April 21, 2016 Conflict in drowning terminology

Lifesaving Resources believes that the new terms used to describe drowning are not appropriate to educate the public, the media and First Responders about the prevention, recognition, and management of drowning and aquatic injuries.

According to the World Congress on Drowning, drowning is defined as “the process of experiencing respiratory impairment due to submersion or immersion in liquid.” This definition allows for only 3 outcomes after drowning: 1) morbidity, 2) no morbidity, and 3) mortality. They advocate that the following terms should no longer be used to categorize “drowning” patients and events: near, wet, dry, active, passive, saltwater, freshwater, or secondary. Their rationale for excluding these terms is that the final common pathway is hypoxemia and eventual cardiopulmonary arrest.

However, it is our opinion that the terms morbidity, no morbidity, and mortality are not common terms used by the general public, the media, and First Responders, including lifeguards, firefighters, law enforcement, search and rescue, and EMS personnel. Furthermore, terms like wet vs. dry explain why some drowning victims are found at the surface versus being submerged; active vs. passive explains why some victims show signs of struggle (active), while others simply submerge or are rendered unconscious due to a medical condition (passive); and secondary, which explains why patients may continue to deteriorate even after being removed from the water. Based on the rationale provided by the World Congress on Drowning, we may as well eliminate terms like distress swimmers vs. drowning non-swimmers, because eventually, if no intervention is provided, both victims will drown.

Lifesaving Resources will continue to use the terms wet vs. dry to explain that if a victim’s lungs are not yet compromised (dry drowning) due to a laryngospasm or other physiologic effects, this victim is likely to be found floating at the surface, or just below the surface, until such times as the victim’s lungs have been compromised at which time the victim will submerge (wet drowning). Although it is true that the “final common pathway is hypoxemia and eventual cardiopulmonary arrest”, the victim at the surface has a greater chance of being recognized and intervention initiated by good samaritans for First Responders. Furthermore, if the victim’s lungs have not yet been compromised, establishing an airway and providing positive pressure ventilation will be easier and much more effective than the patient with compromised lungs.

If we re going to advocate for best practices to reduce drowning and aquatic injuries, we need to use common terms that the general public, the media, and First Responders will understand, rather than terms like morbidity, no morbidity, and mortality.