The Demographics of US Drowning & Data on Guarded Pool Deaths Julie Gilchrist, M.D.

Dr. Julie Gilchrist is a Pediatrician and Medical Epidemiologist with the National Center for Injury Prevention and Control (NCIPC) at the CDC. She graduated from Rice University with degrees in Human Physiology and Sports Medicine before attending U.T. Southwestern Medical School in Dallas, TX. She completed a pediatrics residency at the University of Pennsylvania’s Children’s Hospital of Philadelphia and an epidemiology fellowship at CDC. She has been at CDC since 1997. In her current work at NCIPC, she is responsible for research and programs in drowning prevention and water safety promotion, and sports and recreation-related injury prevention, as well as other issues primarily affecting children: choking, suffocation, ingestions, dog bites, playground injuries, etc. She facilitated the development of CDC’s research agenda for prevention of injuries in sports, recreation, and exercise and has been recognized for her efforts to establish a sports injury prevention program at CDC. As of 2010, she has authored/coauthored more than 54 journal articles and 5 book chapters and is an invited speaker both nationally and internationally. She has earned numerous awards for her efforts and accomplishments in research, communication, and disaster response.

Abstract This presentation will have two sections. In the first, the presenter will describe the epidemiology of the 3,500 drowning deaths in the U.S. by age, gender, race, and location. Opportunities for drowning prevention will be discussed. In the second section, the findings of an examination of deaths occurring in guarded swimming pools will be presented. The data come from a search of news records regarding deaths in pools monitored by lifeguards from 2000 through 2008. A total of 140 deaths from 37 states were identified. Of decedents, 78% were children and 66% were males. African Americans accounted for 44% of deaths among those of known race. Three quarters occurred during May through August; 61% occurred in outdoor pools. Sites for fatal incidents included municipal pools (38%), community organizations (15%), and schools (14%). Of reports which included the information, decedents were initially identified in the pool twice as often by non-lifeguards (eg, other swimmers or bystanders) as by lifeguards. Deaths in pools with lifeguards are uncommon, but do occur. Groups most affected include children, males, and African Americans. While lifeguards provide an important layer of protection at swimming pools, they alone cannot prevent all drowning. Additional safety measures are needed.

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 1

Drowning in the US & Deaths in

Guarded Pools

Julie Gilchrist, MD National Center for Injury Prevention & Control

Centers for Disease Control & Prevention

October 2011

www.cdc.gov/injury/wisqars

10 Leading Causes of Death, 2007

Leading Causes of Death, Ages 1-44 Years

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 2

Drowning

5th leading cause of unintentional injury death among all ages 3rd leading cause among those 1-44 years 3500 deaths per year 6200 ED visits per year � 2800 hospitalized

$5.3 Billion in medical and productivity costs

Age Group in Years Less Than 1 1 to 4 5 to 9 10 to 14

(n=5,883) (n=10,203) (n=7,144) (n=9,088) Suffocation Drowning MVT - Occupant MVT - Occupant

66% 27% 22% 26% MVT - Occupant Pedestrian MVT - Unspecified MVT - Unspecified

8% 15% 15% 15% Drowning Fires/Burns Pedestrian Pedestrian

7% 14% 14% 12% MVT - Unspecified MVT - Occupant Fires/Burns Drowning

5% 13% 13% 10% Other Injuries MVT - Unspecified Drowning MVT - Other

5% 9% 13% 9%

Leading Causes of Unintentional Injury Death

Among Children

CDC Childhood Injury Report, 2008

Drowning by Age Group & Race/Ethnicity

0

0.5

1

1.5

2

2.5

3

3.5

black

white

hispanic

Age group (years)

Rat

e (p

er 1

00,0

00)

Vital Statistics V90, V92, W65-W74, 2006-2007

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 3

Drowning by Age Group & Race/Ethnicity

0

0.5

1

1.5

2

2.5

3

3.5

black

white

hispanic Rat

e (p

er 1

00,0

00)

Age group (years) Vital Statistics V90, V92, W65-W74, 2006-2007

Pool Drowning by Age Group & Race/Ethnicity

0 0.2 0.4 0.6 0.8

1 1.2 1.4 1.6 1.8

Black White Hispanic R

ate

(per

100

,000

)

Age group (years) Vital Statistics W67-W68,1999-2007

Pool Drowning Among 5-19 y.o. by Race/Ethnicity

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Black White Hisp

Rat

e (p

er 1

00,0

00)

Race or Ethnicity

Vital Statistics W67-W68,1999-2007

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 4

Pool Drowning by Age Group & Gender

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

female

male

Vital Statistics W67-W68,1999-2007

Age group (years)

Rat

e (p

er 1

00,0

00)

Pool Drowning by Gender

0

0.05

0.1

0.15

0.2

0.25

0.3

0.35

Female Male

Vital Statistics W67-W68,1999-2007

Rat

e (p

er 1

00,0

00)

Pool Drowning by Location

Drowning rates in South and West are 3 times those of Northest and Midwest

The more urban, the higher the rates

�Significantly higher in Large Metro Areas

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 5

Disposition of Nonfatal Drowning Among 0-14 years

Disposition Annual Estimate

Percent All Unintentional

Injury

Treated and Released

1269 37.8 j y

96.5

Hospitalized or Transferred

1953 58.2 2.4

National Electronic Injury Surveillance System - All Injury Program (2002-2007)

Prevention of Drowning

Managing access to water settings Keeping participants safer in the water Improving outcomes in an emergency

Current Swimming Ability

Adults’ self-reported inability to swim

58% of minority children have limited swimming ability; strongly related to parental ability

% Men %Women %Total Caucasian 17 45 32

African Am. 44 77 62 Asian 26 63 47

Hispanic 31 57 44 Total 21 51 37

Gilchrist et al. PHR 2000; Irwin et al. USA Swimming 2008.

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 6

Improving Swimming Ability: Access

Creating opportunities � Access to appropriate supervised aquatic

environments � Access to training/lessons

Improving Swimming Ability: Education and Training

Increasing participation � Desirability compared to

other activities � Understanding that it is

a life-saving skill � Role models

Benefits of Learning to Swim

Exceptional recreational physical activity Bonding experience Mental, physical and emotional development Potentially life-saving skill Early participation does not increase drowning risks* Opportunity for education of parents and children

*Brenner RA et al. Arch Peds Adol Med 2009

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 7

Deaths in Lifeguarded Pools

Case series: US, 2000-2008 All deaths – not just drowning Guarded swimming pools Case finding: Lexis-Nexus, ProQuest Additional details: death certificates, follow up phone calls, internet

Pelletier AR Injury Prevention 2011

Results

140 fatalities identified 78% were < 18 years old 66% were male Disproportionately black (44%)

Gender & Age Group

Fatalities Percentage % of US pop Sex

Male 93 66 49 Female 47 34 51

Age Group 0-4 16 11 7 5-9 43 31 7

10-14 36 26 7 15-19 17 12 7 >=20 28 20 82

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 8

Race & Ethnicity

Fatalities Percentage % of US pop Race

White 57 52 82 Black 48 44 13 Asian 4 4 4

Unknown 31 -- -- Ethnicity

Hispanic 12 11 12 Non-Hispanic 101 89 88

Unknown 27 -- --

Time & Place

37 states � PA (14) � CA, MD, OH (9) � MI, NY (8) � FL, TX (7)

74% May through August 61% outdoor pools Most on Wed (26), Least on Sun (13)

Sites of Pools

38% municipal 15% community organizations 14% school 12% club 6% apartment 5% summer camp 5% water park 4% other

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 9

Causes of Death 122 of 140 included official cause of death 98% (all but 3) due to drowning � 73 & 80 year old males: heart disease � 13 year old male: undetermined cause

Contributing factors � Disabilities (8): 1 physical, 3 mental, 4 both � Heart disease (7) � History of seizures (7) � Alcohol intoxication (1)

Other Characteristics

Timing of death � 75% died on the same day � 11% died the following day � 14% died 2-27 days after the incident

89% underwent autopsy (n=99) � 2 with trauma: � 19yoM injury on neck, 8yoF bruise on scalp

Other Characteristics

Breath holding (8): 7 between 14-26 years 2 were off duty lifeguards Lifejacket (1): � 3 yo trapped under inflatable raft shared with

sister in 50m outdoor pool with 100 swimmers and 11 guards

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 10

Lifeguards & Swimmers Median guards on duty: 2 (range 1-50) � Data available (n=106)

Number people in pool: 30 (range 1-2000) � Data available (n=57)

Swimmer-LG ratio: 13:1 (range 1:2-75:1) � Data available (n=51)

First identified by: � LG: 22% � Non-LG: 44% � Unknown: 34%

Groups at Risk

Similar demographics to other drowning: � Children, males, blacks

Children: lack of supervision Males: more exposure, alcohol, risk taking Blacks: swimming ability

Indoor vs. Outdoor Pools

Over 60% outdoor Increased exposure in summer months Seasonal pools -- inexperienced staff Summer patrons -- limited ability Environmental factors � overcrowding, glare, heat

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 11

Lifeguards

Enhance water safety Provide parents false sense of security Parents may relinquish responsibility LG are only one layer of protection

Limitations

Underestimate � Other studies suggest 52-72%

LG information not available � Location, experience, certification

Circumstances mission: pool depth, clarity Survivors not included: � Underestimates burden of submersions � Underestimates value of LG

Conclusions

Deaths in LG pools uncommon LG are a layer of protection LG are specifically trained in response Swim with a buddy

National Swimming Pool Foundation ∙ 4775 Granby Circle ∙ Colorado Springs, CO 80919 ∙ (719)540-9119 ∙ www.nspf.org 12