Swimming Safety: Avoid Common Dangers at the Pool This Summer

By Dr. Mercola

Swimming is a favorite summer activity for young and old alike, but it can quickly turn dangerous if careful attention isn’t paid to safety. Such risks are compounded among young children and others who are unable to swim, which makes up a surprisingly large number of the population.

In a survey conducted on behalf of the American Red Cross, 86 percent of respondents said they knew how to swim.¹ Yet, the Red Cross found that only about half (56 percent) of Americans can perform basic core swimming skills necessary for “water competency.” This includes:

• Jumping or stepping into water over your head
• Returning to the water’s surface to tread water or float for one minute
• Circling around and identifying an exit
• Swimming 25 yards to the exit and getting out of the water

Sadly, about 10 people die every day in the US from drowning, making it the 5th leading cause of unintentional injury death in the US.² The risk is even greater among children aged 1 to 4, who have the highest drowning rates, and it remains the 2ndleading cause of accidental death (second only to motor vehicle accidents) for kids 1 to 14.

Would You Recognize Someone Who’s Drowning?

The first step to pool and water safety is learning to swim; formal swimming lessons have been shown to cut the risk of drowning among small children by up to 88 percent.³

However, knowing how to recognize if someone’s in trouble in the water is also important. If you have young children, experts recommend always staying within arm’s length of them while in a pool. This is because drowning can occur quickly and without warning, even when other people are close by.

Contrary to popular belief, a drowning person typically will not flail their arms and shout for help. They can’t, as their body is working hard struggling to breathe.

The movements of a drowning person become instinctual. Francesco A. Pia, Ph.D., a former lifeguard and educator, coined the term “instinctive drowning response” to describe what happens when a person is very close to drowning.⁴

The instinctive response is for your arms to extend out laterally and press down against the water’s surface in an attempt to keep your head above water. Children may even appear to be dog-paddling when in fact they’re drowning.

The other telltale sign of a drowning person is no movement from their legs: a drowning person will not kick but will instead remain upright in the water, sometimes appearing to be climbing an invisible ladder with their feet.

5 Surprising Signs That Someone Is Drowning

If a person is shouting and waving for help, they may still be in distress and need assistance, however the five signs that follow, reported in On Scene, the Journal of US Coast Guard Search and Rescue,⁵ may occur when a person is only 20 to 60 seconds from disappearing below the surface:

• Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary, or overlaid, function. Breathing must be fulfilled before speech occurs.
• Drowning people’s mouths alternately sink below and reappear above the surface of the water. The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help.

• When drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.

• Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.
• Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.
• From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.

Other “quiet” signs of drowning reported by Mario Vittone, a former US Coast Guard rescue swimmer include:⁶

Head low in the water, mouth at water level	Head tilted back with mouth open	Eyes glassy and empty, unable to focus
Eyes closed	Hair over forehead or eyes	Not using legs – vertical
Hyperventilating or gasping	Trying to swim in a particular direction but not making headway	Trying to roll over on the back
Appear to be climbing an invisible ladder	Children who are suddenly quiet

Have You Heard of ‘Dry Drowning’?

Not all cases of drowning occur while swimming. It’s possible to drown hours later in a condition known as “dry drowning” or “delayed drowning.” This occurs typically in children, when water (as little as a few teaspoons) is inhaled into the lungs and prevents oxygen from being transported into the bloodstream properly.

A child may cough when the water is initially inhaled, but then appear to be fine. A person who has experienced a near-drowning is especially at risk, but anyone who has spent time in water can be affected. Signs of delayed drowning to watch out for include:

• Vomiting or involuntary defecation immediately after swimming
• A sudden change in behavior, such as extreme fatigue, lethargy, or agitation
• Trouble breathing or wheezing
• Bubbling from the mouth

Dry drowning can also occur when no water enters the lungs, but rather a sudden rush of water into the throat (such as might occur from jumping into a pool with your mouth open) causes the airway to shut, causing suffocation. 

Pool-Related Disease Outbreaks on the Rise

Aside from water safety, it’s important to be aware that pools and hot tubs can carry disease-causing pathogens that can potentially make you sick. According to a report from the US Centers for Disease Control and Prevention (CDC), such outbreaks have significantly increased in recent years, reaching 90 outbreaks between 2011 and 2012.

The outbreaks were associated with nearly 1,800 illnesses, 95 hospitalizations, and one death. Most of the illnesses were caused by cryptosporidium (crypto), a parasite that’s transmitted via fecal matter and causes diarrhea. E. coli was also involved in about one-third of the outbreaks.

Contrary to popular belief, all germs are not instantly killed off by the chlorine in the water, and swallowing just a small amount of contaminated water can lead to illness.

In order to combat the increasing rates of infection with cryptosporidium, which is highly tolerant to chlorine, the CDC recommends supplementing disinfection at public pools and hot tubs with ultraviolet light or ozone. While crypto is now the leading cause of swimming pool-related outbreaks of diarrheal illness, it’s only one illness you can potentially pick up at the pool aside from other recreational water illnesses (RWIs). According to the CDC:⁷

“Recreational water illnesses (RWIs) are caused by germs spread by swallowing, breathing in mists or aerosols of, or having contact with contaminated water in swimming pools, hot tubs, water parks, water play areas, interactive fountains, lakes, rivers, or oceans.

RWIs can also be caused by chemicals in the water or chemicals that evaporate from the water and cause indoor air quality problems. RWIs include a wide variety of infections, such as gastrointestinal, skin, ear, respiratory, eye, neurologic, and wound infections.

The most commonly reported RWI is diarrhea. Diarrheal illnesses are caused by germs such as Crypto (short for Cryptosporidium), Giardia, Shigella, norovirus, and E. coli O157:H7. With RWI outbreaks on the rise, swimmers need to take an active role in helping to protect themselves and prevent the spread of germs.”

While a strong immune system is always your first line of defense against infectious disease, commonsense measures, such as the following, can also help reduce the spread of disease in pools and hot tubs:⁸

• Don’t go in a pool or hot tub if you have diarrhea
• Shower before getting in the water
• Don’t urinate (or poop) in the water
• Don’t swallow the water

More Pool Safety Risks You Cannot See… DBPs

Another important consideration: swimming pools typically contain chlorine and, along with it, disinfection byproducts (DBPs), which are formed when organic materials like hair, skin, sweat, dirt, and urine react with the large amounts of chlorine used to sanitize the pool water.

DBPs are over 10,000 times more toxic than the chlorine itself and have been linked to DNA damage and cancer. In one study, more than 100 DBPs were identified in pool water, and when researchers measured evidence of genotoxic (DNA damage that may lead to cancer) and respiratory effects on swimmers who swam in a chlorinated pool for 40 minutes, they found:⁹

• Increased micronuclei in blood lymphocytes, which are associated with cancer risk
• Urine mutagenicity, a biomarker of exposure to genotoxic agents
• An increase in serum CC16, which suggests an increase in lung epithelium permeability

This is a serious issue if you swim in chlorinated pools on a regular basis, as your body absorbs higher levels of DBPs by swimming in a chlorinated pool once than you would by drinking tap water for one week.

In fact, in one study on trihalomethanes (THMs), one of the most common DBPs, found the cancer risk from skin exposure while swimming comprised over 94 percent of the total cancer risk resulting from being exposed to THMs!¹⁰ The authors even went so far as to conclude that swimming in a chlorinated pool presents “an unacceptable cancer risk.”

As an aside, DBPs are also the likely culprits for the increased incidence of sinusitis and sore throats among swimming instructors,¹¹ as well as the negative impact of chlorinated pools on the respiratory health of children and adolescents. In fact, one study found that in children with allergic sensitivities, swimming in chlorinated pools significantly increased the likelihood of asthma and respiratory allergies.¹²

Swimming in an ocean is an excellent alternative, as is swimming in a lake or other natural body of water. If you have a pool in your backyard, you can also find a way to keep your pool clean from bacteria, algae, and other organisms without the use of dangerous chemicals. You can also reduce the amount of organic material you bring into the pool, and thereby the amount of DBPs created, by showering prior to entering and teaching your children not to urinate in the water.

Learn to Swim and Other Top Water Safety Tips

If you plan to spend time at the pool or beach this summer, keep the following tips in mind.¹³ They could save your life or someone else’s:

Learn to swim; as mentioned, this is one of the most effective ways to prevent drowning	Wear a life jacket (especially for young children)	Supervise children when in the water (including in the bathtub); supervisors should be in arm’s reach of preschool children at all times, and should not be involved in other distracting activities, such as reading or talking on the phone, when watching children in the water
Always swim with a buddy	Avoid alcohol when swimming or supervising other swimmers	If you have a swimming pool, install a fence completely around the pool and remove toys after use (they may encourage children to enter the pool area); also be aware that air-filled and foam toys are not designed to keep swimmers safe, nor are they an acceptable alternative to a life jacket
Enforce pool safety rules such as no diving, no running, and staying away from drains	If you’re supervising others swimming, be sure you know how to swim well	Learn CPR and first-aid

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