Little-known dangers of “dry” and “delayed” drowning

I often recommend swimming or just moving in water. It’s good, total-body exercise that’s easy on your joints, especially as you get older. Plus, at this time of year, you can swim outside in pools, ponds, lakes, and the ocean. So — you get the double benefits of being outside in the sun and air, while getting some whole-body exercise.

But safety is a real concern. You might think that most drownings occur in deep water far from shore. But drowning commonly occurs in shallow water, close to shore, or in smaller pools (and even bath tubs).

Statistically, drowning in shallow water is a lot like getting in an accident close to home. It happens quite frequently because most swimmers swim in shallow water.

You can look at car accidents the same way…

For example, when I was a child and seat belts were first introduced, my parents focused on buckling up for long trips on the highways or turnpikes, where, frankly, we observed more than one grisly, roadside accident scene (also before the introduction of safety glass). But the public safety campaign emphasized (and still emphasizes) that most motor vehicle accidents occur within 25 miles of home.

Of course, that statistic gets thrown around because most driving, day in and day out, occurs within 25 miles of home, where most drivers have most of their exposure to potential accidents.

I figured out that explanation in middle school, which did not earn me points with my public school safety instructor. But, perhaps, it helped point me toward future training and understanding of biostatistics and epidemiology, which I regularly share with you.

Likewise, there are few long-distance swimmers way out in the middle of the ocean. Plus, people who die out in the open ocean are more likely to die from exposure and hypothermia than from actual drowning.

Indeed, most swimming day in and day out occurs in shallow water. And in my experience as Medical Examiner, I know you can drown in small bodies of water at shallow depths. Even at YMCA pools despite the youthful lifeguards “on duty.”

“Dry drowning” is a real danger

Most people think drowning occurs when water fills the lungs, blocking breathing.

But “dry drowning” can occur when the larynx closes off due to spasm when first exposed to water coming down the back of the throat. No water actually is inhaled into the lungs. Instead, the airway is cut off and no air can enter. Dry drowning is very common and just as deadly.

A second type of dry drowning can occur when a severe inflammatory reaction causes the throat to swell shut, closing off the airway and causing asphyxiation. It can be caused by something as simple as cold droplets of water hitting the larynx through the mouth or nose.

This type of inflammatory reaction actually killed George Washington in December 1799 after he was caught out in a cold rain riding around his Mt Vernon estate. Younger doctors wanted to perform the new procedure of tracheotomy, which would have saved him. But the older, VIP physicians “in charge” of the former President thought they should not use an “experimental procedure.” They instead bled him to death, using outdated medical practice.

High speed submersion — such as going down a water slide, riding a waterfall-type amusement attraction (where you are seated and even have your clothes on), or a high dive into water — can also cause this spasm of the throat.

Another type of “dry drowning” occurs when some water is ingested but continues to irritate the tissues of the larynx or throat even after the person leaves the water.

Watch for “delayed” drowning symptoms for up to 24 hours

Tragically, there have been several examples of “delayed drowning” in the news lately.

It can happen when a swimmer inhales some water into the lungs. It may be only a small amount of water, but it settles into the lung’s air sacs. The body reacts to this foreign fluid causing pulmonary edema, sending more fluids into the lungs from blood and tissues. There is no room to take in air.

This delayed or secondary drowning can occur many hours after inhaling and exiting the water.

In fact, you can experience the symptoms of dry drowning and delayed drowning from one hour, up to one day, after leaving the water. The symptoms may include, chest pain, coughing, gasping, or other trouble breathing, fatigue, blue lips or skin, and behavior changes. Foam around the mouth, coughing, or sputtering in anyone removed from the water requires immediate medical care.

Treatment can range from simple medical observation, to giving oxygen, intubation, or use of a ventilator for assisted mechanical breathing. Chest x-rays may be necessary.

Serious medical procedures are rarely necessary, but make sure you know where to find them, especially if you are older or are in the water with children or grandchildren.

These drownings outside the water account for one to two percent of all drownings in the U.S., of which there are about 10 per day. (Of course, that number pales in comparison to Virginia Governor Terry McAuliffe’s 93 million death per day from guns. But we survived the week, so there must have been something wrong with his statistics.)

And don’t think you’re safe at the local YMCA with their profusion of junior lifeguards. These guards typically appear more interested in socializing, as I have observed as a swimmer. As a former Medical Examiner, I think you would be shocked at the number of drownings I have investigated at YMCA pools with lifeguards on duty. I guess they’re run like a typical “non-profit” organization.