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BACKGROUND

In the past, submersion events have been defined in various ways in the medical literature. The lack of consistency and standardization of terms makes research analysis and communication in the field difficult, confusing, and imprecise. In 2002, the International Liaison Committee on Resuscitation (ILCOR) approved guidelines for definitions and reporting of data related to drowning developed by international investigators and experts in the field.1 Many terms, such as, “near drowned” which previously referred to survival of a submersion victim for longer than 24 hours as well as “wet” and “dry drowning” were abandoned. According to ILCOR, the term drowning should refer to a process resulting in primary respiratory impairment from submersion/immersion in a liquid medium. Submersion implies the entire body, including the airway is under water, while immersion merely describes being covered in water. The term drowned continues to indicate death from a submersion/immersion event.

EPIDEMIOLOGY

Drowning is a significant pediatric problem. In the United States, drowning is the second leading cause of traumatic death in children 1 to 16 years of age. From 1999-2007, drowning represented nearly 7800 unintentional deaths in this age range.2 Toddlers and teenagers are particularly at risk given their unique developmental and behavioral stages, and males are two to four times more likely to drown than females.3 African American males aged 5 to 14 years have a 4- to 15-fold higher drowning rate compared with their white counterparts.4 Morbidity and mortality are high; 15% of admitted patients die, and 20% of survivors have permanent severe neurologic sequelae. Although most submersion events occur in open water sites, bathtubs, toilets, and buckets of water can be dangerous for infants and toddlers as well as children whose mental capacity may be permanently or temporarily impaired.

For the last several decades, however, the death rate from drowning in the United States has been declining. The death rate in 1970 was 3.87  deaths per 100,000 population and between 2005 to 2009, it was 1.29.3,5 This is likely due to a combination of expanded and enhanced knowledge in the pathophysiology of the drowning process leading to the targeted treatments and avoidance of secondary insults in the care of drowning victims as well as increased awareness and education of the lay public in open water and pool safety and cardiopulmonary resuscitation.

PATHOPHYSIOLOGY

Hypoxemia is the final common pathway of injury in the drowning process which, if not interrupted, will ultimately result in profound tissue hypoxia and multiorgan failure. While the lungs are the primary and initial site of injury in the drowning process, the heart and the brain are the most important organs affected, often permanently, as they are particularly sensitive to even brief periods of hypoxia. During the initial phases of submersion, victims hold their breath and struggle until they reflexively breathe, causing the aspiration of fluid. This aspiration results ...

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