Many people believe a drowning person will flail about in the water, splash and make noise to call for help. But this image, widely used on TV shows to depict a drowning, is far from reality.

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. In the video above, you can see an example, in this case a boy who is little more than an arm’s reach away from several other swimmers who are oblivious to his distress.

As Pia explains, when a person is drowning, nature takes over and the movements become a result of instinct. For starters, the person will not be able to call for help, as their body is working on struggling to breathe first and foremost.

They also will not be able to wave their arms to attract attention, as 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 Signs of Drowning to Memorize Before Your Next Trip to the Beach or Pool:

According to Dr. Pia and Mario Vittone, a former US Cost Guard rescue swimmer:2

“The Instinctive Drowning Response represents a person’s attempts to avoid the actual or perceived suffocation in the water. The suffocation in water triggers a constellation of autonomic nervous system responses that result in external, unlearned, instinctive drowning movements that are easily recognizable by trained rescue crews.”

You, too, can learn to recognize the signs that a person is in need of immediate assistance in the water. 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 inOn Scene, the journal of US Coast Guard Search and Rescue,3 may occur when a person is only 20-60 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 Vittone include:4

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

‘Dry Drowning’ and ‘Delayed Drowning’ Are Also Risks

It’s possible to die from drowning even out of the water. In 2008, one widely reported case described a 10-year-old boy who inhaled some water while swimming but otherwise appeared normal. Later that night, after walking home and taking a bath, the boy died in his bed as a result of delayed drowning. This type of drowning, sometimes called secondary drowning, can occur up to 24 hours after exposure to water, and occurs when a small amount of water in the lungs prevents oxygen from being transported into the bloodstream properly. A person who has experienced a near-drowning is especially at risk, but anyone who has spent time in water can be at risk. 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

Dry drowning, on the other hand, occurs 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.

6 Top Water-Safety Tips

If you plan to spend any time in a pool or natural body of water this summer, keep the following tips in mind.7 They could save a life:

• Learn to swim; formal swimming lessons have been shown to cut the risk of drowning among small children by up to 88 percent8
• Wear a life jacket
• 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