The Role of Permission, Supervision, and Precipitating Events in Childhood Pool/Spa Submersion Incidents, United States, 2000-2017.

Kristina R Anderson,James T Schuman,William D Ramos

doi:10.3390/ijerph18168776

Abstract

Drowning is a leading cause of fatality among children in the United States, and pool/spa aquatic structures represent common locations of submersion incidents. This study employed narrative case review to understand characteristics related to permission, supervision, and precipitating events in childhood submersion incidents. Retroactive analysis of 1537 fatal and non-fatal submersion incidents among children age 13 years old and younger was conducted using the U.S. Consumer Products Safety Commission In-Depth Investigations dataset from 2000–2017. Narrative descriptions were coded according to the themes of permission, supervision, and precipitating events. In most (86%) incidents, the child did not have permitted water access, and 80% of narratives indicated the child was alone at time of incident. These attributes were significantly associated with a fatal outcome (No permission: OR 11.98, 95% CI 7.97–18.06; Alone: OR 34.93, 95% CI 19.69–61.96). The average length of inactive supervision time was 15.6 min; this duration significantly differed by non-fatal (3.2 min) and fatal (16.1 min) outcomes (p < 0.001). More than half of cases occurred under the supervision type of a parent (56%), followed by grandparents (14%) and childcare provider (10%). Submersion incidents with a non-parent supervisor were two times more likely to result in a fatal outcome (OR 1.87, 95% CI 1.07–3.64). The most frequently occurring precipitating events included outdoor play (46%), a social gathering (36%), and previous water play (15%). Narrative excerpts further illustrate how tragic submersion events can unfold quickly and unpredictably. Education campaigns should target all adults that supervise children and reiterate key findings in that many submersion incidents occur (1) without permitted pool use, (2) without active supervision, and (3) when a caregiver is distracted. Multiple strategies should be utilized to add layers of projection against submersion injury.

Highlights

Through detailed review of descriptive narratives about submersion incidents occurring in pools and spas, this study identifies and categorizes multiple attributes associated with permission, supervision, and precipitating events in fatal and non-fatal submersion incidents, as reported to the U.S Consumer Product Safety Commission (CPSC) from
This study is the first large-scale effort to employ investigator narrative accounts to examine the role of permission, supervision, and precipitation events in youth submersion incidents
Despite some limitations associated with this approach, our use of the CPSC’s pre-existing INDP dataset allowed for the detailed review of more than 1500 submersion incidents across the U.S Our results suggest that future educational and outreach efforts seeking to prevent childhood drownings should target parents but other individuals that supervise children in communicating the risk of proximate pools and spas

Summary

Introduction

Among children ages 1–4, drowning is the leading cause of fatal injuries in the United States (U.S.) [1], and in reports of unintentional drownings involving swimming pools across several countries, the U.S ranks highest (18%) [2,3]. Whereas drowning is defined as “the process of experiencing respiratory impairment from submersion/immersion in liquid” and its associated outcomes are death, morbidity, and no morbidity, submersion describes all situations in which a victim’s airway is under water [4]. Pools and spas (i.e., home spas or hot tubs) in private and residential backyards are frequently implicated sites of unintentional drowning and submersion incidents, especially.

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