Drowning awareness. Prevention and treatment

BACKGROUND

Drowning is a common, preventable problem, especially in childhood where it is the second most common cause of death by accident in Australia, with 0-4 year olds comprising 22% of all drownings. Commonest sites for drowning are nontidal lakes and lagoons; private swimming pools (especially preschool children); ocean/estuary and surfing beaches; bathtub and bucket drownings (especially in infants and toddlers with up to 10% of bucket drownings due to child abuse).

OBJECTIVE

This article reviews the current information on the epidemiology, prevention and treatment of drowning.

DISCUSSION

Despite prevention strategies, including pool fencing, drowning rates in young children have remained relatively static. In older children, drowning rates have declined dramatically despite the lack of prevention. The indigenous population have a much higher rate of drowning than the overall figure and their toddler rate is very high. Approximately 69% of near drowning victims will have complete neurological recovery, 28% will suffer some selective deficit, and 3% survive in a permanent vegetative state. Alcohol has been strongly implicated in drowning and banning alcohol from adjacent swimming areas has reduced drowning rates. Overseas tourists were 4.7% of all nonboating drownings in Australia with 89% of these drowning in the ocean. Further funding for drowning prevention strategies are essential, yet noticeably lacking.

The Irukandji syndrome. A devastating syndrome caused by a north Australian jellyfish

BACKGROUND

The Irukandji syndrome is a group of delayed (10-40 mins, mean 30 mins) severe systemic symptoms occurring after an initial mild skin sting by small carybdeid (box) jellyfish including Carukia barnesi, known colloquially as the 'Irukandji'. Although the syndrome is well known in tropical Australian waters, the 1998-1999 season in north Queensland was notable for the unusually high number of victims with severe toxic heart failure who needed admission to intensive care facilities for more complex investigations and treatment. There have also been other severe and unusual symptoms reported this year, which leads to the conclusion that there may be more than one species of jellyfish causing the Irukandji syndrome, or a seasonal variation in the symptoms and/or severity of symptoms caused by Carukia spp.

OBJECTIVE

This article describes the updated current state of information on the ecology of jellyfish causing the Irukandji syndrome, introduces the new symptoms, and discusses some treatment regimens that may be effective. Problems associated with inappropriate treatment are also discussed.

DISCUSSION

To date there have been no reported deaths from Irukandji envenomation but there have been a number of patients who were probably only saved by high quality intensive care treatment. Research into the cause and treatment of this potentially devastating syndrome is hampered by lack of funding, although there are large costs to the taxpayers for retrieval and medical treatment of victims. These costs are analysed and presented.

A group approach to overcome loss. A model for a bereavement service in general practice

Unresolved bereavement can increase the incidence of depressive illness. GP consultation can increase following bereavement. Bereavement programmes can address the needs of this client group. This programme can be adapted for use by all members of the primary healthcare team.