‘Dry drowning’ and other myths
ABSTRACT
Drowning is a common and often preventable cause of death, especially in children. The mass media often propagate misinformation about “dry” and “secondary” drowning, diverting attention from appropriate efforts to prevent drowning and rescue and treat those who do drown.
KEY POINTS
- Drowning is a process of aspiration leading to hypoxia and eventually cardiac arrest. However, it is not synonymous with death: it can be interrupted.
- Patients who have been rescued from drowning and who have minimal symptoms generally get better within 4 to 8 hours of the event.
- Rescued victims should be warned that, although a rare condition, if they develop cough, breathlessness, or any other worrisome symptom within 8 hours of being in the water, they should seek medical attention immediately.
RECOGNIZE DISTRESS
When preventive measures fail, responders (usually a health professional is involved) need to be able to perform the necessary steps to interrupt the drowning process.
The first challenge is to recognize when someone in the water is at risk of drowning and needs to be rescued.25 Early self-rescue or rescue by others may stop the drowning process and prevent most cases of initial and subsequent water aspiration, respiratory distress, and medical complications.
DON’T BECOME A VICTIM
Rescuers must take care not to become victims themselves. Panicked swimmers can thrash about and injure the rescuer or clutch at anything they encounter, dragging the rescuer under. And the rescuer can succumb to the same hazards that got the victim into trouble, such as strong currents, deep water, or underwater hazards.
Certified lifeguards are trained to get victims out of the water safely. The American Red Cross slogan “Reach or throw, don’t go” means “Reach out with a pole or other object or throw something that floats; don’t get in the water yourself.”
WHAT TO TELL THE PUBLIC
While some journalists acknowledge that the terms dry drowning and secondary drowning are medically discredited, they still use them in their reports. The novelty of this story—and its appeal to media outlets—is precisely the unfamiliarity of these terms to the general public and the perceived mysterious, looming threat.
We often hear that these terms are more familiar to the public, which is likely true. More concerning, some physicians continue to use them (and older definitions of drowning that equate it with death) in media interviews, clinical care, and publications. The paradox is that we, the medical community, invented these terms, not patients or the media.
As clinicians and researchers, we should drive popular culture definitions, not the other way around. Rather than dismiss these terms as “semantics” or “technicalities,” we should take the opportunity to highlight the dangers of drowning and the importance of prevention, and to promote simpler language that is easier for us and our patients to understand.19,21
Healthcare providers should understand and share modern drowning science and best practices, which will reduce fear, improve resource utilization, and prevent potentially deadly consequences due to misunderstanding or misinterpretation of incorrect terminology.
WHEN PATIENTS SHOULD SEEK CARE
Anyone who experiences cough, breathlessness, or other worrisome symptoms such as abnormal mentation within 8 hours of a drowning incident (using the modern definition above) should seek medical advice immediately.
We tell people to seek care if symptoms seem any worse than the experience of a drink “going down the wrong pipe” at the dinner table.21 But symptoms can be minimal. Careful attention should be given to mild symptoms that get progressively worse during that time. These cases can rarely progress to acute respiratory distress syndrome.
Table 1 explores who needs further medical help after being rescued from the water.26
In most of these cases, it is most appropriate to call an ambulance, but care may involve seeing a doctor depending on the severity of the symptoms.6,21 Usually, drowning patients are observed for 4 to 8 hours in an emergency department and are discharged if normal. Symptoms that are more significant include persistent cough, foam at the mouth or nose, confusion, or abnormal behavior, and these require further medical evaluation.
Patients should also seek medical care even if they are 100% normal upon exiting the water but develop worrisome symptoms more than 8 hours later, and providers should consider diagnoses other than primary drowning. Spontaneous pneumothorax, chemical pneumonitis, bacterial or viral pneumonia, head injury, asthma, chest trauma, and acute respiratory distress syndrome have been mislabeled as delayed, dry, or secondary drowning.3,4,19,21
