SUBMERSION INJURIES IN CHILDREN AND ADULTS
Section snippets
EPIDEMIOLOGY
It is estimated that 6000 to 8000 patients a year die of drowning in the United States alone. Worldwide estimates of drowning are approximately 140,000 to 150,000 deaths yearly. Drowning is the third most common cause of all accidental deaths and is the second most common cause of death in victims less than or equal to 44 years old. Forty percent of all drowning deaths are of children less than 5 years of age, with another 15% to 20% of drowning victims being between the ages of 5 and 20 years.
Education
Liller et al61 conducted a telephone survey of pool owners. They found that families had some knowledge of drowning risks but they had a deficit in their knowledge of the importance of adult supervision and did not know the recommended age to begin swimming instruction (4 to 5 years of age). Forty percent said they did not know how to perform cardiopulmonary resuscitation (CPR) on an adult and most did not know how to perform CPR on an infant or child.61 The first efforts in education must be
PATHOPHYSIOLOGY
Drowning may be subdivided into wet drowning and dry drowning. As the victim becomes submerged, breathholding occurs and panic ensues. In approximately 15% of drowning victims, severe larynogospasm prevents the aspiration of the liquid medium. In the majority of cases, however, wet drowning occurs, and the patient aspirates the water in which he or she is submerged.50
In the 1970s, a large amount of literature made the distinction between fresh water and salt water wet drowning. It was believed
FUTURE AND SUGGESTIONS
The American Academy of Pediatrics Committee on Injury and Poison Prevention has produced a list of 23 recommendations to reduce the incidence of drowning to infants, children, and adolescents. They have also recommended the establishment of a national surveillance system for childhood drowning.21 This system could identify regional risk factors for a more focused public health initiative. Although this proposition is attractive, pediatric intensivists are likely to understand the issues in
ACKNOWLEDGMENT
We express our appreciation to Mary New and Pat Bunce for coordinating submission of our multiple authors and preparing the final manuscript.
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Address reprint requests to Lucian K. DeNicola, MD, FCCM, Division of Pediatric Critical Care, University of Florida Health Science Center/Jacksonville, 820 Prudential Drive, Suite 203, Jacksonville, FL 32207