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Near-Drowning(Drowning; Submersion Incident)
Definition

Near-drowning is respiratory impairment from being in or under a liquid. Normal air exchange is prevented by inhaled liquid when a person’s nose and mouth are under the surface of a liquid or when a person’s face comes in contact with liquid.

Causes

Near-drowning is caused by liquid, most commonly water, filling the lungs resulting in breathing problems. At first, the person will hold their breath. Eventually, the person will no longer be able to hold it. The liquid will then flow into the lungs. This liquid will not allow the normal gas exchange in the lungs to happen.

Risk Factors

Factors that may increase your chance of near-drowning include:

  • Use of drugs or alcohol prior to incident
  • Not knowing how to swim
  • Rough play around water or unsafe diving resulting in trauma
  • Risk-taking behavior around pools or other bodies of water
  • Being in a body of water and having a prior medical condition, such as seizure disorder, fainting, cardiac conditions, or hypoglycemia.

Children are most often the victims of near-drowning. The following factors increase a child’s risk of near-drowning:

  • Not knowing how to swim
  • Being unsupervised around water
  • Having an unfenced pool or spa in the home
  • Among children less than 1 year old, the most common risk factor for near-drowning is being left in a bathtub unattended (even for a few minutes)
Symptoms

Symptoms of near-drowning may include:

  • Drowsiness
  • Being unconscious
  • Inability to breathe
  • Gasping for breath
  • Vomiting
  • Coughing or wheezing
  • Blue skin due to lack of oxygen
  • Seizures
  • Cardiopulmonary arrest

In some people, breathing problems may not happen until several hours after a near-drowning accident.

Diagnosis

A near-drowning injury will be diagnosed based on events and symptoms. A physical exam will be done.

Imaging tests can assess bodily structures. These may include:

Your doctor may need to test your body's oxygen levels. This can be done with:

  • Blood tests
  • Pulse oximetry

Brain Damage from Lack of Oxygen

Brain Damage Oxygen

Copyright © Nucleus Medical Media, Inc.

Treatment

Call for emergency medical services right away. Treatment will depend on how badly the near-drowning episode damaged the body.

Emergency Response

Emergency response and first aid must be done quickly to restore breathing and prevent death.

  • Immediate cardiopulmonary resuscitation (CPR)—Done to provide oxygen-rich air to the vital organs of the body. This may involve giving rescue breaths or doing chest compressions. In all unconscious people and those who have been diving, the head and neck should be supported in case of injuries to the spine.
  • Warming treatments—Done if the body's temperature dropped after being in cold water (hypothermia). They are done slowly to avoid further injury to the body.
  • Endotracheal intubation—A narrow tube is placed into the trachea (windpipe) to maintain an open airway.

Nasogastric (purple) and Endotracheal Intubation

FI00035_96472_1_Endotracheal and Nasogastric Tube Insertion

Copyright © Nucleus Medical Media, Inc.

Follow-up Care

Near-drowning can cause delayed complications from the incident or treatment. Further treatment that is needed depends on what the complications are and their severity.

Complications may include:

Prevention

To help reduce chances that that you or someone you know will drown, take the following steps:

  • Never leave children alone with any body of water such as a pool, bathtub, or spa. Drowning can occur within moments.
  • Take or have your child take swimming lessons. Remember that even a child who knows how to swim is still at risk for drowning and will need constant supervision.
  • A fence or barrier should completely enclose your pool or spa. All gates or doors leading from the house to the pool area should have a self-closing, self-latching gate. It should be above the reach of toddlers and young children. You may want to get a pool alarm or rigid pool cover in addition to the fence and gates.
  • If you use a lightweight, floating pool cover, be extra alert to the potential for drowning accidents. These covers do not keep people from falling in. No one should ever crawl or walk on them.
  • Remove any obstacles to allow a full view of the pool or spa from the house.
  • Body parts and hair can be trapped in pool drains. Be sure that the pool has drain covers or a filter system to release the suction.
  • Ensure careful supervision of all guests if alcoholic beverages are served at a spa or pool.
  • When swimming in open water, choose an area where there is a lifeguard.
  • Always wear life vests when boating.
  • There is a risk of drowning during the wintertime. Warn children and others about the danger of walking or skating on thin ice.
  • Do not allow anyone of any age to swim alone. A supervising adult should be within arm's length of infants and toddlers who are swimming. The adult should know how to swim, be able to rescue someone, and do CPR.

RESOURCES:

American Red Cross
http://www.redcross.org

Healthy Children—American Academy of Pediatrics
http://www.healthychildren.org

CANADIAN RESOURCES:

Canadian Red Cross
http://www.redcross.ca

Children’s Safety Association of Canada
http://www.safekid.org

References:

Driscoll TR, Harrison JA, et al. Review of the role of alcohol in drowning associated with recreational aquatic activity. Inj Prev. 2004;10(2):107-113.

Drowning and near-drowning in children and adolescents: A succinct review for emergency physicians and nurses. Pediatr Emerg Care. 2005;21(9):617-619.

Harries M. Near drowning. BMJ. 2003;327(7427):1336-1338.

Near-drowning. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated March 8, 2013. Accessed November 7, 2014.

Salomez F, Vincent JL. Drowning: A review of epidemiology, pathophysiology, treatment, and prevention. Resuscitation. 2004;63(3):261-268.

Sibert J, John N, et al. Drowning of babies in bath seats: Do they provide false reassurance? Child Care Health Dev. 2005;31(3):255-259.

Szpilman D, Bierens JJ, et al. Drowning. N Engl J Med. 2012;366(22):2102-2110.

5/28/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Committee on Injury, Violence, and Poison Prevention. Policy statement—Prevention of drowning. Pediatrics. 2010;126(1):178-185.



Last reviewed November 2014 by Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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