1. 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

2. 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

3. Water Injuries and Deaths Make the News Headlines 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. 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.

4. 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

5. 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 near- drowning tend to occur on the weekend (40 percent) and between the months of May and August (62 percent). Safe Kids USA

6. 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

7. 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.

8. 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”

9. 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

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

11. 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.

12. 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

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

14. 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

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

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

17. 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

18. Perception of Children That Need Supervision Around Water Parent Survey 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.

19. 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

20. 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

21. 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

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

23. 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.”

24. 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

25. 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 Parent Survey How often do parents wear a PFD in the boat? –30 always –10 almost always –14 sometimes –9 almost never –3 never

26. 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

27. 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

28. 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

29. 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

30. 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 Safety devices present in these pools or spas –3 anti-vortex covers –8 multiple drains –4 safety vacuum release –28 unsure –11 none Parent Survey

31. 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.

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

33. Install a 4-foot High Fence For in-ground pool or an inexpensive inflatable one. Include a self- closing and self- latching gates. Install an alarm on the door from the house.

34. 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.

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

36. 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.

37. 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.

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

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

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

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

42. 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.

43. 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.

44. 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.

45. 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.

46. 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.

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

48. 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

49. 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

50. Resources for Comprehensive Drowning Prevention Efforts Safe Kids Grand Forks. Water Safety. Retrieved from http://www.safekidsgf.com/WaterSafety.html http://www.safekidsgf.com/WaterSafety.html Safe Kids USA. Water Safety Campaign 2008. Retrieved from http://www.usa.safekids.org/water/ 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 http://www.doh.wa.gov/cfh/mch/documents/Child_Drowning_Prevent ion.pdf

51. 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 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.htmhttp://www.lafd.org/drown.htm National Association of Home Inspectors. Safety Guidelines for Pools. Retrieved from http://www.newbeginningshomeinspection.com/pool.html http://www.newbeginningshomeinspection.com/pool.html

52. 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.htmlhttp://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- Whirlpoolshttp://www.buyerschoiceinspections.com/Spas- Whirlpools

53. 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/17pool_spa_entrapment.ht ml http://www.lifesaving.com/issues/articles/17pool_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.pdfhttp://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 http://www.cpsc.gov/phth/vgpsa.pdf

54. Contact Information For Safe Kids Grand Forks Safe Kids Grand Fork C/O Altru Health System Coordinator – Carma Hanson chanson@altru.org 701-780-1489