Each year, Memorial Day weekend marks the time when the eye turns toward the water. Whether it’s wading down the shore, kayaking on local rivers and canals, or opening the family pool in the backyard, summer kicks off by hitting the water for many.
But for some, this ritual carries a human cost. Across the United States, almost 4,000 people drown each year, breaking down into 11 per day for the whole year, but the concentration is naturally much higher during the warmer months. Among children, drowning is one of the greatest causes of preventable deaths.
Zaffer Qasim, MBBS, FRCEM, EDIC, an assistant professor of Emergency Medicine in the Perelman School of Medicine at the University of Pennsylvania, treats a few victims each summer. Treatment for drowning patients varies depending on the condition of the victim when they arrive to the emergency department — factors such as how long a patient was in the water and whether they are at all responsive matter. The best-case scenario is a series of tests, which may include lab work, x-rays and CAT scans looking for any electrolyte problems, injuries, or infections, and a period of observation at the hospital.
“If the victim has not been revived before arriving at the hospital, the care is much more intense,” Qasim said.
For those who weren’t revived before getting to the hospital, resuscitation efforts continue. Breathing and stomach tubes are placed to help with respiration and removing water or air from the gut. Tests also are needed to determine the scope of brain activity and heart and vital organ function. An intensive care unit stay is likely if resuscitation attempts in the emergency department are ultimately successful, but even then (especially if there have been 10 minutes or more of no breathing), long-term survival is not guaranteed.
Qasim knows what drowning victims look like, what it takes for a recovery — and what can keep people out of these situations to begin with.
“Statistically, people who drown are typically young, especially under four years old and male, about 80 percent of the time,” Qasim said. “In the under-four-year group, these children typically will drown in bathtubs or pools when there is a lack of adult supervision or their caretaker’s attention is diverted. But the second peak age of drowning is the 15 to 25-year-old group: They may drown not just in swimming pools but in rivers, at the beach, and in lakes.”
The primary factor in most drownings is an inability to swim, but — typically among the 15-25 group — overconfidence in one’s swimming ability for the conditions or alcohol or drug use also play a significant factor. Medical conditions such as seizures or abnormal heart rhythms can also play a factor if a swimmer is stricken off-shore or even in the bathtub.
When saving a drowning victim, Qasim said there are some characteristics that play a significant role in whether the patient will have better outcomes.
“Typically, they’ll do better if they have been submerged for less than five minutes and a short period of time elapses before they receive basic medical life support — ideally not more than 10 minutes,” Qasim said.
Since getting a person attention quickly is so vital, Qasim recommends calling 911, along with informing life guards as quickly as possible. But he emphasized that a potential rescuer shouldn’t put themselves in danger, too.
“If you don’t know how to swim or the conditions are dangerous, you’re not helping yourself or the victim out by trying to go into the water to get them yourself,” Qasim said.
If a person is successfully able to pull a drowning victim from the water themselves, Qasim recommends the following steps:
- Check for responsiveness by shouting their name or pinching their ear
- Check for breathing: Put a cheek close to the mouth and look at the chest to see if the victim is breathing. Listen and try to feel for breaths
- If the victim isn’t breathing, start rescue breaths: tilt their head back and give five one-second breaths, with pauses in between for exhalation
At this point, if there is no response, Qasim recommends beginning CPR.
“If, at any point, the victim recovers, you can roll them to their side in what is called the recovery position,” Qasim said. “Bend the top arm and leg to keep them in that position. Slightly tilt back the head to keep their airway open.”
If the victim is not revived on site, first responders will continue efforts on their way to the hospital.
All of this is very serious, but Qasim emphasizes that “summer is a great time of year, so it’s important to have fun.”
However, having that fun in a “responsible” way is his main message. He emphasizes adult supervision at all times when children are swimming or near the water. He also encourages people who want to enjoy the water to learn how to swim. However, even those who consider themselves strong swimmers should take care.
“Young adults should always be careful about taking risks,” Qasim added. “And always be aware of posted signs or other information about water conditions like rip currents. Avoid drinking or taking drugs before going into the water so you won’t be disoriented, too.”
Lastly, Qasim encourages everyone to get training in basic life support.
“The skills you learn may just save a life,” he said.