Many aquatics professionals may wonder what to make of terms they hear in the media, such as: dry-, wet-, near-, silent-, and secondary drowning.
Let’s make it simple up front. These terms should not be used to describe drowning. Not by aquatics professionals. Not by doctors. Not by the media. They are inaccurate, and they create confusion among the general public and drowning-prevention professionals.
It’s not just semantics. Using inconsistent, unscientific or medically inappropriate terms can create unnecessary fear. They also can result in poor diagnoses of real medical issues and a failure to document the magnitude of the drowning problem. Here’s how the World Health Organization explains it: “... Effective prevention of drowning requires programs and policies that address known risk factors.” To fully understand the magnitude of the drowning problem, “… a simple but comprehensive deﬁnition is needed.”
International consensus on proper terminology took time, but it was reached well over a decade ago. Prior to the World Congress on Drowning 2002, a discussion paper was published and online debate among experts worldwide resulted. Before, it had been customary to separate fatal drowning (which was simply referred to as drowning), from cases where people ultimately survived (referred to as near-drowning), and also to make other distinctions based on aspiration of water.
Experts recognized, though, that drowning must be defined like all other injuries. No doctor would refer to a case of a near-injury from a traffic accident. A person in a traffic accident survives without injury, is injured, or dies. Similarly, there is no medical recording of a near-injury from a fall. Either the person survives, is injured, or dies from the fall. The agreement was that drowning must be treated in the same manner.
Considering these and many other issues, the following definition was adopted at the conference: “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.” Outcomes should be classified as death, morbidity, or no morbidity. In other words, a person may die, survive with some degree of injury, or survive with no injury.
By 2005, the World Health Organization and the U.S. Centers for Disease Control and Prevention formally adopted this definition. They also agreed that the terms wet-, dry-, active-, passive-, silent-, and secondary drowning should no longer be used.
The American Red Cross, United States Lifesaving Association, and YMCA of the USA have embraced this modern definition. You can find it in their lifeguard training materials and various educational materials.
An Old Term Resurfaces
It takes time for old terminology to disappear, even among trained medical practitioners. On June 7, 2017, the Fort Worth (Texas) Star-Telegram newspaper reported that a 4-year-old boy near Houston died of breathing complications from swimming several days earlier. According to the newspaper, doctors told the boy's family that he had succumbed to dry drowning.
This created intense interest in the mass media and social media. Parental fears seem to have intensified attention to the story. Unfortunately, various medical professionals were quoted in the media perpetuating the “dry drowning” terminology.
There were real impacts. Certainly, parents became overly worried, but emergency room doctors reported parents would bring children with mild coughs days after swimming. ERs wasted time on benign issues.
The Medical Community Responds
On July 11, 2017, the American College of Emergency Physicians issued a press release with a statement from its president, Rebecca Parker, M.D., FACEP:
“Parents are being unduly alarmed by media reports suggesting that children can die from drowning a week after swimming. Some children can experience complications from swimming. For example, it is possible for a child to inhale water and develop an infection, such as pneumonia, which can become very serious and cause breathing problems.
“If a child has breathing problems at any time, the parent should take him or her to the emergency department. But there are no cases of completely normal, asymptomatic patients who suddenly die because they went swimming a few days ago. It’s also time to retire those incorrect terms, because it is inaccurate and incorrect to say a child was initially fine after a water event and then ‘dry drowned’ a day or week later.”
The ACEP strongly discouraged use of the incorrect terms. "These terms are often used instead of the proper term which would be drowning. Drowning is a process, with a spectrum of effects ranging from mild to severe with fatal and nonfatal outcomes.”
The ACEP didn’t suggest that parents should have no concerns about the effects of drowning. It stated you should take your child to the emergency department if they develop respiratory problems or other symptoms of a medical emergency at any time.
The Aquatics Professional’s Role
How does this impact aquatic professionals? Lifeguards are drowning-prevention experts. All aquatics professionals must answer questions from concerned patrons when a drowning incident has occurred, but also in routine conversation, informative publications, and contact with the media. Understanding and using proper terminology is essential, as is understanding the drowning process.
Lifeguards also must distinguish what symptoms could indicate a problem. The epiglottis, a flap of cartilage in the back of the throat, blocks your breathing tube when you swallow. During the initial drowning process, some water may intrude. Coughing is a normal, automatic reaction to this and often clears water that has intruded. If so, the person normally survives.
On the other hand, if a rescued person can’t stop coughing, or has other symptoms, it may signal more serious problems. Even a small amount of water can affect surfactant, which coats the inside of the lungs. A person with drowning symptoms that don’t immediately clear can become progressively worse, with more and more coughing, signs of shock and other indications of serious problems.
So yes, in very unusual circumstances, a person can die a day or more after submersion or immersion in water. What do you call that? Drowning.