Submersion Journal
Water is a necessity for survival. Our
beautiful state is surrounded by it. Unfortunately, because of our area’s
water-related injuries, the Office of the Medical Director has initiated an
injury surveillance program to study this preventable problem. Gathering
information about this injury through epidemiologic surveillance is our first
step toward a scientific understanding. Our system of data collection remains
simple in its design and approach so that the collection and analysis is not
difficult. It remains flexible, should conditions that may not have been
originally considered for inclusion may be added or modified.
It is our goal that this information helps
describe and clarify this preventable injury, as well as stimulates additional
interest in applying community prevention methods to this field of study.
Introduction
A National Problem:
Drowning is the fourth-leading cause of
unintentional injury deaths in the United States in 1994, surpassed only by
motor vehicle, solid/liquid poisonings and fall related deaths.
For children and youths age 1 to 24 years,
drowning was second to motor vehicle crashes, which accounted for 40% of the
50,505 total deaths of these persons in 1994. Drowning deaths per 100,000
population are greatest in the 0-4 year age group. The U.S. Department of
Health and Human Services set a national objective to reduce the crude death
rate for drowning from 3.2/100,000 persons in 1978, the baseline year to
1.5/100,000 persons in 1990
A State of Florida
Problem:
According to the Florida Bureau of Emergency
Medical Services, drowning takes the lives of approximately 400 people each
year. Residents of Florida accounted for 80% of the deaths, with the remaining
deaths occurring to visitors to our state.
Drowning is the leading cause of death for
young children in Florida, with 460 children age 0-4 years drowning in Florida
between 1992 and 1997. Of these children, 310 drowned in swimming pools, and
196 of these drowned in swimming pools other than at home. The pool was
frequently located at the residence of a grandparent, other relative, or
neighbor.
For older people in Florida, drowning is
also a significant cause of death. There were 448 deaths due to drowning in
this age group, and 31 of these persons had acute medical problems such as
Alzheimer’s disease, confusion, balance and/or vision impairment, heart
attack, or diabetes. Of these 448 people, 144 drowned in swimming pools. In
cases where it was documented, 52% of these older people fell into the swimming
pools and were not intending to be in the water when they drowned.
A Pinellas County Problem:
Between 1995 and 1998, an average of 60
persons each year experienced a water related submersion
accident here in Pinellas County. During this same time, an average of 15
persons drowned each year. The number of submersions increased from a low
of 40 to a high of 70 in 1997. The overall death rate from drowning increased
25% between 1995 and 1998, from a low of 1.3 deaths/100,000 in population in
1995 to a high of 1.7 in 1998.
Much of this increase occurred among
Caucasians age 0-5 years, African-Americans age 11-20 years, and other
nationalities ages 2-5 and 61+ years. The rate of drowning for males increased
20% between 1995 and 1998, whereas the rate for females increased 50%. For each
of these years, the death rate was nearly four times greater for males than for
females and three and one-half times greater for Caucasians than for
African-Americans.
The highest submersions occurred among
children less than five years of age, especially among 2-year-olds. Rates
generally declined with age; however, males ages 11-30 years as well as adults
61+ also had high rates.
After compiling our surveillance data over
the last four years, a clearer epidemiologic understanding of this problem is
better understood in the Pinellas County area. The numbers of submersions begin
to incline during the month of April, with the actual peak in the month of
July. They begin to decline after July and taper off by the end of September.
Over the four-year time span, this same 6-month period (April-September)
accounted for 193 or 74% of the 261 total incidents.
Methods of data collection
Data used to determine the number of
drownings and near drownings in Pinellas County for 1995-1998 were obtained
from surveillance performed by the Medical Communications Officer (MCO) and OMD
staff. Real-time feedback from the treating paramedic, communications center
personnel, and an information sharing relationship established between each
hospital in Pinellas County.
The Submersion
Journal, similar in structure to our Sudden Cardiac Arrest Event
Journal, follows the patient’s continued treatment pathway through the
hospital to determine their outcome. Some other important demographics we
include in our journal are:
- Patient age, sex and race
- Caretaker and activity of the caretaker when submersion
occurred
- Water type and temperature
- Total estimated submersion time
- Risk factors present at the scene
- Safety measures in place at location of incident
Our Injury Definitions:
Drowning- Death within the first twenty-four
hours (24) from the time of injury from suffocation due to submersion.
Near Drowning- Survival, at
least temporarily (twenty-four hours from near-suffocation due to submersion).
Our summary of information
excludes drownings related to motor vehicle crashes, suicides and
homicides, which together accounted for 21 incidents from 1995 through 1998.
Our
Results:
From the period of January 1, 1995 through
December 31, 1998, Pinellas County experienced 237 submersion-related
incidents. This reflects the following changes:
95-96 +50%
96-97 +17%
97-98 -3%
The high frequency of activity in the summer
suggests that climate is a causative factor in the accident. Discomfort caused
by summer heat probably leads to swimming in undesignated areas and in public
and private pools. Circumstances of drowning and the profile of a person who
has drowned vary by age, race, and sex. For instance, swimming pools have been
shown to present the greatest aquatic hazard for toddlers.
The administration of Cardio Pulmonary
Cerebral Resuscitation (CPCR), provided by either a bystander or family member
from January 1, 1998 through December 31, 1998, is 43%, compared to the 40% in
95, 50% in 1996 and 39% in 1997.
The purpose of this program is to 1)
describe the epidemiology of the submersion problem within Pinellas County,
Florida, and 2) Review progress made since 1997 toward the national objective,
and 3) recommend measures that will help attain this objective in our local
community.
It is important that information of this
nature be used to better understand our own local problem. Many different
intervention strategies exist today to assist in combating this injury. These
include:
- Developing and implementing standards that govern safe
pool design
- Establishing a home visit program to make parents aware
of pool dangers and other areas of potential injury
- Requiring sign postings regarding depth, undertow, or no
lifeguard on duty in known hazardous-water areas
- Before the seasonal trend, establishing multiple avenues
of community education, i.e. cable TV, frequent mailings, community clubs, etc.
- Requiring ownership education on certain safety
requirements
- Continuing to teach our community Cardio Pulmonary
Cerebral Resuscitation (CPCR)
- Isolating areas of the community that may need focused
attention
From prior years’ experience, such
programs have been instrumental in assisting in the reduction of such injury.
Currently, a grass roots
effort is being made both locally and at the State level to form committees to
combat this problem. Our office continues to work closely with Pinellas County
Public Affairs in sharing this information.
We are happy to report that a local group of
interested educators, prevention specialists, and other interested parties have
formed the West Coast Florida Drowning Prevention Coalition. This group has
initiated a renewed effort in having our local fire departments conduct free
home pool safety surveys, and in producing public education material. Our
office has joined this effort and will continue to provide information. After
meeting with the group several times, we learned of the interest the Pinellas
County Public Health (PCPH) officials have in learning more about the
submersions that have occurred in a commercial pool, as they are required to
inspect them.
We have since added this information to the
Submersion Journal. The Medical Communications Officer (MCO) will now notify
the PCPH for all submersions involving commercial property in Pinellas County.
The Need for More Information
Our office has met with Dr. Mark Nicter,
Pediatric Specialist at All Children’s Hospital, about forming a
partnership in collecting information about the causative factors that have
been responsible for this injury. We have discussed with him the potential of
receiving the neurological outcomes associated with toddler submersion and the
long and short-term prognosis with associated costs of continued care. He
remains interested in working with us; however, some of the information may be
unobtainable.
We believe our joint
relationship with the hospital will provide us a more complete understanding of
the injury, the long-term prognosis of the injured, the associated medical
costs, and any additional information to better educate our public.
We remain interested in tracking the free
home pool safety survey information, as it will provide public education once
disseminated.
We remain committed to sharing this
information and becoming a clearinghouse for gathering additional project
information
References:
1. National Safety Council Accident Facts,
1997 Edition
- Website for the National Spa and Pool Institute (http://www.nspi.org/)
- State Bureau of EMS. "Drowning in Florida",
January 1992-1997
- OMD Trauma Journal, 1998
|
