Update on drowning

Abstract

An 18-year-old matriculant goes to the beach with friends to celebrate his school results. The ensuing boisterous party includes consumption of alcohol. As dusk falls, he goes for a swim with his girlfriend. She is soon seen waving frantically to their friends back on the beach. He has disappeared below the water surface. Their friends swim out, and after 10 minutes they manage to find him, and bring him to shore. They immediately start cardiopulmonary resuscitation (CPR), while calling for help. BackgroundDespite being essential to life, water, which comprises >60% of our body mass and covers >75% of the surface our planet, continues to be an occupational and recreational threat to humans. Drowning among young adults in South Africa (SA) is unfortunately especially common. Poor swimming ability due to historical lack of access to facilities, concomitant alcohol use and easy access to rivers, lakes and the ocean are all contributing factors. This is compounded by relatively limited resources to respond to drowning incidents across wide, unpatrolled areas, resulting in a growing burden of disease affecting the younger population groups in SA. Recognition of a drowning event is also a problem, as not every drowning victim will indicate their need for assistance (Fig. 1). This review examines the evidence and recommendations on drowning from an African perspective, and brings the health fraternity one step closer to developing guidelines for our country. DefinitionDrowning is defined as the process of experiencing respiratory impairment from either submersion or immersion in liquid. [1] Drowning outcomes are classified as either drowning with mortality, drowning with morbidity, or drowning without morbidity.[1] Other older terms (such as wet, dry or near drowning) have been deemed unhelpful, and have been abandoned. EpidemiologyDrowning epidemiology varies dramatically worldwide, but is notably more severe in low-to middle-income countries. US data report ~4 000 drowning deaths, 8 000 hospitalisations and 31 000 emer gency department (ED) visits per year for children ˂19 years old.[2] Regret tably, there are no consistent published data for SA, but preliminary information from Lifesaving South Africa (LSA) reveals similar trends in age demographics, although true numbers are largely unknown. [3] Extrapolation from forensic pathology data in the Western Cape provides an estimation of 4/100 000 fatal drownings per year, which is similar to the World Health Organization's estimations for low-income countries in Africa. Despite only an estimated 1 in 4 cases being reported, Africa has the highest rate of drowning in the world. [4] This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Drowning is defined as the process of experiencing respiratory impairment from either submersion or immersion in liquid. Drowning morbidity and mortality are an under-recognised public health burden in southern Africa. Continuous concerted efforts are underway to improve awareness among recreational water use...

A quest for an integrated management system of children following a drowning incident: A review of the literature

“…Optimal care in the prehospital environment is regarded as an important factor to manage the principle danger of hypoxia and cardiac arrest Cantwell, 2021 gradual rewarming techniques depending on the degree of hypothermia Cantwell, 2021;Macintosh & Austin, 2017;Matthew et al, 2017;.…”

“…Management might include evaluation of chest X-rays, initiation of lung protected ventilation strategies, neurological assessment, monitoring of blood glucose, acid-base balance and electrolyte imbalances and takes place until transfer to the PICU (Cantwell, 2021;Matthew et al, 2017;. pleural or pericardial lavage, although evidence is unclear to which particular clinical setting from the scene of drowning these strategies are directed for implementation.…”

Wilderness medicine in southern Africa

“…In the spirit of growing the discipline in southern Africa, local enthusiasts and experts in the fields present this series of CME articles on wilderness medicine topics, with a focus on their relevance in the region. In this edition, the scope stretches from ocean to mountain, discussing the risks and management of high-altitude illnesses, [1] an update on drowning in SA, [2] and the management of cold-exposure injuries. [3] A further edition in the series will address expedition medicine, psychological and human factors, and heat-related illness.…”

The epidemiology of operations performed by the National Sea Rescue Institute of South Africa over a 5-year period

“…In South Africa fatal drowning occurred in 1411 people during 2015, totalling 4.4% of other external causes of accidental injury [2]. However, true numbers of drowning are lacking and this number might be substantially higher [3]. The National Sea Rescue Institute (NSRI) of South Africa estimates that more than 2000 people die every year from drowning, 600 of which are children [personal communication: Dr. C. Robertson, August 2017].…”