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.
- Peak age: children < 5 years 
- Leading cause of unintentional injury death in children ages 1–4. 
- There are approximately 4000 unintentional drowning deaths in the US each year. 
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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.
Features of drowning injury 
- Impaired consciousness, loss of consciousness
- SCUBA diving injuries
Postmortem features of drowning 
- Pulmonary findings
- Gastrointestinal findings: Wischnewsky spots (gastric mucosal petechial hemorrhages associated with hypothermia)
- External findings
- Clinical evaluation: For further information, see “ .”
- Physical examination
- Laboratory studies: ABG (to detect metabolic and/or respiratory acidosis)
- Imaging: x-ray chest (to confirm the diagnosis of pulmonary edema)
Acute interventions 
- Safe rescue: Rescuers should not put their lives at risk to save a drowning person.
- Immediate resuscitation in unresponsive patients (for further information see “”)
Emergency department management
- Supplementation of O2 
- Advanced cardiac life support
- Management of hypothermia
- For asymptomatic individuals and those with mild symptoms: monitoring for 8 hours (due to risk of delayed symptoms)
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.
- 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)