Child Drowning

immediate resuscitation is discussed in the 2008 WHO/UNICEF World Report on Child Injury Prevention.
In HIC settings, layperson-delivered CPR is usually followed by a rapid response by emergency medical
personnel who can defibrillate the victim at the site of resuscitation, provide advanced life support and
quickly transport the person to a hospital for further specialized care. This type of rapid professional
response is not feasible in the setting of rural LMICs.
Community response in HICs depends on many factors that are not present or are only minimally
available in LMICs. HICs are generally characterized by excellent health, communications and transport
infrastructure, and have well educated populations. Large numbers of people – both adolescents and
adults – have undertaken formal first-response training, understand the urgency required in
resuscitation and can safely carry out rescue of drowning victims. There is often also a community ethos
of bystander intervention, often facilitated by ‘good Samaritan’ laws to protect bystanders from liability
when helping persons in need.
These factors are mostly lacking in LMICs. It is not clear what factors are critical to an effective
community first response system in an LMIC. Any community-based response system will have to be
implemented in a very resource poor environment. The lack of professional emergency responders
requires a heavy reliance on community volunteers. The lack of infrastructure and a population with low
literacy rates present major barriers. These have been shown to be significant barriers to the
achievement of other health and development interventions in rural LMICs. Research done in
Bangladesh has determined that low literacy, religious beliefs and cultural attitudes are also significant
barriers to the completion of CPR training. 68 For these reasons, and given the uncertainty around
successful skills acquisition and the duration of skills retention, CPR has not yet been included in
SwimSafe Bangladesh.
CPR is part of the programme in SwimSafe Thailand and SwimSafe Danang. The training takes place in
primary schools where literacy and teaching proficiency are not barriers to knowledge acquisition.
There are still uncertainties regarding the duration of skills retention, the ability of younger children to
successfully intervene as CPR providers, and the cost-effectiveness of the intervention itself.
Research is currently underway in Bangladesh to determine the feasibility, prevention efficacy and costeffectiveness
of creating a village-based network of CPR-qualified first responders. 69 In Thailand and Viet
Nam, research aims to determine the lower age limit for learning resuscitation skills and duration of
skills retention, and to evaluate effective use. The research findings should provide important
information regarding the feasibility, sustainability and effectiveness of large-scale CPR training in LMIC
settings.
68 Mecrow, T. et al. ‘Barriers to CPR Training in a Rural LMIC Setting’. In: Scarr et al (eds), World Conference on Drowning Prevention, Danang,
Vietnam, 2011. International Life Saving Federation, Leuven, p. 67 accessed at: www.worldconferenceondrowningprevention2011.org.
69 Nusrat, N. ‘Large-Scale Community Training in CPR as a Basis for a Community Response System in an LMIC’. In: Scarr et al (eds), World
Conference on Drowning Prevention, Danang, Vietnam, 2011. International Life Saving Federation, Leuven, p. 72 accessed at:
www.worldconferenceondrowningprevention2011.org.
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