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Childhood injuries Preventing children drowning in AustraliaWe need to take a scientific approach to drowning prevention W Robert Pitt and Danny T Cass
MJA 2001; 175: 603-604 | ||
| Childhood drowning and near-drowning are major public health problems, especially for the 0-4 years age group. Queensland and Western Australia have long considered they have the highest mortality rates, but Edmond et al show that childhood drowning is a greater health problem in the Northern Territory.1 As elsewhere in Australia, more toddlers drown in swimming pools than from any other cause. Drowning prevention is a national health priority and water-safety organisations have worked with all levels of government to develop a national Water Safety Plan. Pool-fencing legislation has been introduced in Victoria, New South Wales, South Australia and Queensland, and national education campaigns receive government and corporate support. | ||||||||||
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Effective, immediate resuscitation influences outcome, but prognosis is bleak if the victim does not respond within 20 minutes.2,3 The effectiveness of educational programs has not been studied for toddler immersions. The potential for "drownproofing" children under four years of age by teaching them swimming skills sufficient for a panic situation is unproven.4 Measures such as pool alarms, pool covers and parental supervision depend on the human factor — the intervention must be activated every time the pool is unattended. Ultimately, the most effective preventive strategies activate automatically to insure against human fallibility, and are aimed at removing hazards from the child's environment. Child-resistant fencing surrounding the pool, with access limited by self-closing gates, has a protective effect.5 Queensland and NSW introduced uniform pool-fencing legislation in the early 1990s and the current pool drowning rate, although still high, is less than half the pre-fencing rate.6-8 This decrease has occurred despite little enforcement of the legislation and a doubling of pool numbers since the legislation was introduced. There are two components to the isolation barrier concept: the static fence and the dynamic gate. The fence is generally effective because few children climb a pool fence and drown. The pool gate is the weakness — the major limiting factor is compliance with gate closure. In many cases the gate is left open by an adult.5 Specific countermeasures are also required for other causes of drowning in children. Young parents must be informed that the presence of an older sibling in the bath does not guarantee safety. The carer should never leave the bathroom while a toddler is in the bath. Dams and other water hazards on rural properties should be separated from the house by a child-resistant fence. Older children drown in natural watercourses, especially in unseasonable or bad weather. In this age group, swimming skills make a difference, but risk taking or alcohol can still bring the strongest swimmer undone. There is no substitute for common sense and supervision, but not every parent is blessed with these qualities, and older children generally lack the life experience for consistent good judgement unless they have been specifically educated to deal with the problem. Drowning prevention has long suffered from an ad hoc approach and energy is sometimes expended on unproven methods. Although domestic pools pose the biggest danger to toddlers, national prevention campaigns still focus on alternatives, sometimes to the detriment of pool-fencing compliance. High levels of pool-fencing compliance require courage and persistence from government. A 1996 report sponsored by Queensland Health found that 42% of pools had fully compliant fencing, 51% had non-complying features and 7% lacked a child-resistant fence.9 By 2001, Australia should have had uniform pool-fencing requirements based on Standards Australia specifications. Part of the reason this has not been achieved is lack of accurate and comprehensive national data gathering and collating mechanisms. Parent descriptions of pool fencing and compliance are often inaccurate. Since 1990, in Queensland, police investigating pool drownings are required to answer four questions relating to compliance of the pool fence and provide a likely explanation of why the child accessed the pool. They involve local government inspectors if necessary. The police investigation routinely includes witness statements and photographs of the pool, gate and any fencing. Not all police are aware of their responsibilities in this regard, and a reminder system is necessary. The Queensland Injury Surveillance Unit performs quarterly analysis of the Registrar General's death certification database to identify cases. Police and medical practitioners are contacted to ensure the necessary information is collected. The system is far from perfect, but does provide evidence regarding the efficacy of pool fencing.10 At the Children's Hospital at Westmead, there is a pilot near-drowning study in which a trained nurse consultant goes to the home. As Edmond et al point out, better data are required. Their recommendation can be extended to all age and cause categories of drowning in Australia. We need the evidence to inform, promote and monitor the prevention strategies. Until we put drowning prevention on a scientific basis, we will not know that we are promoting the most effective methods, targeting the populations and causes that we can best influence, or making best use of the taxpayers' money. This is not to suggest injury prevention is all science or that prevention is not a package. In the years after the introduction of pool-fencing legislation, the evidence indicates that fewer children drowned.6,8 This initial success was almost certainly due to the public awareness generated by the media controversy associated with the introduction of the legislation. The challenge is to replicate and maintain this level of public and political interest in combination with a scientific approach. W Robert Pitt Danny T Cass
©MJA 2001
Readers may print a single copy for personal use. No further reproduction or distribution of the articles should proceed without the permission of the publisher. For permission, contact the Australasian Medical Publishing Company. Journalists are welcome to write news stories based on what they read here, but should acknowledge their source as "an article published on the Internet by The Medical Journal of Australia <http://www.mja.com.au>". <URL: http://www.mja.com.au/> © 2001 Medical Journal of Australia. |
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