Immersion events in residential swimming pools. Evidence for an experience effect

Pediatric submersion events in portable above-ground pools in the United States, 2001-2009

OBJECTIVE

The goal of this study was to describe the epidemiology of pediatric submersion events occurring in portable pools in the United States.

METHODS

A retrospective analysis of fatal and nonfatal submersion events involving children younger than 12 years in portable pools was conducted using injury and fatality data compiled by the US Consumer Product Safety Commission from 2001 through 2009.

RESULTS

There were 209 fatal and 35 nonfatal submersion cases reported to the commission from 2001 through 2009. The majority (94%) involved children younger than 5 years, 56% involved boys, 73% occurred in the child's own yard, and 81% occurred during the summer months. The number of submersion events increased rapidly from 2001 to 2005 and then leveled off from 2005 to 2009.

CONCLUSIONS

The use of portable pools in residential settings poses a significant risk of submersion-related morbidity and mortality to children, especially in the <5-year-old age group. No single strategy will prevent all submersion deaths and injuries; therefore, layers of protection are recommended. Industry is advised to engage in development of protective devices that are effective and affordable for portable pools, including isolation fencing, pool alarms, and safety covers. A strong and pervasive consumer education campaign is needed to make consumers aware of the dangers of portable pools, because these small, inexpensive, consumer-installed pools may not generate the same sense of risk as an in-ground pool.

Systematic review of definitions for drowning incidents

OBJECTIVES

In preparation for the World Congress on Drowning uniform reporting consensus document of drowning incidents we reviewed systematically the medical literature for the terms and definitions used to describe drowning incidents to assess the uniformity of these terms in the medical literature.

METHODS

The search strategy included a literature search of PubMed, MEDLINE and the Cochrane Database from 1966 to April 2002, as well as a review of reference lists of identified studies and a hand search of relevant textbooks and reference works. Search terms used included drowning, near-drowning, submersion, immersion, suffocation, asphyxiation, water injuries, and aspiration. Any article with drowning as a primary focus and containing a definition of drowning was included. Study designs included experimental studies, observational studies, case control studies, reviews, letters, and editorials.

RESULTS

The search identified approximately 6000 articles. Of these 650 were reviewed and 43 articles addressing the definition of drowning were identified. We found a total of 33 different definitions to describe drowning incidents, 20 for drowning and 13 for near-drowning; along with another 13 related terms. There were at least 20 different outcome measures for drowning incidents reported.

CONCLUSIONS

A review of existing drowning literature demonstrates a lack of a standard definition of drowning and a lack of agreement on measures of outcome. This variability in definitions and outcomes makes it very difficult to assess and analyze studies both individually and as a whole and draw conclusions that will influence practice. These objective findings support the need for the drowning Utstein focus on one definition of drowning and validated measures of functional and neurological outcome.

Pediatric near drowning: the experience of King Khalid University Hospital

BACKGROUND

The purpose of the study was to evaluate the outcome of warm pediatric near drowning, and assess possible predictors of the outcome.

SUBJECTS AND METHODS

The study was performed at King Khalid University Hospital, Riyadh, Saudi Arabia. Twenty-eight cases of pediatric near drowning (one to 13 years of age) over a 10-year period ending June 1998, were reviewed retrospectively. Multiple variables during the prehospital and the hospital stages were evaluated to assess their effect on the outcome.

RESULTS

None of the patients' families had official training in cardiopulmonary resuscitation. Only one of the 21 private swimming pools had features compatible with swimming pool safety regulations. Eleven patients (39.3%) died in the pediatric intensive care, and 17 (60.7%) were discharged alive. Submersion time of >5 minutes and the emergency room documentation of absence of vital signs, Glasgow Coma Scale of < or =4, arterial pH of < or =7.0 and blood sugar of > or =10 mmol/L all predicted bad outcome, with a statistical significance (P< 0.05).

CONCLUSION

This audit highlighted major concerns about our prehospital medical care, general population basic life support education and our society's adherence to swimming pool safety regulations. It demonstrated that hypothermia on arrival to the emergency department in warm near-drowning victims is likely to be associated with bad outcome. The audit results also agree with the opinion of not aggressively intervening or prolonging aggressive intervention in warm near-drowning cases presenting with bad prognostic outcome.

The role of bathtub seats and rings in infant drowning deaths

OBJECTIVE

To describe deaths due to drowning that involve the use of an infant bathtub seat or ring.

DESIGN

Case series, cases reported to the US Consumer Product Safety Commission data systems. Setting. United States, 1983-1995.

MAIN OUTCOME MEASURES

Death in which an infant bathtub seat or ring was in use at the time of death and the primary cause of death was drowning.

RESULTS

Thirty-two drowning deaths involving bath seats/rings were identified and investigated by the Consumer Product Safety Commission over a 13-year period. The majority of deaths (84%) occurred from 1991-1995, with more than 50% occurring in the 2 most recent years. The victims' ages at the time of the incident ranged from 5 to 15 months with a mean and median age of 8 months. In more than 90% of incidents there was a reported lapse in adult supervision, with a mean reported lapse of 6 minutes and a median lapse of 4 minutes. Focus groups with parents found that while making bathing somewhat easier, bath seats/rings are useful for a relatively short time period, as the child rapidly outgrows the product. They also suggested that care givers are more likely to leave a child unattended in the tub if one of these products is in use.

CONCLUSION

Bath seats/rings are associated with an increasing number of reported infant drowning deaths. The use of such products may increase the risk of drowning among infants by increasing the likelihood that an infant will be left alone in the tub. However, in the absence of exposure data in a suitable comparison group it is difficult to assess the overall risk inherent in their use. Educational efforts reinforcing the need for continuous adult supervision of infants and children around all bodies of water should now also include a reminder that bath seats/rings are not safety items and are not a substitute for adult supervision. Infants and toddlers should never be left in the bathtub unsupervised, even for brief moments.

Preventing childhood unintentional injuries--what works? A literature review

AIM

The aim of this paper is to report on a systematic review of the world literature to provide information about the most effective forms of health promotion interventions to reduce childhood (0-14 years) unintentional injuries. The findings are of relevance to policy makers at a local or national level, to practitioners and researchers.

METHODS

The relevant literature has been identified through the use of electronic databases, hand searching of journals, scanning reference lists, and consultation with key informants.

RESULTS

Examples of interventions that have been effective in reducing injury include: bicycle helmet legislation, area wide traffic calming measures, child safety restraint legislation, child resistant containers to prevent poisoning, and window bars to prevent falls. Interventions effective in changing behaviour include bicycle helmet education and legislation, child restraint legislation, child restraint loan schemes, child restraint educational campaigns, pedestrian education aimed at the child/parent, provision of smoke detectors, and parent education on home hazard reduction. For the community based campaigns, the key to success has been the sustained use of surveillance systems, the commitment of interagency cooperation and the time needed to develop networks and implement a range of interventions. Education, environmental modification and legislation all have a part to play and their effect in combination is important.

CONCLUSION

The design of evaluations in injury prevention needs to be improved so that more reliable evidence can be obtained. Better information is needed on process, so that successful strategies can be replicated elsewhere. There is also a need for literature reviews on effectiveness to be updated regularly and for their findings to be widely disseminated to policy makers, researchers, and practitioners.

Children's lives or garden aesthetics? A case study in public health advocacy

Following a decade of accumulating clinical reports on child drowning in domestic swimming pools, paediatricians began advocating legislation that would require all pools to be 'isolation' fenced. In 1990, the New South Wales Government introduced and then repeated such legislation following intense lobbying and media advocacy from a group of pool owners. This paper reviews the ways in which isolation fence advocates and opponents framed their public arguments. Five main areas of competing public discourse are identified: why pool drownings occur; the effects of fencing; expert views and community support; the role of the state in prevention; and personalised references to the value systems of those involved in the debate. Two factors seem likely to have contributed most to the overthrow of the legislation: fence opponents inhabiting the same noninterventionist ideological frame of reference as the government; and fence advocates' refusal to compromise on retrospective fencing seems likely to have inspired a commitment in opposition which would have been absent if an incrementalist, prospective fencing policy had been adopted.

From research to public policy: the prevention of motor vehicle injuries, childhood drownings, and firearm violence

PURPOSE

The purpose of this article is to review the development of the modern sciences of injury epidemiology and injury prevention and to illustrate the use of applied research in formulating effective public policy.

SEARCH METHODS

MEDLINE searches were conducted from 1966 to 1990, and bibliographies of articles thus obtained were reviewed. Fugitive sources were identified by multiple means.

MAJOR FINDINGS

Motor vehicle fatality rates on a per mile driven basis have been reduced by 50% over the past 25 years, largely through attention to the road environment and design of motor vehicles. Passive restraint systems such as air bags promise further reductions. Drowning has emerged as a leading cause of death among young children. Complete pool fencing is expected to prevent many of these events. Firearm violence, particularly among young people, is rapidly increasing. Firearms are hazardous consumer products but are not addressed as such by our current regulatory structure and intervention agenda.

CONCLUSIONS

Epidemiologic and other applied research can make important contributions to the development of public policies designed to prevent injury. Such policies often address the design and performance of hazardous products and environments and consider individual behavior change as only a secondary objective.