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In 2002, the World Congress on Drowning developed the following uniform definition for drowning: “The process of experiencing primary respiratory impairment due to submersion or immersion in liquid medium”.[1]  In 2003, an advisory statement of the International Liaison Committee on Resuscitation (ILCOR) recommending the use of a uniform drowning reporting template: the ‘Utstein Style for Drowning’ was published [2], with an update in 2017.[3] This consensus-based document was created to provide more consistency in describing drowning research and improve comparability between individual studies. This statement used the previously developed drowning definition [1]. Implicit in this definition is that a liquid/air interface is present at the entrance of the victim’s airway, partially or completely inhibiting the drowned person from breathing air. The victim may live or die after this process, but whatever the outcome, he or she has been involved in a ‘drowning incident’.[4] The use of the term “near-drowning’, which was considered to be confusing, was thus abandoned.[4] With this definition also came the recommendation to discontinue the use of modifiers such as “near”, “secondary”, “wet/dry”, and “active/passive”.

For more than a decade, this uniform definition of drowning has been adopted by the World Health Organisation (WHO), and it has also been incorporated in the European Resuscitation Council guidelines.[1,4] The use of outdated terminology is unfortunately not a rarity in peer-reviewed literature, as a systematic review found that 32% of drowning-related articles from July 2010 to January 2016 included non-uniform terminology.[5]

The International Drowning Researchers’ Alliance sees this as an opportunity for education and hope that readers may work towards improving the use of uniform drowning terminology in practice and research so that patient care and data collection may be optimized. Therefore, we urge all authors to describe drowning incidents using the terminology advised by ILCOR and the WHO.

Those who survive the incident should be considered to have survived a non-fatal drowning. Further details on discontinued drowning terminology can be found in “Dry Drowning’ and Other Myths[6], “Clarification and Categorization of Non-fatal Drowning”[7] and “Drowning and Aquatic Injuries Dictionary[8]. Drowning crosses many domains in the house of medicine and we look forward to continued engagement with physicians of all specialties as we work to reduce the burden of drowning.

 

References

  1. van Beeck E, Branche C, Szpilman D, Modell J, Bierens J. A new definition of drowning: towards documentation and prevention of a global public health problem. Bull World Health Organ 2005;83:853-6.
  2. Idris AH, Berg RA, Bierens J, Bossaert L, Branche CM, Gabrielli A, Graves SA, Handley AJ, Hoelle R, Morley PT, Papa L, Pepe PE, Quan L, Szpilman D, Wigginton JG, Modell JH, Atkins D, Gay M, Kloeck W and Timerman S. Recommended guidelines for uniform reporting of data from drowning: the “Utstein style”. Resuscitation 2003;59:45-57. doi:10.1016/j.resuscitation.2003.09.003
  3. Idris A, Bierens J, Perkins G, Wenzel V, Nadkarni V, Morley P, Warner D, Topjian A, Venema A, Branche CM, Spzilman D, Morizot-Leite L, Nitta M, Løfgren B, Webber J, Gräsner JT, Beerman S, Youn CS, Jost U, Quand L, Dezfulian C, Handley A and Hazinski MF. 2015 Revised Utstein-style recommended guidelines for uniform reporting of data from drowning-related resuscitation: An ILCOR advisory statement. Resuscitation 2017, 118, 2224–2226, doi:10.1161/HCQ.0000000000000024.
  4. Truhlář A, Deakin CD, Soar J, Khalifa GEA, Alfonzo A, Bierens JJLM, Brattebø G, Brugger H, Dunning J, Hunyadi-Antičević S, Koster RW, Lockey DJ, Lott C, Paal P, Perkins GD, Sandroni C, Thies K, Zideman DA, Nolan JP, Barelli A, Böttiger BW, Georgiou M, Handley AJ, Lindner T, Midwinter MJ, Monsieurs KG, Wetsch WA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation 2015;95:148-20
  5. Schmidt AC, Sempsrott JR, Szpilman D, Queiroga AC, Davison MS, Zeigler RJ and McAlister SJ. The use of non-uniform drowning terminology: a follow-up study. Scand J Trauma Resusc Emerg Med. 2017;25(1):72. doi:10.1186/s13049-017-0405-x
  6. Szpilman D, Sempsrott J, Webber J, Hawkins SC, Barcala-Furelos R, Schmidt A, and Queiroga AC. ‘Dry drowning’ and other mythsCleve Clin J Med. 2018;85(7):529-535. doi:10.3949/ccjm.85a.17070
  7. WHO. Non-fatal drowning terminology. Draft Position Statement available at: https://www.who.int/violence_injury_prevention/drowning/non-fatal-drowning/en/
  8. Szpilman D, Palacios-Aguilar J, Barcala-Furelos R, Baker S, Dunne C, Peden AE, Brander R, Claesson A, Avramidis S, Leavy J, Luckhaus JL, Manino LA, Marques O, Nyitrai NJ, Pascual-Gomez LM, Springer L, Stanley TJ, Venema A, Queiroga AC. Drowning and aquatic injuries dictionary, Resus Plus, 2021; 5. doi.org/10.1016/j.resplu.2020.100072.

 

Suggested citation: IDRA (International Drowning Researchers’ Alliance). Drowning Terminology – context and resources for the widespread use of updated terminology and definitions, February 2021. Available from: http://idra.world/portfolio/drowning-terminology/