There are as many ways to die as there are to live, but one little-known way of going about it is popularly called "dry drowning." Or that's what the media usually calls it, though drowning researchers wish we wouldn't. Drowning, they say, is just drowning.
According to the World Health Organization, drowning is defined as "the process of experiencing respiratory impairment from submersion/immersion in liquid." In order to drown, the entire airway drops below the water, which results in the victim having trouble breathing. The victim can die, be injured or can recover without injury.
Does This Really Happen?
This summer, a 4-year-old boy in Texas named Frankie Delgado was knocked over by a wave while wading in knee-deep water. His head was submerged for several seconds, but after his father hauled him out of the water, he recovered quickly and seemed fine. Over the next few days, he developed stomach-flu-like symptoms and began complaining of a pain in his shoulder. His parents didn't have him evaluated by a doctor in time, and he eventually died in his sleep.
Later, doctors discovered water in his lungs, which suggests that even though the child had been knocked over by the wave several days prior, the cause of death was a drowning-related injury.
Although no autopsy report has been released, Delgado was likely killed by water that entered his lungs, which gradually caused edema, or swelling of the lung tissue. This condition prohibits the exchange of oxygen through the walls of the lungs, causing oxygen level in the blood to plummet and the heart to slow. Symptoms generally include coughing, chest pain, shortness of breath, foaming of the mouth, fever, vomiting or a change in behavior.
Why Calling It "Dry " Doesn't Help
Although cases like Delgado's are rare, drowning experts think terms like "dry drowning" or "secondary drowning" are not only incorrect, they're dangerous. That's because they may affect the way the public seeks treatment after a drowning event.
"The main issue here, other than the use of an incorrect medical term, is using a wrong concept that implies that our children are in danger when they swim or play in water," says Dr. David Szpilman, medical director of the Brazilian Life Saving Society (SOBRASA).
Szpilman worries that people will focus on the ambiguous — and incorrect — idea that a child might go underwater one day and a few days later die without warning. That people don't understand what the actual threat of drowning entails may actually lead to more drownings, he warns.
The term "dry drowning" was coined in the 1970s, and shows up regularly in parenting media, but has never been medically accepted. It was used to describe drowning deaths in which the upper airway (larynx) spasmed from exposure to water, and the victim died strictly due to asphyxiation without water even entering the lungs. Other terms like "near drowning," "delayed drowning" or "secondary drowning" have also been used by the media and sometimes by medical professionals to describe drowning injuries that eventually result in death. The current thinking among drowning researchers is that it doesn't matter what happens to a drowning victim, the treatment will be the same. The Centers for Disease Control, for instance, makes no differentiation in its literature on drowning-related injuries.
"Whether a small or large amount of water — or no water — enters the lungs, the end result is that the patient cannot receive oxygen and can either develop injury or death due to this," says Dr. Andrew Schmidt, a University of Florida-Jacksonville emergency medicine assistant professor and director at Lifeguards Without Borders.
Although a 1997 study of 41,000 lifeguard rescues found that between 0.5 and 5 percent of drowning fatalities exhibited very few symptoms after rescue, that means that 95 to 99.5 percent of patients with these symptoms and a normal blood pressure survive. They key is knowing when to go to the hospital.
According to Schmidt, the terminology we use for a condition affects the public's understanding of it. Drowning injuries are preventable, and the public should know when to seek medical attention. Most of us know what it's like to be knocked over by the surf or pulled under at the swimming pool when we weren't expecting it — in children, these nonfatal drowning events happen five times more often than fatal drownings. And water can remain in lungs. In general, symptoms of a serious drowning injury will show up between two to three hours of the incident, and medical help should be sought if the symptoms are any worse than the experience of taking a big drink of water that goes down the wrong way.
The bottom line is, experts say, terms like "dry," "near," "secondary" or "delayed" drowning sound mysterious and threatening — but drowning is just drowning, and the process might be mild, moderate or severe, fatal or nonfatal. Lots of people survive nonfatal drownings every day, and some people don't. Prevention is key: swimming lessons, supervision of children in the water and after water activity, the use of life jackets, etc. These can go a long way to preventing fatal drowning, as can the knowledge that if a drowning incident happens, expedient medical attention can save a life.