On the safe side: nurse manager talks drownings in Australia

Queensland is known as the Sunshine State. Its hot, humid summers and cool, dry winters make it an attractive place to live. Given the beautiful climate, outdoor recreation is promoted and often includes surfing and swimming. And there are endless opportunities for swimming – in the ocean and rivers, in aquatic centres and home pools, in creeks and estuaries, and in lakes, lagoons, dams and reservoirs.

While there are myriad fun activities, there are also hazards – from marine animal attacks to head and neck injuries, to drowning.

The dangers of shark and crocodile injuries in Australian waters are well documented though reasonably rare. When they occur, the victim usually sustains dramatic injuries. Diving into shallow bodies of water such as rock pools may result in a broken neck or spinal cord injuries, which will have lifelong ramifications.

Drowning is one of the leading causes of death for Australian children under five years of age (Royal Life Saving [RLS] National Drowning Report 2017). Drownings are typically classified as either non-fatal, where the patient survives, or fatal, where the patient dies as a consequence of aspirating water (where death occurs within 24 hours of the event). There is a liquid-air interface that causes respiratory impairment and this prevents the victim from breathing (Beeck et al, 2005).

About 30 children under five years of age drown in Australia each year, and unfortunately last year was no exception. In 2017, 29 Australian children aged 0–4 years drowned. It may be surprising to note that nearly half of these drowning incidents occurred in backyard swimming pools, deeming it the single most dangerous water environment for young children.

Australia boasts 1.2 million households with swimming pools. In Queensland, they must be registered with the Queensland Building Construction Commission and comply with pool safety regulations. They must have a continuous safety barrier maintained by the pool owner that restricts access to the pool. The safety barrier needs to meet specific pool fencing requirements and be self-closing and fitted with a self-locking latch. In Queensland, the latch must be 150cm from the ground to prevent small hands gaining access.

Furthermore, any receptacle that can hold more than 2000 litres of water and is deeper than 30cm requires regulated pool fencing, such as a portable pool fence that features a self-closing and latching safety gate.

The 2017 RLS report also states that almost a quarter of children under five years old (24 per cent) who drowned did so in the bath. While bathing your child is a routine event, it is not a time to be complacent. It is vital to be in the bathroom supervising the child. In the 10 seconds it takes to cross the room for a towel, a child in a bathtub can become submerged under the water. Answering the phone takes about two minutes, but within this time a child submerged in water can lose consciousness. It can take a mere four minutes for a child submerged in a bathtub to sustain permanent brain damage.

The advisable method to counteract these risks when bathing your children is preventive preparation. Do not leave young children unsupervised when in the bath or pool for any reason. The single most common factor for infant drowning is being left alone in or near water.

Thirty-nine per cent of fatal drownings occur in summer. Given that 2017 was the hottest year since global records began (National Centers for Environmental Information) it is not surprising that Australians seek refuge from the soaring temperatures.

In our attempt to cool off, there are various bodies of water that pose a risk. Some of these may seem obvious, such as portable wading pools, clam shell pools, inflatable pools, and all above/below-ground pools. It is important to note that a child can drown silently in as little as 5cm of water, and in fewer than 20 seconds.

Less obvious bodies of water include eskies with water in them from melted ice, buckets of water, septic tanks, feeding troughs for animals, water tanks, wells, fish ponds and rainwater tanks.

Of note, hot tubs, spas and whirlpool bathtubs pose a particular risk: hair entrapment in the suction fitting drain. In several recorded incidents, children were either doing handstands underwater or playing a ‘hold your breath the longest’ game while sitting under water when their long hair became entangled in the strong suction fitting drain.

To mitigate this risk, consider using drain covers or installing multiple drains to reduce suction strength.

Last year there were 291 fatal drownings in Australian waterways. About three-quarters were males and a quarter females. The top three mechanisms for fatal drowning were swimming during recreation (25 per cent) falling into water (16 per cent) and boating incidents (13 per cent). Other activities included diving (8 per cent), watercraft (5 per cent) and rock fishing (3 per cent).

Safety advice

General safety advice includes avoiding alcohol or drugs around water, using the buddy system when scuba diving, and avoiding solo swimming.

Surf Life Saving Australia has developed Beachsafe, an application to download on your phone in addition to the website (beachsafe.org.au). The app provides information on patrolled beaches, tides, swells, rip currents, surf skills, marine animals and much more.

It is important to be able to spot and avoid rip currents, and in addition it is advisable to swim on one of the many beaches patrolled (with lifeguards) denoted by the red and yellow flags, and to swim between these flags.

Life jackets or personal flotation devices (PFD) were designed to improve survival, as they keep the wearer afloat and buoyant for extended periods of time in the water. Design has improved vastly since the cork vest of 1804, and the more modern neoprene rubber PFD offers protection against hypothermia.

Caution should be exercised with new products, particularly those targeting children sold under the auspices of inflatable toys. One recent product is the ‘mermaid tail’, which comes in two types: mono fin and full mermaid suit. It essentially binds the legs of a swimmer and acts like a flipper. It typically comes with an age recommendation of six years or older, but the ACCC has warned the toy could be unsafe and even fatal for young or less skilled swimmers.

There are many things that one can do to mitigate both fatal and non-fatal drowning. Four key actions include supervision, restricting access to the pool, water awareness and resuscitation.

Active supervision involves direct and constant monitoring of children when your children are in or around water. Ensure you are in close proximity (within an arm’s reach is the ideal) and can see them at all times.

Although your pool may comply with safety regulations, this does not mitigate all risk, only vigilant supervision does. A compliant pool does not exclude adult, active supervision of children.

Enrol your children in water awareness and familiarisation programs that promote water safety and skill development. There are many swimming classes available for children of all ages and abilities through clubs, gyms and school curriculums.

There are also many water safety campaigns and programs, from the ‘Kids Alive – Do the Five’, to Royal Life Saving’s ‘Swim and Survive’.

These programs are designed for various age groups to ensure water safety. Australian Olympic and world champion swim coach Laurie Lawrence developed ‘Kids Alive – Do the Five’ in 1998 to reduce the risk of preschool drowning. The five components are:

1. Fence the Pool
2. Shut the Gate
3. Learn to Swim
4. Supervise
5. Learn to Resuscitate.

Cardiopulmonary resuscitation (CPR) is a vital skill to learn. A CPR sign must be displayed and attached to the barrier for the pool, or displayed near the pool, so that the sign is easily visible to anyone near the pool.

Put the ambulance emergency number on your speed dial and keep your phone with you for this reason.

You man also want to consider a Rescue Rashie – an ultraviolet protective vest printed with step-by-step instructions for performing CPR.

Sadly, for every one child that drowns in a pool, about five are hospitalised with non-fatal injuries, some of whom will suffer permanent brain damage. At our paediatric Major Trauma Centre in Queensland, between December 2014 and December 2017, we admitted 182 patients (0–16 years) after a drowning event. About 95 per cent of these patients were younger than six years old. Sixteen of these patients required admission to PICU, and all 16 were four years old or younger.

The importance of swimming lessons or water safety programs cannot be overemphasised, as they enhance your child’s knowledge of safety around water as well furthering their physical skills, including hand-eye coordination and muscle tone.

More importantly, it is a life-long skill that may help keep your child safe, active and healthy throughout their life.

Tona Gillen is nurse manager, trauma, at Lady Cilento Children’s Hospital in South Brisbane.

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