Secondary Drowning

For most of us, the fear of drowning is real and emotional. Nobody wants to be stuck in deep water, struggling for air and feeling the water coming in. The scenes that are drawn in our minds are frightening, and can be easily pictured.
But, could you imagine drowning while at home on your couch?
Between the years of 2005 and 2014, 3,536 people in the United States died by drowning, in non-boating-related accidents. But, for between one and two percent of those people, death came when it was least expected: after they were already out of the water, and had been for several hours.
Dying in this way results from “secondary drowning,” also known as “dry drowning” (and apparently as “parking lot drowning” to some lifeguards). It happens a little differently than the kind of drowning that most of us are familiar with. “Active” or “wet” drowning, the kind of drowning that happens the most often, occurs when the lungs are filled with fluid to capacity, leading to permanent injury and death in a very short time span. The majority of people who drown do so in this way. Secondary drowning, however, can occur in some cases when someone inhales a smaller amount of water or another fluid into his or her lungs, before escaping or being removed from the situation. Foreign fluid that has been accidentally inhaled into the respiratory system causes the tissue in the lungs to swell, which can be hastened or aggravated by other contaminants in the fluid (dirt, sand, chemicals, etc.).  One or both of these things then block the air sacs (or alveoli) in the lungs that divert the oxygen into your bloodstream. The body (including the heart) is consequently deprived of the oxygen it needs to survive. The full effects of these events may take almost twenty four hours from the initial trauma to occur.

Experiences in THE UA office

Angeli, one of the other members of our blog-writing staff here at Underwater Audio, had a brush with this at home with her family, and was willing to share the story.
One day, she went to the local pool with her three children, as per usual with the family schedule. She met up with another friend and her three kids, and began chatting with them. Her five year old, the youngest, had gotten into the water and had already been playing for a while before his head went under the surface.

“He went down into the water and then came up spluttering for air,” said Angeli. “And I kinda went, ‘Oh, poor kid.’ You know? Life’s tough. You’re fine.”
He coughed and choked for a moment on the water he had inhaled; a very natural reaction to bringing liquid down the wrong pipe. He seemed to recover quickly, however, so nobody took any extra notice of it. The day continued normally after that, for the most part.
“On the car ride home, he was really quiet, he didn’t really say anything,” she said. “I noticed that.”
He was lethargic, which is one of the symptoms of oxygen deprivation.
It wasn’t until almost midnight when it became otherwise evident that her son was having a problem. His coughing and wheezing could be heard from his parents’ room, at tones that were getting progressively more strained. It was when they heard him scream, “I can’t breathe!” that they suddenly realized how much he was struggling, and they dashed to his room. His lips had begun to turn blue, and he had begun to panic.
“I had actually just read an article about secondary drowning,” recalled Angeli. “Like, right before.”
“That morning?” I asked.
She gave half a nod. “If not that morning, then within the past two days.”
Angeli and her husband both began “coaching” their son on breathing, and did so until they could get him into the emergency room. After vomiting once, he began to calm down and gain oxygen again, and he was treated and released in a few hours. The doctors did not diagnose the problem as secondary drowning; they called it a croup cough, which is usually a side condition of a cold or virus, and gave her son a steroid treatment. Still, Angeli felt concerned, and described the scene as bizarre.
“Croup is usually a side condition of a cold/virus,” said Angeli. “The ER personnel just assumed he’d had a cold. He hadn’t had any symptoms [of a cold], though, and never did, as far as I could tell.”

Doctors did not confirm that Angeli’s son actually was suffering from secondary drowning, and it is important to remember that secondary drowning may not have been the only possible condition given her son’s symptoms. Still, awareness of what secondary drowning is can bring comfort and a reminder of the importance of being safe near water.

HOW IT HAPPENS

Understanding how secondary drowning can occur is made easier when you know how the human body consumes oxygen. Here’s a rundown of how it works: Air is inhaled through either the mouth or the nose, and is pulled downward into the throat. It passes the larynx (more commonly known as the “voice box”), and reaches the trachea. Here, the air is split and diverted into the bronchi, or, the two main passageways of the lungs. The two bronchi branch outward from the top of the lungs to the bottom and sides, almost like an upside-down tree. As they continue to fork outward into smaller branches, they are called bronchioles. At the ends of these bronchioles, the air finally reaches what are called alveoli – tiny air sacs which are inflated by the breath of air and then deflated when we exhale. The alveoli, in order to properly inflate, are coated with an assisting chemical called surfactant. Minuscule blood vessels called capillaries, which sprawl across the surface of each air sac, pull the oxygen out from the air and into the bloodstream.

The fact that this process all happens as quickly as it takes to breathe in and out is remarkable. Unfortunately, on the other side of the coin, breathing in other substances besides air can also happen in a very short time, and can have massive consequences. Full drowning, when water completely fills the lungs, causes death in a very short time, due in great part to immediate deprivation of oxygen, and to water diffusing into the bloodstream. Secondary drowning is a bit of a different consequence; it’s born from the body’s own reaction. Small amounts of water that collect in the bronchioles and the alveoli cause an inflammatory reaction, and between the water and the inflammation, oxygen cannot effectively enter the capillaries of the alveoli. The water also dilutes the surfactant that allows the alveoli to open up, impairing their total function. When the body notices the lack of needed surfactant, it responds by pushing bodily fluids into the lungs in order to help. Sadly, this can prove to be seriously harmful, because the lungs then fill with fluid, otherwise known as a pulmonary edema.

Symptoms

The progression of events that makes up secondary drowning is not very common. As mentioned, secondary drowning makes up only a little more than 1% of cases of people who have drowned. But they are serious and time-sensitive when they occur, and often cannot be addressed properly without going to the hospital. Doctors and pediatricians tell us that “any person who was submerged in water and came up struggling, especially if he or she had to be retrieved from the water… needs medical evaluation,” and that “If your child feels sick, acts too sleepy, or has a change in mental status/behavior after a day at the pool, take it seriously. The worst thing you can do with a child who may have inhaled water is put them to bed.”
If you are a parent, and your child has just had a water-inhaling incident (in the pool, at the beach, in the bathtub, or anywhere else), there are some specific symptoms to look out for.

PRECAUTIONS to TAKE

The Center for Disease Control and Prevention in the United States has issued a compilation of precautions to take in order to prevent yourself and others drowning, as well as action steps to take when somebody is in the process of drowning. NBC News in Washington D.C. has also provided some direction.
It has been documented that participating in formal swimming lessons reduces the risk of drowning. The risk is not eliminated, however; Angeli’s five-year-old son, mentioned earlier, is a swim-lesson participant. Water accidents happen to even professional swimmers. That is why close supervision is absolutely critical. Children can be submerged in water and lose consciousness in two minutes or less, so be sure to attend directly to them when they are playing in the pool. Warn older teenagers of the danger of swimming, boating, surfing, or participating in any other water sports while under the influence of alcohol or drugs, and encourage them to caution their peers about it, too. (And don’t you dare do it, either.) Learn how to administer cardiopulmonary resuscitation (CPR). And, if you have a pool installed at your home, the CDC has specific instructions for you: Install a fence that completely surrounds the pool, measures at least four feet in height, and has gates and latches that automatically lock behind you when you leave. This is to ensure that children do not enter the pool outside of adult supervision, which would incite the greatest risk of both secondary drowning and active drowning.

CONCLUSION: Be safe!

You might feel worried as a parent after reading this. It’s been said a couple of times throughout, and I’ll say it again: secondary drowning is not very common. If you hadn’t heard about it before, that is probably why; there have been around 3,500 victims of drowning (not counting boat-related incidents) in the United States, and only 1-2% of them were secondary drowning cases.
So, you may ask, “What can I do?”
The American Osteopathic Association states that when swimmers and their loved ones take the time to understand the importance of water safety, the risks of many water-related incidents, including secondary drowning, are significantly lowered. Always be aware of your surroundings and of those you are caring for when any of you are in or near the water, and teach all others to be wise and careful when they venture in. No matter who you’re with; children, spouse, friends, siblings, or even aging parents, it is important for everybody who participates in swimming or water sports to practice safe behavior. Recognize the symptoms of secondary drowning and of other water illnesses when they appear. It’s easier to have fun knowing that your risks of injury are minimized, and that your children, friends, and other loved ones are also aware of the same potential hazards.
If anything, let yourself feel empowered by this knowledge! You can now be of more help to others who might have this problem. Share this article with those you feel would benefit from it, and ask your doctor or your child’s pediatrician if you have more questions.
That is your answer. You can do a lot.