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INTRODUCTION

Drowning is defined as a process resulting in primary respiratory impairment from submersion or immersion in a liquid medium. For drowning to occur, the face and airway must be immersed. Drowning is a major public health problem. According to the World Health Organization (WHO), there are 372,000 deaths per year worldwide attributed to drowning. More than 90% of these deaths occur in low- and middle-income countries. It is 1 of the 10 leading causes of death worldwide among people between 1 and 24 years of age. The full extent of the world’s drowning problem is underreported since statistics exclude intentional drowning and drowning deaths resulting from flood disasters, tsunamis, and water transport incidents.

In the United States, drowning is the leading cause of unintentional injury-related death among children 1 to 4 years of age, with a death rate of 2.4 per 100,000. Approximately 1 in 5 people who die from drowning are children aged 14 and younger. In 2014, there were 7701 emergency department visits for nonfatal unintentional submersions and 892 unintentional drowning deaths in US children 0 to 18 years of age. Fortunately, the death rate due to drowning in children is decreasing. The crude death rate due to unintentional drowning in children decreased from 1.17 per 100,000 in 2009 to 1.06 per 100,000 in 2014. Rates are highest in the southern United States. Most victims of nonfatal drowning do well, but about 5% to 10% of these incidents result in severe neurologic damage secondary to cardiac arrest. These are even more common when drowning occurs in open bodies of water.

Key risk factors for drowning are: a lack of barriers controlling exposure to bodies of water; lack of adequate, close supervision for infants and young children who are a drowning risk; poor swimming skills; low awareness of water dangers; and high-risk behavior, including consuming alcohol while engaging in water-related activities, especially among adolescents and young adults. Other risk factors include the failure to wear life jackets and seizure disorders. In low- and middle-income countries, transport on water and water crossings, lack of safe water supply, and flood disasters are additional risk factors. Drowning victims involved in natural disasters may also have associated traumatic injuries.

There are 2 peaks of incidence of drowning in children: The first is in the infant/toddler age group and occurs in bathtubs and swimming pools, and the second is in the adolescent age group and is frequently related to risk-taking behavior in swimming pools and during recreational water sports in natural bodies of water. Drowning rates are influenced by factors such as access to swimming pools, the motivation to learn how to swim, and participation in water-related recreational activities, as well as demographics. African-American children are at between 3- and 5-fold increased risk of drowning than children of similar ages of other racial or ethnic groups.

Among all US residents between the years 1999 ...

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