The Drowning Process
What drowning actually is
Suffocation caused by liquid blocking the airway and lungs. Water hits the upper airway → reflex laryngospasm (vocal cord closure) → breathing stops (this stage is "dry drowning"). CO₂ rises, the brainstem fires, the now-unconscious person's vocal cords reflexively open and they take strong gasping breaths — water enters the lower airway ("wet drowning"). Without oxygen, brain damage starts.
Active drowning — three phases
- EXHAUSTION (Onemoglost): vertical body, arms outstretched seeking grip, no leg kicking, head tilted back to keep mouth above water, panicked face. NOT shouting — all energy goes to breathing.
- AGONY: heavy gasping, swallow/cough reflex, vocal cords close → respiratory arrest, uncoordinated movements, impaired consciousness.
- IMMOBILITY: unconscious, no breathing, no heartbeat. Floating or submerged in any orientation.
Passive drowning
Sudden unconsciousness from a heart attack, stroke, seizure, intoxication or low blood pressure. The person never goes through the active phases — you find them already motionless on or under the surface.
Time-progression of drowning
- PHASE 1 — Fear and struggle (~30 sec): panic, head-up posture, breathing stops on submersion. Rescue here rarely needs medical treatment.
- PHASE 2 — Respiratory arrest + unconsciousness: rising CO₂ triggers gasping; submerged head → laryngospasm → unconscious. Rescue here may avoid cardiac arrest if airway is opened and oxygen given.
- PHASE 3 — Hypoxic convulsions: foam at the mouth, agonal breaths. Needs 5 initial rescue breaths and oxygen.
- PHASE 4 — Cardiac arrest → death (longer the worse).
Fresh water drowning
Fresh water moves from alveoli into the bloodstream, swells circulating volume and dilutes blood. Red blood cells burst. Alveoli stick together → impaired gas exchange → severe hypoxia.
Salt water drowning
Salt water draws plasma INTO the alveoli — blood thickens, lungs fill with fluid (pulmonary oedema). Foam at the mouth is a classic sign.
Rescue methods — safest to riskiest
- 1. From the shore (throw or extend a flotation aid) — SAFEST, fastest if victim is conscious
- 2. From a boat — for distant victims; approach with propeller AWAY from victim
- 3. Personal rescue with an aid (rescue tube)
- 4. Personal rescue with a long rope (anchored on shore — used in white water)
- 5. Personal rescue, direct contact — last resort; risk of being pulled under by panicked victim
- 6. With spinal-injury board — when neck/spine injury is suspected
Secondary drowning
Happens after small water inhalation in accidents, water slides, or rough play. Person seems fine initially, then develops persistent cough, shortness of breath, chest pain, exhaustion, vomiting, altered consciousness — sometimes hours later. Always send to emergency care.