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Near drowning

Definition

"Near drowning" means a person almost died from not being able to breathe (suffocating) under water.

If a person has been rescued from a near-drowning situation, quick first aid and medical attention are very important.

Alternative Names

Drowning - near

Considerations

• Thousands of people drown in the United States each year. Most drownings occur within a short distance of safety. Immediate action and first aid can prevent death.
• A person who is drowning usually cannot shout for help. Be alert for signs of drowning.
• Children can drown in only a few inches of water.
• It may be possible to revive a drowning person even after a long period under water, especially if the person is young and was in very cold water.
• Suspect an accident if you see someone in the water fully clothed. Watch for uneven swimming motions, which is a sign that the swimmer is getting tired. Often the body sinks, and only the head shows above the water.

Causes

• Attempted suicide
• Blows to the head or seizures while in the water
• Drinking alcohol while boating or swimming
• Falling through thin ice
• Inability to swim or panicking while swimming
• Leaving small children unattended around bathtubs and pools

Symptoms

Symptoms can vary, but may include:

• Abdominal distention
• Bluish skin of the face, especially around the lips
• Chest pain
• Cold skin and pale appearance
• Confusion
• Cough with pink, frothy sputum
• Irritability
• Lethargy
• No breathing
• Restlessness
• Shallow or gasping respirations
• Unconsciousness
• Vomiting

First Aid

When someone is drowning:

• Do NOT place yourself in danger. Do NOT get into the water or go out onto ice unless you are absolutely sure it is safe.
• Extend a long pole or branch to the person, or use a throw rope attached to a buoyant object, such as a life ring or life jacket. Toss it to the person, then pull him or her to shore.
• If you are trained in rescuing people, do so immediately only if you are absolutely sure it will not cause you harm.
• Keep in mind that people who have fallen through ice may not be able to grasp objects within their reach or hold on while being pulled to safety.

If the person's breathing has stopped, begin rescue breathing as soon as you can. This often means starting the breathing process while still in the water.

Continue to breathe for the person every few seconds while moving him or her to dry land. Once on land, give CPR if needed. For step-by-step instructions on rescue breathing, see the article on CPR.

Always use caution when moving a person who is drowning. Assume that the person may have a neck or spine injury, and avoid turning or bending their neck. Keep the head and neck very still during CPR and while moving the person. You can tape the head to a backboard or stretcher, or secure the neck by placing rolled towels or other objects around it.

Follow these additional steps:

• Give first aid for any other serious injuries.
• Keep the person calm and still. Seek medical help immediately.
• Remove any cold, wet clothes from the person and cover with something warm, if possible. This will help prevent hypothermia.
• The person may cough and have difficulty breathing once breathing restarts. Reassure the person until you get medical help.

Do Not

• Do NOT attempt a swimming rescue yourself unless you are trained in water rescue.
• Do NOT go into rough or turbulent water that may endanger you.
• Do NOT go out on the ice to rescue a drowning person if you can reach the person with your arm or an extended object.
• The Heimlich maneuver is NOT part of the routine rescue of near drownings. Do NOT perform the Heimlich maneuver unless repeated attempts to position the airway and to use rescue breathes to get air into the lungs have failed and you suspect the person’s airway is blocked. Performing the Heimlich maneuver increases the chances that an unconscious person will vomit and subsequently choke on the vomit.

Call immediately for emergency medical assistance if

If you cannot rescue the drowning person without endangering yourself, call for emergency medical assistance immediately. If you are trained and able to rescue the person, do so and then call for medical help.

All near-drowning patients should be checked by a doctor. Even though the person may revive quickly at the scene, lung complications are common. Fluid and body chemical (electrolyte) imbalances may develop, and other traumatic injuries may be present.

Prevention

• Avoid drinking alcohol whenever swimming or boating.
• Drowning can occur in any container of water. Do not leave any standing water (in empty basins, buckets, ice chests, kiddy pools, or bathtubs). Secure the toilet seat cover with a child safety device.
• Fence all pools and spas. Secure all the doors to the outside, and install pool and door alarms.
• If your child is missing, check the pool immediately.
• Never allow children to swim alone or unsupervised regardless of their ability to swim.
• Never leave children alone for any period of time or let them leave your line of sight around any pool or body of water. Drownings have occurred when parents left "for just a minute" to answer the phone or door.
• Observe water safety rules.
• Take a water safety course.

References

Richards DB, Knaut AL. Drowning. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 143.