feet high and not caught, cheerleading safety guidelines and universal standards were established.

So far this year, Mueller has logged 24 catastrophic football injuries; typically, there are 36 such injuries every year. He’s also just finished a book on football injuries co-written with Robert Cantu, MD, the NCCIR's medical director. Football Fatalities and Catastrophic Injuries, 1931-2008 details football’s decade-by-decade tragedies and rule changes — like the 1976 outlawing of spearing and more recent adjustments to kickoff wedges. A final chapter discusses injury prevention strategies and other ways to make football safer.

Source: The New York Times

To visit the National Center for Catastrophic Injury Research home page, click here.

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June 6, 2008

"Dry Drowning" Kills Boy in South Carolina

A South Carolina boy named Johnny Jackson drowned more than an hour after he got out of the swimming pool.

How was this possible? Water can remain in the lungs after leaving the pool, and its presence in the lungs prevents the brain from getting enough oxygen. Left untreated, this eventually causes death.

Not many people know about this phenomenon, which is known as "dry drowning." And the symptoms can be hard to spot. From the article:

According to the latest figures, about 3,600 Americans died from drowning in 2005, said the US Centers for Disease Control and Prevention (CDC), including a small percentage that die up to 24 hours later because of water entering the respiratory system. A not insignificant number of the victims are children who died after having a bath.

Dr Daniel Rauch, pediatrician at New York University Langone Medical Center, who spoke to Meredith Vieira on the TODAY show, said there are three important signs that parents and carers should look out for: difficulty breathing, extreme tiredness, and changes in behaviour. All three symptoms result from the brain not getting enough oxygen because of water in the lungs.

Those three symptoms can be easily mistaken for the ordinary after-effects of energetic play, as Dr. Rauch also points out. Therefore it is a good idea to be on the look-out for these symptoms after a child has spent time submerged in water and take the child to the emergency room if he or she has them.

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