Drowning

 At the Rescue Squad, we use the following definition of drowning:

Drowning is experiencing respiratory distress due to total or partial immersion in a liquid.

This definition of drowning does not imply:

• that a drowning person dies
• That there is a need for medical treatment
• that liquid enters the lungs
• that the drowning person is completely submerged
• During partial submersion, with the drowning person's head above water, a drowning person may inhale water if water splashes across the face or if the drowning person becomes unconscious and lands face down in the water.

The drowning process can have two outcomes: 

1. survive (non-fatal drowning) or; 
2. death (fatal drowning). 

If the drowning person is rescued at any point, the process of drowning is interrupted. Non-fatal drowning occurs if the drowning person remains alive thereafter. If at any point the drowning person dies as a result of drowning, this is still called fatal drowning.

Non-fatal drownings can be divided into: 

1. survival without medical complications or; 
2. survival with medical complications. 

These complications are usually brain injuries resulting from lack of oxygen for too long. For example, a drowning person may be rescued within seconds of immersion, cough a few times to clear the airway, and survive without any complications. But a drowning person can also suffer circulatory arrest due to severe lack of oxygen, after which CPR restores the heart, but the brain is irreparably damaged.

The drowning process

When a drowning person, who is conscious, tries to keep the airway clear, water entering the mouth is initially swallowed or spit out. During (partial) immersion, a drowning person holds his breath as a reflex. When the urge to breathe becomes too great to resist, water is inhaled and a drowning person starts coughing in a reflex reaction. The occurrence of vocal cord spasm can temporarily prevent water from entering the lungs. 

If the drowning person is not rescued, the lack of oxygen eventually leads to loss of consciousness, cessation of breathing, and then gradually to cessation of the heartbeat. 

Ventricular fibrillation (a fatal cardiac arrhythmia that causes circulatory arrest) is rare in drowning victims. The entire drowning process, from immersion or partial immersion to circulatory arrest, usually occurs in minutes.

Cold water can be protective

In exceptional situations, such as drowning in ice water, this process can take up to an hour. Immersion in ice water causes, among other things, rapid cooling of the brain and heart. This can result in a protective effect against oxygen deficiency for both organs. Due to the lower temperature, processes at the cellular level will proceed more slowly, which means that less oxygen is consumed and oxygen remains available longer.