Hello, first-time commenter here. I happen to maintain current certifications as a lifeguard and Wilderness EMT. I suffered four non-fatal drownings as a kid myself (https://kycuong.com/drowning/).
I’m really glad your daughter turned out okay! That’s a frightening close call. I wanted to pass on some general insights I’ve learned from my training and research. It’s US-centric for the bodies I cite, but many of the US recommendations are reflected by other organizations abroad.
General knowledge I think most readers would find helpful
Drowning can occur anytime the airway is compromised by liquid. The WHO defines drowning as “the process of suffering respiratory impairment from submersion/immersion in liquid”. Children drown in buckets, bathtubs, even toilets. As unfortunately demonstrated here, standing depth is not necessarily safe depth.
Drowning is silent. Once someone is drowning, they cannot shout or even wave for help. Most people don’t recognize what it looks like. Prevention and rapid recognition + response are vital.
Inflatable arm floats, inner tubes, and other “floaties” are fun, but no substitute for proper life jackets. Arm floats can slip off and there are many examples of children flipping over/off pool toys and ending up in trouble. A life jacket is designed to keep someone’s airway above water even if they are unresponsive (e.g., they hit their head when their boat capsized).
Some specific recommendations
Safety engineering principles apply here. Safety-I focuses on preventing things from going wrong. It would emphasize approaches like defense-in-depth à la the Swiss Cheese Model: barriers around bodies of water, adult supervision, swim lessons, life jackets, and CPR/AED training. (Table 1 in “Preventing Drowning” from the American Academy of Pediatrics)
Safety-II would emphasize what makes things go right: rotation and non-distraction in adult supervision; destigmatizing the use of life jackets; correctly sizing life jackets and ensuring they meet USCG standards); picking a beach with lifeguards, and so on. (Table 3)
The American Academy of Pediatrics now recommends starting swim lessons as early as age 1. The concern that swim lessons introduce a moral hazard (“My kids took swim lessons, therefore I no longer need to monitor them”) is not borne out by the evidence. In fact, swim lessons are a perfect touch-point for educating parents on the importance of adult supervision (see “Swimming Lessons, Water Survival Training, and Water Competency”). More fundamentally, swim lessons introduce the water competency children will need in lakes/rivers/oceans, provide a final line of defense if other measures failed, and extend the time available for help to arrive.
I personally no longer ask “Do you know how to swim?” but instead “What training have you had in swimming?” People have very different assumptions on what “knowing how to swim” means. The American Red Cross defines water competency as the ability to enter water you cannot stand in, return to the surface, float or tread for at least 1 minute, turn around, swim 25 yards, and exit the water. This is the ability to survive an unplanned plunge into a standard-length American pool.
Davis, Christopher A., Andrew C. Schmidt, Justin R. Sempsrott, Seth C. Hawkins, Ali S. Arastu, Gordon G. Giesbrecht, and Tracy A. Cushing. 2024. “Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update.” Wilderness & Environmental Medicine 35 (1): 94–11. https://doi.org/10.1177/10806032241227460.
Dow, Jennifer, Gordon G. Giesbrecht, Daniel F. Danzl, Hermann Brugger, Emily B. Sagalyn, Beat Walpoth, Paul S. Auerbach, et al. 2019. “Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update.” Wilderness & Environmental Medicine 30 (4S): S47–69. https://doi.org/10.1016/j.wem.2019.10.002.
Sempsrott, Justin R., Andrew C. Schmidt, Seth C. Hawkins, and Tracy A. Cushing. 2016. “Drowning and Submersion Injuries.” In Auerbach’s Wilderness Medicine, 7th Edition, 1530–1549. Elsevier.
Open water swimming is my personal passion as a triathlete, but is its own beast.
I know you know this, but for anyone reading along: Open water can be an absolute nightmare, even when it looks safe, and even when the distance is short.
I used to be on the swim team. I could swim a mile, and I could swim 25 meters on about 2 breaths of air. And then one day, I attempted to cross maybe 50 meters of open water with small waves (4-5 inches, max), on a very windy day. I wound up repeatedly inhaling salt water when the wind broke the wavecaps into spray. I’m not entirely sure I would have survived what should have been a trivial swim, at least not without doing it in several long, underwater stretches. Happily, I had planned ahead and I was swimming within easy reach of a rowboat.
I have also done whitewater kayaking, with a good lifevest and a helmet, plus a wetsuit until the water is comfortably warm. (One classic kayaker rule of thumb is to always wear a wetsuit if the air temperature plus the water temperature is less than 120F.) One of the things that really viscerally surprised me is cold shock. I knew all about hypothermia. But the first time that I hit cold May water in a wetsuit and suddenly lost 50% of my swimming ability within 20 seconds was still a surprise.
Hello, first-time commenter here. I happen to maintain current certifications as a lifeguard and Wilderness EMT. I suffered four non-fatal drownings as a kid myself (https://kycuong.com/drowning/).
I’m really glad your daughter turned out okay! That’s a frightening close call. I wanted to pass on some general insights I’ve learned from my training and research. It’s US-centric for the bodies I cite, but many of the US recommendations are reflected by other organizations abroad.
General knowledge I think most readers would find helpful
Drowning can occur anytime the airway is compromised by liquid. The WHO defines drowning as “the process of suffering respiratory impairment from submersion/immersion in liquid”. Children drown in buckets, bathtubs, even toilets. As unfortunately demonstrated here, standing depth is not necessarily safe depth.
Drowning is silent. Once someone is drowning, they cannot shout or even wave for help. Most people don’t recognize what it looks like. Prevention and rapid recognition + response are vital.
Inflatable arm floats, inner tubes, and other “floaties” are fun, but no substitute for proper life jackets. Arm floats can slip off and there are many examples of children flipping over/off pool toys and ending up in trouble. A life jacket is designed to keep someone’s airway above water even if they are unresponsive (e.g., they hit their head when their boat capsized).
Some specific recommendations
Safety engineering principles apply here. Safety-I focuses on preventing things from going wrong. It would emphasize approaches like defense-in-depth à la the Swiss Cheese Model: barriers around bodies of water, adult supervision, swim lessons, life jackets, and CPR/AED training. (Table 1 in “Preventing Drowning” from the American Academy of Pediatrics)
Safety-II would emphasize what makes things go right: rotation and non-distraction in adult supervision; destigmatizing the use of life jackets; correctly sizing life jackets and ensuring they meet USCG standards); picking a beach with lifeguards, and so on. (Table 3)
The American Academy of Pediatrics now recommends starting swim lessons as early as age 1. The concern that swim lessons introduce a moral hazard (“My kids took swim lessons, therefore I no longer need to monitor them”) is not borne out by the evidence. In fact, swim lessons are a perfect touch-point for educating parents on the importance of adult supervision (see “Swimming Lessons, Water Survival Training, and Water Competency”). More fundamentally, swim lessons introduce the water competency children will need in lakes/rivers/oceans, provide a final line of defense if other measures failed, and extend the time available for help to arrive.
I personally no longer ask “Do you know how to swim?” but instead “What training have you had in swimming?” People have very different assumptions on what “knowing how to swim” means. The American Red Cross defines water competency as the ability to enter water you cannot stand in, return to the surface, float or tread for at least 1 minute, turn around, swim 25 yards, and exit the water. This is the ability to survive an unplanned plunge into a standard-length American pool.
Open water swimming is my personal passion as a triathlete, but is its own beast. See recommendations from the United States Lifesaving Association (the standards body for ocean lifeguards) and the National Center for Cold Water Safety.
Reference Resources
American Red Cross Lifeguarding Manual. 2024. American Red Cross Training Services. https://www.redcross.org/store/american-red-cross-lifeguarding-manual/755740.html.
Davis, Christopher A., Andrew C. Schmidt, Justin R. Sempsrott, Seth C. Hawkins, Ali S. Arastu, Gordon G. Giesbrecht, and Tracy A. Cushing. 2024. “Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update.” Wilderness & Environmental Medicine 35 (1): 94–11. https://doi.org/10.1177/10806032241227460.
Denny, Sarah A., Linda Quan, Julie Gilchrist, et al. 2021. “Prevention of Drowning.” Pediatrics 148 (2): e2021052227. https://doi.org/10.1542/peds.2021-052227.
Dow, Jennifer, Gordon G. Giesbrecht, Daniel F. Danzl, Hermann Brugger, Emily B. Sagalyn, Beat Walpoth, Paul S. Auerbach, et al. 2019. “Wilderness Medical Society Clinical Practice Guidelines for the Out-of-Hospital Evaluation and Treatment of Accidental Hypothermia: 2019 Update.” Wilderness & Environmental Medicine 30 (4S): S47–69. https://doi.org/10.1016/j.wem.2019.10.002.
National Center for Cold Water Safety: https://www.coldwatersafety.org.
Sempsrott, Justin R., Andrew C. Schmidt, Seth C. Hawkins, and Tracy A. Cushing. 2016. “Drowning and Submersion Injuries.” In Auerbach’s Wilderness Medicine, 7th Edition, 1530–1549. Elsevier.
Vittone, Mario. 2020. “What Drowning Really Looks Like.” Divers Alert Network. February 1, 2020. https://dan.org/alert-diver/article/what-drowning-really-looks-like/.
I know you know this, but for anyone reading along: Open water can be an absolute nightmare, even when it looks safe, and even when the distance is short.
I used to be on the swim team. I could swim a mile, and I could swim 25 meters on about 2 breaths of air. And then one day, I attempted to cross maybe 50 meters of open water with small waves (4-5 inches, max), on a very windy day. I wound up repeatedly inhaling salt water when the wind broke the wavecaps into spray. I’m not entirely sure I would have survived what should have been a trivial swim, at least not without doing it in several long, underwater stretches. Happily, I had planned ahead and I was swimming within easy reach of a rowboat.
I have also done whitewater kayaking, with a good lifevest and a helmet, plus a wetsuit until the water is comfortably warm. (One classic kayaker rule of thumb is to always wear a wetsuit if the air temperature plus the water temperature is less than 120F.) One of the things that really viscerally surprised me is cold shock. I knew all about hypothermia. But the first time that I hit cold May water in a wetsuit and suddenly lost 50% of my swimming ability within 20 seconds was still a surprise.