June 2004 1

EPIDEMIOLOGICAL SURVEILLANCE OF DROWNING

IN FRANCE

Bertrand Thélot, Céline Ermanel, Cécile Ricard

Institut de Veille Sanitaire

Département Maladies Chroniques et Traumatismes

12, rue du Val d’Osne – 94415 SAINT MAURICE cedex – France

Institut de Veille Sanitaire

June 2004 2

Introduction

Problem under studyDeath by drowning is a major public health problem in France. More than 500 people die in this way each year (out of a total of 534,000 deaths), and even when they are not fatal, drowning accidents can sometimes result in severe sequelae. Drowning accident and their severity depend on risk factors that have not been fully elucidated. And understanding of these risk factors could be very useful to improve prevention and thus avoid drowning accidents.

ObjectivesTo improve the prevention of drowning in France by providing a description of the people who drown and of the circumstances surrounding drowning accidents.

Institut de Veille Sanitaire

June 2004 3

Method

Since 2001, a cross-sectional survey has been undertaken during the summer months by the Institut de Veille Sanitaire (National Institute of Public Health, which has the mission of coordinating public health monitoring in France) in collaboration with the French Civil Protection Agency.

Data were collected on a voluntary basis in 2001.From 2002 onwards the survey was extended to cover the entire country. During the period between June 1 and September 30, all fatal and potentially-fatal drowning accidents are recorded, regardless of their severity, the only condition for inclusion being a rescue intervention followed by death or hospitalization.

The data recorded are the age and sex of the victim, when and where the accident happened (swimming pool, sea, river, lake, etc.), the circumstances of the accident, and the outcome for the drowned person (immediate death or after hospitalization, alive, with or without sequelae). The questionnaire was filled out by rescue teams, then collected and sampled nation-wide.

Institut de Veille Sanitaire

June 2004 4

ResultsFrom June 1 to September 30, 2003, the survey recorded:

1154 drowning accidents, 435 (38%) of these accidents resulted in death

238 (21%) in swimming pools, 57 deaths (24%) 560 (49%) in the sea, 160 (29%) 156 (14%) in lakes, 88 (60%) 153 (13%) in rivers, 105 (69%) 47 (4%) in other places, 20 (43%)

12061 48 63

400

27

52

5105 93

160

20

0

100

200

300

400

500

600

Privateswimming pool

Publicswimming pool

Rivers etc. Lakes etc. Sea Other

Nu

mb

er

nonfatal outcome fatal outcome Institut de Veille Sanitaire

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Incidence and mortality rates

11368 62 48

138

27354

19 34 31

82

203

0

50

100

150

200

250

300

350

400

450

500

0-5 years 6-12 years 13-19 years 20-24 years 25-44 years >=45 years

Nu

mb

er

nonfatal outcome fatal outcome

Global incidence and mortality rates: 1.9 and 0.7 / 100 000Men: 2.7 and 1.1Women: 1.2 and 0.3

Sex ratio: incidence 2.3, mortality 3.5

Under 5 years of age: 4 and 1.3Over 65 years of age: 2.7 and1.1

Institut de Veille Sanitaire

June 2004 6

Accidental drowning in France,June 1st - September 30

01 to 56 to 1011 to 30More than 30

Institut de Veille Sanitaire

June 2004 7

2003/2002

Comparison of the data for 2003 with those for 2002 shows

that there was a major increase in both the number of

drowning accidents: up by 45% (1154/796), and the number of

deaths: up by 73% (435/252).

This increase may have been linked to the exceptionally hot

weather during the summer of 2003 in France.

In particular, it should to be noted that 25 children under 6

years of age drowned in private swimming pools, which was

nearly twice as many as in the summer of 2002 (14).

Institut de Veille Sanitaire

June 2004 8

0

5

10

15

20

25

Nu

mb

er

Accidental drowning in 2002 Accidental drowning in 2003

Death in 2002 Death in 2003

Drowning, France : 2003/2002

June 2004 9

Circumstances 1

In private swimming pools:The 172 victims included 84 children under 6 years of age

52 of them died, including 25 children under 6 years of age

Not knowing how to swim (35%)

Falling into the water (29%)

Lack of supervision (23%)

In public swimming pools:The 66 victims included 43 people under 20 years of age

Only 5 of them died

A medical disorder (malaise, 29%)

Not knowing how to swim (21%)

Risky behavior (dangerous games,… 17%)

Institut de Veille Sanitaire

June 2004 10

Circumstances 2

In rivers:The 153 victims included 68% adults between 20 and 64 y of age

105 of them died

Falling into the water (33%)

Swimming where it is prohibited (28%)

A medical disorder (malaise, 25%)

In lakes:The 156 victims included 74 people under 25 years of age

93 of them died

A medical disorder (malaise, hydrocution – shock, 39%)

Not knowing how to swim (19%)

Exhaustion (13%)

Institut de Veille Sanitaire

June 2004 11

Circumstances 3

In the sea:The 560 victims included 59% people over 45 years of ageIn 7% of cases they were foreign tourists160 of them died

A medical disorder (malaise, heart failure, 35%)Exhaustion (17%)Currents (16%)

In other places:The were 47 victims in other places, including 28 children under 6 years of age 22 in a bathtub, 9 in a pond, 8 in an inflatable swimming pool20 of them died

A lack of supervision (45%)Falling into the water (32%)A medical disorder (malaise, heartfailure, 19%)

Institut de Veille Sanitaire

June 2004 12

Conclusions

These findings show that many deaths by drowning could have been prevented, and that the development of a “culture of prevention” could save many lives.

They provide epidemiological information about the number of children under the age of 6 who drown in private swimming pools:

32 in 2000, 23 in 2001, 14 in 2002, 25 in 2003

and this has already been used to provide the basis for new regulations about fences or other protections for private swimming pools.

Institut de Veille Sanitaire

June 2004 13

Knowing the circumstances under which drowning accidents happen has provided valuable guidelines for the national prevention campaign.

Some specific issues need to be addressed:

* the absolute necessity for close adult supervision of children under the age of 6 in swimming pools,

* the avoidance of unnecessary risks, especially by teenagers and adults,

* the contribution of health problems (malaises, epileptic fits, etc.) in older people,

* the need for prevention messages that specifically target

foreign tourists in France. Institut de Veille Sanitaire