Scope of the Problem
In most industrialized countries, drowning ranks second or third
behind motor vehicles and fires as a cause of unintentional injury deaths to children
under the age of 15. In the United States, nearly 5,000 people die each year from
drowning, including 1,000 boating-related drownings. Death rates from drowning are
highest in children less than 5 years old and in teens and young adults 15-24 years.
It has been estimated that for each childhood drowning fatality,
about 4 children are hospitalized and 14 are seen in the emergency department and
released. However, among those sustaining immersion and losing consciousness, the
morality rate is as high as 50%. The outcome for most children with immersion is
determined by their status on arrival to the emergency department; medical and ICU
care appear to have relatively little impact on outcome. Contrary to popular notion,
most drownings do not involve loud thrashing or verbalization of distress. Hence,
prevention is key to decreasing morbidity and mortality from drowning.
Among children, the risks of drowning are age and, to some degree,
location-related. For infants, bathtub drowning poses the greatest hazard. Once
children attain mobility as toddlers, pools pose the greatest risk of immersion
injury. Certain interventions, such as floating pool covers (as opposed to externally-supported
rigid pool covers) may increase the risk of drowning in a pool. Pools continue to
play a role in drowning among young, school-age children, but immersion in natural
bodies of water either while swimming or boating plays an increasingly important
role as children move into adolescence. Among adolescents, alcohol use around water
has been found to be associated with as many as one-half of drowning incidents.
Unfortunately, while many studies have been done
on the incidence and epidemiology of drowning, few studies have evaluated intervention
programs for their effectiveness. In this review we examine 11 different potential
prevention strategies for child and adolescent drowning.