HEALTH: So, you want to go swimming this summer?

It was a warm Sunday morning last summer and most of the families were out in one of the beaches in Davao City. Five-year-old Jane was swimming along with other kids along the seashore. No adults were looking for them. Jane’s mother, Charlene, was busy preparing their food for lunch while the father, Jonathan, was buying soft drinks in the nearby store.

Suddenly, three consecutive big waves hit the kids. Jane was carried away into the deeper part and before she knew it, she was already gasping and drinking a lot of water. The other kids could not help her since they, too, didn’t know how to swim. It was just a matter of minute and Jane went down to the water. It was at this moment that Aida, a neighbor who was also in the beach, came and immediately rescued Jane.

But it seemed it was already late. Jane was already pale and was not moving anymore. “Will somebody help us,” Aida shouted. Everyone who heard the shout came running. “What happened?” Charlene inquired and when she saw it was her daughter she was shocked.

Fortunately, Ferdinand, Aida’s son, and his friend, Renato, were around. Both had attended a first aid workshop a couple of weeks ago conducted by the Philippine National Red Cross. Sensing that Jane was no longer breathing, the two immediately did mouth-to-mouth resuscitation. First, it was Ferdinand who breathed into Jane’s mouth. Afterwards, Renato took over. Three minutes later, Jane vomited some water and started breathing again.

Charlene was crying and smiling when she saw her daughter has been brought back to life. They immediately brought her to the hospital. “Thank you very much,” she told Ferdinand and Renato. “You have saved the life of my daughter just on time.”

In the Philippines, about eight persons die every day due to drowning, according to the country report presented at the World Conference on Drowning Prevention (WCDP) in 2011. Victims of near drowning was even higher: 10 cases per day.

A research done by the United Nations Children’s Fund (UNICEF) listed drowning as the fourth leading cause of death from injury in the Philippines. The top five causes were road traffic accidents (20%), gun shots (17%), stabbings (14%), drowning (12%), and electrocution and falls (4% each).

According to the findings of a study conducted by Safe Kids Philippines, the Philippine Life Saving Society and the Department of Health, almost 2,000 children die yearly from drowning.

The result of the study – Child drowning in the Philippines: The silent killer speaks – ranked drowning as the second leading cause of death among children aged one to 14 years old, outnumbering deaths from serious diseases such as tuberculosis, malnutrition, diarrhea, cancer, and meningitis.

The UNICEF research found that drowning rates were highest among boys and girls less than 5 years old compared to other age groups and higher among females than males for all age groups.

In addition, the drowning rates were higher among males under 5 years and among those under 15 years compared to females of the same ages. This gender difference is largest for male toddlers whose relative risk for drowning death is 1.5 times higher than female toddlers, the research pointed out.

Swimming is fun

Drowning and near drowning

Drowning and near drowning are two different terms. Near drowning is “severe oxygen deprivation” (suffocation) caused by submersion in water but not resulting in death; when death occurs, the event is called drowning.

“When a person is submerged under water, water enters the lungs,” explains “The Merck Manual of Medical Information.” “The vocal cords may go into severe spasm, temporarily preventing water from reaching the lungs. When filled with water, the lungs cannot efficiently transfer oxygen to the blood. The decrease in the level of oxygen in the blood that results may lead to brain damage and death.”

According to the Geneva-based World Health Organization (WHO), drowning is the third leading cause of unintentional injury death worldwide, accounting for 7% of all injury related deaths. It defines drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid.”

Drowning itself is quick and silent, although it may be preceded by distress which is more visible. “People who are drowning and struggling to breathe are usually unable to call for help,” the Merck manual reminds. “Children who are unable to swim may become submerged in less than one minute compared with adults, who may struggle longer.”

What happens during the drowning event? Dr. Ben Wedro, who practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin, shares this sequence: First, the person panics or struggles followed by submersion with breath-holding. Loss of consciousness can begin within three minutes of being under water. The brain may suffer damage if it is deprived of oxygen for more than six minutes. The heart may go into an irregular rhythm that doesn’t allow the heart to pump blood, if it too is deprived of oxygen for more than a few minutes.

People who survived drowning may have symptoms ranging from anxiety to near death. “They may be alert, drowsy, or comatose,” the Merck manual informs. “Some may not be breathing. People who are breathing may gasp for breath or vomit, cough, or wheeze. The skin may appear blue (cyanosis), indicating insufficient oxygen in the blood. In some cases, respiratory problems may not become evident for several hours after near drowning.”

More often than not, people generally call the emergency hot line when someone is drowning. But “ambulances take too long to get to places where they are needed most because of horrendous traffic and other conditions they have get through,” says Dr. Siang Hiong Goh, head of emergency medicine at the Changi General Hospital in Singapore.

In most parts of Asia, including the Philippines, the response time for emergency ambulance calls is between 10-20 minutes. That’s beyond the six-minute mark. Experts estimate that once the heart stops, there is a crucial window of four to six minutes to restore circulation.

“The universal final step to dying is when the heart stops to beat or pump so that circulation of blood and distribution of oxygen to every part of the body cease,” explains Dr. Roberto A. Raymundo, the chairman of the cardiopulmonary resuscitation (CPR) of the Philippine Heart Association. “Our cells in the body cannot survive without oxygen. Brain cells, in particular, begin to die in 4 to 6 minutes in the absence of oxygen supply.”

So, when a rescuer breathes air into victim’s lungs, oxygen is provided into the blood. Or when a rescuer compresses on the chest, the oxygen-carrying blood is moved or circulated through the body of the victim.

Cardiopulmonary resuscitation

CPR is considered the cornerstone of emergency medicine. “When done properly, CPR can help preserve the brain and heart functions until the actual cause of the arrest can be addressed,” says Dr. Raymundo.

There are lots of reasons why someone’s breathing or heartbeat might stop – heart attack, stroke, drowning, electrocution, vehicular accidents, overdose and many others.

According to Dr. Raymundo, many untimely deaths can be prevented if only bystanders know and can do CPR until the emergency response team in ambulances arrives. A warning though: If you are not trained in CPR, do not attempt to resuscitate.

Experts share the following instructions you need to do in case of an emergency. Take note, however, that these are for use on unresponsive victims age 8 and older.

1. Have someone call the emergency hotline or the number for Emergency Medical Services (EMS) in the area.

2. With victim lying face-up, tilt the head back by lifting the chin up with one hand, pushing down on the forehead with the other hand, to open the airway.

3. Look, listen and feel for signs of normal breathing (chest rising and falling, breath on your face or ear) for about five seconds.

4. If victim is not breathing, pinch the nostrils shut and give two slow full mouth-to-mouth breaths, making sure a good seal is formed and making sure you see the chest rise.

5. Check for normal breathing, moving and coughing – signs of circulation.

6. If victim begins regular breathing and regains consciousness, monitor until help comes. If he is breathing but unconscious, turn him onto his side and monitor until help arrives.

7. If the victim is still not breathing, moving or coughing within 5 to 10 seconds, give 15 chest compressions at a steady rhythm of about 2 per second: Place the heel of one hand with the other atop it at the center of the breastbone directly between the nipples. Lock your elbows and align your shoulders directly above your hands. Push down just enough to move the breastbone about one and a half to two inches.

8. Repeat rescue breaths and chest compressions. After four cycles, check for signs of breathing and circulation.

9. Until circulation and breathing return or help arrives, continue compressions and rescue breaths at a ratio of 15 to 2. Check for signs of circulation and breathing every few minutes.

Drowning doesn’t just happen in beaches, lakes, rivers and oceans. A person can get drowned in a bathtub – or even a wading pool. Sometimes, drowning occurs because of another injury, a heart attack or stroke that causes unconsciousness. Sometimes, it can happen from a head injury caused by diving into shallow water. Cramps, too, can cause panic, which in turn may lead to drowning.

According to health experts, the common causes of drowning are as follows: alcohol consumption (which impairs coordination and judgment), boating accidents, child abuse or neglect, diving and scuba diving accidents, falling through the ice of a body of water, fatigue or exhaustion, illicit drug use, inability to swim, having no life preserver, failure to observe water safety rules, and suicide attempt.

Now, that you know the rules, you can proceed swimming. Don’t be afraid. Swimming, after all, is good for your health. It works your whole body, improving cardiovascular conditioning, muscle strength, endurance, posture, and flexibility all at the same time. Your cardiovascular system in particular benefits because swimming improves your body’s use of oxygen without overworking your heart.

“Swimming with increasing effort to gradually increase your heart rate and stimulate your muscle activity is easily accomplished in the water,” explains Mathew Luebbers, a professional American coach, working with all ages of competitive swimmers, fitness swimmers, and triathletes. “After a land workout, swimming a few laps can help you cool-down, move blood through your muscles to help them recover, and help you relax as you glide through the water.”

As you become fitter and are able to swim longer, your resting heart rate and respiratory rate will be reduced, making blood flow to the heart and lungs more efficient. If you’re looking to lose weight, swimming is just the ticket.

While most of the exercises concentrate on a single section of your muscles, swimming exercise works all your muscles. It works on overall muscles and helps strengthen them. One of the swimming health facts is that it promotes fat loss. It is best exercise to burn calories and lose body weight.

“On average,” points out the Lifescript Editorial Staff, “a swimmer can burn as many calories in an hour as a runner who runs six miles in one hour.” No wonder, some experts call swimming the perfect form of exercise.

Have fun in the water. But don’t get drown!