Prevention and Treatment of Drowning

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2016 Apr 1;93(7):576-582.

  Patient information: See related handout on preventing drowning, written by the authors of this article.

Author disclosure: No relevant financial affiliations.

Nearly 4,000 drowning deaths occur annually in the United States, with drowning representing the most common injury-related cause of death in children one to four years of age. Drowning is a process that runs the spectrum from brief entry of liquid into the airways with subsequent clearance and only minor temporary injury, to the prolonged presence of fluid in the lungs leading to lung dysfunction, hypoxia, neurologic and cardiac abnormalities, and death. The World Health Organization has defined drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” Terms such as near, wet, dry, passive, active, secondary, and silent drowning should no longer be used because they are confusing and hinder proper categorization and management. The American Heart Association's Revised Utstein Drowning Form and treatment guidelines are important in guiding care, disposition, and prognosis. Prompt resuscitation at the scene after a shorter duration of submersion is associated with better outcomes. Because cardiac arrhythmias due to drowning are almost exclusively caused by hypoxia, the resuscitation order prioritizes airway and breathing before compressions. Prevention remains the best treatment. Education, swimming and water safety lessons, and proper pool fencing are the interventions with the highest level of current evidence, especially in children two to four years of age. Alcohol use during water activities dramatically increases the risk of drowning; therefore, abstinence is recommended for all participants and supervisors.

Drowning kills nearly 4,000 persons in the United States and more than 300,000 persons worldwide every year.1 For U.S. children between one and four years of age, drowning has surpassed motor vehicle crashes as the most common injury-related cause of death at 2.6 per 100,000 persons annually.2 Despite this significant health burden, public health initiatives have lagged because of lack of standardization in definitions and reporting.

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Alcohol greatly increases drowning risk and should not be used when participating in or supervising water activities.

C

1013

In drowning victims, the order of resuscitation efforts should be airway, breathing, and compressions (ABC), rather than compressions, airway, and breathing (CAB), because cardiac arrhythmias are almost exclusively secondary to hypoxia.

C

23

Educational programs, swimming and water safety lessons, and pool fencing may be effective strategies in preventing childhood drowning.

B

12, 13, 29


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Alcohol greatly increases drowning risk and should not be used when participating in or supervising water activities.

C

1013

In drowning victims, the order of resuscitation efforts should be airway, breathing, and compressions (ABC), rather than compressions, airway, and breathing (CAB), because cardiac arrhythmias are almost exclusively secondary to hypoxia.

C

23

Educational programs, swimming and water safety lessons, and pool fencing may be effective strategies in preventing childhood drowning.

B

12, 13, 29


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Definition

Before the first World Congress on Drowning (WCOD) in 2002, public health surveillance, research, and policy on drowning were impeded by a lack of clear terminology.3 Highlighting this problem, a systematic review of the literature from 1966 to 2002 found at least 33 different definitions for drowning incidents.4 The WCOD was organized largely to remedy this issue. The WCOD developed consensus guidelines using the Utstein principles—a term coined from a series of meetings held at Utstein Abbey in Stavanger, Norway, to clarify the nomenclature associated with out-of-hospital cardiac arrests.4 The guidelines applied the same principles to clarify definitions, terminology, and data sets used in the epidemiology and treatment of drowning.5 Following extensive discussion and debate, the World Health Organization agreed on the following definition: “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.”

The Authors

show all author info

TIMOTHY F. MOTT, MD, is a staff physician at Naval Hospital Pensacola (Fla.) Family Medicine Residency, and an assistant professor at the Uniformed Services University of the Health Sciences, Bethesda, Md....

KELLY M. LATIMER, MD, MPH, is residency director at Naval Hospital Pensacola Family Medicine Residency, and an assistant professor at the Uniformed Services University of the Health Sciences.

Address correspondence to Timothy F. Mott, MD, Naval Hospital Pen-sacola Family Medicine Residency, 6000 West Hwy. 98, Pensacola, FL 32512 (e-mail: timothy.f.mott.mil@mail.mil). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Xu JQ. Unintentional drowning deaths in the United States, 1999–2010. NCHS data brief no. 149. Hyattsville, Md.: National Center for Health Statistics; 2014. http://www.cdc.gov/nchs/data/databriefs/db149.htm. Accessed September 4, 2015....

2. Centers for Disease Control and Prevention (CDC). Vital signs: unintentional injury deaths among persons aged 0–19 years—United States, 2000–2009. MMWR Morb Mortal Wkly Rep. 2012;61:270–276.

3. van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJ. A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ. 2005;83(11):853–856.

4. Papa L, Hoelle R, Idris A. Systematic review of definitions for drowning incidents. Resuscitation. 2005;65(3):255–264.

5. Idris AH, Berg RA, Bierens J, et al.; American Heart Association. Recommended guidelines for uniform reporting of data from drowning: the “Utstein style.” Circulation. 2003;108(20):2565–2574.

6. Centers for Disease Control and Prevention (CDC). Drowning—United States, 2005–2009. MMWR Morb Mortal Wkly Rep. 2012;61(19):344–347.

7. Bowman SM, Aitken ME, Robbins JM, Baker SP. Trends in US pediatric drowning hospitalizations, 1993–2008. Pediatrics. 2012;129(2):275–281.

8. United States Consumer Product Safety Commission. National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP). http://www.cpsc.gov/en/Research--Statistics/NEISS-Injury-Data/. Accessed January 22, 2016.

9. Centers for Disease Control and Prevention. Web-Based Injury Statistics Query and Reporting System (WISQARS). http://www.cdc.gov/injury/wisqars/. Accessed September 4, 2015.

10. Weiss J; American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Technical report: prevention of drowning. Pediatrics. 2000;126(1):e253–e262.

11. Driscoll TR, Harrison JA, Steenkamp M. Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev. 2004;10(2):107–113.

12. Wallis BA, Watt K, Franklin RC, Taylor M, Nixon JW, Kimble RM. Interventions associated with drowning prevention in children and adolescents: systematic literature review. Inj Prev. 2015;21(3):195–204.

13. American Academy of Pediatrics Committee on Injury, Violence, and Poison Prevention. Policy statement: prevention of drowning. Pediatrics. 2010;126(1):178–185.

14. Szpilman D. Near-drowning and drowning classification: a proposal to stratify mortality based on the analysis of 1,831 cases. Chest. 1997;112(3):660–665.

15. Orlowski JP, Abulleil MM, Phillips JM. The hemodynamic and cardiovascular effects of near-drowning in hypotonic, isotonic, or hypertonic solutions. Ann Emerg Med. 1989;18(10):1044–1049.

16. Grmec S, Strnad M, Podgorsek D. Comparison of the characteristics and outcome among patients suffering from out-of-hospital primary cardiac arrest and drowning victims in cardiac arrest. Int J Emerg Med. 2009;2(1):7–12.

17. Szpilman D, Bierens JJ, Handley AJ, Orlowski JP. Drowning. N Engl J Med. 2012;366(22):2102–2110.

18. Quan L, Mack CD, Schiff MA. Association of water temperature and submersion duration and drowning outcome [published correction appears in Resuscitation. 2014;85(9):1304]. Resuscitation. 2014;85(6):790–794.

19. Szpilman D, Soares M. In-water resuscitation—is it worthwhile? Resuscitation. 2004;63(1):25–31.

20. Bolte RG, Black PG, Bowers RS, Thorne JK, Corneli HM. The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA. 1988;260(3):377–379.

21. Guenther U, Varelmann D, Putensen C, Wrigge H. Extended therapeutic hypothermia for several days during extracorporeal membrane-oxygenation after drowning and cardiac arrest: two cases of survival with no neurological sequelae. Resuscitation. 2009;80(3):379–381.

22. Watson RS, Cummings P, Quan L, Bratton S, Weiss NS. Cervical spine injuries among submersion victims. J Trauma. 2001;51(4):658–662.

23. Vanden Hoek TL, Morrison LJ, Shuster M, et al. Part 12: cardiac arrest in special situations: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care [published corrections appear in Circulation. 2011;123(6):e239, and Circulation. 2011;124(15):e405]. Circulation. 2010;122(18 suppl 3):S829–S861.

24. Manolios N, Mackie I. Drowning and near-drowning on Australian beaches patrolled by life-savers: a 10-year study, 1973–1983. Med J Aust. 1988;148(4):165–167,170–171.

25. Muth CM, Shank E, Hauser B, Radermacher P, Groger M, Ehrmann U. Infrared ear thermometry in water-related accidents—not a good choice. J Emerg Med. 2010;38(4):417–421.

26. Modell JH, Graves SA, Ketover A. Clinical course of 91 consecutive near-drowning victims. Chest. 1976;70(2):231–238.

27. Noonan L, Howrey R, Ginsburg CM. Freshwater submersion injuries in children: a retrospective review of seventy-five hospitalized patients. Pediatrics. 1996;98(3 pt 1):368–371.

28. van Berkel M, Bierens JJ, Lie RL, et al. Pulmonary oedema, pneumonia and mortality in submersion victims; a retrospective study in 125 patients. Intensive Care Med. 1996;22(2):101–107.

29. Thompson DC, Rivara FP. Pool fencing for preventing drowning in children. Cochrane Database Syst Rev. 2000;(2):CD001047.

30. Cassan P. Foreword to the second edition. In: Bierens JJ, ed. Drowning: Prevention, Rescue, Treatment. 2nd ed. New York, NY: Springer; 2014.

31. U.S. Coast Guard. PFD selection, use, wear, and care. http://www.uscg.mil/hq/cg5/cg5214/pfdselection.asp. Accessed September 4, 2015.

32. Tester DJ, Medeiros-Domingo A, Will ML, Ackerman MJ. Unexplained drownings and the cardiac channelopathies: a molecular autopsy series. Mayo Clin Proc. 2011;86(10):941–947.

33. Quan L, Bennett E, Branche C. Interventions to prevent drowning. In: Haas E, Doll LS, Bonza SE, Mercy JA, Sleet DA, eds. Handbook of Injury and Violence Prevention. New York, NY: Springer; 2007:81–96.



 

Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article