Drowning by Accident

I have had a fascination with the effects of water on swimmers, well ever since I became a swimmer and beyond. A drowning in a pool for which you have responsibility is a life changing experience. Yet the amount of authoritative documentation on both these topics is scarce. A piece of work I am engaged in currently concerns drowning accidents and particularly trying to ascertain when drowning takes place. I was searching for evidence of this and came across a new publication. It didn’t tell me what I wanted to know but wow what a body of work, from a UK doctor whose dad used to be swimming pool manager (Baths Superintendent) who taught her to swim. Respect.

Not to put it to strongly, I wish to hell I had this book when I started my career in swimming pools particularly when I was a lifeguard and pool manager. Much of the book is though about open water drowning and all the circumstance that beset accidental drowning but there are aspects of it which provide authoritative information on our work in PWTAG and anyway I found that when I was responsible for pool safety people expected me to also know about open water and similar circumstance where drowning can happen.

To indicate the nature of the content I have provided the contents and a brief note on what is covered in some sections. As I have said its not all about swimming pools but ranges across all the places where drowning can and does occur.

Drowning By Accident explains why it is so easy to drown, where accidents happen and how to save lives by early rescue and resuscitation.

More than 600 people die by drowning in Britain every year. Swimming is promoted as a particularly safe form of exercise, so that swimmers forget or ignore the dangers of frigid lakes, swollen rivers, incoming tides or outgoing rip currents. Drowning accidents take place because we don’t recognise water as a hostile environment. We overestimate the strength and endurance of our bodies and underestimate the power and deceptiveness of water.

Year after year, victims lose their lives in typical drowning accidents, often sinking so quickly and silently that nearby family, friends and onlookers fail to notice the tragedy taking place close beside them. Babies drown in baths. Toddlers drown in garden ponds. School children fall off rafts. Teenagers strike too far from the shore. Pensioners wade into rivers to save their dogs.

Victims often die within minutes of sinking beneath the surface. A quarter of those who reach hospital alive will also die, while others survive with severe permanent brain damage. This means that it is vitally important for parents, grandparents, teachers, lifeguards and lawmakers to recognise the risks and prevent drowning accidents before they take place.

Dr E. A. Meinhard is a Fellow of the Royal College of Pathologists. When her family moved to Oxfordshire, she took over a rural general practice and worked as a family doctor for twenty years.

Why Do So Many People Drown?

Part 1: Water is a hostile environment

1 Weighed down and buoyed up: Understanding about buoyancy of the body.

2 Balance of forces: The difference between balance on land and in water, and the implications for swimmers especially children.

3 Shapes in the water: Water is 800 times denser than air and the attraction between water molecules makes water 50 times more viscous than air.

4 Safe entry: Diving and jumping into water – the risks explained.

5 Diving under pressure: Scuba and snorkel, trying to use a snorkel just two feet down is like trying to breathe with a 300 lb weight on your chest.

6 Looking out for trouble: Swimmers with 20:20 vision on land are reduced to 20:200 when they open their eyes underwater. Vision is severely compromised.

7 Feeling the vibrations: When we are swimming, our hearing is so severely compromised that we cannot tell whether the muffled sounds are from the left or right, from ahead or behind us!

8 Flexing the muscles We cannot move through water until we learn the strokes. Beginners direct most of their effort to keeping their heads above the surface. They exhaust themselves by rapid, feeble flailing with their arms and ineffectual thrashing of their feet. They soon have to stop to regain strength and catch their breath.

9 Going the distance: At rest the body contains about 2 litres of oxygen ready for use. 500ml in the lungs, almost 1,000ml loosely bound to the haemoglobin in the blood, 300ml held by myoglobin in the muscles, and 250ml dissolved in the tissues. During strenuous swimming, all of this available oxygen is consumed by aerobic muscle contraction within a couple of minutes.

10 Fresh water and salt water: Researchers noted that members of the Australian National Swimming Team sweated out more liquid during their pre-competition practice sessions than they took in.  When swimming in fresh water, the pull of osmosis draws water through the skin into the swimmer’s body. The kidneys then produce more urine, ridding the body of excess water by a process called diuresis (Greek: ‘flowing through’). Diuresis causes a swimmer no problems during brief sessions in a swimming pool, apart from the need to leave the pool to empty the bladder.

11 Chilled to the bone: The water in public swimming pools is usually kept between 25°C and 29°C. Swimmers notice the cold when they first enter the water, but the sensation soon fades. Nevertheless, within a quarter of an hour or so, unless they generate heat by vigorous swimming, they will lose so much body heat to the water that they start to shiver.

12 Capturing oxygen: We have no store of oxygen in the body, apart from the partially de-oxygenated alveolar air in our lungs and small amounts of oxygen bound to haemoglobin in the blood and to myoglobin in the muscles – enough for a minute or two at most. If the supply is cut off we only have minutes before we die.

Part 2: A closer look at drowning accidents

13 Danger in the garden: Over the course of four months in 2008, Leicester Royal Infirmary admitted five young children found floating unconscious in garden ponds. Three of the children died.

14 Open water: Over five years, 2009–2013, the Royal Society for the Prevention of Accidents (RoSPA) recorded 422 fatal drowning accidents in open water: 62 in ponds, 162 in lakes, 35 in reservoirs and 163 in canals.

15 ‘Wild swimming’ and open-water races: As long as swimmers monitor their performance moment by moment, and get out of the water if they become breathless, if their fingers start to spread, or if they notice that they are feeling colder, they will suffer no long-lasting harm. But swimmers are in immediate danger if they begin to shiver. Their quivering muscles produce heat, but not enough to compensate for the heat they are losing to the water. The work of shivering will quickly exhaust them. Hypothermia can kill.

16 Hard landings

Most swimming pools, especially those in hotels and private houses, are too shallow for safe diving. Without the presence of a lifeguard to keep discipline, however, swimmers sometimes find it impossible to resist the temptation to dive in. The damage may be limited to a wedge of collapsed bone or a ‘teardrop’ fracture chipped from the surface of a vertebra. Sometimes two or more vertebrae are affected. On occasion, an entire vertebra is smashed to pieces – a burst fracture – and jagged fragments of bone are propelled backwards towards the spinal cord.

17 Swept downstream

18 Floods and storm surge

19 At the seaside: tides, waves and rip currents

20 Peril on the sea

21 Hazards on holidays abroad: swimming pools & water parks Foreign holidays rarely last longer than two weeks. Yet more British children drown in the swimming pools of hotels, campsites, and holiday villas abroad than drown throughout the whole year in the swimming pools in Britain. And British children on holiday in America have an even higher drowning rate than those on holiday in Europe.

22 Hazards on holidays abroad: by the sea

23 Shallow water blackout: The rate and depth of our breathing is controlled by the respiratory centre in the brain. If we try to hold our breath, within half a minute the respiratory centre prompts us, then forces us, to breathe in. Surprisingly, it is the level of carbon dioxide in the blood, much more than the level of oxygen, which regulates respiratory drive. When the carbon dioxide level rises, as it does during exercise, the respiratory centre stimulates faster, deeper breathing. If the level of carbon dioxide in the blood is low, the respiratory drive weakens, delaying the urge to breathe. Such a fall in respiratory drive has been responsible for many drownings due to shallow water blackout.

24 Health warnings: Epilepsy, Asthma, Long QT syndrome, Heart disease

25 Drowning in the bath

26 Children drowning on school trips

27 The global death toll of drowning

28 A drowning accident explained: While the swimmer struggles underwater, he holds his breath for as long as he possibly can. But now he cannot rid his body of carbon dioxide, which accumulates in his bloodstream. The respiratory centre in his brain responds to the increasing level of carbon dioxide by prompting him to breathe. His diaphragm begins to jerk up and down, its contractions stimulated by the build-up of carbon dioxide. The urge to breathe becomes increasingly difficult to resist, and he counters by swallowing repeatedly, gulping mouthfuls of water. Nevertheless, however hard he tries to prolong his breath-holding, within one and a half minutes at the most, and usually much sooner, he will be compelled to take a breath. Then he will inhale water instead of air.

Part 3: Coping with a drowning accident

29 Rescue

30 First aid and resuscitation at the scene: Sometimes a swimmer takes some water into his lungs but revives quickly and declines further attention. Thinking he has had a lucky escape, possibly feeling embarrassed at the fuss he caused, he leaves the scene of the accident and returns home. However, the slightest cough, wheeze or chest tightness may be early signals of worse to come. Several hours after his apparent recovery from near-drowning, he begins to feel breathless and coughs up frothy, pink-tinged fluid. Now he needs urgent hospital admission because further deterioration may be sudden and life-threatening. This frightening and avoidable scenario was once classed as ‘secondary drowning’.

31 Hospital treatment and intensive care

32 The problem of water in the lungs

To “Heimlich” or not?

33 Inquest verdicts and drowning statistics

34 The tragic aftermath of a drowning accident

Part 4: The importance of prevention

35 A dozen ways to prevent drowning accidents

I believe that anyone who has a role to play or responsibility for swimming pool safety should read or ideally have a copy of this book for the vital information it contains to add knowledge to practice. It also has implications for PWTAG in influencing our writing in future and currently.

Drowning by Accident, together with the PWTAG Code of Practice I would make compulsory reading for all those who work in a swimming pool. I would provide all staff with copies of these and from time to time test them to make sure they know and understand just what a significant part they play in their work. But I also feel we have a moral obligation for if in our privileged position we are aware of or made aware of knowledge that can have an impact on life and death then don’t we have a responsibility to pass this on for the benefit of everyone?

Ralph Riley, PWTAG Vice Chair

Jan 2023

Drowning by Accident

  • Publisher: Matador (15 Feb. 2022)
  • Language: English
  • Paperback: 712 pages
  • ISBN-10: 1800464983
  • ISBN-13: 978-1800464988

Available also on Amazon