Instinctive Drowning Response: Why you can’t shout or splash when you’re drowning
Unless you’ve been unfortunate enough to actually see it, almost all our images of people drowning come from movies or television where, for dramatic effect, splashing and other motions are put on by the actor or actress. The director, on some dry, warm deck of a boat shouts down into the water “more, more!” and demands the actress “liven it up a bit” so people know she’s in trouble.
Yet, in reality drowning is less animated than in the movies. In fact, it’s hard to even tell that someone is drowning at all.
Drowning, as opposed to simply being in distress in the water, is suffocation due to liquid entering the lungs, eventually causing asphyxiation. The World Health Association ranks it as the third leading cause of unintentional deaths, with around 380,000 estimated deaths worldwide every year.
So it seems strange that most people, me included, would think drowning was a dramatic event, with splashing, shouting and violent movements from the victim designed to draw attention to themselves. This is essentially what was assumed before 1974, when Frank Pia, a lifeguard at Orchard Beach, New York released an paper titled “Observations on the Drowning on Non-Swimmers” in the Journal of Physical Education.
In it, Pia challenged this misconception and put forward the idea that drowning was an inherently much more silent and unnoticeable trauma. Stories are abound of victims dying in the water as friends and family watch on, oblivious to the tragedy occurring feet away from them, but even without our director friend’s instructions for more drama, surely we’d be aware of it?
In his paper, Pia notes that traditionally, the definition of how to tell someone was drowing was simply a “convulsive agitation which advertises the fact that the person is drowning.” But after years as a lifeguard, Pia wasn’t convinced this was the case. To investigate, he assigned one of his lifeguard colleagues to film rescue attempts that he made and see the how victims acted while struggling in the water. The video which accompanied the paper (which I am unable to find online) shows these rescue attempts and was the basis for his paper.
What Pia noticed was that in actuality there are two differing types of problems people face in the water. First, there is what’s called “aquatic distress”, where somebody who can swim is becoming panicked, whether that be through tiredness, distance from shore or large waves impeding their swimming. They key point is that swimmers who are simply unable to get back to shore are in distress, not actually drowning.
Drowning, the physical act of water entering the lungs, is defined differently. Drowning involves non-swimmers, people physically unable to swim, who suddenly find themselves in water above their heads and thus are unable to breathe.
Individuals in distress may be likened to a boat afloat, in no immediate danger of sinking, but without power to return to shore. A drowning non-swimmer may be likened to a boat which has a leak in it and is beginning to sink. The former needs only to be towed into shore, while the latter needs to be supported, prevented from sinking, and then towed into shore.
This, he says, is a key distinction, but not one that was being observed in the mid 1970s. Pia notes that “existing rescue techniques do not differentiate between distress situations and drowning situations and offer rescue personnel techniques tailored to meet the demands of only distress situations.” Essentially, lifeguards were running in the water and using techniques that required the victim to be able to support them self, something that a non-swimmer obviously couldn’t do. It is with these definitions that Pia forms the actual reactions to drowning that the people undertake: something called Instinctive Drowning Response.
Firstly, as the person cannot intake enough air to breathe, shouting or calling out is physiologically impossible. The lung’s primary function is respiration, with making noise a secondary task. Pia notes that there are situations where victims have shouted out for help, but it is much rarer than usually thought. The body simply priorities breathing over shouting. Often, even if the victim can muster enough breath to call out, he is being dunked in and out of the water and thus cannot breathe out, breathe in and then shout out for help fast enough.
Pia notes that this is often one of the main reasons that a drowning person is not identified as such; they’re not shouting out asking for help and thus are assumed to be fine or are simply not noticed.
The next traditional image of drowning is splashing the water with the arms in order to attract more attention. Again, like with breathing, the body has better use for the arms. Instinctively, the arms trash downwards into the water in an attempt to prevent submersion. Keeping the head above the water and being able to intake air is the priority and as the person does not know how to swim the arms cannot be used for direction, manoeuvring or for attracting attention. “Once a non-swimmer is in water over his head, instinct forces him to react,” says Pia, and this reaction is “common to all non-swimmers, regardless of swimming areas.” To somebody unaware, this would appear to simply be treading water, with the person’s head titled back and looking up.
Both of these responses are instinctual, unlearned and override the majority of normal impulses. The body knows something’s wrong and so kicks into auto-pilot to prevent death. And it doesn’t have long to react. The non-swimmer, once the process of drowning has begun, can only struggle for around 20 to 60 seconds before he/she is submerged in the water. From here, the victim will attempt to hold onto as much air as possible in the lungs causing panic and further body movements which uses up more oxygen. Once depleted, a lack of air results in the victim becoming unconscious and combined with a possible cardiac arrest due to the chemical changes water in the lungs causes, the movement of oxygen to brain will cease and brain damage or death can occur.
It’s a horrible and quite haunting reality of human beings and water. We are, compared to fish and other native creatures, so ill-equipped in both movement and survival in the sea and lakes that consume the vast majority of our planet.
In the rest of the paper, Pia challenged many techniques used by lifeguards to save people struggling in the water. The Pia Carry, a way to support victims who are in Instinctive Drowning Response by bringing their head out of the water, is a universally regarded method for saving the lives of non-swimmers drowning.
Frank Pia’s “Observations on the Drowning on Non-Swimmers” is an fascinating paper that not only challenged the traditional view of life saving, but the fundamental image of what drowning looks like.
It finishes with a simple, direct sentence of its intent:
It is hoped that this paper will serve as a guide that will enable rescue personnel, be they lifeguards or lifesavers, to assess intelligently a victim’s plight and then tailor their rescue accordingly.
Something it clearly fulfils.
You can download a text version of Observations on the Drowning of Non-Swimmers here.
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