Clinical Pearls & Morning Reports

Posted by Carla Rothaus

Published October 5, 2022


What are some of the steps that may be taken to prevent drowning?

Drowning is an understudied public health problem, especially in low- and middle-income countries. However, there are evidence-based measures that can be applied to prevention. Read the NEJM Review Article here.

Clinical Pearls

Q: Is drowning more common in males than in females?

A: Across countries, sex and age have been identified as major factors associated with the risk of drowning. In 2020, U.S. rates of fatal drowning among males were at least double those among females throughout the life span, and the rates among adolescent boys and young adult men (from ages 15 through 24 years) were approximately 5 times the rates among adolescent girls and young adult women.

Q: How does age correlate with rates of drowning?

A: Rates of fatal drowning are higher among very young children than in any other age group. In the United States in 2020, the rate of fatal drowning among children who were 1 to 4 years of age was 2.70 deaths per 100,000, as compared with 0.44 per 100,000 among children who were 10 to 14 years of age. Rates tend to increase again in adulthood, peaking among very old adults.

Morning Report Questions 

Q: Describe some of the circumstances under which drownings occur.

A: Among infants, who cannot leave their homes independently, most fatal drownings in the United States occur in bathtubs. Children younger than 14 years of age are most likely to drown in swimming pools, whereas teens and adults tend to drown in natural bodies of water. Older women, as well as people with epilepsy, are most likely to drown in bathtubs. According to a review of data from selected countries, approximately 10 to 30% of fatal drownings associated with recreational aquatic activity may be attributable to contemporaneous alcohol use. In the United States, drownings are often assumed to be due to recreational activities. However, the commercial fishing industry has an occupational fatality rate that is 29 times as high as the national average among all workers, and most of the deaths in that industry are due to drowning.

Q: What are some of the steps that may be taken to prevent drowning?

A: Given the inherent unreliability of supervision, placement of physical barriers is recommended, where possible, to separate vulnerable persons from water hazards. In Australia, for example, four-sided (i.e., perimeter) fencing around residential swimming pools has been shown to reduce toddler drownings by 83%. Well-crafted legislation can lead to increased installation of fencing. As children age and venture farther from home, they are more likely to be exposed to bodies of water with their peers, which can lead to an increased risk of drowning. Caregivers can steer older children to swimming areas with lifeguards and make sure that the children understand that even people who know how to swim should always wear U.S. Coast Guard–approved personal flotation devices when they are on the water. Legislation may be an effective tool for increasing the use of life jackets among males, who are less likely than females to follow recommendations that promote their use. Some promising educational approaches have been described, including teaching parents how to protect their children from drowning and persuading adults to wear personal flotation devices. Generally, however, the field of water safety has been overly reliant on education, despite evidence suggesting that environmental modifications and regulation could reduce drowning-related morbidity and mortality.

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