John E. Monaco, MD
During one of my recent weekends on call I was reminded that the drowning season is indeed upon us, so I thought it would be worthwhile to review a few of the basics.
Over the course of two days at our institution, there were three children brought in to our emergency department because they had drowned or nearly drowned. For the purposes of definition, near drowning refers to a submersion accident where the victim survives. These accidents are referred to as drownings if the patient dies within 24 hours of the event.
Of the three cases we had that weekend, one was an actual drowning while the other two were, thank goodness, in the near drowning category. Interestingly, all three of these children were under three years of age, one of the statistical age peaks for drowning. Another peak occurs in later childhood in adolescents when many more victims, ironically, actually know how to swim. These accidents occur as a result of unsafe swimming and other accidents of this type.
The child who died followed the classic example. She was two and a half years old and managed to sneak out the back door when the mother wasn't looking. It takes only moments for children to get into the water when they are unattended and probably only between five and ten minutes under water, without oxygen, before there is irreversible brain damage and eventual death. Supervision, not swimming classes, would have saved this child.
Lapses in supervision were also behind the two near drownings. One case again involved a swimming pool. This time it was an 18 month old. And for any of you who are lucky enough to have an energetic toddler around the house, you know how quickly they can get into trouble. Factor in older siblings, pets and perhaps a swimming pool and the risks are ratcheted up considerably.
Luckily, the child was noticed to be missing almost immediately, and although he was found face down at the shallow end of the pool, his cool thinking caretaker pulled him out and performed CPR immediately, restoring the child's effective breathing quickly. By the time he arrived at the emergency room, he was coughing and wheezing somewhat, but his brain, and his life, were intact due to the quick reactions and thinking of his family.
The third case was one that we thankfully don't see very often. This young man was nine months old. Just to remind you a nine month old cannot yet walk, typically, but is able to sit quite well unsupported. Therefor, they usually do quite well in the bathtub, with shallow water, because they are able to sit and play easily while they are being washed. If they slip, or are somehow submerged, they may have considerable difficulty pulling themselves back up out of the water. This was indeed the case with this child.
He had been placed in the bathtub, and no sooner had the bath begun when the phone rang. For a split second the mother tried to decide whether to answer the phone. (She shouldn't have!) Her child seemed so safe, she decided to run and see if the call was one she had been expecting. Luckily it was not.
Because in the two minutes it took her to go to the phone, answer it, realize it was not the party she was expecting, ask them to please call back later, and then return to the tub, the child had somehow submerged himself and was now face down in the water, blue and unresponsive. She was not trained in CPR, but knew enough to pull him out and give him rescue breaths. He was probably submerged a short enough time that his heart had not yet stopped, so the breathing was all that was necessary to restore her child to spontaneous breathing, and to life. He spent the night in the hospital, required a brief period of oxygen and a few breathing treatments but in the morning was sent home in good condition.
A few things are worth noting. The best treatment for drowning is prevention and supervision. There is no substitute for NEVER having your child in an unsafe water environment. And when they are swimming, they must ALWAYS be supervised. Why? Well, the statistics tell the story. Children who are bought to the emergency department from the scene of a submersion accident with no heart beat and unresponsive have a nearly 100% chance of death or survival in a vegetative state. Despite all the advances in pediatric trauma, emergency and critical care, there is no substitute for what happens at the pool, lake or tub side. In other words, it is prevention and/or rapid treatment that saves livesÉ not advanced hospital care.
So with summer here, have fun! Swim with your kids. Teach them to respect the water. But, NEVER let them swim alone. And, sharpen up your CPR skills. You never know when they might come in handy.
John E. Monaco, M.D., is board certified in both Pediatrics and Pediatric Critical Care. He lives and works in Tampa, Florida. He welcomes your comments, suggestions, and criticisms
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