Introduction and Initial Reactions

• Josh Clark and Chuck Bryant discuss drowning topic
• Both hosts experienced anxiety/panic attacks while researching
• Previously covered in "Worse Ways to Die" episode years ago
• Debunked myth that drowning is peaceful - survivors describe it as burning "like lava"
• Comparison to liquid going "down wrong pipe" - much worse when actually drowning

Medical Definitions and Statistics

• 2002 World Congress of Drowning (Amsterdam) established universal definitions
• 350,000 people die annually from drowning globally
• Third most common cause of accidental death worldwide
• Media still uses unclear terminology not recognized by medical community
• Drowning is injury type that can result in death, but survivors can have "drowned"

Physiological Process of Drowning

• Starts when water contacts larynx/voice box
• Triggers reptilian brain response, motor instincts take over
• Initial gasp, then voluntary breath holding
• Larynx spasms to prevent liquid entering lungs
• Hypoxemia develops (decreased oxygen in bloodstream)
• Body becomes acidotic, can disrupt heart electrical system
• After ~87 seconds, body forces breath attempt
• If underwater, water enters lungs causing different complications

Water Type Effects on Lungs

• Fresh water: destroys surfactant, alveoli collapse
• Salt water: washes away surfactant
• Fresh water passes easily into bloodstream, diluting blood
• Within 3 minutes: equal parts water and blood in fresh water drowning
• Salt water draws water from blood, concentrating it
• Experimental animals lost 40% normal blood water volume in 3 minutes with salt water
• Takes ~8 minutes to die from salt water (slower than fresh water)

Dry Drowning

• 10-20% of drowning deaths have no water in lungs
• Die from asphyxiation before larynx stops spasming
• Term "dry drowning" coined in 1970s but CDC says it's just "drowning"
• Media incorrectly uses "secondary drowning" for delayed deaths

Delayed Drowning Cases

• 2017 case: 4-year-old Frankie Delgado in Texas
• Knocked over by wave, seemed fine initially
• Died days later in sleep with small amount of water in lungs
• Only takes 4 CCs per kilogram of water in lungs to cause death
• Health decline obvious within 2-3 hours: sluggishness, vomiting, behavior changes
• Parents often mistake symptoms for stomach flu

Complications and Injuries

• Brain damage most common if survive
• Lung tissue damage, pneumonia possible
• ARDS (Acute Respiratory Distress Syndrome)
• Often co-occurs with head/neck/spinal injuries
• Diving accidents can cause immediate unconsciousness underwater

What Drowning Actually Looks Like

• Movies/TV portray drowning incorrectly
• Splashing and yelling is "aquatic distress" (pre-drowning)
• Francesco Pia defined "Instinctive Drowning Response"
• Very quiet process, no calling for help
• Mouth at water level, can't speak due to breathing priority or larynx spasms
• Arms flap uncontrollably to keep head above water
• Cannot grab rescue equipment
• No evidence of kicking (unclear why)
• Vertical position in water
• Lasts 20-60 seconds typically
• Signs: head low, mouth at water level, blank/glassy eyes, hair over eyes

Tragic Statistics

• Kids drown within 25 yards of supervising adult
• 10% of parents actually watch drowning happen without recognizing it
• Substantial number of children drown while parent is watching

Rescue and Treatment

• Send someone for help/call 911
• Get defibrillator if available
• Assess breathing and pulse
• Drowning victims still need mouth-to-mouth resuscitation (unlike other CPR)
• Support neck due to possible spinal injury
• Roll unconscious but breathing victims on side to prevent vomit aspiration
• CPR for no pulse/breathing victims

Racial Disparities in Drowning

• Significant disparities between racial groups in US
• African-American kids ages 11-12 drown in pools 10x rate of white kids
• Native Americans and Alaskan natives also higher rates
• Historical segregation prevented swimming lessons/pool access
• Intergenerational - only 13% chance to learn swimming if parents didn't
• Discrimination in 1920s-30s and 1950s-60s coincided with swimming popularity surge

Prevention Strategies

• Swimming lessons help but don't "drown-proof" children
• ~25% of drowning deaths are people who knew how to swim
• "Touch supervision" for children under 4 (arm's length away)
• Pool fencing with self-closing, self-latching gates
• Pool covers and safety equipment
• Landline phone near pool
• Learn CPR
• Monitor children after water incidents for delayed symptoms

Other Drowning Locations

• Infants can drown in 1 inch of water
• Dog water bowls, open coolers, toilets, cleaning buckets
• Cars in flood situations
• Bathtubs: ~330 deaths annually in US, 5,000 in Japan
• Hot tubs dangerous due to alcohol, temperature, dizziness
• Examples: Orville Redenbacher, Whitney Houston

Geographic Factors

• More car drownings in Florida due to waterfront roadways
• Natural bodies of water more dangerous for Indigenous peoples due to exposure and underwater hazards