Perspectives in Disease Prevention and Health Promotion
Aquatic Deaths and Injuries -- United States
In 1980, 7,000 drownings, primarily associated with
recreational
activities, occurred in the United States. After motor vehicle and
fall deaths, drownings are the third leading cause of unintentional
injury deaths, and for ages 5 to 44, rank second only to motor
vehicle
deaths. Data show that death rates from drowning are more than
five
times greater for males than females (1) and nearly three times
greater for blacks than whites (2).
It is often assumed that most aquatic deaths occur in swimming
pools, but pools account for only about 10% of all reported
drownings;
persons are more likely to drown in lakes, rivers, or oceans.
Quarries, pits, ornamental ponds, and bathtubs add to the toll (3).
Residential home pools, however, do play a major role in childhood
drownings when toddlers fall or wander into them. There is strong
evidence that adequate fencing and self-latching gates
substantially
reduce the number of childhood drownings and virtually eliminate
drownings among toddlers (4-6).
Although no precise statistical data exist on the total number
of
water-related injuries, it is estimated that 140,000 injuries
associated solely with swimming activities occur annually (7).
Diving
and head-first sliding into water account for the most serious
aquatic
injuries because of damage to spinal cords, often as a result of
striking the bottom or side of a shallow body of water. Of the
estimated 700 spinal cord injuries resulting from aquatic accidents
each year, the majority are sufficiently serious to cause permanent
paralysis (8). A 10-year study of 152 sports-related cervical
spinal
cord injuries shows that three water-related activities--diving,
surfing, and water skiing--accounted for 77% of all reported spinal
injuries (9). Spinal cord injuries from diving alone exceed the
total
reported from all other sports combined (10).
The data below identify three additional factors that
significantly influence aquatic deaths and injuries:
In recent years, residential spa and hot tub use has
markedly
increased. In 1980, an estimated 1,100 persons with spa
or
hot tub injuries required emergency room treatment, as
compared with only 200 the previous year. Alcohol was
cited
as a contributory factor in 12 of 30 residential
spa-associated deaths reported to the Consumer Product
Safety
Commission since 1979 (11). The high temperatures of spas
and hot tubs combined with a moderate level of alcohol in
the
blood stream tend to accelerate drowsiness. Death often
results from drowning after a victim falls asleep (12).
Coast Guard data show that 7% of the boats involved in
mishaps lacked available and accessible personal
floatation
devices, but this 7% accounted for 29% of fatalities (3).
Onboard and overboard falls contributed from 20% to over
30%
of water-related fatalities, often when the victim was
undertaking an activity other than boating (e.g., fishing)
(3).
Many complex factors, both human and environmental, relate to
water safety, including pre-existing illness and alcohol. Alcohol
consumption is often cited as an indisputable factor in drowning
and
injury. One study showed that 47% of adults who drowned had
evidence
of alcohol in their blood (2). Many other studies support those
findings and indicate that positive blood-alcohol tests on drowning
victims are especially common, even among experienced swimmers.
A retrospective study to determine the epidemiologic features
of
recreational injuries and to identify intervention strategies to
reduce the incidence of such injuries was recently completed by the
Washington Department of Social and Health Services. Among its
epidemiological conclusions:
Aquatic recreational activities present a hazard for males,
generally
less than age 25. It is clear that the full spectrum of injury,
from
minor to death, is possible in aquatic activities. Depending on
the
age under discussion and the injury, the target problems change.
For
the young, swimming pools present the greatest aquatic hazard due
to
drownings. Private rather than public pools are more frequently
involved. Yet on an overall basis, swimming pools are not the
major
focal point for drowning prevention. The same appears true for
spinal
injuries. Here the target group is the diving teenager. The
behavioral implications as well as environmental controls are
evident
in most of the descriptive literature regarding aquatic injuries,
and
it is clear prevention strategy cannot ignore the realities of
either.
(3).
Reported by Environmental Health Svcs Div, Center for Environmental
Health, CDC.
Editorial Note
Editorial Note: A National Conference on Injury Control,
co-sponsored
by CDC and held at Johns Hopkins School of Hygiene and Public
Health
on May 18-19, 1981, (13) brought together 25 leaders in the
injury-control field. They represented public health and medical
schools, state and local health departments, and other public and
private agencies. The conference report suggests strategies or
approaches for transforming existing knowledge and technology into
measures that prevent injuries. Some of the suggested intervention
strategies to prevent aquatic deaths and injuries are:
Develop and implement standards that govern safe pool
design.
Require licensing for private and public pool construction
and ownership based on certain safety requirements,
including
adequate fencing and accessible rescue and resuscitation
equipment.
Require sign-posting in known hazardous-water areas
regarding
depth, undertow, or slippery banks.
Restrict the sale and consumption of alcoholic beverages
in
boating, pool, harbor, marina, and beach areas.
Impose sanctions for drunken boat drivers.
Integrate information into health department home-visit
programs to make parents aware of pool, pond, and bathtub
hazards.
Develop and institute programs for employees, who work in
or
near bodies of water, on how to recognize hazardous,
environmental conditions and about emergency procedures
that
reduce the consequences of water-related injuries (e.g.,
procedures for extrication).
Conduct surveillance programs using emergency medical
service
logs, lifeguard data, coroner's records, and data from
environmental groups, which are critical to evaluating the
effectiveness of interventions.
References
National Safety Council. Accident Facts, 1981. Chicago:
National
Safety Council.
Dietz PE, Baker SP. Drowning: epidemiology and prevention. Am
J
Public Health 1974;64:303-12.
Center for Environmental Health. Report: a model state
recreational injury control program. Atlanta: CDC, October
1981.
Milliner N, Pearn J, Guard R. Will fenced pools save lives? A
10-year study from Mulgrave Shire, Queensland. Med J Aust
1980;2:510-1.
Pearn J, Brown J 3d, Hsia E. Swimming pool drowning and
near-drownings involving children. A total population study
from
Hawaii. Milit Med 1980;145:15-8.
Pearn J, Wong R, Brown J 3d, Ching Y, Bart R Jr, Hammar S.
Drowning and near-drowning involving children: a five-year
total
population study from the city and county of Honolulu. Am J
Public Health 1979;69:450-4.
U.S. Consumer Product Safety Commission. Statistical Analysis
System Hazard Identification and Analysis, estimates report
(calendar year 1981). National Electronic Injury Surveillance
System (NEISS), U.S. Consumer Product Safety Commission,
Washington, D.C. (computer run, July 1982).
Gabrielsen MA. Diving's deadly toll. Paper. National
Environmental Health Association Conference, New Orleans, June
20,
1982.
Shields CL Jr, Fox JM, Stauffer ES. Cervical cord injuries in
sports. Physician and Sports Medicine, September 1978.
Gabrielsen MA, ed. Diving--producer of the most catastrophic
of
all sport-related injuries. A critical insight to the problem.
Huntington Beach, California: Council for National Cooperation
in
Aquatics and Aquatic Department of Indiana University, November
1979.
Brown V. Spa associated hazards--an update and summary.
Washington D.C.: U.S. Consumer Product Safety Commission, May
1981.
Environmental Health Services Division. Suggested health and
safety guidelines for public spas and hot tubs. Atlanta: Center
for Environmental Health, CDC, April 1981.
Teret SP, Baker SP, Trinkoff AM, DeFrancesco S, eds. Report of
the National Conference on Injury Control. (Johns Hopkins
School
of Hygiene and Public Health, May 18-19, 1981). Atlanta: CDC
1981.
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