Epidemiology

Drowning is the third leading cause of accidental death in the United States, killing about 4500 people each year. Although the exact number is uncertain, many more individuals survive serious near-drowning episodes.

Freshwater drowning, especially in pools, is more common than saltwater drowning, even in coastal areas. There is a bimodal age distribution, with large numbers of deaths among children under age 4 and then later among teenagers, although risk climbs again in the elderly from bathtub drowning. Young children are also at risk for drowning in a bathtub, even in the presence of siblings, and neglect or intentional injury should be considered in such cases. 1 Responses to a careful history may change over time and reveal inconsistencies, especially in regard to developmental age. Caretakers must ensure constant attention by an individual of appropriate age.

Alcohol or drug use by victims or even by supervising adults often plays a role in drowning and boating accidents. Consistent use of personal flotation devices by adults and children when boating is crucial. Children may be oblivious to potentially dangerous situations, especially in rivers and lakes. Some cases follow traumatic injury in or around the water, including spinal injury. Hypothermia is a factor in some drownings, while causes of syncope, including hyperventilation before underwater swimming, are responsible for a few cases. Patients with seizure disorders must receive careful supervision if swimming and should, depending on seizure control, probably bathe in showers or tubs with open drains and plastic stalls. This patient education is important when first-time seizure patients are discharged from emergency departments.

Drowning deaths may be prevented by adequate, well-maintained fencing with self-locking gates that surrounds pools themselves, rather than simply isolating the backyard, leaving access to the pool from the house and yard. However, fencing is not a complete answer.2 Childhood pool drowning occurs rapidly and silently, and caretakers must not be diverted by chores, socializing, telephone calls, or other seemingly momentary distractions. Cardiopulmonary resuscitation (CPR) is frequently not started by rescuers, and pool owners should be encouraged to learn CPR and have telephones in the pool area. Swimming lessons for young children are controversial. Toddlers cannot understand their true skill level, nor the danger posed by water, nor do they have the strength to exit a pool. Swimming lessons, or more accurately, floating lessons, may induce a dangerous false sense of security among caretakers, putting the child at even more risk. On the other hand, there is evidence that trained children entering the water accidentally may have the skill to remain on the surface longer. 3

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