Drowning outside of the water – Really?

A little-known threat, dry and secondary drowning, many parents are not aware of. The child is out of the pool, toweled off and dressed – out of the drowning zone. Right? Wrong.

I surveyed a number of parents who have been taking their children to pools and to beaches for a long time, and some of them even have children who have turned out to be accomplished swimmers. I was astonished by how very few of these parents knew about dry and secondary drowning, and even fewer knew what to do when faced with the threat. The number of dry and secondary drowning deaths (as reported, 1-2% of the total drowning incidents) is small, but that is still too many. I am sure there are many such drowning incidents, including near-fatal ones that are not reported.

Dry and secondary drowning can occur minutes after the victim has been out of the water or even after 24 hours after the victim has been out of the water. The symptoms of these two kinds are very similar but are different. In many press reports and literature, you may find these two types are being used interchangeably.

Dry drowning happens when the victim inhales water, and the body in order to prevent water from getting into the lungs, causes spasm in the breathing tube and results in constricting it.   In the process, the supply of air to the lungs and oxygen to the blood stream and brain is cut-off. The dry drowning happens shortly after the incident.

On the other hand, secondary drowning happens when the victim actually inhales water in the lungs that results in a build-up of fluid in the lungs – a phenomenon called pulmonary edema. The excess fluid collect in air sacs in the lung and makes it difficult to breathe and cuts off the supply of oxygen. Unlike dry drowning, secondary drowning can happen much later, usually within 1 to 24 hours from the incident.

Both, dry and secondary drowning, have similar symptoms. The usual symptoms – coughing and/or complaining of chest pain; has trouble breathing; shows sign of extreme fatigue; throws up; and feels sleepy. Some parents might take these signals very lightly as regular exhaustion due to swimming, long and tiring day, etc. Due to reduced supply of oxygen to the brain, the victims may even show signs of erratic and unusual behavior. Do not undermine any of these symptoms. The only way to respond to these symptoms is to seek medical help right away, including, calling 911 if the situation dictates.

And, yes, dry and secondary drowning is not limited to the pool and large bodies of water, they can happen even in the confine of your bathtub.

The incidents like the drowning of a 10-year old boy in South Carolina and near-fatal experience of a toddler in California may have drawn some attention and news coverage. But, there is still much need to be done to increase the awareness. Please spread the word!

– Meghna Sil


Drowning due to a pump failure – Really?

Unfortunately, it does. A water pump failure in a Rayleigh, NC community swimming pool caused the drowning death of a teenager.  The pool water was electrified after a water pump failed and a corroded conductor carried electricity to the pool water instead of taking it to a circuit breaker. Sounds simple, but sadly a teenager paid the price.

This loss of a young life could have been prevented, only if there were stronger regulations around electrical maintenance and inspection. Should there have been an inspection, the corroded conductor would have been spotted before the tragic incident and not after the county sheriff’s office requested an investigation. 17-year-old Rachel Rosoff would still be alive and her family and friends would not be mourning her death now.

The swimming pool, where the tragic incident happened, was built in 1979 and passed the electric inspection then with no requirement for future electrical inspection. Wake County, where this pool is, does not require regular electric inspection unless a permit for major renovation is requested. This pool has been operating since 1979 (37 years) without an electric inspection after the initial one – something to seriously think about. Request for a permit or not, electric inspections should be mandated for the swimming pools, just like safety and emission inspections for the cars.

This incident should serve notice to: the legislators to enact stringent regulations; the swimming pool owners should voluntarily conform to the latest electric codes; swimming pool users should check with the pool owner or management about the currency of the electric maintenance and inspection of the pool.

Drowning due to electrocution is completely preventable. The number of drowning deaths due to electrocution in the swimming pools may be small, but that is still too many.

The report from the Wake County Inspection Administrator can be found here.

– Meghna Sil

Preventing Drowning during Triathlons – are we doing enough?

Yesterday was a sad day for the sport of triathlon. Collin Campbell, a 27-year-old triathlete from Woodlands, Texas, died of an apparently drowning during the swimming event of Onalaska Half Distance Triathlon in Lake Livingston near Houston. According to witnesses, he had crossed half-way point of the 1.2 miles swim leg of the race before going under. He was a well-trained and strong swimmer with no prior health condition. What could have caused this drowning death? Does not look like age, ill preparation for the swim or prior health conditions.

Not long time ago, in April 2016, 25-year-old Taurean Blake drowned in Calcasieu River during a triathlon at Sam Houston Jones Park, Louisiana, and later died in the hospital. He had just started the swim and had hardly gone 75 to 100 yards.   What could have caused this drowning death? Does not look like age or fatigue.

A recently published research by the Duke University researchers indicated that majority of the case they studied were due to some cardiac abnormalities. Some of these abnormalities are not evident under normal circumstance, but may get accentuated by cold water. Should the organizers mandate actual stress test under similar conditions before allowing the triathlete to get into the race? Maybe the self-certification of health condition by the athletes is not working, and the athletes (more so the ones in extreme sports) have too much of ego and sense of invincibility to admit.

Another aspect that potentially can be overlooked is the panic attacks in open water. Too many swimmers with the arms and legs kicking and splashing water can create a very chaotic and claustrophobic environment. My conversations with multiple triathletes (some of them have even participated in Ironman races) make me believe panic attack is not very uncommon, some know how to manage it and some do not. Triathlon is a sport of physical endurance as well as a sport of mental endurance. Should the organizers mandate panic management classes before allowing the triathletes to get into the race? Again, how many swimmers were actually stuck by panic in a real race will be hard to determine since most of them may not admit.

With the triathlon season winding down for the year, it’s time for triathlon organizers and governing bodies to introspect, time to get the medical professionals and technical innovators involved to carve the drowning, and time to bring awareness. Statistically, 1.5 drowning deaths out of 100,000 participants in USA Triathlon sanctioned events may look insignificant. But, for a nation that is thinking of sending a man to another planet, that number is too many.

– Meghna Sil

Electric Shock Drowning – Completely Preventable!

Just this past Labor Day weekend, we lost a young life in Raleigh, North Carolina to Electric Shock Drowning (ESD). A teenage girl drowned after entering the electrified water. Prior to this incident, a 15 years old lost her life in Smith Lake, Alabama to a tragic ESD incident. The teenager’s father had lowered a metal ladder to the water to help her on board without realizing that the ladder was leaking electricity. A nightmare that no parent should live with.

Drowning due to electric shock is not much talked about or mentioned frequently in the news. Nevertheless, it is still a threat, particular, in the fresh water near docks or boats with electric connectivity. The ESD stats available may not be a true indication of the reality since many deaths are simply classified under ‘drowning’.

ESD happens when a human body makes contact with water that is ‘electrified’ due to a faulty electric connection, damaged live power cord, and faulty or no ground fault protection. Human body serves as a conductor and even a small fraction of electricity can paralyze the muscular system, impair breathing and eventually lead to drowning.  A ground fault protection mechanism is meant to help detect electricity leakage and turn the power off.

Every boat comes with an owner’s manual and every dock or marina owner is required to follow certain protocol to keep it safe. But at times, negligence and accidents do happen. What can we, as swimmers, do to protect ourselves? Again the common sense should prevail – DO NOT swim near the boats, marinas or docks, which have electric connections.  If you ever feel a jolt, swim away from the boat or the dock.

Even though statistics undermine the actual numbers, we need to pay attention since ESD is completely preventable. According to the Electric Shock Drowning Prevention Association, since the experts started tracking recently, there have been over 60 incidents of ESD, several near misses and likely hundreds of deaths have gone unreported; a random sampling of shore power cords in the several freshwater marinas in the US displayed 13% of the boats were leaking lethal amount of electric current into the water. Alarming statistics for something that is completely preventable!

– Meghna Sil

Opportunity to Promote Swimming among African-American Children

Just concluded 2016 Olympics at Rio had many memorable moments that included the retirement of the most decorated Olympic swimmer, Michael Phelps, and the emergence of Katie Ledecky – call it passing of baton if you may.

Not taking anything away from other swimmers, two of the most significant performances, in my opinion, in the pools of Rio were by Simone Manual and Ashleigh Johnson. They both cemented their place in history – as the first African-American to win an individual Olympic gold and the first African American to be in the US women’s Olympic water-polo team.

The contributions of Simone and Ashleigh are much more than just bringing home gold medals. They became role models to millions of children overnight. As evident from various media coverage and social media trends, their successes have reinvigorated the discussion on why the African-Americans are behind in swimming and reinforced the fact (and busted a myth) – yes, the African Americans can swim!

Simone’s gold medal winning performance in the 100-meter freestyle was very symbolic – initially she fell behind, but she kept at it and surged ahead during the last quarter of the race. What a finish! On the other hand, Ashleigh, the primary pillar of the team whose other members were all white, held her own as the goalie and kept the opponents at bay. The color of the skin did not matter!

As the statistics published by the CDC indicates, African-Americans children, age 5-19 years, are almost 6 times more vulnerable to drowning than their white counter part. What can the parents and communities do to help save those lives?

It is an opportunity for the black parents to tell their children stories of Simone and Ashleigh. If one family in Sugar Land can raise a Simone and a single mother in Miami can raise an Ashleigh, many more Simones and Ashleighs can be raised. They do not have to win medals, as long as they learn to swim and enjoy it.

Years of segregation, discrimination and economic disparity kept many African-Americans away from learning swimming and left them fearful of drowning. But, there is no reason to continue to pass the fear of drowning down the generations.

If we believe our society is desegregated, we should formulate policies and legislations to make swimming affordable for all through public-private partnerships and by making swimming lessons mandatory in our schools.

– Meghna Sil

Why are African Americans behind in swimming?

Many a time you will hear: “blacks are not built for swimming” – a myth. Even among the African Americans it’s not uncommon: “swimming is an elite and white sport” – well, another myth.

A research paper by Maria Burzillo chronicles a comprehensive history of African Americans and Swimming, and helps in busting many myths. Another informative read is an article by International Swimming Hall of Fame (ISHOF) that outlines some of the major accomplishments by the black swimmers. In my minds, this is the kind of information that our society needs to be made aware of.

We, as a society, have collective responsibility to acknowledge, bring awareness, and act to solve critical problems that our society faces. I have highlighted in some of my earlier articles how prevalent drowning is, particularly, among the children. According to a Center for Disease Control and Prevention (CDC) Report, on an average 10 people die from drowning everyday in the USA; about one in five who dies from drowning is a child under the age of 14; and for every child that dies of drowning, 5 children require emergency care for nonfatal submersion injuries, and these injuries may include severe brain damage and permanent loss of basic functioning.

Even more alarming are the drowning statistics when laid out by race or ethnicity. A research study commissioned by USA Swimming Foundation found nearly 70% of African American children have low to no swim ability as compared to 40% Caucasians. According to a report from CDC, African American children and adolescents aged 5-18 years are 6 times more likely to drown in a swimming pool than their white peers.

Per the Washington Post article, we are seeing some improvement, but still less than 2% NCAA Divisional I collegiate swimmers are African American. African Americans have been able to excel in so many other sports, but why not so in swimming?

Why am I bundling high drowning rates and low participation in competitive swimming in the same article? I strongly believe they have the same underlying cause. Could this be a direct result of high percentage of the African Americans not being encouraged or provided the opportunity to learn to swim at an early age?  Swimming, like walking and running, is a basic life skill. Learning to swim saves lives!

The realities, which I agree with, for about 70% African American children with low to no ability to swim and they being 6 times more likely to drown in a swimming pool than their white peers can be contributed to:

  • Fear factor (added with some of the myths), mainly among the parents.
  • Economic disparity – swimming facilities and lessons are expensive as compared to say basketball.
  • Lack of swimming role models.
  • A large population in the inner city has no access to affordable swimming pools.
  • Overall lack of awareness of the usefulness of swimming and encouragement by the parents.

It is about time to steer the policies to help communities and remove the barriers for all. It is about time for the parents to step up and encourage their children to learn to swim. I am also hoping a few African American swimmers who have risen to the top will help encourage the younger generation – someone like Cullen Jones, an Olympic medalist, will have a positive impact on the African American youths in the coming days.

I would highly recommend the readers to listen to an interesting sound bite from Jody Jenson on NRP radio.

– Meghna Sil

Rip Current – may look innocent but can be deadly

Polling beachgoers on what they fear most in the seawater almost always comes back with the standard response of ‘sharks’. Very few would cite rip currents; only a fraction of that would know how to deal or even identify rip currents.

Statistics are staggering. On average 100+ people drown every year in rip currents within the US itself. In comparison, the average death count due to shark attacks is 1 person per year. Rip currents account for over 80% of the rescues performed by surf beach lifeguards.

Formation of rip currents is a natural phenomenon. We cannot stop the generation of rip current, but we can acknowledge its power, know how to recognize it, and learn how to deal with it. I would highly recommend my readers to visit NOAA’s National Weather Services’ educational website for details on rip current, and would also urge my readers to spread the word. Awareness is key!

As the waves move from deep waters to the shore, they are broken by sandbars, strongly at some places and weakly at some places. Breaking waves result in ‘pileup’ of water on the beach that eventually needs to retreat seaward (gravity comes into play!). The water would follow the path of least resistance that can either be shallow spots or break in sandbars. This might result in a concentrated flow of water returning to the deeper waters – giving rise to rip currents.

Source: http://www.ripcurrents.noaa.gov

It might be difficult for untrained eyes to easily spot the rips currents, but there are some indicators one should look out for. The rip current normally has a different color than the surrounding water, it is murkier due to floating seaweeds, foams, and debris; darker; a gap in breaking waves; and choppy and churning surface.

If ever caught by a rip current, stay calm and do not fight it. Remember, rip current is a horizontal current – pulls the swimmer away from the shore and not downward. In order to escape it, swim parallel to the shore until out of the current and then swim towards the shore. If unable to break out of the current, tread water and float along the current until it subsides and then swim away from the current and towards the shore. The drowning happens when one is unable to keep afloat either due to panic, exhaustion, or inability to tread water or float.

The speed of the rip current is typically 1-2 feet per second, but can be as high as 8 feet per second, faster than any Olympic swimmer, and strong enough to sweep the strongest of swimmers!

– Meghna Sil

Movies and TV shows – wrong about drowning

Any drowning scene from a movie or TV show, more than likely, portrays a drowning victim flailing arms and screaming for help. Sometimes, the victim is even able to gather enough strength to surface repeatedly above water and scream for help. Eventually, depending on the scene, the victim either drowns or is rescued, but this perpetuates an entirely wrong depiction of reality. In reality, there is hardly any splashing, waving or screaming, and the victim quietly sinks beneath the surface of the water, like the way the sun quickly slips beneath the horizon during the last minutes of dusk. Drowning is almost always quick, silent and unspectacular.

Unfortunately, these misleading depictions by TVs and movies do influence how drowning is perceived, and impairs our ability to identify a drowning victim and our subsequent response. Many preventable child drowning incidents happen within a close distance from the parents, as there are no cues to pick on like screaming and splashing to draw their attention.

According to CDC report, on an average 10 people die daily due to unintentional drowning in the US alone. 20% of such victims are children under 14 years of age. For every child that dies, five children need ER care for non-fatal submersion injuries. Some of the non-fatal injury victims suffer brain damage and long term disabilities. About 10% of these drownings, particularly of younger children, happened within a safe distance and under the ‘watch’ of the parents. Parents failed to recognize the child was drowning.

During drowning the victim’s natural instincts takeover, and the victim becomes incapacitated to perform any voluntary action like waving arms for help, moving towards safety or screaming for help. Breathing is essential to survival, but not speech. In order to avoid actual or perceived suffocation, the natural instinct forces the victim to extend arms laterally and press down on the water surface to lift the mouth out of the water to breath – a phenomenon referred to as Instinctive Drowning Response. Unless rescued, the struggle lasts for only 20-60 seconds before the victim loses consciousness and submerges under the water.

What some people confuse flailing of arms and scream of help with drowning is Aquatic Distress (or panic).  Unlike drowning, during aquatic distress the person has mental ability to scream for help, and respond to rescue efforts like holding on to rope, ladder, lifebelt, etc. Nevertheless, the victim still needs help. I personally have been a victim of aquatic distress. That’s for another article.

Drowning is silent, but let us break the silence to get the message out on drowning misconceptions.

– Meghna Sil

Innovation & Swimming – Helping Resurface

During the summer of 2015, circumstances brought four like-minded high schoolers with similar interests.  The problem in front of us was – why drowning even among professional triathletes was high and what can be done?

Late night brainstorming and long hours in the labs resulted in a successful and working prototype of an inflatable device that can be worn as an armband and can be easily inflated on-demand by pull of a string. The device is capable of taking a swimmer up to 350 lbs. to safety when the disaster strikes.  ReSurface was born!

– Meghna Sil

Prevent Shallow Water Blackout – don’t ignore your body signals!

As part of my research on swim safety and drowning prevention, I have spent a considerable amount of time studying Shallow Water Blackout (SWB), a nightmare for elite swimmers. As more and more swimmers are pushing the envelope of physical endurance, I feel that swimmers need to pay more attention to SWB drowning. Death of two NAVY Seals last year in a Virginia Beach training pool was attributed to SWB. Even a recent death of a Dartmouth varsity swimmer in Florida was initially suspected to SWB drowning and later attributed to a rare heart condition per the autopsy report.

Chances of SWB happening is higher for professional and well-trained swimmers -who do rigorous underwater training or underwater breath holding for increasing their endurance limit. Underwater training by itself is not the cause; it happens when the swimmer stretches the ‘boundary’, let the competitive spirit take over without being aware that it may lead to SWB. Statistics show drowning among the well-trained swimmers is mostly due to SWB.

Under normal circumstance, as oxygen is metabolized in our lungs, the O2 level goes down and CO2 level goes up. The brain ‘monitors’ the CO2 and when the level rises to a threshold value, it sends the signal and urges the body to breathe. A professional swimmer (when the competitive pride and sense of invincibility takes over) can suppress the urge to breathe and deprive the brain of Oxygen. Alternatively (done more often), swimmer can trick the brain by lowering the CO2 level by hyperventilation before diving into the water. The starting CO2 level is so low that even if it rises while the swimmer is underwater, it never rises to the threshold before the brain is deprived of O2. Due to O2 deprivation to the brain, the swimmer passes out. Eventually, the CO2 level reaches the threshold and the body gets the urge to breathe and that results in lungs filled with water and eventual drowning.

Despite the concept of Shallow Water Blackout is being understood, there is a general lack of awareness among the swimmers and coaches. Even though I am not a professional swimmer, I have never been told by any coach of the implications of rigorous exercise (that can cause hyperventilation) prior to underwater swimming or breath holding can cause blackout.

Sense of invincibility is important to winning, but stay tuned and respond to your body signals.

I am glad to see that recently some famous swimming personalities, including Michael Phelps and his coach Bob Bowman, have taken upon themselves to bring awareness to other coaches and swimmers. We definitely need more Phelps and Bowmans! Some local governments, and swimming facilities are taking steps in the right direction to implement policies to prevent SWB. A good start, but a long way to go!

– Meghna Sil