Real drowning looks little like the Hollywood version.

Those who think they know what a drowning looks like because they've seen it often in movies or on TV should reconsider. The real thing looks little like the Hollywood version. As summer continues to sizzle and people seek relief in water activities, it's important to recognize what really happens, experts say.

Drowning is the second-leading cause of death among children to age 14, behind vehicle crashes — and in most cases the child was being "supervised" by an adult. The problem, according to former Coast Guard rescue swimmer Mario Vittone, is that drowning doesn't look like drowning.

The Centers for Disease Control and Prevention said that between 2005-2009, there were an average of 3,533 fatal unintentional drownings (non-boating related) annually in the United States — about 10 deaths per day. An additional 347 people died each year from drowning in boating-related incidents.

Experts told the Baltimore Sun that about 375 children a year drown in Florida, for example, within 25 yards of a parent. The American Academy of Pediatrics estimates that "for every drowning death, there are one to four nonfatal submersions serious enough to result in hospitalization. Children who still need cardiopulmonary resuscitation (CPR) in the emergency department have a poor prognosis, with at least half of survivors suffering significant neurologic impairment."

"Drowning is not the violent, splashing, call for help that most people expect," Vittone wrote. "Drowning is almost always a deceptively quiet event. The waving, splashing and yelling that dramatic conditions (television) prepares us to look for is rarely seen in life."

The person who is in trouble appears to bob up and down in the water, mouth rising and falling above the water line, which makes it look like he's breathing. But there's no time to inhale and exhale. He doesn't call for help — it's usually not possible because the respiratory system has taken over and is trying but not succeeding at breathing, which is its first priority. Speech is usually impossible.

A drowning individual can't wave for help. Instinct drives him to extend his arms laterally and press on the water's surface, an effort to rise out of the water to breathe. As he does that, part of a process that Francesco A. Pia named the Instinctive Drowning Response, he has no voluntary control of his 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," Vittone and Pia wrote in an article in On Scene, the Coast Guard's search and rescue journal.

During that above-surface response, which typically lasts less than a minute, the person is upright. Then he slips below the surface.

"This doesn't mean that a person that is yelling for help and thrashing isn't in real trouble — they are experiencing aquatic distress. Not always present before the instinctive drowning response, aquatic distress doesn't last long — but unlike true drowning, these victims can still assist in their own rescue. They can grab lifelines, throw rings, etc.," Vittone said.

The main clue someone is drowning may be that he doesn't look like he's drowning. Experts say to ask them if they're all right. If they don't answer, the clock's ticking away and immediate rescue response is required.

Other signs these experts listed that show someone's drowning include head low in the water, mouth at water level, head titled back and mouth open, eyes glass and empty or closed, hair over forehead or eyes, not using legs while vertical, hyperventilating or gasping, swimming without making headway, trying to roll over on the back or appearing to climb an invisible ladder.

The CDC said that the factors that lead to drownings are inability to swim, lack of barriers, lack of close supervision, failure to wear life jackets when appropriate, alcohol use and seizure disorders. Location also matters, but the likelihood of drowning varies with age. "For example, most children ages 1-4 drown in home swimming pools. The percentage of drownings in natural water settings, including lakes, rivers and oceans, increases with age. More than half of fatal and nonfatal drownings among those 15 years and older (57 percent respectively) occurred in natural water settings."

You can watch a video of what drowning really looks like on

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