Step 1: Immersion syndrome is a form of atypical drowning in which sudden death occurs from vagal inhibition (cardiac arrest) when the body strikes water. It is also known as hydrocution, submersion inhibition, or vagal inhibition.
Step 2: The vagal reflex is triggered by sudden contact with very cold water, by duck diving (entering feet first), or by horizontal entry with impact on the epigastrium. Death is almost instantaneous, before water enters the lungs.
Step 3: In wet drowning, water does enter the lungs producing froth and pulmonary oedema, so it is not immersion syndrome. In dry drowning, intense laryngospasm keeps water out and death is from asphyxia, which is a different mechanism.
Step 4: Secondary (near) drowning is delayed death after rescue due to complications such as hypoxic encephalopathy and pulmonary oedema. Hence the synonym for immersion syndrome is hydrocution.