EPIDEMIOLOGICAL SURVEILLANCE OF DROWNING IN FRANCE

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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 dOsne 94415 SAINT MAURICE cedex
  France

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Introduction

• Problem under study
• Death 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.
• Objectives
• To improve the prevention of drowning in France
  by providing a description of the people who
  drown and of the circumstances surrounding
  drowning accidents.

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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.

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Results

• From 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)

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Incidence and mortality rates
Global incidence and mortality rates 1.9 and 0.7
/ 100 000 Men 2.7 and 1.1 Women 1.2
and 0.3 Sex ratio incidence 2.3, mortality
3.5 Under 5 years of age 4 and 1.3 Over
65 years of age 2.7 and1.1
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Accidental drowning in France, June 1st -
September 30
0 1 to 5 6 to 10 11 to 30 More than 30
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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).

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Drowning, France 2003/2002
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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)

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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)

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Circumstances 3

• In the sea
• The 560 victims included 59 people over 45 years
  of age
• In 7 of cases they were foreign tourists
• 160 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 pool
• 20 of them died
• A lack of supervision (45)
• Falling into the water (32)
• A medical disorder (malaise, heartfailure, 19)

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• 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.

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• 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.