5/13/ National Drowning Prevention Symposium, Pittsburgh, April Linda Quan Monday Plenary Presentation 1

Transcription

1 Drowning in Open Water Recreational settings Linda Quan, MD Seattle Children s Hospital Professor, Pediatrics University of Washington School of Medicine, Seattle, WA 1

2 Open Water Drowning Who drowns in OW? Who? Victim Why/What? Pre-drowning activities How to prevent OW drowning? What works? Evidence based interventions Consensus based recommendations International Task Force project Drowning Definitions Drowning Event during which airway is submerged in a liquid medium Drowned Died Survived No morbidity With morbidity Verboten!! near drowning, dry drowning, 2

3 70 Drowning Deaths in 1-24 yo USA, Swim Pool Open Water Bath Unspecified y 5-9y 10-14y 15-24y 3

4 Fatal Drowning rates by Site W. Washington State Deaths per million person-years Pools Outside Age in years Bathtubs Addressing cultural minorities: Vietnamese parents and teens: Attitudes, behaviors, beliefs around water safety Don t know how to swim or poor swimmers Swimming not a recreation in Vietnam Drowning is caused by ghosts, cramps Supervision is watching Prefer not to go where lifeguards are Believe children can swim unsupervised if they know how to swim or are old enough 4

5 Alcohol and Water Don t Mix Nearly half of adult males report drinking alcohol l (average 4 drinks) with aquatic activities Half of adult drowning deaths are BAC + Higher the BAC, the higher the risk of drowning death 5

6 Risk factors for open water drowning death Age: teen, young adult Gender: Males Nonwhite/ethnic minorities Alcohol use In water activities- swimming, X rivers Boating: No PFD use No Lifeguards Preventing open water drowning Education Swimming Water Hazards PFD use Alcohol use etc Intervention PFDs Mandatory boating ed Safe swim area Life guards Legislation Require PFD use Enforce BUI Ban alcohol Close waters 6

7 Consensus based guidelines to prevent open water recreation drowning May

8 Background Many people drown while recreating at open water settings 1. Learn swimming and water safety survival skills. (lakes, rivers, oceans) Background Drowning is a major cause of injury death for all ages. According to the WHO Global Burden of Disease estimates, people died in 2004 as a result of drowning around the world, of whom 45% were under the age of 20 years. 1 Global data show that approximately 28% of all unintentional injury deaths among children are due to drowning. 2 The drowning rate in low-income and middle-income countries is six times higher than in high-income countries (with rates of 7.8 per and 1.2 per respectively). 1 The majority of drownings occur in open water. 1. World Report On Child Injury Prevention, World Health Organization, Bierens, JLM, Editor. Handbook on Drowning. Springer-Verlag Berlin Heidelberg,

9 Background Organizations around the world provide different drowning messages. A concise and consistent set of prevention messages is needed. Formed a Task Force of international experts in drowning prevention. Target families and individuals recreating at open water The 18 Member International Task Force Co-Chairs: L Quan (USA), University of Washington School of Medicine and Seattle Children's Hospital K Moran (New Zealand), University of Auckland E Bennett (USA), Seattle Children s Hospital Members: S Beerman (Canada), J Bierens (Netherlands), BC Brewster (USA), J Connelly (Ireland), N Farmer (Australia), R Franklin (Australia), P George (Australia), J Kania (Kenya), B Matthews (Australia), A Rahman (Bangladesh), R Stallman (Norway), T Stanley (New Zealand), D Szpilman (Brazil), RMK Tan (Singapore), M Tipton (UK), Secretariat: M Tansik (USA) 9

10 Developing the set of Guidelines The Task Force addressed 5 questions: What hazards in the environment should I check for when I, my group, or my family goes to open water settings? What rules should I have for myself, my group or my family around open water? What kind of supervision should there be for children, teens and adults around open water? What skills should I or someone nearby have to protect myself or others around open water? What technology aids should I bring or make sure are available to aid drowning prevention in open water environments? Methods Created a list of guidelines which were placed into two groups: Keep Yourself Safe and Keep Others Safe. Prioritized the guidelines using a modified Delphi technique that consisted of two rounds of ranking the messages. Combined and approved wording of the final guidelines. 10

11 Results: 8 Final Guidelines for Take care of yourself 1. Learn swimming and water safety survival skills. 2. Always swim with others. 3. Obey all safety signs and warning flags. 4. Never go in the water after drinking alcohol. 5. Know how and when to use a life jacket. 6. Swim in areas with lifeguards. 7. Know the water and weather conditions before getting in the water. 8. Always enter shallow and unknown water feet first. Take care of yourself 1. Learn swimming and water safety survival skills 11

12 Take care of yourself 2. Always swim with others Take care of yourself Yourself Safe 3. Obey all safety signs and warning flags. 12

13 Take care of yourself 4. Never go in the water after drinking alcohol. Take care of yourself 5. Know how and when to use a lifejacket. 13

14 Take care of yourself 6. Swim in areas with lifeguards. LIFEGUARDs Following a drowning event In water Rescue Resuscitate Prevent drowning -- Decrease drowning risk behaviors 1:18 million risk (USLA) 5x risk without lifeguard 14

15 Take care of yourself 7. Know the water and weather conditions before getting in the water. Take care of yourself 8. Always enter shallow and unknown water feet first. 15

16 8 Final Guidelines for Keep Others Safe 1. Help and encourage others, especially children, to learn swimming and water safety survival skills. 2. Swim in areas with lifeguards. 3. Set water safety rules. 4. Always provide close and constant attention to children you are supervising in or near water. 5. Know how and when to use lifejackets, especially with children and weak swimmers. 6. Learn first aid and CPR. 7. Learn safe ways of rescuing others without putting yourself in danger. 8. Obey all safety signs and warning flags. Keep Others Safe 1. Help and encourage others, especially children, to learn swimming and water safety survival skills Photo credit: Centre for Injury Prevention and Research, Bangladesh (CIPRB) 16

17 Swimming lessons decrease children s drowning risk <5 year old children who had had swim lessons had significantly lower drowning risk than children with no history of swim lessons Older children with swimming lessons had less drowning risk Association was less strong; smaller numbers Brenner, 2009 Keep others safe 2. Swim in areas with lifeguards 17

18 Keep Others Safe 3. Set water safety rules Keep Others Safe 4. Always provide close and constant attention to children you are supervising in or near water 18

19 Keep Others Safe 5. Know how and when to use life jackets, especially with children and weak swimmers Keep Others Safe 6. Learn first aid and CPR 19

20 Keep Others Safe 7. Learn safe ways of rescuing others without putting yourself in danger Keep Others Safe 8. Obey all safety signs and warning flags. 20

21 Implications and Next steps Disseminate these guidelines to national and international organizations promoting water safety and to the general public Make the guidelines available in different languages Encourage organizations to adapt the guidelines to address their local open water settings and groups at risk for drowning Thanks! Contact Information: Elizabeth Tizzy Bennett: Kevin Moran: Linda Quan: To learn more: 21

22 What is good supervision? have sufficient maturity, respect for, and ability to enforce safety alert not under the influence of alcohol or drugs possess swimming skills appropriate to the venue being supervised know how to activate an emergency plan: where and how to call for help (location of lifeguard, phone/cellphone) can locate and use necessary safety equipment to perform non-swim rescues such as reaching and throwing assists recognize signs/behaviors of a person in trouble in the water know and perform CPR and first aid 22