Drowning Diagnosis and Investigation

Scene Investigation and Circumstances

The American Heart Association recommends documenting the time the face was first seen underwater and the time removed from water to establish submersion duration, which is the most important predictor of outcome and helps confirm the drowning process 1, 2
The American Heart Association suggests recording the water temperature, as this may influence physiological findings and should be documented 3
The American Heart Association recommends documenting the type of water/liquid, as heavily contaminated water may result in additional complications such as infection and pneumonitis 3
Witness statements regarding the victim's behavior before submersion, any struggle observed, and estimated time intervals should be documented, as recommended by the American Heart Association 2

The American Heart Association defines drowning as a process resulting in primary respiratory impairment from submersion in a liquid medium, and this definition should be used to determine the primary cause of death 4
The manner of death should be determined based on scene investigation and autopsy findings, as recommended by the American Heart Association 5

The American Heart Association recommends comprehensive toxicology screening for alcohol, drugs, and medications that may have impaired the victim or precipitated the drowning, and blood alcohol concentration and drug levels should be quantified 2

Cutis anserina (goosebumps) may be observed on the skin, and Washerwoman skin (wrinkling of palms and soles) occurs after prolonged immersion, indicating that the body was in water, according to the American Heart Association 6
A dilated right side of the heart may be observed, as noted by the American Heart Association 6

Precipitating events such as syncope or seizure, impairment from drugs, alcohol, or hypothermia, trauma, and cardiac events should be noted as they may confound the diagnosis, as recommended by the American Heart Association 7
Duration of submersion is an important factor to document when possible, and differentiation between drowning and other causes of death is crucial, especially in cases with evidence of trauma or preexisting medical conditions, according to the American Heart Association 7