Dr. Linda Quan: Safety in and near the water

[0:00:21]

LINDA QUAN: I’m Linda Quan. I’m a pediatric emergency medicine physician at Seattle Children’s Hospital and a professor in pediatrics at the University of Washington School of Medicine. And for 40 years, I’ve studied drowning resuscitation and drowning prevention—who drowns, why and what works and is effective at preventing drowning.

[0:00:50]

LINDA QUAN: About 4,000 people die every year from drowning in the United States. It’s one of the three leading causes of unintentional—that means accidental—injury death in those who are under 29 years of age in this country. So that’s a big deal. And it causes more deaths in 1- to 4-year-olds than any other condition except for birth defects. And as a pediatrician, I’m specifically drawn to drowning because toddlers, those 1 to 4 years of age, have the highest drowning rates of all age groups. And that’s true, actually, throughout the world. In the 1- to 4-year-old age group, the most common cause of death is actually drowning. And the recurring scenario in our country is that these toddlers fall into their home pool, to which they’ve gotten unsupervised access.

The second-highest drowning rate is in teenagers—and actually teenagers on up to young adults, that is 24-year-olds. They have the second-highest drowning rate in most states in this country. And this age group and adults drown mostly in open water. That means at lakes or rivers, the ocean, ponds. And usually, they’ve been swimming or boating in those settings. So now what is interesting to me is—and should be interesting to everybody—is that we’re seeing an emerging in Canada, they’ve called it an emerging epidemic of drowning in adults, those who are over 45 years of age. So being older is not wiser. And this hasn’t been well-studied, but it’s mostly men. And they’re fishing or boating or swimming and not wearing life jackets. And often, 50% of the time, they’re drinking alcohol.

[0:03:01]

LINDA QUAN: With fewer lifeguards being there as our last line of defense and protecting our family, friends from drowning is that we have to choose the site that you swim in wisely so that you put in extra effort to find that beach that does have a lifeguard, that you provide adequate supervision. And that’s always been the case. But this time, you really have to put away the cellphone, the book, and not chatting while the kids are in the water. And that kid could also be a teenager, so let’s not forget them. And so by removing those distractions, that should improve your ability to watch.

But you also—for the poor swimmer, the nonswimmer, you need to be within arm’s reach of them. And then the other thing you can do to help you—and I believe parents, supervisors need all the help they can when they’re around the water—and that is to put your weak swimmers, your nonswimmers in life jackets so that if something happens—and, you know, being an ER doc, I believe in Murphy’s Law—something bad could happen, it may well happen. So get them, those people who can’t swim well—and again, that could include your teenager—to get them into swim lessons, as well as into life jackets so they can learn the skills and the smarts that they need.

[0:04:52]

LINDA QUAN: Drowning is not a fair injury. Drowning risk varies among races and cultures and sexes in our country. And whites have the lowest drowning rates overall, but they have the highest drowning rates in 1- to 4-year-olds. In our country, Native Americans, Alaska Natives have the highest drowning rates in all age groups and in all settings. And nationally, Blacks have higher drowning rates than whites. And these disparities between Blacks and whites become really pronounced in swimming pool drownings involving kids under the age of 5. Now, the reasons for these disparities have nothing to do with their physical or physiologic differences. It has nothing to do with that. We believe these are all due to what we call the social determinants of injury and health, which is what kind of history the families have had with involvement with water activities, what kind of knowledge and comfort they’ve had, access to and availability of swim lessons in their communities and swim opportunities.

[0:06:22]

LINDA QUAN: Swim lessons is a very vague term and can be used in different ways with different goals at different ages, so that the American Academy of Pediatrics now recommends swim lessons can be started at age 1. And in that setting and that age group, really, it’s more an effort not to have the child particularly learn any skills but to learn to be comfortable in the water, to enjoy the water and have a bonding, fun time with their parent. And, as we all know, these are hard to come by in our society, aren’t they, as we’re all so busy. So it’s supposed to be an interactive, positive experience.

And then to actually start physical psychomotor skill acquisition is something that, you know, is when the child is comfortable and developmentally ready, meaning they can start slowly putting it all together. And we know that they can most efficiently put it all together at age 5, the average kid. Now, what I think parents need to understand and as a grandparent who takes her grandkids to swimming lessons, it takes a long time. It’s not easy. And their parents should be aware of kind of like, where is my kid at? Because we know parents are taking their kids out of swim lessons before they acquire all the skills we’d like them to have. And so they need to understand. It’s not a matter of one session, it’s not a matter of sometimes even one season. It’s really multiple sessions, maybe even 20 sessions. You’re in for the long haul.

[0:08:33]

LINDA QUAN: Assume people if they look like they’re in trouble are in trouble. The other thing is never assume that you’re going to hear someone who’s in trouble. So this is the big problem people have when they set themselves up, if you will, for a bath drowning or a pool drowning. I’ll just go inside the house. You know, I’ll get those, you know, get that hot dog, and I’ll hear so-and-so if they’re in trouble. Well, once you get into trouble, you are struggling to breathe. You are literally—you are aware you are dying and that your only mission is to try to breathe. And you do not have the—really, there are multiple reasons why you can’t talk, and so you cannot shout. The mother in the next room, even with the door open to the bathroom, will not hear that child who is submerged in the bathtub. So do not expect to be able to hear. The answer is watch, watch carefully, consistently, with constant attention. The other piece is when they really get in trouble, the clue is they’re suddenly—you’re looking at their face. You’re not looking at the top of their head as they’re trying to, you know, swim towards wherever they’re going. They’re looking at you, facing you, because they’re trying to get up.

[0:10:15]

LINDA QUAN: What you should do is take a first aid class, have taken a first aid class on how to rescue safely someone and your limit—you’re very limited. And that is to throw something at them that floats. And so they’re—I have, you know, the beach that we go to, I have a throw rope. I have a—Hawaii, actually, has pioneered this and just reported on it’s being used—is they have those lifeguard rescue tubes that you saw on “Baywatch.” And I think “Baywatch” did probably a great public service by showing them being used and so that people actually have used them and made saves and decreased the drowning rates in the beaches in Hawaii that have placed them there. So the point is, use something that floats, and it could be the Styrofoam cooler that you brought. You know, even throw sneakers. Sneakers float. Crocs float. If that person can grab on to them and just float a little bit holding onto them, extending, it might help them.

The answer is also to reach. So throw or reach, reach with something long. You know, here in the northwest, there’s always a tree nearby, a branch. Reach out with that, use the shepherd hook in the pool, in the pool area that’s there. And really, just grab and throw stuff and reach with it. And the end, the rest of that is reach, throw, don’t go unless you’ve been trained how to in-water rescue because we see too many people dying, usually fathers who are trying to save their child.