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Dry-Drowning Doesn't Exist

April 24, 2018

Well, it looks like Summer 2018 is going to be like the Summer of 2017...2016...2015... It seems once the weather warms up and pools open, there is an effort to scare the hell out of parents with the

threat of the modern day boogie-man, silent killer, stealing lives in the night, known as "dry-drowning". Unfortunately, "dry-drowning" doesn't exist, it's just some catchy words that grab attention(exactly why it's in my title). In fact, there has never been a documented case in medical literature of a completely asymptomatic person dying as the result of drowning at a later time. 

 

Drowning is a serious issue and we don't want to make light of something that results in about 3,500 American deaths every year, per the CDC. However, the efforts at education, prevention, and truth are being hijacked by fear-mongering and non-existent entities. The first thing we have to answer is where the actual term came from. Like many things in medicine, there are terms and phrases that were used in the past to describe something we didn't understand. This is the case with "dry drowning", which was used along with terms like "delayed drowning" and "secondary drowning" in an attempt to describe the processes that were being seen. These terms were never actually adopted by medicine and yet they are still plastered across media outlets and websites as legitimate medicine. 

 

In the 2002 World Congress on Drowning, a consensus definition of drowning was established. Drowning was defined as the "process of respiratory impairment from submersion/immersion in liquid." Yes, there was actually a world meeting about that. From this, there are now only three accepted definitions of drowning...

 

  1. Fatal Drowning- Death related to drowning or it's complications.

  2. Nonfatal Drowning with Injury- Someone who did not die but has injuries or complications that do not lead to death.

  3. Nonfatal Drowning without Injury- A drowning episode that does not cause injury or death. 

 

Drowning is caused by the aspiration of water into the lungs that obstructs the absorption of oxygen into the blood. This can be cause by the direct impact of the water in the airway or from inflammatory changes of the lungs which we call aspiration pneumonitis. Either way, the cause of the symptoms and deaths are disruption of the processes by which the oxygen and blood interact in the lungs.

 

What we are seeing in the media and hysteria is stories of deaths and injuries that are legitimate drowning incidents, but also many are completely unrelated to water, swimming, or anything of the

like. The most widespread story in 2017 was the unfortunate death of a child that was actually related to cardiomyopathy, a heart condition. The most recent one of 2018 is a child with aspiration pneumonia/pneumonitis that got ill after "nonfatal drowning with injury". The child aspirated while playing in a pool and had complications resulting in a hospital admission. Thankfully the mother did exactly what she should have done and had the child evaluated when she became concerned of breathing difficulties in the child. This child recovered without long-term complication. The symptoms were related to drowning, but there was nothing dry about it. 

 

The problem that physicians around the country have with this misnomer is it distracts from the real risks of drowning. There are about 3,500 US deaths annually from drowning. This is just the tip of the iceberg as the CDC reports there are about 6,000-13,000 annual emergency department visits for nonfatal drowning episodes with the highest risk of fatal and nonfatal drowning being in children age 1 to 4. Among children, for every death there are about 5 evaluations for nonfatal drowning in the emergency department. 

 

The key take-home is that the patients at risk are going to be symptomatic. In these patients, it is important to get an evaluation and observation. Here are some tips to help guide your concern and course of action...

 

  • Almost every person has the episode of water "going down the wrong pipe" followed by several minutes of coughing and some shortness of breath. If this resolves within a few minutes with no other persistent symptoms, the risk is near zero and you can relax that there isn't likely going to be any complications. Remember, there has been no documented case of an asymptomatic person in the US dying later directly related to the drowning. 

  • Any persistent symptoms after a drowning episode warrants evaluation by a doctor. These are the patient that have the risk of significant aspiration that can cause secondary complications and death. The numbers are small with less than 5% of prolonged symptomatic patients having a significant risk of eventual fatal drowning. 

  • Any episode of drowning that requires significant intervention or resuscitation at the time of the event requires immediate evaluation in an emergency department. People that have significant aspiration and/or loss of consciousness are the highest risk of deterioration and death. This isn't like the movies where a couple of breaths and some awkward leg pumps save the day and the person wakes up and is ready to fight crime or carry on with their day. 

  • This is a situation where close monitoring and evaluation for anyone with symptomatic concerns is perfectly reasonable.

  • The best preventions for drowning are well known and documented. A barrier around the pool, focused adult supervision while children swim, flotation devices for those

    that are not great swimmers, learn to swim, keeping doorways to a pool locked, do not keep any form of standing water if you have young children(mop buckets, tubs, etc.) and finally, if you have a pool and you don't know where a child is, check the pool first. You may only have minutes in a drowning situation.  

 

The moral of my story is that we must be realistic about the risks of drowning and activities around

water. What I want to prevent is the ongoing proliferation of conditions that don't exist and are used to create and potentiate fear among parents. Do not stay up at night, concerned that your child may be the victim of "dry drowning" after a heavy rain or playing in the pool, but we do need to be vigilant for symptomatic drowning patients and take the steps to decrease risk and prevent further injury/death. Enjoy the summer, enjoy the pool, and don't fall victim to the annual fear-baiting of the media and the misinformed. 

 

 

 

 

 

Dr. Ryan Stanton is the founder and host of StantonMD and CEO of Everyday Medicine LLC. He is a board certified emergency physician in Lexington, KY. Dr. Stanton has been in media since age 14 and currently has a syndicated show(StantonMD) and weekly segment talking about trends in the ER(What's Going Around). Dr. Stanton uses media outlets with a goal to educate the public, promoting health, safety, prevention, and overall wellness.

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