Abstract:

Drowning process often results in respiratory impairment and may lead to death. World Health Organisation has identified drowning as third leading cause of unintentional death at the world level. Annually, 360000 people die because of drowning and its complications. Children, males and individuals with access to water are at risk of drowning. Drowning prevention focuses usually on asphyxia and secondary pneumonia. Prevention of craniocerebral trauma may reduce mortality due to drowning. Drowning prevention is a challenging area. The present paper is an attempt to give an overview of epidemiology, experiences, prevention & therapy, traditional & new approaches, special precautions and innovations in drowning prevention. Importance of the swimming skills, parental motivation, use of life jackets and availability of lifeguards has been realized time and again. There is a strong need to improve EMS response to drowning incidents. The governmental agencies need to bring and enforce strict legislations and policies on water safety. The professional societies need to contribute towards the improvement of professional practice guidelines. Water safety of travelers is also an area of concern. Alcohol intoxication near the water bodies and on water transport needs to be controlled. Community-based drowning prevention interventions can help effectively in drowning prevention.

 

 

INTRODUCTION:

Drowning is the process wherein the individual faces submersion or immersion in the liquid and the process results in respiratory impairment. As per World Health Organisation (WHO) reports, drowning is third leading global cause of unintentional death. Annually, 360000 people lose life due to drowning. Drowning deaths can be classified into the following categories:

1.         Deaths from unintentional drowning.

2.         Deaths from intentional drowning - suicides.

3.         Deaths from intentional drowning - homicides.

4.         Deaths from flooding.

5.         Deaths from water transport mishaps.

 

There have been many reports published on drowning incidents in the standard biomedical literature¹.  Y. Henderson was the first one to apply the physiology of respiration to resuscitation. His report on drowning prevention focused on asphyxia and secondary pneumonia². Asphyxia caused by drowning in Genoa has been described³. Alcoholic intoxication near water bodies such as bathing beaches and swimming pools can lead to drowning. Prevention of craniocerebral trauma may be useful in reducing the deaths associated with drowning⁴. Drowning often results into needless deaths⁵.  Drowning has been taking the form of global public health problem⁶. Drowning is also one area of concern to general practitioners⁷. Drowning prevention poses challenge to health bodies⁸. Drowning prevention remains a challenging area particularly in low and middle income countries ^9-10.

Countries affected:

Almost all countries of the world are affected by drowning. These countries include United States (US), United Kingdom (UK), Iran, India, Bangladesh, China, Singapore, Vietnam.

 

Epidemiology:

Epidemiology of drowning of adults in Sacramento County has been described. Drowning rate has been found to be high for men aged 20-29 years and blacks. Alcohol use was associated with 48% of the drowning deaths¹¹. Emergency Medical Services (EMS) epidemiology of drowning prevention has been studied. There is a need for continuous quality improvement as far as drowning death prevention is concerned¹². The occurrence and prevention of drowning cases in Singapore and elsewhere has been highlighted^13-16. Occurrence of drowning and its prevention in one of the oriental countries (China) has been discussed¹⁷.

WHO has identified three population groups to be at the risk of drowning:

1.     Children.

2.     Males.

3.     Individuals with access to water.

 

90% of Unintentional drowning deaths are reported from low and middle income countries¹.

 

Experiences:

Drowning prevention campaign in King County (US) has been evaluated. Children of the adequately aware parents have been found to make increased use of life vests. The children who can not swim well have a modest sense of ownership for the life vests¹⁸. Awareness of drowning prevention and treatment methods has been evaluated¹⁹. Prevention of drowning can be made effective by educating the parents on preventive measures^20-21. Parents need to value drowning prevention information given by attending medical teams²². A considerable number of urban minority youth lack the ability to swim. This inability may have a bearing on success of drowning prevention plans²³. Community-based intervention has been deliberated for drowning prevention in low- and middle- income countries²⁴. Such prevention has been tried and evaluated in northern Iran²⁵.

 

Prevention & Therapy:

Centers for Disease Control and Prevention as well as various journals have highlighted the importance of drowning management and prevention^26-28. Prevention and treatment of drowning has been discussed²⁹. Wilderness Medical Society has given Practice Guidelines for Drowning Prevention and Treatment. These guidelines are applicable to out-of-hospital and emergency medical care establishments. These guidelines rely on American College of Chest Physicians criteria for supportive practices³⁰.

 

Traditional approaches:

No doubt, training and practice of swimming can help reduce drowning deaths. Safety measures such as lifejackets and life guards can also contribute towards reducing mortality and injuries related to drowning. Royal Life Saving Societies and the organizations of similar nature operating in Commonwealth Countries are specifically dedicated to the cause of bringing down the mortality caused by drowning. At the same time, these organizations focus on promoting swimming, water safety and other lifesaving skills. Many of these skills are imparted to the members of Red Cross / Red Crescent societies; disaster relief forces; and the personnel of fires  & emergency services; police, paramilitary and military forces.

UK’s Royal Life Saving Society (RLSS) operates a training program for the individuals aspiring to be life guards.

RLSS UK’s National Pool Lifeguard Qualification program has trained more than 90000 lifeguards³¹.

Despite the fact that lifeguards can play an important role in drowning prevention, a large number of deaths take place in life-guarded swimming areas. There is urgent need to adopt strategies³² for:

1.              Regular training and boosting confidence of lifeguards.

2.              Regular practice via simulated exercises.

3.              Addressing staff schedules.

The ocean lifeguard drowning prevention paradigm (with reference to California) has been discussed in detail. Most of the preventions and rescues have taken place during summer months, weekends and afternoons³³. Drowning prevention and CPR resuscitation tips have been described. Antibiotic prophylaxis is generally not needed³⁴.

 

New Approaches:

Safety engineering approach (Drowning alarm) has been described for prevention of drowning incidents³⁵. Targeted prevention can reduce cases of accidental drowning³⁶. Recommendations for water safety of travelers have been discussed³⁷. Safety legislation and public health policy can help in drowning prevention³⁸. Water safety has its own role in drowning prevention³⁹. Suggestions have been made to prevent cases of open water drowning while boating⁴⁰. Drowning prevention education resources are available aplenty in the United States. It is recommended to focus preventive education on safety precautions, supervision, preventing access, safety equipment, emergency procedures, and aquatic education⁴¹.

 

Special Precautions:

Interventions to prevent recreational drowning of adults have been documented. These recommendations are based on a survey of peer-reviewed papers published from 1990 to 2012 in English language⁴². Epidemiology, risk factors and strategies to prevent unintentional fatal drowning in individuals aged 50 years and above has been discussed. This research is based on the papers published between 1980 and 2015 in English, Portuguese and Spanish languages. The prevention strategies recommended are education and wearing life jackets⁴³.

 

Innovations:

Reanimation of drowning has been undertaken for complete understanding⁴⁴. Bangladesh has developed framework for overcoming implementation gap in drowning prevention interventions. The paper has described the details of Saving of Lives from Drowning (SoLiD) Project in Bangladesh⁴⁵. The authors have identified following reasons for implementation gaps:

1.              Insufficient funds

2.              Absence of technical capacity

3.              Limited coordination

 

A survey of usage of life jacket in Washington State on open water drowning prevention has been conducted. Children have been found to be motivated by adult using life jackets in water activities. Social marketing is needed to encourage adult life jacket wear⁴⁶. Testimonial videos have been used for Drowning Prevention Program in China. Such videos contribute towards increased safety knowledge and decreasing risky behaviors⁴⁷. River drowning prevention strategies based on a modified Delphi process can be developed⁴⁸. Vietnam has implemented a Classroom-Based Water Safety Education Program in 229 schools. Water safety messages have been quite useful for Water Safety Education⁴⁹.

 

CONCLUSIONS:

Drowning prevention is really a challenging task. Low- and middle- income countries need to be more vigilant to reduce unintentional drowning deaths. There is also need to exercise restraint over selfie fever and other risky behaviour amongst the youth. Drowning alarms have a potential to reduce drowning incidents. Safety precautions, supervision, preventing access, safety equipment, emergency procedures, and aquatic education can change the landscape of the drowning incidents. Saving of Lives from Drowning (SoLiD) Project in Bangladesh has helped in identifying the gaps that can reduce drowning mortality. Social marketing, testimonial videos and Classroom-Based Water Safety Education also have a potential to decrease the drowning deaths. One can conclude that drowning prevention programs can succeed and help to save precious human lives.

 

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Received on 08.05.2019       Modified on 11.05.2019 Accepted on 12.05.2019      ©A&V Publications All right reserved Research J. Science and Tech. 2019; 11(2):155-158. DOI: 10.5958/2349-2988.2019.00023.8