DROWNING - Medicine for Mountaineering and Other Wilderness Activities - page 436

strategies that require thought and judgment have also usually not been effective in adoles-
cents.
Fences
Probably the largest impact of passive strategies has been with residential swimming
pools. Fences have been shown to reduce the incidence of drowning by approximately 50
percent. However, fences may not be effective if the pool is open to the house or a wall of
the house with openable windows forms part of the fence.
Supervision
Supervisionhasamajorimpactontheincidenceofdrowning.Thequalityandproximity
ofsupervisionarebothsignificant.Thecasefatalityrateforswimmerssupervisedbyadults
is 30 percent, by lifeguards 42 percent, and by peers 71 percent.
Among children aged one to four years, most drownings occur in residential swimming
pools. Most young children who drown in pools were last seen inside the home, had been
out of sight less than five minutes, and were in the care of one or both parents. Young chil-
dren should never be left alone, even momentarily, where they have access to standing wa-
ter.
Lifeguards
No studies document the effectiveness of lifeguards, but they are widely considered to
have prevented many drownings and effectively resuscitated many drowned individuals.
However, CPR competency is not mandated for lifeguards in all localities. Upgrading life-
guard effectiveness has been recommended.
Swimming Techniques
Inareviewofstudiesoftheimpactofswimminglessonsinthepreventionofdrowning,
the ability to swim was found sometimes to lead to overconfidence and swimming in haz-
ardous situations. Although swimming lessons are recommended for ages five and older,
educational programs that explain high-risk situations and avoidance activities may be
more beneficial.
Personal Flotation Devices
Coast Guard studies in 2003 indicated that over 90 percent of boating-related drowning
could have been prevented by personal flotation devices.
Alcohol and Other Drugs
Legal and societal acceptance of imbibing alcohol during recreational activities is lax
whencomparedtodriving.Advertisements widelypromoteitsappeal.Anydrinkingoruse
of other recreational drugs in an aquatic environment is risky and should be discouraged.