Drowning Essential Tool or Silly Affectation

2021, May/June Adirondac

ALTHOUGH MOST Adirondack lakes are frozen as I write this column, they will be approaching swimmable by the time you read it. Thus, this is a good time to discuss an oft-neglected cause of wilderness fatalities.

Although there is no central registry of data, most experts cite three thousand to four thousand as the number of fatal drownings in the U.S. annually. Most are infants and toddlers, or adolescent and young adult males. For the first group, the culprit is often unsecured home swimming pools. For the second, the unfortunate combination of alcohol and youth bravado is a leading contributor. If there is an effective preventive strategy for this, I would love to hear about it!

Although fatalities in the wilderness are overall quite uncommon, drowning is one of the leading causes. A study of deaths at the U.S. Outward Bound schools showed drowning as the leading cause; overall, death in these programs was extremely rare. The National Park Service states that drowning has been the leading cause of unintentional death in national parks every year since 2007. The Adirondacks have not escaped this; reports of backcountry water tragedies occur regularly.

Despite these facts, most wilderness medicine or wilderness first aid courses and wilderness medicine books pay little attention to drowning. When they do, they often veer into esoterica such as the physiologic differences between fresh and salt water drowning – a topic of importance to the critical care physician but of little consequence to the High Peaks camper!

The treatment of drowning is well covered in CPR courses; as I mentioned in an earlier column, drowning is one of the few scenarios in which wilderness CPR is likely to be useful. The best “treatment” for drowning is prevention. Indeed, the vast majority of drowning deaths are preventable.

Unfortunately, there are not a lot of published resources for folks interested in learning about safe wilderness swimming. The curricula of most lifeguarding and water safety courses do not pay much attention to the topic. One resource is the Outdoor Swimming Society (yes, there is such a thing!), whose website (outdoorswimmingsociety.com) has a wealth of information. I will highlight what I consider to be the most important considerations, but urge readers to consult the organization’s site.

Selection of a safe spot is the first priority for a wilderness swim. Ideally, one wants clear, still water with a gentle slope and no underwater debris. (Think Sand Lake in the Five Ponds Wilderness.) Moving water is more problematic. Rapidly moving streams may produce vortexes and currents that may not be apparent, but which could be deadly. Since many New York streams have hydropower dams, the character of a seemingly still spot can change quickly.

Regardless of how the site appears, I always recommend footwear for wilderness swimming. One simply cannot risk a punctured foot while miles away from a trailhead.

Regardless of group size, any wilderness swim must use a “buddy system.” Each swimmer must agree to be in visual contact with his or her “buddy” at all times. Larger groups should designate one member to remain on shore as lookout and lifeguard for everyone else. When I guide canoe trips, I often have this role filled by someone in a canoe in the swimming area.

If one is leading a group from an organized camp, the New York State Health Department has very detailed regulations for wilderness swimming. Groups operating summer camps, such as the Boy Scouts of America, also have specific policies and practices for the activity.

Finally, remember that these comments pertain to “voluntary” swimming. Most drownings in the backcountry are due to inadvertent water entry. Although I was a competitive swimmer and still am very comfortable in the water, I would never venture onto my stand-up paddle board (SUP), kayak, or canoe without wearing a personal flotation device (PFD). Swimming in wild water at the end of a long day of hiking is a special treat. Just keep it safe!

Tom Welch, M.D., is a physician at Upstate Medical University in Syracuse, New York, and a member of the Wilderness Medical Society. He is a licensed professional guide and Wilderness Education Association instructor, and has guided groups in the Adirondacks, Montana, and Alaska. More information is available on his website and blog, adirondoc.com.


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Topics: Environmental Injuries, General First Aid, Water