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It’s summertime again and we are all enjoying the hot summer sun and our cool lakes and pools! As we relax and play in the refreshing waters, it is also important to remember to practice safety in order to prevent water-related accidents, particularly those that may lead to secondary drowning events. Secondary drowning, as with all accidents, occurs when we least expect it. This type of drowning is rare – it occurs in only 1-2% of all drowning injuries, but it is very important to recognize the signs and seek treatment early to prevent serious injury or fatality.

What is secondary drowning?

Secondary drowning can occur after a person inhales water into the lungs during a near-drowning or water-struggle event. Those affected tend to appear to recover quickly and resume their normal activities. Unfortunately, if water is inhaled in large enough amounts, the person can suffer a cascade of physical changes in the lungs that result in lung swelling and reduced air exchange. The signs and symptoms are often not immediately apparent, and may take as long as 72 hours after the incident to occur. Airway spasms in the throat and bronchial areas may also ensue, once again leading to reduced oxygen exchange. Secondary drowning creates a perfect environment for pneumonia to cultivate in the lungs, complicating treatment and prohibiting recovery.

What are the signs and symptoms of secondary drowning?

Initial signs and symptoms are often subtle and difficult to determine, particularly in children who are already tired after an active day of water play. They include:

  • Fatigue
  • Drowsiness
  • Cough, wheezing, or complaints of chest pain
  • Changes in their voice
  • White, blue, purple, or pale pallor to the face, lips, or nail beds
  • Sudden changes in behavior
  • A person experiencing airway spasms (indicating an inability to breathe) or frothy, pink foam in the mouth or throat is having a serious medical emergency — 911 emergency services should be notified immediately!

What should I do if I witness or experience a water-struggle event?

It is essential to closely monitor the person for signs and symptoms over the next 24-72 hours. If any of the above symptoms are detected, or you notice any abnormal behavior, seek medical evaluation immediately. Early intervention is key to recovery.

If you have any concerns that water inhalation has occurred, report to the ER for evaluation, even if signs and symptoms do not appear to be present.

How can I prevent secondary drowning?

  • Everyone should know how to swim – and all adults should learn CPR so they may be able to assist in an airway emergency.
  • Provide close, attentive adult supervision of children at all times when water is nearby – put away your cell phones, magazines, alcoholic beverages and other distractions.
  • Remember, water drowning can also occur in bathtubs, baby pools and even buckets, so be alert to unexpected sources of water when children are in the area. And don’t forget to flip over those baby pools and water buckets to empty them of water when not in use.
  • Designate a group of adults to supervise children and take turns relieving the adults of duty.
  • Erect security fencing around pool areas with self-latching locks out of reach of children. You can also add fence and pool alarms to alert you if an unsupervised entrance occurs.
  • Teach children not to panic in water, to be familiar with water safety, and to ‘blow out’ water that gets in their mouth, not inhale it.
  • Always wear Coast Guard-approved flotation devices in the water, especially in open swim areas (oceans, lakes and rivers).
  • Avoid alcoholic drinks or other mind-altering substances which may impair judgment.
  • Learn water and boating safety at your local community pools, YMCA, American Red Cross, aquatic and fitness centers, and state parks and wildlife departments.

I hope you have found this information beneficial. Have a safe and happy summer!

For more information on this topic, you may access the following resources

WebMD information about Dry Drowning
CDC information on child water safety
CDC information on recreational water illness and injury prevention
News story from Asbury Park Press about a recent secondary drowning
News story from Good Day Austin

Donna Welborn, B.S.N., R.N.
Trauma Injury Prevention Coordinator
St. David’s Round Rock Medical Center

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