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Fatal Drownings: A Public Health Problem?

November 21, 2022

Written by Aaron Lacy

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Drowning is a common cause of death worldwide. The duration of submersion is the best predictor of outcome, with immediate on-scene CPR and ventilation improving outcomes. Prevention is the best medicine, with public health intervention and policy being the most effective way to prevent drowning.

Why does this matter?
Underreporting limits the true scope of the problem, but drowning is the leading cause of death in toddlers aged 1-4 in the United States and is of particular concern in low- to middle-income countries where 90% of all fatal drownings occur. This number is only expected to go up as evidence shows that climate change will lead to an increase in deaths from drowning.

Keeping heads above water
90% of all fatal drownings occur in low- and middle- income countries. Up to a third of all fatal drownings are associated with recreational water activates under the influence of alcohol, the commercial fishing industry, and weather events (hurricanes, tsunamis, and flooding) making up other major contributors to fatal drowning.

Immediate bystander and EMS CPR, in particular early ventilation, improves outcomes in the drowning victim. The duration of submersion is the most important variable in predicting outcomes after a drowning event. The evidence behind management of the drowning victim after arrival to the hospital is based mostly in expert opinion. If hypoxemia, hypercarbia (pCO2 > 50 mmHg), or acidosis is found, patients may require intubation. Children who present with normal mentation after a drowning event and maintain normal vital signs and oxygenation for 6 hours can be considered for discharge. 

We often focus on patients after arrival to the hospital, but drowning truly is a public health problem, with evidence-based approaches to prevention. Overall, there has been an overreliance on education to prevent drowning when there is clear evidence that environmental modifications are more effective. Legislation that requires proper infrastructure around water, such as bridges over rivers, fences around pools, and requiring piping of water have been shown to be highly effective in reducing drowning deaths. There is some hope that drones carrying flotation devices can be effectively employed in the future.

As medical experts we should be using our knowledge and experience to help drive public policy and protocols. Think about how you can help facilitate change to prevent drowning in your community.

Prevention of and Emergency Response to Drowning. NEJM 2022 Oct 6. Doi:10.1056/NEJMra2202392

What are your thoughts?