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Submersion injury is a major public health problem and accounts for more than half a million deaths annually worldwide.1 It is the second most common cause of unintentional death in the United States for children between ages 1 and 19 years (Fig. 117-1), second only to motor vehicle crashes. In 2002, there were 3447 unintentional submersion deaths in the United States, averaging 9 people per day.3 Of these, 1158 (34%) were children. It is estimated that for each submersion death, there are up to four children who receive emergency medical care for nonfatal submersion injuries. More than 40% of these children are hospitalized and 20% of the survivors suffer permanent disability.

Figure 117-1.
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Unintentional submersion deaths ages 0–19 per 100,000 per year (2000–2005, USA. National Center for Injury Prevention and Control).


Submersion injury is not a problem unique to the United States. In Scotland, the rate of submersions in 1999 was 1.6 per 100,000 persons per year, where most events occurred not in private swimming pools, but in cold waters such as the sea or a reservoir.4 In Canada, the overall, unintentional submersion rate declined from 21.7 per 100,000 persons per year in 1979 to 5.8 per 100,000 in 2002.5 Drowning is the third most common cause of death (13.5%) in children. Populations that appear to be at particularly high risk of submersion injury include toddlers ages 1 to 4 years (1.85 deaths per 100,000) and youth ages 15 to 19 years (1.28/100,000). Submersion injury is a particular problem in China, where it is estimated that more than one fifth of worldwide submersion deaths occur.6 In Guangxi province of China, the mortality rate for submersions in male and female children ages 1 to 4 years was 29.8 per 100,000 and 29.6 per 100,000, respectively.7 Submersion injury is also a serious public health problem in India, where a study in one region showed average unintentional submersion injury rate for ages 1 to 12 years was 25.9 per 100,000.8 There, young children were most likely to drown in vessels containing water, since there are no piped water supplies in most villages. In the 10- to 12-year age group, 80% of the submersion injuries were in large open-irrigation wells without protective walls.


Submersion injury risks vary by gender, age, race, and socioeconomic status. After the first year of age, US males are at greater risk of death from submersion than females (Fig. 117-1). Among females, submersion deaths peak at 1 year and decline thereafter. Male incidence patterns exhibit a bimodal distribution, with peaks in ages 1 to 4 years and in the adolescent age ranges. Between the ages of 10 to 19 years, African American males have a higher submersion injury rate than do Caucasian males.3


Within the pediatric population, submersion circumstances vary ...

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