Aging Begins at 30

Drowning

This time it was so unexpected and a real shock. The death was of one of my medical school classmates. Four weeks to the day before his death we had dinner together at our 57th medical school reunion. We caught up with news since we had last met. I mentally remarked to myself "This man is very fit and will outlast us all." I remember that distinctly. Most unfortunately he didn't. The obituary said "Dr. James Thompson" (not his real name) "died on June 15 by drowning, the result of a boating accident on Loch Lomond.... After retirement he found time to indulge his many hobbies such as boating on Loch Lomond...." Indeed he was a skilled yachtsman and lived for many years on Inchtavannaich an island on the Loch. There were no details. Was it someone else's fault? Perhaps the death resulted from a collision by another boatman, unskilled or intoxicated?

Drowning is the third leading cause of death from unintentional injuries in the United States and causes about 150,000 deaths annually. Motor vehicle accidents are first, falls second and drowning third. In our 80-year-old age group 1 per 100,000 women and 4 per 100,000 men drown. That's not too different from the rates for 49 to 70 year olds. It contrasts with 6 to 9 per 100,000 deaths from drowning in youths aged 5 to 20 but only 1 to 3 in similar aged girls and young women. Drowning is classified into two major groups. The larger one includes drowning not related to boats. The boat-related drownings are about a fifth the size of the first. Half these boat-related drownings occur in May through August and half on Saturdays and Sundays. A third group, half the size of the second, is included with motor vehicle accident deaths. Also about 10% are work related and 5% are suicidal. Alcohol intoxication over age 13 is found in 60%. My friend was not a drinker. We each drank half a glass of white wine during our 2- to 3-hour reminiscing dinner.

In the boat-related accidents, a one-third fall from the boat, in a fifth the boat capsizes and in another fifth drowning follows a collision. About two thirds were wearing a life vest but many were not using it correctly.

Over the years some favorable trends have developed. From 1986 to 1996 drownings have decreased 30%, but high risks still remain for boys and girls under 5 and for males aged 15 to 34. Intoxication has fallen from 1975 to 1995 from 50% to 22%. In a different study it is pointed out that drowning victims were intoxicated in 34% and motor vehicle accident victims in 33%. If the fall in intoxication is real, have the "don't drink and drive" education programs provided a similar benefit on boats? Have swimming places become safer and better supervised? Has the noted fall in physical fitness led to less swimming and boat recreation? None of the observed decrease in deaths was due to improved medical care, according to one group of investigators in the State of Washington. After one has explored all the possible causes of the decrease in drownings half the decrease remains unexplained. The Centers for Disease Control and Prevention advises that drowning prevention efforts should include 1) decreasing alcohol and illicit drug use among both boating passengers and operators; 2) Focusing on the proper use of life vests not only among children but also among persons of all ages; and 3) instructing caretakers to supervise children and maintain adequate fencing around swimming pools. For a pool fence to protect against drowning, the fence must completely enclose the pool and must be at least 4 feet high with vertical openings less than 4 inches wide with a functional self-latching gate. Teaching must be appropriate for the highest risk populations.

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See related Patient Topics Drowning, Injuries and Wounds, Safety or Water Safety (Recreational).

See related Provider Topics Injuries and Wounds or Safety.

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