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 600 copies of this public document were printed at a cost of $90.00 o* 15? per copy.