What is near-drowning?  

Background:
Drowning is defined as death secondary to asphyxia while immersed in a liquid, usually water, or within 24
hours of submersion. The classic image of a victim helplessly gasping and thrashing in the water rarely is
reported. A more ominous scenario of a motionless individual floating in the water or quietly disappearing
beneath the surface is more typical.

Near drowning connotes an immersion episode of sufficient severity to warrant medical attention that may lead
to morbidity and death.

Frequency:
In the US: Drowning deaths number more than 6500 per year. A bimodal distribution of deaths is observed, with
an initial peak in the toddler age group and a second peak in adolescent to young adult males.  Despite
preventive measures, drowning is second only to motor vehicle accidents (MVAs) as the most common cause
of injury and death in children aged 1 month to 14 years. Morbidity from submersion occurs in 12-27% of
survivors in this age group. Preschool-aged boys are at greatest risk of submersion injury. A survey of 9420
primary school children in South Carolina estimated that approximately 10% of children younger than 5 years
had an experience judged a "serious threat" of near drowning. Residential swimming pools are the most
common submersion site in this age group.  Submersion-related injuries are the fifth leading cause of
accidental death in the US in all age groups; incidence is approximately 2.5-3.5 per 100,000 population.
California reports approximately 25,000 ocean rescues on its beaches each year. True incidence of near
drowning has yet to be defined accurately, however, since many cases are not reported.

Gender:
Male-to-female ratios are approximately 12:1 for boat-related drownings and 5:1 for non–boat-related
drownings.  Only in bathtub incidents do girls predominate in incidence.

Age:
Peak incidences of submersion injury occur in the following 2 age groups:
--Children younger than 4 years
--Young adults aged 15-24 years

History:
Typical incidents involve a toddler left unattended temporarily or under the supervision of an older sibling, an
adolescent found floating in the water, or a victim diving and not resurfacing.  The submersion time, water
temperature, water tonicity, symptoms, associated injuries (especially cervical spine and head), type of rescue,
and response to initial resuscitation are all relevant factors.

Causes:
Bathtub drowning is most common in children younger than 1 year.  A majority of these victims drown during a
brief (<5 min) lapse in adult supervision.

In preschool-aged children, drownings occur most commonly to residential swimming pools.  Many residential
pools have no physical barrier between the pool and the home.

Open gates are involved in up to 70% of drownings in cases involving fenced-in pools.

Young adults typically drown in ponds, lakes, rivers, and oceans.

Cervical spine injuries and head trauma, which result from diving into water that may be shallow or contain
rocks and other hazards, have been implicated.

Alcohol and, to a lesser extent, other recreational drugs are implicated in many cases. Australian, Scottish, and
Canadian data showed that 30-50% of older adolescents and adults who drowned in boating incidents were
inebriated, as determined by blood alcohol concentrations.

Deterrence/Prevention:
Children, especially toddlers, should be supervised at all times when they are around water, including a
bathtub or bucket full of water.

All pools should be fenced appropriately, with the gate to the area locked when not in use under adult
supervision. Parents who own pools or who take their children to pools are encouraged to learn
cardiopulmonary resuscitation (CPR).

All individuals involved in boating should be able to swim, should use personal flotation devices when on the
boat or in the water, and should avoid the use of alcohol or other recreational drugs. Boaters should be taught
to anticipate wind, waves, and water temperature, and to use protective suits and other insulating garments in
cold weather.

All children should be taught to check the water carefully for depth and possible injurious objects before
diving in. Children also should be taught their swimming limitations and to not play dangerously in pools or on
the decks surrounding pools.

All individuals should be taught not to drink alcohol or use other recreational drugs when swimming.

Individuals with underlying medical illnesses that may place them at risk when swimming, such as seizure
disorders, diabetes mellitus, significant coronary artery disease, severe arthritis, and disorders of
neuromuscular function, should swim under the observation of another adult who can rescue them should they
get into trouble.

Information about near-drowning taken from http://www.emedicine.com/emerg/topic744.htm
About Near Drowning
Gloria Delphine Endermann