Trauma

June 11, 2024

Every summer, patients who experience drowning present at trauma centers nationwide. Trauma centers have a critical role not only in treating these patients, but also in spreading the word about drowning prevention in their communities.

While its potential mortality may come to mind when the general public considers drowning, the medical reality includes far more gradations.

In fact, to better communicate among health professionals and with the general public, the 2002 World Congress on Drowning developed a formal definition of drowning and relevant outcomes. The official definition by this congress is "the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes are classified as death, morbidity and no morbidity."

Some individuals live through drowning yet experience no complications. Others experience complications, such as acute respiratory distress syndrome; arrhythmia; brain damage from hypoxia or ischemia; metabolic or respiratory acidosis; or pulmonary insufficiency, according to the June 2014 Joint Trauma Conference at Mayo Clinic in Minnesota.

Drowning also is a leading cause of accidental death globally, according to the World Health Organization (WHO). The WHO indicates 236,000 drowning deaths occurred worldwide in 2019. These deaths are particularly prevalent in young people: More than half of the 2019 drowning deaths occurred in individuals under 30 years old. For children ages 5 to 14, drowning ranked sixth in cause of death.

Trauma centers and the need for community drowning prevention efforts

As the WHO indicates that community-based solutions have a significant role in drowning prevention, trauma centers can advocate for water safety, partnering with community organizations such as fire and rescue, American Red Cross, public health and parks and recreation departments, and public and private local swimming pools, beaches and swim clubs.

One key action communities can take, says the WHO, is striving for water-access control barriers for all residences and other facilities. This would involve both physical barriers to water and supervision in the form of child care for children.

In partnership with these community organizations, trauma centers also can encourage individuals — parents in particular — to take proactive steps to prevent drowning.

Nicole M. Guerton, M.S., an injury prevention coordinator at Mayo Clinic Trauma Center in Minnesota, also recommends using existing, active social media accounts to post drowning prevention messages. Additionally, she encourages trauma centers to call on existing news media connections or form new connections with local news media to pitch and facilitate news stories related to drowning prevention. Trauma centers can assist local news media with story development by connecting them with patients and family members who can recount personal drowning experiences and by providing a spokesperson on the topic.

Guerton says she personally enjoys spending time around water and engaging in water-related recreational activities. Using tools from her professional background, Guerton has developed a perspective on keeping her family safe around water.

"As I've grown wiser and implement a 'know better, do better' philosophy, boundaries I practice include those outlined in the 5 Layers of Protection from the National Drowning Prevention Alliance," she says.

For example, Guerton says she encourages or enforces the following in her family:

• Using life jackets.
• Taking swimming lessons to develop water competency.
• Providing proper supervision or a buddy system with a competent older swimmer, especially for younger family members.
• Preparing for emergencies, such as taking a CPR course.

Guerton readily admits that water-related injury prevention involves planning and acknowledging vulnerability even for herself and water-competent family members and friends.

"While I may be confident in my own ability to swim, an unexpected weather change or health incident, or any number of other injury-causing events could mean the difference between a minor injury and a fatal injury in myself or someone I care about.

"I would rather proceed intelligently, with caution, using knowledge and resources available to enjoy a great time in or around the water," says Guerton.

Treating drowning injuries in your trauma center

When drowning injuries occur in your community, the involved individuals likely will present at your trauma center. Daniel Stephens, M.D., trauma surgeon and adult medical director at Mayo Clinic Trauma Center, offers the following suggestions:

• Remember the Advanced Trauma Life Support protocol. This course provides the framework for your evaluation and treatment of the patient, beginning with an assessment of the airway, breathing and circulation, often called the trauma ABCs.
• Perform core rewarming. Administer warmed intravenous fluids, heated oxygen, or warmed bladder, gastric, pericardial, peritoneal or pleural lavage for patients with hypothermia. Use extracorporeal membrane oxygenation as a last resort.
• Conduct an eConsult. If desired, trauma center professionals may contact trauma professionals and other specialists at Mayo Clinic in Rochester, Minnesota, 24/7. If the patient codes with cardiopulmonary arrest, a physician from Mayo Clinic can direct the code through an eConsult and provide input on stabilization, initial treatment and transfer. Pharmacists also are available to offer guidance on medications and dosing.
• Call for transfer. As soon as possible, contact the Admission and Transfer Center at 507-255-2910 to arrange for the patient's transfer to a higher level of care.

For more information

Bierens JLM, ed. The World Congress on Drowning 2002: A move towards the future. In: Drowning: Prevention, Rescue, Treatment. Springer; 2014.

Trauma Review: Drowning. Presentation. Joint Trauma Conference. Mayo Clinic, 2014.

Drowning. World Health Organization.

Learn the 5 layers of protection. National Drowning Prevention Alliance.

Refer a patient to Mayo Clinic.