drowning: clinical aspects When victims of immersion die, it is not usually because of inhaling water. Rather, most have swallowed copious amounts of water, which exacerbates the effects of immersion hypothermia. Only when they become unconscious as a result of hypothermia does water rush into their lungs.

The witness at the water side may believe the victim to be dead from drowning, but should not be discouraged from starting resuscitation, because ultimate revival may be possible. A victim who is not breathing should not be assumed to be dead: a hypothermic person does not need to breathe very much. The action to be taken is first to clear the airway and start artificial respiration (mouth-to-mouth or mouth-to-nose), then to take wet things off and wrap the victim in whatever dry warm coverings are available. If there seems to be no circulation — no pulse — the advisability of starting external cardiac massage is somewhat dubious, since it may convert an imperceptible, weak, slow, but regular heart rhythm into ineffectual ventricular fibrillation. Once started, the rhythmic cardiac compression would have to be maintained until professional help and hospital treatment became available.

Once started, cardio-pulmonary resuscitation should be continued until body core temperature has risen to near normal. Only then, if there is still no spontaneous heart activity, can the victim be said to have drowned. Up to that time they were suffering a near-drowning event.

G. R. Grey