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