A study on rescuer drowning and multiple drowning incidents

Knowing how to swim and drowning prevention in children aged 10 to 14 years. Systematic review

PURPOSE

Drowning is 1 of the 10 leading causes of death due to unintentional injuries in children and adolescents worldwide. Knowing how to swim has been traditionally associated with water safety. However, its conceptualization may vary across studies, leading to different measurements and effects on the risk of drowning. This review sought to understand the current state of scientific evidence associating both issues.

OBJECTIVES

To identify conceptualizations of knowing how to swim and to analyze the evidence indicating whether "knowing how to swim" may be a protective or a risk factor for unintentional drowning in children aged 10 to 14 years.

METHOD

A systematic review of observational etiology studies was conducted, considering original peer-reviewed research published up to the year 2020. Databases including PubMed, Cochrane Central, Tripdatabase, Science Direct, Epistemonikos, Bvs and Bireme were searched for studies associating swimming skills as a risk or a protective factor for drowning (10-14 years). Study quality was assessed, and quantitative data were synthesized (without performing a meta-analysis).

RESULTS

A total of 6,508 results were identified, with only 6 studies meeting the criteria for inclusion in the final cohort. It was evidenced that the exclusive possession of swimming skills, without a concurrent understanding of water safety, is associated with increased exposure to aquatic environments. Consequently, this may increase the risk of drowning.

CONCLUSIONS

Among children aged 10 to 14 years, there is insufficient evidence regarding whether knowing how to swim serves as a protective factor against drowning compared to not knowing how to swim.

PRACTICAL APPLICATIONS

The insufficiency of evidence and a lack of consensus in the conceptualization of swimming as a form of knowledge underscores the need for further research. Such research is crucial for informing investments in drowning prevention interventions, particularly during early adolescence.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2024 Update

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management of drowning in out-of-hospital and emergency care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the second update to the original practice guidelines published in 2016 and updated in 2019.

The burden, risk factors and prevention strategies for drowning in Türkiye: a systematic literature review

INTRODUCTION

Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies.

METHODS

Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design.

RESULTS

From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies (n = 23) and case series (n = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies (n = 30) focused on urban areas across three provinces: Antalya (n = 6), Istanbul (n = 6), Izmir (n = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions.

DISCUSSION

There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning.

PRACTICAL APPLICATIONS

There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry.

TRIAL REGISTRATION

#CRD42022382615.

Assessing risk associated with recreational activities in coastal areas by using a bayesian network

Taiwan is an island and therefore has a considerable amount of coastal land. Drowning or near-drowning incidents often occur in coastal recreational areas. To reduce the risk of drowning or near-drowning associated with marine recreational activities in Taiwan, this study collected data on the risk associated with marine recreational activities. It selected risk factors using a modified Delphi panel method, with an expert panel used to obtain probability values for each risk factor. A Bayesian network for risk assessment was then established. The results of this study can serve as a reference for stakeholders involved in marine recreational activities. Severe weather conditions increase wave height and current speed, resulting in an increased risk of drowning or near-drowning when coastal recreational activities occur under these conditions. Individuals who undertake marine recreational activities without safety awareness are more likely to exhibit risky behaviors. When self-rescue ability is insufficient to prevent possible danger, the probability of drowning or near-drowning is higher. Serious incidents may lead to death, and therefore, marine recreational activities should be avoided when weather conditions are poor. In addition, the safety awareness and self-rescue ability of individuals undertaking coastal recreational activities should be improved. This study did not explore emergency response measures or postincident policy management.

Rip current knowledge: do people really know its danger? do lifeguards know more than the general public?

Introduction

Drowning is a global problem. This so-called "silent killer" claims hundreds of thousands of lives every year around the world. Despite this, beaches are a fundamental space in the lives of many people throughout the world. The scant knowledge regarding aspects of safety, accident prevention and the identification of risks in these natural aquatic environments, all contribute to the number of aquatic accidents that happen. The objective of this study was to establish the reality about the Spain population's knowledge of risks on the beaches.

Methods

A study was carried out using a questionnaire, generated through Google Forms©. The questionnaire was available for 7 days, from May 12 to 19, 2022. 289 responses were selected. The Chi-square statistic was used to analyze the associations while Cramér's V statistics and the Odds Ratio were applied to analyze their strength. The significance level was p < 0.05 for the entire study.

Results

50.5% of the participants knew how to correctly identify a rip current. In terms of definition, identification and response to a current, those who were lifeguards were more likely than the general population to answer correctly.

Conclusions

Sex, age or place of residence do not seem to explain knowledge about rip currents in an active population group. Finally, as a factor in avoiding possible accidents related to currents, the importance of having professional lifeguards in natural aquatic environments is confirmed.

Public rescue tube deployment in Hawaii: protective association with rescuer drownings

Objective

To describe the association between public rescue tube (PRT) flotation devices and fatal rescuer drownings in Kauai, Hawaii.

Methods

We reviewed Hawaii death certificate data from 1993 to 2017, sometimes supplemented with autopsy and emergency medical service reports, to identify fatal rescuer drownings. Incidents were analysed in relation to the initial 2008 deployment of PRT.

Results

Over the 25-year period, only 13% (228) of the 1750 identified drownings occurred in Kauai, but nearly half (46%, or 13) of the 28 rescuer deaths occurred there. However, only 1 of the 13 rescuer deaths in Kauai occurred after the 2008 deployment of PRT. The state-wide proportion of rescuer deaths in Kauai decreased significantly from 60% (12 of 20) from 1993 to 2007 to 13% (1 of 8) from 2008 to 2017. There were no apparent changes in the proportions of rescuer drownings in the other three counties of the state, where PRTs were essentially non-existent.

Conclusion

Despite valid concerns, we found no fatal rescuer drownings related to PRT use after their 2008 introduction in the county of Kauai. Instead, we observed a reduction in the number of rescuer drownings, and in their proportion of total drownings in association with the deployment of PRT. The findings of this study have the potential to directly impact ocean and other open water environment-related fatal drowning prevention policy and practice.

Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2018, almost 900 US children younger than 20 years died of drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in prevention of drowning.

Descriptive Epidemiology of Rescue-Related Fatal Drowning in Turkey

Drowning is a public-health threat and a leading cause of injury-related death. In Turkey, drowning results in 900 fatalities annually, and the rate is rising. As data on rescue-related drowning are scarce, this retrospective study explores the epidemiology of fatal drowning among rescuers in Turkey. As there are no routinely collected death registry data on drowning in Turkey, data were sourced from media reports of incidents between 2015 and 2019. Rescuer fatalities were analysed by age, sex, activity prior to rescue, location, incident day of week and season, and place of death. Statistical analyses comprised X² tests of significance (p < 0.05) and calculation of relative risk (95% confidence interval) using fatality rates. In total, 237 bystander rescuers drowned (90% male; 35% 15–24 years). In 33% of cases, the primary drowning victim (PDV) was successfully rescued, while in 46% of cases the rescue resulted in multiple drowning fatalities (mean = 2.29; range 1–5 rescuers). Rescues were more likely to be successful in saving the PDV if undertaken at the beach/sea (X² = 29.147; p < 0.001), while swimming (X² = 12.504; p = 0.001), or during summer (X² = 8.223; p = 0.029). Risk of bystander rescue-related fatal drowning was twice as high on weekdays compared to on weekends (RR = 2.04; 95%CI: 1.56–2.67). While bystanders play an important role in reducing drowning, undertaking a rescue is not without risk and can lead to multiple drowning incidents. Training in rescue and resuscitation skills (especially the prioritization of non-contact rescues) coupled with increasing awareness of drowning risk, are risk-reduction strategies which should be explored in Turkey.

Lay-rescuers in drowning incidents: A scoping review

OBJECTIVE

Many victims of drowning fatalities are lay-people attempting to rescue another. This review aims to identify the safest techniques and equipment (improved or purpose made) for an untrained bystander to use when attempting a water rescue.

METHOD

A sample of 249 papers were included after the bibliographic search, in which 19 were finally selected following PRISMA methodology and 3 peer review proceeding presented at international conferences. A total of 22 documents were added to qualitative synthesis.

RESULTS

Geographical location, economic level, physical fitness, or experience may vary the profile of the lay-rescuers and how to safely perform a water rescue. Four lay-rescuers profiles were identified: 1) Children rescuing children in low- and middle-income countries (LMICs), 2) Adults rescuing adults or children, 3) Lay-people with some experience and rescue training, 4) Lay-people with cultural or professional motivations. Three types of techniques used by those lay-rescuers profiles: a) non-contact techniques for rescues from land: throw and reach, b) non-contact techniques for rescue using a flotation device and, c) contact techniques for rescue into the water: swim and tow with or without fins.

CONCLUSION

The expert recommendation of the safest technique for a lay-rescuer is to attempt rescue using a pole, rope, or flotation equipment without entering the water. However, despite the recommendations of non-contact rescues from land, there is a global tendency to attempt contact rescues in the water, despite a lack of evidence on which technique, procedure or equipment contributes to a safer rescue. Training strategies for lay-people should be considered.

Management for the Drowning Patient

Drowning is "the process of experiencing respiratory impairment from submersion or immersion in liquid." According to the World Health Organization, drowning claims the lives of > 40 people every hour of every day. Drowning involves some physiological principles and medical interventions that are unique. It occurs in a deceptively hostile environment that involves an underestimation of the dangers or an overestimation of water competency. It has been estimated that > 90% of drownings are preventable. When water is aspirated into the airways, coughing is the initial reflex response. The acute lung injury alters the exchange of oxygen in different proportions. The combined effects of fluid in the lungs, loss of surfactant, and increased capillary-alveolar permeability result in decreased lung compliance, increased right-to-left shunting in the lungs, atelectasis, and alveolitis, a noncardiogenic pulmonary edema. Salt and fresh water aspirations cause similar pathology. If the person is not rescued, aspiration continues, and hypoxemia leads to loss of consciousness and apnea in seconds to minutes. As a consequence, hypoxic cardiac arrest occurs. The decision to admit to an ICU should consider the patient's drowning severity and comorbid or premorbid conditions. Ventilation therapy should achieve an intrapulmonary shunt ≤ 20% or Pao₂:Fio₂ ≥ 250. Premature ventilatory weaning may cause the return of pulmonary edema with the need for re-intubation and an anticipation of prolonged hospital stays and further morbidity. This review includes all the essential steps from the first call to action until the best practice at the prehospital, ED, and hospitalization.

The Visible Behaviour of Drowning Persons: A Pilot Observational Study Using Analytic Software and a Nominal Group Technique

Although drowning is a common phenomenon, the behaviour of drowning persons is poorly understood. The purpose of this study is to provide a quantitative and qualitative analysis of this behaviour. This was an observational study of drowning videos observed by 20 international experts in the field of water safety. For quantitative analysis, each video was analysed with Lince observation software by four participants. A Nominal Group Technique generated input for the qualitative analysis and the two principal investigators conducted a post-hoc analysis. A total of 87.5% of the 23 videos showed drowning in swimming pools, 50% of the drowned persons were male, and 58.3% were children or teenagers. Nineteen persons were rescued before unconsciousness and showed just the beginning of downing behaviour. Another five were rescued after unconsciousness, which allowed the observation of their drowning behaviour from the beginning to the end. Significant differences were found comparing both groups regarding the length of disappearances underwater, number, and length of resurfacing (resp. p = 0.003, 0.016, 0.005) and the interval from the beginning of the incident to the rescue (p = 0.004). All persons drowned within 2 min. The qualitative analysis showed previously suggested behaviour patterns (immediate disappearance n = 5, distress n = 6, instinctive drowning response n = 6, climbing ladder motion n = 3) but also a striking new pattern (backward water milling n = 19). This study confirms previous assumptions of drowning behaviour and provides novel evidence-based information about the large variety of visible behaviours of drowning persons. New behaviours, which mainly include high-frequency resurfacing during a struggle for less than 2 min and backward water milling, have been recognised in this study.

Dying to help: Fatal bystander rescues in Australian coastal environments

Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches.

The epidemiology of fatal drowning in children: a 13-year retrospective study in Turkey

This retrospective study aimed to investigate the prevalence of unintentional fatal drowning in children aged 0-17 years in Turkey between 2005 and 2017 and to determine the risk factors in drowning. This study is based on media reports, and all data were obtained from the media. All data were presented in frequency and percentage. Relative risk and 95% confidence intervals were calculated using the relevant population data. A total of 3,419 children died by drowning in these 13 years. The unintentional fatal child drowning rates in Turkey were 1.16; 1.80 for males and 0.48 for females per 100,000 children, which means males drowned nearly four times more than females. In terms of season, the highest rate of unintentional fatal drowning was in summer (0.69 per 100,000 children), and the lowest rate in winter (0.05 per 100,000 children). The unintentional fatal drowning rate decreased after reaching a peak in 2010 (1.52 per 100,000 children). As of 2015, the rate of unintentional fatal drowning decreased every year and reached a minimum in 2017 (0.66 per 100,000 children). Even if the mortality rate in children has decreased in recent years, more measures are still needed to prevent drowning in children.

Wilderness Medical Society Clinical Practice Guidelines for the Treatment and Prevention of Drowning: 2019 Update

The Wilderness Medical Society convened a panel to review available evidence supporting practices for acute management and treatment of drowning in out-of-hospital and emergency medical care settings. Literature about definitions and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded available evidence supporting practices according to the American College of Chest Physicians criteria and then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking. This is the first update to the original practice guidelines published in 2016.

A Lack of Aquatic Rescue Competency: A Drowning Risk Factor for Young Adults Involved in Aquatic Emergencies

Drowning is an important public health issue with major impacts on young adults aged 15-24 years, yet little is known about the causal factors for drowning for this group. As young adults recreate with peers in unpatrolled aquatic environments, the capacity to perform effective and efficient rescues seems pivotal. This study examined perceived ability of young adults to perform a rescue; determined the level of aquatic rescue knowledge; and measured the effect of an aquatic rescue intervention. In total, 135 participants completed pre- and post-intervention surveys and rescue practical testing. Wilcoxon matched pairs signed rank tests were used to assess significant differences pre- and post-intervention and Mann-Whitney tests used to compare groups. Pre-intervention, participants had a low level of rescue knowledge (Mdn = 50) and the relationship between perceived rescue ability and practical rescue testing was weak (r_s = 0.33, p ≤ 0.001). Post-intervention, ability to perform a contact tow demonstrated significant improvement (z = - 9.09, p < 0.001, r = - 0.79) and rescue knowledge also improved significantly (Mdn = 100, z = - 9.42, p < 0.001, r = - 0.81). Many young adults lacked both the physical capacity and knowledge required to safely perform a rescue, a factor that may place them at increased drowning risk if they attempt an aquatic rescue. As a rescue based intervention can significantly improve competency of young adults regardless of previous experience and/or qualifications, research needs to consider how best these competencies can be promoted and/or developed with this high risk group.

Who rescues who? Understanding aquatic rescues in Australia using coronial data and a survey

OBJECTIVE

To examine fatal drowning associated with aquatic rescues and prior self-reported experience of undertaking an aquatic rescue in Australia.

METHODS

Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue-related fatal unintentional drowning between 1 January 2006 and 31 December 2015.

RESULTS

Twenty-three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X² =35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X² =13.5; p<0.001). Females were more likely to have rescued a child (0-4 years of age) (X² =29.2; p<0.001) from a swimming pool (X² =34.3; p<0.001). Fifty-one people drowned while performing an aquatic rescue (Males=82.4%; 25-44 years of age=53.0%; beaches=54.9%).

CONCLUSIONS

Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community-wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning. Implications for public health: There is a need to train people early in their life on how to undertake a safe rescue and provide resuscitation, including promoting regular updates, in particular if supervising children.

Characteristics of aquatic rescues undertaken by bystanders in Australia

An issue of growing importance within the field of drowning prevention is the undertaking of aquatic rescues by bystanders, who sometimes drown in the process. The main objectives of this study were to describe characteristics of bystanders making rescues in different Australian aquatic environments, identify the role of prior water safety training in conducting bystander rescues and provide insights into future public education strategies relating to bystander rescue scenarios. An online survey was disseminated via various social media platforms in 2017 and gathered a total of 243 complete responses. The majority of bystander rescues described took place in coastal waterways (76.5%; n = 186), particularly beaches (n = 67), followed by pools (17.3%; n = 42) and inland waterways (6.2%; n = 15). The majority of respondents were males (64.2%; n = 156) who rescued on average approximately twice as many people in their lifetime (6.5) than female respondents (3.6). Most rescues occurred more than 1 km from lifeguard/lifesaver services (67%; n = 163), but in the presence of others (94.2%; n = 229). The majority of bystander rescuers had water safety training (65.8%; n = 160), self-rated as strong swimmers (68.3%; n = 166), conducted the rescue without help from others (60%; n = 146), did not use a flotation device to assist (63%; n = 153), but were confident in their ability to make the rescue (76.5%; n = 186). However, most considered the situation to be very serious (58%; n = 141) and felt they had saved a life (70.1%; n = 172). With the exception of pools, most bystanders rescued strangers (76.1%; n = 185).While Australia clearly benefits from having a strong water safety culture, there is no clear consensus on the most appropriate actions bystanders should take when confronted with a potential aquatic rescue scenario. In particular, more research is needed to gather information regarding bystander rescues undertaken by those without prior water safety training.

The Influence of Alcohol and Drugs on Drowning among Victims of Senior Years

Unintentional fatal drowning among older people is an issue as lifespans lengthen and older people embrace active retirement. While pre-existing medical conditions are a known risk factor for drowning among this age group, less is known about the role of alcohol and drugs. This 15-year (1 July 2002 to 30 June 2017) Australian study used coronial data to investigate the impact on older people (aged 65 years and older) of the obtundent effects of prescribed drugs which had been ingested by those with a positive blood alcohol concentration (BAC). Of the closed coronial cases with toxicological information (N = 471), one quarter (24.6%; N = 116) had consumed alcohol prior to drowning (one in seven BAC ≥ 0.05%), of which a third also had obtundent drugs present (33.6%; N = 39). Rivers/creeks/streams and swimming pools were the locations with the highest number of drowning deaths. Bathtubs (36.8%) and rivers/creeks/streams (17.9%) recorded the highest proportion of cases with victims having a BAC ≥ 0.05%. Bathtubs (13.2%), lakes (7.0%), and rivers/creeks/streams (6.8%) recorded the highest proportion of drowning cases with obtundent drug involvement. Obtundent drug involvement was significantly more likely for activities where the person who drowned was alone (i.e., unknown activity) (X2 = 6.8; p = 0.009). Common obtundent drugs included Diazepam, Tempazepam, and Codeine. Advocacy to prevent drowning in older people is a complex challenge, due to the myriad of locations where drowning occurs, the consumption of alcohol, and polypharmacy required for treating illness and maintaining good health.

Sports related to drowning

Aquatic sports are included in the top list of risky practices as the environment per se carries a possibility of death by drowning if not rescued in time. Not only are aquatic sports related to a high risk of death, but also all sports practiced on the water, over the water and on ice. Whatever the reason a person is in the water, drowning carries a higher possibility of death if the individual is unable to cope with the water situation, which may simply be caused by an inability to stay afloat and get out of the water or by an injury or disease that may lead to physical inability or unconsciousness. The competitive nature of sports is a common pathway that leads the sports person to exceed their ability to cope with the environment or simply misjudge their physical capability. Drowning involves some principles and medical interventions that are rarely found in other medical situations as it occurs in a deceptively hostile environment that may not seem dangerous. Therefore, it is essential that health professionals are aware of the complete sequence of action in drowning. This article focuses on the pulmonary injury in sports and recreational activities where drowning plays the major role.

Drones may be used to save lives in out of hospital cardiac arrest due to drowning

BACKGROUND

Drowning leading to out-of-hospital cardiac arrest (OHCA) and death is a major public health concern. Submersion with duration of less than 10min is associated with favorable neurological outcome and nearby bystanders play a considerable role in rescue and resuscitation. Drones can provide a visual overview of an accident scene, their potential as lifesaving tools in drowning has not been evaluated.

AIM

The aim of this simulation study was to evaluate the efficiency of a drone for providing earlier location of a submerged possible drowning victim in comparison with standard procedure.

METHOD

This randomized simulation study used a submerged manikin placed in a shallow (<2m) 100×100-m area at Tylösand beach, Sweden. A search party of 14 surf-lifeguards (control) was compared to a drone transmitting video to a tablet (intervention). Time from start to contact with the manikin was the primary endpoint.

RESULTS

Twenty searches were performed in total, 10 for each group. The median time from start to contact with the manikin was 4:34min (IQR 2:56-7:48) for the search party (control) and 0:47min (IQR 0:38-0:58) for the drone-system (intervention) respectively (p<0.001). The median time saved by using the drone was 3:38min (IQR 2:02-6:38).

CONCLUSION

A drone transmitting live video to a tablet is feasible, time saving in comparison to traditional search parties and may be used for providing earlier location of submerged victims at a beach. Drone search can possibly contribute to earlier onset of CPR in drowning victims.

The 4Rs of Aquatic Rescue: educating the public about safety and risks of bystander rescue

From 1980 to 2014, 87 persons drowned in New Zealand while attempting to rescue others; all incidents occurred in open water and most (80%) fatalities were male. While bystander rescue has been promoted as a way of preventing drowning, little is known about the knowledge base that informs potential rescuers. This study utilized a family water safety programme to promote a resource entitled the 4Rs of Aquatic Rescue. Participants (n = 174) completed a pre-intervention survey and were then provided with information and access to electronic resources on safe bystander rescue techniques. Most respondents (71%) had never been taught rescue techniques, and males were more confident of their rescue ability. Upon completion of the programme, significant differences were evident in respondents' understanding of rescue safety, but this did not translate to greater confidence or disposition towards performing a rescue. Ways of promoting bystander safety around water are discussed and recommendations for future studies are made.

Impact of error self-perception of aerobic capacity in the safety and efficacy of the lifeguards

INTRODUCTION

The strong physical demands that are required of lifeguards during rescues also require an accurate self-perception of one's fitness level to be able to regulate the intensity of effort.

OBJECTIVES

The aim of this study was to determine the real aerobic capacity (RAC) and to compare it with two self-reported measurements: subjective appraisal of aerobic capacity (SAAC) and appraisal of physical exercise (APE).

METHODS

Fifty-two professional lifeguards were included in the study. For an objective assessment of RAC, the lifeguards' maximum oxygen uptake (VO2max) values were measured during treadmill stress tests. A fitness assessment questionnaire was used to obtain the SAAC and APE values.

RESULTS

We found a statistically significant association between the APE and RAC variables in the contingency analysis (p < 0.001). In total, 93.7% of the lifeguards who obtained a VO2max value below 43 ml kg(-1) min(-1) considered their aerobic capacity to be high or very high.

CONCLUSION

This self-perception error of true aerobic capacity could lead to premature fatigue during a rescue, endangering both the lifeguard's life and the life of the victim. These data may help lifeguards and beach managers to become aware of the need to know lifeguards' true physical conditions through testing and structured training programs.

Wilderness Medical Society Practice Guidelines for the Prevention and Treatment of Drowning

The Wilderness Medical Society convened a panel to review available evidence supporting practices for the prevention and acute management of drowning in out-of-hospital and emergency medical care settings. Literature about definition and terminology, epidemiology, rescue, resuscitation, acute clinical management, disposition, and drowning prevention was reviewed. The panel graded evidence supporting practices according to the American College of Chest Physicians criteria, then made recommendations based on that evidence. Recommendations were based on the panel's collective clinical experience and judgment when published evidence was lacking.

Mortality among drowning rescuers in China, 2013: a review of 225 rescue incidents from the press

BACKGROUND

Drowning is common worldwide. Rescue efforts attempted by untrained bystanders often lead to the death of the primary drowning victim (PDV), the rescuer or both. Our study aimed to inform prevention by identifying risk factors in rescuer drowning.

METHODS

Data on drowning rescue incidents reported online in mainland China, 2013, were reviewed. Information on the drowning incidents, PDVs and rescuers were retrieved for analysis.

RESULTS

A total of 225 rescue incidents were identified, of which 14 were victim-rescuer drowning incidents (VRDIs) (6.2%). A person-to-person rescue by swimming to PDVs was the most commonly used method (58.9%). Resuscitation was given immediately to 35.5% of PDVs after rescue. The mortality rate of the rescuers (13.3%) was similar to that of the PDVs (11.5%) (χ(2) = 0.5, p =0.49). Being an adult (OR = 0.2, 95% CI: 0.1-0.5) and other than the first rescuer (OR = 0.4, 95% CI: 0.2-0.9) decreased the risk of rescuers drowning.

CONCLUSIONS

Most of the currently employed life-saving methods are dangerous and even potentially life threatening. The idea of "rescuers' safety first" should be embraced, especially with teenage and child rescuers, who should never be encouraged to rescue others without first guaranteeing their own safety. Promotion of basic rescue skills should be implemented in the general public.

Creating a drowning chain of survival

All nations would benefit from a simple, clear Drowning Chain of Survival. In high income nations this tool will refine prevention and the call for action. In low and middle income nations this tool is a guide for policy making, resource allocation and priority setting in drowning prevention. A best evidence approach was utilized to create a universal Drowning Chain of Survival. Education on how to prevent drowning and to how react when a drowning incident occurs has not always been guided by good levels of evidence, or high levels of specialized training in drowning process recognition and management. The Drowning Chain of Survival refers to a series of steps that when enacted, attempts to reduce mortality associated with drowning and attempted aquatic rescue. The term "chain of survival" has provided a useful metaphor for the elements of the emergency cardiac care system for sudden cardiac arrest, however interventions and patient management in drowning involves principles and actions that are specific to these situations. The result is a unique and universal Drowning Chain of Survival comprised of five links guiding the important life-saving steps for lay and professional rescuers. This may significantly improve chances of prevention, survival and recovery from drowning. The steps of the chain are: Prevent drowning, Recognize distress, Provide flotation, Remove from water, and Provide care as needed.