In Tuscany, 52 deaths by drowning were recorded in the two-year period 2024-2025, a critical figure highlighted by the latest report from the Higher Institute of Health (Iss).
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The region and local authorities have promoted extraordinary bathing prevention campaigns, but Tuscany is also at the forefront in research and innovation in emergency-urgency thanks to the DrownInEd project (Drowning in the Emergency Department), a multicenter observational study dedicated to patients with drowning syndrome: the process that causes acute respiratory damage following immersion or submersion in a liquid, causing severe oxygen deprivation (hypoxia) that can damage the brain, lungs, and other vital organs, and requires immediate medical assistance. A project that is now entering its active phase.
“Our activity began two years ago to fill a ‘gap’ in scientific research on patients saved from drowning who arrive at the emergency room: while the rescue and survival chain from the sea to the ambulance is well structured, we noticed a lack of data regarding what happens in the hospital,” explains Dr. Giuseppe Pepe, director of the Emergency Department and urgent care medicine at Versilia hospital in Lido di Camaiore (Lucca) and regional president of Simeu, the Italian society of emergency-urgency medicine.
Over 300 deaths every year in Italy
In Italy, there are on average over 300 deaths per year due to drowning. Between 2017 and 2021, 1,642 people died from drowning. Of these, 12.5% were aged 0 to 19 years, while the most “affected” are adults between 40 and 60, mostly foreigners.
Drownings in swimming pools, children are the most exposed
The percentage of drownings in swimming pools is quite low. But the risk is high for children: 53% of drownings in pools involve minors up to 9 years old, with a peak vulnerability in the 1 to 4 years age group.
Each year about 41 deaths involve children or adolescent youths, with males representing a substantial 81% of all pediatric drowning mortalities.
The study involves Tuscan emergency rooms
“To accredit, as the jargon goes, the research we turned to the emergency rooms in the northwest area of the region (Cecina, Livorno, Massa, and Pisa) and also Siena; not yet Careggi because it has a very limited case load. Pietra Ligure has joined these, but soon Genoa and facilities from other neighboring regions will join as well, also because many have asked us to participate,” adds Pepe.
What happens in the hours following drowning
The syndrome involves a set of disorders that can arise in those saved from drowning within the next 6-12 hours, due to the presence of water in the lungs which could in turn cause a severe respiratory syndrome.
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Similarly, salt water in the stomach, for those who have ingested it, could cause metabolic disorders. Contrary to what one might think, the depth of the water does not matter but muscle exhaustion does, evidenced by the very high levels of lactic acid in the legs found in emergency rooms.
Likewise – it has been seen – drowning does not only happen at sea nor only in summer: surfers practice the activity all year round, and cases of people falling into water regardless of the season are not uncommon, although it is obviously more frequent in summer.
DrownInEd, the goal is to study 700 patients
“Having obtained clinical study authorization from the Ethics Committee (we handle anonymized data but still from people), last year we enrolled, as the jargon goes, 25 patients. The first was a fragile young man from Florence who had risked drowning twice. Our goal is to enroll 700 by 2030, the natural deadline of the research,” continues the director.
The project also aims to understand if, for the patient, there are differences between simple oxygen administration and ventilation through a device. The data are progressively analyzed and made available to institutions, with the possibility of starting in the future a comparison also with manufacturers of personal safety devices.
The role of the Coast Guards
To complete the picture, Pepe would also like to acquire data from the Coast Guards and the rescue chain.
“Their role – he notes – is fundamental and their experience would be valuable to identify predominant characteristics, if any, in the case series.”
A clinical study, not an experiment
To avoid misunderstandings, the doctor clarifies: “Ours is a clinical study, not experimental: we observe and record, certainly we do not ‘administer’ anything to our volunteers.”