Drowning: What Actually Happens and What to Do

Drowning kills approximately 76,000 Indians annually — most young children and adolescents, most in unfenced water bodies, ponds, canals, and unsupervised swimming pools. The specific presentation is often silent, not dramatic. The response window before permanent brain damage is roughly 4-6 minutes. Prevention plus response knowledge is the specific combination that saves lives.

What drowning actually looks like

• Silent — often no cries or splashes (person cannot draw breath to shout).
• Vertical position in water, arms not swimming.
• Head low in water, mouth at water level.
• Eyes glassy or closed.
• Hyperventilation or gasping.
• Trying to climb an invisible ladder.
• Not able to reach for a rescue rope or hand.
• Under 20-60 seconds visible before submersion.

Recognising when a swimmer is in trouble

• Person suddenly quiet who was calling.
• Person head-tilted-back with mouth open.
• Person's hair over eyes.
• Person appears to be climbing out of water.
• Person's legs not visibly kicking.
• A child playing loudly then suddenly quiet is often the drowning signal.

The response — the four Rs

• Recognise — silent distress is the signal.
• Reach — extend rescue equipment (rope, pole, floatation) — don't enter water yourself if avoidable.
• Rescue — get person out of water safely.
• Resuscitate — begin CPR immediately if not breathing.

The critical don'ts

• Don't enter the water yourself unless trained — many drowning victims drown their rescuer.
• Don't waste time trying to drain water from lungs — traditional "hold upside down" makes things worse.
• Don't do the Heimlich manoeuvre (was previously taught, now not recommended).
• Don't assume 'coughing means fine' — secondary drowning possible hours later.
• Don't ignore near-drowning — hospital assessment needed even if seemingly recovered.

The rescue technique

• From poolside or bank: reach with pole, rope, or floatation.
• Throw floatation if within throwing distance.
• Only enter water as last resort, ideally with a floatation device.
• Approach from behind if possible.
• Keep victim's face above water.
• Get them out onto firm surface as soon as possible.

Once out of water

• Check breathing.
• If breathing: recovery position, monitor, ambulance.
• If not breathing: 5 rescue breaths first (unlike adult cardiac arrest).
• Then chest compressions 30:2 (or continuous with breaths if trained).
• Continue until breathing returns or medical help arrives.
• Never assume dead until warm and dead — hypothermia protects the brain.

The specific paediatric considerations

• Drowning is a top cause of death in Indian children 1-14.
• Most in unattended situations — buckets, tubs, ponds, uncovered wells.
• A child can drown in 2.5 cm of water.
• Constant supervision within arm's reach for children in or near water.
• Never leave a child alone in a bath, even briefly.
• Fence pools with self-closing gates.
• Cover wells and water tanks.
• Teach swimming — protective but not preventive.

Secondary drowning — the specific delayed danger

Water in the lungs can cause delayed pulmonary complications hours later, even after apparent recovery. Signs to watch for in the 24 hours after a near-drowning:

• Persistent cough.
• Difficulty breathing.
• Extreme fatigue or lethargy.
• Chest pain.
• Any change in behaviour.

Any of these warrants emergency assessment. Anyone with a significant near-drowning event should be observed in hospital for 4-6 hours minimum.

Prevention — the household audit

• Cover water tanks.
• Fence swimming pools with self-closing gates.
• Empty buckets, bathtubs immediately after use.
• Never leave water unattended near young children.
• Life jackets on any boat or unfamiliar water.
• Swim only with supervision.
• Avoid swimming after alcohol.
• Know your limits — don't overestimate swimming ability.
• Learn CPR — half the households don't.

What to record after a drowning event

• Time submerged (estimated).
• Water type (fresh, salt, chlorinated).
• First response given.
• Hospital treatment.
• Any complications.
• Recovery timeline.
• Any long-term neurological or pulmonary effects.

The specific difference between watching a child play near water and understanding drowning is silent is often the specific difference in outcome. A drowning is a preventable emergency; a completed drowning is a permanent tragedy.

References

• WHO — drowning prevention
• AHA — resuscitation for drowning
• PMC — drowning epidemiology India