Five Things I Want You to Know about Drowning

Today (July 25^th) is World Drowning Prevention Day – a day dedicated to advocacy and discussion on how we can prevent death from drowning. Here in Australia, the latest national figures paint a concerning picture. Between 1 July 2024 and 30 June 2025, 357 people drowned in Australia, 27% more than the 10-year average.¹ Behind each of those deaths is a life lost and a family, group of friends and community left grieving. Yet fatal cases are only the part of the drowning burden that we count consistently.

Estimates of non-fatal drowning vary considerably. Australian research has reported approximately two non-fatal drownings for every fatal drowning in one ambulance-attended cohort,² while another similar study found ratios exceeding twenty to one.³ Other sources give us figures somewhere in between the two. This variation probably tells us as much about differences in definitions, populations and data collection as it does about how often non-fatal drowning occurs. What is clear to me is that non-fatal drowning is not rare in Australia. What remains unclear is its true scale.

This uncertainty sits at the centre of my PhD research. It has involved the rather glamorous task of reading well over 100 drowning research papers, manually reviewing more than 10,000 ambulance records identified as potentially water-related, and working through an equally substantial collection of marine search and rescue records.

Having now spent more time reading and thinking about drowning and other water-related emergencies than any reasonable person should, here are five things I want everyone, and particularly clinicians, to know about drowning.

Note: Today’s post is a little different and not targeted solely at clinicians. The first two points are probably more relevant for clinicians, but the last three are important for anyone who swims or otherwise is around water.

Just like there is no such thing as a near-cardiac arrest, there is no such thing as near-drowning

Drowning is the process of experiencing respiratory impairment following submersion or immersion in liquid.⁴ It can result in no morbidity, ongoing morbidity or death. It does not require cardiac arrest, unconsciousness or a fatal outcome.

The key point here is that drowning is a physiological process, not an outcome.⁵ A person who develops persistent coughing or hypoxia, or requires oxygen or ventilation following submersion, has experienced drowning. If they survive, the correct term is non-fatal drowning. Just as surviving cardiac arrest does not mean someone experienced a “near-cardiac arrest”, surviving drowning does not mean they “near-drowned”.

If any respiratory impairment follows submersion or immersion, the person experienced drowning, with either a fatal or non-fatal outcome.

None of this is new. The accepted definition has been established for more than two decades. Yet drowning continues to be described instead in terms such as “near-drowning”, “saltwater aspiration” and “water inhalation”. Clinically, this distinction matters because terminology influences clinical communication, documentation, safety-netting and our ability to conduct drowning surveillance. When non-fatal drowning is recorded under several different labels, it becomes much harder to identify cases consistently and understand the true burden (something I have personally experienced in my own research).

The language we use also matters for raising awareness and public health efforts in our communities to prevent drowning from occurring in the first place.

Much like the bogeyman, “secondary drowning” does not exist, and it isn’t coming to get you

The persistence of outdated drowning terminology does not stop at “near-drowning”. While near-drowning is an unhelpful term that potentially masks the true burden of drowning, other terms that persist in the drowning space are, in my opinion, more problematic. In particular, “secondary drowning”, “dry drowning” or “delayed drowning” remain common in public discussion, literature and, concerningly, in clinical advice – with potential for confusion, anxiety and even harm.

These terms, most commonly secondary drowning, are generally used to describe someone, often a child, who despite appearing well after leaving the water, becomes critically unwell hours or days later. To be very clear, there is no recognised medical condition called secondary drowning. Consequently, the term was rejected by the WHO when the accepted definition of drowning was developed more than two decades ago.⁴

This does not mean that deterioration following non-fatal drowning is impossible. Drowning causes pulmonary injury at the time of the event and someone with initially mild respiratory symptoms may worsen over the following hours (although literature suggests this is rare).⁶ This is not a “secondary drowning”. It is the progression of an injury that began during the original drowning process. Symptoms would be present initially, most commonly a persistent involuntary cough.

Importantly, this is different from the often-repeated idea (or more accurately myth) of secondary drowning, that an entirely well person can suddenly deteriorate or even die from drowning hours or even days after a near-miss in the water. There remains no credible evidence of a case in which a person was clinically assessed, initially found to have no symptoms, and later deteriorated or died from a drowning injury.⁶

It is my view that the language here matters because advice to “watch for secondary drowning” can make almost any brief accidental submersion feel ominous. Throughout my research and clinical work, I have encountered both parents calling an ambulance because they were concerned about secondary drowning and clinicians using the term in safety-netting advice. I myself have even been given this advice while undertaking swimming lessons with our young child. The intention behind this advice is well-meaning but can create anxiety in asymptomatic cases (i.e., non-drowning) or confusion in non-fatal drowning.   

Anyone who experiences respiratory impairment following submersion or immersion has drowned and should absolutely receive clinical assessment, even if they appear to fully recover or their symptoms appear mild. Persistent or worsening coughing, difficulty breathing, abnormal drowsiness, confusion or other concerning symptoms require urgent assessment.

However, the completely well patient who experienced no cough or other respiratory symptoms at any stage post immersion has not drowned simply because they swallowed water or required rescuing of some kind. Importantly, they should not be left with advice to be concerned that they (or their loved one) may suddenly deteriorate without warning. In fact, they may need reassurance that the bogeyman of secondary drowning isn’t coming to get them.

Alcohol is a persistent, yet preventable contributor to fatal drowning – especially in young men

Australians, in my experience, are generally very comfortable mixing alcohol and water recreation, despite years of public health efforts to highlight the risks involved. Unfortunately, the tendency to assume that “she’ll be right” probably plays a part in this and alcohol continues to be a significant factor involved in fatal drowning. An analysis of drowning deaths in Australia over two decades found that alcohol was present in almost one-quarter of cases.⁷

The combination of drowning and alcohol appears repeatedly throughout the research.⁸ Alcohol impairs judgement, coordination, reaction time and the ability to recognise danger. It may influence the decision to enter rough water, swim further than intended, remove a lifejacket or attempt an unsafe rescue. Importantly, the risk is not limited to people who deliberately enter the water and alcohol is also a factor in drowning involving falls from boats, jetties and shorelines.

Often, I will hear informal discussions suggesting that international visitors and people born overseas are most at risk of drowning. These groups absolutely do experience a high per-capita risk, which warrants targeted prevention measures. However, general discourse focusing on this can obscure the fact that drowning in Australia is not predominantly a problem affecting international visitors.

Men, particularly young men (under 30), represent the majority of fatal drowning events, and alcohol is an important part of that risk profile. The same study mentioned above found that men aged 15-29 accounted for 79% of drowning fatalities in Australia between 2002-2022 and nearly a third of these involved alcohol.⁷

That statistic is sobering and certainly something worth sitting with for a second.

Do not turn one drowning patient into two

The impulse to help someone in difficulty is powerful. It is especially difficult to stand back when the person in the water is a friend, family member or child. However, entering the water without the necessary training, equipment and understanding of the environment can quickly turn one drowning patient into two. This happens with enough frequency that there is a term for exactly this – Aquatic Victim Instead of Rescuer (AVIR) syndrome, and every year around five Australians lose their lives attempting to rescue someone else from drowning.⁹

The safest rescue is the one where the rescuer never enters the water. If you ever find yourself needing to assist someone in the water, think: Talk, Reach, Throw. Try to talk to the person to help them remain calm and to self-rescue, reach with a suitable object, or throw a rope or something that floats. A lifejacket, bodyboard, life ring, esky lid or ball may provide enough buoyancy to interrupt the drowning process while trained rescuers are on their way. I have even used an empty jerry can once, thrown to someone while waiting for Surf Life Rescue volunteers to arrive.

Entering the water should be a last resort and, if unavoidable, should involve flotation.

This applies to emergency workers as much as it does to members of the public. Concerningly, I have also encountered incidents in which rescue efforts by non-lifeguard emergency service personnel have resulted in either significant risk or realised harm to the rescuer after entering the water.

While it is understandable that, in the moment, individuals want to help in any way possible, I am reminded of the saying: no emergency should result in a second emergency.

Watch your children around water – actively

My final point is a little more of a plea to anyone supervising children around water to give that task their undivided attention.

“Watch children around water” in some form or another is advice older than the internet. But that word “actively” matters most, especially in the world of said internet. Being somewhere nearby is not the same as supervising. Now that we have devices in our pockets that constantly seek our attention, this is a message I am happy to repeat like a broken record.

Children can get into difficulty quickly and without attracting attention. Put bluntly, drowning can be a silent killer. While there has been a reduction in fatalities in recent years, drowning remains a leading cause of avoidable death in children aged 0-14 years.^1,10  

Phones, conversations, household tasks and alcohol all reduce our ability to notice when something changes. Stories surrounding childhood drowning often describe everyday, brief distractions: preparing food, packing belongings, answering a phone, attending to another child, otherwise briefly turning away or assuming that someone else was watching. These are not stories of “bad” parents, rather they highlight how easily distraction amid the chaos of parenting can lead to dire, irreversible consequences.

This is why I want to highlight that supervision around water should be active, meaning that someone is focused only on supervising and close enough to intervene immediately.

For young children and non-swimmers, that means being within arm’s reach, preferably in the water with them. At gatherings, supervision should be allocated explicitly. Do not assume that another parent, an older sibling or the nearest adult is watching – I have personally seen this go wrong on more than one occasion. Alcohol raises its head again here too – if alcohol is involved, decide in advance who will remain sober and responsible for that supervision.

Swimming lessons, lifejackets, pool fences and lifeguards are all important layers of protection, but none of these replaces active supervision. I’m sometimes astounded when walking through my local pool at the level of supervision. It is worth remembering that lifeguards are watching an entire pool or beach and even in the brief time it may take to notice and react to someone in danger, drowning can occur. Most importantly, lifeguards cannot provide individual supervision for your child.

If you’re a parent looking for practical resources to enjoy the water safely, I’d recommend visiting Kids Alive Do the Five.

Final comments and thoughts

My intention today is not to be all doom and gloom, and the water is not something to fear, but it must be respected. Swimming, boating and playing around water are core parts of many of our lives and bring enormous benefits to individuals and communities. With active supervision, appropriate skills, suitable safety equipment and sensible choices, water recreation should be embraced and enjoyed.

Remember: Anyone can drown, but no one should.

And as always, stay curious and be excellent to each other.

References

Show References (10)

1.            Royal Life Saving Australia. National Drowning Report (2025) [Internet]. 2025. Available from: https://www.royallifesaving.com.au/__data/assets/pdf_file/0004/118273/National-Drowning-Report-2025-V2.pdf   

2.            Matthews BL, Andrew E, Andronaco R, Cox S, Smith K. Epidemiology of fatal and non-fatal drowning patients attended by paramedics in Victoria, Australia. Int J Inj Contr Saf Promot. 2017;24(3):303–10. https://doi.org/10.1080/17457300.2016.1175479

3.            Mead E, Shu CC, Sarrami P, Macniven R, Dinh M, Alkhouri H, et al. Rates and ratios of fatal and nonfatal drowning attended by ambulance in New South Wales, Australia between 2010 and 2021. J Safety Res. 2024 Dec 1;91:373–80. https://doi.org/10.1016/j.jsr.2024.09.019

4.            van Beeck EF, Branche CM, Szpilman D, Modell JH, Bierens JJLM. A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ. 2005 Nov;83(11):853–6. https://pmc.ncbi.nlm.nih.gov/articles/PMC2626470/

5.            Bierens JJLM, Lunetta P, Tipton M, Warner DS. Physiology Of Drowning: A Review. Physiology. 2016 Mar;31(2):147–66. https://doi.org/10.1152/physiol.00002.2015

6.            Szpilman D, Sempsrott J, Webber J, Hawkins SC, Barcala-Furelos R, Schmidt A, et al. ‘Dry drowning’ and other myths. Cleve Clin J Med. 2018 Jul 1;85(7):529–35. https://doi.org/10.3949/ccjm.85a

7.            Miller L, Willcox-Pidgeon S, Scarr JP, Koon W. Analysis of unintentional fatal drowning in Australia 2002-2022: Progress, challenges and data to inform prevention. Aust N Z J Public Health. 2025 Aug 1;49(4):100258. https://doi.org/10.1016/j.anzjph.2025.100258

8.            Hamilton K, Keech JJ, Peden AE, Hagger MS. Alcohol use, aquatic injury, and unintentional drowning: A systematic literature review. Drug Alcohol Rev. 2018 Sep;37(6):752–73. https://doi.org/10.1111/dar.12817

9.             Royal Life Saving Australia [Internet]. 2020 Nov 10. How to Carry Out a Rescue Safely. Available from: https://www.royallifesaving.com.au/stay-safe-active/in-an-emergency/how-to-carry-out-a-rescue-safely

10.         Australian Institute of Health and Welfare [Internet]. 2026. Injury in Australia: Drowning and submersion. Available from: https://www.aihw.gov.au/reports/injury/drowning-and-submersion