Secondary Drowning – What is it?

Today’s topic is water safety & secondary drowning – sometimes called Delayed Drowning. In short, it’s a condition in which a person who has survived near-drowning then goes on to ‘drown’ on dry land or in their bed at a later time. It’s something we talk about when we discuss water safety in the Child Care and Standard First Aid courses, but it’s not very well-known – so here goes….

What causes secondary drowning?

Water or fluid build-up in the lungs, which prevents oxygen getting to the blood (and so eventually there’s not enough getting to heart, lungs & brain). Imagine a person who nearly drowns: They get rescued and seem to recover. During the near-drowning, they manage to breathe in say 30 mLs (2 table spoons full) of water. It’s a bit irritating and they cough a lot, but eventually seem to recover. The water collects in the very bottom of their lungs and isn’t much trouble. That night they lay down and go to sleep. While sleeping, the water spreads. Because the person is now on their back the water can cover up to half of their lung surface. It prevents oxygen exchange and they slowly stop breathing and die. Take a look at the picture and see what we mean!

Lungs show water levels during secondary drowning

Water in the lungs could have been breathed in while they were having the near-drowning episode. It could also be caused by minor irritation of the lung from eg: sand in the water. If a person happened to inhale a small amount of dirty water, the constant irritation can cause fluid build up (just like constant irritation on, say, your feet can cause a blister).

How to prevent secondary drowning

Um… basic water safety and avoiding near-drowning events. Really you can’t prevent secondary drowning – you have to be aware that it’s possible and be on the watch for it. Obviously good water safety will help – along with learning to swim, staying within your depth, etc. Anyone who has been involved in a near-drowning situation should be watched closely for the next 72 hrs. Near drowning is where they’ve struggled and needed rescue, it doesn’t mean your kid ducked under water and came up spluttering!

Signs & Symptoms of secondary drowning

  • Irritation or pain in the throat or chest
  • Coughing after taking a deep breath
  • Persistent coughing or wheezing
  • Shortness of breath or difficulty breathing
  • Unusual fatigue
  • Dizziness/altered level of consciousness
  • Vomiting or diarrhea

Treatments for secondary drowning

Prevention (water safety!) but if it happens, call 9-1-1, EMS, get to hospital. Be aware of the potential need to do CPR.

Secondary Drowning in the News

Yes, it really happens. The biggest issue is that people aren’t aware of it. Here are a couple of articles we found:

(10 year old) Boy dies of ‘secondary drowning’ while napping after swim

A 60-year-old man fell into New York’s Long Island Sound, pulled himself out — and then died several hours later


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About Tony Howarth

Tony is a First Aid & CPR Instructor Trainer with Sea 2 Sky Safety Training Services and the company founder. Tony started with the British Red Cross in 1994. Has acted as first aid attendant for hundreds of events & treated many hundreds of people as a result. He is experienced in training a wide range of courses. He previously worked as an ambulance attendant with the British Red Cross. He is now in BC as a first aid instructor, and an instructor trainer (one who trains others to become instructors) Finally, Tony works at Squamish General Hospital as the pharmacist manager when not busy training safety
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20 Responses to Secondary Drowning – What is it?

  1. aquillans says:

    Thanks for the post very useful!very nice!

  2. Pingback: 5 Pool Safety Guidelines You Need To Know | Safety un-Limited

  3. Karl Liebengood says:

    I choked trying to syphon water away from a water pipe leak. I actually could not catch my breath and swallowed orange clay water and dirt clods through the sypon hose. I feel scratchy throat, pain on left side of my chest, and raspy voice. Should I be concerned to go to sleep tonight?

    • Tony Howarth says:

      If you only swallowed it, then no – you’ll be fine. If it got into your lungs then get checked out.
      The chest pain could be serious, or could just be your stress from the situation. You’re the one who knows yourself best.

  4. Joanne says:

    Thanks for this! I’ve shared it on facebook.

  5. Robyn Worley says:

    My lil girl has some of the symptoms or could it be a cold very nervous please help

  6. Pingback: What is secondary drowning and could my baby be in danger following submersions? | Lets Talk About Baby Swimming

  7. Vonnie says:

    Can secondary occur by drinking water by lying on your back and goes into your lungs?

    • Tony Howarth says:

      Kind of – although that would be called ‘aspiration’ and is the topic of another post. It would be more likely to give you pneumonia than anything else because we naturally tend to cough out the water (and you’re not struggling under the lake at that moment).

  8. Lisa says:

    How would you know the difference between just a “coughing up water” close call versus secondary drowning? I see the symptoms you mention , but these seem somewhat discrete symptoms. How would you determine its def time for a hospital trip?

    • Tony Howarth says:

      If it’s ‘coughing up water’ then it’s likely to be home observation either way – there may be nothing for a hospital to find even if they looked… time will tell.

      As to deciding to go? Always play it safe! But I think timing my be important here. We all have a ‘dive reflex’ when we hit the water unexpectedly. The throat spasms to prevent water getting into the lungs. Then, well, you cough up the water. The longer you (or whoever) are under the water, the more likely that this reflex relaxes and water enters the lungs. Unfortunately how long this takes varies (child/adult, strong/weak, etc.) No strict rules here, but a quick dunk while playing is usually fine.

  9. Wendy says:

    Went kayaking Saturday and fell in the water by some logs and I almost drowned and now my throat hurts like bad and I got cough now should I get checked out and my head hurts bad to

    • Tony Howarth says:

      Well, you don’t have secondary drowning as far as we can tell from here, but if it’s that bad yes get checked. You could easily have picked up an infection from the water.

  10. Melissa says:

    My daughter went swimming late tonight with friends. She fell off a raft, and not being a strong swimmer, went under water and struggled to get out. She didn’t need any intervention, but said that she took in a good bit of water (she is 9 and I didn’t witness the event so have to go by what she tells me). She is now very tired (however it is late at night). She is in bed sleeping now. I am a worried mess and my husband thinks I am crazy. What can I do? What symptoms do I look for while she’s sleeping? Should I wake her up? Prop her up? Take her to the ER? Help please.

    • Tony Howarth says:

      My best guess (from far away) is that she swallowed a lot of water rather than inhaling it. Inhaling it would make her breathing more challenging. Monitor her breathing through the night – perhaps every 30-60 minutes, let’s face it you’re not going to be sleeping anyway. If she shows signs of breathing difficulty, for sure get her checked out. Hopefully she’ll be just fine.

      • melissa says:

        Thank you. You’re right, I’m definitely not sleeping. I have been checking her about every 30 minutes. She is breathing quickly, which may be normal for her at 4AM….lol, but doesn’t seem to be in distress. I’ve been reading a lot and most articles mention coughing or wheezing, and I’m not hearing any of that either. How quickly would/could something change for the worse? Are we in the clear by morning (when she gets up)?

        • Tony Howarth says:

          In general things can change quickly with kids, but that also means they improve quickly too. By the time she’s woken up and you’re out and about, she should be just fine. Do still keep an eye open for any worsening over the next few days (e.g.: productive cough) which could indicate a minor infection from the water. Sounds like you’ll all be just fine.

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