Let’s stop drowning!! On the 1st UN World Drowning Prevention Day, come and chat to world experts (Jenny Smith, Mike Tipton, Adey Mayhew, Paddy Morgan and Beckie Ramsay) about the process and prevention of drowning.

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1. Learn to swim.
2. Don't go near water if you cannot swim.
3. Do not go swimming alone.
4. Do not go swimming in areas without a lifeguard on duty.
5. Be aware of the weather, currents and tides, especially riptides.
6. Never let children swim unattended.
7. Never swim too far from shore.
8. Never dive into waters of an unknown depth.
9. Be aware that someone drowning may thrash and flail in a manner dangerous to their rescuer.
10. Never swim while fatigued, sick, or intoxicated.

What did I miss? :)

Wear a life vest when you're in a boat. My Uncle's life may have been saved if he had wore one. He hit his head on the boat before going in the water. His friends tried but couldn't find him. He was only 19.

Condolences. It is a sad fact that 1 person every 3 weeks loses their life in situations where they should have been wearing a life jacket but weren't. Also, to function properly a life jacket should fit properly, include crotch straps, a light, a splash guard and be regularly maintained.

Lunt, H., White, D., Long, G. & Tipton, M. (2014) Wearing a crotch strap on a correctly fitted lifejacket improves lifejacket performance. Ergonomics. 2014 May

Pointer, K., Milligan, G. S., Garratt, K. L., Clark, S. P. & Tipton, M. J. (2018) A 10-year retrospective analysis to determine whether wearing a lifejacket would have prevented death by drowning in the United Kingdom: An analysis of Maritime and Coastguard data. Safety Science. 109: 195-200. https://doi.org/10.1016/j.ssci.2018.06.003.

All very good suggestions. We add - wear appropriate clothing (swim hat / high visibility / tow float). Carry a pea-less whistle. Rewarm thoroughly after exiting the water. Be supervised.

Swim hat? Toe float? What are those?

Rubber swim hat (in a bight colour) and https://outdoorswimmer.com/product-reviews/tow-floats-and-dry-bags

Never swim while fatigued, sick, or intoxicated.

And generally stay away from water if you're consuming alcohol, even if you don't plan to swim. In Finland, they say that "Alcohol and water don't mix." Every year on Midsummer, people tend to drink heavily around water and drown, especially when they aren't expecting to end up in the water.

Yes, and we include in this other chemical substances. Unfortunately, we have a similar issue here in the UK.

https://www.rlss.org.uk/about-dont-drink-and-drown

My friend and I were swimming and he had an asthma attack and started drowning. I kind of dragged him to shore but I almost drowned myself in the process. What's the right way to save someone in water where you can't touch the floor?

We would always recommend a non-contact rescue. 3 steps - Shout (tell them to float on their back - see Float to Live on the RNLI website), Reach (use a reaching aid / pole), Throw (a rope). Avoid getting into the water - see our previous answer.

Thank you for this info. Tragically, two of my high school classmates drowned together. One couldn’t swim well and began to struggle when he accidentally lost his footing in a lake. His friend attempted to rescue him, but sadly he pulled her down and they both drowned.

This event has stuck with me my whole life. People need to be educated on what to do and what not to do in an open water emergency.

That is so sad. Agree. See earlier comments regarding avoiding going into the water as a rescuer. If you are in the UK, call 999 or 112 to get help.

Thank you so much for doing this! I'm someone who drowned and was resuscitated, to the point where I was told if I was under maybe 15 seconds longer, or the ambulance took 15 seconds longer, I wouldn't have woken up in the hospital. Usually when I see the words drowning in a headline it makes me instantly divert my attention, but this is the first time in years that it's made me smile. Thank you!

What would you say is the best way to get people aware on how to stop this kind of thing from happening?

Thanks for your post. We are pleased that you are finding this useful. Our ambition would be to get a simple, classroom-based lesson on water safety covering cold shock, rips and tides and what to do about them taught to a national standard in all schools and audited regularly. We are just about to publish data to support this approach.

During the recent heat wave I saw a lot of warnings against the dangers of open water swimming and some tragic drownings that occurred.

I find it difficult to internalise the danger of open water swimming because I'm a pretty strong swimmer, and if there are any dangerous incidents the media vaguely euphemistically says someone 'got into difficulties' and without specifics. I -- ( I'm sure, naively ) can't see that happening to me, and I'm not sure what i should be especially careful of.

I did some further reading and I guess Cold Water Shock is a common thread. I've got no experience open water swimming, but I've decided as long as a stay close enough to an exit point or stay where it's not too deep and use some common sense, I'll be fine - why should I be worried?

It's important to note that about 60% of those who die in cold water in the UK were regarded as good swimmers. Many are otherwise fit and healthy individuals. Cold habituation can increase rather than decrease the risk by making people feel comfortable and thereby overstaying their welcome in cold water. For more information see:

Tipton, M. J. & Bradford, C. (2014) Moving in extreme environments: open water swimming in cold and warm water Extreme Physiology & Medicine. 3:12. http://www.extremephysiolmed.com/content/3/1/12.

Add to this rips, tides, currents and unforeseen hazards and ....

ANYONE CAN DROWN: NO ONE SHOULD

In Sweden a lot of those who drown are drunk. Going out on water when drunk (or getting drunk there) is a risk.

Agree.

Sailing with young children.

What is your best advice to keep infants and toddlers safe on a sailboat?

1) close supervision (within arms reach) and know exactly who is in charge of the supervision 2) properly fitted and worn life jacket with crotch straps / retention system 3) clip on at all times 4) refer to RYA guidelines

I've seen ISR (infant swimming resource) being promoted on social media a lot, what do you guys think about that technique ?

We are not aware of the research that surrounds the effectiveness of this approach - but the safety messages appear to be sensible.

I would think the first step is to get them familiar with water before you take them sailing. Teach them water safety such as how to turn on their back in a controlled environment.

Agreed!

When he was a toddler, my mother-in-law definitely kept my husband in a life jacket. Underneath he had a harness with the rope tied to her waist.

No idea if that's a thing that should be done now or if there might be special equipment, but it sounded safe. He had a tendency to go to the side and try to jump off without anyone noticing

Depending on length and whether or not they float, ropes can be problematic and have contributed to deaths in the past. It's much better to keep children closely supervised and wearing an appropriate life jacket / personal flotation device .

I live on a small island and there's reports of beach drownings most years. A lot of the time it's someone who has over-exerted themselves, but sometimes the person who tries to help them too. How can you help someone in that situation, assuming there's no life rings around, without seriously endangering yourself?

1) Avoid going in yourself and call for assistance ASAP 2) Lobby for the provision of rescue equipment, training and signage 3) lobby for water safety lessons in your local schools 4) People need to understand that the water environment is much more demanding especially with rips, currents and off shore winds as well as thermal demands. These challenges require a higher level of fitness.

What age should swim lessons start?

As soon as possible following birth - we are talking weeks / months old rather than years old! Look out for mother and babies swimming lessons.

It seems to me that more and more people don‘t know how to swim anymore. Is that true? And if so, do you people know why?

In the UK, the curriculum does include swimming 25 metres but up to 25% of those children do not reach this standard. Something all children should be able to learn relatively easily is how to float. Remember, swimming in open water is harder than swimming in a pool and needs to be approached carefully.

My boyfriend cannot float, I've never seen anything like it. I've tried to show him how I float but he just doesn't stay on the surface! What's with that? I know that one of the rules if you're in danger is to float and it worries me that he just can't do that.

Don't worry if he can't float - the message is do as little as possible until your breathing is back under control. This may require some gentle sculling. Importantly, don't panic.

As a parent of young kids I'm always terrified of dry drowning. Is there a better way to prevent that other than me having a panic attack and googling "dry drowning symptoms" after every swim? I'm not even sure I understand what would cause it in the first place

We think you might be referring to 'secondary drowning' (note this term in no longer used) i.e., drowning after leaving the water. The best way to avoid this is to supervise your children well when they are in the water and prevent any aspiration.

https://www.surfersmedicalassociation.org/drowning-sea-misinformation-dry-drowning-secondary-drowning-andrew-schmidt-d-o-mph/

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Dr Sempsrott - please can you add a video of your recent discussion on this topic!!

Hi Drs- this is actually one that someone sent me, but I thought I’d pass it along -

Over the past few years I have visited the WHO website and looked up Drowning. I have seen the figure of 372,000 the first time I visited years ago, the WHO Drowning Implementation Guide attached lists 360,000 as the global drowning number in the Foreword and 360,000 was the number given on the web page on 11/12/2019. The last time I looked before today the web page had been updated in February of 2020 and that page listed the global drowning number as 320,000.

Today when I went onto the WHO site the number of annual global drowning deaths is 236,000. This represents a 34% decrease from the 360,000 listed in their implementation guide and a 26% decrease from the 320,000 listed on their webpage before this current update. 34% and 26% seem like significant numbers and I am wondering if anyone has any insight into what this can be attributed to?

Because the US Water Safety Action Plan originated from a World Health Organization recommendation and we are basing our recommendations on statistical data and facts, I felt it might be important to understand where their information is derived from and what led to the big decrease in annual global drowning fatalities.

https://www.who.int/health-topics/drowning#tab=tab_1https://urldefense.com/v3/__https://www.who.int/health-topics/drowning*tab=tab_1__;Iw!!NuzbfyPwt6ZyPHQ!8FIfc1StgG-nebwUTNCVFzecRD5b8LrhAc9tXtorWwxFI4l_OAqH1AyKUUsm3FGI49OW1dtL$

-Dr Justin

Thank you for this.

What are the risk factors for autonomic conflict? Is there an association with water temp, age, pre-existing heart disease, etc…?

Thanks Justin and good morning ... please see these papers. Pay particular attention to the predisposing factors in the first paper and long QT in the second paper.

Shattock, M & Tipton, M. J. (2012) “Autonomic conflict”: a different way to die on immersion in cold water? Journal of Physiology. 590 (Pt 14): 3219-30.
Winter, J., Tipton, M. J. & Shattock, M. J. (2018) Autonomic conflict exacerbates long-QT associated ventricular arrhythmia. Journal of Molecular and Cellular Cardiology. 116:145-154. doi: 10.1016/j.yjmcc.2018.02.001.
Tipton, M. J. (2013) Sudden cardiac death during open water swimming. British Journal of Sports Medicine. 48(15):1134-5

I’m almost 40 and terrified of swimming, I can’t get my head under the water.

It always bothers me when I see flooding videos or scenes where a car goes off-road into a lake and they have to swim out.

I feel it’s far too late to learn, as it’s so much to de-program out of my DNA at this point. Not being near water is the best option (and wearing a life jacket when near it) seems sufficient for a person like me, but I always wish I could get the fear conquered. What would be your opinion on this?

It's never too late learn. There are specialist swim teachers who are specifically trained to assist those with aquaphobia. If you are in the UK, you can find these teachers on the STA website.

I’m surprised by the percentage of juvenile drownings. To what extent are such drownings a result of inadequate supervision? In other words, what could the parents and guardians have done, and what lessons can other parents learn?

Everyone should understand the risks and ways of mitigating those risks. This may include a variety of interventions from a simple school lesson on the risks of immersion, to the provision of lifeguards, and engineering solutions in other areas. Something we can all do is lobby to act on climate change that is increasing water levels and causing heat waves and floods.

We are in Plymouth, associated with the RNLI, D&C Coastsafe and Above Water (Torquay) we have set up a water safety initiative and are raising money and awareness of the dangers, but one of our biggest obstacles is consumerism and retailers selling inappropriate equipment. We feel like the fun police re open water swimming, leashes and PFD. Is education purely the key, or is legalisation actually an option? (PS we love education- we are teaching water safety in my school, through PD and assemblies, as well as teaching 224 of the new cohort of year 7s coming in Float to Live, CPR and Defib training!)

All approaches that can significantly contribute to drowning prevention are valuable. Manufacturers and retailers have real opportunity to be ethical in this area.

Are children who have swimming diplomas still at risk of drowning in a pool? (I know the ocean can have currents and such, but know many people who keep their older children unsupervised in the pool)

Yes. Some drownings occur due to things like breath hold competitions (not recommended), horse play etc. Children should be supervised at all times.

Have you worked with Bode Miller to raise awareness? I believe he became very vocal about swimmer safety/drownings after his tragic loss

No, we are UK based. We have Beckie Ramsay on this AMA - please see https://www.facebook.com/DoingItForDylan/

When I swim I have no buoyancy do to myotonia congenita and I was wondering if there was a known % of people who just lack (or have reduced) buoyancy?

On average a person is buoyant and between 2% and 6% of the body will remain above the surface of the water depending on the individuals body characteristics and the salt content of the water. Some individuals are negatively buoyant but their sinking force is low and should be able to be overcome by gentle sculling. So, the recommendation remains on initial immersion, do as little as possible to keep your airway clear of the water until you get your breathing back under control. Don't panic.

What are your thought on using masks with the nose covering?

Really depends on which water activity you are undertaking. For most swimmers they prefer the goggle style so they can breath out through their nose in a controlled way during the head under phase. For those snorkelling who may duck dive having the nose covered allows them to clear their mask and/ or equalise the pressure inside the facemask so they don’t get “Mask Squeeze”.

There are some Full face mask snorkels that encompass the whole face including mouth and nose. As with any device there is a balance of risk. One the one side there is an association with accumulating Carbon Dioxide when breathing out if the volume if gas being breathed out is not significantly greater than the volume of the mask and the snorkel. The other side of the coin is that it is easier to use than separate mask and snorkel setups. The key to drowning prevention in this situation is:

- Choose the correct sized equipment

- Be trained in how to use the equipment safely

- Take slow and deep breathes, avoid rapid shallow “hyperventilation like breathes”

- Watch out for changes in behaviour of those around you especially children.

- Follow the other guidelines for safe open water activities!

Thanks for the AMA! Not prevention-related, but I’m doing a literature review at the moment looking at ECMO* treatment after drowning, most specifically under what circumstances a patient should be transported directly to an ECMO centre rather than the nearest emergency department. What are the gang’s thoughts on this? Is ECMO more useful for rewarming hypothermic drowning patients than for its lung bypass feature? Is Covid-19 changing the landscape of ECMO availability in the UK?

*to keep it understandable by all, extracorporeal membrane oxygenation, a machine that takes blood out and does the work of the lungs (and potentially heart) without needing your actual pulmonary system to be working fully, and puts the blood back

Whilst not directly related ECMO, and more general ECLS (Extra-corporeal Life-support) as it can include Cardiac bypass, does have an expanding role in the treatment of drowning victims which ultimately reduces the number of people who die as a result, and reduces the disability that can be caused due to the lack of oxygen. Dr Thom and colleagues recently published there systematic review on treatment of lung injury which include ECLS use. https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-021-03687-2.pdf

We also looked at this as part of the preparation for international resuscitation guidance: https://www.sciencedirect.com/science/article/pii/S0300957221000423?casa\_token=GL6j8KuyBYYAAAAA:f-g1HzwmLcLcAyQ-9RSCeiiWa\_nGLcBDzPn5B78N5F8HxX9QdPdKTbGOA5AA70bc2FxmrhVPrT5e

The bottom line is that ECLS works for drowning patients, if you are not in cardiac arrest when you go onto ECLS your outcomes are better. Each patient is different so some aren’t hypothermic, some are but are not hypoxic. The number of people being put on ECLS for drowning in the UK are low at present, but momentum is building to formalise the pathways!