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Preventing Water Injuries & Deaths North Dakota Conference on Injury Prevention Lois Ustanko Clinical Preventing Water Injuries & Deaths North Dakota Conference on Injury Prevention Lois Ustanko Clinical Instructor Public Health Nursing “Drowning is quick and silent. ” Martin Eichelberger, CEO of Safe Kids USA

Reducing the Risk for Pool and Spa Drowning “There is an inherent danger anytime Reducing the Risk for Pool and Spa Drowning “There is an inherent danger anytime water is involved. ” Brian Strom, Aquatics Director at UND Hyslop Pool

Water Injuries and Deaths Make the News Headlines • 7/8/07 -A 22 -month-old Winona, Water Injuries and Deaths Make the News Headlines • 7/8/07 -A 22 -month-old Winona, MN girl was found dead in an above ground swimming pool. The pool with a ladder was unattended at the time. • 7/5/07 -A 6 -year-old Edina, MN girl is in serious condition after several feet of her intestines were pulled out by the suction of a wading pool drain. • 7/5/07 -An 18 -month-old Mahnomen child was pulled from a backyard swimming pool. The child started breathing after an aunt did CPR.

A Problem Oriented Assessment Purpose-to examine the circumstances of drowning & near drowning in A Problem Oriented Assessment Purpose-to examine the circumstances of drowning & near drowning in children ages 14 and under treated in the local hospital Qualitative Data-windshield observations & interviews Quantitative Data-chart reviews & parent surveys

Pools and Spas are Fun Nationally drowning is the second leading cause of injury-related Pools and Spas are Fun Nationally drowning is the second leading cause of injury-related death to children under 14 years of age. Drowning and neardrowning tend to occur on the weekend (40 percent) and between the months of May and August (62 percent). Safe Kids USA

About 260 children under five drown in swimming pools every year in the U. About 260 children under five drown in swimming pools every year in the U. S. This amounts to almost one nursery school class a month. An additional 2, 725 children are treated annually in emergency rooms for pool submersion injuries, most occurring in residential pools. Safe Kids USA reports that 80% of these incidents happened in residential pools of family or friends & the child was out of sight for less than 5 minutes. Source: Consumer Product Safety Commission

Inflatable Pools are Very Dangerous • Are popular because they are inexpensive • Can Inflatable Pools are Very Dangerous • Are popular because they are inexpensive • Can hold up to 5000 gallons of water • Fences or barriers not typically used • Flexible sides allow easy access for children CPSC reports 47 children died in inflatable pools from 2004 -2006.

Only 4 Drowning Deaths in ND from 2000 -2005 • All of the children Only 4 Drowning Deaths in ND from 2000 -2005 • All of the children were 5 -9 years of age • Factors that reduce the risk may include: – Limited amount of recreational water (lakes, pools, etc. ) – Short summer months Source: ND Dept. of Health Note: No available data for “near drowning”

Chart Review Results 8 Local Water Events from 2000 -2006 • Outcome-6 survived, 1 Chart Review Results 8 Local Water Events from 2000 -2006 • Outcome-6 survived, 1 died, 1 unknown (grave condition when transported) • Race-62. 5% white, 25% other, 12. 5% unknown • Location-25% hotel pool, 50% pond or water in yard, and 25% in hot tub or wading pool • Gender-75% male, 25% female • Age-62. 5% were 1 -4 years, 25% were 5 -9 years, 12. 5% were 10 -14 years

Young Boys Are Curious Boys 1 -4 years tend to explore & slip away Young Boys Are Curious Boys 1 -4 years tend to explore & slip away quickly. Adults underestimate the danger of water features in the yard.

Supervision is Important • There was a lapse in supervision for 75% of the Supervision is Important • There was a lapse in supervision for 75% of the local children (6) involved in these events • No lifeguard was present in any of these 8 events • The American Academy of Pediatrics reports a child loses consciousness in 2 minutes & suffers irreversible brain damage in 4 -6 minutes.

Near-Drowning is Devastating • 20% of children with submersion injuries suffer severe, permanent neurological Near-Drowning is Devastating • 20% of children with submersion injuries suffer severe, permanent neurological disability – Initial treatment costs about $75, 000 – Ongoing cost of $180, 000 -$250, 000 per year for long-term care Source: American Academy of Pediatrics

Parent Survey-Demographics • Gender – 95 % Female – 5 % Male • Race Parent Survey-Demographics • Gender – 95 % Female – 5 % Male • Race – 91 % White – 9 % Other • Age of Children – – – 14 < 1 year 34 1 -4 years 33 5 -9 years 22 10 -14 years 103 total children • Trained in CPR – 60 % Yes – 40 % No • No time or trained in the past but need to re-certify

Types of Pools & Spas Accessible to these Children • 6 In-ground home pool Types of Pools & Spas Accessible to these Children • 6 In-ground home pool • 29 In-ground public pool • 7 Home above ground pool • 7 Large inflatable pool • 25 Wading pool • 8 Hot tub Parent Survey

Activities These Children Participated in This Year • 48 % Boating • 14 % Activities These Children Participated in This Year • 48 % Boating • 14 % Water sports Parent Survey • 83 % Swimming • 30 % Hot tub

Perception of Children’s Vulnerability to Water Hazards • • • 19 % Not vulnerable Perception of Children’s Vulnerability to Water Hazards • • • 19 % Not vulnerable 54 % Somewhat 14 % Vulnerable 7 % Very vulnerable 6 % Extremely Parent Survey

Frequency of Swimming Lessons and Rating of Swimming Ability • Times lessons taken – Frequency of Swimming Lessons and Rating of Swimming Ability • Times lessons taken – – 32 Never 13 Once 6 Twice 14 Three or more • Child’s swimming ability – – – 12 % Very well 18 % Well 26 % Somewhat 17 % Not well 28 % Cannot swim Parent Survey

Perception of Children That Need Supervision Around Water Parents with very young children are Perception of Children That Need Supervision Around Water Parents with very young children are thinking in terms of pools & spas rather than bath tubs & other water sources. As children get older parents think they need less supervision. Parent Survey

Parent Responsibility When Lifeguard is on Duty • 92 % report adult still needs Parent Responsibility When Lifeguard is on Duty • 92 % report adult still needs to supervise • 8 % report they do not need to supervise if there is a lifeguard Parent Survey

Perception of When Child Can Swim Without Supervision • 12 report “when the child Perception of When Child Can Swim Without Supervision • 12 report “when the child is with a buddy” • 15 state when the child is an “excellent” swimmer • 36 identify after the child has had several years of lessons Parent Survey

Distractions Reported While Children Are Swimming • 22 talked on the phone • 55 Distractions Reported While Children Are Swimming • 22 talked on the phone • 55 talked with others • 19 read • 24 ate • 7 closed eyes to relax Parent Survey

Definition of Supervision • 26 Stay within arm’s reach • 53 Constant visual contact Definition of Supervision • 26 Stay within arm’s reach • 53 Constant visual contact • 8 Periodically observe the child Parent Survey

Designate Supervision with the Water Watchers Program • “Just as a designated driver is Designate Supervision with the Water Watchers Program • “Just as a designated driver is responsible for driving safely, the designated Water Watcher is the adult responsible for actively supervising children to assure that they stay safe in the water. ”

Safety Features at the Pools & Spas Used By These Children • 27 telephone Safety Features at the Pools & Spas Used By These Children • 27 telephone • 23 four sides enclosed • 20 emergency numbers posted • 20 CPR instructions posted • 12 shepherd’s hook • 8 self-latching gates Parent Survey

Personal Flotation Devices • Reports of when children should wear – 84% in watercraft Personal Flotation Devices • Reports of when children should wear – 84% in watercraft – 70% during water sports – 57% when in or around open water • Reasons children have not worn PFDs – 3 because the child can swim – 5 had no PFD available • How often do parents wear a PFD in the boat? – – – 30 always 10 almost always 14 sometimes 9 almost never 3 never Parent Survey

Life Jacket Loaner Program • Life jackets are available for use in, on or Life Jacket Loaner Program • Life jackets are available for use in, on or around the water • Can “loan” the jackets for up to 2 weeks free of charge

Inflatables Do Not Protect Children From Water Hazards • Parents think inflatables can protect Inflatables Do Not Protect Children From Water Hazards • Parents think inflatables can protect children – 42% believe air-filled water wings protect children – 32% believe inner tubes protect children • Children slip out or fall off these inflatable toys • Children can easily drift into deep water Parent Survey

This water safety and boating course is presented each May. There is a 40 This water safety and boating course is presented each May. There is a 40 minute interactive presentation on water & boating safety plus five skills stations which include – – – Effects of hyperthermia Life jacket relay Water rescue techniques Fatal vision goggles Sample boating skills in battery-operated 2 person boats that are in the pool

Knowledge About Entrapment • Knowledge level – – – 33% not at all familiar Knowledge About Entrapment • Knowledge level – – – 33% not at all familiar 39% somewhat 12% familiar 12% very 3% extremely familiar • Sources of information – – – 14 TV 14 Friend or family 14 Safety professional 9 Swim teacher 8 Newspaper Parent Survey • Body parts at risk for entrapment – 41 identify arms or legs – 26 identify torso – 44 identify hair

More Thoughts About Entrapment • Where it can happen – – – 39 in-ground More Thoughts About Entrapment • Where it can happen – – – 39 in-ground home pool 36 in-ground public pool 31 above ground pool 25 large inflatable pool 23 wading pool 36 hot tub Parent Survey • Safety devices present in these pools or spas – – – 3 anti-vortex covers 8 multiple drains 4 safety vacuum release 28 unsure 11 none

Recommendations to Reduce the Risk for Drowning in Pools & Spas 1. Actively supervise Recommendations to Reduce the Risk for Drowning in Pools & Spas 1. Actively supervise children. 2. Put a fence around all pools. 3. Install pool and gate alarms. 4. Cover pools and spas when not in use. 5. Make sure your pool drain has a safety cover or a safety vacuum release system to prevent entrapment. 6. Remove pool ladders and toys. 7. Be prepared for emergencies. 8. Make sure your pump and filter are protected by a ground-fault circuit interrupter (GFCI) to prevent electric shock. 9. Drain wading and kiddie pools when not in use. 10. If a child is missing, check the pool first.

Actively Supervise Children Infants & toddlers should be within arms reach. Never leave children Actively Supervise Children Infants & toddlers should be within arms reach. Never leave children unsupervised.

Install a 4 -foot High Fence • • • For in-ground pool or an Install a 4 -foot High Fence • • • For in-ground pool or an inexpensive inflatable one. Include a selfclosing and selflatching gates. Install an alarm on the door from the house.

Use a Safety Cover When the Pool or Spa are Not in Use Never Use a Safety Cover When the Pool or Spa are Not in Use Never allow a child to climb on the covers since they can collapse and entangle a child under water.

Safety with Large Inflatable Pools • Fence the area where the pool is erected. Safety with Large Inflatable Pools • Fence the area where the pool is erected. • Always remove the ladder after each use.

Use an Alarm • Pool and spa alarms are designed to raise an alert Use an Alarm • Pool and spa alarms are designed to raise an alert if someone enters the water when he or she is not supposed to.

Cover Drains This cover prevents the suction from making a complete seal holding a Cover Drains This cover prevents the suction from making a complete seal holding a person’s body against the drain. The wedges on the top of the cover prevents hair from getting caught.

Remove Toys or floats attract children to the water. Remove ladders from above ground Remove Toys or floats attract children to the water. Remove ladders from above ground pools when the pool is not in use.

Be Prepared for Emergencies Keep life preservers, rescue hooks and a cordless phone near Be Prepared for Emergencies Keep life preservers, rescue hooks and a cordless phone near the pool. Learn CPR!

Prevent Electric Shock Make sure your pump and filter are protected by a ground-fault Prevent Electric Shock Make sure your pump and filter are protected by a ground-fault circuit interrupter (GFCI) to prevent electric shock.

Drain Kiddie Pools Drain wading pools when not in use and turn them upside Drain Kiddie Pools Drain wading pools when not in use and turn them upside down.

If a Child is Missing Check the Pool First • Parents think if their If a Child is Missing Check the Pool First • Parents think if their child falls in the water, they will hear lots of splashing and screaming. Many children slip under the water silently.

Safety When Away from Home • Check the water rules, equipment condition and degree Safety When Away from Home • Check the water rules, equipment condition and degree of supervision at friend’s homes. • At a public or commercial pool or spa personally check that drains are covered before allowing a child in the water. • When a guest, find out where the cutoff switch is for a pool or spa pump.

Entrapment How it happens 1. Hair gets sucked into the drain and becomes tangled Entrapment How it happens 1. Hair gets sucked into the drain and becomes tangled around the drain. 2. Flat, old fashioned pool or spa drain covers suck a child’s body part to the drain making it impossible to pull them off. 3. Loose, broken or missing pool or spa drain covers can allow a child to be pulled into the piping below the drain cover allowing a suction entrapment. How to prevent 1. Wear a bathing cap or pin long hair up. 2. Never allow children to play near the drain-keep heads above the water in a spa. 3. Shut down the pool or spa if the drain cover is missing or broken.

Danger Lurks Below the Surface The powerful forces that circulate the water in your Danger Lurks Below the Surface The powerful forces that circulate the water in your pool or spa are capable of sucking young children onto the drains at the bottom or side of your pool or spa. Safe Kids USA reports 34 children under 14 years of age died and 130 were injured from 1985 -2004 from entrapment.

The Pool Pump Pulls Them Down This 8 -year-old drowned when he got sucked The Pool Pump Pulls Them Down This 8 -year-old drowned when he got sucked against a circulation drain while trying to recover a ball from a swimming pool.

Strengths • Swim lessons available • Kids in Boats Program at Y Family Center Strengths • Swim lessons available • Kids in Boats Program at Y Family Center & • Coast Guard Auxiliary UND patrols MN water • Water Watchers • PFD required for programs at area hotels children under 10 years • Lifeguards present at in ND & MN public pools & some hotels

Needs • Highlight the risk of entrapment • Set regulations for checking drains • Needs • Highlight the risk of entrapment • Set regulations for checking drains • Tell of the hazards of inflatable pools that are not fenced • Teach adults how to “actively” supervise • Increase advertising about swimming lessons & availability of scholarships • Inform about the danger of koi ponds and other open water around the yard • Enforce fencing laws • Increase the amount of adult education about these risks & methods of prevention

Where can we reach adults who supervise the children? • • • Day care Where can we reach adults who supervise the children? • • • Day care centers Library Doctors offices Park programs Newborn parent information packets • Chamber or visitor’s bureau information • Schools • Media Outlets • Housing authority and developments • County social service office • Public health departments • Boat shows • Fishing tournaments • Grocery stores • Churches

Resources for Comprehensive Drowning Prevention Efforts Safe Kids Grand Forks. Water Safety. Retrieved from Resources for Comprehensive Drowning Prevention Efforts Safe Kids Grand Forks. Water Safety. Retrieved from http: //www. safekidsgf. com/Water. Safety. html Safe Kids USA. Water Safety Campaign 2008. Retrieved from http: //www. usa. safekids. org/water/ Washington State Department of Health. Child Drowning Prevention. (2004). Retrieved from http: //www. doh. wa. gov/cfh/mch/documents/Child_Drowning_Prevent ion. pdf

Resources to Prevent Injuries in Swimming Pools Center for Disease Control. Healthy Housing Reference Resources to Prevent Injuries in Swimming Pools Center for Disease Control. Healthy Housing Reference Manual: Residential Swimming Pools and Spas. Retrieved at http: //www. cdc. gov/nceh/publications/books/housing/2006_HHM_FI NAL_chapter_14. pdf Los Angeles Fire Department. Backyard Pool Safety Tips. (2006). Retrieved from http: //www. lafd. org/drown. htm National Association of Home Inspectors. Safety Guidelines for Pools. Retrieved from http: //www. newbeginningshomeinspection. com/pool. html

Resources to Promote Safety in Spas, Hot Tubs and Whirlpools Underwriters Laboratories. Product Safety Resources to Promote Safety in Spas, Hot Tubs and Whirlpools Underwriters Laboratories. Product Safety Tips: Personal Spas. (2008). Retrieved from http: //www. ul. com/consumers/spa. html United States Consumer Product Safety Commission. Consumer Product Safety Alert: Spas, Hot Tubs and Whirlpools. (2008). Retrieved from http: //www. buyerschoiceinspections. com/Spas. Whirlpools

Resources for Reducing the Risk of Entrapment Dworkin, G. M. (1998). Pool and Sap Resources for Reducing the Risk of Entrapment Dworkin, G. M. (1998). Pool and Sap Entrapment. Life Saving Resources. Retrieved from http: //www. lifesaving. com/issues/articles/17 pool_spa_entrapment. ht ml United States Consumer Product Safety Commission. Guidelines for Entrapment Hazards: Making Pools and Spas Safer. (2005). Retrieved from http: //www. cpsc. gov/cpscpub/pubs/363. pdf United States Consumer Product Safety Commission. Virginia Graeme Baker Pool and Spa Safety Act: Staff Interpretation of the Drain Cover Standard. (2008). Retrieved from http: //www. cpsc. gov/phth/vgpsa. pdf

Contact Information For Safe Kids Grand Forks Safe Kids Grand Fork C/O Altru Health Contact Information For Safe Kids Grand Forks Safe Kids Grand Fork C/O Altru Health System Coordinator – Carma Hanson [email protected] org 701 -780 -1489