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     June 2, 2011

A special issue of the CSN Newsletter - Focus on water safety

In This Issue                       With the approach of summer, CSN has produced this special
                                    newsletter issue on water safety, which includes research articles,
General drowning prevention         fact sheets, policy statements, and reports on drowning
and water safety                    prevention. Safety resources are provided for pools and spas,
                                    open bodies of water such as lakes and rivers, boats, and the
Pools and spas                      home water hazards of bathtubs, bath seats, buckets, and
                                    decorative ponds or fountains.
Open water

                                    <<Back to the CSN Newsletters
Home water safety

General drowning prevention and water safety

1. Unintentional Drowning: A CDC Fact Sheet
"In 2007, there were 3,443 fatal unintentional drownings in the United States, averaging ten deaths
per day. An additional 496 people died, from drowning and other causes, in boating-related

More than one in five fatal drowning victims are children aged 14 and younger. For every child who
dies from drowning, another four received emergency department care for nonfatal submersion

2. Prevention of drowning: An AAP policy statement

This policy statement includes 14 water safety tips that will educate parents.

Recommended community interventions include: legislation to mandate 4-sided

isolation pool fencing for all new and existing residential pools; efforts

to ensure that community pools and other pools accessible to the public (such as pools at
apartments, hotels, and motels) have certified lifeguards; state and local legislation

and regulations to establish basic safety requirements for natural swimming areas

(e.g., mandating the presence of certified lifeguards in designated swimming

areas); and enforcing laws that prohibit alcohol and other drug consumption by boat occupants,not
just operators.

3. Drowning prevention: A Safe Kids USA webpage

"In the pool, at the beach or even in your bathroom, water can be dangerous to your kids if you
don't take the right precautions. Drowning can happen any time of year, but parents need to be
particularly vigilant during warmer months, when the number of drownings skyrockets."

Resources featured on this Safe Kids webpage include fact sheets, research reports, safety tips, a
video, and a list of other useful websites.

4. Prevention of drowning: Technical report - An AAP publication

This report describes evidence-based child drowning prevention practices: adult supervision; pool
fencing; pool covers; pool alarms; lifeguards; CPR training; swimming instruction and water-survival
training; and personal floatation devices (PFDs).

5. Clear Danger: A National Study of Childhood Drowning and Related Attitudes and Behaviors. -
A Safe Kids report (2004)

Safe Kids' objectives in conducting this study were to examine the circumstances of drowning in
children ages 14 and under and to determine the knowledge, attitudes, and behaviors of parents
regarding water safety.

As children approach adolescence, they are given more freedom and begin to take greater
responsibility for their own safety. For this reason, Safe Kids also surveyed "tweens" (children ages
8 through 12) to assess their knowledge, attitudes, and behaviors.

The report highlights four important components of water safety: active supervision by a
designated adult, safe water environments, proper gear, and education.
6. The association between swimming lessons and drowning in childhood: a case-control study

This study (Brenner RA, et al. Arch Pediatr Adolesc Med. 2009 Mar;163 (3):203-10) finds that
participation in formal swimming lessons was associated with an 88 percent reduction in the risk
of drowning in 1- to 4-year-old children.

CSN will provide copies of the article to state Maternal and Child Health and state public health
staff on request:

7. Urban minority youth swimming (in)ability in the United States and associated demographic
characteristics: Toward a drowning prevention plan

This study (Irwin CC, et al. Inj Prev. 2009 Aug; 15(4): 234-9) examines swimming ability among
1,680 inner-city, minority children in six U.S. cities: Chicago, IL; Houston, TX; Memphis, TN; Miami,
FL; Oakland, CA; and Philadelphia, PA.

Poor minority children, specifically African-American and Hispanic/Latino, were at a significant
disadvantage concerning swimming ability.

Female subjects were notably more "at risk" regarding their swimming ability than male subjects.

Age, race, and socioeconomic factors were significantly associated with children who have low
swimming ability.

CSN will provide copies of the article to state Maternal and Child Health and state public health
staff on request:

8. Lifeguard Effectiveness: A report of the working group. - A CDC report
This report, published by the CDC's National Center for Injury Prevention and Control (CDC) in
2001, assesses lifeguards as a strategy for preventing drowning and water-related injuries.

The product of an expert meeting and a review of data from the United States Lifesaving
Association (USLA) and other sources, the report helps communities, local government officials,
and owners of private water recreational areas make informed decisions about whether to begin,
retain, or discontinue lifeguarding services.

9. Keep Your Eyes on the Kids: Florida drowning prevention campaign

Tragically, Florida is known as the drowning capital of the country for children under the age of
four. Even with new laws in Florida that require fencing around the perimeter of residential pools
built since 2000, the number of drownings continues to rise, along with the number of residential

Since 2006, the Florida Department of Health (DOH) has annually identified the counties with the
highest number of drowning deaths in the 1-4 age group. The DOH provides funds and materials for
these counties to participate in "Keep Your Eyes on the Kids", a drowning prevention campaign that
focuses on young children.

In 2009, the top counties were: Brevard, Broward, Dade, Escambia, Hillsborough, Lee, Orange,
Osceola, Palm Beach, and Pinellas. These counties' health departments work with local partners,
including Children's Medical Services (CMS) offices and Safe Kids chapters, to carry out drowning
prevention activities. These activities include distributing educational materials and resources, such
as Water Watcher Tags, in their communities.

Through the campaign, some county health departments have formed public/private partnerships
and have secured additional funding for early childhood drowning prevention programs.
10. Washington State drowning prevention efforts

Washington State Drowning Prevention Network

In Washington state, an average of 25 children and teens drown every year.

Over 70 percent of these drownings occur in open water.

Males in the 15-24 year age group are at the highest risk of drowning.

The Washington State Drowning Prevention Network, developed in 1994, seeks to prevent
drowning among children and teens on open water bodies, such as the ocean, lakes, or rivers.

A community guide can be used to establish a statewide regional or local drowning prevention

Additional resources include: a middle school program guide, life vest plan program guide,
educational materials and activities, and a Spanish-English fotonovela designed for families.

The Washington State Child and Youth Open Water Drowning Prevention Task Force created a five-
year plan to implement policy changes that will prevent open water drowning among children and

Wear it Washington campaign: Summer 2011
During the State Parks Boating Program's "Wear It Washington!" campaign this summer, special
teams of volunteers, U.S. Coast Guard Auxiliary, marine law enforcement officers, local marina
personnel and other organizations will be at "Wear It Washington!" events demonstrating the
latest designs in life jackets and asking boaters to take the "Wear It!" pledge.

"Wear It Washington!" events will be held at various locations across Washington throughout the

Pools and spas

11. CPSC annual reports on children's submersion and entrapment incidents

In 2005-2007, there was an annual average of 385 pool and spa-related drownings of children
younger than 15; about 78 percent of these children were younger than five.

In 2007-2009, there was an estimated average of 4,200 pool or spa emergency department-treated
submersions for children younger than 15; children between the ages of 12 to 35 months
represented 47 percent of estimated injuries for these years.
About 54 percent of the estimated injuries for 2007-2009, and 74 percent of the fatalities for 2005-
2007 occurred at a residence and involved children younger than age 15.

Pool and Spa Submersions 2010:
Circulation/Suction Entrapments 2010:

12. Pool Safely: A CPSC campaign

This campaign, launched by the U.S. Consumer Product Safety Commission (CPSC) in 2010, is a first-
of-its-kind national public education effort to reduce child drowning, non-fatal submersions, and
entrapments in swimming pools and spas.

The campaign is a key part of the CPSC's efforts to carry out the requirements of the Virginia
Graeme Baker Pool and Spa Safety Act (P&SS Act), federal legislation signed into law in 2007
mandating new requirements for pool and spa safety.

The major Pool Safely messages are: just adding an extra safety step in and around the water can
make all the difference, and the greatest water safety assurance comes from practicing as many
water safety measures as possible: barriers that completely surround the pool with self-closing,
self-latching gates; staying close, being alert, and watching children at the pool; learning and
practicing water safety skills (knowing how to swim and perform CPR); and having the appropriate
equipment (compliant drain covers, alarms, barriers, and sensors).

Simple Steps Save Lives: 2011 Pool Safely PSAs

These television and radio public service announcements (PSAs) urge parents to watch children at
all times around pools and spas this summer.

13. Safety Barrier Guidelines for Home Pools

This manual helps families to build the barriers intended to prevent drownings and near-drownings
of children in home pools, spas and hot tubs.

Guidelines cover fences, gates, audible alarms for doors with access to pools, and power safety

14. Virginia Graeme Baker Pool and Spa Safety Act

This bill was passed by the Senate on December 13 and signed into law on December 19, 2008. The
law is named for the granddaughter of former Secretary of State James A. Baker, III, who in 2002 at
the age of 7, died in a spa after the powerful suction of a drain entrapped her under water.

The law includes: prohibition of the manufacture, sale, or distribution of drain covers that do not
meet anti-entrapment safety standards established by the U.S. Consumer Product Safety
Commission (CPSC); a requirement that the CPSC establish a safety standard for anti-entrapment
drain covers; creation of an incentive grant program for states to adopt comprehensive pool and
spa safety laws; establishment of a national drowning prevention education program within the
CPSC; and a requirement that public pools incorporate anti-entrapment drain covers and other
layers of protection.

15. Pool fencing for preventing drowning in children

The objective of this review (Thompson DC, Rivara FP. Cochrane Database Syst Rev. 2000; (2):
CD001047) was to determine if pool fencing prevents drowning in young children.

Case control studies which evaluate pool fencing interventions indicate that pool fencing
significantly reduces the risk of drowning.

Isolation fencing (enclosing pool only) is superior to perimeter fencing (enclosing property and
pool) because perimeter fencing allows access to the pool area through the house.

The reviewer concludes that legislation should require isolation fencing with secure, self-latching
gates for all pools - public, semi-public, and private.

CSN will provide copies of the article to state Maternal and Child Health and state public health
staff on request:

Open water: lakes, rivers, and the ocean

16. International open water drowning prevention guidelines: A Seattle Children's Hospital
publication (2010)

An international task force on open water drowning prevention - 18 experts from 12 countries -
established these brief guidelines for families and individuals recreating at any open water site.

The guidelines emphasize swimming and water safety survival skills for everyone and provide
strategies for those who are responsible for children while recreating in open water.


17. Kids Don't Float Program

Kids Don't Float (KDF) is an injury prevention program that was first developed in Alaska in 1996 to
address that state's high child and youth drowning rate.

KDF combines personal floatation device (PFD) loaner stations at boat ramps and harbor entries
with water safety education.

The KDF manual and school curriculum materials are being used to replicate the program in
communities across the country. There are currently more than 500 KDF programs in the United

For the "Loaner board guide" revised in 2010, visit

 For the "KDF peer education program" curriculum,

 For more information,

18. Personal Watercraft Use by Children and Adolescents: An AAP policy statement; published in
2000, reaffirmed in 2010)

"No one younger than 16 years should operate a personal watercraft.
The operator and all passengers must wear US Coast Guard-approved personal flotation devices.

Other safety recommendations are suggested for parents and pediatricians.";105/2/452.pdf

19. Boating Education Laws

Each state has unique boating education requirements, and boating rules, laws, and regulations
vary from state to state for obtaining a boat license or safety certification.

20. Drowning among personal watercraft passengers: the ability of personal flotation devices to
preserve life on Arkansas waterways, 1994-1997

The purpose of this study (Jones CS. J Ark Med Soc. 1999 Aug; 96(3): 97-8) was to determine the
effectiveness of personal flotation devices (PFDs) to prevent drowning and near-drowning of
individuals involved in personal watercraft (PWC) crashes.

The researchers examined the 48-month collection of PWC crash data from the Arkansas Game and
Fish Commission for 1994-1997. They considered: PFD use: swimming experience; whether
passengers were ejected from the watercraft; and crash cause.

Results show that 38 percent of the PWC crash victims were not swimmers, 98 percent wore a PFD,
and 54 percent were ejected from the PWC.

Alcohol was a causal factor in six crashes and one death.

It is estimated that PFDs saved 38 Arkansans who could have drowned.

CSN will provide copies of the article to state Maternal and Child Health and state public health
staff onrequest:

Home water safety
21. Submersions related to non-pool and non-spa products: A CPSC report

The end of outdoor swimming and pool season doesn't mean the end of drowning dangers for
young children. After pools, more children drown in bathtubs than in any other product in and
around the home.

This report, published by the U.S. Consumer Product Safety Commission (CPSC), warns of in-home
drowning dangers with bathtubs, bath seats, and buckets.

For 2003-2005, an annual average of 90 children younger than five years of age drowned in
bathtubs (62 percent), baby seats or bathinettes (15 percent), buckets and pails (11 percent),
landscaping or yard products (6 percent), and other products (4 percent).

For 2005-2007, an annual average of 39 non-fatal submersion incidents was reported for the same
products. The majority of drownings and non-fatal submersion incidents involved children younger
than two years old.

Many of the reported incidents involved a lapse in supervision, such as leaving the bathroom
momentarily while the child was in the bathtub or leaving an older sibling to watch a younger

CPSC offers safety tips for parents and caregivers to follow when children are around bathtubs,
bath seats, buckets, spas, or decorative ponds or fountains: never leave young children alone, even
for a moment, near any water; don't leave a baby or toddler in a bathtub under the care of another
young child; and never leave a bucket containing even a small amount of liquid unattended.

22. Home water hazards for young children: AAP guidelines

"Children must be watched by an adult at all times when in or near water. Children may drown in
an inch or 2 of water."

The findings and conclusions in these newsletter materials are those of the authors and do not
necessarily represent the position of the Children's Safety Network.