Qu'est-ce qu'une noyade ?

What is drowning?

Despite existing precautions, the risk of drowning cannot be reduced to zero. It can happen in a matter of seconds and have dramatic consequences. Every year, thousands of people perish in the water, often due to a lack of prevention or knowledge about the dangers of swimming. Contrary to popular belief, drowning is not always noisy and visible: it can be silent and take place without any apparent movement.

The two types of drowning

There are two main types of drowning, with several possible names. This distinction makes it possible to explain the types of drowning in a clear and simple way:

  • Drowning due to asphyxia because of water reaching the lungs (also known as wet drowning, primary drowning or primitive drowning) is the most common type of drowning (~90% of cases) and is most often caused by a lack of swimming skills or fatigue.
  • Syncopal drowning (~10% of cases), sometimes known as secondary drowning occurs mainly as a result of medical or external problems leading to loss of consciousness. Note that the "secondary drowning" terminology is now obsolete from a pure medical perspective.

What about dry drowning?

This is not exactly a type of drowning in the sense that the water does not reach the lungs. The term "dry drowning" is not a real medical term.

This phenomenon occurs when the vocal cords spasm and close up because of exposure to the water, without inhaling it. This can block the respiration by shutting off the airways or at least making it hard to breathe.

If you notice difficulty for your child to breathe and persistent coughing, it may be due to this and you should consult a doctor very quickly or call the emergency services. But althouth this is frightening, it remains rare.

Drowning by asphyxia (or primary drowning) and the associated pathophysiological mechanisms1

Drowning by asphyxia occurs in 4 stages. Some people may not go through all these stages. It is important to recognise the signs of drowning and to act as quickly as possible without putting yourself in danger.

Stage 1 - Aquastress

Aquastress is an instinctive reaction linked to the fear of drowning.

The victim will become stressed and start making large movements in order to stay afloat; the person will sink into the water and then rise up using their arms to take a breath and then sink again, and so on. He or she will begin to stress and will find it difficult to communicate his or her problem to rescuers or witnesses. The person starts to swallow water, but the liquid has not yet reached the lungs.

Symptoms:

  • Victim conscious
  • Moderated stress
  • Starting to be exhausted

What to do:

  • Call the emergency services or lifeguards in supervised bathing area
  • Calming and isolating the drowning victim
  • Warming the victim up

Stage 2 - Slight hypoxia

If the person is unable to regain support or calm down, he or she will begin to inhale small amounts of water into the lungs. This irritates the airways and begins to reduce the oxygen supply (hypoxia2). The first signs of confusion and loss of coordination may appear.

Symptoms:

  • Victim conscious
  • Anxiety, fear
  • Exhaustion
  • Cough
  • Hypoxia2
  • Hypercapnia3
  • Cyanosis4
  • Hypothermia5

What to do:

Stage 3 - Severe hypoxia

As the water inhalation continues, the hypoxia2 becomes more severe. The body enters a state of acute respiratory distress, leading to a significant reduction in the supply of oxygen to the brain. The victim is no longer able to stay afloat and gradually loses consciousness. Other signs may appear, such as spume6 at the corners of the mouth, hyperventilation7 and fainting.

Symptoms:

  • Somnolence/fainting
  • Agitation
  • Obnubilation8 or coma
  • Respiratory distress
  • Cyanosis
  • Hypothermia
  • Spume

What to do:

Stage 4 - Anoxia9

The person has already spent several minutes in the water, is exhausted and has swallowed or inhaled a lot of water, including in the lungs. He or she is unconscious, no longer breathing and blood is no longer circulating. The victim is in a deep coma or even cardiac arrest, in a state of apparent death.

Symptoms:

  • Coma or cardiac arrest
  • Very weak pulse
  • Cyanosis
  • Hypothermia
  • Spume

What to do:

Syncopal (or secondary) drowning

Syncopal or secondary drowning corresponds to a medical problem, shock or trauma that leads to loss of consciousness in the water and subsequent drowning. The main cause of this type of drowning is cold-water drowning10.

Cold-water drowning

Cold-water drowning is fainting or cardiac arrest due to thermo-differential shock (a large difference in temperature between the body and the liquid).

The cold of the water will cause a reduction in the diameter of the arteries, which can lead to a stoppage in blood circulation and subsequent loss of consciousness.

Other causes

There are several other causes of syncopal drowning. These generally cause the victim to faint or become unconscious:

  • Allergy (algae, jellyfish)
  • Heart or neuronal problems (epilepsy, tetany, hypoglycaemia, heart attack, etc.)
  • Laryngeal spasms (laryngeal muscles that tighten to limit the entry of water but also block breathing)

The right thing to do - Analyse and react

Whether you're a victim or a witness, whether you're comfortable in the water or not, you need to follow some basic rules to avoid danger.

Victim - In case of difficulties in the water

Whether you are an experienced swimmer or not, when you encounter a difficulty, try to follow this list of instructions, which may make your rescue easier and increase your chances of survival:

  • Don't panic and don't get agitated. All too often, a person who is drowning and getting agitated is mistaken for someone who is playing. Staying calm will prevent you from wasting energy unnecessarily, but it will also make it easier to alert and communicate with others in the vicinity by making clear gestures and using your voice if the wind and the distance from the others allow you to do so.
  • Don't fight the current, waves or rollers. As with the point above, stay calm and let yourself be guided, so you can save your strength.
  • If you feel very tired, try floating on your back. This position will allow you to breathe normally and keep your strength.

Always adapt your body to the temperature of the water.

After long exposure to the sun, jumping into the water can cause cold-water drowning.

To avoid cold-water drowning:

  • Avoid prolonged exposure to the sun before swimming,
  • Wet the back of your neck and stomach with the water you want to go in,
  • Do not swim if you feel shivery or dizzy,
  • Do not bathe after drinking alcohol, overeating or intense physical effort.

Witness - Analyze and understand the situation

Do you see someone flailing in the water? Is he or she playing or drowning? Here's how to analyze the situation:

  • Check carefully before intervening. Many people confuse drowning with someone playing, so ask them directly or go and see them if you can.
  • If you do witness a drowning, reactivity is the key to ensure the victim's survival. Apply first aid whenever you can (see next section) and quickly contact the lifeguards, first aid station or emergency services.
  • Keep your eyes on the victim.

Look after your own safety!

If the victim is in a dangerous environment, only intervene if you are absolutely sure you can save yourself.

The victim may be in a state of panic, with an instinct to cling to anything and everything as long as he or she can get to the surface. The victim will probably try to hold on to you and will be very agitated. It is even possible that you will be dragged down with him/her inadvertently.

Stay on your guard, try to communicate and calm he or she down. If the victim clings to you, go underwater and then come back up; the person will probably have let go of you and you can resume manoeuvring.

Witness - First Aid

You'll certainly want to go and help the victim, but ask yourself the question: do you really have the ability to do so? To save someone, you need to be a good swimmer and be able to pull the victim through the water. Drownings sometimes involve people who have put themselves in danger by trying to save someone else.

If you are able to go and get the victim yourself, here are the techniques for a successful rescue:

  • Use a flotation device to help you and save your strength (adapted buoy, canoe, boat, etc.).
  • The easiest way to bring a person back to shore is to lie on your back, take the person on top of you by passing your weak arm under his/her armpit and holding his/her head up with that same hand to prevent his/her airways from going into the water. Swim while on your back by doing a one-handed backstroke using your strong arm and doing the breaststroke movement with your legs.
  • If you can't use this technique, you can put the victim on his/her back (make sure he/she floats), then take one of his/her hands or wrist and pull him/her by swimming while checking that his/her airways remain out of the water.

Here are some alternatives if you don't feel able to go and get the victim yourself while waiting for help to arrive:

  • Throw a buoyancy aid at the victim
  • Use a pole, towel or any other object to which the victim can cling

Rest after the rescue

If the victim has not been taken care of by the emergency services, the person who fetched the victim from the water should avoid performing first aid him or herself whenever possible; he or she has become very tired while fetching the victim from the water and should now rest.

The person checking the victim's condition (trained in first aid if possible) must follow the following procedure:

Procedure for checking the condition of a drowning victim

The defibrillator

If there is a defibrillator (AED) nearby, the witness can send someone to get it.

If the witness is alone, 2 minutes of CPR (cardiopulmonary resuscitation, i.e. cycles of insufflation and compression) are needed before you can call for help and look for a defibrillator without moving too far away from the victim.

Post-traumatic injuries

In the long term, a person who has drowned may develop complications.

Respiratory complication

The water inhaled by the victim may contain algae, products or other elements that damage the lungs. Some people will not suffer any after-effects, while others may have respiratory problems, pulmonary fibrosis11, bacterial pneumonia, heart failure, etc.

Neurological complication

In the event of drowning, the skull and brain may also be affected, due to a temporary lack of oxygen or shock. A lack of oxygen can cause cerebral oedema, encephalopathy12 and so on. Shock can cause cranial trauma.

Psychological complication

It should not be forgotten that drowning remains a very dangerous accident that can cause death. Some victims can develop a fear of water that can go as far as a phobia.

Risk factors

In the event of drowning, the body is put under great strain and pushed to its limits. Not everyone has the same chances of survival, depending on their age and gender, for example, and the risk of drowning also varies according to geographical area.

Age

In France (fairly representative of the global situation in developed countries), between 1 June and 21 August 2023 and 1 June and 21 August 2024, 2020 drownings were recorded by the official agency Santé publique France and SNOSAN (Système National d'Observation de la Sécurité des Activités Nautiques or National Water Sports Safety Monitoring Agency). They were able to categorise drownings into four age groups: 0-5 years, 6-12 years, 13-17 years and 18 years and over.

Adults (aged 18 and over) are the most affected, particularly in the case of fatal drownings. Young children (0-5 years) come second, accounting for almost a third of cases. The 6-12 and 13-17 age groups are less represented, although they are still affected by this risk.

Drowning figures for the summers of 2023 and 2024 by Santé Publique France

Gender

Statistics show that men are twice as likely to drown as women. The main cause is greater contact with water on average than for women, but there are also generally riskier behaviours (apnea, diving, swimming alone, alcohol, etc.).

Professional risks

The United Nations Food and Agriculture Organisation estimates that more than 32,000 fishermen die every year. Climate change has worsened weather conditions and natural disasters, making their work even more dangerous.

Climate risks

As we have just said, global warming has increased the number of natural disasters, including floods. 75% of deaths during a flood are due to drowning. These figures are even higher in low- and middle-income countries, where flood warning and protection infrastructures are underdeveloped.

Poverty and inequality

Low- and middle-income countries are more affected by drowning than developed countries for a number of reasons: unsuitable infrastructures; greater unawareness of the risks; lower rates of swimming instruction; greater use of ponds, lakes and rivers for everyday purposes.

Migration and refugees

Political and economic instability is causing many people to travel in boats that are not designed for such large numbers of passengers, or with no safety equipment. In the event of an accident during a crossing (of varying length), the toll is often heavy and dramatic.

Safety and prevention measures

This section covers solutions to limit the risk of drowning.

Legal safety obligations

Since 2004, it is compulsory in France to install at least one approved safety device in your private swimming pool. To find out more, read our blog post on safety requirements for swimming pools

For children

Children, especially the very young, are particularly prone to drowning. They are not aware of the danger, they can drown in 2.5 cm of water. That's why it's up to adults to make sure that nothing happens to them.

  • Keep a constant eye on your child whether he or she is near or in the water (bath, swimming pool, lake, paddling pool, etc.).
  • Accompany your child in the water when he or she is swimming, even if he or she is wearing an armband or floatation device. Such equipment is no substitute for learning to swim at an early age, or at least learning how to save oneself.
  • Equip your child with an anti-drowning T-shirt if you want him or her to be able to play near water without the risk of drowning if he or she falls.
  • Don't leave objects that could attract children in the water, and be careful of objects that could fly away and bring children close to the water (towels, buoys, etc.).

For all ages

Adults generally have a more developed sense of danger than children, but some don't take enough consideration of their physical condition, the weather or safety rules. Here are a few suggestions to help you enjoy your outings without putting yourself in danger:

  • Don't overestimate yourself (to avoid ending up in a risky situation or even a second drowning when you want to help someone)
  • Don't swim alone (to alert others and get help if you feel unwell)
  • Respect the safety instructions for bathing areas and give preference to supervised areas
  • Wear a lifejacket or buoyancy aid during your water activities
  • Do not drink alcohol or take dangerous drugs before or during swimming.
  • Check the depth of the water before diving in
  • Do not bathe if you have eaten a lot or are feeling unwell
  • After long exposure to the sun, remember to wet the back of your neck and your stomach before entering the water to avoid cold-water drowning

Drowning is a phenomenon that is often underestimated. Yet it is the leading cause of accidents in everyday life and the fourth leading cause of death among 0-5 year olds in France, whether in a natural environment (lake, sea, etc) or an artificial one (bath, swimming pool, etc).

Understanding its physiopathological mechanisms1, recognising the warning signs and taking the right action can save lives. For any drowning, every moment counts.

By making the general public and the youngest members of society more aware of the dangers of drowning and how to protect themselves, the risk of drowning can be greatly reduced. Caution and vigilance should always be the key rules when you're in or near to the water.

I want to protect a child I want to protect an adult

Sources:

  • 1 - Physiopathological mechanisms: the body's reactions to danger or any other situation that disrupts organic functions
  • 2 - Hypoxia: lack of oxygen in relation to the body's demand
  • 3 - Hypercapnia: excess of CO2 in the lungs as a result of holding one's breath. Oxygen is consumed but the CO2 that should be released remains trapped in the lungs.
  • 4 - Cyanosis: the skin turns blue due to a lack of oxygen in the blood
  • 5 - Hypothermia: body temperature falls abnormally below 35°C
  • 6 - Spume: foamy saliva at the corners of the lips
  • 7 - Hyperventilation: breathing disorder in which the breathing rate is abnormally high and uncontrollable
  • 8 - Obnubilation: a physical and psychological state in which simple stimuli (noise, light, etc.) do not cause the body to react.
  • 9 - Anoxia: absence of oxygen in the blood
  • 10 - Cold-water drowning: thermal shock between your body and the water. The difference in temperature between the two elements is too great; the cold water constricts the arteries and blocks blood circulation, leading to discomfort or even cardiac arrest.
  • 11 - Pulmonary fibrosis: infection of lung tissues
  • 12 - Encephalopathy: term used to describe a dysfunction or disease affecting the brain (memory impairment, behavioural changes, etc.).
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