02. DEFINITION OF "DROWNING"

Before 2002, the term "drowning" had a variety of other terms and definitions ascribed to it making it difficult to collect data and render critical epidemiological analysis. That year the World Congress on Drowning (WCD) met in Amsterdam and proposed that the single term "drowning" be used with the following definition (5):
"The process of experiencing respiratory impairment as the result of submersion/immersion in a liquid medium."
The WCD further proposed that all drowning statistical data be subclassified as non-fatal (morbidity and no morbidity) and fatal (mortality) in accordance with the Utstein reporting system.

In 2005, the World Health Organization (WHO) adopted the drowning definition, as did the Centers for Disease Control and Prevention (CDC) in the USA and other health agencies worldwide (6). WHO's International Classification of Diseases (ICD-10th Revision) classifies "Drowning and Non-Fatal Submersion" with the ICD code T-75.1 under "Injuries: Effects of Other External Causes", which excludes intentional drowning (e.g., assault, homicide and suicide), drowning related to catastrophes (e.g., Hurricane Katrina in 2008 and the 2011 Japanese tsunami), and drowning secondary to other causes (e.g., submerged motor vehicle incidents). The code further lists subcategories of unintentional injury by drowning and non-fatal submersion under a large number of sub-codes, for example V90-92 and W65-74 depending upon the type of watercraft and water body respectively, as well as decimal subdivisions for the location of the reported event, such as at home, work or play (7).

But old and familiar usage takes time to change. Reviewing the medical literature from 1966 to 2002, Papa, et al, (2005) found that 33 different terms and definitions were used for drowning, including "wet drowning" for fatalities with water in their lungs and "dry drowning" for the converse (8). The authors also evaluated peer-reviewed papers published after the 2002 WCD's recommended changes and determined that use of the term "near drowning" (a term used for non-fatal drowning), as well as other terms without the key word "drowning" included, still prevailed despite its removal from the official lexicon. Until popular use of the alternative terms and definitions for "drowning" is curtailed, comprehensive literature searches and statistical analysis for drowning will be hampered.