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Medicine for the Outdoors

Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Drowning (Submersion Incidents) Terminology

In response to my post entitled "Prevention of Submersion (Near-Drowning) Incidents," a reader corresponded: "Would you please include in an upcoming entry an explanation of the consensus definition of drowning which was adopted at the 2002 World Congress of Drowning and then subsequently by the Centers for Disease Control? It was also be helpful to discuss where adoption of this uniform definition, the process of experiencing respiratory impairment from submersion/immersion in liquid, leaves related terms such as near-drowning, wet drowning, dry drowning, active or passive drowning, secondary drowning, silent drowning, etc. There still seems to be a lot of confusion about this subject, even within the medical community, but especially among lay people involved with aquatics."

At the 2002 World Congress mentioned above, the following definition was adopted by consensus of the conference attendees: "Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid." It was further recommended that drowning outcomes should be classified as death, morbidity, and no morbidity. As noted in a paper entitled "A new definition of drowning: towards documentation and prevention of a global health problem," authored by E.F. van Beeck, C.M. Branche, D. Szpilman, J.H. Modell, and J.J.L.M. Bierens (Bulletin of the World Health Organization 2005;83:853-856), other recommendations emanating from the conference include that the terms "wet," "dry," "active," "passive," "silent," and "secondary" drowning should no longer be used. The reason for simplifying the definition of drowning and avoiding the use of modifying terms for which there have been few uniform definitions, is to "facilitate surveillance and lead to more reliable and comprehensive epidemiological information on this global, and frequently preventable, public health problem."

I concur with the conclusion of the authors. For instance, let's consider the term "dry drowning." This has been taken by some to mean the initial laryngospasm that is sometimes seen when water enters the oropharynx and assaults the vocal cords, regardless of the ultimate outcome (e.g., life or death), and by others to mean a death from drowning in which little or no water appears to have entered the lungs. Imprecise definitions lead to errors in recording of epidemiological data, and therefore to under- or overestimation of situations and outcomes.

The pathophysiology of submersion/immersion and drowning is complex, and varies to some degree with the victim (e.g., age, underlying health, lung status), water properties (e.g., temperature, salinity), co-morbid conditions, time of submersion/immersion, and many other factors. These should all be described as best possible when case reports are recorded or data are collected, to aid doctors, epidemiologists, and researchers in their efforts to improve rescue techniques, field medicine, in-hospital therapies, and the advice offered to laypersons.

For the purposes of persons involved with aquatics, the consensus definition and recommendations are sufficient. For the purposes of persons seeking to understand the nuances of the medical presentations and the impacts of interventions, more details are necessary. However, the necessity to "complete the picture" on any particular victim is not unique to drowning. Whether we attempt to assist someone with drowning, frostbite, or high altitude cerebral edema, the devil's in the details.

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About the Author

Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.