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Understanding Drowning: Insights for Healthcare Professionals

02 April 2024 - Grace Larson

Emannuel is a 15 year old boy who cannot swim, he has fallen into the deep end of the swimming pool and has been underwater for more than 10 minutes.

Two police officers have just pulled Emannuel from the water 10 minutes after submersion and commenced CPR.

Is Emmannuel likely to survive neurologically intact? 

Emmannuel did survive his drowning episode and was discharged from hospital following a 1 week stay in ICU and 3 week stay in hospital. His good outcome was contributed to a few key factors. But before we highlight these, let's first review the stages of drowning.

The stages of drowning

Drowning is a complex process that occurs in several stages, each with its own distinct characteristics. Understanding these stages is crucial for effective prevention and response strategies. Here are the typical stages of drowning:

  • Initial Distress: This stage occurs when a person first encounters trouble in the water. It may involve panic, flailing, and gasping for air as the individual struggles to stay afloat. During this phase, the person is still able to call for help and may exhibit signs of distress, such as waving arms or shouting.

  • Active Drowning: During active drowning, the person is submerged and unable to keep their mouth above the water consistently. They may make desperate attempts to reach the surface but are typically unable to call for help or signal distress effectively. The movements become more erratic and uncoordinated as the person fights for survival.

  • Submersion: In this stage, the person goes beneath the surface of the water, either intentionally or unintentionally. Submersion may occur due to exhaustion, loss of consciousness, or incapacitation. Once submerged, the individual may struggle briefly before becoming still.

  • Unconsciousness: After submersion, the individual may lose consciousness due to lack of oxygen. This stage is critical, as the brain can only survive for a limited time without adequate oxygen supply. Unconsciousness leads to passive drowning, where the body sinks deeper into the water.

  • Hypoxic Convulsions: In some cases, particularly in cold water or with sudden submersion, the individual may experience hypoxic convulsions. These involuntary muscle contractions can occur shortly after submersion and may cause the person to appear to be thrashing or convulsing in the water.

  • Cardiac Arrest: Prolonged submersion and oxygen deprivation can lead to cardiac arrest, where the heart stops beating. Without immediate intervention, such as cardiopulmonary resuscitation (CPR) and defibrillation, cardiac arrest is often fatal.

  • Death: If resuscitation efforts are not successful, drowning ultimately results in death. The exact cause of death may vary, but it is typically due to a combination of oxygen deprivation, cardiac arrest, and secondary complications such as aspiration of water into the lungs.

Factors which influenced a positive outcome

So why, despite a prolonged submersion time, did Emmanuel not only survive his drowning event but also recover neurologically intact?

  1. CPR was commenced at the scene by two trained police officers following the principles of DRSABCD 

  2. High quality and effective CPR was provided with assistance from a CPR feedback device

  3. Additional police officers placed the EleGARD device and elevated Emmanuel's head allowing for better blood flow to the heart and brain

  4. The mechanical compression device LUCAS was then applied which freed personnel to intubate Emmanuel and gain IV access.

  5. Neuroprotective hypothermia was applied in the ICU for 24 hours 

The importance of embracing innovative approaches to resuscitation

Emmanuel's remarkable recovery challenges the status quo and underscores the importance of embracing innovative approaches to resuscitation. The integration of head-up CPR, and mechanical compression devices represents a significant leap forward in the field of emergency medicine.

Moreover, Emmanuel's case serves as a poignant reminder of the critical role played by first responders in initiating life-saving interventions. Through ongoing training and access to advanced equipment, healthcare professionals can enhance patient outcomes and improve survival rates in cases of cardiac arrest.

In conclusion, Emmanuel's journey from the brink of death to a full recovery exemplifies the transformative impact of modern resuscitation techniques. By leveraging cutting-edge technology and interdisciplinary collaboration, medical professionals can continue to push the boundaries of what's possible in emergency care.

Related courses

The ALERT™ Course - this comprehensive course covers the assessment and management of acute life-threatening emergencies including the critical aspects of crisis resource management. It is designed for clinicians primarily working in the urgent care/emergency care and acute care settings.


A Medical First; Some Called it a Modern Miracle

LUCAS Device

Head Up CPR: Improving Neurological Outcomes

Do automated real time feedback devices improve CPR quality?

The experience of drowning

Grace Larson
Grace Larson

Grace Larson, RN, BN, CertIV(TAE), GradDipClinNurs(PaedCritCare), MAdNursPrac(PaedCritCare), has extensive experience in paediatric nursing, with 13 years in Paediatric Intensive Care Units (PICU). She’s published journal articles in the specialty area of pain and sedation in PICU, and has presented at national and international conferences on the area of pain and sedation in paediatrics. Grace has previously worked with the ACCCN delivering Paediatric Advanced Life Support in Victoria, bringing a wealth of experience into her clinical teaching on paediatric resuscitation. She has also consulted with NSW Health on quality and safety delivering within PICU, and has been contracted with the ANMF to develop nursing programs for nurses who require additional education as part of their practice requirements.

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