Drowning

Last updated: February 3, 2022

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Drowning is the process of respiratory impairment due to submersion in liquid, most commonly a body of water. It is the leading cause of unintentional injury death among children under the age of five in the US and the third leading cause of unintentional injury death for all age groups worldwide. Risk factors include poor safety (especially inadequate supervision of children), inability to swim, intoxication (e.g., with alcohol), and preexisting medical conditions associated with seizures, cramps, loss of consciousness, and/or poor neuromuscular control (e.g., epilepsy, diabetes mellitus, cardiovascular disease, Parkinson disease). Urgent rescue and first aid, especially basic life support in unresponsive individuals, are fundamental to the prevention of injury and death. Rescued individuals, including those who are responsive, should receive prompt medical evaluation, including assessment of neurological and pulmonary function (e.g., dyspnea, apnea, cough, wheezing, impaired consciousness), past medical history, history of substance use, the type of liquid involved (e.g., fresh water or salt water), and the amount of liquid aspirated. Complications of drowning, e.g., ARDS and cardiac arrest, may occur days or even weeks after the event.

Epidemiological data refers to the US, unless otherwise specified.

  • Inability to swim
  • Poor safety, esp. inadequate supervision of children; , access to open bodies of water , not wearing life jackets during water activities such as boating, and risky behavior
  • Use of recreational or prescription drugs that may impair consciousness, awareness, and/or motor function (e.g., alcohol, SSRIs, benzodiazepines)
  • Hypothermia or hyperthermia (while swimming or bathing)
  • Medical conditions associated with seizures, cramps, loss of consciousness, and/or poor neuromuscular control (e.g., epilepsy, cardiovascular disease, preexisting injuries, diabetes mellitus, Parkinson disease).
  • Living in areas prone to natural disasters such as floods and storms.
  • Submersion → panic → holding of breath → activation of the inspiratory reflex within 1–2 minutesaspiration of liquid or laryngospasmhypoxemia → organ hypoxia (especially cerebral and cardiac) → possible injury or death

Features of drowning injury [5][6]

Postmortem features of drowning [7]

  • Pulmonary findings
  • Gastrointestinal findings: Wischnewsky spots (gastric mucosal petechial hemorrhages associated with hypothermia)
  • External findings
    • White or pink froth cone over nostrils and/or mouth
    • Pallor and wrinkling of the palms, soles, fingers, and toes
    • Prone body position: back upwards, head and extremities dangling downwards
    • Travel abrasions and lacerations on the forehead, backs of the hands, knees, and dorsum of the feet

Rescuers should not put their lives at risk to save a drowning person.

In unresponsive patients, CPR should be performed immediately after rescue for resuscitation to be successful.

We list the most important complications. The selection is not exhaustive.

  • Factors associated with poor outcome (see “Complications” above) include:
    • Submersion lasting > 5 min
    • CPR delayed > 10 min
    • Glasgow Coma Scale < 5 upon presentation
  • Swimming education
  • Safety equipment (e.g., life jackets)
  • Water rescue training
  • Water safety signs posted at potential sites of drowning
  • Rescue equipment and personnel (e.g., lifeguards) at recreational swimming locations (e.g., pools, beaches)
  • Avoidance of alcohol and drug consumption before swimming
  • Installing barriers around potential water hazards (e.g., pools, wells, waterfronts)
  • Close supervision of children around water (e.g., during bathing as well as swimming)
  1. McCall JD, Sternard BT. Drowning. StatPearls. 2021 .
  2. Bierens JJLM, Lunetta P, Tipton M, Warner DS. Physiology Of Drowning: A Review. Physiology. 2016; 31 (2): p.147-166. doi: 10.1152/physiol.00002.2015 . | Open in Read by QxMD
  3. Armstrong EJ, Erskine KL. Investigation of Drowning Deaths: A Practical Review. Academic Forensic Pathology. 2018; 8 (1): p.8-43. doi: 10.23907/2018.002 . | Open in Read by QxMD
  4. Drowning Facts. https://www.cdc.gov/drowning/facts/index.html. Updated: June 17, 2021. Accessed: December 3, 2021.
  5. Drowning. https://www.who.int/news-room/fact-sheets/detail/drowning. Updated: April 27, 2021. Accessed: October 20, 2021.
  6. Drowning facts. https://www.cdc.gov/drowning/facts/index.html. Updated: June 17, 2021. Accessed: December 29, 2021.
  7. Howland J, Hingson R, Mangione TW, Bell N, Bak S. Why are most drowning victims men? Sex differences in aquatic skills and behaviors.. Am J Public Health. 1996; 86 (1): p.93-6. doi: 10.2105/ajph.86.1.93 . | Open in Read by QxMD
  8. -. Part 10.3: Drowning. Circulation. 2005; 112 (24_supplement). doi: 10.1161/circulationaha.105.166565 . | Open in Read by QxMD
  9. Michael Parenteau, Zsolt Stockinger, Stephen Hughes, Brad Hickey, James Mucciarone, Christopher Manganello, Andrew Beeghly. Drowning Management. Military Medicine. 2018; 183 (suppl_2): p.172-179. doi: 10.1093/milmed/usy136 . | Open in Read by QxMD
  10. Madea, Mußhoff, Dettmeyer. Basiswissen Rechtsmedizin. Springer Verlag (2007) ; 2007

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