Jenny and Adam Bennett comfort their son, Jackson, while he was on life support at a Houston hospital in Bennett thought she had taken the right precautions. She had two doors separating the house from the pool: a storm door over the back door and tight cover on the pet door. We made it very clear that the dog door remains locked.
But that day was unusual. She had to pick her husband up from work after his truck broke down and grabbed her three kids. With no time to let the dogs out, she opened the dog door and left the house. We thought he was safe upstairs with his sisters. The Bennetts' story is not unusual.
Nearly 1, children died from drowning in the United States in It's the leading cause of accidental death for children 1 through 4. More than 8, others nearly died by drowning, according to the American Academy of Pediatrics. There are ways to keep it from happening to your child, according to the American Academy of Pediatrics and the Centers for Disease Control and Prevention. They call it the "many layers of protection to prevent drowning. Parents or caregivers should never -- not even for a moment -- leave young children alone or in the care of another child anywhere near pools, spas, wading pools or bathtubs, even if a lifeguard is present.
Most young children who drowned in pools had been out of sight for five minutes or less and were in the care of one or both parents at the time, according to a study by the Consumer Product Safety Commission. The same goes for any standing water. Toddlers can drown in just an inch or two of water. Caregivers should also empty any water from containers, such as pails, buckets and kiddie pools, immediately after use. The rule is that an adult with swim skills should literally be within one arm's length, providing "constant touch supervision.
Most persons can hold their breath for a minute, very many for a minute and a half, some for two minutes. In one of the variety theatres of New York appeared recently "The Brilliant Pearl of the Enchanted Grotto, christened Undine, who performs, while under water, incased in a mammoth crystal illuminated glass tank, feats of astonishing suppleness and almost unbelievable endurance. I have myself, watch in hand, seen Johnson, the celebrated ocean-swimmer, remain under water, in a tank before an audience, for the astonishing space of three minutes and twenty seconds, and, before he rose, the involuntary contractions of his respiratory muscles were uncomfortable to witness.
In such cases, although extreme distress may be felt, there is no approach to unconsciousness. But if a person's head is under water, and he does not hold his breath, unconsciousness will usually come on in one or two minutes at the farthest. If this be so, it is evident that a person will drown more quickly if he loses his presence of mind on falling into the water than if he retains it. In the former case he will swallow water with his first gasp after sinking, while in the latter case he will hold his breath as long as he can.
The latter will suffer more than the former. There is also a difference in the amount of mental agony in the two cases. A person who cannot swim sinks at the first plunge, but, as soon as the impetus of his fall is destroyed, his frantic struggles or a kick against the bottom, if he happens to touch it, sends him up to the surface, for the specific gravity of the body is so nearly that of water that a very slight motion of the hands or feet is sufficient to keep one afloat.
Arrived at the surface, he gasps for breath, swallows a quantity of water, sucks some of it into his lungs, catches hold of straw's or small floating objects in a wild, senseless way, and, every time he lifts his arm above the surface, produces the same effect as if a piece of lead had been tied to his feet. So down he goes again half strangled, and the same process is repeated.
As soon as unconsciousness comes on, the struggles cease, and the body remains beneath the surface. During all this agony the suffering of the drowning man is undoubtedly chiefly mental.
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It comes from the instinctive dread of death which even the stoic cannot rid himself of, and is of the same nature as the mental agony of the condemned man before his execution, though less prolonged. A swimmer, or a person whose presence of mind enables him to keep his head above water for some time before drowning, passes through a different experience. But, although data are wanting on this point, it is probable that his final agony is short and painless. His physical exertions, kept up for a long time in the hope of relief, together with his exposure to cold and wet, and the lack of nourishment, combine to reduce his strength very rapidly, and it is not altogether a conjecture to suppose that a single draught of water into the lungs, when he finally gives up, is enough to bring on unconsciousness.
His suffering, too, is chiefly mental, but he experiences the additional discomforts of exhaustion, cold, and hunger, if his struggle for life is a prolonged one. It is believed that the rapidity and painlessness of death by drowning are due chiefly to the speedy obstruction of the circulation of the blood through the lungs.
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In ordinary asphyxia, by the simple deprivation of air, the blood throughout the body becomes charged with carbonic acid, and the arteries as well as the veins become filled with venous blood. Drownings in other fluids are rare, and often relate to industrial accidents. Populations groups at risk: . Behavioral and physical factors:  . Drowning can be considered as going through four stages: .
Generally, in the early stages of drowning a person holds their breath to prevent water from entering their lungs. A conscious person will hold his or her breath see Apnea and will try to access air, often resulting in panic , including rapid body movement. This uses up more oxygen in the blood stream and reduces the time to unconsciousness.
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The person can voluntarily hold his or her breath for some time, but the breathing reflex will increase until the person tries to breathe, even when submerged. The breathing reflex in the human body is weakly related to the amount of oxygen in the blood but strongly related to the amount of carbon dioxide see Hypercapnia.
During apnea, the oxygen in the body is used by the cells , and excreted as carbon dioxide. Thus, the level of oxygen in the blood decreases, and the level of carbon dioxide increases. Increasing carbon dioxide levels lead to a stronger and stronger breathing reflex, up to the breath-hold breakpoint , at which the person can no longer voluntarily hold his or her breath.
The breath-hold break point can be suppressed or delayed either intentionally or unintentionally. Hyperventilation before any dive, deep or shallow, flushes out carbon dioxide in the blood resulting in a dive commencing with an abnormally low carbon dioxide level; a potentially dangerous condition known as hypocapnia. The level of carbon dioxide in the blood after hyperventilation may then be insufficient to trigger the breathing reflex later in the dive and a blackout may occur without warning and before the diver feels any urgent need to breathe.
This can occur at any depth and is common in distance breath-hold divers in swimming pools. Hyperventilation is often used by both deep and distance free-divers to flush out carbon dioxide from the lungs to suppress the breathing reflex for longer. It is important not to mistake this for an attempt to increase the body's oxygen store.
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The body at rest is fully oxygenated by normal breathing and cannot take on any more. Breath holding in water should always be supervised by a second person, as by hyperventilating, one increases the risk of shallow water blackout because insufficient carbon dioxide levels in the blood fail to trigger the breathing reflex. A continued lack of oxygen in the brain, hypoxia , will quickly render a person unconscious usually around a blood partial pressure of oxygen of 25—30 mmHg. Artificial respiration is also much more effective without water in the lungs. At this point the person stands a good chance of recovery if attended to within minutes.
The lack of water found in lungs during autopsy does not necessarily mean there was no water at the time of drowning, as small amounts of freshwater are readily absorbed into the bloodstream. Hypercarbia and hypoxia both contribute to laryngeal relaxation, after which the airway is effectively open through the trachea. There is also bronchospasm and mucous production in the bronchi associated with laryngospasm, and these may prevent water entry at terminal relaxation.
The hypoxemia and acidosis caused by asphyxia in drowning affect various organs. There can be central nervous system damage, cardiac arhythmias, pulmonary injury, reperfusion injury, and multiple-organ secondary injury with prolonged tissue hypoxia. A lack of oxygen or chemical changes in the lungs may cause the heart to stop beating. This cardiac arrest stops the flow of blood and thus stops the transport of oxygen to the brain.
Cardiac arrest used to be the traditional point of death but at this point there is still a chance of recovery. The brain cannot survive long without oxygen and the continued lack of oxygen in the blood combined with the cardiac arrest will lead to the deterioration of brain cells causing first brain damage and eventually brain death from which recovery is generally considered impossible.
The brain will die after approximately six minutes without oxygen at normal body temperature, but hypothermia of the central nervous system may prolong this. The extent of central nervous system injury to a large extent determines the survival and long term consequences of drowning, In the case of children, most survivors are found within 2 minutes of immersion, and most fatalities are found after 10 minutes or more. If water enters the airways of a conscious person, the person will try to cough up the water or swallow it, often inhaling more water involuntarily.
When water enters the larynx or trachea, both conscious and unconscious persons experience laryngospasm , in which the vocal cords constrict, sealing the airway. This prevents water from entering the lungs. Because of this laryngospasm, in the initial phase of drowning, water generally enters the stomach and very little water enters the lungs.
Though laryngospasm prevents water from entering the lungs, it also interferes with breathing. In most persons, the laryngospasm relaxes some time after unconsciousness and water can then enter the lungs causing a "wet drowning". In forensic pathology , water in the lungs indicates that the person was still alive at the point of submersion. Absence of water in the lungs may be either a dry drowning or indicates a death before submersion.
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Aspirated water that reaches the alveoli destroys the pulmonary surfactant , which causes pulmonary oedema and decreased lung compliance which compromises oxygenation in affected parts of the lungs. This is associated with metabolic acidosis, and secondary fluid and electrolyte shifts. During alveolar fluid exchange, diatoms present in the water may pass through the alveolar wall into the capillaries to be carried to internal organs. Presence of these diatoms may be diagnostic of drowning. Of people who have survived drowning, almost one third will experience complications such as acute lung injury ALI or acute respiratory distress syndrome ARDS.
Whether a person drowns in fresh water versus salt water makes no difference in the respiratory management or the outcome of the person. This reflex protects the body by putting it into energy saving mode to maximize the time it can stay under water. The strength of this reflex is greater in colder water and has three principal effects: [ citation needed ]. The reflex action is automatic and allows both a conscious and an unconscious person to survive longer without oxygen under water than in a comparable situation on dry land.
The exact mechanism for this effect has been debated and may be a result of brain cooling similar to the protective effects seen in people who are treated with deep hypothermia. The actual cause of death in cold or very cold water is usually lethal bodily reactions to increased heat loss and to freezing water, rather than any loss of core body temperature. Submersion into cold water can induce cardiac arrhythmias abnormal heart rates in healthy people, sometimes causing strong swimmers to drown. Upon submersion into cold water, remaining calm and preventing loss of body heat is paramount.
Hypothermia and also cardiac arrest present a risk for survivors of immersion, as for survivors of exposure; in particular the risk increases if the survivor, feeling well again, tries to get up and move, not realizing their core body temperature is still very low and will take a long time to recover. Most victims of cold-water drowning do not develop hypothermia quickly enough to decrease cerebral metabolism before ischemia and irreversible hypoxia occur. The WHO further recommended that outcomes should be classified as: death , morbidity , and no morbidity. Forensic diagnosis of drowning is considered one of the most difficult in forensic medicine.
External examination and autopsy findings are often non-specific, and the available laboratory tests are often inconclusive or controversial. The purpose of investigation is generally to distinguish whether the death was due to immersion, or whether the body was immersed post mortem. The mechanism in acute drowning is hypoxemia and irreversible cerebral anoxia due to submersion in liquid. Drowning would be considered as a possible cause of death when the body was recovered from a body of water, or in close proximity to a fluid which could plausibly have caused drowning, or when found with the head immersed in a fluid.
A medical diagnosis of death by drowning is generally made after other possible causes of death have been excluded by means of a complete autopsy and toxicology tests. Indications of drowning are seldom completely unambiguous, and may include bloody froth in the airway, water in the stomach, cerebral oedema and petrous or mastoid haemorrhage. Some evidence of immersion may be unrelated to the cause of death, and lacerations and abrasions may have occurred before or after immersion or death. Diatoms should normally never be present in human tissue unless water was aspirated, and their presence in tissues such as bone marrow suggests drowning, however, they are present in soil and the atmosphere and samples may easily be contaminated.
An absence of diatoms does not rule out drowning, as they are not always present in water. Most autopsy findings relate to asphyxia and are not specific to drowning. The signs of drowning are degraded by decomposition. Large amounts of froth will be present around the mouth and nostrils and in the upper and lower airways in freshly drowned bodies.
The volume of froth is generally much greater in drowning than from other origins. Lung density may be higher than normal but normal weights are possible after cardiac arrest reflex or vaso-vagal reflex. The lungs may be over inflated and waterlogged, filling the thoracic cavity, and the surface may have a marbled appearance, with darker areas associated with collapsed alveoli interspersed with paler aerated areas.
Fluid trapped in the lower airways may block the passive collapse that is normal after death. Haemorrhagic bullae of emphysema may be found. These are related to rupture of alveolar walls. These signs, while suggestive of drowning, are not conclusive. Most drowning is preventable.
Many pools and designated bathing areas either have lifeguards , a pool safety camera system for local or remote monitoring, or computer-aided drowning detection. However, bystanders play an important role in drowning detection and either intervention or the notification of authorities by phone or alarm. Lifeguards may be unaware of a drowning due to "failure to recognize the struggle, the intrusion of non-lifeguard duties upon lifeguards' primary task-preventive lifeguarding, and the distraction from surveillance duties".
Pool alarms have poor evidence for any utility. Many people who are drowning manage to save themselves, or are assisted by bystanders or professional rescuers. The statistics are not as good for rescue by bystanders, but even there, a minority require CPR. Rescue involves bringing the person's mouth and nose above the water surface. A drowning person may cling to the rescuer and try to pull himself out of the water, submerging the rescuer in the process.
Rescuers should avoid endangering themselves unnecessarily and where possible should provide assistance from a safe position, such as a boat, or by providing flotation or a means of towing from a distance. Where it is necessary to approach a panicking person in deep water, it is advised that the rescuer approach with a buoyant object, or from behind, twisting the person's arm on the back to restrict movement. If the rescuer does get pushed under water, they can dive downwards to escape. After a successful approach, negatively buoyant objects such as a weight belt are removed.
The priority is then to transport the person to the water's edge in preparation for removal from the water. The person is turned on their back with a secure grip used to tow from behind. If the person is cooperative they may be towed in a similar fashion held at the armpits. If the person is unconscious they may be pulled in a similar fashion held at the chin and cheeks, ensuring that the mouth and nose are well above the water.
Rescue, and where necessary, resuscitation, should be started as early as possible. If conscious, the person should be taken out of the water as soon as possible. In-water resuscitation may increase the chances of a favourable result by a factor of about three, if there will be any delay in getting the person out of the water, but the necessary skills require training. Only rescue ventilation is practicable in the water, chest compressions require a suitable platform, so in-water assessment of circulation is pointless. If the person does not respond after a few breaths, cardiac arrest may be assumed, and getting them out of the water becomes the priority.
The checks for responsiveness and breathing are carried out with the person horizontally supine. If unconscious but breathing, the recovery position is appropriate. If not breathing, rescue ventilation is necessary. Drowning can produce a gasping pattern of apnea while the heart is still beating, and ventilation alone may be sufficient. The airway-breathing-circulation ABC sequence should be followed, rather than starting with compressions as is typical in cardiac arrest,  as the basic problem is lack of oxygen. Five initial breaths are recommended, as the initial ventilation may be difficult because of water in the airways which can interfere with effective alveolar inflation.
Thereafter a sequence of two breaths and 30 chest compressions is recommended, repeated until vital signs are re-established, the rescuers are unable to continue, or advanced life support is available. Attempts to actively expel water from the airway by abdominal thrusts, Heimlich maneuver or positioning head downwards should be avoided as there is no obstruction by solids, and they delay the start of ventilation and increase the risk of vomiting, with a significantly increased risk of death, as aspiration of stomach contents is a common complication of resuscitation efforts.
Treatment for hypothermia may also be necessary. However, in those who are unconscious, it is recommended their temperature not be increased above 34 degrees C. People with a near-drowning experience who have normal oxygen levels and no respiratory symptoms should be observed in a hospital environment for a period of time to ensure there are no delayed complications. Positive end-expiratory pressure will generally improve oxygenation. Drug administration via peripheral veins is preferred over endotracheal administration. Hypotension remaining after oxygenation may be treated by rapid crystalloid infusion.
Ventricular fibrillation is more likely to be associated with complications of pre-existing coronary artery disease, severe hypothermia, or the use of epinephrine or norepinephrine. While surfactant may be used no high quality evidence exist that looks at this practice.
People who have drowned who arrive at a hospital with spontaneous circulation and breathing usually recover with good outcomes.