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Perspectives in Disease Prevention and Health Promotion Aquatic Deaths and Injuries -- United States

In 1980, 7,000 drownings, primarily associated with recreational activities, occurred in the United States. After motor vehicle and fall deaths, drownings are the third leading cause of unintentional injury deaths, and for ages 5 to 44, rank second only to motor vehicle deaths. Data show that death rates from drowning are more than five times greater for males than females (1) and nearly three times greater for blacks than whites (2).

It is often assumed that most aquatic deaths occur in swimming pools, but pools account for only about 10% of all reported drownings; persons are more likely to drown in lakes, rivers, or oceans. Quarries, pits, ornamental ponds, and bathtubs add to the toll (3). Residential home pools, however, do play a major role in childhood drownings when toddlers fall or wander into them. There is strong evidence that adequate fencing and self-latching gates substantially reduce the number of childhood drownings and virtually eliminate drownings among toddlers (4-6).

Although no precise statistical data exist on the total number of water-related injuries, it is estimated that 140,000 injuries associated solely with swimming activities occur annually (7). Diving and head-first sliding into water account for the most serious aquatic injuries because of damage to spinal cords, often as a result of striking the bottom or side of a shallow body of water. Of the estimated 700 spinal cord injuries resulting from aquatic accidents each year, the majority are sufficiently serious to cause permanent paralysis (8). A 10-year study of 152 sports-related cervical spinal cord injuries shows that three water-related activities--diving, surfing, and water skiing--accounted for 77% of all reported spinal injuries (9). Spinal cord injuries from diving alone exceed the total reported from all other sports combined (10).

The data below identify three additional factors that significantly influence aquatic deaths and injuries:

  1. In recent years, residential spa and hot tub use has markedly increased. In 1980, an estimated 1,100 persons with spa or hot tub injuries required emergency room treatment, as compared with only 200 the previous year. Alcohol was cited as a contributory factor in 12 of 30 residential spa-associated deaths reported to the Consumer Product Safety Commission since 1979 (11). The high temperatures of spas and hot tubs combined with a moderate level of alcohol in the blood stream tend to accelerate drowsiness. Death often results from drowning after a victim falls asleep (12).

  2. Coast Guard data show that 7% of the boats involved in mishaps lacked available and accessible personal floatation devices, but this 7% accounted for 29% of fatalities (3).

  3. Onboard and overboard falls contributed from 20% to over 30% of water-related fatalities, often when the victim was undertaking an activity other than boating (e.g., fishing) (3). Many complex factors, both human and environmental, relate to

water safety, including pre-existing illness and alcohol. Alcohol consumption is often cited as an indisputable factor in drowning and injury. One study showed that 47% of adults who drowned had evidence of alcohol in their blood (2). Many other studies support those findings and indicate that positive blood-alcohol tests on drowning victims are especially common, even among experienced swimmers.

A retrospective study to determine the epidemiologic features of recreational injuries and to identify intervention strategies to reduce the incidence of such injuries was recently completed by the Washington Department of Social and Health Services. Among its epidemiological conclusions: Aquatic recreational activities present a hazard for males, generally less than age 25. It is clear that the full spectrum of injury, from minor to death, is possible in aquatic activities. Depending on the age under discussion and the injury, the target problems change. For the young, swimming pools present the greatest aquatic hazard due to drownings. Private rather than public pools are more frequently involved. Yet on an overall basis, swimming pools are not the major focal point for drowning prevention. The same appears true for spinal injuries. Here the target group is the diving teenager. The behavioral implications as well as environmental controls are evident in most of the descriptive literature regarding aquatic injuries, and it is clear prevention strategy cannot ignore the realities of either. (3). Reported by Environmental Health Svcs Div, Center for Environmental Health, CDC.

Editorial Note

Editorial Note: A National Conference on Injury Control, co-sponsored by CDC and held at Johns Hopkins School of Hygiene and Public Health on May 18-19, 1981, (13) brought together 25 leaders in the injury-control field. They represented public health and medical schools, state and local health departments, and other public and private agencies. The conference report suggests strategies or approaches for transforming existing knowledge and technology into measures that prevent injuries. Some of the suggested intervention strategies to prevent aquatic deaths and injuries are:

  1. Develop and implement standards that govern safe pool design.

  2. Require licensing for private and public pool construction and ownership based on certain safety requirements, including adequate fencing and accessible rescue and resuscitation equipment.

  3. Require sign-posting in known hazardous-water areas regarding depth, undertow, or slippery banks.

  4. Restrict the sale and consumption of alcoholic beverages in boating, pool, harbor, marina, and beach areas.

  5. Impose sanctions for drunken boat drivers.

  6. Integrate information into health department home-visit programs to make parents aware of pool, pond, and bathtub hazards.

  7. Develop and institute programs for employees, who work in or near bodies of water, on how to recognize hazardous, environmental conditions and about emergency procedures that reduce the consequences of water-related injuries (e.g., procedures for extrication).

  8. Conduct surveillance programs using emergency medical service logs, lifeguard data, coroner's records, and data from environmental groups, which are critical to evaluating the effectiveness of interventions.


  1. National Safety Council. Accident Facts, 1981. Chicago: National Safety Council.

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

  3. Center for Environmental Health. Report: a model state recreational injury control program. Atlanta: CDC, October 1981.

  4. Milliner N, Pearn J, Guard R. Will fenced pools save lives? A 10-year study from Mulgrave Shire, Queensland. Med J Aust 1980;2:510-1.

  5. Pearn J, Brown J 3d, Hsia E. Swimming pool drowning and near-drownings involving children. A total population study from Hawaii. Milit Med 1980;145:15-8.

  6. Pearn J, Wong R, Brown J 3d, Ching Y, Bart R Jr, Hammar S. Drowning and near-drowning involving children: a five-year total population study from the city and county of Honolulu. Am J Public Health 1979;69:450-4.

  7. U.S. Consumer Product Safety Commission. Statistical Analysis System Hazard Identification and Analysis, estimates report (calendar year 1981). National Electronic Injury Surveillance System (NEISS), U.S. Consumer Product Safety Commission, Washington, D.C. (computer run, July 1982).

  8. Gabrielsen MA. Diving's deadly toll. Paper. National Environmental Health Association Conference, New Orleans, June 20, 1982.

  9. Shields CL Jr, Fox JM, Stauffer ES. Cervical cord injuries in sports. Physician and Sports Medicine, September 1978.

  10. Gabrielsen MA, ed. Diving--producer of the most catastrophic of all sport-related injuries. A critical insight to the problem. Huntington Beach, California: Council for National Cooperation in Aquatics and Aquatic Department of Indiana University, November 1979.

  11. Brown V. Spa associated hazards--an update and summary. Washington D.C.: U.S. Consumer Product Safety Commission, May 1981.

  12. Environmental Health Services Division. Suggested health and safety guidelines for public spas and hot tubs. Atlanta: Center for Environmental Health, CDC, April 1981.

  13. Teret SP, Baker SP, Trinkoff AM, DeFrancesco S, eds. Report of the National Conference on Injury Control. (Johns Hopkins School of Hygiene and Public Health, May 18-19, 1981). Atlanta: CDC 1981.

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