Effect of integrated intervention to prevent child drowning in rural areas of Guangdong, China: a cluster randomized controlled trial.

BACKGROUND: Drowning is the leading cause of death for children under the age of 15 years in Guangdong Province, China. This serious public health issue also exists in low- and middle-income countries (LMICs), which have few value-integrated intervention programs. The current study presents an integrated intervention project that aims to explore an effective pattern of prevention for child drowning in rural areas and feasibility to perform in other LMICs. METHODS: We conducted a cluster randomized controlled trial by comparing the incidence of non-fatal drowning among children in two groups in rural areas of southern China. We recruited the participants in two phases and reached a total of 10 687 students from 23 schools at two towns in Guangdong Province, China. At the first and second phases, 8966 and 1721 students were recruited, respectively. RESULTS: The final evaluation questionnaires were collected after 18 months of integrated intervention, where we obtained 9791 data from Grades 3-9. The incidence of non-fatal drowning between the intervention and control groups after intervention did not differ significantly from the baseline according to the total number of students, male students, female students and Grades 6-9 [0.81; 95% confidence interval (CI): [0.66, 1.00]; p = 0.05, 1.17; 95% CI: [0.90, 1.51]; p = 0.25, 1.40; 95% CI: [0.97, 2.02]; p = 0.07 and 0.97; 95% CI: [0.70, 1.34]; p = 0.86], except for Grades 3-5 (1.36; 95% CI: [1.02, 1.82]; p = 0.037). The study observed a significantly positive benefit of awareness and risk behaviours of non-fatal drowning between the intervention and control groups (0.27, 95% CI: [0.21, 0.33]; p = 0.00, -0.16; 95% CI: [-0.24, -0.08]; p = 0.00). CONCLUSIONS: The integrated intervention exerted a significant impact on the prevention and management of child non-fatal drowning, especially in rural areas.

Quick Rescue self-inflating flotation device for rescuing sea swimmers in distress versus conventional tube or buoy rescues. / Eficacia del Quick Rescue (dispositivo flotante autoinflable para el rescate de ahogados en el mar) en comparación con el tubo y la boya de rescate.

OBJECTIVES: To compare the efficacy of the new self-inflatable Quick Rescue (QR) flotation device to conventional tube and buoy devices. To compare lifeguard fatigue after rescues with different flotation devices. MATERIAL AND METHODS: Forty lifeguards participated in this quasi-experimental field study. Each performed simulated rescues of sea swimmers in distress under 4 conditions (no device, the QR device, a tube, and a buoy) assigned in random order. The swimmer in distress was located at a distance of 100 m. Ambient conditions, victim type, and beach were standardized. Participants underwent training to use the inflatable QR float and all other devices. Expertise was defined as a score of at least 3 on a Likert scale of 1 to 5. We recorded rescue times (total, and approaching, securing and towing back the distressed swimmer) as well as the lifeguards' perceptions of effort (overall and for each stage). RESULTS: Most rescue times did not differ between conditions, with the exception of time needed to secure the victim, which was shorter by 3 seconds when no device was used (P<.05). The rescuers did not perceive differences between devices in overall effort or effort during any of the phases. CONCLUSION: The new self-inflating QR device is as useful as other flotation devices in terms of rescue times and effort expended by lifeguards. We can therefore recommend its use for rescuing sea swimmers in distress.

OBJETIVO: El Quick Rescue es un nuevo dispositivo flotante de rescate (DFR) autoinflable. Se compara su eficacia frente al tubo y la boya de rescate ante una víctima con distrés en el mar, y la fatiga del socorrista tras los rescates con los distintos DFR. METODO: Estudio cuasiexperimental con aleatorización de condiciones (sin DFR, con tubo de rescate, con boya de rescate y con Quick Rescue). Cada participante realizó cuatro rescates de víctima con distrés a 100 m en el mar, con estandarización de las condiciones ambientales, tipo de víctima y playa. Se registró el tiempo de rescate (total, aproximación, control de víctima y remolque) y la percepción del esfuerzo (total y segmentaria) de los socorristas. RESULTADOS: En general, no hubo diferencias entre las cuatro condiciones en los tiempos de rescate. A excepción del tiempo de control de la víctima, que sin material fue en torno a 3 segundos inferior que en las tres condiciones con DFR (p < 0,05). No hubo diferencias en la percepción del esfuerzo total ni segmentaria entre condiciones. CONCLUSIONES: El DFR autoinflable Quick Rescue presenta una validez similar a los DFR habituales en relación a los tiempos de rescate y la fatiga. Por lo tanto, recomendamos su uso para víctimas distrés en el mar.

Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia.

OBJECTIVES: The epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning. DESIGN: A subset of data on fatal unintentional drowning from the Royal Life Saving National Fatal Drowning Database was compared on a like-for-like basis to data on hospital separations sourced from the Australian Institute of Health and Welfare's National Hospital Morbidity Database for the 13-year period 1 July 2002 to 30 June 2015. A restrictive definition was applied to the fatal drowning data to estimate the effect of the more narrow inclusion criteria for the non-fatal data (International Classification of Diseases (ICD) codes W65-74 and first reported cause only). Incidence and ratios of fatal to non-fatal drowning with univariate and Χ2 analysis are reported and used to calculate case-fatality rates. SETTING: Australia, 1 July 2002 to 30 June 2015. PARTICIPANTS: Unintentional fatal drowning cases and cases of non-fatal drowning resulting in hospital separation. RESULTS: 2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0-4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65-74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal. CONCLUSIONS: This study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.

Systematic review of drowning in India: assessment of burden and risk.

AIM: To examine the burden and risk factors for fatal and non-fatal drowning in India. METHODS: Relevant literature was identified through a systematic search of 19 electronic databases and 19 national and global, institutional, organisational and government sources of injury data. Search terms used pertained to drowning, injury, trauma, morbidity and mortality in India. RESULTS: A total of 16 research articles and five data sources were included in the review. Three national data sources provided counts of drowning deaths, reporting a range of 1348-62 569 drowning deaths per year. A further three national data sources provided information on drowning-related morbidity; however, each source presented different outcome measures making comparison difficult. Ten research studies investigated risk factors associated with drowning in India. Key risk factors reported were male gender, young age (0-5 years) and individuals residing in the North-Eastern part of the country who have high exposure to water sources within community settings. CONCLUSION: Drowning-related morbidity and mortality have a significant impact on India, with risk factors identified for this setting similar to those within other low-income and middle-income countries. Regional data which look beyond routinely collected data are required to accurately investigate the burden and impact of drowning, to inform targeted, context-specific approaches for drowning reduction initiatives.

Dry Drowning: Myths and Misconceptions.

Drowning is a leading cause of death in children and is highly preventable. More than 10 people die of drowning in the United States each day, most of them adults. Rates of drowning are highest in children given their developmental vulnerabilities. Drowning incidents that result in cardiopulmonary arrest have a straightforward emergency clinical response, but the management approaches to the more common scenario of brief, nonfatal submersion is less clear. Clinicians must make clinical-care decisions based on evidence to provide safe and effective care in a timely manner and to help families avoid unnecessary anxiety. Such anxiety has been heightened by reports of unanticipated "dry drowning" appearing in the media. This article discusses this concept and provides guidance for clinicians. [Pediatr Ann. 2017;46(10):e354-e357.].

How can lifeguards recover better? A cross-over study comparing resting, running, and foam rolling.

PURPOSE: The aim of this study is to compare the effectiveness of active recovery in form of running or foam rolling on clearing blood lactate compared to remain sitting after a water rescue. METHOD: A quasi experimental cross-over design was used to test the effectiveness of two active recovery methods: foam rolling (FR) and running (RR), compared with passive recovery (PR) on the blood lactate clearance after performing a water rescue. Twelve lifeguards from Marín (Pontevedra) completed the study. The participants performed a 100-meter water rescue and a 25-minute recovery protocol. RESULTS: The post recovery lactate levels were significantly lower for foam rolling (4.4±1.5mmol/l, P=0.005, d=0.94) and running (4.9±2.3mmol/l, P=0.027, d=1.21) compared with resting (7.2±2.5mmol/l); there was no significant difference between foam rolling and running (P=1.000). CONCLUSIONS: We found that surf lifesavers clear out blood lactate more efficient when performing an active recovery protocol. Foam rolling is an effective method of increasing the rate of blood lactate clearance. These two recovery methods are also adequate for surf lifeguards as they do not interfere with the surveillance aspect of their job.

Unintentional, non-fatal drowning of children: US trends and racial/ethnic disparities.

OBJECTIVE: The current study aimed to better understand trends and risk factors associated with non-fatal drowning of infants and children in the USA using two large, national databases. METHODS: A secondary data analysis was conducted using the National Inpatient Sample and the Nationwide Emergency Department Sample databases. The analytic sample (n=19,403) included children <21 years of age who had a diagnosis code for near-drowning/non-fatal drowning. Descriptive, χ(2) and analysis of variance techniques were applied, and incidence rates were calculated per 100,000 population. RESULTS: Non-fatal drowning incidence has remained relatively stable from 2006 to 2011. In general, the highest rates of non-fatal drowning occurred in swimming pools and in children from racial/ethnic minorities. However, when compared with non-Hispanic Caucasian children, children from racial/ethnic minorities were more likely to drown in natural waterways than in swimming pools. Despite the overall lower rate of non-fatal drowning among non-Hispanic Caucasian children, the highest rate of all non-fatal drowning was for non-Hispanic Caucasian children aged 0-4 years in swimming pools. Children who were admitted to inpatient facilities were younger, male and came from families with lower incomes. CONCLUSIONS: Data from two large US national databases show lack of progress in preventing and reducing non-fatal drowning admissions from 2006 to 2011. Discrepancies are seen in the location of drowning events and demographic characteristics. New policies and interventions are needed, and tailoring approaches by age and race/ethnicity may improve their effectiveness.

Oxylator and SCUBA dive regulators: useful utilities for in-water resuscitation.

INTRODUCTION: In water resuscitation has been reported to enhance the outcome of drowning victims. Mouth-to-mouth ventilation during swimming is challenging. Therefore, the efficacy of ventilation utilities was evaluated. METHODS: Ventilation was assessed with the Oxylator ventilator, as well as the consecutive self-contained underwater breathing apparatus (SCUBA) regulators using an anaesthetic test lung: Poseidon Cyklon 5000, Poseidon XStream, Apeks TX 100, Spiro Arctic, Scubapro Air2 and Buddy AutoAir. RESULTS: Oxylator, Apeks TX 100, Arctic and Buddy AutoAir delivered reliable peak pressures and tidal volumes. In contrast, the ventilation parameters remarkably depended on duration and depth of pressing the purge button in Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2. Critical peak pressures occurred during ventilation with all these three regulators. DISCUSSION: The use of Poseidon Cyklon 5000, Poseidon XStream and Scubapro Air2 regulators is consequently not recommended for in-water ventilation. With the limitation that the devices were tested with a test lung and not in a human field study, Apeks TX 100, Spiro Arctic and Buddy AutoAir might be used for emergency ventilation and probably ease in-water resuscitation for the dive buddy of the victim. Professional rescue divers could be equipped with the Oxylator and an oxygen tank to achieve an early onset of efficient in-water ventilation in drowning victims.

Recommendations for rescue of a submerged unresponsive compressed-gas diver.

The Diving Committee of the Undersea and Hyperbaric Medical Society has reviewed available evidence in relation to the medical aspects of rescuing a submerged unresponsive compressed-gas diver. The rescue process has been subdivided into three phases, and relevant questions have been addressed as follows. Phase 1, preparation for ascent: If the regulator is out of the mouth, should it be replaced? If the diver is in the tonic or clonic phase of a seizure, should the ascent be delayed until the clonic phase has subsided? Are there any special considerations for rescuing rebreather divers? Phase 2, retrieval to the surface: What is a "safe" ascent rate? If the rescuer has a decompression obligation, should they take the victim to the surface? If the regulator is in the mouth and the victim is breathing, does this change the ascent procedures? If the regulator is in the mouth, the victim is breathing, and the victim has a decompression obligation, does this change the ascent procedures? Is it necessary to hold the victim's head in a particular position? Is it necessary to press on the victim's chest to ensure exhalation? Are there any special considerations for rescuing rebreather divers? Phase 3, procedure at the surface: Is it possible to make an assessment of breathing in the water? Can effective rescue breaths be delivered in the water? What is the likelihood of persistent circulation after respiratory arrest? Does the recent advocacy for "compression-only resuscitation" suggest that rescue breaths should not be administered to a non-breathing diver? What rules should guide the relative priority of in-water rescue breaths over accessing surface support where definitive CPR can be started? A "best practice" decision tree for submerged diver rescue has been proposed.

Physiological response of beach lifeguards in a rescue simulation with surf.

The objective of this study was to examine the physiological response of 14 lifeguards in a swimming pool simulation with 1.7 m waves and to study the efficiency of the torpedo buoy. The rescue time was determined with and without material, as were lactate levels, heart rate and VO(2max). The results obtained showed a VO(2 max) rate of 3.4 +/- 0.8 l/min without equipment and 3.3 +/- 0.8 l/min with equipment. Moreover, the time taken to swim towards the victim without equipment decreased by 7.7 s, while towing time was reduced by 10.8 s if said equipment was used. These results show that aquatic rescue makes considerable physiological demands on the swimmer and they also provide important data on the type of training and aptitude levels required by individuals wishing to join these rescue groups. The equipment currently used has a negative affect on the swim. STATEMENT OF RELEVANCE: The study shows that beach rescues make very high physiological demands on rescuers, thus underlining the need to perform entry tests for these highly demanding rescue teams. The auxiliary equipment is a help in the return time of rescue. However, it causes delays in the approach to the victim.

Management of water incidents: drowning and hypothermia.

Dangers exist wherever water is present, and death resulting from submersion in water is likely to occur rapidly. This article discusses the management of drowning and hypothermia. Information on water hazards and preventive measures, the risks associated with rescuing people from water, and the pathophysiology of drowning and hypothermia is provided, enabling practitioners to translate theory into practice. The emphasis of first aid in this setting is on quick, effective action, including alerting the emergency services and maintaining the safety of all potential rescuers.

Unintentional pediatric submersion-injury-related hospitalizations in the United States, 2003.

The objective of this study was to examine the demographic characteristics and hospital resource utilization of submersion-injury-related hospitalizations among persons < or =20 years of age in the USA in 2003. All 1475 pediatric submersion-injury-related hospital discharges in the Kids' Inpatient Database were identified by ICD-9-CM diagnosis code or external cause of injury code. These cases represent an estimated 2490 pediatric submersion-injury-related hospitalizations nationwide. Inpatient costs for these estimated hospitalizations were approximately $10 million. The overall pediatric submersion-injury-related rate of hospitalization was 3.0 per 100,000 persons. Children aged 0-4 years had the highest rate of hospitalization (7.7 per 100,000 persons). Children with permanent submersion-injury-related morbidity accounted for 5.8% of hospital admissions and 37.3% of hospital costs in our study, and children with submersion-injury-related in-hospital death accounted for 11.6% of hospital admissions and 20.0% of hospital costs in our study. Prevention of submersion injury using focused, proven strategies deserves increased attention.

Promoting childhood water safety: the physician's role.

Injuries and deaths secondary to drowning are a significant issue for children. The risks associated with drowning change with a child's age and developmental abilities. Nationally, children under the age of 4 years and male adolescents represent the pediatric groups with the highest rates of drowning. In Wisconsin, 1998-2002, preteen children were involved in drowning or near-drowning events more often than teens, with boys being involved more than 2 times as often as girls for all childhood ages assessed. The drowning gender disparity is even greater among adults. Physicians are in a position to promote water safety for their patients and the community by educating families on age-appropriate drowning-prevention methods, supporting community safety campaigns, and advocating for "best practice" drowning-prevention legislation. Although injury prevention anticipatory guidance is important for all family members, directing the message to males is particularly important. Physicians can help children enjoy the benefits of water recreation while decreasing the risk for water-associated injury.

[Epidemiology of accidents related to sea-swimming in the Tuscany Region using a health-promotion strategy. Preliminary report]. / Epidemiologia degli incidenti correlati all'attività balneare nella Regione Toscana per una strategia di promozione della salute--nota preliminare.

In the summer season 1999 an integrated epidemiological surveillance system (involving mobile emergency medical services, first aid and tourist stations, hyperbaric medical centres, bathing attendants) of sea-bathing-related accidents was set up on the coasts of Tuscany, central Italy, aimed at health promotion and education. The pilot phase allowed to collect a first set of information on periods and time with highest incidence of events, type of assistance delivered, kind of accident (trauma or illness) and seriousness of the event as codified by emergency medical services. The pilot experience also pointed out the changes to detection tools needed in order to obtain more precise and comparable data. Such corrections, introduced during the summer season 2000, could contribute to the creation of a model with potential applications in other Italian and European coastal regions.