Drownings in a Private Lake -- North Carolina, 1981-1990

Drowning is the third most common cause of death from unintentional injury in the United States (1); in 1989, in North Carolina, drownings were the leading cause of years of potential life lost before age 65 per death (2). From July 1 through August 31, 1990, two drownings occurred in a private lake in Beaufort County (1990 population: 42,283), North Carolina. A review of data from the Office of the Chief Medical Examiner (OCME) in North Carolina identified two additional drownings at this lake during 1981-1990, and a total of 17 drownings in the county during the 10-year period. At the request of the local health director, in October 1990, the North Carolina Department of Environment, Health, and Natural Resources (DEHNR) investigated the drownings using information from OCME files, hospital medical records, and ambulance reports. This report summarizes the investigation of the four drownings in the private lake, recommendations to prevent additional drownings, and characteristics of drownings in North Carolina in 1989.

This lake is on a private campground but is accessible to the general public. It is approximately 250 feet wide and 400 feet long with an average depth of approximately 9 feet, has a sandy bottom, and fills naturally by seepage of groundwater. To control algae, the owners had added a blue dye that made the water impermeable to light and reduced underwater visibility.

The decedents ranged in age from 7 to 15 years; all were male. Postmortem blood alcohol testing was obtained for three decedents; all tests were negative. Two decedents were reported by family members to be poor swimmers, and two were known to have been swimming without supervision. All the drownings occurred during June, July, or August; three were on a weekend or holiday, and all occurred between 1:30 p.m. and 4:30 p.m. Lifeguards were not present during any of the drownings, and a posted sign read "swim at your own risk."

All the drownings occurred in a heavily used part of the lake. Two persons had jumped off a diving board near the shoreline and reportedly never resurfaced. Another drowned approximately 8 feet from shore near the transition from shallow (approximately 4.5 feet) to deep (approximately 7 feet) water. The fourth drowned near a platform approximately 25-30 feet offshore. Two persons were under water less than or equal to 10 minutes and received cardiopulmonary resuscitation (CPR) at the scene. The other two were under water approximately 6 hours each. Three died at the scene, and the fourth survived 11 hours. None of these persons had external signs of trauma, and all drownings were determined to be unintentional.

Based on the investigation, during December 1990, state and local public health officials recommended that the owners of the lake implement the following measures: 1) maintain a lifeguard on duty during regularly scheduled hours of operation, 2) establish a safe-bather capacity based on a recommended amount of water surface per person, 3) display clearly labeled lifesaving equipment, 4) install float-lines marking water depths, 5) post signs displaying safety information, 6) use algae-control methods that do not reduce water clarity, and 7) consult a design engineer regarding the placement of recreational equipment at the site.

Owners of the lake had not acted on any of these recommendations by May 1991 when a fifth person (a 15-year-old boy) drowned at the lake. The county health director subsequently declared the lake to be an imminent hazard and instructed the owners to comply with several of the safety recommendations. As a consequence, by June 1991, the owners hired full-time lifeguards, restricted swimming in certain parts of the lake, posted depth markings, provided safety guidance for swimmers, and discontinued the use of coloring agents to control algae. No drownings have occurred at the lake since the owners implemented these safety recommendations. State and local health officials have continued to work with the owners of the lake to reduce drowning hazards and to evaluate the effectiveness of drowning-prevention actions.

To characterize drownings that occurred in natural swimming areas in North Carolina, the DEHNR reviewed data from the OCME, local health departments, and local police agencies for 1989 (the most recent year for which complete data were available). During 1989, 57 (38%) of the 151 drownings occurred in lakes or ponds. Of these 57 drownings, 32 (56%) occurred while the persons were swimming; in 10 of these incidents, the swimming area had been openly advertised as accessible for public swimming. However, six of these 10 incidents occurred in locations where lifeguards usually were not present.

Reported by: G Taylor, MPH, S Jones, Beaufort County Health Dept; D Brewster, TB Cole, MD, Injury Control Section, PD Morris, MD, B Williams, E Norman, MPH, Environmental Epidemiology Section, JB Butts, MD, Office of the Chief Medical Examiner, JN MacCormack, MD, State Epidemiologist, North Carolina Dept of Environment, Health, and Natural Resources. Div of Field Epidemiology, Epidemiology Program Office; Program Development and Implementation Br, and Epidemiology Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: In the United States, drowning rates are highest for males, children less than 5 years of age, and young adults 15-24 years of age (3-5). Factors commonly associated with drowning while swimming include lack of supervision (6); alcohol consumption (7); poor swimming ability (7); and absence of persons trained in lifesaving techniques, including CPR (8,9). Persons who swim in natural bodies of water may be at increased risk because of additional hazards including changing environmental conditions (e.g., depth, currents, and weather); insufficient warning signs; murky or cloudy water; close proximity to watercraft; and inaccessibility of emergency medical services.

In some states, laws have been enacted to establish basic safety requirements for natural swimming areas, including depth markings and warning signs, lifeguards, lifesaving equipment and first aid supplies, telephones for emergency use, safety plans, and restrictions on density (i.e., the number of persons allowed in a specified beach area). Further research is needed to evaluate the effectiveness of these drowning-prevention strategies. However, based on the results of the North Carolina investigation, states should strongly consider mandating basic safety requirements for natural swimming areas and discourage the use of algae-control methods that reduce water clarity.

References

1. CDC. Alcohol use and aquatic activities -- Massachusetts, 1988. MMWR 1990;39:332-4.

2. Office of the Chief Medical Examiner, North Carolina Department of Environment, Health, and Natural Resources. North Carolina Medical Examiner System annual report, 1989. Raleigh, North Carolina: North Carolina Department of Environment, Health, and Natural Resources, 1990.

3. CDC. North Carolina drownings, 1980-1984. MMWR 1986;35:635-8.

4. CDC. Drownings -- Georgia, 1981-1983. MMWR 1985;34:281-3.

5. CDC. Drownings in the United States, 1978-1984. MMWR 1988;37 (no.SS-1):27-33.

6. Quan L, Gore EJ, Wentz K, et al. Ten-year study of pediatric drownings and near-drownings in King County, Washington: lessons in injury prevention. Pediatrics 1982;83:1035-40.

7. Dietz PE, Baker SP. Drowning -- epidemiology and prevention. Am J Public Health 1974;64:303-12.

8. Patetta MJ, Biddinger PW. Characteristics of drowning deaths in North Carolina. Public Health Rep 1989;103:406-11.

9. Wintemute GJ, Kraus JF, Teret SP, et al. Drowning in childhood and adolescence: a population-based study. Am J Public Health 1987;77:830-2.

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