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For 17 years Michael and Jo Ann Morris felt their family’s plight was invisible, and that their son Samuel didn’t count.

After falling into a pool aged two and experiencing what experts call a non-fatal drowning, Samuel suffered lifelong injuries. “He couldn’t eat, couldn’t talk, couldn’t communicate,” said Jo Ann. “He was in pain, had seizures, and his limbs were contorted from the hypoxic brain damage.”

Samuel didn’t fit neatly into Australian drowning statistics where someone either fatally drowned or miraculously survived, said his father Michael.

Michael and Jo Ann Morris.Credit: DG Media

That was until last week, when a range of new research on non-fatal drowning was unveiled at the World Conference on Drowning Prevention in Perth by some of the 750 delegates.

The World Health Organisation’s Dr David Meddings, the lead on drowning prevention, also unveiled a new classification system that could be used to better identify and support people who had experienced a non-fatal drowning. It ranges from mild, for someone with temporary distress, to someone with severe injuries and disability.

For every one of the 236,000 people who fatally drown each year globally, it is estimated another three people are hospitalised after being resuscitated, the conference heard. Some are unscathed. Some have minor injuries and learning disabilities. Others, like Samuel, suffer lifelong injuries.

That could mean that fatal and non-fatal drownings kill and injure as many as a million people a year, Meddings said.

The problem, though, was definitions: “We have such a heterogenous group of people who are currently labelled non-fatal.”

When some data was examined, Meddings said they’d find it included the child of an anxious parent who may be taken to hospital after they coughed a lot, put into the same category as children such as Samuel, whose injuries shortened his life. He died aged 10 in 2014.

“They get lumped in the same basket, making it difficult for researchers who want to move the field of non-fatal drowning forward,” Meddings said.

While the rate of fatal drownings had dropped, Australian researcher Dr Amy Peden said there was a need to shine a light on this often-overlooked area of non-fatal incidents.

“For those who survive a drowning, we know far less about their treatment and long-term health outcomes,” said Peden, a drowning prevention researcher at the School of Population Health, University of NSW. She credited the Samuel Morris Foundation, a non-profit established by the Morris family for raising awareness.

The medical system was not well set up for the complex health needs of those with persisting medical conditions, and to support caregivers.

In Australia, for every child under five who fatally drowns, an estimated eight children are brought back to life, she said.

In the United States, for every 4500 unintentional fatal drownings, there are more than 8000 emergency visits by people who have experienced a non-fatal drowning, Dr Tessa Clemens from the Centres for Disease Control and Prevention told the conference.

“We believe this is an underestimate and there are far more. But 40 per cent of non-fatal are transferred for further care and hospitalised. That compares to only eight per cent of other injuries,” she said.

A paper from the United Kingdom found 31 per cent of people who survived being immersed in water required increased assistance with daily life.

In a NSW review of people aged 0-25 admitted to hospital from July 1, 2001, to March 31, 2019, with a diagnosis or cause of death saying drowning or immersion, 1934 cases were identified.

Of these, 1871 survived. Slightly more than half were under five years old.

Of those who survived, nearly nine per cent were readmitted for further treatment later. One of the co-authors of the NSW research, Chen-Chun Shu of the George Institute for Global Health, said she believed non-fatal drowning was underreported.

There were similar results from a Victorian study too.

Fatal v non-fatal drowning: The experts’ definitions

Drowning is the process of experiencing respiratory impairment from submersion or immersion in liquid.

Fatal drowning happens when the drowning results in death.

Non-fatal drowning happens when a person survives a drowning incident.

Non-fatal drowning has a range of outcomes.

The new definitions proposed by the World Health Organisation are: 

Source: The World Health Organisation, the Centres for Disease Control and Prevention, and the Royal Life Saving Society Australia.

“When we experienced a non-fatal drowning one of the key questions for us was where were kids like Samuel in the data and the narrative,” Michael Morris said. “The fact that we [now] have a rich body of work, and families like ours won’t be invisible, is tremendously heartwarming.”

Michael said Samuel’s non-fatal drowning was often wrongly described as a near drowning. “There was nothing near about it,” said Michael.

At huge emotional cost, they retold Samuel’s story over and over again until experts listened.

Jo Ann Morris with her son Samuel. He did in 2014, aged 10. Credit: Janie Barrett

Professor John Pearn, a Queensland paediatrician and a leading water safety expert, agreed that there was a need for a new classification system that assessed the degree of injury, and detailed where and how it occurred.

The best indicator of outcome was “time to first gasp”, referring to the interval following the extraction of the victim from the water.

“If they made the first gasp within a half hour, virtually everyone does quite well,” he said.

With drownings, the quality of the bystander first aid was crucially important. He said a drowning was the complete antithesis of a heart attack, “where you’ve got a non-beating heart, but a blood system full of oxygen”.

With drowning, the oxygen in the blood stream was exhausted. “At least 70 per cent of children have a beating heart, though they are apparently dead, and they need air,” Pearn said.

In some countries, non-fatal drownings became fatal because of poor first aid or harmful and community beliefs. In Bangladesh, for example, rescuers often covered the victim in ash, or spun the person overhead, so the victim would throw up water.

Julie Power’s airfare to the conference was paid for by the Royal Life Saving Society Australia.

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