When Michelle Ostler's nearly three-year-old daughter Jewel was found at the bottom of a cold pool she'd probably been unconscious for as long as 15 minutes.
The little girl made it to hospital where a doctor told Ms Ostler that Jewel was unlikely to survive the night because "every single part" of her brain was damaged.
"There were organ donor people there [outside the door] wanting to talk to me, but I wasn’t ready for that yet, I couldn’t give up hope," Ms Ostler said.
For every Australian child under five who fatally drowns, about eight survive but with brain injury, paralysis and other serious and, very often, lifelong problems, finds new Australian research just published in the medical journal BMJ Open.
Health experts agreed in 2005 that definitions of drowning should be redefined to include three outcomes: fatal drowning or death, non fatal or morbidity (injuries) or no morbidity, to replace the terms such as drowning and near-drowning.
Many people resisted the new definitions, yet Ms Ostler was distressed when people said Jewel had experienced a "near-drowning" when it occurred six years ago on a relative's pool on a five-acre property.
"There was nothing near about the change in our life." The change in definitions, from near-drowning to non fatal, was small but meaningful to Ms Ostler. "She was in the water unconscious for up to 15 minutes. Her lungs were full of water," Ms Ostler said.
Jewel's case was one of the worst doctors had seen, and they were shocked she lived despite forecasts that she would suffer 100 per cent brain injury. Now nine, Jewel has nearly recovered all the language she lost, but she still struggles to follow directions because the incident affected the frontal lobes that determine executive function.
The research warns the true incidence of non fatal and fatal drowning is underestimating the real number and the true burden because overly restrictive definitions used.
By Amy Peden of the Royal Life Saving Society Australia, the research is the first of kind to quantify non fatal drownings in Australia. It finds that between July 2002 and 30 June 2015, 2272 Australians fatally drowned while 6158 were hospitalised.
Ms Peden, the research manager with Royal Life Saving, found the overall ratio was one fatal drowning for every 2.7 non fatal. That's nearly twice as high as reported in previous overseas studies.
Children under five had the highest rate of non-fatal drowning of any group, and were significantly more likely to drown in swimming pools and bathtubs than adults. About 85 per cent of non fatal drownings in swimming pools were children.
"Children are both disproportionately likely to drown and disproportionately likely to be rescued, likely because they are rarely swimming alone," said the paper.
In contrast, adults were more likely to drown in natural waterways (beaches and rivers). And older adults were more likely to fatally drown, with fewer than one non fatal injury for every fatal, because they were often swimming alone or in more remote areas.
Ms Peden said the research highlighted the significant burden on families and the health system from non fatal drownings. It underscored the importance of keeping children under constant supervision and within arms reach when they were in the water, she said. And when something went wrong, it was important that adults called for an ambulance immediately and knew how to do CPR.
Ms Ostler said Jewel's injuries and non fatal drowning changed everyone's life. The family moved from Queensland to Western Australia because there were too many reminders of what had happened.
Although her survival was a cause of great joy, Jewel's personality changed after the accident.
"Before the accident Jewel was a bright, vibrant happy two-year-old who would talk to anyone. When we got home it became clear she had lost a lot of her speech. She could say two words: 'Mum' and 'No'.
"I went from being a parent to being a carer and teacher. Jewel didn’t want to have a bath so that became a battle every day, and I had to try to make it fun for her. All three of the kids needed to relearn how to get back into the water. Jewel had chronic fatigue and didn’t want to do anything, and her words were just not coming back," says Michelle.
Jewel, though, was incredibly lucky. Though she suffered speech delays, Jewel's nearly caught up, but it took intensive therapy by experts and her parents.
To recognise the impact of non fatal drownings, the Royal Lifesaving is offering $2500 grants to support parents and guardians of children who have been impacted by a drowning and have suffered permanent injuries. They can be used for any service, resource, treatment, therapy, modification or item that they feel with make a different to the child’s care and welfare, or that of the family.