Quick and silent
Many drownings are not noticed until it’s too late. Who is most likely to drown? And how do you spot someone in trouble?
It took more than four minutes for anyone to notice the 5-year-old boy who appeared to have drowned in a small pool within touching distance of families and other children.
When drowning experts reviewed a video showing the boy floating face down for several minutes, they were shocked. It was nearly impossible to watch, even for people whose work is saving people from drowning. But the unconscious boy was resuscitated and survived. Unlike many non-fatal drownings, he suffered no lifelong injuries.
In New Zealand, in 2021, Water Safety NZ says there were 90 recreational (intending to be in the water) and non-recreational (no intention of being in the water) preventable drowning fatalities. This is a rate of 1.76 per 100,000 population, up from the 5-year average of 1.67. Over the 2021-22 summer only, there were 47 fatalities, compared with a 5-year average of 25.
Preventable deaths in the 2021 year increased by 7% on 2020 (84) and 13% on the 5-year average (80). Last year New Zealand had the highest number of preventable drowning deaths since 2011.
Why didn’t anyone hear the boy’s call for help?
Because he didn’t call for help. Contrary to the Hollywood stereotype, no-one in any of the 23 videos reviewed by international experts waved or called for help. (The videos were from closed-circuit cameras and from people who had realised only after the event that they had filmed a drowning.) That backs up what lifesavers see on beaches and in pools and rivers.
‘‘There was a clear debunking of that theory,’’ says Dr Shayne Baker, a volunteer lifesaver for 25 years on some of Queensland’s most dangerous beaches.
In November 2020, a wellpublicised video captured the recovery of a 24-year-old Chinese student who fell in a river. She made no noise and floated face down until she was rescued by Stephen Ellison, a British diplomat and consul-general.
In half the videos studied by experts, bystanders swam, walked or waded near the person in trouble. In the video of the boy, he is seen trying to reach the edge of the pool. He makes it momentarily, only to drop in exhaustion next to adults chatting in the shallows. Face down beneath the water, his limp body is carried by the movement of the water across the pool. He comes to rest next to a woman who raises the alarm.
‘‘It is bizarre,’’ says Baker. ‘‘When you are watching the videos, you think, how can you not see this child is not coping? They are not playing; they are fighting for their lives.’’
Other videos show people swimming laps over the top of people who have sunk after only a few strokes, and children whose flotation devices have capsized, trapping the child upside down in both a pool and a large bath.
‘‘The idea that you are going to get a clear sound, or indications, such as raising arms above the water, is wrong,’’ says Baker.
Not only is drowning a ‘‘silent killer’’ but it can happen quickly, found drowning prevention expert Dr Amy Peden, a lecturer in injury prevention at the University of NSW. In the case of the boy in the video, his mother had left the pool to have a sauna with a friend, presuming he would be safe surrounded by adults and children.
Peden studied the drowning deaths of 447 children under 5 in which coroners ruled distraction was a factor. A child can die in the time it takes to hang out a load of washing or stir food on the stove.
And new research released in November found the risk of a child drowning triples following a child’s first birthday.
How can you tell that someone is drowning?
Until the advent of mobile phone and surveillance cameras, there was only anecdotal evidence from survivors about what happened and how they reacted. But the videos of people drowning found
19 were rescued before they became unconscious and 5 were unconscious.
Baker says the videos show that people who are trained to respond – lifesavers and lifeguards – can spot someone in trouble much faster than untrained bystanders. In more than half of the videos, bystanders failed to recognise any signs at all.
He says that, when weak swimmers begin to tire, they usually have trouble with any overarm action. This is followed by changing to underwater arm action and then they are more upright in the water and are looking about for the closest point of safety or exit.
They tend to lose any capacity to propel themselves forward, he says. They often look like they are attempting to climb an underwater ladder or pushing their arms down behind them.
‘‘While there might be a great deal of arm action, it is not guiding or directing them in any particular direction. They have already begun to drown . . .’’
Most swimmers don’t have the experience or skills to know to float and raise an arm. It sounds obvious, but
watch for people whose faces drop below the water and don’t surface fully to take a breath.
Someone who can’t swim will struggle to lift their head clear of the water to breathe and will have no control or capacity to control their body position/ rotation.
What happens when a person is drowning?
Australia’s former surgeongeneral Professor John Pearn, a paediatrician, describes drowning as a hypoxic march of events that reduces oxygen to the brain until none flows at all.
When someone falls into water, they involuntarily hold their breath. That causes their pulse rate and blood pressure to rise until they reach ‘‘break point’’, says Pearn.
That’s when rising levels of carbon dioxide cause a receptor in the brain to fire off an irresistible compulsion to take a breath. Virtually all children, though, have a ‘‘brain-sparing diving reflex’’ that delays the intake of breath to provide them with an extra 30 seconds, he says.
There comes a time, though, when everyone has to take a breath and you can’t get your head above the water. ‘‘It is a terrible moment. Against one’s will, one has to inhale, and the water hits the larynx at the back of the throat.’’
Water rushes into the lungs, causing the person to become unconscious. ‘‘At this stage, the heart is still beating, racing to overcome the lack of oxygen, up to about 200 beats a minute,’’ Pearn says.
‘‘Finally, the heart will slow down because it hasn’t got any oxygen. Usually, they’ve been unconscious for three to five minutes in the water.’’
It takes an average of two minutes for someone drowning to become unconscious.
Would holding your breath delay this response? It may but even if you could, you shouldn’t. Most people can hold their breath for only 30 to 60 seconds.
Although schools once had competitions to see who could hold their breath longest, experts recommend against hyperventilating or breath-holding before or during an endurance underwater swim. It can disable the ‘‘safety receptor’’ and cause some people to lose consciousness.
Or, as Pearn describes it, ‘‘if the drive to breathe is lost, unconsciousness from cerebral hypoxia may occur before the hypoxia-induced breakpoint is reached’’.
More men die from drowning in New Zealand than women. There were 76 male drowning deaths in 2021, the highest male total since 2003 (80).
The most male drowning fatalities occurred in the 65+ age group (18). The largest age group for female drowning deaths in 2021 was the under-5s, with three.
Deaths occurred more in the older age groups of 45+, with a total 58% of drowning fatalities (52).
Research has shown men overestimate their swimming abilities, and their assessment of their skill doesn’t match reality.
Peden says men are more likely to engage in high-risk behaviour, they’re more likely to spend a longer time in deeper water compared to women, more likely to drink and swim, and eschew lifejackets.
Young men are also most at risk of getting caught and drowning in a rip current, says Surf Life Saving Australia.
Isn’t all drowning fatal?
The definition of drowning is the ‘‘process of experiencing respiratory impairment from submersion and/or immersion in liquid’’, according to the World Health Organisation.
Some submersion results in death but many other people experience a non-fatal drowning that may result in lifelong injuries.
Michelle O’s (full name withheld) 3-year-old daughter was found unconscious in a cold pool, where she had been for an estimated 15 minutes. No-one thought the little girl would survive. Organ donation staff were on standby.
The girl lived but lost her ability to speak, which she recovered after years of work with her mother, physiotherapists and doctors. She still struggles to follow directions because the non-fatal drowning damaged her frontal lobe.
Mrs O prefers the term ‘‘nonfatal’’ to the outdated ‘‘near’’ drowning previously used. ‘‘There was nothing ‘near’ about the change in our life,’’ she says. ‘‘She was in the water unconscious for up to 15 minutes. Her lungs were full of water.’’
Samuel Morris was a ‘‘happy cuddly little 2-year-old’’ who lived for eight years after a nonfatal drowning in his family’s backyard pool in 2006. He experienced a severe hypoxic brain injury and was left with a range of severe disabilities.
‘‘I will never, no matter how hard I try, get the picture out of my head how my son was,’’ Samuel’s mother, Jo-Ann, wrote on her website about the moment when she found Samuel floating in the pool wearing only his T-shirt and nappy. ‘‘The look, the taste, the smells, the sounds or the feeling will be with me forever.’’
Who survives drowning?
Survival depends on how long a person has been in the water and how long it takes before someone starts cardiac-pulmonary resuscitation (CPR). ‘‘If chest compressions happen within five minutes, you will do better,’’ says emergency retrieval doctor Brian Burns. ‘‘The longer that [blood] doesn’t flow to the brain, the worse you will do.’’
Survival also depends on where you are and your proximity to emergency services. In remote and rural areas where young men may get into trouble in a dam or creek, it can take too long to get help.
A study by Pearn reviewed 250 toddlers rescued from backyard pools with no pulse. To find why some were resuscitated and survived and why others died, they attained estimates of how long a child could have been in the water.
Those children who died had been immersed for ‘‘somewhere between five and 10 minutes’’.
‘‘If we can rescue a person and get oxygen into the bloodstream again via the lungs, the brain and the heart are resilient and normal life can be resumed.
‘‘If a young child, apparently dead, is taken out of a backyard pool, a fishpond or irrigation channel [close to an ambulance, or near someone who can do CPR], for example, the chance of getting a save is 50% [on average], which is very good.
‘‘But if the person on the scene – usually one of hysteria, shouting and crying – who attempts resuscitation happens to have done a first-aid course, the chance of that child surviving rises to 70%.’’
What can you do? How well should a child be able to swim?
Do a first-aid course, learn water-safety techniques, including how to recognise someone in trouble and call for help, teach your children to swim, and swim only at patrolled beaches, waterways and pools.
‘‘If you have a 6-year-old, and your child can’t swim continuously for five metres, you need to think about doing something about it quickly,’’ urges Justin Scarr, who worked with Surf Life Saving Australia and other organisations to develop nationally approved guidelines.
He says being able to swim five metres – no matter how – means a child can probably make it to the side of a pool or its stairs if he or she gets into trouble. At that age, each child should also know how to float and identify people in trouble in the water who need help.
‘‘Non-swimming children become non-swimming adults, and that is a ticking time bomb.’’
Basic swimming skills provide some protection from drowning but not immunity, says Scarr. ‘‘To increase protection, we need our young people to develop lifesaving and basic rescue skills. This was a rite of passage in high school but sadly doesn’t happen often enough any more.’’
There has also been a spike in bystander rescues, resulting in the death of both the person attempting the rescue and the person drowning. Scarr says before attempting a rescue, people need to explore all options (to talk, to reach, to throw a rope or buoy, or to call help).
‘‘A swimming rescue is a last resort and should only be attempted by expert swimmers and lifesavers. Even strong swimmers should take a flotation aid, a rescue tube, a surfboard’’ in an emergency.
‘‘As difficult as it is to watch a child or loved one in trouble, if you don’t have expert swimming skills, you really need to find someone who has.
‘‘It is really why weak swimmers should never swim or wade at unpatrolled locations. Choose a council pool, go to a patrolled beach, even wear (or put your child in) a lifejacket if you are unsure of their swimming skills.’’