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INTRODUCTION

Drowning is a leading cause of death among children and young adults in every region of the world; an estimated 372,000 people die from drowning each year.1 Worldwide, it is the major cause of death among children 1–4 years and the second major cause of unintentional injury deaths among those 10–29 years.2 This serious public health problem disproportionately affects those in low- and middle-income countries (LMIC) where 90% of global drowning deaths occur. However, it remains a concern even in the high-income countries (HIC) like the United States (US). In the US, drowning kills more children 1–4 years of age than anything else except birth defects.3 In 2016, almost 5000 Americans lost their lives to drowning of all intents, even more if one includes those related to boating, motor vehicle crashes, flooding, and other natural disasters.4 Unintentional drowning rates have been decreasing (Fig. 173-1)5 but the rate of decrease has slowed in the past two decades. Although studies have revealed some effective interventions, continued drowning research, and development and implementation of prevention programs remain largely neglected. In this chapter, drowning is defined and the epidemiology, risk factors, and prevention are discussed. Two frameworks are presented for considering prevention interventions and implementation strategies.

FIGURE 173-1

Fatal unintentional drowning—United States, 1999–2016.

Drowning has been defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid.”6 Outcomes depend on when in the process one intervenes to reestablish effective ventilation and how damaged the organs may be due to the effects of hypoxia (lack of oxygen at the tissue level). Victims can recover without morbidity, be left with a variety of lasting consequences as severe as a persistent vegetative state, or die.

The Burden of Drowning

Drowning is an injury mechanism which can occur from different intents (homicide, suicide, unintentional, or undetermined), although unintentional intent predominates (Fig. 173-2).5 Each year in the US, there are about 4300 emergency department (ED) visits for unintentional drowning and an additional 3300 hospitalizations and 3500 deaths.4 Studies suggest that about half of emergency department visits for drowning result in hospitalization or transfer for further care, compared with about 6% of ED visits for all unintentional injuries.7,8 For most other injury mechanisms, each more serious level of disposition (ED visits, hospitalizations, deaths) vastly outnumbers the next, creating a pyramid that describes the burden of injury.9 However, the drowning “pyramid” is more like a column; in 2013, there were 3701 unintentional drowning deaths, 3115 victims hospitalized and 2664 treated and released from emergency departments.5,10 This demonstrates that a greater proportion of drowning injuries, compared with other mechanisms, is severe, resulting in hospitalization or death.

FIGURE 173-2

Fatal drowning by intent—United States, 2012–2016.

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