Publications

Lifeguard Effectiveness

Most drownings occur at unguarded sites, according to an October 2001 report by CDC’s Injury Center . This report assessed lifeguard services as a strategy for preventing drowning and water-related injuries. Data from 1988–1997 show more than three-quarters of drownings at U.S. Lifesaving Association (USLA) sites (mostly ocean beaches) occurred when beaches were unguarded. In contrast, the chance of drowning at a beach while it is being protected by lifeguards trained under USLA standards is less than 1 in 18 million. These findings underscore the importance of having trained lifeguards at all beaches where people swim. This report will help communities, local government officials, and owners of private water recreational areas make informed decisions about whether to begin, retain, or discontinue lifeguarding services.

2001 Report

Branche CM, Stewart S, editors. Lifeguard effectiveness: A report of the working group. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2001.

2015 Book Chapter

This report was updated and summarized for a chapter of the 2016 book, The Science of Beach Lifeguarding.

Gilchrist J, Branche C. Lifeguard Effectiveness. In: Tipton M, Wooler A, ed. The Science of Beach Lifeguarding. Boca Raton: CRC Press, 2016.

CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 year olds in the United States, 2000-2006.

Unintentional injuries, including drowning, are the leading cause of morbidity and mortality among children in the United States.  This report uses data from the National Vital Statistics System and the National Electronic Injury Surveillance System – All Injury Program to provide an overview of fatal and nonfatal unintentional injuries related to drowning, falls, fires or burns, transportation-related injuries, poisoning, and suffocation.  Results are presented by age group and sex, as well as geographic distribution of injury death rates by state.  The drowning death rate among children 0-19 year of age was 1.4 per 100,000, second only to transportation.  Drowning rates varied by gender with a rate of 2.0 per 100,000 among males and 0.8 per 100,000 among females.  Drowning rates varied by age group with the highest rates among children 1-4 years of age at 3.0 per 100,000; among this group, drowning represented 27% of all unintentional injury deaths.

Borse NN, Gilchrist J, Dellinger AM, Rudd RA, Ballesteros MF, Sleet DA. CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 year olds in the United States, 2000-2006.  Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2008.

Racial/Ethnic Disparities in Fatal Unintentional Drowning Among Persons Aged ≤29 Years — United States, 1999–2010

In the United States, almost 4,000 persons die from drowning each year (1). Drowning is responsible for more deaths among children aged 1–4 years than any other cause except congenital anomalies (2). For persons aged ≤29 years, drowning is one of the top three causes of unintentional injury death (2). Previous research has identified racial/ethnic disparities in drowning rates (3,4). To describe these differences by age of decedent and drowning setting, CDC analyzed 12 years of combined mortality data from 1999–2010 for those aged ≤29 years. Among non-Hispanics, the overall drowning rate for American Indians/Alaska Natives (AI/AN) was twice the rate for whites, and the rate for blacks was 1.4 times the rate for whites. Disparities were greatest in swimming pools, with swimming pool drowning rates among blacks aged 5–19 years 5.5 times higher than those among whites in the same age group. This disparity was greatest at ages 11–12 years; at these ages, blacks drown in swimming pools at 10 times the rate of whites. Drowning prevention strategies include using barriers (e.g., fencing) and life jackets, actively supervising or lifeguarding, teaching basic swimming skills and performing bystander cardiopulmonary resuscitation (CPR). The practicality and effectiveness of these strategies varies by setting; however, basic swimming skills can be beneficial across all settings.

Gilchrist J, Parker EM. Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤29 years—United States, 1999–2010. MMWR 2014;63:421–6.

Drowning — United States, 2005–2009

Drowning is a leading cause of unintentional injury death worldwide, and the highest rates are among children. Overall, drowning death rates in the United States have declined in the last decade; however, drowning is the leading cause of injury death among children aged 1–4 years. To update information on the incidence and characteristics of fatal and nonfatal unintentional drowning in the United States, CDC analyzed death certificate data from the National Vital Statistics System and injury data from the National Electronic Injury Surveillance System – All Injury Program (NEISS-AIP) for 2005–2009. The results indicated that each year an average of 3,880 persons were victims of fatal drowning and an estimated 5,789 persons were treated in U.S. hospital EDs for nonfatal drowning. Death rates and nonfatal injury rates were highest among children aged ≤4 years; these children most commonly drowned in swimming pools. The drowning death rate among males (2.07 per 100,000 population) was approximately four times that for females (0.54). Racial/ethnic disparity in drowning death rates was greatest among children aged 5–14 years (blacks, 1.34; Hispanics, 0.46; and whites, 0.48). From 2005 to 2009, death rates declined significantly from 1.34 per 100,000 to 1.25 (p=0.002). Half (50.2%) of the ED patients required hospitalization or transfer for further care. In addition, of nonfatal drowning injuries among those aged ≥15 years, 21.8% were associated with alcohol use. To prevent drowning, all parents and children should learn survival swimming skills. In addition, 1) environmental protections (e.g., isolation pool fences and lifeguards) should be in place; 2) alcohol use should be avoided while swimming, boating, water skiing, or supervising children; 3) lifejackets should be used by all boaters and weaker swimmers; and 4) all caregivers and supervisors should have training in cardiopulmonary resuscitation.

Laosee OC, Gilchrist J, Rudd RA. Drowning — United States, 2005–2009. MMWR 2012: 61(19);344-347.

Vital Signs: Unintentional Injury Deaths Among Persons Aged 0–19 Years — United States, 2000–2009

Unintentional injuries are the leading cause of death in the United States for persons aged 1–19 years and the fifth leading cause of death for newborns and infants aged <1 year. This report describes 10-year trends in unintentional injury deaths among persons aged 0–19 years. CDC analyzed 2000–2009 mortality data from the National Vital Statistics System by age group, sex, race/ethnicity, injury mechanism, and state. From 2000 to 2009, the overall annual unintentional injury death rate decreased 29%, from 15.5 to 11.0 per 100,000 population, accounting for 9,143 deaths in 2009. The rate decreased among all age groups except newborns and infants aged <1 year; in this age group, rates increased from 23.1 to 27.7 per 100,000 primarily as a result of an increase in reported suffocations. The poisoning death rate among teens aged 15–19 years nearly doubled, from 1.7 to 3.3 per 100,000, in part because of an increase in prescription drug overdoses (e.g., opioid pain relievers). Childhood motor vehicle traffic–related death rates declined 41%; however, these deaths remain the leading cause of unintentional injury death. Drowning death rates decreased 28% from 1.6 to 1.2 per 100,000; however, drowning has become the leading cause of injury death among children 1-4 years of age. Among states, unintentional injury death rates varied widely, from 4.0 to 25.1 per 100,000 in 2009.

Gilchrist J, Ballesteros MF, Parker EM. Vital Signs: Unintentional Injury Deaths Among Persons Aged 0–19 Years — United States, 2000–2009. MMWR 2012: 61(15);270-276.

Nonfatal and Fatal Drownings in Recreational Water Sites— United States, 2001–2002

During 2001–2002, an estimated 4,174 persons on average per year were treated in U.S. hospital emergency departments (EDs) for nonfatal unintentional drowning injuries in recreational water settings. About 53% required hospitalization or transfer for specialized care. In 2001, 3,372 persons suffered fatal unintentional drownings in recreational settings. Nonfatal and fatal injury rates were highest for children ages 4 years and younger and for males of all ages. To reduce drownings, environmental protections (e.g., isolation pool-fences and lifeguards) should be adopted; alcohol use should be avoided while swimming, boating, water skiing, or supervising children; and all participants, caregivers, and supervisors should know water-safety skills and be trained in cardiopulmonary resuscitation (CPR).

Gilchrist J, Gotsch K. Nonfatal and Fatal Drownings in Recreational Water Settings— United States, 2001–2002. MMWR 2004;53(21);447-52.

Prevalence of Pools and Adequate Pool Fencing in the United States, 2001-2003

Nearly 15% (16.3 million) U.S. households reported access to a swimming pool at their residence; only 74% were reported to be adequately fenced (i.e., four-sided scale-resistant fence, completely separating the pool area from the house and yard, with self-closing, self-latching gate) .  Household factors associated with adequate pool fencing included: lower income, renting the residence, and residing in a building with multiple units or an attached house.  An estimated 488,633 households with pool access, where the family owns the residence and has children less than 5 years old, were not adequately fenced.  Between 1994 and 2001-2003, the percentage of pools that were adequately fenced did not change substantially.  This study highlights that need for continued efforts to target families with young children with drowning prevention interventions that include and emphasize adequate pool fencing.

Gilchrist J, Mack K. Prevalence of Pools and Adequate Pool Fencing in the United States, 2001-2003.  IJARE 2008;2(1);16-26

Injury Control and Risk Survey: Assessment of Self-reported Swimming Ability

CDC Injury Center researchers analyzed data collected during the first Injury Control and Risk Survey to assess how well American adults reported they could swim. Younger respondents reported greater swimming ability than older respondents, and self-reported ability increased with level of education. Among racial groups, African Americans reported the most limited swimming ability. Men of all ages, races, and educational levels consistently reported greater swimming ability than women. Men also have much higher drowning rates. These data will help public health practitioners identify groups at greater risk for drowning and better target water safety messages and swimming education efforts.

Gilchrist J, Sacks JJ, Branche CM. Self-reported swimming ability in U.S. adults, 1994. Public Health Rep 2000;115(2–3):110–1.