Drowning is the leading cause of injury-related death in children. Drowning is defined as the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes are defined as “death,” “no morbidity” or “morbidity.” It is important to note that the terms “wet,” “dry,” “active,” “passive,” “silent,” “secondary” drowning and near-drowning are no longer be used. More than half of the drowning deaths of children 0 to 4 years old occurred in swimming pools. There are risks involved whether it is a portable, inflatable, permanent in-ground, or personal home pool, or a hot tub or a public pool in a residential area or at a hotel.
Guidelines that should be provided to parents and caregivers of children should be as follows:
There are many concerning misconceptions about home pool safety, including above-ground pools, inflatable pools, and infant swim lessons.
Recently, there has been an increase in the popularity of inflatable or portable large above ground swimming pools. These are typically between 18 to 48 inches deep, and some require filtration equipment. Many owners of these pools do not consider fencing to be necessary given the height of the pool. However, the pools with the soft-siding are a risk for a child leaning against the pool and falling in head first. Additionally, it has been shown that a child between 42 and 54 months of age can climb into a pool with a 48-inch wall, even with the ladder removed. Parents and caregivers should be made aware of these risks.
Infant swim lessons have controversially been shown on the internet as a way to prevent babies from drowning. Social media has provided a means of spreading videos of infants being submerged in water and then being able to recover and float on their back. These videos are concerning as they can give parents a false sense of security of the safety of their baby. There has been no scientific research to support that rolling over and floating on their back would prevent an infant from drowning.
Drowning leads to 372,000 deaths annually worldwide and severe morbidity secondary to asphyxiation or aspiration. A total of 12,529 weighted patients presented to emergency departments (ED) or submersion injury in 2013 yielding a rate of 9.29 per 100,000 ED visits.
End Organ Effects of Drowning
Fluid aspiration results in varying degrees of hypoxemia, and the water can wash out surfactant, effectively producing pulmonary edema and acute respiratory distress syndrome (ARDS). The hypoxemia causes anoxic brain injury and neuronal damage. In non-fatal drownings, arrhythmias can be seen secondary to hypoxemia. Sinus tachycardia, sinus bradycardia, and atrial fibrillation are the most common arrhythmias seen in this setting. Metabolic and respiratory acidosis is often seen initially in nonfatal drowning patients.
Upon presentation to the emergency department, resuscitative efforts should be made. In those patients who do not require intubation, supplemental oxygen should be applied. If necessary, positive pressure ventilation should be applied. A trauma evaluation should be performed when necessary and appropriate imaging studies should be considered.
Diving and jumping into pools provides an additional risk. Caregivers should always advise no running on a pool deck, and no jumping or diving where the depth of the water is unknown. One-third of diving injuries occur in swimming pools. This risk is especially high in above-ground pools. Patients who participate in competitive diving also put themselves at risk. A diver from a 10-meter board hits the water at a 64-kilometer-per-hour speed. Without proper training and supervision, this could cause significant injury.
There have been a number of studies that indicate that drowning is most common from May to August. Healthcare teams should engage in interprofessional action plans in the spring to prepare for the warmer weather and an increase in the risk of drowning. Brochures can be made for parents to explain the guidelines for pool safety. Members of the team in an outpatient setting can establish their role in providing face-to-face advice on water safety with parents and patients. Emergency department physicians and nurses should work together to have clear algorithms for drowning cases.
|||Weiss J, Prevention of drowning. Pediatrics. 2010 Jul [PubMed PMID: 20498167]|
|||Prevention of drowning. Pediatrics. 2010 Jul [PubMed PMID: 20498166]|
|||Quan L,Cummings P, Characteristics of drowning by different age groups. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2003 Jun [PubMed PMID: 12810745]|
|||El Sibai R,Bachir R,El Sayed M, Submersion injuries in the United States: Patients characteristics and predictors of mortality and morbidity. Injury. 2018 Mar [PubMed PMID: 29452731]|
|||Bierens JJ,Lunetta P,Tipton M,Warner DS, Physiology Of Drowning: A Review. Physiology (Bethesda, Md.). 2016 Mar [PubMed PMID: 26889019]|
|||Jones NS, Competitive Diving Principles and Injuries. Current sports medicine reports. 2017 Sep/Oct [PubMed PMID: 28902759]|