Near drowning

[WendyT]

Drowning Fact Sheet

Drowning accidents are the leading cause of injury/deaths among children under five. A temporary lapse in supervision is a common factor in most drownings and near-drownings. Child drownings can happen in a matter of seconds--in the time it takes to answer the phone. There is often no splashing to warn of trouble. Children can drown in small quantities of water and are at risk in their own homes from wading pools, bathtubs, buckets, diaper pails, and toilets as well as swimming pools, spas, and hot tubs.

Death and Injuries

A swimming pool is 14 times more likely than a motor vehicle to be involved in the death of a child age 4 and under. Each year, approximately 1,150 children ages 14 and under drown; more than half are preschoolers (ages 0-4). An estimated 5,000 children ages 14 and under are hospitalized due to near-drownings annually in the United States. Of children surviving near-drownings, 5-20 percent suffer severe and permanent disability.

Where Drownings Happen

Approximately 50 percent of preschooler drownings occur in residential swimming pools. Each year, more than 2,000 preschooler near-drownings occur in residential pools. Of preschooler pool drownings, 65 percent occur in the child's home pool and 33 percent at the homes of friends, neighbors or relatives. Each year, 350 drownings (for all ages) happen in bathtubs and approximately 40 children drown in five-gallon buckets. In ten states--Alaska, Arizona, California, Florida, Hawaii, Montana, Nevada, Oregon, Utah, and Washington-- drowning surpasses all other causes of death to children ages 14 and under.

How and When Drownings Happen

Of all preschoolers who drown, 70 percent are in the care of one of both parents at the time of the drowning. Of all preschoolers who drown, 75 percent are missing from sight for five minutes or less. Two-thirds of all drownings happen between May and August with 40 percent occurring on Saturdays and Sundays. It is the artificial method of circulating blood and oxygen through a body and attempting to keep the brain alive. CPR does work. When initiated within four minutes, the survival rate is 43 percent. When initiated within four to eight minutes, the survival rate is ten percent.

Why Learn CPR?

One in seven people will have the opportunity to use CPR in their lifetime. Ninety percent of the time, CPR will be done on a family member or close friend. More than 650,000 people die annually from heart attack in the United States each year. More than 350,000 die before reaching the hospital. When the brain starts to go four to six minutes without oxygen, brain damage/death begins. http://www.elcajonfirefighters.org/drownings.htm

Statistics on Pediatric Drownings

Water-Related Injuries: Fact Sheet http://www.cdc.gov/ncipc/factsheets/drown.htm

Centers for Disease Control and Prevention at Department of Health and Human Safety Overview

· In 2003, there were 3,306 unintentional fatal drowning's in the United States. averaging nine people per day. This figure does not include 473 drowning's in boating-related incidents (CDC 2005).

· For every child 14 years and younger who dies from drowning, five receive emergency department care for nonfatal submersion injuries.

· More than half of these children require hospitalization (CDC 2005). Nonfatal drowning's can cause brain damage that results in long-term disabilities ranging from memory problems and learning disabilities to the permanent loss of basic functioning (i.e., permanent vegetative state).

Drowning is the second leading cause of injury death of infants and children younger than 15 in the U.S.

Children less than 5 and adolescents between the ages of 15-24 yrs have the highest drowning rates

For every child who drowns, four children are hospitalized for near-drowning.

One third of near-drowning pediatric victims who are comatose on admission to the hospital will suffer significant neurologic damage

The annual cost of care per year in a chronic care facility for an impaired survivor of a near-drowning event is approximately $100,000.

The annual lifetime cost attributable to drowning and near-drowning in children less than 15 years of age is $384 million.

Children less than 1 year of age most frequently drown in bathtubs and buckets

Children between the ages of 1-4 years most often drown in home or apartment swimming pools. Most of these children drown by entering the pool from their home through the unprotected side of the pool. In the majority of cases, the children were last seen in the home, but were out of eye contact for only a moment and the immersion was silent (no screams or splashing was heard).

Children between 5-19 most often drown in lakes, ponds, rivers and pools.

In the event of a drowning--

§ Remove the victim from the water, have someone call 9-1-1 or your local emergency number. § Check consciousness and breathing.

§ If the victim is not breathing, open the airway and attempt

rescue breathing.§ If breaths do not go in, re-tilt the head and attempt rescue breathing again. § If air still does not go in, give abdominal thrusts (Heimlich maneuver) for children and adults to clear the airway.

§ Once the airway is clear, provide rescue breathing or CPR as needed.

[frontcrawl]

The 2005 AHA Guidelines say

Management of the drowning victim’s airway and breathing is similar to that recommended for any victim of cardiopulmonary arrest. There is no need to clear the airway of aspirated water, because only a modest amount of water is aspirated by the majority of drowning victims and it is rapidly absorbed into the central circulation, so it does not act as an obstruction in the trachea. Some victims aspirate nothing because they develop laryngospasm or breath-holding. Attempts to remove water from the breathing passages by any means other than suction (eg, abdominal thrusts or the Heimlich maneuver) are unnecessary and potentially dangerous. The routine use of abdominal thrusts or the Heimlich maneuver for drowning victims is not recommended.

Here's a related story (pre 05) and a WHO Bulletin regarding the definition of drowning.

[BEorP]

The 2005 AHA Guidelines say

You are my favourite member with one post. Exactly what I said in my post... a significant amount of water will not be aspirated.

[JPINFV]

I see your AHA article and raise you an emedicine article.

After initial gasping and possible aspiration, immersion stimulates hyperventilation, followed by voluntary apnea and a variable degree and duration of laryngospasm (see Image 1). This leads to hypoxemia. Depending upon the degree of hypoxemia and resultant acidosis, the person may develop cardiac arrest and central nervous system (CNS) ischemia. Asphyxia leads to relaxation of the airway, which permits the lungs to take in water in many individuals ("wet drowning"), although most patients aspirate less than 4 mL/kg of fluid. Approximately 10-20% of individuals maintain tight laryngospasm until cardiac arrest occurs and inspiratory efforts have ceased. These victims do not aspirate any appreciable fluid ("dry drowning").

Prehospital Care: Bystanders should call 911 immediately. They should never assume the individual is unsalvageable unless it is patently obvious that the individual has been dead for quite a while. If they suspect injury, they should move the individual the least amount possible and begin cardiopulmonary resuscitation (CPR).

Prehospital care is focused on the following important points:

* Optimal prehospital care is a significant determinant of outcome in the management of immersion victims. The victim should be removed from the water at the earliest opportunity. Rescue breathing may be performed in water, but chest compressions are inadequate because of buoyancy issues. The patient should be removed from the water with attention to cervical spine precautions. If possible, the individual should be lifted out in a prone position. Theoretically, hypotension may follow lifting the individual out in an upright manner because of the relative change in pressure surrounding the body from water to air. Management of the ABCs is the priority, with particular attention to securing the earliest possible airway and providing adequate oxygenation and ventilation.

o In the patient with an altered mental status, the airway should be checked for foreign material and vomitus.

o Immediately place the patient on 100% oxygen by mask. If available, continuous noninvasive pulse oximetry is optimal. If the patient remains dyspneic on 100% oxygen, or manifests a low oxygen saturation, use CPAP if available. If it is not available, consider early intubation, with appropriate use of positive end-expiratory pressure (PEEP).

* Immobilize the neck if the patient has facial or head injury, is unable to give an adequate history, or may have been involved in a diving accident or MVA.

* Begin rewarming. Wet clothing is ideally removed before the victim is wrapped in warming blankets.

http://www.emedicine.com/emerg/topic744.htm

I actually looked this article up last year when I started working at a water park.