Drowning accidents are frequent in public swimming pools in Shanghai. Photo: CFP

Just days after Shanghai's education authorities issued numerous safety reminders for children at the start of the summer season, a series of drownings and near-fatal accidents involving children ensued, continuing its worrying legacy as a city that can't swim.

In the beginning of August, Shanghai's most sweltering month that sees millions of swimmers and non-swimmers alike clamoring for the nearest public pool, a 13-year-old boy drowned in a Fengxian district pool. Only a few days later, an 8-year-old local girl nearly drowned while playing in a pool aboard a cruise liner.

In the second instance, the girl's mother had turned her attention away from the pool for several minutes. Her daughter survived, but has lost the ability of autonomous respiration.

When contacted by the Global Times, Alvin Loh, a doctor with ParkwayHealth in Shanghai, emphasized that children should never be left to swim alone and all youngsters should be closely supervised no matter how shallow the water or their supposed swimming ability.

"In this sense, community education is the key to preventing such tragedies from reoccurring," said the general practitioner. "Parents should also know clearly their own abilities in swimming."

Standard rescue

There are 698 swimming pools in Shanghai, 98 of which are public. This past July saw 3.17 million people flock to the city's numerous swimming pools for relief from thermometer-bursting temperatures. "Boiling dumplings" is the popular expression used to describe Chinese public pool swimmers in the summer because the crowded pools offer so little room.

Due to this overcrowding, however, swimming pools in China have also developed a notorious reputation for being unsafe. In response to the worrying frequency of drownings and accidents in Shanghai pools, it is now a compulsory policy that a lifeguard be present at all times at private and public swimming facilities.

But Lin Libo, a lifeguard working at Sanlin Sports Center in Pudong New Area, said that despite new local policies requiring every swimmer having a personal space of at least 2.5 square meters, it is rather difficult for lifeguards at pools with a high density of swimmers to keep an eye on every single person.

"It's sometimes confusing whether someone is in a near-drowning situation or just practicing holding their breath under water. But we can't take any risks, so we jump in to check whenever we find it necessary."

For this reason, Lin told the Global Times that during peak hours during peak summer months, two lifeguards remain on duty together. "We don't allow young kids to go into the water without their parents by their side. But for primary or middle school students, they can swim independently," said Lin, a lifeguard of three years.

According to Lin, it is important that when you approach a person who appears to be drowning, you must first shout out to them to stop struggling. "This is vital because a man who is misusing his strength as they are struggling to stay afloat can cost not only his own life but also the life of the rescuer."

After a victim has been moved out of the water, Dr Loh said the first thing to do is to check the person's breathing by looking at their chest or putting one's face near the person's nostrils and mouth, to feel if the person is still breathing. If not, Dr Beng Lin Liam, a general practitioner at Shanghai East International Medical Center, suggests cardiopulmonary resuscitation (CPR), but care should be taken due to water in the lungs.

"In near-drowning situations, you should do artificial respiration first - you ventilate the person before performing an external cardiac massage. Near-drowning means liquid has gone into the person's lungs, so you need to first get gas exchange for the person, who is suffering from lack of oxygen. That can subsequently cause inflammations in the lungs or cause the brain to die," Liam said.

Dr Loh agrees and offers some additional tips. "We can first give two rescue breaths - blowing air into the person's mouth enough to make the patient's chest rise and holding it there for 4 to 5 seconds, then try it again. After that, you can check for a pulse by putting your hands just below the person's neck. If you can't feel any pulse, proceed with chest compressions. Look for the chest bones and give 30 chest compressions at a rate of 100 compressions per minute, and then two rescue breaths. You repeat such a cycle until you save a life or proper help arrives."

Dr Liam emphasized that people should never let a person who has just survived a near-drowning incident decide if they want to visit a hospital. "The necessity is dependent on how long the person has been under water. But in most cases, one must visit a doctor, especially children."

The doctor said that any child who has survived a near-drowning should be immediately examined by a medical expert to check their oxygenation. If the level remains low, the hospital will take further measures. There could be additional hazards, according to Dr Liam, who said that inflammation in the lungs may cause pneumonia, which is also very critical and could be fatal.

A higher survival rate

Compared with adults, Dr Liam pointed out that children's bodies are in fact able to tolerate going under water for a longer period of time. "For youngsters between the age of 5 and 9, official studies have shown that one out of five will die in near-drowning, but four can actually survive. The survival rate also has much to do with the water temperature - the more freezing it is, the higher the survival rate can be."

However, Dr Loh said 33 percent of those children who have survived near-drowning accidents later suffer from varying degrees of neurological complications, with 11 percent of survivors afflicted with severe neurological complications.

Local media have also recently warned of "dry drowning," whereby a person may die an hour or so after getting out of the swimming pool. One such incident was recently shared online, and while the child's death was tragic, it also raised viral awareness among the unsuspecting public who otherwise would not have known about "dry drownings."

Dr Loh said 10 to 20 percent of individuals who have had what is called a "laryngospasm," a brief spasm of the vocal cords that results in a temporary difficulty to breathe, while they are submerged under water have later perished due to a primary respiratory impairment, but he also pointed out that the term "dry drowning" is not proper medical terminology.

Because of the recent "dry drowning" scare, Dr Liam stresed the importance of sending a child who has encountered the slightest water immersion to a hospital.