Drowning prevention: a community affair.

Water--it surrounds us. It is a part of us, and it is vital for our existence. It can be our friend or our enemy. Water is a source of recreational play that millions of Americans enjoy annually, yet each year it is estimated that there are approximately 500,000 significant submersion injuries with 50,000 requiring medical attention and an average of 6,000 to 8,000 deaths annually.

More than 50 percent of the drownings that occur involve people under the age of 20; 40 percent to children under the age of four. Sixty percent of all drownings occur in the summer months and the highest number of drownings occur on weekends. Males are most commonly involved in all age ranges (about 3 to 4:1 male: female ratio). There are two peak ages of incidence. One is toddlers (18 to 36 months) due to their exploratory behavior and curiosity, and the other is school-age children (six to 18 years) due to risky behavior, alcohol and drug usage. Drowning is a national issue that knows no boundaries--economic, racial, religious, gender or age.

Drowning prevention is a focus of many safety professionals across the country. There are several national agencies and committees which are developing an awareness of how to prevent drownings and submersion injuries, and they include but are not limited to: The Drowning Prevention Foundation, The Spinal Cord Injury Foundation, United States Lifesaving Association, Water Safety Congress, NRPA Aquatic Section, The National Spa and Pool Institute and the American Red Cross, YMCA, YWCA and various scouting groups.

Additionally, numerous local coalitions such as the Oklahoma Safe Kids Coalition's Drowning Prevention Committee, the Georgia Safe Kids Coalition, and other active coalitions in California, Florida, Texas, Arizona and Maine provide ongoing activities.

Facility managers and aquatic professionals who are interested in preventing drowning can take heart because there are several successful organizations around the country that can give advice on how to get started. Coalitions can use a wide variety of local professional resources depending upon the goals and objectives of the committee. For example, see chart below.

Many obstacles can block a committee, such as a lack of money and time, data to support the cause, volunteer support and/or strong leadership. A well-defined committee should break up into subcommittees with specific tasks assigned for each, along with timelines for each task and some form of accountability. Each task should be led by a strong member of the main committee. Most people don't like to attend many meetings, and in fact, many working committees do not meet as a whole except on a few occasions to cover general information that pertains to all. The subcommittee leaders report to the committee chair and become the nucleus for the group's activity.

Most local programs are interested in providing educational curriculums for schools and water safety material packets that make parents aware of the dangers of water and causes of drowning. Some take a lot of time to create their own packet, but several national agencies already have excellent programs available at a low cost.

The Red Cross "Longfellow's Whale Tales" program is a curriculum guide for school-age children, K-six, and has also been very successful with preschoolers. Whale Tales includes five lesson plans for children K-third, with three additional lesson plans for children grades fourth through sixth. There are fact sheets which provide the teacher background material to lecture from and 48 work sheets that are user-friendly and can be duplicated for all the classes. In addition, there is an answer key to each of the worksheets. A set of colorful cartoon posters and certificates accompanies the program.

The Whale Tales is accompanied by a 13-minute video that illustrates children discussing potential dangers and arriving at safe solutions. The video is narrated by a cartoon whale named Longfellow in commemoration of Commodore Wilbert E. Longfellow, who originated the water-safety movement back in the early 1900s. Most Red Cross Chapters can provide Longfellow packets as well as order the video for local organizations.

A new booklet that has just been released by the American Red Cross is entitled "Waddles." This booklet, geared for children preschool through second grade, has stickers and a story line that discusses safety around the pool and pool rules. The colorful cartoon characters are professionally illustrated and help young readers prepare for swimming lessons.

The National Spa and Pool Institute (NSPI) has the "Gus and Goldie" program which is designed for preschoolers aged three to six. Gus and Goldie are two Goldfish puppet costumes that are used to capture the imagination of children and may be available from state NSPI organizations. NSPI has a short video in which the puppets provide tips about pool rules and other water safety information. NSPI also has brochures available for distribution entitled "Children Aren't Waterproof," "Pool and Spa Emergency Procedures for Infants & Children" and "Knowing How to Dive Can Be Worth More Than Gold--It Can Be Worth Your Life."

The United States Lifesaving Association sponsors the Silver Dolphin Beach Safety Club for children ages seven to 12, which provides teachers with a lesson handout and a video that discusses water safety tips and drowning prevention information targeted to the ocean. Children can receive a Silver Dolphin certificate after taking the short 90-minute program. The Coast Guard "Otter" program is another vehicle for promoting water safety, and the Water Safety Congress provides a variety of materials on boating and lake safety as well as beach and river safety.

Other videos that relate to drowning prevention include the American Red Cross "Home Pool Safety: It Only Takes a Minute" and "Water: the Deceptive Power." In addition there is a new video by Ellis and Associates which is entitled "In Too Deep," and Frank Pia's classic video, "The Reasons People Drown."

The Red Cross video "Home Pool Safety" is geared for parents and discusses backyard pool safety. This video illustrates the need for safety precautions which include maintaining a barrier to keep small children from getting near the pool's edge. This 20-minute video should be heavily promoted to parents with small children. The second Red Cross video, "Water: the Deceptive Power" discusses the issue of teenagers and the risks and dangers of being around recreational waters. Young boys and men, ages six to 18, are the second largest group that die or are permanently disabled by taking risks in and around the water. This video should be targeted to junior and senior high school youths, particularly males.

Ellis and Associates' "In Too Deep" video focuses on classifying drownings and providing common scenarios, victim recognition, high-risk groups and other views of near drownings. This video is targeted for parents, discusses both pool and open-water situations, and is also ideal as a training tool for lifeguards and other water-safety professionals.

Ellis and Associates has utilized their "living laboratory" of waterparks and pools to film near drownings as a part of their risk management auditing program. They have been able to document the typical drowning response and thus provide water safety professionals with a first-class view of how to recognize a victim in distress or in a state of near drowning. Their work begins where Frank Pia's work ended with his research from Orchard Beach years ago. (Pia also filmed several drowning rescues in the ocean). Ellis and Associates auditors have been able to obtain first-hand videos of actual near drownings below and above the water, along with the lifeguard's rescue techniques which demonstrate how various victims react in a drowning and panicked state.

These are just a few of the current resources on the market that will help with any drowning prevention effort. Using these water safety programs in conjunction with swimming lessons, water exercise classes, and water safety programs will help to promote drowning prevention. Coalitions can provide a speakers bureau to present various topics at local schools, especially the parent/teacher sponsor organizations, as well as various social clubs such as Kiwanis, Lion's and Rotary. You can build a public relations campaign around a drowning prevention program. Radio and television publicity is usually available when associated with timely drowning prevention messages.

Many coalitions focus on one area of drowning prevention such as backyard pool safety, or safety around the ocean or lake, or even safety in the home. Almost all states have a variety of water related deaths and should emphasize multiple problems and concentrate on methods for meeting those problem areas.

The Fairfax County, Virginia, Park Authority has introduced their new S.S.W.E.T. Program, which stands for Survival Swimming and Water Emergency Training. This program provides mandatory training for more than 1,000 registered firefighters and rescue personnel who are often called upon to respond to a drowning incident in full turnout gear. All new recruits in the Fairfax County Fire and Rescue Department now are required to be able to demonstrate the minimum swimming proficiency and pass the rescue skills component of their training.

Another example of providing a concentrated program to a city area was the recent effort by the Oklahoma Safe Kids Drowning Prevention Committee. They purchased 180 Longfellow's Whale Tales (LWT) packets and 35 LWT videos from their local Red Cross Chapter at cost, and gave them to each of the county area elementary schools. After obtaining a letter of endorsement from the state superintendent of schools, volunteer committee members gave the superintendents of each individual school district within Oklahoma and Canadian counties videos to be shared by their schools, a copy of the LWT packet, and a proposal for their school district.

"Several of the superintendents set up meetings with all their respective principals for our volunteers to provide a presentation, which saved me and some of our other volunteers a lot of legwork" said Jean Dunlap, SAFE KID's Drowning Prevention Committee member. Three of the school districts then set up a meeting with all the physical education teachers and other interested teachers to hear about how to teach the program, and the incentive plan for their efforts in providing this program.

The incentive plan was to provide the top three participating schools with a prize consisting of 25 LWT packets and a video for first place, ten LWT packets and a video for second, and one packet and video for third. In addition, organizers gave $5 off coupons to White Water Bay, a local waterpark in Oklahoma City, to all the children who participated. They gave complimentary tickets to the teachers who taught the course and turned in the LWT course record for documentation. White Water Bay also agreed to donate $1 for each coupon redeemed to help the Drowning Prevention Committee pay for the program.

The end result of this successful program was that out of 153 available elementary schools, 115 principals agreed to provide the program. Due to a late start, 69 schools (48 percent) actually participated, with 168 school teachers turning in course records documenting 19,054 students participating in the Red Cross Longfellow's Whale Tales program. At the end of the summer, based upon coupon redemptions, White Water Bay contributed over $2,700 dollars to the Drowning Prevention Committee. The committee spent a little over $1,700 on the total program for a $1,000 dollar profit.

The Portland Area Aquatics Council in Oregon meets monthly to discuss professional aquatics issues and areas of concern. "No one group dictates what we will accomplish, but the Red Cross Water Safety Committee meets after the council meeting to discuss their local issues," said Mark Hokkanen, former chair of the council and the Red Cross Water Safety Committee. One drowning prevention effort by the council was working with the City of Troutdale to post police officers with lifeguard training along the Sandy River to help safeguard the swimmers.

"An additional area of concern was confronted by the Oregon Marine Council and the Army Corps of Engineers in Oregon. They provided signage along the many rivers in the Portland metropolitan area posting rules and safety tips on windsurfing. They distributed flyers with safety tips about the dangers of hypothermia and of windsurfing near the tug boats that would navigate up and down the river," said Hokkanen.

Bobbi Williams, program services director of the Newburyport YWCA in Massachusetts, was honored as the Newburyport YWCA recently won the National Aquatic Award from the Olin Corporation and the National YWCA for their drowning prevention efforts. Williams first attended a conference in Connecticut where she saw the film, "The Reasons People Drown," by Frank Pia, and was motivated to attempt a program back in Newburyport. Williams said "no real educational materials were available to the public about the basic safety tips and drowning prevention strategies. We used Pia's film to capture the adults' attention about the problems associated with our local beaches."

Also, Williams used the American Red Cross "Longfellow's Whale Tales" for school age children and a video entitled "Children Aren't Waterproof" for preschoolers. "Children Aren't Waterproof" is a short video developed by the Tucson, Arizona Drowning Prevention Committee which is similar to the Gus and Goldie tape. Williams said, "In the community we have educated more than 1,000 people about drowning prevention and increased public awareness for the entire community. Our YWCA has the only pool within a 25-mile radius, so we have a captive audience for water-safety programs, swimming lessons and now drowning prevention seminars. Local schoolchildren are bused to the Y as a part of their Learn To Swim program, which is a component of their physical education curriculum."

Down south, the Georgia Safe Kids Coalition has 11 individual active coalitions, with eight more that are still developing throughout the state. Diane Vaughan, Safe Kids of Georgia coordinator, reports that many of their efforts are focused on educating the public about the dangers of swimming along the coastal shores where many of the beaches are not monitored by lifeguards. "Georgia has a large problem with all the coastal waters and we are trying to use a variety of educational resources to educate our public about these dangers," said Vaughan.

In Tucson and Phoenix, Arizona Drowning-prevention committees have had tremendous success by creating their own water-safety curriculum complete with a video, as well as several creative ad campaigns with buttons, posters, slogans and media promotions. In Tucson, the local committee lobbied to get a mandatory pool fencing law, which has dramatically reduced the number of drownings in backyard pools. This local committee has reportedly been around the longest and has had the most success of any local drowning-prevention committee. The key to their success has been involvement and strong leadership by a variety of sources.

Campaigns such as these are formed through a number of methods. Most coalitions link up with a children's hospital, which provides credibility, financial support, medical research and a host of committee members who have a vested interest in reducing the number of all forms of injury. Aquatic facility managers also have an interest in becoming involved in drowning-prevention committees, because of the need for continuing education for their staff, the opportunity for public visibility, and the potential to promote their water safety programs and swimming classes.

For facility managers, drowning prevention is a difficult concept to sell, because most individuals and family members may not think about drowning prevention unless they have just purchased a pool for their home, a new boat, or have enrolled their child in swimming lessons. At this point many parents may become interested in learning about water safety. Statistics show us that most drownings involving small children ages one through four occur in and around the home, but that for individuals above the age of eight drownings occur more frequently in open bodies of water.

Drownings themselves are difficult to track, because many hospitals do not classify them as such unless they resulted in immediate death. If the individual died as early as 12 to 24 hours after a submersion injury, they may classify death by other causes such as a head injury, pneumonia, asphyxiation, or a number of other medical conditions.

Sue Makintubee, R.N., M.P.H. director of Injury Epidemiology at the Oklahoma State Department of Health, reports that "continuous, systematic data collection is essential for planning and evaluating preventive programs." Therefore, the first step a drowning-prevention committee must undertake is to gather submersion data for its area. Data regarding the number of drowning deaths is easiest to find. The state or local medical examiner/coroner, state vital statistics department and the state lake patrol are good sources for this data. However, data which deals only with deaths is limited in scope. For this reason, you should try to gather non-fatal injury data as well.

Several state health departments have implemented injury surveillance systems. Since 1987, the Oklahoma State Department of Health has conducted statewide surveillance for specific injuries including hospitalized and fatal submersions (drowning/near drowning), burns and traumatic spinal cord injuries. The system is being expanded to include traumatic brain injuries. Primary sources of submersion surveillance reporting include intensive care units and the state medical examiner. Secondary sources of reporting include newspaper clippings, ambulance reports, lake patrol reports and emergency room reports. According to Makintubee, "specific information such as the person's age, sex, location, date and time of injury is collected. Information regarding the series of events which led to the injury and contributing factors such as alcohol use is also collected. (See Figures 1-3.) The data is used to design and evaluate prevention programs."

Data collection takes a great deal of time and resources. "The Center for Disease Control can be of help and can provide a variety of national statistics," according to Dr. Alison Osinski,, Aquatic Consulting Services, San Diego, CA. Osinski also reports that the California Department of Health Services prepares a report titled "EPIC" (Emergency Preparedness and Injury Control Program) which provides state statistics on all forms of injuries, including drowning. This report could be used as a possible model for data collection for other state coalitions. (For information, [phone].

The Centers for Disease Control (CDC) produces a document entitled Injury Mortality Atlas of the United States 1979-1987, which provides national statistics on submersion-related injuries. This atlas contains color-coded maps illustrating the geographic distribution of county level mortality rates across the U.S. for eight major causes of injury-related deaths, including drowning. This document can be obtained from Owen Divine, M.S., mathematical statistician, Injury Control Division at CDC in Atlanta, GA., [phone].

"Additional information on boating-related drownings nationwide can be obtained from the U.S. Coast Guard which prepares an annual document entitled Boating Statistics," according to Osinski. Osinski also said that "more generic information can be found in the U.S. Government Statistical Abstract drowning section each year." Any of these statistics can be quoted to the media when you are building a press campaign, or are approaching the legislation on some form of legislative action such as mandatory backyard fencing, or use of lifejackets by all age groups. The media will need these statistics to help build their story line.

Most media is focused on drowning in May and June, especially around Memorial weekend, throughout the summer and on Labor Day weekend. Northern states can capitalize on winter-related drownings due to falls through the ice or motor vehicle crashes that take place in the water because a vehicle fell through the ice. However, fewer than one percent of all car crashes involve water.

The United States Consumer Product Safety Commission promotes an annual Water Watch program which provides local organizations with sample press releases and PSA's which can be localized. Some organizations such as the American Red Cross launch national campaigns such as their recent infant/child drowning prevention campaign Mer Babies, which promotes a drowning-prevention message associated with safe swimming through swim instruction.

Fundraising is a major issue for most coalitions, and presents a challenge for those who are not use to asking for money. Some tips and suggestions include:

* Develop a campaign that has mass appeal.

* Develop a theme, phrase or point of sale to promote the campaign.

* Make a contact list, with the name of the CEO, public relations coordinator, or personnel manager.

* Make your contacts and presentations professional.

Fundraising is not for everybody, but the individuals who are responsible for managing this task must be professional, with good people skills and selling ability. They must truly believe in the cause and have a good knowledge base, or be someone that can help answer any technical questions. As a drowning prevention spokesperson to the media, and/or any foundation, group or company that they are presenting to, they have become a recognized expert in aquatics.

Resources to prevent drowning abound across the country and are easily available, but drowning prevention requires a committment from each person, and each community.