Drowning is medically defined as the process of experiencing respiratory impairment from submersion or immersion in liquid. This process is often far more subtle than portrayed in film, where loud splashing and yelling are common misconceptions. The reality is typically silent and undramatic, leading to delayed recognition. Understanding the true signs of a person struggling in the water can be the difference between a minor scare and a fatal incident.
The Reality of Active Drowning
A person who is actively drowning enters the Instinctive Drowning Response (IDR), a physiological state that prioritizes breathing above all other voluntary actions. This reflex prevents them from calling out for help, as the respiratory system is dedicated solely to gas exchange. Their mouth alternately sinks below and reappears above the surface, not staying up long enough to exhale, inhale, and speak.
The body posture during the IDR is distinct, with the person appearing vertical in the water, often with no supporting kick motion. Their arms will extend laterally and press down on the water’s surface in a desperate, involuntary effort to leverage their body just enough to lift their mouth for a brief breath. Because their focus is entirely on breathing, their eyes may appear glassy, unfocused, or closed, and they may not respond to questions. This struggle is typically brief, lasting only 20 to 60 seconds before the person submerges.
Distinguishing Between Distress and Active Drowning
It is important to differentiate between a person in aquatic distress and a person experiencing the Instinctive Drowning Response. A distressed swimmer is struggling but is still capable of assisting in their own rescue. They may be able to wave their arms, call out for help, and actively reach out to grab a thrown flotation device or a rescue line.
The body of a distressed swimmer may be horizontal, vertical, or diagonal, and they are usually still making some, albeit weak, forward progress. This state often precedes active drowning, making it a crucial window for intervention.
An active drowning victim, in sharp contrast, is physically unable to wave for attention or move toward a rescuer because their arms are solely occupied with pushing down on the water’s surface. The distressed swimmer is panicked but can communicate; the drowning victim is silent and focused only on the reflex to inhale.
Delayed Symptoms After Rescue
Even after a successful rescue, the risk does not end when the person is removed from the water. A small amount of inhaled water can lead to a dangerous post-immersion complication, often incorrectly called “dry” or “secondary” drowning. Clinically, this involves respiratory difficulties, primarily pulmonary edema, that manifest hours after the event.
Inhaled water can wash away surfactant, a substance lining the lungs that keeps the tiny air sacs (alveoli) open. This loss compromises the lung’s ability to transfer oxygen into the bloodstream, a condition exacerbated by the inflammation and fluid buildup of pulmonary edema.
Anyone who has had a significant struggle or brief submersion should be monitored closely for up to 24 hours. Signs to watch for include persistent, wet coughing and difficulty breathing, such as rapid or shallow breaths. Other concerning symptoms are unusual lethargy, extreme fatigue, chest pain, or a marked change in mood or behavior. Symptoms requiring immediate medical attention usually present within four to six hours of the incident.
Immediate Action and Seeking Help
Upon recognizing a person in danger, immediately call for emergency medical services. Personal safety must be the priority; avoid entering the water unless you are a trained professional, as a panicked victim can inadvertently pull a rescuer under.
Instead, use the “Reach, Throw, Row” method to aid the person from a safe position on land. If the person is close to the edge, a reaching assist can be performed using a long object like a pole, branch, or towel.
If they are too far to reach, throw them a flotation device, such as a life ring, cooler, or anything that floats, to help them stay above the surface. Anyone rescued from the water, even if they appear fine, requires a professional medical assessment to check for subtle lung damage and prevent delayed respiratory complications.