If you and your family are planning to spend some of this summer by the sea, by the pool, or perhaps even a river or lake, perhaps you should ask yourself, would you be able to spot someone in trouble in the water, in time to save their life: do you really know what drowning looks like?

Mario Vittone, a writer on maritime safety, tells a story about a former life guard, now a boat captain, who spotted a potentially fatal incident from fifty feet away. The captain jumped off his own boat, and sprinted toward a family swimming between the beach and their anchored boat: he sped past the astonished parents, to save their nine-year old daughter, who had been quietly drowning not ten feet behind her father.

Vittone, whose articles have appeared in many magazines, including Reader's Digest, said he was not surprised when he heard this story: he knows a thing or two about drowning, having served nineteen years in the US Navy and Coast Guard, and his strongest message is "Drowning Doesn't Look Like Drowning".

Many of us, who have perhaps unwittingly been coached by TV dramas and cartoon films, when asked to describe a drowning person would probably say they would be thrashing their arms about wildly above their heads and making loud cries of help. But the reality is that a person who is drowning is more likely to remain quiet, unnoticeable, and sink silently.

According to the US Centers for Disease Control and Prevention (CDC), in 2007, there were 3,443 fatal unintentional drownings in the US, an average of ten deaths a day, with more than 1 in 5 victims of fatal drowning being children aged 14 years and younger. Plus, for every child that drowns, four others receive emergency care for nonfatal injuries related to submersion.

Furthermore, says the CDC, many parents have watched their child drown without realizing what was happening. They did not know what the captain who saved the little girl in Vittone's story was trained to notice and her parents were blissfully unaware of: the signs of Instinctive Drowning Response, a term coined by Dr Francesco A. Pia, a water safety expert.

Vittone and Pia wrote about the Instinctive Drowning Response, in the Fall 06 issue of On Scene, the journal of the US Coast Guard Search and Rescue. Pia says it is what people do to avoid suffocating in water: they don't splash much, they don't wave, and they don't yell or call out. Quite different to what many of us might expect.

Pia and Vittone make these points about the Instinctive Drowning Response:

• In the vast majority of cases, drowning people are physiologically incapable of calling out for help because the human body is wired to give priority to the primary respiratory function, breathing, and not to speech, which is a secondary overlaid function.
• Drowning people's mouths are not above the water long enough to enable them to exhale, draw breath and call out, they have barely time to exhale and inhale quickly before their mouths go back under the water.
• When we are drowning, our natural instinct is to press our arms outwards and downwards onto the surface of the water so we can leverage our bodies upwards to catch our breath.
• Waving arms about to draw attention is a voluntary movement: we have to stop drowning first before we can physically perform voluntary movements like waving for help, grabbing rescue equipment or moving toward a rescuer.
• While in the Drowning Response, people stay upright but they don't perform supporting kicks, and unless rescued, they struggle on the surface of the water up to 60 seconds before they go under.

These points echo an important rule one learns in basic first aid training and life saving: the casualties that scream for attention are not the priority in the first instance, no matter how desperate their cries. You go to the silent ones first, in case they are unconscious and unbreathing, in which case they are the ones in more urgent need of life saving help.

Vittone also says parents should be aware that children playing in the water usually make a noise: when they go quiet, you should get to them quickly and find out why.

He also lists a number of signs that can help us notice when people might be drowning: their eyes are either closed or appear glassy and unfocused; their head is tilted back with the mouth open or it is low in the water with the mouth at water level; their hair covers their forehead and eyes; they are hyperventilating or gasping; they are trying to swim in one direction but getting nowhere; they try to roll on their back or their body is vertical and they are not using their legs.

There are also other things we can do to prevent accidental drowning, and in many instances, they are to do with ensuring children can't get into the water inadvertently.

According to the CDC, most unintentional drownings of very young children in the US occur in residential swimming pools, and one of the major factors is lack of barriers and supervision.

Their records show that most of the young children who drowned in pools in 2007 were last seen indoors, had been out sight for less that 5 minutes, and were under the supervision of one or both parents at the time.

Having barriers like pool fencing can help stop children getting into the pool area, or at least delay the time it takes them to do that before the adult in charge notices they are gone.

Among older children, the dangers tend to be further away from home: for instance the percentage of American children that drown in natural water settings such as lakes, rivers and the sea goes up with age. Among those that died in boating incidents (709 deaths in 2008, most from drowning), 9 out of 10 of them were not wearing a life jacket, said the CDC.

If you are keen on swimming, boating and doing other recreational activities in natural water, it is important to be aware of local weather conditions, and how to interpret the colored flags on the beach.

Also, look out for dangerous waves and rip currents. If you are caught in one, swim parallel to the shoreline and don't swim toward the shore until you are free of the rip current.

If boating, ensure everyone, no matter how good a swimmer or how far they are travelling, or how big the boat, wears a coast guard approved life jacket.

Alcohol is also a problem: about half of adult and adolescent deaths that occur in and around recreational water and about 1 in 5 American deaths linked to boating are associated with alcohol. Alcohol affects judgement, balance and coordination, and being in the heat and sun while under the influence affects them even more.

Whatever happens, don't assume, if one of your crew falls overboard and they look OK that they are OK.

As Vittone reminds us, drowning does not always look like drowning: the person may look like they are casually treading water and looking up at you or the boat and there is nothing to worry about. But how do you know?

So just to be sure, get their attention and ask them, "Are you OK?" And if they say "yeah, I'm fine", then they probably are. But if they continue to stare blankly, you may only have 30 seconds to reach them.

Sources: mariovittone.com, On Scene, CDC.

Written by: Catharine Paddock

Copyright: Medical News Today