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Patterns of Child DrowningPatterns of Child DrowningPatterns of Child Drowning Patterns of Child Drowning in Utah: 2005in Utah: 2005 20102010in Utah: 2005in Utah: 2005‐‐20102010
Catherine GrosecloseCatherine GrosecloseInjury EpidemiologistInjury Epidemiologist
OverviewOverviewOverviewOverview
N i l DNational Data
Utah DataUtah Data
Violent Death Reporting System
Child Fatality Review Committee
hCase Photos
AssumptionsAssumptionsAssumptionsAssumptions
M l hildMostly young children.
Mostly in swimming pools.Fences alarms & pool covers are best defenseFences, alarms, & pool covers are best defense.
d k hKids knowing how to swim preventsdrowningdrowning.
N i l DN i l DNational DataNational Data
Top 4 Causes of DeathTop 4 Causes of DeathUS, 2006US, 2006--20082008
per 100,000per 100,000
Infants 1-4 5-9 10-14 15-18
CongenitalAnomalies
135.2
CongenitalAnomalies
3.2
Malignant Neoplasms
2.3
MVTraffic
3.2
MVTraffic18.3
ShortGestation
113.3
Drowning2.7
MVTraffic
2.3
Malignant Neoplasms
2.2
Homicide8.93.3 .3 .
SIDS55 9
MVTraffic
CongenitalAnomalies Homicide
1 1Suicide
6 355.9 2.5 0.9 1.1 6.3
Maternal Homicide Drowning Suicide Malignant lPreg. Comp.
40.9
Homicide2.4
Drowning0.7
Suicide1.0 Neoplasms
3.0
345.2 10.8 6.1 7.5 36.5
Drowning Cause of Death Rank by Age GroupDrowning Cause of Death Rank by Age GroupUS 2006US 2006--20082008US, 2006US, 2006 20082008
Infants 1-4 5-9 10-14 15-18
Suffocation(6)
22.4
Drowning(2)2.7
MV Traffic(2)2.0
MV Traffic(1)3.2
MV Traffic(1)
18.3
Homicide(15)8.1
MV Traffic(3)2.5
Drowning(4)0.7
Homicide(3)1.1
Homicide(2)8.98. .5 0. . 8.9
MV Traffic(>20)
Homicide(4)
Homicide(5)
Suicide(4)
Suicide(3)
2.8 2.4 0.7 1.0 6.3
Drowning( )
Fire/Burn( )
Fire/Burn( )
Drowning( )
Drowning( )(>21)
1.2(6)1.2
(6)0.6
(7)0.6
(7)1.3
By Region, USBy Region, US4 5
4
4.51-4 5-9
3
3.5
2
2.5
1.5
2
0.5
1
0NE South MW West
By Race/Ethnicity, USBy Race/Ethnicity, US
7
8
91-4 5-9
5
6
7
2
3
4
0
1
2
U h DU h DUtah DataUtah Data
Utah Population DensityUtah Population Density
2009, Utah2009, Utah
DROWNING-RELATED EMERGENCY DEPARTMENT VISITS
AgeState
PopulationNumber of ED Visits Rateg Population ED Visits Rate
<1 54,310 6 11.01-4 213,749 54 25.3,
5-14 468,556 28 6.015-24 451,656 20 4.4
2009, Utah2009, Utah2009, Utah2009, Utah
DROWNING-RELATED HOSPITALIZATIONSDROWNING RELATED HOSPITALIZATIONS
AState
P l tiNumber of
H it li ti R tAge Population Hospitalizations Rate<1 54,310 0 0.0
1 4 213 749 5 2 31-4 213,749 5 2.3
5-14 468,556 <5 **
15-24 451 656 <5 **15 24 451,656 <5
2009, Utah2009, Utah2009, Utah2009, Utah
UNINTENTIONAL DROWNING FATALITIES
AgeState
Population Number of Deaths Rate
<1 54 310 0 0 0<1 54,310 0 0.0
1-4 213,749 5 2.3
5 14 468 556 <5 **5-14 468,556 <5 **
15-24 451,656 7 1.5
National Violent Death National Violent Death Reporting SystemReporting System
Link records
Timely information
Describe circumstances
Characterize perpetratorsCharacterize perpetrators
•Are violent deaths in schools increasing or decreasing?
•What proportion of homicides result from illicit drug deals?
•How often do murder-suicides occur?
•How frequently are homicides associated with child maltreatment?associated with child maltreatment?
•How serious a threat are mass killings?•How serious a threat are mass killings?
DrowningDrowning QuestionsQuestions toto AnswerAnswerDrowning Drowning Questions Questions to to AnswerAnswer• Are drowning deaths in pools increasing or
decreasing?
• What proportion of drowning deaths result from inability to swim?inability to swim?
• How often were PFDs worn?
• How frequently are drowning deaths associated ith l k f i i ?with lack of supervision?
• To what extent could fencing alarms and pool• To what extent could fencing, alarms and pool covers prevents drowning deaths?
Utah Child Fatality Utah Child Fatality R i C ittR i C ittReview CommitteeReview Committee
Utah CFRCUtah CFRC GoalsGoalsUtah CFRC Utah CFRC GoalsGoals
1. Data & Information
2. Service System Responsesy p
3. Make Policy Recommendations
CFRC MembershipCFRC Membership
• Utah Department of Health • Office of the Medical ExaminerOffice of the Medical Examiner • Primary Children’s Medical Center • Utah law enforcement agenciesUtah law enforcement agencies• Juvenile Justice • Utah Attorney General’s Office y• SL County District Attorney's Office • Administrative Office of the Courts • Division of Child and Family Services • Department of Human Services • Utah State Office of Education
The Review ProcessThe Review ProcessThe Review ProcessThe Review Process
• Monthly CFRC MeetingsMonthly CFRC Meetings• Preliminary Death Certificate Review
P i l R i• Perinatal Review• Birth Defects • DCFS Review• Annual Full Committee MeetingAnnual Full Committee Meeting
2005 20102005-2010UtahUtah
Child F liChild F liChild Fatality Child Fatality DatabaseDatabase
Drowning Table VariablesDrowning Table Variables
S V i bl D i iSource Variable Description
VIPP Child 5 or under wander off undetected by adult supervisor?
VIPP Child 8 or under 'supervised' by another child or teen (18 or under)?
Michigan Was decedent wearing an appropriate/fitting PFD?Michigan Was decedent wearing an appropriate/fitting PFD?
Michigan Is there an account of the decedent's having known how to swim?
Michigan Reported water temperature (Fahrenheit).
VIPP Number of minutes decedent reported being under water.
VIPP Rescue Narrative.
PrimacyPrimacyPrimacyPrimacy
Child fatality reviewChild fatality reviewMedical examiner recordPolice reportEMSEMSHospital recordsDeath certificate
Utah Drowning Scenarios (N=57)Utah Drowning Scenarios (N=57)Bath Tubs
15.8%
Teens in Open Water 15.8%
WanderOther
Water 10.5%
Wander Out of House
Other21.1%
12.3%
Family PartyNon-15.8%Supervision
24.6%
Bathtub Deaths (N=9)Bathtub Deaths (N=9)Bathtub Deaths (N 9)Bathtub Deaths (N 9)
< 1 year-olds(1 in bath chair) = 4
1 year olds = 4* (1 w/3 yr. old sibling)
10 year old = 1*10 year old = 1
WanderWander--Off FromOff From IInside (N=7)nside (N=7)WanderWander Off From Off From IInside (N 7)nside (N 7)
< 1 year-old = 1< 1 year old 1
1 year-olds = 3
2 year-olds = 3
Family Party (N=9)Family Party (N=9)Family Party (N 9)Family Party (N 9)
1 year-old = 31 year old 3
2 year-olds = 2
3 year-old = 1 4 year-old = 1
5 year-old = 1
13 year old 113 year-old = 1
Teens in Open Water (N=6)Teens in Open Water (N=6)Teens in Open Water (N 6)Teens in Open Water (N 6)
Ages 15-18Ages 15 18
All male
All lakes or reservoirs
All with friends/witnessed
All substance-free
Most known to be good swimmersMost known to be good swimmers
NonNon‐‐Supervision Locations (N=14)Supervision Locations (N=14)Public Pool
7.7%Apartment Complex
Pool
River15.4%
Pool7.7%
Lake 7 7%
Inflatable
7.7%
Residential
Kiddie Pool7.7%
es de t aIn-Ground
Pool38 5%Above-
Junction Box7.7% 38.5%Above
Ground Pool 7.7%
NonNon‐‐Supervision (N=14)Supervision (N=14)
6
5
3
4
2
3
1
0<1 1 2 3 4 5 6 7 8 9
“Other” Cases (N=13)
18* Reservoir Witnessed drowning in Yuba Reservoir
18 River Found in Provo River.18 River Found in Provo River.
18 Lake Sail boating with brother (not swimming).
18 Cave Tunnel Caving with three others.
17 River Went into river; found unresponsive approx. 7 minutes later.
17* River Raft capsized on Colorado River; parents witnessed drowning.
16* P l D i i b k d l16* Pool Drowning in own backyard pool.
16 Canal Caught in undertow; flow was slowed.
15 Creek Attempted to cross on rope bridge. p p g
15 Lake Bear Lake; went in to save cousin.
12 Creek Playing with friend in creek.
9 River Witnessed fall into Provo River; in water for 25 minutes.
8 Canal Clothing matches victim of witnessed drowning.
Drowning Locations (N=57)Drowning Locations (N=57)Drowning Locations (N 57)Drowning Locations (N 57)Canal 5.2%
Cave Tunnel Junction Box Bath Tub1.7% 1.7%
Kiddy Pool
Bath Tub15.5%
y6.9%
Lake/River/Reservoir
17.2%
River/Creek 19.0%
PondPond6.9%Pool
25.9%
Fence / Alarm / Pool Fence / Alarm / Pool CCover?over?AgeAge Pool TypePool Type IssueIssue FenceFence AlarmAlarm CoverCoverAgeAge Pool TypePool Type IssueIssue FenceFence AlarmAlarm CoverCover0 Kiddy Pool yes1 Home Pool Not enough information1 Home Pool In pool/supervision no no no1 Home Pool In pool/supervision no no no1 Kiddy Pool In pool/supervision no no no1 Kiddy Pool yes1 Pool yes yes2 Pool yes2 Complex Pool yes2 Pool yes3 Kiddy Pool In pool/supervision no no no3 Pool In pool area/supervision no no no4 Pool In pool area/supervision no no no5 Home Pool Not enough information5 Home Pool Not enough information5 Home Pool In pool/supervision no no no7 Home Pool no no no8 Home Pool In pool/supervision no no no8 Home Pool In pool/supervision no no no9 Public Pool In pool/supervision no no no13 Complex Pool In pool/supervision no no no16 Home Pool In pool no no no
ObservationsObservationsObservationsObservations
• Some kids were in PFDs before event (foundSome kids were in PFDs before event (found without).
• Several incidents happened at grandma’s.
• Several decedents found by their sibling.
• Toddlers could move ladders.
8 y.o. male canal drowning8 y.o. male canal drowning8 y.o. male canal drowning8 y.o. male canal drowning
ConclusionsConclusionsConclusionsConclusions
• We need to look beyond age sex date ofWe need to look beyond age, sex, date of death, and residence.
• Type of water setting alone does not dictate iprevention strategy.
• Age of child alone does not dictate prevention strategy.gy
Data SourcesData SourcesData SourcesData Sources
Indicator-Based Information System for d cato Based o at o Syste oPublic Health (Utah)
Web-based Injury Statistics Query and R ti S t (US)Reporting System (US)
Contact InformationContact InformationContact InformationContact Information
Catherine GrosecloseCatherine GrosecloseViolence & Injury Prevention ProgramU h D f H l hUtah Department of Healthcgrosecl@uath.gov801-538-9124health utah gov/vipphealth.utah.gov/vipp
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