Immersion events in residential swimming pools: evidence for an experience effect

Article Abstract:

Drowning and near-drowning are targets for injury-prevention efforts in the US, in part because such accidents occur quite often. Six hundred fifty-two children between the ages of one and four drowned in 1987, and as many as four times this number had to be hospitalized because of near-drowning. Between 52 and 85 percent of these accidents occur in residential swimming pools. Four-sided fencing can reduce this rate by as much as 90 percent, but a universal requirement for such fencing is not popular in this country. The hypothesis was advanced that an experience effect for immersion events exists, and that these events peak in frequency shortly after a household installs a pool or moves to a house where a pool is located. (An immersion event was defined as an episode in which a person gets into trouble in the water, such that he or she might have drowned.) This was tested by surveying households with in-ground pools in Sacramento County, California. The survey was carried out by mail, with households reporting their immersion events and the exposure to a pool. The rates of immersion events were calculated on a pool-year (PY) basis for the first six months after pool installation (or a move to a house with a pool), the period seven to 24 months after installation, and the period after 24 months. Six hundred thirty-seven households responded, with 5,735 PY of exposure over a period from 1959 to 1987. Forty-five households reported 61 immersion events, giving an overall rate of 11 events per 1,000 PY. Seventy-four percent involved children younger than five, and a similar proportion involved boys. Immersion events occurred at a higher rate during the first six months of pool exposure, but most events (77 percent) occurred outside this period. The swimming pool at home was the most significant water hazard for these households, with 91 percent of all immersion events involving the households taking place at that pool. Immersion injuries were rare in this group: three emergency resuscitations were needed, and one of these children died. The results indicate that there is a high-risk period during the first few months for immersion events in family pools. Residential pool fencing requirements should at least be extended to homes where pool exposures are beginning. (Consumer Summary produced by Reliance Medical Information, Inc.)

Safety and security measures, Laws, regulations and rules, Swimming pools

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Childhood drowning and near-drowning in the United States

Article Abstract:

Drowning is estimated to be the leading cause of death, in many states, for children under 5 years of age, and the third leading cause of unintentional death among children between 0 and 4 years. In 1986, 2,122 childhood drownings occurred; 78 percent of the drowning victims were males, and 85 percent were 5 years of age and older. Drowning rates of 1- to 3-year-old white children are nearly double those of black children. However, the reverse holds true in children over 3 years. Severe and permanent injury can occur within minutes after immersion and rescue. Any delay in the application of cardiopulmonary resuscitation (CPR) techniques increases the risk of permanent injury or death. Consciousness is lost after two minutes of anoxia (lack of oxygen) and brain damage follows after four to six minutes. When aggressive CPR is still required in the emergency room, the prognosis is poor. Survival after immersion in cold water is very rare. (The US has a temperate climate.) Cost data is not readily available, but the hospital fees for maintaining and caring for a child, who suffers brain injury due to a water accident, can be as high as $100,000. The same annual costs can be expected for severely brain damaged children. Costs incidental to patient care are substantial in earning losses, social disintegration of the family, and deterioration of the family structure. Intervention needs require primary prevention, that is, prevention of the injury. The most obvious and simple intervention requires the installation of appropriate fencing around the pool, not the yard, to keep unsupervised children from getting into the water. Data from Australia suggest that the minimum fence height should be 5 feet. During the 'off' season, pool covers may be used. This is not feasible during the season, unless the cover is mechanically moved into place. Training in CPR for pool owners and users would hasten resuscitative efforts for drowning victims and improve their chance for a full recovery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Statistics, Artificial respiration, Mechanical ventilation, First aid in illness and injury, First aid, Study and teaching, Drowning victims

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Mortality among recent purchasers of handguns

Article Abstract:

Some people who buy a handgun may be suicidal. In a study of 238,292 people who bought a handgun in California in 1991, suicide was the leading cause of death after the purchase. This was especially true among women. During the first week after a handgun purchase, the rate of suicide using a gun was 57 times higher than in the general population. This indicates that many of those who bought a handgun bought the gun specifically to kill themselves. However, both men and women who bought a handgun remained at a higher risk of suicide over the next six years than the general population.

Statistical Data Included, Purchasing, Patient outcomes, Mortality, Risk factors, Suicide, Firearms, Firearms owners

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