Tuesday, June 13, 2017

On "Dry Drowning"

On June 3, 2017, a 4 year old child suddenly died. The initial treating physicians told the family this was due to a rare condition known as "dry drowning", since the child had swam a few days earlier and now had evidence of water in his lungs. Despite the fact that this term does not exist in medicine and that it goes against every current national and international guideline for drowning terminology, physicians and the media together have perpetuated its use to a dangerous level over the last week.

A quick history:
In 2002, the World Congress on Drowning created the following Uniform Definition for drowning:

The process of experiencing respiratory impairment due to submersion or immersion in a liquid.

From this definition, there can be 3 outcomes
  1. Fatal drowning
  2. Non-fatal drowning without morbidity (injury)
  3. Non-fatal drowning with morbidity
That's it... The primary definition has nothing to do with outcome (living vs dead), location, water type, water temperature, or time since submersion. Bottom line: if a person's airway drops below the water and they have breathing problems because of it, it is considered a drowning.

With this definition came recommendations to discontinue the use of the following modifiers to describe drowning: near, secondary, delayed, wet, dry, active passive.

This definition and these recommendations have been accepted by all of the following
  • Centers for Disease Control and Prevention
  • American Heart Association
  • European Resuscitation Council
  • American Red Cross
  • United States Lifesaving Association
  • International Surf Life Saving Federation
  • And many, many more...
Just as you can't have a near-stroke or a near gun shot, you can't have a near drowning. Drowning is a process that begins at the beginning and doesn't appear out of nowhere. That is why the term "dry drowning" is incorrect. It suggest the child had no injury and then suddenly drowned while in bed. 

What the heck happened?
Incorrect information was given to the family from the beginning. This is not surprising. Research we have conducted over the past 5 years tells us that even in the highest quality medical literature, incorrect terms are used 30-40% of the time. We still have work to do.

Next, the news quickly disseminated this incorrect information. Again, not too surprising. We like to rely on the media for correct information, but in a competitive market speed often trumps accuracy.

What followed was the sad part. The media turned to medical professionals for guidance, most of whom allowed the media to create the message and then gave blind stamps of approval. Even some of those interviewed stated that they knew this term was wrong, but then continued to use it and justify this with "it's what the public is used to". At very few points did anyone stop to check if what they were saying was true or accurate or yield to some one knowledgable in the field.

Why does this matter?
Ok, so nitty-gritty details about drowning were incorrect. So what? Well, drowning is a preventable injury, and prevention feeds off of data and communication. Knowing how big a problem is, where to target efforts, and what efforts work is essential.  This cannot happen if we are unable to speak to one another, and a major road block to that is using correct terms.

We also want an informed public. When a parent's decision on whether or not to have their child evaluated after a drowning event is based on their own experiences and knowledge (much of which comes from the headlines), we need that parent to understand the truth. We need them to know what drowning IS and what it ISN'T. Most of all, we need them to trust the physician who is telling them "it is ok for your child to go home". When everything they have heard over the past week from the media and uninformed medical "experts" is telling them otherwise, this trust is lost.

What about the child?
As of today, no autopsy report has been released. In the initial reports, there was talk of "fluid around the heart" which is not a common finding in drowning. There are a hundred other things which could have caused this child's death and many individuals in the drowning research community are doubting drowning as the actual cause of death.

What you need to know.
Anyone who experiences a drowning event needs to be evaluated carefully by a medical professional.  Obviously children love to jump in and choke on water, but this is usually resolved with a few coughs. The time to worry is when the child has a prolonged submersion, definitely has trouble breathing after, or continues to have coughing, foam from the mouth, vomiting, or altered behavior. Those without symptoms can safely be released after a period of observation. Symptoms may worsen over time, but they don't appear out of nowhere. 

For medical professionals, choose your words wisely, vet your message, and if you are not familiar with the information you are giving or haven't updated your own knowledge in a while, have patience and look it up.