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Full text of "Drowning deaths in North Carolina"

I 



A SPECIAL REPORT SERIES BY THE N.C DEPARTMENT OF HUMAN RESOURCES, DIVISION OF 
HEALTH SERVICES, STATE CENTER FOR HEALTH STATISTICS, P.O. BOX 2091, RALL.GM, N.C. 2/6U2 



SEP — a M* 

HC. STATE LSHAaY 
RALEIGH 
No. 42 '- August, 1986 



DROWNING DEATHS IN NORTH CAROLINA 

by 
Michael J. Patetta 



INTRODUCTION 

It has been shown that the availability and nature of 
bodies of water in an area are closely related to the fre- 
quency of drowning. Nations with comparatively high 
drowning rates include India, Japan, and Mexico, all of 
which are nations in close proximity to water. (1) With 
approximately 320 miles of ocean shoreline, 65 major 
rivers, and 100 major lakes and reservoirs, it should come 
as no surprise that the State of North Carolina has a 
comparatively high drowning rate. In fact, U.S. data from 
1977 to 1979 show that only 14 states had a higher 
drowning rate than North Carolina (2). 

What part can public health officials play to reduce the 
high drowning rate? A first step could be examining the 
circumstances surrounding the death. What activity did 
the decedent engage in before drowning, in what setting 
did the drowning occur, were there other fatalities 
involved in the incident, and what was the blood alcohol 
concentration of the decedent? These and other questions 
are addressed in the present study. 



BACKGROUND 

In 1984, drowning was the third leading cause of death 
due to unintentional injury in the United States, with only 
motor-vehicle deaths and falls having a higher total 
number of injury deaths. The overall drowning rate is 
highest in the 0-4 and 1 5-24 year age groups. (3 ) Further- 
more, the rate for blacks is about twice that for whites. 
The only exception is with children ages 1 to 4 among 
whom the rate for whites is almost twice that for blacks. 
(2) 

The male to female ratio of drowning rates is about 12: 1 
for those related to boats and about 5:1 for all others. 
Drowning rates by age and sex show that for males the rate 
peaks at age 2 , declines until about age 1 0, and then peaks 
at age 18. For females, the rate peaks at age 1, decreases 
sharply and does not rise again. (2) 

A 1971 study of 5,237 drownings in the U.S. con- 
ducted by the U.S. Department of Health, Education, and 
Welfare (HEW) (4) showed that approximately 36% of 



the drowning victims were swimming before they drowned. 
Most of these drownings occurred while swimming in an 
unorganized facility. The study also showed that approx- 
imately 14% of the victims were playing adjacent to water, 
11% were standing or walking near water, 7% were in a 
motor vehicle crash, 7% were fishing from a boat, 3% 
were motorboating, 3% were attempting a rescue, and 2% 
were taking a bath. Popular water sport activities such as 
canoeing, sailing, and scuba diving each accounted for 1 % 
of the drownings. 

This 1971 study indicated that activities associated 
with drowning varied by age. Children less than five 
accounted for 64% of the bathtub drownings and 69% of 
the victims who were playing adjacent to water, while they 
contributed only 16% of the total drownings. Other activ- 
ities associated with age included bathing or wading (58% 
were 5-14 years), swimming (58% were 10-19 years), 
playing on a raft or float (82% were 5-19 years), playing 
on ice (95% were 1-14 years), motorboating (43% were 
25-44 years), canoeing (79% were 15-34 years), and 
scuba diving (76% were 15-34 years). For drowning vic- 
tims ages 65 and over, 48% were reported to have been 
standing or walking near water before they drowned. (4) 

The main settings associated with the drownings were 
lakes or ponds (35%), rivers or creeks (29%), swimming 
pools (13%), oceans or bays (9%), and bathtubs (2%). 
(5) For the drownings in swimming pools, approximately 
56% were children under age 10. Furthermore, this age 
group accounted for about 77% of the drownings in 
private swimming pools. Inadequate fencing around the 
pools was reported to have been a factor in many of these 
drownings. (6) 

Available information from the 1971 HEW study on 
rescue and resuscitation efforts show that the body was 
not recovered for at least 30 minutes in 70% of the cases. 
There was also no primary revival effort in 7 out of 10 
drownings. (5) A study completed by Dietz and Baker in 
Maryland (7) had similar results. They reported that of 
the drownings they reviewed, 75% were witnessed and in 
most cases the witness was old enough to have learned 
lifesaving and resuscitation techniques. However, the 
speed with which the victim slipped out of view and the 
failure of recovery efforts in the first few minutes were 
major obstacles to successful resuscitation attempts. 

Preexisting illness has been found to be a risk factor in 
drowning. Dietz and Baker (7) found that 6% of the 
drownings they reviewed had a preexisting illness that 
may have contributed to the drowning. These medical 
conditions include seizures, severe mental retardation, 
organic brain syndrome, and myocardial infarction. The 
percentage of victims with preexisting illnesses was even 
greater (20 percent) in their alcohol study group. Of the 
20 persons in the combined primary and alcohol study 
groups in whom illness was identified, eight were known 
to suffer from seizure disorders. 



The role of alcohol in drowning has been documented 
in several studies. Dietz and Baker (7) reported that 47% 
of the victims aged 1 5 years or more had consumed alco- 
hol and that 38% had blood alcohol concentrations 
(BAC's) of .10 percent or higher. Plueckhahn (8) com- 
pleted a 25-year study in Australia and he found that 55% 
of all men 20 years and older who drowned had consumed 
alcohol, 37% had BAC's of .08 percent or higher, and 
29% had BAC's of . 1 5 percent or higher. Plueckhahn also 
cited the Davis and Smith study in South Africa, in which 
64.1% of the drowning victims 15 years or older had 
consumed alcohol and 50.2% had BAC's higher than .10 
percent, and the Cairns, Koelmoyer, and Smeeton study 
in New Zealand, in which 50% of those age 1 5 and over 
had consumed alcohol and 37% had BAC's in excess of 
.10 percent. 

METHODOLOGY 

The present study examines 1980-1984 drowning 
deaths that occurred in North Carolina. Information 
about these deaths was obtained from the Office of the 
Chief Medical Examiner at Chapel Hill. Under North 
Carolina law, all suspicious, unusual, or unnatural deaths 
are to be investigated by licensed physicians participating 
in the Medical Examiner System. Data on the Medical 
Examiner file include demographics of the decedent, 
means of death, place of death, and if applicable, autopsy 
and toxicology information. Most of these data are 
entered into a computer file; however, important sections 
of the Medical Examiner file such as a narrative summary 
of circumstances surrounding the death are not put in 
computer-readable form. Therefore, a "Drowning 
Abstract Form," shown in Appendix 1, was filled out and 
matched to the computer file to form a complete case 
history for each decedent. Appendix 2 shows the activity 
and setting codes used. 

Each data item on the abstract form and selected items 
on the computer file, such as the decedent's blood alcohol 
percent, were summarized to form descriptive statistics on 
all the drownings. Crosstabulations were generated to see 
how certain characteristics varied by activity of decedent 
and setting of drowning. For example, a crosstabulation of 
activity by age of victim was computed to see if certain 
activities had an age distribution different from that for 
total drownings. For each activity and setting, only the 
major differences are reported in the results section. The 
binomial test of significantly different proportions was 
used to indicate which differences were not likely to be 
due to random variation. 

RESULTS 
Total Drownings 

A total of 1,052 drownings for the period 1980-1984 
were abstracted from the Medical Examiner file. The 
demographics of these drownings are shown in Figures 1 
and 2. Males accounted for 87% of the drownings and 



males ages 15-29 accounted for 36% of the drownings. 
The approximate rates of drowning* show that non white 
males had the highest rates across all the age groups, with 
the highest being in the 15-29 age group (11.7 per 
100,000 population). The rate of drowning was also 
higher for nonwhites than for whites (4.8 vs 2.6) and 
higher for males than for females (5.8 vs 0.8). 

* Rates are approximate due to the use of the Medical 
Examiners File which does not include North Carolina 
residents who drown out of state. Victims who were 
out-of-state residents were not used in the computa- 
tion of the rates. 



Figure 3 depicts drowning by activity. Swimming 
(including wading) accounted for the highest percentage 
of drownings, followed by "all other" and fishing. The 
overwhelming majority of the activities in the "all other" 
category were unintentional falls into a body of water such 
as a creek, ditch, or pond, and activities that were 
unknown. 



Figure 3 

1980-84 North Carolina Drownings 
by Activity 



Figure 1 

1980-84 North Carolina Drownings 
by Race and Sex 



White Male 55.5% 



Nonwhite Male 31.7% 




onwhite Female 4.8% 
White Female 8% 



Swimming 41 .3% 



All Other 18.7%- 




Fishing 14.9% 



escue Attempt 2.3% 
athing 3.8% 

Motorbooting 4.8% 

Other Recreation 6.2% 
Motor Vehicle Crash 7.9% 



Figure 4 shows drownings by setting. Lakes or ponds 
had the highest percentage of drownings followed by riv- 
ers or creeks and ocean or bays. In the "all other" cate- 
gory, incidental water (water that is temporarily in a loca- 
tion such as a ditch full of water) had the highest 
percentage of drownings, followed by rock quarries and 
canals. 



Figure 2 

1980-84 North Carolina Drownings 
by Age, Race, and Sex 



0-14 15-29 



30-44 



45-59 



60+ 




Figure 4 

1980-84 North Carolina Drownings 
by Setting 



Lake/Pond 39.155 



River/Creek 29.4%- 




Ocean/Bay 10.6% 



Private Pool 3.8% 
athtub 4% 

Other Pool 4.4% 
All Other 8.7% 



WMale 



W Female 



NW Male 



NW Female 



The places where drownings most frequently occurred 
are listed in Tables 1 through 4. Nags Head was the coastal 
town (places within 5 miles of the ocean and less than 
10,000 population) with the most drownings followed by 
Emerald Isle and Sneads Ferry. The body of water with the 
most drownings was the farm pond, with the Atlantic 



Ocean and unspecified ponds tied for second. The pond 
was usually unspecified when it was too small to be 
named. Lake Norman, located near Charlotte, was the 
lake with the most drownings and the Cape Fear River, 
which runs through Wilmington, was the river with the 
most drownings. 



Table 1 

North Carolina Coastal Towns with 
4 or more Drownings, 1980-84 

Number of 
Town Drownings 

Nags Head 10 

Emerald Isle 8 

Sneads Ferry 7 

Beaufort 5 

Kill Devil Hills 5 

Ocracoke 5 

Wrightsville Beach 5 

Atlantic Beach 4 

Carolina Beach 4 

Sunset Beach 4 



Table 3 

North Carolina Lakes with 
5 or More Drownings, 1980-84 

Number of 
Lake Drownings 

Lake Norman 24 

High Rock Lake 18 

Kerr Lake 14 

Gaston Lake 12 

Hyco Lake 10 

Badin Lake 9 

Lake James 9 

Falls Lake 7 

Belews Creek Lake 6 

Lake Hickory 6 

Lake Santeetlah 5 

Lake Wylie 5 



Table 2 

North Carolina Bodies of Water with 
15 or more Drownings, 1980-84 

Number of 
Body of Water Drownings 

Farm Pond 64 

Atlantic Ocean 57 

Unspecified Pond 57 

Bathtub 42 

Private Swimming Pool 40 

Unspecified Creek 30 

Lake Norman 24 

Ditch 23 

Cape Fear River 21 

Unspecified Lake 19 

High Rock Lake 18 



Table 4 

North Carolina Rivers with 
5 or More Drownings, 1980-84 

Number of 
River Drownings 

Cape Fear River 21 

Neuse River 13 

Lumber River 12 

Catawba River 11 

Tar River 10 

Pamlico River 9 

Tuckasegee River 9 

Roanoke River 8 

New River 7 

Yadkin River 7 

Chowan River 6 

Dan River 6 

Oconaluftee River 6 

French Broad River 5 

North River 5 



The number of drownings decreased 45% from 1980 to 
1 98 1 , dropping from 305 to 1 67 . All four race-sex group 
drownings declined considerably with nonwhite females 
showing the largest decline at 93% (28 to 2). This 
decrease was also noted in drownings associated with 
motor vehicle crashes, swimming, and "all other" activi- 
ties. Since 1981, the total number of drownings has fluc- 
tuated: 176 in 1982, 219 in 1983, and 185 in 1984. 
However, other recreational drownings and bathing 
drownings have increased over time. 

Other information from the drowning abstract form 
shows that 56% of the drownings were witnessed. The 
percentage witnessed by activity ranges from 92% for 
swimming in a group to 3% for bathing in a bathtub. For 
setting it ranges from 95% for drownings in an inlet to 2% 
for drownings in a bathtub. Of the 74 children 0-5 years 
old who drowned, 59 or 80% were unattended. Twenty- 
nine of these children fell into a body of water such as a 
swimming pool or a lake, eight were bathing in a bathtub, 
and seven were swimming or wading in a swimming pool. 
Of the drownings that were witnessed, 33% had a resusci- 
tation attempt. This percentage did not vary much by 
activity, but for setting it ranged from 97% for swimming 
pools to 10% for inlets. 

Activities most likely to involve other persons in the 
incident in addition to the drowning victim (other peo- 
ple's lives were in danger) were motor vehicle crashes 
(61%), motorboating(61%), and canoeing/rafting (50%). 
The overall percentage of drownings in which other per- 
sons were involved was 24%. Activities most likely to 
involve other fatalities in the incident in addition to the 
drowning victim were rescue attempts (57%), motor ve- 
hicle crashes (42%), and motorboating (27%). For total 
drownings this percentage was 13%. 

Medical information from the abstract form shows that 
of the drowning victims 8% had significant fatty liver 
reported, 6% had significant cardiovascular disease, and 
7% had seizure disorders. The number of drowning vic- 
tims with mentioned health conditions did not vary much 
by activity except for victims with seizure disorders, who 
accounted for 53% of the drowning victims who were 
bathing in a bathtub. 

Alcohol Involvement in Drownings 

Of the 1,052 drownings for which information was 
abstracted, 839 or 80% of the victims were tested for 
blood ethanol. The reasons why some victims were not 
tested include the youth of the victim, the survival time 
after the injury, and the decomposition of the body. Of 
those tested for blood ethanol, 52% were negative, 14% 
had a blood ethanol level less than 100 mg% (less than 
100 mg/dl or .10% blood alcohol concentration), and 
34% had a level of 100 mg% or greater. (A person is 
legally intoxicated in North Carolina if his blood alcohol 
percent is . 10 or greater.) For decedents ages 15 and over, 
the percentage of drowning victims with a blood ethanol 



level of 100 mg% or greater was 38. In comparison, Figure 
5 shows that, among persons ages 1 5 and over, 1 9% dying 
from falls, 56% dying by fire, and 43% dying in motor 
vehicle crashes were legally intoxicated. 

Figure 5 

1980-84 North Carolina Injury Deaths 
to People Age 15 Years and Older 
by Injury Typ« and Blood Ethanol Lovolt 



100 



Negative 



Percent Tested 



< 100 mg% 

mm 



100 mgJC + 




Fall 



Drowning 



Fire 



M.V.A. 



The variations of blood ethanol levels by race-sex 
group, age group, activity, and setting are exhibited in 
Figures 6 through 9. The population groups with highest 
intoxication levels were nonwhite males (40%), 30-44 
year-olds (50%), and 45-59 year-olds (42%). The activity 
with the highest intoxication level among drowning vic- 
tims was motor vehicle crashes (51%) and the settings 
with the highest intoxication levels were rivers and creeks 
(41%) and other settings (42%). Population groups by 
activity or setting with the highest intoxication levels 
include nonwhite males who drowned in a stream or creek 
(67%), nonwhite males who drowned in a motor vehicle 
crash (82%), and 30-44 year-olds who drowned while 
swimming alone (74%). 

Figure 6 

198C-84 North Carolina Drownings 
by Race, Sex, and Blood Ethanol Levels 



100 
90 
B0 
70 
60 
50 
40 
30 
20 
10 




Negative 

I I 

Percent Tested 



< 1 00 mgX 



100 mg% + 



W Male 



W Female 



NW Mole 



NW Female 



Figure 7 

1980-84 North Carol ; na Drownings 
by Age and Blood Ethanol Levels 



Negative 
I 1 



< 1 00 mg% 

mm 



100 mg% + 



Percent Tested 




0-14 



15-29 



30-44 



45-59 



60+ 



Figure 8 

1980-84 North Carolina Drownings 
by Activity and Blood Ethanol Levels 



Negotive 



Percent Tested 



< 100 mgX 



1 00 mgX + 



Swim Fish 



Boat 



Rec 



Bath Other 



Figure 9 

1980-84 North Carolina Drownings 
by Setting and Blood Ethanol Levels 



Negative 



Percent Tested 



< 100 mgX 



1 00 mgX + 



90 
80 
70 
60 
50 
40 
JO 
20 
10 





Drownings by Demographic Characteristics 

The activities that differed from total drownings by sex 
distribution were activities related to fishing, motorboat- 
ing, motor vehicle crashes, and bathing. Males accounted 
for 98% of the fishing deaths and 96% of the motorboat- 
ing deaths. The overrepresentation of males in fishing 
fatalities was seen in both races, with nonwhite males 
being overrepresented in fishing-from-shore deaths and 
white males being overrepresented in fishing-from-boat 
deaths. Females accounted for a relatively high percentage 
of drownings in motor vehicle crash deaths (27%) and 
bathing deaths (43%). Most of the females who drowned 
in motor vehicle crashes were passengers. 

The age distribution of drowning victims varied by 
activity. Children less than the age of 5 years accounted 
for 6% of total drownings, but 25% of bathing drownings 
and 20% of "all other" drownings. Persons 10-24 years 
old represented 38% of total drownings but 60% of 
swimming deaths. Males 10-24 years old were highly 
represented in the category of swimming deaths. Of the 
352 males ages 10-24 who drowned, 66% drowned while 
swimming. Furthermore, of the 147 nonwhite males ages 
10-24 who drowned, 77% drowned while swimming. 

The race-sex distribution of drownings was skewed in 
motorboating and other recreational deaths. White males 
were overrepresented in motorboating deaths, accounting 
for 71%. This was especially true of white males aged 
25-59 years, as they accounted for 49% of the motorboat 
drownings compared to 24% of the total drownings. 
White males were also overrepresented in other recrea- 
tional (canoeing, sailing, scuba diving, water skiing, etc.) 
drownings, accounting for 82%. Furthermore, 37% of the 
other recreational drowning victims were white males ages 
15-39 years. 

Variation in the demographic characteristics of drown- 
ing victims was also evident by setting. For example, 
females represented 28% of the private pool drownings 
and children less than the age of 5 years accounted for 
43% of these drownings. In public or motel pools, how- 
ever, nonwhites constituted 59% of the drownings and 
persons age 10-19 years represented 52% of these drown- 
ings, yet only 23% of the total drownings. The age differ- 
ence between drownings in private pools and those in 
public or motel pools was also evident in the victim's 
activity before drowning. In the public and motel pools, 
91% of the drownings were swimming deaths. However, 
in private pools only 63% of the drownings were swim- 
ming deaths. The reason for this discrepancy was the large 
number of children who fell into a private pool. 

Several settings had skewed race-sex distributions 
compared to total drownings. Nonwhite males accounted 
for a high percentage of drownings in ponds (50%) and in 
incidental water (47%), while white males accounted for a 
high percentage of drownings in a rock quarry (77%) and 
in the ocean (75%). Males 15-29 years old especially were 
overrepresented in rock quarry drownings, accounting 
for 82%. 



Lake 



River 



Ocean 



Pool 



Bathtub Other 



DISCUSSION 

The purpose of this paper is to examine the circumstan- 
ces and settings associated with North Carolina drown- 
ings. A significant finding is the large number of non- 
swimming drownings. Many of the decedents in the study 
simply fell into the water, either from a boat while fishing 
or into a swimming pool while playing. These are people 
who apparently had no intention of getting wet, but sud- 
denly found themselves in a lethal situation. Another 
significant finding is the large number of drownings 
occurring in small ponds, creeks, and rivers. With 
approximately 320 miles of shoreline and thousands of 
people swimming there each year, it is somewhat surpris- 
ing that the Atlantic Ocean made such a small contribu- 
tion to the total number of drownings in North Carolina. 

The most profound results of this study, however, are 
the alcohol findings. Of the 839 drowning victims who 
were tested for blood alcohol, 283 or 34% had a blood 
alcohol concentration of 100 mg% or greater. This is 
equivalent to .10% blood alcohol, which under North 
Carolina law means the person is legally intoxicated. This 
level of intoxication was found in 38% of ages 15 years or 
older with the highest frequency evident among middle- 
aged males. Furthermore, in several types of activities and 
settings associated with drowning, blood alcohol concen- 
trations of 100 mg% or greater were found in 33% or 
more of the drowning victims. 

A shortcoming of this study is the absence of informa- 
tion about swimming ability. It would have been useful, 
for example, to identify what proportion of drowned 
persons were excellent, good, fair, or nonswimmers. The 
reason this was not undertaken was that the data in the 
Medical Examiner records pertaining to swimming ability 
were found to be too imprecise and also were too infre- 
quently reported. Even if this information were accurate, 
it would not be possible to determine here the safety 
benefits of swimming ability per se. An epidemiologic 
study designed for that purpose would have to compare 
the abilities of swimmers who drown with those of unin- 
jured persons exposed to similiar circumstances. ( 1 ) 

Even with the absence of data on swimming ability, this 
study does suggest that some drownings are preventable. 
For example, most of the 126 drowning victims who were 
swimming or wading alone (see Appendix 2) might have 
been saved if the victims were swimming with someone 
who knew basic rescue techniques. This is why the Amer- 
ican Red Cross (9) recommends never swimming alone, 
no matter how well you swim. The drownings that 
occurred while swimming or wading in a group might have 
been prevented if the victim had known how to recognize 
hazardous conditions and practices, such as swimming 
while intoxicated, or if others in the group knew of 
appropriate rescue techniques. Since the majority of these 
drownings occurred in the 10-24 age group, a water safety 
course either in grammar school or high school may be of 
some help. 



Other drownings that were preventable were the 205 
drownings that involved boats. Although information on 
personal flotation devices (PFD's) was not collected in 
this study, Shkrum (10) reportd that in 69% of the boat- 
ing fatalities in North Carolina from 1981 to 1983, the 
victim was not wearing a PFD. The State of North Caro- 
lina can help reduce boat-related drownings by changing 
the law regarding PFD's. The current law states that for 
everyone in a boat there must be a coast guard approved 
PFD readily accessible [General Statute 75A-6 (F)]. 
However, if the law were changed to require everyone on a 
boat to wear an approved and appropriate PFD, it is 
probable that the number of boat-related drownings 
would decline. It should be noted that the American Red 
Cross (9) recommends that everyone wear a PFD, espe- 
cially nonswimmers and novices. 

Drownings that were clearly preventable are the 74 
drownings in the 0-5 age group. Adult supervision would 
have had an immediate impact on these drownings, espe- 
cially the ones that occurred in bathtubs and swimming 
pools. However, adequate supervision of children appears 
to be difficult to teach and impossible to legislate. (11) 
Waller ( 1 ) suggests that adequate fencing around swim- 
ming pools with a high, hidden, self-closing, and self- 
locking latch would be a preventive measure. Unfortu- 
nately, it is unknown how many children drowned in 
unfenced swimming pools. Rivara (11) suggests that 
swimming instruction for toddlers might help decrease 
the number of drownings in this group, but there is as yet 
no conclusive evidence to suggest that these "water baby" 
type programs are effective in preventing drowning deaths 
among the very young. 

Some drownings that involve motor vehicle crashes are 
preventable because the majority of the victims were 
intoxicated. The recent enactment of tougher drinking- 
and-driving laws may help to reduce the number of these 
drownings. The State of North Carolina could also build 
more guardrails along roads bordering ditches and water- 
ways and increase the spatial separation between roads 
and canals or other bodies of water in order to further 
reduce the number of motor vehicle crash drownings 
(12). 

A statistic that suggests the need for additional thera- 
peutic measures by first responders is the low percentage 
(33%) of resuscitation attempts among drownings that 
were witnessed. A possible reason for this is delay in the 
retrieval of the victim because of the inability to locate the 
body underwater. Rapid identification of persons in 
trouble underwater could be augmented by more visible 
swimwear, underwater lights in pools, and lights on boats 
(12). Maclachlan (13) suggests that another possible rea- 
son for the low percentage of resuscitation attempts 
among drowning victims may be a lack of knowledge by 
the public of emergency first aid procedures. A concerted 
campaign to increase the number of people with life- 
saving skills would probably help reduce the number of 
drownings. 



Another statistic that suggests preventive measures is 
the high percentage (57%) of "other fatalities" among 
drownings that involved rescue attempts. In most cases, 
the rescuer jumped in the water to try to save the person in 
trouble, with the unfortunate consequence of both per- 
sons drowning. The American Red Cross (9) strongly 
discourages this practice, as they claim that reaching 
assists are the safest methods of rescue. The rescuer 
should reach with whatever is available such as an arm, a 
leg, a pole, a towel, a branch, or a ski. This should be 
strongly recommended to all school children in their 
health education courses. 

The high percentage of persons with significant seizure 
disorders (53%) among drownings while bathing in a 
bathtub is worth noting. Although data on populations at 
risk were not available for this study, recent studies sug- 
gest that there is a higher risk of drowning among people 
with epilepsy (14). Therefore, it may be prudent to warn 
epileptics and people with other seizure disorders about 
their increased risk of drowning. 

The large decrease in the number of drownings from 
1980 to 1981 is also worth noting. This decrease was 
especially prevalent in swimming deaths, motor vehicle 
crash deaths, and "all other" deaths. Examining the trend 
of the number of drownings during the past ten years, one 
finds that 1980 had an unusually high number and that 
the general trend during the latter part of the seventies was 
one of decline. At this time there is no apparent reason for 
the high number of drownings in 1980. 

Results from this study that are consistent with all 
drowning studies are the race and sex differences in 
drowning rates. Baker (2) suggests that a possible reason 
for the higher male drowning rate is the difference 
between the sexes in exposure to potentially hazardous 
activities. Also, Buescher (15) found that males are much 
more likely than females to abuse alcohol. Waller ( 1 ) 
believes that the contrast between the races in drowning 
rates may be due to nonwhites having less access to organ- 
ized instruction in swimming techniques and nonwhites 
being more likely to have recreational access to only 



unguarded swimming areas such as rivers, canals, and 
ponds. 

A result that is prevalent in a number of drowning 
studies is the high rate of alcohol intoxication among 
drowning victims. A possible reason for this is that alco- 
hol has a depressant effect on the central nervous system. 
Plueckhahn (8) states that such depression will result in a 
decreased awareness of sensory stimuli, a depression of 
conditioned reflexes, and consequently a reduced ability 
to deal with unexpected situations or emergencies. Pearn 
(16) adds that alcohol will also impair judgment and 
increase one's risk of water injuries and of immersion. 

Another explanation for the high rate of alcohol intoxi- 
cation among drowning victims is that alcohol can depress 
one's swallowing and breathing reflexes. For example, 
Gooden (17) believes that general cerebral depression 
from alcohol may lead to failure of the larynx to prevent 
aspiration of water, interference with the normal increased 
delivery of oxygen to the brain after sudden immersion in 
water (the diving response), and a reduction in sensitivity 
of the brain's respiratory center to increasing carbon 
dioxide levels in the blood. All three of these conditions 
may lead to rapid loss of consciousness and an increased 
risk of drowning compared to a non-intoxicated person. 

In conclusion, it is hoped that this paper shows that 
most drownings are not "accidents" that are attributable 
to chance or bad luck. The prevention of drownings can 
and should be a major public health undertaking. Federal, 
state, and local governments can help through environ- 
mental modification, stricter regulation enforcement, and 
more public education programs. The goal is to change an 
individual's behavior and public health officials can help 
society realize that safe, responsible behavior will ulti- 
mately reduce the number of drownings. (13) 

ACKNOWLEDGEMENTS 

The author would like to acknowledge Steven Swanger 
for completing the Drowning Abstract forms, Dr. Paul 
Biddenger for providing insight and direction, and Dr. 
Thomas Cole for sharing his medical expertise. 



REFERENCES 

1. Waller J. Injury Control — A Guide to the Causes and Prevention of Trauma. Lexington, Massachusetts: Lexington 
Books, 1985. 

2. Baker S, O'Neill B, Karpf R. The Injury Fact Book. Lexington, Massachusetts: Lexington Books, 1984. 

3. National Safety Council. Accident Facts, 1985. Chicago: National Safety Council, 1985. 

4. "Accidental Drownings by Age and Activity." Metropolitan Life Insurance Company Statistical Bulletin, May 1977; 
58:3-5. 

5. "Accidental Drownings by Cause and Site." Metropolitan Life Insurance Company Statistical Bulletin, June 1977; 
58:9-11. 

6. "Swimming Pool Drownings." Metropolitan Life Insurance Company Statistical Bulletin, July-August 1977; 58:4-6. 

7. Dietz P, Baker S. "Drowning — Epidemiology and Prevention." American Journal of Public Health, April 1974; 
64:303-312. 

8. Plueckhahn V. "Alcohol and Accidental Drowning." The Medical journal of Australia, July 1984; 141:22-25. 

9. American Red Cross. Basic Rescue and Water Safety. The American National Red Cross, 1984. 

10. Shkrum M, Hudson R. "Boating Fatalities Can Be Reduced." Unpublished manuscript, June 1985. 

11. Rivara F. "Traumatic Deaths of Children in the U.S.: Currently Available Prevention Strategies." Pediatrics, March 
1985; 75:456-462. 

12. Robertson L. Injuries. Lexington, Massachusetts: Lexington Books, 1984. 

13. Maclachlan J. "Drownings, Other Aquatic Injuries and Young Canadians." Canadian Journal of Public Health, 
May-June 1984; 75:218-221. 

14. Greensher J. "Prevention of Childhood Injuries." Pediatrics, November 1984; 74:970-975. 

15. Buescher P, Patetta M. "Alcohol-Related Morbidity and Mortality in North Carolina." SCHS Studies, July 1986; 
41:10. 

16. Pearn J. "Drowning and Alcohol." The Medical Journal 0/ Australia, July 7, 1984; 141:6-7. 

17. Gooden B. "Drowning and Alcohol." TKe Medical Journal of Australia, September 29, 1984; 141:478. 



Appendix 1 



DROWNING ABSTRACT FORM 



1. Case Number: 



8. Condition of significant cardiovascula 
disease: 

□ 1. Yes □ 3. Not Stated 

□ 2. No 



2. Race: 



□ 1. White 

□ 2. Black 



D 3. American Indian 
□ 4. Other 



9. Condition of seizure disorders: 

□ 1. Yes D 3. Not Stated 

□ 2. No 



3. Sex: 



□ 1. Male □ 3. Undetermined 

□ 2. Female 



10. Specific activity engaged in before drowning 
(see Activity Codes): 



4. County of Residence: 



11. Specific setting where drowning occurred 
(see Setting Codes): 



5. Specific body of water where drowning 
occurred (i.e., Lake Wheeler, Haw River): 



12. Were there other people involved in the 
incident? 



□ 1. Yes 

□ 2. No 



□ 3. Not Stated 



6. Specific town or city where drowning 
occurred (i.e., Atlantic Beach): 



13. Were there other fatalities involved in the 
incident? 



□ 1. Yes 

□ 2. No 



□ 3. Not Stated 



7. Condition of Fatty Liver: 

D 1. Yes □ 3. Not Stated 

□ 2. No 



14. Was there a resuscitation attempt? 

□ 1. Yes □ 3. Not Stated 

□ 2. No 



STATE LIBRARY OF NORTH CAROLINA 

iiiii mi in ii ii mi i if in i limn 



3 3091 00747 9579 



Appendix 2 



Frequency of Drownings in Activities and Settings 



Code 

01 
02 
03 

04 
05 
06 
07 

08 

09 

10 

11 

12 
13 
14 
15 
16 
17 

18 
19 
20 
99 



Number of 
Activity Drownings 

Swimming/ wading alone 126 

Swimming/wading in a group 273 

Swimming/ wading 

unknown number 36 

Fishing from shore 43 

Fishing from a boat 100 

Fishing, other or unknown 14 

Motorized watercraft accident 

while cruising 19 

Motorized watercraft accident 

while drifting 8 

Motorized watercraft accident 

while craft secured 3 

Motorized watercraft accident, 

other or unknown 21 

Canoeing/paddling/sailing/rowing/ 

rafting 54 

Scuba diving 5 

Water skiing 4 

Surfing 2 

Motor vehicle accident — driver 48 

Motor vehicle accident — passenger ... 35 

Motor vehicle accident — other or 

unknown 

Bathing in a bathtub 38 

Bathing, unknown 2 

Involved in a rescue attempt 24 

Unknown or other activity 197 



Number of 

Code Setting Drownings 

01 Lake 270 

02 Pond 141 

03 River 204 

04 Stream/creek 105 

05 Ocean 57 

06 Sound/bay /harbor 33 

07 Inlet 22 

08 Private Pool 40 

09 Public Pool 20 

10 Commercial/Motel pool 25 

1 1 Other or unknown pool 1 

12 Bathtub 42 

13 Incidental water 34 

14 Canal 13 

15 Quarry 22 

16 Swamp 1 

17 Well 2 

99 Other or unknown setting 20 



Department of Human Resources 

Division of Health Services 

State Center for Health Statistics 

P.O. Box 2091 

Raleigh, N.C. 27602-2091 

919/733-4728 



BULK RATE 

U.S. Postage PAID 

Raleigh, N.C. 27602-2091 

Permit No. 1862 



CHERYL W. MCLEAN 

ASSISTANT DOCUMENTS LIBRARIAN 
DIVISION OF STATE LIBRARY 
ARCHIVES/LIBRARY BUILDING 
RALEIGH, NC INTEROFFICE 



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