Water-Related Injuries: Fact Sheet

How big is the problem?

• In 2005, there were 3,582 fatal unintentional drownings in the United States, averaging ten deaths per day. An additional 710 people died, from drowning and other causes, in boating-related incidents.^{1, 2}
• More than one in four fatal drowning victims are children 14 and younger.¹ For every child who dies from drowning, another four received emergency department care for nonfatal submersion injuries.¹
• Nonfatal drownings can cause brain damage that may result in long-term disabilities including memory problems, learning disabilities, and permanent loss of basic functioning (i.e., permanent vegetative state).

Who is most at risk?

• Males: In 2005, males were four times more likely than females to die from unintentional drownings in the United States.¹
• Children: In 2005, of all children 1 to 4 years old who died, almost 30% died from drowning.¹ Although drowning rates have slowly declined,^{1, 3} fatal drowning remains the second-leading cause of unintentional injury-related death for children ages 1 to 14 years.⁴
• Minorities:
  • Between 2000 and 2005, the fatal unintentional drowning rate for African Americans across all ages was 1.3 times that of whites. For American Indians and Alaskan Natives, this rate was 1.8 times that of whites.¹
  • Rates of fatal drowning are notably higher among these populations in certain age groups. The fatal drowning rate of African American children ages 5 to 14 is 3.2 times that of white children in the same age range. For American Indian and Alaskan Native children, the fatal drowning rate is 2.4 times higher than for white children.¹
  • Factors such as the physical environment (e.g., access to swimming pools) and a combination of social and cultural issues (e.g., valuing swimming skills and choosing recreational water-related activities) may contribute to the racial differences in drowning rates. If minorities participate less in water-related activities than whites, their drowning rates (per exposure) may be higher than currently reported.⁵

What are the major risk factors?

• Lack of barriers and supervision. Children under one year most often drown in bathtubs, buckets, or toilets.⁶ Among children ages 1 to 4 years, most drownings occur in residential swimming pools.6 Most young children who drowned in pools were last seen in the home, had been out of sight less than five minutes, and were in the care of one or both parents at the time.⁷ Barriers, such as pool fencing, can help prevent children from gaining access to the pool area without caregivers’ awareness.⁸
• Age and recreation in natural water settings (such as lakes, rivers, or the ocean). The percent of drownings in natural water settings increases with age. Most drownings in those over 15 years of age occur in natural water settings.⁹
• Lack of appropriate choices in recreational boating. In 2006, the U.S. Coast Guard received reports for 4,967 boating incidents; 3,474 boaters were reported injured, and 710 died. Among those who drowned, 9 out of ten were not wearing life jackets. Most boating fatalities from 2006 (70%) were caused by drowning; the remainder were due to trauma, hypothermia, carbon monoxide poisoning, or other causes. Open motor boats were involved in 45% of all reported incidents, and personal watercraft were involved in another 24%.²
• Alcohol use. Alcohol use is involved in up to half of adolescent and adult deaths associated with water recreation and about one in five reported boating fatalities.^{10, 11} Alcohol influences balance, coordination, and judgment, and its effects are heightened by sun exposure and heat.¹²
• Seizure disorders. For persons with seizure disorders, drowning is the most common cause of unintentional injury death, with the bathtub as the site of highest drowning risk.¹³

What has CDC research found?

A CDC study about self-reported swimming ability¹⁴ found that:

• Younger respondents reported greater swimming ability than older respondents;
• Self-reported ability increased with level of education (i.e., high school graduate, college graduate, etc.);
• Among racial groups, African Americans reported the most limited swimming ability; and
• Men of all ages, races, and educational levels consistently reported greater swimming ability than women.

Details about additional studies and their findings are highlighted in the Water-Related Injuries: CDC Activities fact sheet.

How can water-related injuries be prevented?

To help prevent water-related injuries:^{1, 8, 9, 12, 13}

• Designate a responsible adult to watch young children while in the bath and all children swimming or playing in or around water. Adults should not be involved in any other distracting activity (such as reading, playing cards, talking on the phone, or mowing the lawn) while supervising children.
• Always swim with a buddy. Select swimming sites that have lifeguards whenever possible.
• Avoid drinking alcohol before or during swimming, boating, or water skiing. Do not drink alcohol while supervising children.
• Learn to swim. Be aware that the American Academy of Pediatrics does not recommend swimming classes as the primary means of drowning prevention for children younger than 4. Constant, careful supervision and barriers such as pool fencing are necessary even when children have completed swimming classes.
• Learn cardiopulmonary resuscitation (CPR). In the time it might take for paramedics to arrive, your CPR skills could make a difference in someone’s life. CPR performed by bystanders has been shown to improve outcomes in drowning victims.
• Do not use air-filled or foam toys, such as “water wings”, “noodles”, or inner-tubes, in place of life jackets (personal flotation devices). These toys are not designed to keep swimmers safe.

If you have a swimming pool at home:

• Install a four-sided, isolation pool fence that completely separates the house and play area of the yard from the pool area. The fence should be at least 4 feet high. Use self-closing and self-latching gates that open outward with latches that are out of reach of children. Also, consider additional barriers such as automatic door locks or alarms to prevent access or notify you if someone enters the pool area.
• Remove floats, balls and other toys from the pool and surrounding area immediately after use. The presence of these toys may encourage children to enter the pool area or lean over the pool and potentially fall in.

If you are in or around natural bodies of water:

• Know the local weather conditions and forecast before swimming or boating. Strong winds and thunderstorms with lightning strikes are dangerous.
• Use U.S. Coast Guard approved life jackets when boating, regardless of distance to be traveled, size of boat, or swimming ability of boaters.
• Know the meaning of and obey warnings represented by colored beach flags.
• Watch for dangerous waves and signs of rip currents (e.g. water that is discolored and choppy, foamy, or filled with debris and moving in a channel away from shore). If you are caught in a rip current, swim parallel to shore; once free of the current, swim toward shore.

References

¹Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2008) [cited 2008 March 23]. Available from: URL: www.cdc.gov/ncipc/wisqars.

²U.S. Coast Guard, Department of Homeland Security (US). Boating Statistics – 2006 [online]. 2008. [cited 2008 March 26]. Available from URL: www.uscgboating.org/statistics/Boating_Statistics_2006.pdf.

³Branche CM. What is happening with drowning rates in the United States% In: Fletemeyer JR and Freas SJ, editors. Drowning: New perspectives on intervention and prevention. Boca Raton (FL): CRC Press LLC; 1999.

⁴Centers for Disease Control and Prevention. Swimming and Recreational Water Safety. In: Health Information for International Travel 2005-2006. Atlanta: US Department of Health and Human Services, Public Health Service, 2005. 5 Branche CM, Dellinger AM, Sleet DA, Gilchrist J, Olson SJ. Unintentional injuries: the burden, risks and preventive strategies to address diversity. In: Livingston IL, editor. Praeger handbook of Black American health (2nd edition): Policies and issues behind disparities in health. Westport (CT): Praeger Publishers; 2004. p. 317-27.

⁶ Brenner RA, Trumble AC, Smith GS, Kessler EP, Overpeck MD. Where children drown, United States, 1995. Pediatrics 2001;108(1):85–9.

⁷Present P. Child drowning study. A report on the epidemiology of drowning in residential pools to children under age five. Washington (DC): Consumer Product Safety Commission (US); 1987.

⁸U. S. Consumer Product Safety Commission. Safety barrier guidelines for home pools [online]. [cited 2007 Mar 21]. Available from URL: www.cpsc.gov/cpscpub/pubs/pool.pdf.

⁹Gilchrist J, Gotsch K, Ryan GW. Nonfatal and Fatal Drownings in Recreational Water Settings—United States, 2001 and 2002. MMWR 2004;53(21):447–52.

¹⁰Howland J, Mangione T, Hingson R, Smith G, Bell N. Alcohol as a risk factor for drowning and other aquatic injuries. In: Watson RR, editor. Alcohol and accidents. Drug and alcohol abuse reviews. Vol 7. Totowa (NJ): Humana Press, Inc.; 1995.

¹¹Howland J, Hingson R. Alcohol as a risk factor for drownings: A review of the literature (1950–1985). Accident Analysis and Prevention 1988;20(1):19–25.

¹²Smith GS, Kraus JF. Alcohol and residential, recreational, and occupational injuries: A review of the epidemiologic evidence. Annual Rev of Public Health 1988;9:99–121.

¹³Quan L, Bennett E, Branche C. Interventions to prevent drowning. In Doll L, Bonzo S, Mercy J, Sleet D (Eds). Handbook of injury and violence prevention. New York: Springer, 2007

¹⁴ Gilchrist J, Sacks JJ, Branche CM. Self-reported swimming ability in U.S. adults, 1994. Public Health Reports 2000;115(2–3):110–1.

(Source: CDC -- Water-Related Injuries: Fact Sheet)

Drownings: The Reality

We all want to keep our children safe and secure and help them live to their full potential. Knowing how to prevent leading causes of child injury, like drowning, is a step toward this goal.

When most of us are enjoying time at the pool or beach, injuries aren’t the first thing on our minds. Yet, drownings are the leading cause of injury death for young children ages 1 to 4, and three children die every day as a result of drowning.

Thankfully, parents can play a key role in protecting the children they love from drowning.

Prevention Tips

Fence it off. Install a four–sided isolation fence, with self–closing and self–latching gates, around backyard swimming pools. This can help keep children away from the area when a parent cannot supervise them. Pool fences should completely separate the house and play area from the pool.

Make life jackets a "must." Make sure kids wear life jackets in and around natural bodies of water, such as lakes or the ocean, even if they know how to swim.

Learn CPR. Learn cardiopulmonary resuscitation (CPR) and get recertified every two years. CPR can help a child stay alive with little or no brain damage.

Be on the look out. Supervise young children at all times around bathtubs, swimming pools, and natural bodies of water. Adults watching kids near water should avoid distracting activities like playing cards, reading books, or talking on the phone.

(Source: CDC -- Drownings: The Reality)