Shallow Water Blackout Incident Report

The intent of this report is to create a central repository to record incidents of a drowning or near-drowning after the swimmer experienced an underwater blackout.  While not scientific we are attempting to capture the magnitude of shallow water blackouts.  We will follow-up with each respondent (Recorder) to verify the information submitted.  If we are unable to do so we will remove the incident from this report, which we will update after each incident is verified.  Please provide as much of the following information as possible.

Swimmer's Name
Swimmer's Name
Name of Reporter:
Name of Reporter:

*Activity refers to what the individual was doing at the time of the incident.  Please use the following key:

·       Competitively swimming and/or training – CS

·       Non-competitive (recreation) swimming - NCS

·       Free diving – FD

·       Military training - MT

·       Playing breath-holding games - BHG

·       Snorkeling – S

·       Spearfishing – SF