Drowning can be a quiet, invisible killer. As we approach July 4 this year — with an extra day or two off for many Americans, if not more — and with the entire summer still ahead of us, families need to know the best information available on how to avoid drowning before heading to the beach or the pool.

LifeZette spoke with Dr. Linda Quan, a fellow of the American Academy of Pediatrics and vice chair of the American Red Cross Scientific Advisory Council, to share with readers key information about how and why people drown — and how to prevent such a tragedy.

Quan is a pediatric emergency physician at Seattle Children’s Hospital and a professor of pediatrics at the University of Washington School of Medicine.

Question: What critical information right off the bat do you want readers to know about preventing anyone from drowning?
Answer: Drowning requires layers of protection. And never trust the water. People should learn the multiple steps they can take to keep the water an enjoyable and fun setting for themselves and their families. (Learn how to handle a rip current, for example, in the video below.)

Q: Can you explain the instinctive drowning response? It’s a formula that was put together by Dr. Francesco Pia.
A: The following are the signs of this to know:

  • head low in the water, mouth at water level
  • head tilted back with mouth open
  • eyes glassy and empty, unable to focus
  • eyes closed
  • hair over forehead or eyes
  • not using legs
  • hyperventilation or gasping
  • trying to roll over on back
  • appearing to climb an invisible ladder

Q: What else you would add from your experience about the conditions surrounding a drowning or near-drowning event?
A: Drowning happens super-fast. And that what you see [in terms of any signs of trouble] may depend on the age of the person.

What Dr. Pia was describing is what happens when you’re desperate to get oxygen, to get your nose above the water, so that you can breathe. The person who’s drowning goes very quickly from ‘Oh my gosh, I’m not comfortable,’ or basically, ‘I’m panicking’ or ‘I’ve aspirated some water,’ [to] ‘Now I’m having trouble breathing’ — where they may actually flail their arms, which is what’s portrayed in the movies.

Related: Drowning Is Not What You Think: It’s Quick, Silent, and Easy to Miss

But generally [for a school-aged person or older], people start flailing their arms to try to get above the water. That’s what the flailing of the arms is about. And this is when — if people are watching and see this, especially teens — they think, ‘Oh, that guy’s just fooling around or pretending to drown.’ Kids die because others thought they were just fooling around.

But then they’ll go very quickly, really within a minute or less — and all of those efforts with their heads back, and not being able to move forward, are because they’re trying literally to get out of the water and get their heads above the water.

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You can call it an instinctive reflex, and it’s basically ‘Get me to air.’ So it’s important to know when you see this that someone’s going to go under any second.

Q: Do you think Hollywood’s usual depiction of drowning is a concern because it could be misleading? How often do you think the flailing around actually happens?
A: I’m not a lifeguard. But after reading accounts of what people describe — the EMS reports and the police reports — I don’t think the flailing actually happens too often.

You don’t go to the beach and just say, “Great, we’re here. Let’s just kick back and have a good time and let the lifeguard watch my kid.”

All of this sort of rapid progression [activity] — of being in the water, being in trouble, beginning to flail, maybe, then beginning to work like crazy to be able to keep your airway above the water — it’s all happening within a minute or two. And then people go down.

You’ve got to watch. You’ve got to keep your eye constantly on the person who is not a good swimmer.

Q: Do you think most lifeguards are well aware of the actual signs and symptoms of drowning, and the diverse signs you might see?
A: Lifeguards basically know that they have to be taught. Parents [and others] haven’t been teaching people how to watch for drowning the way they teach their children about other things — so I think everybody has to be taught.

Q: Anyone watching a video of a near-drowning experience would see how inconspicuous the event seems to the untrained eye. Is that correct?
A: Absolutely right, and it’s very clear lifeguards can miss it, too. We see people drown while they are under a lifeguard’s supervision — and again, the behaviors are so subtle. You need layers of protection. You don’t go to the beach and say, “Great, we’re here. Let’s kick back and have a good time and let the lifeguard watch my kid.”

Q: What other things does the American Red Cross do to raise awareness of drowning issues and dangers?
A: Our Scientific Advisory Council [shares] provisions and recommendations, and we have the information posted for instructors. The Red Cross does more of the science behind this, and works so very hard to make these recommendations in a very thoughtful, consensus-based manner. We should be taking every precaution we can as the ultimate adviser.

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Quan also told LifeZette in the interview it’s vital for families or people in a group to designate a “water watcher.” These are people in the group — anybody who is a good swimmer — who watch out for water dangers for others. Ideally they’d be within that “layer of protection” where there is a lifeguard. Additionally, choose a safe place to swim.

Drownings take an average of 10 lives per day, according to the Centers for Disease Control and Prevention. The U.S. Consumer Product Safety Commission (CPSC) estimates that “drowning is the leading cause of unintentional death in children [ages] one to four.”

Related: Parents, Pay Attention to Mom’s Warning About Playground Slides

The American Red Cross has a number of resources to help people avoid drowning. Don Lauritzen, communications officer at the Red Cross, told LifeZette the organization offers swim lessons and lifeguard classes, and is a partner in the CPSC Pool Safely program.

Not only are there tips on the Red Cross website, but there are also guides for drowning prevention and what to do if someone’s in trouble. And a swim app is available for people to have handy on their mobile phones in case of emergency.

Kyle Becker is a content writer and producer with LifeZette. Follow him on Twitter.