EPIDEMIOLOGICAL SURVEILLANCE OF DROWNING IN FRANCE

1. Institut de Veille Sanitaire 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 d’Osne – 94415 SAINT MAURICE cedex – France

2. Institut de Veille Sanitaire 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.

3. Institut de Veille Sanitaire 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.

4. Institut de Veille Sanitaire 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%)

5. Incidence and mortality rates Institut de Veille Sanitaire 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

6. Institut de Veille Sanitaire Accidental drowning in France, June 1st - September 30 0 1 to 5 6 to 10 11 to 30 More than 30

7. Institut de Veille Sanitaire 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).

8. Drowning, France : 2003/2002

9. Institut de Veille Sanitaire 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%)

10. Institut de Veille Sanitaire 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%)

11. Institut de Veille Sanitaire 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%)

12. Institut de Veille Sanitaire 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.

13. Institut de Veille Sanitaire 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.