Summer’s here and coroners and medical examiners are more likely to be dealing with water-related deaths. For many, but not all, water-related deaths the cause is drowning.
Since we’re talking summer, let’s limit the discussion to outdoor water deaths, whether in natural water (ocean, river, etc) or swimming pools. Water deaths usually end up being classified as accidental in manner, although all the other manners – homicide, suicide, natural, and undetermined – are possible. It’s safe to say that water deaths are preventable. It’s also safe to say that everyone should have the opportunity to learn to swim.
Risk Factors for Drowning
Drowning can happen regardless of age, health, or ability to swim. Still, those in the younger age groups are more likely to drown, especially those under four years of age or 10-20 years of age. Young drowning victims are more likely to be male, black, or living in a rural area, according to the Center for Disease Control and Prevention (CDC). People of any age with significant medical conditions such as seizure disorders or advanced heart disease also need to be cautious around water. No one should ever swim alone.
Drug and alcohol use is a common risk factor in both adolescent and adult drownings. Boating under the influence, for example, is like driving under the influence. Toxicological testing should always be done on bodies found in water. Positive findings need to be carefully assessed as to their role in the death. That’s not always easy, as illustrated in the following case.
Seizure disorders and heart disease are common medical conditions that pose a drowning risk. Just as with drug use, it’s often difficult to determine what role the health condition played in a water-related death. Seizures cannot be diagnosed at autopsy. Again, toxicology is critical. If someone with known seizures has sub-therapeutic levels of anti-seizure medication, it’s more likely that a seizure may have led to the drowning.
Case Study
A man in his late thirties was found submerged in a river not far from his home. It was unknown how he had ended up in the water. Exam and autopsy showed no traumatic injuries or medical conditions that could have accounted for the death. There was a history of depression due to recent personal difficulties. Toxicology was positive for a high level of phencyclidine (aka PCP, Angel Dust). Vitreous electrolytes showed profound hyponatremia (low sodium level). The pathologist determined the cause of death to be Drowning Complicated by Phencyclidine Intoxication. The coroner certified the manner of death as undetermined.
Some high-profile water-related deaths (yes, I know many may not recognize all the names):
- Mary Jo Kopechne (read about it here)
- Natalie Wood (cause: drowning and other undetermined factors, manner undetermined)
- Jessica Savitch (investigated and certified by Bucks County, PA coroner)
Shallow Water Blackout
This less common cause of drowning happens because of prolonged underwater breath holding. The brain stimulates the body to breathe when it senses a certain level of carbon dioxide has built up. If someone hyperventilates before going underwater – so they can stay under longer – the carbon dioxide level stays low longer and oxygen is used up before the person feels the need to breathe. The lack of oxygen to the brain results in loss of consciousness while still under water. This should be considered if an otherwise healthy younger person drowns in calm or shallow water despite being a good swimmer.
Recommended Reading
- Armstrong EJ and Erskine KL. 2018. Investigation of Drowning Deaths: A Practical Review. Acad Forensic Pathol 8(1): 8-43 (Website Link or PDF here)
- CDC Data Brief on Unintentional Drownings in Children