Last summer more than 400 people drowned in South Africa. Many of them were children.

“In fact, drowning is fourth on the list of causes of unnatural deaths among children. The other three are guns, car accidents and burns.

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“The stories of the adults and parents on the different scenes are all very similar,” says Nick Dollman of Netcare 911. “Children slip away unnoticed and they are later found in the water. Often it is unclear how long they have been in the water and deprived of oxygen.”

Even if the child initially revives, tragedy may follow. “Drowning" is the term used when a person dies due to a lack of oxygen to the heart and brain. "Near-drowning" is when a person has survived after having suffocated in water or another fluid – but survival can be accompanied by damage to the respiratory system, a build-up of fluid in the lungs after recovery. This, in turn, could lead to pneumonia or even a fatal condition called "late drowning".

For every child who drowns, says Dollman, five are left with permanent brain damage as a result of the prolonged lack of oxygen during a near drowning. It takes only four minutes without oxygen for irreversible brain damage to occur.

Child drownings are preventable
And children certainly don’t only drown in deep swimming pools.

“A few hundred millimetres of water can be fatal to a small child, and parents and childminders need to be aware of the water hazards in and around the home - including swimming pools, fish ponds, water features, toilets, pets' water bowls, dams, streams and rivers, bore holes and open drains, to name a few,” says Dollman.

“We have even attended to a small child who had fallen into a large plastic bucket that was being used to clean nappies,” he said.

Dollman said that he had attended several scenes where the child of a domestic worker had drowned, or nearly drowned, at their parents’ place of work.

“Some of these children are from other provinces and come to visit their family for the holidays and are not familiar with swimming pools and the hazards they pose. In fact, some of the employers, who did not have small children, had not protected their pools with the right covering, which led to the tragedy.”

Children (especially one to three-year-olds) are most at risk, and supervision is therefore always needed if a child is near water. Because of the disproportionate weight of their heads, toddlers can easily topple over and find it difficult to lift their heads to breathe.

Recognising an emergency
It may not always be obvious that a person is in trouble. Know that these are the signs for which you should be looking:

• A swimmer who is struggling to breathe may be unable to call for help; so if the swimmer's strokes become erratic and jerky or stop entirely, or if the body sinks so that only the head shows above the water, you can take it that this person is in trouble.
• If, when they’re on dry land, their breathing is laboured, or if they’re unable to control their coughing, get help.
• They might also have a blue tinge to their skin colour. Their skin may be pale and cool.
• They may vomit, or have a swollen stomach
• They may appear stunned or to be losing consciousness, and their pulse may be very rapid, weak or slow.
• If the person is not breathing, unconscious or you suspect a spinal injury, call the emergency services immediately.

Drowning incidents per city/province
433 adult and child drowning/near-drowning incidents were attended to by Netcare 911 between 1 September 2006 and 31 August 2007

• Kwazulu-Natal: 147
• Johannesburg: 107
• Western Cape: 88
• Eastern Cape: 34
• Pretoria: 18
• North West: 18

Gauteng is the inland province with the highest incidence of drownings/near drownings, and the majority of these occur in unprotected swimming pools.

Alcohol and adult drowning
Dollman pointed out that adult drownings can often be linked to a combination of drinking alcohol and playing water sports.

“Alcohol and water, or water sports, are a potentially fatal combination. Never dive into any water if the water is murky or if you cannot see the bottom; people have died or sustained serious and permanent spinal damage after diving from boats or jetties into rivers, lakes and dams - all sorts of hazards lie beneath the water surface such as rocks, broken glass bottles and sand banks.”

Prevention of drowning
Dollman suggested the following:

• Be vigilant when children are around water.
• Keep pool gates locked, or cover the pool with a certified pool net.
• Ensure gates and nets are in a good condition and free of damage or holes.
• Employ electronic splash sensors that trigger an alarm when a splash is detected.
• Take a basic course in first aid and CPR – it can make a dramatic difference in the outcome should the skills be applied in time.
• In any emergency situation, immediately contact the correct emergency number for the relevant authority.
• Memorise the number for emergency services in your area and keep the number saved in your cell phone or close to your landline telephone.

What you can do to help

• The first principle is safety; never try to rescue someone if it will endanger your life. Rather call for help.
• If a spinal injury is suspected and CPR is not required, the person should not be moved.
• Keep them lying face up until help arrives as the water will immobilise the spine.
• If the person has to be moved, slide a board under his head, back and buttocks, taking care to keep the head and neck aligned.
• If the person is not breathing but has a pulse, perform mouth-to-mouth breathing immediately. Don't waste time by trying to drain swallowed water.
• If the person starts breathing again, he is likely to vomit. Place him on his side with his head lower than his torso to clear the airway.
• If the person has a spinal injury, take care to keep the head and neck in alignment at all times.
• If there is no pulse, place the person on a hard surface and do CPR, taking care not to extend the head backwards.
• Place the person in the recovery position if there are no spinal injuries.
• Keep him warm and treat for hypothermia if necessary.
• Call a doctor if someone has nearly drowned even if they have recovered completely

The national emergency number for Netcare 911 is 082-911. For first aid courses phone the Netcare 911 School of Emergency and Critical Care at 011-695-9600.

(Amy Henderson, Health24, December 2007)
 

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