A critical assessment of the diatom test of rib bone marrow as a supporting procedure in the case of drowning.

Diatoms (Bacillariophyta), being single-celled photosynthetic organisms, are widely distributed in aquatic ecosystems around the globe. Their exoskeletons are resistant to most environmental factors as well as chemical reagents in laboratory settings. Moreover, the ornamentation featured on exoskeletons can be used to identify individual diatomaceous species. As a result, the detection of diatoms in the internal organs, and especially rib marrow, of corpses found in water can serve as an important tool for diagnosing drowning as the cause of death as long as passive postmortem penetration of diatoms into those organs is excluded. In the environmental experiments described in this paper, diatoms were detected in rib marrow only when contamination resulted from a mechanical breach of bone integrity and structure, irrespective of the residence time of bone material in the aquatic environment. Our research suggests that the presence of diatom in the rib marrow may be the gold standard in the diagnosis of drowning in the future. Our animal model research dispels one of the doubts, such as the possibility of passive penetration of diatoms into the bone marrow, which is still under discussion in the forensic medicine community.

Drowning incidents precipitated by unusual causes (DIPUCs): A narrative review of their diagnoses, evaluation and management.

Drowning is a cause of significant morbidity and mortality worldwide. In most circumstances, the proximate cause is attributable to human factors, such as inexperience, fatigue, intoxication, or hazardous water conditions. The phenomenon of drowning incidents precipitated by unusual circumstances (DIPUCs) - either fatal or nonfatal - involving otherwise healthy individuals under generally safe conditions has not been comprehensively addressed in the medical and drowning literature to date. In this review, we discuss etiologies of DIPUCs, diagnostic clues, suggested workup, suggested postmortem testing, and implications for surviving patients and families. Identifying the cause of a drowning incident can be extremely challenging for the initially treating physician, relying perforce on historical context, environmental clues, physical exam, medical history, eyewitness accounts or video recordings. If no clear explanation for a drowning incident emerges despite a thorough investigation, clinicians should consider some of the less common diagnoses we describe in this paper, and, when appropriate, refer for an autopsy with postmortem molecular genetic testing. While time-consuming, these efforts can prove life-saving for some non-fatal drowning victims and the families of all victims of DIPUCs.

Next-Generation swimming pool drowning prevention strategy integrating AI and IoT technologies.

Drowning, as a leading cause of unintentional injury-related deaths worldwide, is a major public health concern. Swimming pool drowning is the main cause of most drowning incidents, and even with preventive measures such as surveillance cameras and lifeguards, tens of thousands of lives are lost to drowning every year. To address this issue, technology is being utilized to prevent drowning accidents and provide timely alerts for rescue. This paper explores the use of drowning prevention technology in embedded systems within enclosed environments, artificial intelligence (AI), and the Internet of Things (IoT) to decrease the likelihood of drowning incidents. Embedded systems play a critical role in such technology, enabling real-time monitoring, identification of dangerous situations, and prompt alerting. Due to their ease of installation and technical implementation, embedded devices are especially effective as drowning prevention devices. The image recognition capabilities of drowning prevention systems are enhanced through computer vision. Swimming pool drowning situations can be identified with the help of cameras and deep learning technologies, thereby increasing rescue efficiency. Finally, the IoT endows drowning prevention systems with comprehensive intelligence by connecting various devices and communication tools. Real-time alert transmission and analysis have become possible, enabling the early prediction of dangerous situations and the implementation of preventive measures, significantly reducing drowning incidents. In summary, the integration of these three types of drowning prevention technologies represents significant progress. The flexibility, accuracy, and intelligence of drowning prevention systems are enhanced through the incorporation of these technologies, providing robust support for safeguarding human lives and thus potentially saving tens of thousands of lives each year.

Characteristics of drug-related deaths where individuals are found submerged in a bath or hot tub in the United Kingdom, 1997-2023.

INTRODUCTION: Recent media reports highlight that drug-related fatalities can occur while individuals are immersed in water in domestic settings. We aimed to determine the case characteristics, circumstances of death and type of implicated drugs among individuals dying due to unintentional drug-related causes found immersed in a bath or hot tub. METHODS: Retrospective cohort study in the United Kingdom using coronial records from the National Programme on Substance Abuse Deaths, 1997-2023. Information was available on decedent socio-demographics, characteristics of death and drugs implicated in death. RESULTS: One hundred fifty-six decedents were found immersed in the bath and six in a hot tub, a mean of 6.4 deaths per year (SD 3.7; range 1-13). Overall decedents were predominantly male (n = 94, 58.0%), of White ethnicity (n = 98, 60.5%) with a mean age of 40 years (SD 13; range 19-74). Only 12 decedents had any physical contributory factor to death other than poisoning or drowning. The median number of drugs detected at post-mortem was 3 (interquartile range 2, 5) with multiple drug toxicity implicated in the majority of cases (n = 90, 55.6%). The most common implicated drugs were heroin (n = 53, 32.7%), alcohol (n = 46, 28.4%) and cocaine (n = 33, 20.4%). DISCUSSION AND CONCLUSIONS: Over the last two decades in the United Kingdom there have been consistent numbers of unintentional drug-related deaths each year where individuals were found in a bath or hot tub. Polysubstance, opioid and alcohol use are overrepresented. Targeted advice to avoid bathing while intoxicated would appear to be an appropriate harm reduction message.

Child drowning in Indonesia: insights from parental and community perspectives and practices.

Child drowning is a significant public health issue in Indonesia, however, there is insufficient understanding of the issue and its associated risk factors within communities. This qualitative study aimed to explore parental and community perceptions and practices related to child drowning in Indonesian communities, and the perceived causes and risk factors. Seven focus group discussions (n = 62) were conducted with parents of children aged under-5 years and village community leaders in seven villages across all districts of Lombok Island, West Nusa Tenggara Province of Indonesia. Participants were recruited using purposive and snowball sampling. The thematic analysis, guided by Braun and Clarke's framework, used both deductive approaches, utilizing the Health Belief Model's constructs and inductive approaches. Most participants were unaware of the susceptibility of their children and others in their community to drowning and of the potential severe outcomes of drowning such as injury, disability and death. Participants generally associated drowning with beaches or open seas. Unprotected wells, tubs and buckets were identified as notable risk factors for child drowning in and around the home, shaped by some experience of child drowning incidents in the community. Supervision was identified as protective factor, however, mothers were often unavailable to supervise children, and supervision responsibility was often delegated to other family and community members. This study highlights the urgent need to enhance public awareness regarding children's susceptibility to drowning. Further exploration of local contexts and social determinants of drowning in Indonesian communities is crucial for ensuring effective water safety and drowning prevention strategies.

National trends in pediatric drowning - insights from the Israeli Ministry of Health registry-based cohort.

This study analyzes the epidemiology of pediatric drowning in Israel from 2010 to 2022, focusing on differences across age groups, sex, and regions. We conducted a retrospective cohort study using data from the Ministry of Health's administrative databases, covering all children aged 0-17 years who were seen in the emergency department, discharged after hospitalization, or died at the scene due to drowning, excluding cases of intentional harm or suicide. The primary outcome was the annual drowning rate per 100,000 children, categorized by age, sex, and region, along with hospitalization duration, intensive care unit admissions, and mortality rates. A total of 2101 drowning incidents were identified, with 9% resulting in death. Higher drowning rates were found in younger children (1-4 years) and teenagers (15-17 years), with notable differences by sex. Drowning rates were higher in coastal regions and more frequent during winter and spring. An increase in drowning rates was observed over the last 3 years of the study (2020-2022). Children hospitalized for more than 3 days had significantly higher mortality rates, both in general wards and intensive care units. CONCLUSIONS: Pediatric drowning is a persistent public health concern in Israel, with distinct seasonal, regional, age-specific, and sex-specific patterns in incidence and mortality. This study underscores the need for a comprehensive prevention strategy that includes year-round public education, environmental safety measures, and targeted interventions for high-risk groups to reduce drowning incidents and fatalities among children effectively. WHAT IS KNOWN: • Pediatric drowning represents a significant public health challenge globally, with varying rates. • In Israel, pediatric drowning is the second leading cause of death from all injury-related deaths. Thus far, the measures and interventions to reduce fatalities were not proven effective enough. WHAT IS NEW: • Pediatric drowning in Israel, with a 9% mortality rate, revealed a biphasic rate varied by sex and is higher in coastal regions and during winter and spring. • There was a notable increase in drowning incidents during the last 3 years of the study period (2020-2022), coinciding with the COVID-19 pandemic.

Turn Around, Don't Drown: A Systematic Review of Risk Factors for Motor Vehicle-Related Drowning in Floods and its Preventive Strategies.

OBJECTIVE: Exposure to flood, one of the most widespread disasters caused by natural hazards, increases the risk of drowning. Driving through flooded waterways is a cause of death due to flood-related drowning, especially in flood-prone areas. This study aimed at identifying the risk factors for motor vehicle-related drowning in floods and its prevention strategies. METHODS: International and national databases (WOS, PubMed, Scopus, Google Scholar, Magiran, and SID) were searched in the time span from 2000 to 2022. The studies investigating the risk factors relevant to land motor vehicle-related drowning in floods and its prevention strategies were included and analyzed using thematic content analysis. RESULTS: In 14 eligible studies, risk factors for land motor vehicle-related drowning in floods were identified and categorized in 3 subthemes: driver (3 categories: socio-demographic characteristics, knowledge and attitude, and beliefs); technology (1 category: land motor vehicles); and environment (2 categories: physical and socio-economic environment). Physical and structural measures (1 category: road safety improvement) and nonstructural measures (4 categories: research and education and raising awareness, risk management, promoting social-cognitive beliefs, and reconstruction and improvement of legal infrastructure) were proposed as drowning prevention strategies. CONCLUSIONS: The knowledge, attitude, and belief of the driver; the vehicle; and the environment were the most important risk factors of driving through flooded waterways. These factors should be considered when designing programs and physical and structural strategies for future interventions to curb this dangerous and potentially fatal driving behavior.

Auditing learner driver information about floodwaters: An environmental scan of government issued resources in Australia.

INTRODUCTION: Vehicles driving, or being swept, into floodwaters is a leading cause of flood-related death. Establishing safe behaviors among learner drivers may reduce risk throughout their driving lifetime. METHODS: An environmental scan of publicly available government issued learner and driver handbooks across the eight Australian jurisdictions was conducted to identify information provided regarding floodwaters. Search terms included 'flood,' 'rain,' 'water,' and 'wet.' A visual audit of flood-related signage was also conducted. RESULTS: Twelve documents, across eight jurisdictions, were analyzed. Four jurisdictions' documents provided no information on flooding. Of the four jurisdictions that provided information, content varied. This included highlighting risks and discouraging entering floodwaters in a vehicle, including penalties associated with travel on closed roads, to advising depth and current checks if crossing a flooded roadway, with recommendations based on vehicle size (preference given to bigger vehicles, i.e., 4wds). Information on flood-related signage was found in one jurisdiction. DISCUSSION: Learner and driver handbooks represent a missed opportunity to provide flood safety information. Currently, information is not provided in all jurisdictions, despite flood-related vehicle drowning deaths of drivers and passengers being a national issue. Where information is presented, it is limited, often lacks practical guidance on how to assess water depth, current, and road base stability, and could better use evidence regarding the psychological factors underpinning, and behavioral prompts for performing, or avoiding, risky driving behavior during floods. CONCLUSIONS: The provision and content of information in learner driver and driver handbooks must be improved, particularly within the context of increasing flooding and extreme weather associated with the effects of climate change. PRACTICAL APPLICATIONS: We encourage all jurisdictions to provide practical information that draws on evidence-based risk factors and empirically established psychological factors for behavioral change to help establish safe driver behaviors around floods in the formative years of learning to drive.

Homicide by drowning: a literature review and analysis of three cases.

Background: Homicide by drowning in adults is rare. Usually, marks of violence are found on both the victim and the perpetrator, unless the victim was under the influence of alcohol, drugs, or was unexpectedly forced or dragged into the water. Indeed, many cases of drowning in adults are believed to be accidental, but they may be the result of drunken fights or attempts to make the death appear ac-cidental. In order to define the manner of death, cooperation between the forensic pathologist and the investigators is mandatory. Indeed, the autopsy is important to distinguish homicide by drowning from other kinds of drowning. The purpose of this study is to highlight the features of homicide by drowning. Materials and Methods: Literature search was conducted using PubMed databases, using the following keywords: "(homicide) and (drowning)". 3 articles were included in the systematic review, in addition to 3 cases observed in our institute. Conclusions: Both external examination and autopsy findings and the results of the investigation are essential to differentiate a homicide by drowning from accidental ones. The low specificity and variability of external and internal findings, the possibility of atypical asphyctic and nonasphyctic pathophysiological mechanisms, whose nature is not detectable at postmortem examinations, makes the diagnosis of cause of death difficult and often based on exclusion criteria only. In complex cases only using a strict forensic method allows to use the essential tools to identify the real manner of death.

Gaps in Education: A Cross-Sectional Survey Study of Knowledge of Advanced Lifesaving Interventions among Canadian Lifeguards.

Objective: The aim of this study was to assess lifeguards' knowledge retention of airway management, oxygen administration, and ventilation interventions following certification and employer-provided training. Methods: This cross-sectional study was conducted using an online survey administered between February and May 2024. A total of 1322 responses from Canadian lifeguards certified in airway management and oxygen administration were deemed eligible for analysis. The survey included 15 knowledge assessment questions, with data analyzed based on lifeguard experience and the date of last certification or in-service training. Results: The mean knowledge assessment score was 10.4 ± 2.2 (69.3 ± 14.6%), with the highest scores in the airway management category and the lowest in the oxygen administration category. Lifeguard experience significantly increased knowledge retention, whereas recertification showed no significant impact, and employer-provided training significantly decreased knowledge retention. Conclusions: The findings underscore the importance of lifeguarding experience in knowledge retention among lifeguards. Optional airway management and oxygen administration recertification, coupled with inconsistent in-service training, have created significant gaps in lifeguard education. This study identifies the need for regular, competency-based training delivered by qualified facilitators. Addressing these gaps is crucial for enhancing the effectiveness of lifeguards in emergency response and ensuring high-quality care for drowning victims.

Goggle-free swimming as autonomous water competence from the perspective of breath control on execution of a given distance.

This study aimed to examine the ability of adolescents to maintain breathing rhythm while swimming with and without goggles, in the context of pedagogical interventions for implementation of water competence skills, rather than simply teaching swimming technique (strokes). 25 females and 25 males, 12-13 years old, swam the front crawl both with goggles and without goggles. Distance covered and the ability to maintain breathing rhythm were evaluated by experts. For both girls and boys, the lack of goggles reduced the breath control. The boys in contrast to the girls, could "swim" (cover a distance) but did not have the "competence" to swim effectively/safely-with breathing rhythm-regardless of the goggle factor. Goggle-free swimming as an autonomous component of water competence is highly recommended in elementary swimming education. The following elements for pedagogical intervention in the area of water competence development are proposed: (1) the formatting of breath control on the basis of the student's preferred, simplest form of swimming (not strokes); (2) the a priori treatment of swimming goggles as an unnecessary teaching aid; (3) the gender differences in area of both adaptation in visual perception (the goggles factor) and motor control (breath control factor) should be considered.

Population-based study of factors associated with severe paediatric drowning events in Maryland.

INTRODUCTION: Paediatric drowning is an injury associated with significant morbidity and mortality. OBJECTIVE: The objective is to describe drowning trends, including associations with inpatient hospitalisation or fatality, in a state-wide paediatric cohort to inform prevention strategies. METHODS: In this retrospective cohort study using the Health Services Cost Review Commission database, we used International Classification of Diseases, Tenth Revision (ICD-10) codes to identify patients aged 0-19 years with an outpatient (including emergency department) or inpatient medical encounter following a non-fatal or fatal drowning event between 2016 and 2019. Descriptive statistics and logistic regression were used to summarise the data and evaluate associations with inpatient hospitalisation or fatality. RESULTS: There were 541 medical encounters for drowning events, including 483 non-fatal outpatient encounters, 42 non-fatal inpatient encounters and 16 fatal cases. Overall, most patients were boys, 0-4 years, white and lived in urban settings. White children accounted for 66% of encounters among those aged 0-4 years, whereas non-white children accounted for 62% of visits among those aged 10-19 years. Non-white children were more likely than white children to experience a fatal drowning (OR 3.6, 95% CI: 1.2 to 11.5). Adolescents were more likely than younger children to be hospitalised (OR 3.1, 95% CI: 1.6 to 6.5) and had higher charges in outpatient (p=0.002) and inpatient settings (p=0.003). DISCUSSION: Our study revealed high fatality rates among non-white children and high admission rates among adolescents.

Prehospital guidelines on in-water traumatic spinal injuries for lifeguards and prehospital emergency medical services: an international Delphi consensus study.

BACKGROUND: Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed. METHODS: An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75-85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2. RESULTS: Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90-95%). The integral flowchart received strong consensus (93%). CONCLUSIONS: This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.

The Use of Unmanned Aerial Vehicles to Assist Lifeguards Identifying, Preventing, and Rescuing: A Systematic Review.

When dealing with drowning scenarios, time is of capital importance. In this sense, the search for innovative strategies that provide more effectiveness and safety for lifesaving professionals, as well as for bathers, is essential. The aim of this study was to systematically review the feasibility and effectiveness of unmanned aerial vehicles as a tool to assist lifeguards in performing their duties. A systematic literature search was conducted in October 2023 across the databases PubMed, Web of Science, Academic Search Complete, and Scopus, using the search terms: ((drone) OR (Unmanned Aerial Vehicles)) AND ((drowning) OR (water rescue)). A total of 5 studies were included in this review, whose quality ranged from moderate to strong, according to the EPHPP Quality Assessment Tool for Quantitative Studies. The results suggest that unmanned aerial vehicles may assist lifeguards in the prevention, detection, and rescue of drowning victims and people in distress in the water. Although preliminary, evidence suggests that lifeguards would benefit from the use of unmanned aerial vehicles regarding lifeguards' and others' safety.

[Forensic characteristic of drowning cases in the Russian Federation for the period from 2013 to 2022]. / Sudebno-meditsinskaya kharakteristika sluchaev utopleniya v Rossiiskoi Federatsii s 2013 po 2022 god.

OBJECTIVE: To study forensic characteristic of drowning mortality cases in the Russian Federation for the period from 2013 to 2022. MATERIAL AND METHODS: Dynamics and territorial specificity of drowning (in absolute values and in terms of 100 thous. population), proportion of histological examinations, cases of ethanol detection in the blood upon the occurrence of death by drowning and the proportion of children under 14 years among deceased from drowning. RESULTS AND CONCLUSION: The evidence suggests the necessity for intersectoral approaches of preventive measures creation. The results of the study could be used to establish a monitoring system as part of a national water safety strategy.

Global, regional, and national drowning trends from 1990 to 2021: Results from the 2021 Global Burden of Disease Study.

BACKGROUND: Drowning is a preventable public health concern that burdens emergency care systems globally. This study comprehensively evaluated fatal drowning patterns across population, time, and geography from 1990 to 2021 to inform effective prevention strategies. METHODS: Using the 2021 Global Burden of Disease Study framework and standardized estimation methods, the study analyzed global and regional drowning burden in terms of mortality, incidence, and disability-adjusted life-years (DALYs), based on population registry data and drowning-related epidemiological covariates. RESULTS: Global drowning incidents decreased by 33.67% from 1990 to 2021. The drowning incidence rate and mortality rate declined from 24.20 and 9.68 per 100,000 in 1990 to 10.85 and 3.48 per 100,000 in 2021, respectively. Years of life lost and DALYs rates due to drowning also decreased significantly, from 715.80 and 718.69 per 100,000 in 1990 to 197.64 and 198.92 per 100,000 in 2021. Regionally, East Asia had the highest drowning mortality (27.15% of global deaths), while the high-income Asia Pacific region experienced the highest incidence rate (21.38 per 100,000). South Asia had the greatest number of drowning deaths (75,639). Tropical Latin America showed the largest incidence decline, while high-income Asia Pacific exhibited increasing trends. Drowning disproportionately affected children under 5 and the elderly in most regions. CONCLUSIONS: While global drowning rates have declined, progress varies across regions. To improve prevention, focus should target low-income/middle-income countries and vulnerable populations like children and the elderly. Increased investment in safety education and rescue resources is vital to address their disproportionate risks.

Burden of unintentional drowning in Indonesia: insights from the Global Burden of Disease Study 2019.

INTRODUCTION: A high burden of unintentional fatal drowning has been reported in low- and middle-income countries. However, little is known about unintentional drowning in Indonesia. METHODS: This population-based retrospective cohort study analysed unintentional drowning data for Indonesia sourced from The Global Burden of Disease Study 2019. Estimates of trends, mortality rates, incidence rates, years lived with disability (YLDs) and disability adjusted life years were generated. RESULTS: A decline in unintentional drowning mortality rates was observed, with an average annual mortality rate of 2.58/100 000. Males were 1.81 (95% CI 1.79 to 1.84) times more likely than females to unintentionally drown. Average annual mortality rates were highest among the under-5 age group (9.67/100 000) and 70 and over (5.71/100 000 for males; 5.14/100 000 for females). Distributions of drowning deaths vary depending on region, with mortality rates higher in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara regions. DISCUSSION: While a decline in drowning mortality rates in Indonesia was identified between 2005 and 2019, mortality rates for unintentional drowning remained high among children under 5 years, the elderly population and those residing in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara, warranting further focused attention. CONCLUSION: A downward trend in the rate of unintentional drowning deaths in Indonesia is observed from 2005 onwards, with risk variation based on age, gender and region. The findings highlight the importance of addressing drowning as a cause of premature mortality and health system burden in Indonesia, including through enhancing drowning data collection systems and identifying drowning risk factors.

Quantitative Morphological Study of Larynx APUD-Cells in Asphyxial Type of Drowning in Fresh Water (Experimental Study).

An additional microscopic diagnostic sign has been identified for verification of asphyxial type of drowning. In white non-linear male rats (age 2 months) subjected to free drowning, significant hyperplasia of argyrophilic and morphofunctional activity of serotonin-containing APUD-cells of the laryngeal mucosa were revealed under conditions of acute anoxia in comparison with the intact control. These changes promote the development of laryngospasm, which prevents water penetration into the airways and lungs in asphyxial type of drowning. The presence of statistically significant hyperplasia of argyrophilic and morphofunctional activity of serotonin-containing APUD-cells of the laryngeal mucosa under conditions of acute anoxia can be used as an additional diagnostic criterion for asphyxial type of drowning in experimental studies.

Negative prior aquatic experiences and children's aquatic competency: Do parent perceptions differ from reality?

ISSUE ADDRESSED: Achieving aquatic competence is recommended for preventing childhood drownings, yet many children in Victoria, Australia do not meet aquatic benchmarks despite participating in swimming and water safety programs. While few studies have explored factors influencing aquatic competency development, negative prior aquatic experiences (NPAE) have surfaced as a potential influence. Research on children's NPAE has primarily focused on parental perceptions rather than the child's actual experiences. METHODS: Parents and children (aged 10-12 years) completed reliable surveys for background information and NPAE-related data. Children also completed aquatic competency assessments against benchmark standards. Chi-square tests determined relationships between NPAE and aquatic competency, and thematic analysis categorised themes related to perceptions of the child's NPAE. RESULTS: Most parents (82.9%) indicated their child had not had NPAE, while only half (51.0%) of children did not report NPAE. Children reporting NPAE often perceived incidents as nearly drowning (41%), encompassing swimming pool environments and underwater submersion. Similarly, parents reported varied situations, noting NPAE involving open water and the child's loss of control. Parent-reported NPAE was associated with children less likely to achieve knowledge, continuous swimming, and survival competency benchmarks (p < .05). Children reporting NPAE were less likely to achieve underwater competencies (p < .05). CONCLUSIONS: The disparity between parent and child perspectives of NPAE demonstrates the importance of considering both perspectives. This should assist in providing appropriate support for children to develop aquatic competencies. SO WHAT?: Using NPAE data, practitioners can customise swim teaching approaches to address and prevent NPAE, particularly as many children associate their NPAE with pools, the common setting for aquatic education.

Characteristics of fatal and non-fatal drownings at a Texas level-1 paediatric trauma centre.

BACKGROUND: Drowning is a leading cause of death for young children and knowing what puts a child at risk helps efforts across the spectrum of prevention. The purpose of this study was to identify risk and protective factors associated with hospital admission and mortality following paediatric drowning from a large level-1 paediatric trauma centre. METHODS: Children (ages 0-17) who presented at an emergency department or were admitted for a drowning event between 2017 and 2023 were included in this retrospective cohort study (n=698). This study examined differences between patients who were admitted compared with not admitted, and those who survived compared with those who did not survive. RESULTS: Participants who had adult supervision at the time of their drowning were significantly less likely to be admitted (OR=0.31, 95% CI 0.22 to 0.43, p<0.001) and significantly more likely to survive (OR=6.9, 95% CI 3.2 to 15.4, p<0.001). The environment also played a significant role in drowning outcomes. Children who drowned in a pool compared with other bodies of water were significantly more likely to survive (OR=3.0, 95% CI 1.6 to 5.5, p<0.001). Children from communities with higher child opportunity compared with those from very low opportunity were both simultaneously more likely to be admitted (IRR=1.7-2.4, 95% CI 1.3 to 3.3, p<0.001) and more often survived (IRR=1.7-3.0, 95% CI 1.3 to 3.5, p<0.001). CONCLUSION: Our analysis revealed significant differences in drowning risk related to adult supervision, location of drowning and where a child lives. These findings can help drowning prevention strategies mitigate the severity of drowning by enhancing educational messages, resources and policy.