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
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