Life After Drowning

The drowning numbers remain tragic, but not at all surprising to  Corwin Warmink, M.D., medical director of Cook Children’s Emergency Department. Already this year, seven children have fatally drowned after being rushed to Cook Children's. But another 35 children wer treated for non-fatal drownings

“For us, in the Emergency Department, it’s just sad because this is something that’s totally preventable,” Dr. Warmink said. “It was an unusual summer because of the number of kids who came here because of drowning, but it’s something we see all the time. It’s not a freak occurrence. We live in Texas. There are a lot of pools here. It’s just water and children don’t mix without supervision.”

Dr. Warmink understands that people focus on the number of fatal drownings that occur during a given year. But he says that a near drowning can be devastating for a child.

“Kids come in here and they don’t die, but we know that their outcome is not going to be a good one,” Dr. Warmink said. “People think, ‘He didn’t die, so everything will be great.' But often times, that’s not true. There is a large subset of children who survive, but end up with catastrophic outcomes.”

Time under water = brain

Dr. Warmink describes drowning as the inability to breathe, normally due to submersion in a liquid, usually water.

The outcome, including death, of the person who drowned depends on how long he or she was under water.

“Everything is based on getting oxygen to vital organs,” Dr. Warmink said. “The outcomes of drowning and the adverse effects are based on that lack of oxygen. The most effected parts of a drowning victim are the brain, lungs and the kidneys. The one that is most catastrophic and the one that will kill you is the brain. “

The amount of time children spend under the water while drowning usually determines their outcome. The lack of oxygen destroys brain cells and that causes damage to the brain, ranging from short term (forgetful, clumsy …) to severe (can’t walk to vegetative).

Dr. Warmink says there are several variables that shape how severe the brain damage will be, including how long the person was submerged in the water and how quickly he or she received CPR.

Once a child arrives to the Cook Children’s ER, treatment begins that may include oxygen, X-rays, intubation or medication.

“But a lot of it is supportive care for the children that come in here,” Dr. Warmink said. “We may have to support their lungs because they have been damaged and they have difficulty breathing. Their kidneys could be damaged, so we will do lab work to see what's going on there. But our biggest concern is the brain and honestly, there's not a whole lot we can do. The vast majority of treatment for drowning is supportive. We see what we can do to keep that child alive. That said the earlier you can intervene, the better. One of the things that helps outcomes is early, good CPR. By the time they get to us, it may be too late.

Adult supervision – the hallmark

As a parent, Dr. Warmink stresses supervision of his own children in the pool. He calls it a hallmark of making sure children are safe. Half of all drownings occur within 25 feet of an adult.

“Children should never be in water without adults watching them,” he said. “If you have a toddler, that child shouldn't be in water without what we call touch supervision. You need to be in hand's length and it's not just pools. That includes bathtubs or any other container with water. I've seen kids drown in buckets. A child can drown in any water, even a few inches deep.

“Supervision isn't, Hey there’s six of us cooking hamburgers and text messaging. It means there’s someone who has the designated job to watch the children in the water.”

Other layers of protection Dr .Warmink stresses include:

• Fencing around the pool. A fence on all sides of the pool has been shown to reduce fatalities by more than 80 percent.
• Swim lessons for everyone who will be in the pool, including adults.
• Coast-guard approved floating devices. Water wings and “floaties” do not constitute a floatation device.
• Drowning doesn’t look like drowning. Drowning is a silent killer. Kids aren’t kicking and flailing. Dr. Warmink says it’s usually someone looking for their child and they see them at the bottom of a pool.

“As the adult, you have to be actively watching at all times, counting even. OK, there are five kids in this pool. How many heads do i see? Kids will drown right in front of you,” Dr. Warmink said. “It's not a long process of them screaming and crying. It's just one second they are fine and the next second they are under.”

Take it from Dr. Warmink. Unfortunately, he’s had plenty of experience.

Related articles:

• Cook Children's drowning prevention page
• Drowning prevention - 9 ways to protect your kids
• Drowning prevention - watch your kids
• Drownings double from a year ago 
• Be a water watcher. Adult supervisions saves lives.
• Is your baby ready for swim lessons?
• Drowning tragedy - 'I can't believe this happened to me.'
• Swimming with Type 1 diabetes
• The life-saving reason for Water Watchers