How realistic is drowning when shown on TV?

January 30, 2012 12:47 PM

How accurate, from a medical perspective, is the typical TV/Movie representation of someone nearly drowning? I refer to the "Receive mouth to mouth resuscitation whilst unconscious, cough up a little water and regain consciousness then everything's fine again." depiction of drowning.
posted by dougrayrankin to science & nature (28 answers total)

For a starter's overview of the answer "pretty much as inaccurate as possible", see TV Tropes on drowning and resuscitation.
posted by ambrosen at 12:57 PM on January 30 [3 favorites]

Though I haven't revived a drowning victim, the thing they don't depict in TV or the movies is the vomiting. There's a lot of it with CPR.
posted by Mercaptan at 1:04 PM on January 30 [1 favorite]

And the broken ribs. Lot of that with CPR, too.
posted by entropone at 1:06 PM on January 30 [1 favorite]

It is not realistic at all. I once spent a few weeks over the summer as a lifeguard and teaching lifeguard classes at a Boy Scout camp. Afterwards, I went to the beach for a while with a friend who had been doing essentially the same thing with me at the camp. I was about 17.

One day while we were sitting up on a break water in the sun, we heard shouting and looked down to see someone dragging a body, floating face down, onto the shore. We immediately ran on down to help. When we got there, many people were standing around, looking at the man's body still face down on the sand. My training kicked in, and I put one arm up to make him easy to roll and rolled him over to start CPR. I almost vomited when I saw his face.

There was blood and sea foam coming out of his nose. Bloody water just gushed from his mouth - way more than I would have thought possible. I don't know where it was coming from, but it was more than one mouthful. The worst for me was that his eyes were open and bloodshot, and they were filled with more sea foam and sand. I don't know how long he was in the water, but he was clearly messed up. He was pale, but wasn't blue.

I just couldn't bring myself to do mouth to mouth. I actually was so disgusted I stood up and walked away for a second. When I turned around, someone was trying CPR chest compressions, but they had no idea what they were doing, so I moved them aside and started doing real ones. I was also yelling for someone to call for help. With each chest compression water fountained out of his mouth. After a few times, he started breathing a little, but was sucking water back in as well and sputtering. I stopped compressions then, as he was breathing but he was still taking water in and out with each breath and sputtering. Looking back now, it is because his head was uphill on the beach, and the water he forced out was just running back in. We put him on his side, in the recovery position, and that seemed to help, but he was still out cold with his eyes open. We kept him there for a few minutes.

About that time, the real professional lifeguards showed up. They immediately did stuff I had never seen - lifted him up from behind with arms around his waist, so his head was down, and squeezed. Lots more water came out. They then put him down and intubated him with a long tube. I don't know where it went - I assume his lungs - but they then hooked it up to a pump and started pumping water out. Other pro lifeguards then showed up and they took him up to an ambulance. I couldn't see inside, but they stuck the tube from the pump out a vent window, and as they drove off there were still small spurts of water coming out.

It was totally shocking. It wasn't clean or neat, and I felt that I had failed because I didn't follow my training and give breaths before compressions (This was many years ago, and I think now they may only recommend compressions). This was overseas, so I have no idea if he made it or not, but if he didn't I wouldn't be surprised. Ever since then, I carried a CPR mask when I was in a position to be potentially responsible for giving breaths. It would have helped greatly then.
posted by procrastination at 1:19 PM on January 30 [161 favorites]

Wow, procrastination, that was an incredibly vivid and disturbing description. I'll never look at lifeguards the same again. Thank you for sharing. (I think.)
posted by widdershins at 1:31 PM on January 30

procrastination, I understand that part of the reason they don't recommend mouth to mouth is that so few volunteers are compliant. Not just because of the experience you retell but also because of fears of communicable diseases.
posted by kalessin at 1:40 PM on January 30

I once listened to a guy talk. He was a former ASIO officer (the Australian federal security service), had been the Dali Lama's personal security guard, and served as private security in Iraq. He seemed to know his stuff.

He said that the majority of people completely lose their shit in this kind of situation. He related an instance where he and his wife were walking along the beach (off duty) and they heard someone wailing and ran over to find a young girl in the water trapped under a log. The father was basically running in circles panicking. Mr ASIO pulled the girl out of the water and started CPR, Mrs ASIO called an ambulance. The girl survived. But the point of his story was that the father knew CPR, but just completely panicked when it came to the crunch. He didn't even have enough sense to pull the girl out of the water. To be able to effectively perform CPR on someone, it takes more than just knowing the procedure.

I've also heard that the success rate of mouth-to-mouth and/or CPR administered by non-professionals is very very low, but ... better than nothing. But I can't remember where I heard that... perhaps from Mr ASIO.
posted by Diag at 1:48 PM on January 30 [2 favorites]

TV/movie depictions of drowning or near-drowning prior to resuscitation usually don't take into account Instinctive Drowning Response, as described in this article: Drowning Doesn't Look Like Drowning.
posted by illenion at 1:50 PM on January 30 [10 favorites]

It depends. I have been in situations like procrastination's before. I've also been part of a rescue of a young girl who had drowned. That situation looked much more like what you would typically see on TV. A few rounds of CPR and rescue breathing, she coughed up water, then started crying and reaching for her mother. That was, by far, the best CPR outcome I've ever seen. So, it may be rare, but it happens.
posted by kamikazegopher at 4:15 PM on January 30 [2 favorites]

I perform CPR with some regularity, although I've only seen a few drownings. There's good info above, but I wanted to chime in on a couple points.

1) Procrastination, you should not blame yourself or feel as if you failed the drowning victim. You were the first and perhaps most vital link in the chain of survival that was his only chance at life. Early and effective compressions are the single most important element of CPR. The American Heart Association is now emphasizing compressions over respirations, even for emergency workers, and I believe the layperson training no longer includes any mouth-to-mouth at all. You jumped in and did what you had been taught. Many people do not.

2) Drowning victims can suffer severe health crises, even death, hours or days after surviving the initial event, due to destruction of the lung surfaces or infection.
posted by itstheclamsname at 4:38 PM on January 30 [1 favorite]

Previously, on the blue: What drowning really looks like
posted by neckro23 at 5:05 PM on January 30 [1 favorite]

When I got my basic CPR certification, the teacher told us that children do sometimes come back just from CPR, like in the movies, but adults really don't. Apparently children have stronger hearts and lungs for their size. When you're performing CPR on an adult, you're just trying to move the blood around enough that they don't get brain damage before they're revived.

I've never had to perform CPR, but my firefighter brother tells me that it's pretty damn icky. Usually people don't actually wake up before the ambulance gets there, but they're still alive.
posted by Nibbly Fang at 6:39 PM on January 30

I'm in nursing school currently. We learned that near-drownings can still result in pulmonary edema (sometimes leading to death), which is why these people need to be transported to a hospital even after successful CPR, as supported by this article.
posted by sugarbiscuit at 6:52 PM on January 30

"layperson training no longer includes any mouth-to-mouth"

FWIW, we recently took CPR classes and the emphasis was definitely on compressions - 2 breaths, 30 compressions. The instructor specifically stated that effective compressions were more important and that if the idea of mouth-to-mouth was upsetting, compressions alone were much better than nothing.
posted by Rat Spatula at 9:08 PM on January 30

The incredible amount of "water" you saw was probably, indeed pulmonary edema. As a respiratory therapist one deals with this. The tubes that would have been put into the patience would be an endotracheal tube (through the mouth or nose, down through the vocal cords and set there) and through that, a suction tube, to remove the fluid.

The thing with pulmonary edema is that no amount of suctioning out that froth, those bubbled, will remove it unless the cause of the pulmonary edema is removed. In this case the pulmonary circulation was probably completely messed up. Read Pathophysiology : Pulmonary Effects for more details.

It's also likely a lot of fluid was swallowed, and some of what you saw could have been coming from the stomach as well. This is speculation on my part, I'd defer to a pumonologist on being able to characterize the event procrastination witnessed. But I think you did all you could possibly have done. A patent airway, oxygen, IV fluids, positive pressure ventilation, and correct pulmonary circulation is what was needed. Most of that required a full set of life support tools - a crash cart basically - that the paramedics would have brought.
posted by artlung at 9:28 PM on January 30 [4 favorites]

My CPR instructor told us that survival after CPR in any situation is only 10%, 15% in the E.R. so your chances are not that great.
posted by sybarite09 at 6:00 AM on January 31 [1 favorite]

Yeah, I've been repeatedly told by CPR instructors that survival is quite rare from CPR (better if it's something that an AED can help with and you've got an AED). Of course, the flip side is that if you're doing CPR on someone, they're ALREADY DEAD, and so your actions can pretty much only help.
posted by rmd1023 at 6:37 AM on January 31 [1 favorite]

I just completed a full day of First Responder training. I'm completely freaked out. Mind, I took an EMT course a few decades ago and things have changed SO MUCH it's not even funny.

The reason not to do breathing was pretty well explained: when you are exhaling into someone, you're not breathing oxygen into them, but carbon dioxide. The victim has a better chance with compressions. Lots and lots of compressions done to the rhythm of "Stayin' Alive" by the BeeGees.

We have an AED at our office and now I know how to use it.

As for drowning, yikes. That sounds awful.
posted by Ruthless Bunny at 7:41 AM on January 31

procrastination is exactly right.

I was a beach lifeguard in Northeast Florida for 6 years. I was fortunate enough to only have to work one near-drowning, one actual drowning and one quasi-drowning (lightning strike victim died in the water) during all that time, but I can tell you for a level fact that nothing you've seen on TV comes even close to depicting the reality of those calls.

In speaking with my colleagues after the drowning that I worked, I've come to conclude that it was a fairly typical call, both in terms of the specifics and the outcome, so maybe the best thing to do would be to tell the story and try to explain what happened, and why it's so different from what you see on TV.

I was sitting tower on a beautiful, sunny weekday afternoon in an isolated section of beach. My tower was the only tower visible in either direction, because the County could only afford to set up towers at beach access ramps on weekdays, and this particular stretch of beach had the only major ramp for several miles in either direction. The truck that was responsible for patrolling the zone of the beach we were at was rotating out the lifeguard at the other tower in the zone, nearly 4 miles to my south. I was completely on my own.

The beach wasn't very crowded that day, and I only had a handful of beachgoers to mind in my immediate vicinity. As ever, there were a few other swimmers well to my north and south, primarily tourists from the rented beach houses and condos that line the beach all over Florida, who for whatever reason choose to swim far away from the only lifeguard tower in the area.

Out of the corner of my eye, I spotted a woman in her mid-40s sprinting towards my tower. One thing you learn after working the beach for a while is that there are certain people in this world who would only sprint while wearing a bathing suit if something had gone horribly wrong, and this woman was undoubtedly one of those people. The hairs on the back of my neck stood up, and I instinctively grabbed my radio from the seat back. When she got to within about 10 yards of me she sobbed "I think he's in trouble! I think he needs help!" and then started running back the way she came. I radioed my truck to let them know that I had a rescue in progress (of unknown type), dropped the flag on my tower (to indicate that it was no longer manned), grabbed my buoy and started running to catch up.

I caught up with the woman about 100 yards south of my tower. While running alongside her, I tried to get more info from her, but she was so disturbed and out of breath that all she could do was point. It was impossible to tell exactly where she was pointing, but a small crowd was gathered on the shore about a quarter mile further south of us, so I sprinted in their direction.

When I got there, everyone was looking out in the water, but for the life of me I couldn't see anything. Two men were standing in waist-deep water pointing out to sea, so I charged out to them, told them I needed them to guide me out to whatever or whoever they were looking at, and started swimming. I stopped twice on my way out; once just past the first line of breakers, and once about 80 yards out, and both times the men onshore would wave frantically at me to keep going.

I finally found him about 100 yards out, in maybe 10 feet of water. The only thing that was visible were his rounded shoulders; everything else was underwater. When I rolled him over, his mouth was agape, and a thin trickle of pink foam flowed out in to the water. His eyes were wide open and utterly, horribly lifeless. I tried to check his pulse, but his neck was completely cold and bloodless. At that moment, as I set to the task of dragging him back to shore, I felt a fleeting sense of the most profound loneliness that I have ever experienced.

Towing the body to shore was a nightmare. The man was huge, easily over 250 pounds, and his back and arms were broad enough that floating him on the buoy was out of the question. Instead, I was forced to wrap an arm across his shoulder and under his armpit and swim him back to shore one-handed. His lifeless eyes and foamy mouth were inches from my face the entire trip. They were the first thing I saw every time I lifted my head to breathe.

Miraculously, it didn't take long to get him back in to the breaking surf, and with the help of some well-timed waves we were back in shallow water in no time. I screamed at the men who had guided me out to come help me, and the three of us dragged the body up on to the sand, while the woman who had sprinted to my tower wailed in the background. I immediately began doing chest compressions on him, and almost immediately separated his sternum. The feeling and sound of his cartilage breaking was completely surreal. Each compression shot a puff of pink foam out of his mouth, and without a mask there was no question of my attempting rescue breathing.

I think I got through about 100 compressions by the time my truck arrived. The two guards in the truck quickly unloaded the oxygen bag, the AED and the suction unit, and we worked him for maybe 2 minutes until another truck arrived with more guards. Twice, the foam got so bad that we had to roll him on his side and squeeze his torso to drain it out. When the second truck pulled up, I was finally shifted off of compressions, and we intubated him and packaged him up to transport to an ambulance that was waiting back at the ramp behind my tower. The last I saw of him, his chest was deformed from the CPR, his limbs and lips were dark blue, his face and neck were smeared with blood and foam, and his lifeless eyes were full of sand.

There was nothing out of the ordinary about that call. That's what drowning looks like. It's nothing like what you see in media depictions.

I think that TV generally gets three things badly wrong:

- As procrastination mentions, the lack of foam is a glaring omission. Aspirating sea water generates huge amounts of bright pink pulmonary foam. In a patient that's still attempting to breathe on their own (as in the case of the near-drowning I worked) this foam is often accompanied by a fair amount of blood as well, running from the nose, the mouth, and even the corners of the eyes (I'm led to believe that this is the result of the violence of the victim's spastic attempts at breathing, combined with the lung and throat damage caused by the salt water). Managing the foam is a huge part of the medical intervention that beach lifeguards are trained to perform, both in terms of minimizing it (through suction devices) and avoiding direct exposure to it (via face masks for rescue breathing).

- Nothing I've ever seen has accurately depicted the violence of the rescue. In their animal panic, near-drowning victims fight their rescuers; chest compressions break bones and bulge eyes (nothing like the limp massages that TV thinks they are); friends and family scream and wail; sirens blare and machines hiss and sputter; victims' lifeless eyes stare in to space, sometimes filling with dirt or foam; blood and vomit are routine.

- Finally, CPR DOESN'T FUCKING WORK for virtually any drowning victims. CPR can be a miraculous intervention when someone is having a heart attack; it can help to control arrhythmia and greatly increase the chance that a heart attack victim survives the trip to the hospital. But for someone who drowned, heart arrhythmia isn't the problem, the problem is that they fucking DROWNED. The success rate for CPR in that scenario is extraordinarily low; I was 0 for 2 during my six years, and I knew career guys with records as bad as 1 for 30. These were extraordinarily talented rescue workers with decades of experience, and every one of them, despite having working dozens of drownings, could count on one hand the number of times that the victim had been revived by CPR (or survived at all).


Very, very long story short: drowning is ugly, it's violent, it's messy, and the outcome is almost never a happy one. TV gets it completely wrong.
posted by saladin at 8:18 AM on January 31 [34 favorites]

When I was about 5, another child pushed me off a pier. It was twilight, and the only adult who noticed the splash was my oldest brother. He dove in and pulled me out, spluttering. I was in the water maybe 30 - 60 seconds and I don't think I breathed in any water. If it's under 3 - 4 minutes of not breathing, maybe the scenario has a bit of credibility. Water temp has a lot to do with recovery, as well.
posted by theora55 at 8:47 AM on January 31

Diag: "I've also heard that the success rate of mouth-to-mouth and/or CPR administered by non-professionals is very very low, but ... better than nothing. But I can't remember where I heard that... perhaps from Mr ASIO."

I heard this from my girlfriend who was an EMT. She says that in most cases, CPR is just theater (you have to do -- and appear to be doing -- something). Most patients who need CPR will die, but on the off chance that one is salvageable, the CPR is what saves them.
posted by klanawa at 9:07 AM on January 31

I would be hesitant to label CPR as mere theater. In my career as a paramedic, I've seen multiple saves in which early CPR was a definitive factor in the patient's survival.

It's important to understand the role CPR plays in effective resuscitation. By itself, CPR doesn't bring people back, despite the way it's often dramatized. Exceptions exist, but they are very rare. CPR maintains a minimum level of arterial pressure and keeps the heart and brain oxygenated while more effective treatments (defibrillation and medications) are underway. Without fast and effective CPR, patients do not survive long enough for all my Advanced Life Support paramagic to have any effect.

I understand that CPR might feel pointless because experienced professionals see people die despite employing it, but patients deserve the best chance we can give them, no matter what. I would hate for anyone to take way the message the CPR is not effective and therefore not worth employing when the need arises. It may not save everyone, but for those who do live through a cardiac arrest, it's typically a key to their survival.
posted by itstheclamsname at 11:34 AM on January 31 [2 favorites]

correction: "take away the message that CPR"
posted by itstheclamsname at 11:36 AM on January 31

I can confirm that drowning doesn't look like drowning. A friend of mine saved a Russian bloke from drowning in a lake a few years ago. He canoed past him as he was treading water and a few minutes later canoed past in the other direction, and the guy was still there, just sinking lower, but making no evident signals of distress. So he told him to grab the canoe and towed him to shore. There, the guy told him he was almost gone and forced him to accept gold jewelry for saving him.

Then last year, I kayaked past a kid in the lake who was doing exactly the same thing, just swimming in place, out of his depth, looking totaly fine but a little low in the water. I went a hundred yards, then thought about my friend, and how strange it was for a kid to be treading water in the middle of the lake, and turned round. I said 'if you need help grab the boat', and he did. I towed him back to shore and he ran off to his parents. It was all so incredibly undramatic that I didn't even get out of the kayak but every time I thought about it later I became more convinced that he'd have just silently drowned if I had turned around.
posted by unSane at 9:15 PM on January 31 [3 favorites]

*hadn't
posted by unSane at 9:16 PM on January 31

One thing about drowning that my lifeguard and EMT friends from the Pacific Northwest say is that nobody's dead until they're warm - the cold of the Pacific can apparently be a boon if you drown. I don't know if CPR helps under those circumstances - if there's no exposed lung surface to oxygenate, how much good can pumping deoxygenated blood around do? But I would try compressions anyway. I mean, assuming I was in a position of authority and I didn't wig out.
posted by gingerest at 10:22 PM on January 31

I spent some time on a lifeboat crew in Scotland. During our training one of our sea survival instructors explained that the following combination kills more people than drowning in situations such as cold water ship wrecks:

1. Panic: heart rate goes up
2. Gasp reflex on entering water: hyperventilation putting strain on the lungs
3. Muscle spasm
4. Blood vessel constriction.

The problem is one of a massive spike in blood pressure causing a heart attack - especially in people older than about their mid 30s. The victim does not get time to die by drowning. Some more information and survival suggestions.
posted by rongorongo at 2:31 PM on February 1 [1 favorite]

I recall jumping into the water in December just off Skye. This does not surprise me as I literally remember nothing between hitting the water and thinking aggh and standing on the quay. Apparently it was quite an impressively fast 10 meters to the steps; I don't know what was running me but it was such an instinctive reaction that no real concious thought was involved. I can't imagine what the hell it would be like to fall off in the North Sea.
posted by jaduncan at 4:32 AM on February 7