Whatcha’ Think?

Wilderness Drowning –
Why Do We Care
a. One of the top 1-3 causes of fatalities in the wilderness
b. Drowning (both in wilds and civilization) kills mainly
young adults, leading to a huge societal cost
c. In general is relatively easy to treat (if recognized) in
wilderness
d. All of the above
 Wilderness Drowning –
Why Do We Care?
Usually in top 3 causes of wilderness
fatalities
• US National Parks - #1 cause of fatalities
• Colorado backcountry - #3 cause of fatalities
• Costa Rica US travelers - #1 cause of fatalities
• California Nat’l Parks -- #2 cause of fatalities
 Drowning - Definition
• Respiratory impairment due to
submersion in liquid
• Not necessarily death
• A continuum from mild
symptoms to death
• In past many terms used:
“near drowning,” “wet” or
“dry drowning,” “secondary”
or “delayed drowning,” etc.
• “Drowning” includes all:
It is a continuum
 Drowning Epidemiology

• Internationally
- Over a third of a million deaths a year
- 2nd leading cause of accidental death
• US
- 5th leading cause of accidental death
- Up to 4,000 deaths annually
• For every fatal drowning there are at
least 5 times more patients treated
for drowning, with serious morbidity
issues
 Drowning – Epidemiology
Non-Fatal Drowning
• Short and/or long term prognosis often not good

• ~20% of patients going to ED need hospitalization

or transfer (compared to 6% for all injuries)
• Injuries include memory problems, learning
disabilities, loss of physical functioning, etc.
 Drowning Demographics
• > Quarter US fatalities less than 5 years old
• 2nd leading cause pediatric injury death
• 3.5: 1 male-female ratio, fatal drowning
• Males: tri-modal
(infant, teen, elderly)
• Females: bi-modal
(infant, elderly)
 Drowning & Gender
• Males 3.5 times more likely overall
• After age 1 males account for 88%
of all drownings in natural water
• Why?
 Whatcha Think?
Why are males so much more likely to
drown
a. Males have more exposure (commercial
fishing, maritime work, etc.)
b. Males tend to consume more alcohol
c. Males, due to testosterone (and probably
societal influences) take more risks
d. All of the above
 Drowning & Gender
The Three Ts
- Teens and Testosterone
- Tequila
- Trade (occupation)
 Drowning & Drugs
• General Substance Impact
- Decreases
Judgment
Physical ability to swim, re-gain boat, keep head upright,
etc.
Laryngeal reflexes
- Increases
Heat loss
Vomiting
• Alcohol present in >60% of fatal US male
drownings
• Impact of other drugs unknown but
probably not insignificant
 Drowning & Predisposing
Medical Factors
• Hypoglycemia
• Cardiac Issues
• Depression/mental health
• Seizures and/or syncope
• For toddlers, previous abuse
Drowning - Epidemiology
Location

Up to 10% of drownings
occur in submerged
vehicles
 Drowning: Prevention
• Gender reassignment?
• Learn to swim
• Swimming
- Use buddy system
- No diving
- Watch rip currents – in salt water >80% of rescues; > 100 US deaths/yr
• Boating
- Wear a PFD (84% of those fatally drowned were not!)
- Avoid alcohol
- 29% of deaths occurred on boats, anchored, docked, adrift
• Swimming Pools
- Fences and locks
- Supervision
• Submerged or water trapped vehicles – escape ASAP
 Rip Currents
Break the Grip of the Rip!
- Not always obvious - Don’t fight the current
- Call/wave for help - Relax, float, tread water
- Swim parallel to beach
to escape
 Whatcha Think?
In Cold Water (just above freezing)
how long does a person have to live
a. 5 minutes
b. 10 minutes
c. 20 minutes
d. 60 minutes
 Drowning Prevention
Cold Water
• Can live surprisingly long time if head above water
• Wear PFD
• Dress warmly and keep clothing on
• Get out of water ASAP, but try not to swim
• Get up out of water on boat, ice, anything
• Use HELP or huddle positions
• If possible enter water feet first, keep head above
water, avoid cold water shock
 Cold Water Immersion Syndrome
Breathing Difficulties
• Cold water causes gasp and sudden intake of
breath; if head underwater = sudden fatal
drowning
• Hyperventilation can also occur, can lead to
panic
• Hard to hold breath
 Cold Water Shock Response
Cardiac & Blood Pressure Difficulties

• Sudden vasoconstriction
• Instantaneous and massive increase in heart
rate and blood pressure
• Can greatly increase danger of heart failure and
stroke, particularly in in vulnerable individuals
 Cold Water Shock Response
Mental Challenges
• Panic due to hyperventilation
• Initial hypothermia can lead to poor decision
making
• Panic, fear, and/or hypothermia can cause
inability to think clearly and make and follow
good plans
 Cold Water 1:10:1 Rule
1:10:1 Rule suggests someone in cold water has:
1: One minute to get breathing under control
10: Ten minutes of usable muscle control
1: One hour before succumbing to fatal hypothermia
Assumes unconscious person floats face up and regular outdoor clothing

Developed by Dr. Gordon Giesbrecht, U of Manitoba

HELP and Huddle Positions
 Drowning Prevention
PFDs
• Only works if worn!
• At very least, know where they are
• Ensure it fits snugly
• Types
 Drowning - Boat Capsize
• Stay with boat
- some flotation
- can get you out of cold water
- easier to spot
- survival materials
• Try to get up on top of boat
• Look for, grab any thing floating
 Whatcha Think?
For Wilderness River Crossings
a. Remove shoes to keep footgear dry and prevent
blisters, trenchfoot, etc.
b. If a rope is available tie it around people or clip them in
so that if they “swim” they can be more easily rescued
c. Tighten pack straps to improve balance while crossing
d. Location of stream crossing is most important
consideration
 Drowning – Stream Crossing
• If any question, don’t!
• Location, location, location
- Think about downstream consequences
- Choose wider spot
- Stick thrown in water, should travel slower than walking
pace
 Drowning – Stream Crossing
• Wear footgear
• Face upstream
• Use trekking poles hiking pole, or sapling
 Stream Crossing (cont)
• Use group, supporting each other with hands on
shoulders; biggest person in lead to break force of
current, using pole of some kind
• Undue waist/sternum straps, loosen shoulders
• Tie bear rope or p-cord to pack and leave coiled loose on
top to more easily retrieve pack in case it is jettisoned;
never tie someone into rope
• Dump pack if you go for
a “swim”
 Whatcha Think?
If a vehicle is driven into water or
becomes submerged
a. Wait until the car fills with water, otherwise it will be
impossible to open doors, and then escape
b. Escape vehicle as soon as possible by lowering or
breaking window
c. Breaking a vehicle window to escape is relatively easy
d. Should not be a big concern as such situations are
rare and seldom result in drowning
 Submerged Vehicle Drownings
• Approximately 10% of fatal drownings in US
• Prevent by conservative driving practices and not
entering flooded roadways
• In flooded roads vehicle can float (and be pushed
downstream into deeper water) in only 1-2 feet (36-
60 cm) of water
• Vehicle sinking in deep
water will completely
fill within 3-8 minutes
 Response to submerged/flooded vehicle
• Unbuckle seatbelts
• Exit vehicle as quickly as possible via windows
• If windows not working, break (electric windows
should work if engaged quickly)
• If children involved, release starting with oldest 1st
• Do not delay escape to use cell phone until out of
vehicle
 Drowning Difficult to Detect
• Victims are first seen floating motionless
or sinking silently below the surface
• Victims simply dive in water, never surface
• Seldom have breath to shout
• Often don’t wave arms above head
because they are trying stay afloat
What drowning can look like