Statistics and studies show that a large proportion of drowning accidents happen close to the shore and on boats. In retrospect, those affected were often judged to be good swimmers. Research results since the beginning of the 1980s explain the causal relationships and divide the process of drowning by sudden immersion in water into four phases. The cold shock as a determining factor in water sports incidents is triggered by wetting the skin with water.
The physiological response to contact with cold water occurs as early as 20 ° C water temperature, the area below 15 ° C water temperature is more threatening. The lower the water temperature, the stronger the reaction of the organ systems involved.
Inhaling fluids causes the epiglottis to close immediately . This protective mechanism is triggered by receptors located in the area of the entrance to the larynx. At the same time an attempt is made to remove the foreign bodies, the liquid etc. from this area by coughing up .
The death by drowning is to be distinguished from the death by bathing .
|Water temperature||Time to exhaustion
|Theoretically possible survival time|
|0.3 ° C||<15 min||up to 45 min|
|4.5 ° C||30 min||up to 90 min|
|10 ° C||1 h||3 h|
|15 ° C||2 h||6 h|
|21 ° C||7 h||40 h|
|26 ° C||12 h||> 40 h|
After involuntary immersion in cold water , parallel reactions of several body systems occur within the first few minutes. The breathing, the circulation, the muscles and the nervous system are involved. The larger the wetted skin area and the greater the temperature difference, the clearer the physiological response to this environmental stimulus will be. Intensive inhalation ( inspiration ) is triggered reflexively via the information provided by the skin's thermoreceptors . Further consequences are a sharp increase in heart rate ( tachycardia ) and respiratory drive ( tachypnea ). First there are involuntary breaths, which are followed by hyperventilation (rapid and disordered breathing). The tidal volume is significantly increased and at a water temperature below 15 ° C the ability to hold one's breath is reduced to ten seconds. The synchronization of inhalation and swimming movements is severely restricted.
In addition to this breathing reaction, panic occurs and the position in the water can no longer be controlled. The mouth and nose cannot be held over the water in a targeted manner. Water enters the airways and is aspirated . In the same phase, there is a dramatic increase in heart rate and blood pressure: especially in people who are exposed to the risk of a heart attack ( myocardial infarction ) or stroke (apoplexy). The changed ambient temperature also causes immediate contraction of the skin vessels ( vasoconstriction ), changes in the heart rhythm ( extrasystoles ) and an increase in blood pressure ( hypertension ). The work of the heart increases, the cardiac blood flow decreases, the oxygen supply to the heart muscle tissue decreases.
In the UK, where sea water is often very cold, 55% of all victims drowned no more than ten feet from the shore or from a boat, although a third of them were considered good swimmers.
Chronological sequence of the phases after immersion in water (each depends on the water temperature):
- Phase 1: Cold shock (approx. 1–3 minutes)
- Phase 2: swimming failure (approx. 3–30 minutes)
- Phase 3: hypothermia (approx. 30-60 minutes)
- Phase 4: Circulatory reaction from the rescue (during the rescue or hours after the rescue)
On the high seas, in cold inland waters and when the ice breaks in, drowning people also die directly from hypothermia . After a few minutes at low temperatures, but sometimes only after incorrect recovery ( recovery death ). See table under cold shock .
Body temperature cannot be permanently maintained in water below 28 ° C. The core body temperature drops due to the release of thermal energy to the surrounding water. The speed of this decline depends on the factors water temperature, body mass, body fat, insulating clothing, the movement of the water and the nutritional status before the event. Physical and mental abilities decrease. Hypothermia occurs when the core body temperature falls below 37 ˚C. Depending on the course of time, the transition from unconsciousness (risk of aspiration ) to cardiac arrest will be fluid.
In addition to the influence on thermoregulation, the water temperature affects the performance of the muscle cells. At the same time, the speed of the conduction of stimuli via the nerve pathways is reduced. Muscle contraction, gripping strength and hand coordination decrease rapidly, making it difficult to impossible, e.g. B. put on a swimming aid or pull yourself out of the water. The person's ability to swim is restricted as it becomes more difficult to synchronize breathing and swimming strokes. The swimmer comes into a more upright position to keep their mouth afloat, resulting in inefficient swimming strokes.
The two phases mentioned above explain the timing of many drowning accidents without affecting the core body temperature.
The next phase of hypothermia follows if the affected person should z. B. be held by a swimming aid (life jacket / life jacket, other buoyancy aid) on the water surface.
Pathophysiologically distinguished drowning in is fresh water from the in salt water , which has different effects on the body. While much attention was paid to these mechanisms in the past, the prevailing view today is that the amount of water absorbed and the resulting electrolyte disturbances are mostly irrelevant, and sees hypoxia as the most important pathophysiological principle of drowning as a result of the lack of oxygen and local disorders of the lungs ( atelectasis formation , Washing out of surfactant ).
When drowning in the sea, salt water gets into the lungs. The concentration of ions in the lungs is higher than in the adjacent tissue, so that the concentration is equalized. Since biomembranes are semi-permeable (impermeable to ions, permeable to water molecules), the concentration compensation must be carried out with the help of the diffusion of water molecules. The concentration of water molecules in the lungs is lower than in the adjacent tissue, so that water molecules are withdrawn from the tissue and the lungs continue to be filled with water. This process is similar to plasmolysis (water flows out of the cells) in plant cells.
Even when drowning in fresh water , water gets into the lungs. The concentration of water molecules in the lungs is now higher than that in the cells of the adjacent tissue. To compensate for this difference in concentration, water molecules diffuse from the lung tissue into the erythrocytes , which ultimately burst. This process is similar to deplasmolysis (water flows into the cells) in plant cells.
If, after liquid (water) has entered the airways, a permanent glottic cramp occurs, it can persist and lead to the death of the person. This is known as dry drowning because the dead do not allow water to enter the lungs. This is particularly feared by small children (puddles, shallow garden ponds).
Drowning is a silent death. The popular assumption that drowning people will always draw attention to themselves by shouting or waving is wrong. This does not mean that a swimmer calling for help is not in an emergency situation. A person drowning due to a cold shock does not breathe to call for help. Speaking is a subordinate function to breathing; if you don't get enough air to breathe, you can't shout. Those who are in danger of drowning are most likely to stand out because they are standing vertically in the water and not moving or treading water, i.e. trying to push the water away from under them instead of doing classic swimming movements. The water is not stirred up, or only slightly more strongly than during normal swimming. In addition, drowning people tend to fall into shock breathing and tilt their heads back. If there is hair on the face, the drowning person will not push it aside with his hand. If you are in danger of drowning, you don't answer a shout.
Behavior as a victim
Survive in cold water
On the basis of the findings on cold shock, Gordon G. Giesbrecht formulated the rule of thumb "1-10-1" - after involuntary immersion in cold water, even in ice water, there is a higher chance of survival if the following phases and their characteristics are known:
- 1st minute
Cold shock : Immediate deep inhalation is followed by hyperventilation , which can be ten times normal breathing. If you don't keep your airways clear, you risk drowning. This cold shock will pass in about a minute. During this time, one should focus on avoiding panic and getting breathing under control. Wearing a life jacket is very important at this stage.
- Next 10 minutes
Freezing cold sets in : within about the next 10 minutes you lose your ability to move your fingers, arms and legs in a meaningful way. One should concentrate on self-rescue and, if that is not possible, secure oneself in such a way that the airways remain free. It is during this critical time that swimming failure occurs and without a life jacket or buoyancy, one is likely to drown.
- 1 hour
Hypothermia : Even in ice water, you can remain conscious for up to an hour before you lose consciousness due to hypothermia. If one understands the mechanisms of hypothermia, techniques to delay it and possibly to save oneself and to call for help, the chances of survival increase considerably.
Survival in warm water
From a water temperature of 20 ° C, people can, under favorable circumstances, survive in the water for several days if they wear a life jacket and manage to keep their heads above the water.
The downproofing method developed by the American swimming instructor Fred Lanoue teaches you how to breathe with the least amount of effort in order to survive floating in the water for a long time:
- You take a vertical position. The head is tilted slightly forward. The back of the head touches the surface of the water.
- Raise your arms gradually with your elbows bent until your hands are in front of your shoulders.
- To take a breath, move your hands downwards and slightly backwards, which drives the body upwards. Instead of or in addition to this, you can also do the straddle leg kick, as in breaststroke swimming . However, the head should only rise out of the water just enough to allow you to catch your breath. This is repeated every ten to twelve seconds.
- You take a deep breath and leave the air in your lungs. Only when you rise your head again do you breathe out quickly and then in again immediately. One kilogram of lift is gained per liter of air volume in the lungs . So it takes less force to lift your head above the surface of the water to breathe.
Most people are a little lighter than water and float on the surface of their own accord. However, a certain proportion sinks in the water if no swimming movements are performed. It is more difficult for these “sinkers” to learn the downproofing method.
If a person is in danger of drowning, you should first try to save them while observing your own safety. For this purpose, the person should be given or thrown a floating object, if possible, in order to avoid direct contact; if the person is in a panic, they can push the rescuer underwater.
First aid and resuscitation
If the patient is safe, he should be placed on his side if he is unconscious . It is important to watch out for signs of breathing activity. In the event of insufficient breathing or cardiac arrest , cardiopulmonary resuscitation must be started immediately . Measures to remove water from the lungs and airways are not indicated.
To prevent hypothermia , a quick rescue is life-saving. If the water temperature is low and hypothermia is suspected, the rescue must be carried out particularly carefully (horizontal rescue). If you are hypothermic, remove wet clothing and slowly warm your body through body contact. Until the ambulance service arrives, the patient's circulation and breathing ( vital parameters ) must be monitored continuously. Then transport to an emergency clinic.
Measures by the rescue service
Responsive patients are treated with oxygen insufflation. In patients with impaired consciousness, the indication for endotracheal intubation is given generously. Because of the high risk of aspiration in drowning victims , this is carried out as rapid sequence induction , followed by PEEP ventilation .
A necessary resuscitation is carried out without any special additives. Hypothermic patients are continuously resuscitated, since in such cases successful resuscitation has sometimes been observed even after a long time. This is due to the extremely slowed metabolism in hypothermic patients. According to the latest guidelines, the hypothermic patient requiring resuscitation should only be warmed to 34 ° C; this temperature is maintained in the hospital for a further 24 hours in order to keep brain damage as low as possible.
Although there is no scientific research with a high level of evidence, there is evidence that training programs, swimming lessons, and fencing in pools, especially in children between the ages of two and four, can prevent drowning. It is estimated that with adequate supervision, swimming lessons, and public education, 85% of all drowning cases can be prevented.
There are a number of preventive measures and rules of conduct which, if followed, will significantly reduce the risk of drowning. This includes:
- Fence around pools and swimming ponds
- Do not let children swim alone
- Wear suitable life jackets for boat trips etc.
- Do not walk on frozen water
- Do not bathe or swim under alcohol
- Avoid unfamiliar waters
- Avoid unguarded waters
- Take warnings of currents seriously: Surf currents are the most common cause of swimming accidents at sea
- No dives into unknown or low waters
- If the air temperature is high and / or the body is heated, do not go into the water without first cooling down (e.g. showering)
- Do not overestimate your own strength and stay close to the shore
Swimmers can also use these options:
- In the "dead man" lying position, you can relax in the water if you are exhausted
- If exhaustion threatens, a less strenuous swimming style can also be chosen. For example side swimming , in which the lower extremities swim while the upper extremities relax.
- Spasms can be eased by stretching in the water
Situations at increased risk of drowning
There are many high-risk situations for death by drowning.
When ships capsize, people on board drown, especially if they cannot reach life- saving appliances such as lifeboats , lifeboats , lifeboats , lifeboats , lifeboats and lifeboats , and don't wear life jackets. Shipwrecked people are exposed to the risk of colliding with obstacles such as rocks, bridge piers or moored ships in flowing waters, but also in an ocean or tidal current, especially with the latter, with the additional risk of being pressed under a floating body by the current. If a ship is aground at a depth that is not too great, there is a certain chance of survival in a trapped air bubble, but if the ascent is too rapid, there is also a risk of decompression sickness .
In the seafaring industry, people fall overboard in a storm or simply through inattentiveness. Rescue is usually difficult and is therefore practiced intensively during training and is part of the examination for skippers and seafarers.
If aircraft crash into the sea or other bodies of water, there is a risk of drowning in addition to the risk of injury from the impact.
Sports swimmers can also drown in competitions. In 2010, for example, a swimmer died in a 10 km competition in 30 ° C warm water, which is a particularly high temperature for long distances. For competitions in the pool, the recommended range is 26 ° C to 28 ° C. After that, among other things, the number of escort boats was increased. In the 10 km competition of the European Swimming Championships 2014 in Berlin, a swimmer was exhausted and pulled unconscious from the water and thus rescued.
In Asia, drowning death is the leading cause of one to four year olds and a common cause of death in the five to 17 year old age group. About 20 times as many people drown in Asia as in highly developed nations. Bangladesh reports about 18,000, Vietnam 13,000 and Thailand 2,600 drowning deaths each year.
Until 2000, statistics on drowning in Germany were only available from the Federal Statistical Office. The DLRG has been collecting drowning statistics since 2000 , including data on the age of the drowned, breakdown by federal state and location of the accident (for example river, lake, sea) and now also by gender. These statistics include not only swimming accidents , but also, for example, ice falls, falls into the water (for example in docks) and so on. There is no breakdown according to pure swimming accidents. The statistics do not compare with the size of the population or the number of those who stay in certain places (for example, how many bathing days take place in rivers and lakes as opposed to the sea and so on.).
|year||Drowned||Number sea||Share of river / stream / lake / pond||Proportion of men||Supporting documents and comments|
|1951||2105||Figures for 1951-2005|
|1993||655||from 1993 including the new federal states|
|2007||484||19th||73.97%||72.67%||2007–2018: DLRG website|
According to the World Health Organization, Germany, along with the Netherlands and Great Britain, is one of the three safest countries in Europe when it comes to drowning. Since around 2001, the age group of preschool children is no longer statistically particularly at risk, but mainly older cohorts. About half of all German "bathing dead" are over 50 years old, and in three out of four cases they are male (as of 2016). Overall, the number of bathing deaths is tending to decline: In the past 20 years, the number of German bathing deaths has been between 400 and 600 per year, and the trend is falling on average. Upward outliers always correlate with hot summers, such as 2015, but also 2006 (606 deaths) or 2003 (644 deaths). Until the 1970s, annual casualties of more than 1,000 people were common, at the beginning of the 1950s over 2,000 Germans lost their lives in bathing waters, and in 1926 there were 3,552, almost 10 per day (see also table). After reunification, the eastern German states initially had twice as high the number of drownings, but by 2000 they fell significantly.
A total of 34 people drowned in Switzerland in 2017.
The waterboarding , the simulated drowning.
There are some medical myths about drowning for which there is no scientific evidence.
From a medical point of view, it is not recommended to attribute a drowning case with “almost”, “wet”, “dry”, “secondary”, “active” and “still”. It can be confusing and difficult to treat. Such attributions also do not correspond to the WHO definition of drowning and were explicitly rejected when a WHO definition was drawn up.
The so-called "dry drowning" ( English Dry Drowning ) was never a medical term generally accepted. There are several meanings. “Dry drowning” is used as a synonym for “secondary drowning”, among other things. It can also represent the lack of water in the lungs during an autopsy of bodies found in the water. Laryngospasm is also suggested as an explanation for “dry drowning”. Laryngospasm could play a role in less than 2% of drowning cases in which no other cause of death is identified. Typically, a laryngospasm is brief and is terminated by breathing movements that allow air to escape in the lungs and water to be inhaled. One problem with the term "dry drowning" is the harm from incorrectly diagnosing sudden deaths as drowning when there are other causes of death. Most importantly, medical case management is the same whether there is little or no water in the lungs. There is therefore no clinical distinction between “dry” and “wet” drowning.
The term "secondary drowning", which is not generally recognized in medical terms, has several meanings. It is sometimes used synonymously with "dry drowning". “Secondary drowning” can also mean a physiological reaction to foreign content in the lungs after immersion in water in the form of a pulmonary edema . The designation is imprecise and not scientifically recognized.
Hypo- and hypervolemia
Drowning in salt water does not cause dehydration (hypovolaemia). Drowning in fresh water does not cause excess fluid in the bloodstream (hypervolaemia), hemolysis, or hyperkalemia.
Drowning in literature
- Joost JLM Bierens (Ed.): Handbook on Drowning - Prevention, Rescue, Treatment . Springer, Berlin / Heidelberg 2005, ISBN 978-3-540-43973-8 , doi : 10.1007 / 3-540-29656-5 (English).
- Wolfgang Schwerd: suffocation (lack of oxygen). In: Wolfgang Schwerd (Hrsg.): Brief textbook of forensic medicine for doctors and lawyers . 3rd, revised and expanded edition. Deutscher Ärzte-Verlag, Cologne-Lövenich 1979, ISBN 3-7691-0050-6 , 71–84, here: pp. 80–84 ( death in water ).
- DLRG - German Life Saving Society
- SLRG - Swiss Life Saving Society
- Wasserwacht.de - Wasserwacht
- DGzRS - German Society for the Rescue of Shipwrecked People
- Drownings in Canada, 10 Years of Research Module 2 - Ice & Cold Water Immersion . (PDF; 3.74 MB) Canadian Red Cross, 2006
- coldwaterbootcamp.com - visualization of cold shock and self-rescue options according to the 1-10-1 principle
- Film contribution to the representation of the self-rescue possibilities after falling through ice. umanitoba.ca
- Quoted from: Hypothermia (PDF; 85 kB)
- Survival time: here the time from the onset of hypothermia to death.
- Zeit Wissen , October / November 2008, p. 86
- Drowning doesn't look like drowning . , German translation on nordsee24.de
- coldwaterbootcamp.com 1-10-60 phases on Giesbrecht's website, accessed April 6, 2018
- More detailed explanations in German can be found in the text " Cold water effects in water sports falls (PDF) by Peer Christoph Sowa, 2014, from p. 12; as well as in Udo Beier's article in the coastal canoe hiking newsletter (No. 43/14) (PDF)" Kaltwasserprobleme (Health) ", from p. 25, June 16, 2014
- The website drownproofing.com provides information on the method ; accessed in February 2019
- T. F. Mott, KM Latimer: Prevention and Treatment of Drowning . In: American family physician . tape 93 , no. 7 , April 2016, p. 576-582 , PMID 27035042 .
- The water rescue service (WRD) of the DLRG / water rescue service stationary
- wasserwacht-trostberg.de ( Memento of the original from May 2, 2015 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice.
- 500 meters from the finish the World Cup third was killed , Welt.de from October 25, 2010, accessed on August 14, 2014
- Dramatic rescue in the 10 km competition - help with delay , ORF.at of August 13, 2014
- Conference 2011 of the Australia's Royal Life Saving Society and The Alliance for Safe Children in Da Nang, Vietnam; quoted in Viet Nam News, May 11, 2011, pp. 1 and 2
- Proportion of men in the total number of drowned people whose gender is known; almost every year the statistics show for several cases that the gender is unknown
- Swimming accidents . In: Der Spiegel . No. 44 , 2016 ( online ).
- Figures 1951–2005 from the overview statistics of the DLRG annual reports 2000 (p. 18 f.) And 2005 (PDF); in the case of obvious typing errors in the 2005 annual report (also in comparison to the graph), the figures were taken from the 2000 report. The number for the year 2000 was taken from the text of the 2000 report and 2005 report; the number used in the graph and a heading from the 2000 report includes additional deaths as noted in the report, e.g. B. abroad, and otherwise would not be comparable with the figures from other years.
- DLRG Annual Report 2000 (PDF)
- DLRG Annual Report 2001 (PDF)
- DLRG Annual Report 2002 (PDF)
- DLRG Annual Report 2003 (PDF)
- DLRG Annual Report 2004 (PDF)
- DLRG Annual Report 2005 (PDF)
- DLRG Annual Report 2006 (PDF)
- DLRG drowning statistics from 2007 on the DLRG website: https://www.dlrg.de/presse/pm-ertrinkungsstatistik.html
- DLRG Annual Report 2003, p. 23 (PDF) in later years and statistics further confirmed
- DLRG Annual Report 2000, p. 19 (PDF)
- Swimming accidents 2018: More children drowned in Swiss waters In: srf.ch , October 8, 2018, accessed on October 8, 2018.
- E. F. van Beeck, CM Branche, D. Szpilman, JH Modell, JJ Bierens: A new definition of drowning: towards documentation and prevention of a global public health problem . In: Bulletin of the World Health Organization . tape 83 , no. 11 , November 2005, p. 853-856 , PMID 16302042 , PMC 2626470 (free full text).
- David Szpilman, Justin Sempsrott, Jonathon Webber, Seth C. Hawkins, Roberto Barcala-Furelos, Andrew Schmidt, Ana Catarina Queiroga: 'Dry drowning' and other myths . In: Cleveland Clinic journal of medicine . tape 85 , no. 7 , July 2018, p. 529-535 , doi : 10.3949 / ccjm.85a.17070 , PMID 30004377 (English, review).
- J. P. Orlowski, D. Szpilman: Drowning. Rescue, resuscitation, and reanimation. In: Pediatric clinics of North America . tape 48 , no. 3 , June 2001, p. 627-646 , PMID 11411297 (review).
- David Szpilman, Joost JLM Bierens, Anthony J. Handley, James P. Orlowski: Drowning . In: New England Journal of Medicine . tape 366 , no. 22 , May 31, 2012, p. 2102–2110 , doi : 10.1056 / NEJMra1013317 (English).
- Adrian Arab: Secondary drowning "He took a deep breath without exhaling". In: Welt Online . June 12, 2017. Retrieved June 11, 2017 .
- "There are two main reasons why the term 'secondary drowning' is no longer used today - one is strictly defined, the other is primarily justified in terms of content." Why is the term "secondary drowning" no longer used today? on geo.de