Preventing summer drownings

For children under the age of 14, drowning is the second leading cause of trauma deaths nationwide


By Robert Donovan

In sunny California, prime land is scarce, and real estate can be expensive. As a result, land developers have always strived to put the largest houses they can on the smallest possible lots, and still charge outrageous prices. Then, in places like the Central Valley where our summers are hot, what nicer addition to a new home than a swimming pool in the backyard?

Since backyards these days can be postage stamp size, the end result is that, for many homes, simply take a few steps out the back door and you end up in the water.

A young family of four recently moved into a rental home. It was their hope that in the next few months, if the bank loan was approved, they could move again and become homeowners.

Dad had just left for work and Mom was bustling around the house getting the 4-year-old boy ready for kindergarten. Following behind the mother's every step was a 23-month-old girl. They were almost ready to leave the house, but still missing was one of the 4-year-old's sneakers, and the mother was looking everywhere for it. She looked out the window, spied the sneaker in the backyard, and sprinted out to retrieve it.

The sight no parent wants to see
Back inside, she adroitly places the sneaker on the remaining foot and takes a quick inventory before she plans to go. She looks around expecting to see the 2-year-old nearby, but curiously the child is nowhere to be seen. Suddenly the mother's intuition raises an alarm, and she sprints outside — only to see her baby girl at the bottom of the pool!

Without hesitation she dives in, and plucks her daughter off the bottom of the pool. As she pulls her baby girl out, the child is blue around the mouth and has gurgling respirations. Sheer panic ensues, and she rushes out into the front yard holding her baby, and over to a neighbor who is working in the yard. The wise neighbor starts mouth-to-mouth rescue breathing, and within a few moments the little girl starts breathing on her own.

They called 911 and the fire department, followed closely by the paramedics, arrived on scene. Quickly and expertly, the airway is suctioned, supplemental O2 is begun, and an IV started. The toddler is brought to my Emergency Department, now screaming and having a fit.

First, the good news — the child did fine. Nevertheless, drownings continue to be a tragic part of each summer. I'd like to share this recent case that presented to my Emergency Department, and see if I can convey some useful information to help you with your next 911 call for a drowning victim.

Nationwide, for children under the age of 14, drowning is the second leading cause of trauma deaths. In California, Florida, and Arizona it is number one1.

As EMS professionals, we have all been involved in the push for car seats as a way to reduce child mortality from MVA's. Did you know that a swimming pool is 14 times more likely than a car to be involved with a young child's death? Those are scary numbers.

As I examine the fortunate little girl, she continues to let me know she isn't happy. But her screams are just music to my ears, since I know that the likelihood of her having a bad outcome diminishes with each passing hour, if she stays like this. Her chest x-ray is clear, and her labs are all within normal limits.

So, can we guess just how she is going to do? A great deal of research has been looking at this question. One measuring scale, called the Orowski Score, has been developed to estimate the chances of a drowning child surviving neurologically intact. I think you will find this score useful and intuitive. It is based on just 5 elements, listed below.

☐ Age 3 years or older
☐ Submersion time of more than 5 minutes
☐ No resuscitative efforts for more than 10 minutes after rescue
☐ Comatose on admission to the emergency department
☐ Arterial pH of less than 7.10

If you have two or less checkboxes, you have a 90 percent chance of complete neurologically intact survival.

If you have three, four, or five, you only have a 5 percent chance of surviving neurologically intact.

Our 2-year-old girl was lucky — her score was zero. I watched her for several hours, then sent her home with her grateful parents.

Take home lessons
• All children sink. Teach them to swim as soon as they can learn, but never trust them. Even a young child who is taught to swim may panic if accidentally falling in the pool, especially with their clothes on when it's not a designated "swimming time".

• Assume that a motivated, curious child can get past most every obstacle you can imagine to get into trouble.

• Drownings are much more likely to occur if there are lots of distractions or stressors in the environment. Often times, the more people around, the less likely one designated person is watching the child, so the end result is that no one is really watching closely.

• As healthcare professionals, we have a responsibility to teach. Because we swim (no pun intended) in medical knowledge, we can often be unaware of how little the average person may know about the risks. Uses every teachable moment you can.

• Encourage people to take CPR classes. Every time you're talking to the parent of a child you're transporting, regardless of the illness, ask them directly if they have taken a CPR course, even if you're just transporting the child for a stubbed toe. It is a teachable moment whenever a parent sees their child in an ambulance, so I recommend that the teachable moment be put to good purpose.

• Finally, if you are thinking of building a pool for your own house, consider adding a motorized pool cover. We have one on our pool, and with a turn of a key I can lock it2. They aren't cheap, but neither is a funeral, so bite the bullet and get one.

I would love to hear your thoughts — feel free to drop me a line or comment in the member section below.

References
1. Health, United States 1996-97 and Injury Chartbook. DHHS Publication No (PHS) 96-1232. US Department of Health and Human Services. Hyattsville, Md: National Center for Health Statistics;. 1997
2. I had Aquamatics install our motorized pool cover, and I am sure there are many other excellent companies who have similar products.

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