A retrospective study of drowning victims presenting to a pediatric emergency department

Jamie Holland, MD
Wendi Wendt, MD

Drowning is the leading cause of death in children ages 1 to 4 and is the second leading cause of unintentional injury related death in adolescents ages 5 to 14 in the United States. Prior works have reported that rates of drowning death vary with age, sex, and race. In addition, age has been found to be an important determinant of drowning location, with infants being more likely to drown in bathtubs and buckets, preschool-aged children being more likely to drown in swimming pools, and older children and adolescents being more likely to drown in natural bodies of water.

This study aims to describe encounters for patients presenting to a single emergency department after a drowning event to identify possible risk factors for these events to help target future interventions.

We performed a retrospective chart review for a single tertiary-care, academic emergency department from November 2012 to June 2023, including patients age 0-17 presenting after a drowning event. Data collected included both patient specific information, as well as details of the drowning or submersion event. Summary statistics were used for descriptors, whereas Chi-Square, Wilcoxon, and Kruskal-Wallis tests were used for comparisons.

We identified 161 children presenting for care after a drowning event. The median age for patients was 4.0 years, with a greater proportion being male (53.4%). When a location was listed, drownings most often occurred around the home (16.1%), at a natural body of water (16.1%), or at a hotel pool/spa (14.9%). Saturday was the most common day for drowning events to occur (28.0%). When separated by age, patients 0-4 years were more likely to drown around the home compared to older children. Patients >4 years were more likely to drown at private pools and hotel pools/spas compared to younger children. Public pools and natural bodies of water posed a drowning risk for children of all ages.

For the majority of patients (59.0%), a parent or family member was identified as being the supervisor at the time of the drowning event. The rescuer was most often a parent or family member (49.1%), followed by a bystander (15.5%).

Similar to prior studies, our results found that young children, as well as males are at highest risk for drowning events. With regards to event details, we identified natural bodies of water, specifically Lake Michigan, as a common location for drowning events. In addition, our findings highlighted the dangers of hotel pools/spas that do not have lifeguards on duty and are frequently locations for parties and gatherings where supervisors may easily become distracted. Parents and family members were often both the supervisor and the rescuer at the time of these drowning events. Results from this project may be used to shape future drowning prevention efforts and lead to improved water safety in our community.

1. Recognize the frequency of drowning related deaths in children and the impact it has on our communities
2. Discuss possible risk factors for pediatric drowning events
3. Emphasize the need for further drowning prevention efforts to promote water safety for children

Pop-Up Safety Town: Pediatric Injury Prevention Education Reimagined

Jamie Holland, MD
Andrew Hashikawa, MD
Ashley Tracy, CHES
Wendi Wendt, MD

Unintentional injuries are the leading cause of death in children, with a disproportionate impact on populations experiencing health disparities. The Pop-Up Safety Town (PST) initiative, conceived by a group of pediatric emergency medicine physicians in Michigan, reimagines pediatric injury prevention education using a mobile, community driven approach to address the current barriers and limitations of traditional pediatric injury prevention education. We detail how we adapted and implemented PST in a second location to provide injury prevention education to young children living in underserved communities.

Two academic physicians from a tertiary children’s hospital adapted and expanded PST with contributions from the local Safe Kids coalition. We partnered with a local community center and school district primarily serving Hispanic (95%) and low income (75%) families. During Fall 2023, we scheduled four half-day PST sessions for all K4 and K5 students. PST curriculum spanned eight domains that were identified as areas of high need by school staff, including 1) animal safety, 2) bike safety, 3) burn safety, 4) car seat safety, 5) dental safety, 6) fire safety, 7) pedestrian safety, and 8) water safety and were developed by PST program leaders using evidence-based recommendations from the American Academy of Pediatrics. A North American foundation provided a one-time grant for financial support.

Over the four half-day PST sessions, we provided essential injury prevention education to over 400 students on the topics stated above. All children rotated through 15-minute stations for each topic. Volunteers, recruited from our hospital/medical school, local Safe Kids coalition, and local fire and police, engaged and educated each child at each topic station. Every child was fitted individually with an adjustable bike helmet to take with them for use at home. A drawstring backpack filled with injury prevention resources in both English and Spanish was provided to each child to share with their caregivers. Information on upcoming Safe Kids events and car seat checks was also provided to families.

Our PST events demonstrate the potential for a scalable, budget-friendly injury prevention model adapted to the unique needs of at-risk children living in underserved communities. Having demonstrated the program’s success in a second location, efforts are underway to secure sustained funding for its continuation for the following school year.

1. Unintentional injury is a leading cause of death in children, and there are substantial disparities.
2. Pop-Up Safety Town (PST) is a pediatric injury prevention program developed to address the limitations of a “traditional” Safety Town and include children and families who otherwise are unlikely to have access to injury prevention education and/or resources.
3. PST has now been shown to be adaptable and reproducible in different settings.