Eighteen-month-old Joy Laboda’s lips and eyelids were purple. Her hair was coated in vomit from her father’s attempts to resuscitate her. Her limp body lay in the arms of an off-duty police officer who was performing chest compressions.

This was the first thing fire Capt. Patrick O’Neill saw when he jumped off of the truck at the Laboda home on Dec. 29, 2016.

O’Neill, who has worked for the Phoenix Fire Department for 12 years, said he immediately knew the situation was dire.

“This little girl was sopping wet,” he said. “She was very ice cold to the touch. Her skin was light blue and almost mottled.”

Despite decades of drowning prevention classes and public service campaigns, dozens of children still drown or nearly drown in the Phoenix area every year.

According to the City of Phoenix website, the Phoenix Fire Department responded to 75 total drownings and water-related incidents in 2016. Of those incidents, 41 involved children.

From the moment Phoenix Fire Station 17 got the call about an “18-month-old female found in pool. Not breathing,” O’Neill said the crew knew time was limited. When they got to the scene minutes later, Joy, who had fallen into her parents’ fenced backyard pool, was in cardiac arrest.

It only takes 2 to 3 minutes for brain damage to occur after a brain is deprived of oxygen. Children who are removed from the water before it enters their lungs often don’t require CPR or overnight hospitalization, said Dr. Anthony Pickett, who works at Phoenix Children’s Hospital. It’s when children like Joy are underwater for more than 3 minutes that the risk of brain damage and death begins to rise.

Seventeen minutes later, Joy was in the hospital. She made a surprising recovery. In May, O’Neill, Dishong and other first responders attended her second birthday party.

But many drowning cases do not get Joy’s happy ending.

“I’ve had a lot of cases involving kids, and a lot of times they don’t work out so well,” O’Neill said.

First responders and medical professionals are used to dealing with trauma, but Pickett said child drownings take a distinct emotional toll.

“Just before this happened, they were a completely normal child, and I know that for the sickest ones they’re not going to be a ‘normal’ child again” said Pickett, who works in a pediatric emergency room. “That's what really affects me the most — knowing the profound impact that this injury is going to have, not only on the child but on the whole family.”

Even when children do survive a near-drowning incident, brain injuries and infections sustained can cause a lifetime of consequences, said Dr. Laura Wilner, Pediatric Physical Medicine and Rehabilitation Specialist at Children’s Phoenix Hospital.

“What's the chances you're going to be able to respond within 2 to 3 minutes?” Wilner said. “The so-called miracle cases are great, but there’s many, many other children who grow up with lifelong disability needing therapy and special education.”

Santana Black was one of these children.

The Aftermath

When Santana was 22 months old, he wandered out of his babysitter’s sight and plunged into his grandparents’ backyard pool.

Unable to swim or call for help, his brain went without oxygen for 20 minutes. His heart stopped beating for 45 minutes.

On Dec. 16, 2006, Santana went from a healthy, rambunctious boy to the brink of death.

Santana’s mother, Lindsey Black, rushed to Saint Joseph’s Hospital and Medical Center. She first noticed the tubes covering her son’s body. His blue tint and swollen lips made him unrecognizable to Black. Doctors were not sure if he would make it through the night, Black said.

For the next nine days, Black did not leave Santana’s side in the pediatric intensive care unit. She, her husband and her older son spent Christmas in the hospital. Black rarely ventured out of the hospital in January.

When Black found out Santana could go home on Feb. 1, 2007, Black said she was in disbelief. She was not sure how she would care for him. He was brain dead and would require 24-hour care for the rest of his life.

Santana’s mother grieved for her son in the days after the accident, but she channeled that grief into finding a way to improve his condition. She dedicated the following years of her life to caring for him.

“I grieved who Santana was,” she said. “He was a happy little boy smiling all the time, and I really grieved that. I wanted to know who he could have been.”

Grief expert and counselor Gloria Horsley said shifts in the family dynamic often occur before the grief subsides. Changes to the family routine add additional stress.

Because Black’s family home was a tri-level with stairs, they built a new home to accommodate Santana’s wheelchair. Santana’s older brother had to learn to suction Santana’s fluid from his mouth so he would not choke.

After the accident, Black spent most of her days in bed. Her husband worked long hours to distract himself, and their different methods of mourning drove them apart, Black said.

They divorced.

Black said her identity became synonymous with Santana’s because she spent so much time taking him to different therapies everywhere from Florida to California to New Mexico.

Despite Black’s efforts, Santana died in 2014 from complications brought on by his near-drowning. Black said she questioned her faith in God as she grieved the loss of her son for a second time.

“My child unfortunately died twice,” she said. “I lost who he was back in 2006, and I lost who he’d become in 2014.”

Horsley said it can take about 8 years for most bereaved parents to mourn the death of a child.

“When he was gone, I just felt like I was gone,” Black said. “I felt like there was nothing left . . . I had to go through my process of not only losing Santana, losing myself.”

Black said she has found herself through honoring the memory of Santana by advocating for water safety and drowning prevention.

The Advocates

First responders, people like Black and organizations have poured resources into trying to stop drownings and the lasting damage they cause.

For children under 4, who are most at risk, no amount of preparation can replace close parental supervision.

“Everybody thinks that while they’re grilling or while they’re folding laundry or on the phone that they can watch their kids,” said Becky Hulett, aquatics supervisor of Phoenix. “You can’t do that in a pool situation.”

Curious toddlers present a danger when parents have misconceptions about what a drowning looks and sounds like, said Michele Long, who works for the Mesa Fire Department. Long has developed several drowning prevention campaigns.

“Drowning is very, very silent, and it’s important that people realize that it’s not like you see in the movies,” Long said.

Bob Hubbard of the Hubbard Family Swim School suggested designating one adult at social events to be a “water watcher.” Hubbard said passing around a whistle can help make sure that someone is counting heads and supervising children at all times.

“When everybody is watching, nobody is watching,” Hubbard said.

The Phoenix City Council passed a stringent pool fencing ordinance in 1990 that requires houses to have both an exterior fence around the property and an interior fence separating the house from the pool. The rules apply to pools built after 1990 and to all houses with children under age 6.

The number of drowning or near-drowning incidents for children under age 5 was cut in half the year after the ordinance went into effect, according to the Arizona Department of Health Services.

“You have to set those barriers in place because each one gives you a little bit more time to find that child before they get to the water,” Long said.

But some sacrifice safety for beauty. While barriers can help prevent drownings, Debra Allen, a realtor with Berkshire Hathaway HomeServices, said sometimes people who don’t have small children take out pool fences because they aren’t aesthetically pleasing.

Long sees a similar trend happening in Mesa.

“We see more drownings in the nicer homes that have beautiful yards that don’t want to put up the pool fences,” she said.

Cases of changing home ownership and the 6-year-old child requirement can make the ordinance difficult to enforce, said Tom Wandrie, a Phoenix city official who oversees pool fence permits. Officials only check new pools, unless there are specific complaints.

But Wandrie warned against homeowners having a false sense of security.

“It’s not foolproof,” Wandrie said. “It’s a layer of extra protection.”

Swimming lessons and CPR classes are another safeguard against drownings. However, Phoenix public pools are only open eight weeks out of the year, which Hubbard said reduces the availability of swim classes for the Phoenix population.

For low-income families, economic barriers can keep them from taking swim classes at all.

“If someone has to decide if they’re going to put food on the table or take swimming lessons, they’re going to choose to put food on the table,” Hulett said.

If swim classes are a financial stretch, Hubbard recommended that parents do their best to teach their children to swim. The city of Phoenix also offers a limited number of discounted classes.

Years later, Black said she wonders if swim classes would have saved her son. But Hubbard said a few short sessions aren’t sufficient to ensure children have the skills they need to be safe in water. Drownings can still occur.

“It is sometimes discouraging because you can work as hard as you can on everything, get that word out, and there will still be incidents,” Long said.

Long hears over and over that families never thought a drowning could happen to their child. Because of these drownings, their lives and their communities are permanently altered.

“It’s called the ripple effect,” Long said. “It impacts that family immediately, but it spreads out into their communities, into their churches, into their schools, and in families. It just lasts a lifetime.” ■

Dow Jones News Fund

2017 digital media interns

Kimberly Armstrong • Rachel Cohrs • Lillian Donahue • Lily Haight • Rose McManus • Cheyanne Mumphrey • Em Okrepkie • Chloe Ranshaw • Hayley Sanchez • Nicholas Serpa • James Tyner

Produced by digital media interns of the Dow Jones News Fund in association with the Walter Cronkite School of Journalism at Arizona State University.