1. Association between Response time and Mortality in Drowning Patients in Thailand Mr.Phichet Nongchang Dr PH 567110001-5 Faculty of Public Health, Khon Kaen University

2. Drowning is defined as the process of experiencing respiratory impairment from submersion/immersion in liquid BACKGROUND BACKGROUND

3. Drowning is a leading cause of accidental death worldwide Injuries account for nearly 10% of total global mortality. Drowning is the 3rd leading cause of unintentional injury death, accounting for 7% of all injury-related deaths, low- and middle-income countries account for 96% of unintentional drowning deaths (WHO)

4. BACKGROUND BACKGROUND In Thailand 2008, drowning was the second cause of death in injuries (4,065 cases) Emergency medical services (EMS) Response time effected improving patient outcomes. It is not yet clear for Thailand

5. To determine association between response times and mortality in drowning patients in Thailand OBJECTIVE OBJECTIVE

6. MATERIALS AND METHODS Cross sectional analytical Thailand EMS database. National Institute for Emergency Medicine (NIEM) Across country (except Bangkok) 2011-2012

7. Study Outcome The primary outcome: mortality of drowning on emergent patients (out-of-hospital) Independent variables: response time Scene time, Transport time CPR, Gender, Age, Region

8. Statistical Analysis Statistical analysis by Stata version 12.0 Descriptive statistics (frequency and percentage) multiple logistic regression Odds Ratios, 95% Confidence Intervals, and p-value.

9. RESOULT Total number of ALS service case (n = 437,770) Drowning Patients (n= 2,047) Drowning Patients (n= 2,047) Emergent of Drowning Patients (Red Code) (n=1,255) Emergent of Drowning Patients (Red Code) (n=1,255) Exclude with other case (435,723) Excluded with Urgent, Non-urgent and other (792)

10. Demographic Characteristics Demographic Characteristics

13. CharacteristicN% Response times (Mean: SD) 1,238 14.0: 16.8 Scene times (Mean: SD) 1,058 9.7: 19.8 Transport times (Mean: SD) 1,182 11.3: 10.8 Death on drowning (Out-of-hospital)1,24313.8

14. Factor OR adj95%CIP-value Response times 1.010.99 - 1.030.255 Scene times 1.01 1.01 - 1.020.001 Transport times 1.030.99 - 1.070.169 Gender Female 1 0.575 Male 1.23 0.60 - 2.51 Age Less or equal 12 1 0.014 13 - 24 0.39 0.11 - 1.32 25 - 36 1.41 0.56 - 3.46 37 – 48 1.19 0.52 - 2.71 49 – 54 0.87 0.20 - 3.72 55 – 66 1.70 0.68 - 4.26 67 or greater 0.92 0.19 - 4.44 Region South 1 0.008 East 0.64 0.15 - 2.69 North 0.45 0.07 - 2.73 Northeast 1.67 0.53 - 5.24 Central 3.06 0.94 - 9.98 CPR No 1 Yes 4.532.36 - 8.71<0.001 1 2 3 4 5 6 7 8 9 10 0 0.5

15. DISSCUSSION This study did not show significant increase in mortality of drowning patients form increase response times OR adj = 1.01 95 % CI (0.99 - 1.03) P-value=0.255

16. DISSCUSSION Response times association survival in out-of-hospital cardiac arrest (OHCA) by drowning Response times affected patient mortality and associated with higher mortality rates response times no associated mortality with in Acute Heart Failure Patients

17. DISSCUSSION Did not demonstrated association between scene time and transport times and mortality Transportation time correlate with mortality in Acute Heart Failure Patients No association between transport interval and outcome OHCA Cardiopulmonary resuscitation (CPR) associated mortality in drowning patients

18. CONCLUSIONS The study could not demonstrate that Response times association mortality in emergent drowning Patients in Thailand Further study should be conducted to the pre-hospital factors effect survival of drowning, and the effectiveness of CPR for drowning survival

19. THANK YOU for your attention