Child Drowning

Thailand and SwimSafe Danang, the research shows it is possible to use portable pools to safely train
large volumes of children at low cost. 64
Portable pools can be adapted to cater to the specific health conditions experienced by children in
LMICs. For example, due to their small stature, children with growth retardation may be at increased
risk while in the water. The pools allow the water level to be varied to ensure a child’s head remains out
of water. Physiological conditions such as epilepsy and other seizure disorders, as well as cardiac rhythm
disorders such as Long QT syndrome also place children at increased risk of drowning. Both types of
conditions have prevalence rates in the range of 1 per 1,000 to 5 per 1,000 or higher. 65 The scale
required in a national survival swimming programme will mean that hundreds to thousands of children
with those conditions will be enrolled and will need special measures in place to ensure their safety.
These conditions present significant risks when the teaching venues involve opaque water as is the case
in ponds. Children may lose consciousness due to the condition, and are likely to slip under the surface
of the water while unconscious. Unless the water is clear and supervision is very close by, they cannot
be seen and may drown as a result. The issue has been identified in HICs and recommendations have
been made that swimming should be done in clear, shallow water with supervision close at hand. 66
Portable pools with sand filtration systems provide clear water teaching venues. The use of portable
pools which are 6 metres across and 12.5 metres long ensures that a supervisor is always very close to
the children being taught.
The operational experience of the SwimSafe Danang Programme in Viet Nam has provided data on
potential throughputs that can be achieved with portable pools at primary schools with large volumes
of children. A class-based approach allows teaching cohorts of children all of the same age and
approximate physical stature. Using skilled teachers at the school as survival swimming instructors
provides instructors who are trained and have experience with other discipline and safety issues in
young children. This approach has shown to be efficient and suitable for achieving the scale necessary in
countries with high primary school enrolment rates.
3.6 ISSUES REGARDING RESUSCITATION
Developing a community response system with sufficient numbers of providers to ensure rapid CPR
delivery to drowning victims requires significant resources and funding. Pilot programmes will need to
explore feasibility, provide information on the numbers of CPR-trained persons required in different age
groups and community roles, and to develop procedural protocols.
Studies in HICs such as Japan and the United States show that community response networks can
provide CPR to drowning children, increasing their chance of survival. 67 The importance of ensuring
64 Cox, R., A. Peden and T. Rubin. ‘The Use of Portable Pools to Increase Swim Learning: The SwimSafe Danang experience’. In:
Scarr et al (eds), World Conference on Drowning Prevention, Danang, Vietnam, 2011. International Life Saving Federation,
Leuven, p. 206 accessed at www.worldconferenceondrowningprevention2011.org; Rubin, T. et al. ‘Portable pools and the
SwimSafe Thailand experience’. In: Scarr et al (eds), World Conference on Drowning Prevention, Danang, Vietnam, 2011.
International Life Saving Federation, Leuven, p. 234 accessed at: www.worldconferenceondrowningprevention2011.org.
65 Sridharan, R. and B. N. Murthy (May 1999). ‘Prevalence and Pattern of Epilepsy in India’. Epilepsia, 40(5): 631–636; Schwartz, P.
J. et al. (2009). ‘Prevalence of the Congenital Long-QT Syndrome’. Circulation, 120(18): 1761-1767.
66 Besag, F.M.C., (21 April 2001). ‘Tonic seizures are a particular risk factor for drowning in people with epilepsy’. British Medical Journal,
322(7292), doi: 10.1136/bmj.322.7292.975; Diekema, D.S., L. Quan and V. L. Holt (March 1993). ‘Epilepsy as a Risk Factor for Submersion Injury in
Children’. Pediatrics, 91(3): 612 -616; Albertella L., J. Crawford and J. R. Skinner. (2011). ‘Presentation and outcome of water-related events in
children with long QT syndrome’. Archives of Diseases in Childhood, 96(8): 704-707.
67 Kyriacou D. N. et al. (1 August 1994). ‘Effect of immediate resuscitation on children with submersion injury’. Pediatrics, 94(2):137– 142;
Wigginton J., (2002). ‘The key role of layperson actions in drowning incidents. In: World Congress on Drowning: Prevention, Rescue and
Treatment, 26– 28 June 2002. Amsterdam: Consumer Safety Institute, 2002; Kitamura T. et al. (2010). ‘Bystander-initiated rescue breathing for
out of hospital cardiac arrests of non-cardiac origin’. Circulation, 122:295-299.
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