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Background and Objectives: Drowning, the leading cause of unintentional injury death among California children less than five years of age, averaged 49 annual fatalities for the years 2010–2021. The California Pool Safety Act aims to reduce fatalities by requiring safety measures around residential pools. This study was designed to analyze annual fatality rates and drowning incidents in California among children 1–4 years of age from 2017–2021.Methods: We identified fatalities, injury hospitalizations, and emergency department (ED) visits from California state vital statistics death data and state hospital and ED discharge data using the EpiCenter California Injury Data Online website.Results: Over the five-year study period, 4,166 drowning incidents were identified: 234 were fatalities, 846 were hospitalizations, and 3,086 were ED visits. The observed difference in fatality rates from 2017 to 2021 failed to achieve statistical significance (P = 0.88). Location-based analysis of the 234 fatal drowning incidents revealed that pools were the most common injury site, accounting for 65% of the cases.Conclusion: Drowning remains the leading cause of unintentional, injury-related death among California children 1–4 years of age, as the annual rate of fatality over the five-year study period did not decline. While the EpiCenter California Injury Data Online website is excellent for analyzing annual rates of drowning incidents among California residents over time, it is limited in providing insight into modifiable risk factors and event circumstances that can further inform prevention. The development of robust integrated fatal and non-fatal local, state, and national systematic data collection systems could aid in moving the needle in decreasing pool fatalities among young children.

Surf lifesaving members are essential first responders who patrol public waterways, performing rescues and resuscitation to individuals in the community when needed. In this way, surf lifesaving members experience arduous physical requirements alongside extensive psychological stress during resuscitation. Surf Life Saving Queensland (SLSQ) represents the predominant, frontline lifesaving service in Queensland, Australia; however, little research has explored key aspects of drowning resuscitations involving this organisation, as well as in the broader lifesaving industry, limiting current understanding on this vital topic. We sought to explore key aspects of drowning resuscitations within SLSQ and create a framework to generate evidence-based practice. In guiding future lines of inquiry addressing this deficiency, a six-step research framework has been proposed to aid in holistically understanding the resuscitation process from a surf lifesaving perspective. Evidence generated from applying this framework will create a much- needed knowledge base for surf lifesaving organisations to use in the development of practical, strategic, and effective decisions to enhance their practices and ultimately better prevent drowning fatalities. [ABSTRACT FROM AUTHOR]

Traditionally, public understanding of drowning survival has focused on swimming capacity, often measured by how far a person can swim. With respect to the high incidence of adult drowning in high-income countries, using the more inclusive concept of water competency may yield a more comprehensive explanatory framework for understanding the reasons behind these drownings. Any competency base required to survive a drowning situation is dynamic, complex, and multi-faceted. Furthermore, perceptions of risk and capacity to cope with that risk are likely to be pivotal to the avoidance of drowning. Adults' perceived water competence was measured against their actual water competence in a pool environment. Adults were tested on their competence in entering and exiting water, floating, and swimming. Despite most adults (98%) being unable to swim more than 100 m in open water, more than half (59%) perceived themselves as good swimmers, and more than quarter (27%) thought they could swim more than 200 m at the post-survey. In conclusion, reality gaps were found in water competence among adult groups. Differences between perceived and actual competence suggest that many adults may underestimate the risk of drowning and overestimate their competency. This provides a plausible explanation as to why many adults drown. [ABSTRACT FROM AUTHOR]

During a drowning incident where a lifeguard is not present, a bystander -- referred to as a lay rescuer - may put themselves in danger by attempting a rescue. When lay rescuers can avoid entering the water by using rescue equipment to help a drowning victim, it serves to not only help the person actively drowning, but also provides a layer of protection to a lay rescuer. This study sought to examine the following questions: (a) which pieces of rescue equipment were preferred by lay rescuers at pre-determined short and long distances, (b) whether lay rescuers select appropriate rescue equipment based on the condition, (c) whether lay rescuers correctly deploy their preferred rescue equipment, and (d) what factors influence rescue equipment preference. A lab-based experiment was conducted where study participants were asked to react to a simulated drowning victim using six common pieces of rescue equipment provided. The findings suggested that life rings were preferred rescue equipment by lay rescuers and should be provided in unguarded aquatic environments. [ABSTRACT FROM AUTHOR]

Surf‐related drowning fatalities are a public health concern in the Great Lakes region of North America, and within Canada there are few beaches with lifeguards and no regional beach safety strategy. This short paper presents the results of a survey completed in the northern hemisphere summer of 2022 to determine the perceptions of beach users at Station Beach in Kincardine, Ontario, a popular tourist beach town on Lake Huron. Results suggest that beach safety knowledge and choice of location to occupy along the beach depend on experience with the beach, with frequent visitors tending to select quieter locations located further from a jetty that can result in a structural rip current. Infrequent visitors tended to be closer to the jetty and selected that location based on convenience (e.g., close to parking), suggesting the need for structural changes to guide behaviour towards safer areas of the beach. Results also highlight the challenges of developing an effective warning system to inform beach users of potentially dangerous surf and currents in the absence of an investment in lifeguards or a regional/provincial beach safety strategy. [ABSTRACT FROM AUTHOR]

Introduction: No published evidence was identified regarding the use of oxygen in the treatment of drowning in two recent systematic reviews. The aim of our study was to investigate the impact of on scene, pre‐Emergency Medical Services (EMS) oxygen therapy by lifeguards in the resuscitation of drowning victims. Method: We conducted a retrospective case match analysis of drowning patients presenting to the EDs of Sunshine Coast Hospital and Health Service. Patients were matched for age, sex and severity of drowning injury. The primary outcome was in‐hospital mortality. Secondary outcomes included positive pressure ventilation (PPV) by EMS and the ED, as well as admission to the Intensive Care Unit. Results: There were 108 patients in each group. Median (IQR) age was 22 (15–43) in the oxygen group and 23 (15–44) years in the non‐oxygen group. There were 45 females in the oxygen group and 41 females in the non‐oxygen group. Sixteen patients had suffered cardiac arrest and three patients respiratory arrest in each group. There were five deaths in each group. Initial oxygen saturation on arrival of EMS was identical in both groups 89.2% (±19.9) in the oxygen group versus 89.3% (±21.1) (P = 0.294) in the non‐oxygen group. The oxygen group required PPV more frequently with EMS (19 vs 11, P < 0.01) and in the ED (19 vs 15, P < 0.01). Conclusion: On scene treatment with oxygen by lifeguards did not improve oxygenation or outcomes in drowning patients. [ABSTRACT FROM AUTHOR]

Drowning is among the most common reasons for children's death aged one to fourteen around the globe, ranking as the third leading cause of unintentional injury death. With rising populations and the growing popularity of swimming pools in hotels and villas, the incidence of drowning has accelerated. Accordingly, the development of systems for detecting and preventing drowning has become increasingly critical to provide safe swimming settings. In this paper, we propose a comprehensive review of recent existing advancements in automated drowning detection and prevention systems. The existing approaches can be broadly categorized according to their objectives into two main groups: detection-based systems, which alert lifeguards or parents to perform manual rescues, and detection and rescue-based systems, which integrate detection with automatic rescue mechanisms. Automatic drowning detection approaches could be further categorized into computer vision-based approaches, where camera-captured images are analyzed by machine learning algorithms to detect instances of drowning, and sensing-based approaches, where sensing instruments are attached to swimmers to monitor their physical parameters. We explore the advantages and limitations of each approach. Additionally, we highlight technical challenges and unresolved issues related to this domain, such as data imbalance, accuracy, privacy concerns, and integration with rescue systems. We also identify future research opportunities, emphasizing the need for more advanced AI models, uniform datasets, and better integration of detection with autonomous rescue mechanisms. This study aims to provide a critical resource for researchers and practitioners, facilitating the development of more effective systems to enhance water safety and minimize drowning incidents. [ABSTRACT FROM AUTHOR]

This study tackles the feasibility of energy harvesting from wearable life jackets to assist in search and rescue operations through modeling and analyzing the motions of drowning individuals and the associated power (energy) distributions. Computer vision analysis of underwater footage and motion capture lab experiments are used to collect data for modeling and simulation to predict the movements and potential power generation of the life jackets. The proposed model enables the identification of optimal design parameters for energy harvesting with wearable life jackets, providing an insight into the potential of wearable energy harvesting technologies for enhancing the safety of individuals in aquatic environments. [ABSTRACT FROM AUTHOR]

A novel detection model, MS-YOLO, is developed in this paper to improve the efficiency of drowning rescue operations. The model is lightweight, high in precision, and applicable for intelligent hardware platforms. Firstly, the MD-C2F structure is built to capture the subtle movements and posture changes in various aquatic environments, with a light weight achieved by introducing dynamic convolution (DcConv). To make the model perform better in small object detection, the EMA mechanism is incorporated into the MD-C2F. Secondly, the MSI-SPPF module is constructed to improve the performance in identifying the features of different scales and the understanding of complex backgrounds. Finally, the ConCat single-channel fusion is replaced by BiFPN weighted channel fusion to retain more feature information and remove the irrelevant information in drowning features. Relative to the Faster R-CNN, SSD, YOLOv6, YOLOv9, and YOLOv10, the MS-YOLO achieves an average accuracy of 86.4% in detection on a self-built dataset at an ultra-low computational cost of 7.3 GFLOPs. [ABSTRACT FROM AUTHOR]

The article presents a study on the barriers to participation and child comfort with five swimming skills by child age, gender, and race and ethnicity. Topics discussed include parent report of child being very comfortable with each of five swimming skills to survive a drowning situation, reasons why Chicago, Illinois children had not taken swimming lessons in the prior year, and a common barrier across groups.

OBJECTIVES: Drowning is the leading cause of death during flood disasters. Little is known about these deaths. Child death review teams review details of child deaths to understand circumstances and risk factors to inform prevention. METHODS: Using data entered in 2005 to 2021 for children ages 0 to 17 years from the National Fatality Review-Case Reporting System, we identified 130 drowning deaths directly attributed to natural disaster or weather incidents, and 14 deaths indirectly attributed to these incidents. Frequencies, proportions, and χ² statistics were used to describe selected measures and compare with other drowning deaths. RESULTS: Children who drowned as a direct result of a natural disaster- or weather-related incident were more likely to be aged >4 years (81% vs 40%, P < .001) and located in a rural or frontier setting (63% vs 30%, P < .001). They were more likely to be supervised at the time of the incident (61% vs 38%, P < .001), and it was more likely for additional children (35% vs 5%, P < .001) or adults (33% vs 3%, P < .001) to have perished. The indirect deaths were commonly a result of damage to protective barriers. CONCLUSIONS: The characteristics of natural disaster- or weather-related drowning deaths among children differ from other drowning deaths. Natural disaster- or weather-related drowning may warrant tailored drowning prevention strategies. Improved surveillance of all water-related deaths may be a proactive action leading to the development of these prevention strategies, whereas poststorm remediation of protective barriers can be used as a reactive prevention after a storm has passed. [ABSTRACT FROM AUTHOR]

Objectives: To improve national drowning surveillance efforts, we developed and evaluated a definition for unintentional drowning for use in the National Syndromic Surveillance Program's ESSENCE platform (Electronic Surveillance System for the Early Notification of Community-Based Epidemics) and described drowning-related emergency department (ED) visits from 2019 through 2022 using the new definition. Methods: We adapted an unintentional drowning definition from a previous version, which included all drowning-related ED visits regardless of intent (including drowning related to assault and suicide, as well as unintentional drowning). We reviewed a random sample of 1000 visits captured by the new definition of unintentional drowning and categorized visits as likely, possibly, and unlikely to be related to unintentional drowning. We compared monthly drowning-related ED visits from 2020, 2021, and 2022 with monthly drowning ED visits from 2019, overall and by sex and age group. Results: A total of 35 431 ED visits related to unintentional drowning (10.71 per 100 000 ED visits) occurred from 2019 through 2022. Most visits (86%) captured by the new definition and manually reviewed were likely related to unintentional drowning. Rates were highest among males (14.04 per 100 000 ED visits) and children aged <1 to 4 years (65.61 per 100 000 ED visits). The number of drowning-related ED visits was higher in May and August 2020, May and June 2021, and May 2022 as compared with the same months in 2019 among people aged 18 to 44 years. Conclusions: The definition for unintentional drowning is available in the National Syndromic Surveillance Program's ESSENCE platform for state and local jurisdictions to use to monitor unintentional drowning-related ED visits in near-real time to inform prevention strategies. [ABSTRACT FROM AUTHOR]

This study explores the integration of a human kinetic energy-harvesting mechanism into lifejackets to address the energy needs of aid search and rescue operations in aquatic environments. Due to the limited data on the movement patterns of drowning individuals, a human motion model has been developed to identify optimal design parameters for energy harvesting. This model is developed from computer vision analysis of underwater footage and motion capture laboratory experiments and is used to quantify the potential for power generation. The field testing experiment is conducted underwater, replicating the environment used for footage collection and analysis for the modelling. During the field testing, the participant wears a lifejacket integrated with the energy-harvesting device. Field testing data are then collected to verify the model. The efficacy of this approach is demonstrated with observed power outputs ranging from 0 mW to 754 mW in simulations and experiments. Despite challenges such as the "dead zone" in a drowning person's motion, the success of the experiments underscores the potential of the proposed energy-harvesting mechanism to efficiently harness the kinetic energy generated by a drowning person's movements. This study contributes to the development of sustainable, energy-efficient solutions for search and rescue operations, particularly in remote and challenging aquatic environments. [ABSTRACT FROM AUTHOR]

Drowning kills at least 3,72,000 people every year and is the 3rd leading cause of unintentional deaths. In addition to the human tragedy, drowning represents a huge economic problem with direct and indirect costs, including many Disability-Adjusted Life Years. In India, there is limited knowledge about the epidemiology of drowning. The objective of the study was to study the incidence, manner and epidemiology of deaths due to drowning in and around Vadodara region. The present study was conducted from May 2022 to April 2023 in Government Medical College, Baroda on 82 cases to study the various epidemiological parameters of drowning. In this study period, 1989 cases of post-mortem examination were done out of which 82 cases were of drowning deaths. A maximum number of cases were seen in the age group of 21-30 years with 43% cases of males, dominating the study population. 62% of deaths were accidental in nature and occurred during the rainy season. The most common place of occurrence of drowning was river (38%) followed by water canal (31%). Soddening of hands and feet was the most common external feature of drowning followed by the presence of froth at mouth and nostril. Drowning is a most ignored public hazard worldwide with serious implications for the society. Public awareness regarding safety measures and drowning prevention strategies suitable to the needs of geographical region should be adapted. [ABSTRACT FROM AUTHOR]

Drowning remains a significant cause of mortality worldwide, necessitating accurate diagnostic tools for forensic investigation. This paper conducts a comparative analysis of the Drowning Index (DI) to ascertain its relevance in distinguishing drowning deaths from non-drowning asphyxial deaths. Drowning deaths present a challenge for forensic pathologists, because the autopsy findings may occur in many non-drowning scenarios. Previous studies have attempted to identify patterns in organ weights that may be specific for drowning. The drowning index has been defined as the weight ratio of the lungs and pleural effusion fluid to the spleen. We compared the lung and pleural effusion weight, spleen weight, and DI from 124 autopsies of asphyxia deaths including both drowning deaths and non-drowning asphyxia deaths such as hanging, strangulation, suffocation and mechanical asphyxia at the department of Forensic Medicine and Toxicology at the Gandhi Medical College, Bhopal from September 2021 to August 2022. Findings highlight the potential utility of the DI as a valuable adjunctive tool in forensic investigations, providing insights into its comparative efficacy in differentiating drowning from other modes of asphyxial deaths. Such insights are critical for enhancing accuracy in forensic diagnoses and contributing to advancements in medicolegal death investigations. [ABSTRACT FROM AUTHOR]

African American, Black, Hispanic, Latino, and low-socioeconomic communities have lower swimming ability and higher relative drowning rates than White and high-socioeconomic communities, distinguishing the former as high-priority populations to engage with effective learn-to-swim programming. This article demonstrates how prioritizing the reduction of fear-producing brain processes while learning to swim can result in 79.5% of high-priority population nonswimmers being able to jump into deep water, roll onto their backs and either float or tread for 60 seconds, and swim 25 yards after an average of 14 practice sessions. Practical explanations of four key components-- water exploration, structured games, emulating coaches, and water safety education--are provided. Three realworld programming examples detail how the curriculum was structured and results for (1) a youth learn-to-swim program, (2) a high school program, and (3) a weekly day camp program. [ABSTRACT FROM AUTHOR]

Introduction: Disrupted weather patterns are associated with climate change. Between 2001 and 2018, nearly 74% of disasters were water-related, including floods and cyclones. Such water-related cataclysmic events increase the risk of drowning. We aimed to map evidence on the impact of climate change on water-related physical events, associated human migration, and drowning burden in India. MATERIALS AND METHODS: We searched electronic databases, government reports, and relevant websites to map evidence on water-related physical events (including but not limited to sea-level rise, glacier bursts, lake bursts, floods, rainfall, cyclones, and droughts) and consequent human migration using narrative review approach, while drowning burden through scoping review approach. We summarized the results narratively. Results: Evidence from 48 studies and seven reports suggest that India will witness the greatest sea-level rise, significantly impacting poor coastal communities. An increase in droughts, cyclonic rainfall, storms, and floods, with increasing surface rainwater and streamflow water, due to melting glaciers is expected. Climate change–triggered migration is expected notably in northeast and south India, making farmers, drivers, street vendors, women, and youth most vulnerable. No direct evidence was identified on the impact of climate change, water-related disasters, meteorological events, or seasonal variations on drowning from India. Conclusion: Our study highlights a significant gap in the availability of context-specific and localized data to improve disaster response and strengthen public health systems, especially for areas most vulnerable to climate change. There is an urgent need to generate new knowledge and understanding of climate change, water-related or meteorological events, and seasonal variations’ impact on drowning burden as the level of risk remains unknown.

Abstract Background Drowning remains a common cause of death among children. However, the epidemiology and impact of drowning in Thailand was underexplored. This study aimed to analyze the epidemiology and clinical outcomes of pediatric drowning in Thailand and to determine the factors associated with the need for intubation and mortality. Methods Data derived from the Thai healthcare delivery system for the period between 2015 and 2019 were used to examine the monthly admissions, mortality rates, length of hospital stay, and the number of patients who received endotracheal intubation. Multivariate logistic regression analysis was employed to identify the risk factors associated with the need for intubation and mortality. Results Of the 4,911, 58.8% were under six years old, 63.5% were male, and 31.2% were from the Northeastern region. The majority drowned during April, which is the summer season in Thailand. Among these patients, 28.8% required intubation, with the highest proportion found in the 6-

Abstract Background Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed. Methods An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75–85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (

Background: Drowning remains a common cause of death among children. However, the epidemiology and impact of drowning in Thailand was underexplored. This study aimed to analyze the epidemiology and clinical outcomes of pediatric drowning in Thailand and to determine the factors associated with the need for intubation and mortality. Methods: Data derived from the Thai healthcare delivery system for the period between 2015 and 2019 were used to examine the monthly admissions, mortality rates, length of hospital stay, and the number of patients who received endotracheal intubation. Multivariate logistic regression analysis was employed to identify the risk factors associated with the need for intubation and mortality. Results: Of the 4,911, 58.8% were under six years old, 63.5% were male, and 31.2% were from the Northeastern region. The majority drowned during April, which is the summer season in Thailand. Among these patients, 28.8% required intubation, with the highest proportion found in the 6-<12 years age group (35.9%). The independent risk factors for intubation were metabolic acidosis (adjusted odd ratio [aOR] 9.74; 95% confidence interval [CI] 7.14–13.29; p < 0.001) and pulmonary edema (aOR 5.82; 95%CI 3.92–8.65; p < 0.001). The overall mortality rate due to drowning was 12.6%. Factors significantly associated with mortality included in-hospital cardiac arrest (aOR 4.43; 95%CI 2.78–7.06; p < 0.001), and the presence of drowning-related complications, particularly renal failure (aOR 7.13; 95%CI 3.93–12.94; p < 0.001). Conclusion: Drowning admissions and mortality were highest among male children under six years old, occurring mainly during the summer season. Significant factors associated with intubation requirement included metabolic acidosis and pulmonary edema. The mortality was significantly associated with in-hospital cardiac arrest and drowning-related complications, particularly renal failure. Trial registration: This is an observational study, does not include any intervention, and has therefore not been registered. [ABSTRACT FROM AUTHOR]

Introduction: A drowning definition is available for use with National Syndromic Surveillance Program (NSSP) data. However, its accuracy in capturing drowning emergency department and urgent care visits at the regional level is unknown. We tested the ability of the syndromic surveillance (SS) definition in capturing unintentional and undetermined intent drowning (UUID) and describe UUID SS visit trends in a large metropolitan area. Methods: We applied the drowning definition to NSSP data from 2016 to 2022 for the 8-county metropolitan Houston region. We queried the dataset for UUID ICD-10-CM codes and manually reviewed the chief complaint (CC) and discharge diagnosis (DD) for SS visits. True-positives were calculated by dividing the number of UUID cases identified by UUID ICD-10-CM codes and CC/DD review by the total visits captured by the SS definition. Demographics and trends of UUID visits were calculated from 2018 to 2022 due to limited data from 2016 to 2017 in NSSP. Results: 2,759 visits were captured by the SS definition. After case review, 2,019 (73.2%) had ICD-10-CM drowning codes of any intent; and 2,015 of those (99.8%) were classified as UUID. Of the remaining 740 cases with no ICD-10-CM codes that were pulled by the SS definition, 690 (93.2%) had a CC/DD diagnosis of drowning/submersion/underwater related to aquatic exposure. Taken together, 2,705 (98.0%) were true-positive UUID visits based on the SS drowning definition.. Children (aged < 18 years) constituted 79% of UUID visits. Black, White and Asian/Pacific Islander persons comprised 17%, 60% and 4% of UUID visits respectively. Rates of UUID visits were lowest in 2020. Conclusion: Syndromic surveillance is a novel and accurate method to conduct real-time drowning surveillance in a large metropolitan region. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion and Conclusions Recent media reports highlight that drug‐related fatalities can occur while individuals are immersed in water in domestic settings. We aimed to determine the case characteristics, circumstances of death and type of implicated drugs among individuals dying due to unintentional drug‐related causes found immersed in a bath or hot tub.Retrospective cohort study in the United Kingdom using coronial records from the National Programme on Substance Abuse Deaths, 1997–2023. Information was available on decedent socio‐demographics, characteristics of death and drugs implicated in death.One hundred fifty‐six decedents were found immersed in the bath and six in a hot tub, a mean of 6.4 deaths per year (SD 3.7; range 1–13). Overall decedents were predominantly male (n = 94, 58.0%), of White ethnicity (n = 98, 60.5%) with a mean age of 40 years (SD 13; range 19–74). Only 12 decedents had any physical contributory factor to death other than poisoning or drowning. The median number of drugs detected at post‐mortem was 3 (interquartile range 2, 5) with multiple drug toxicity implicated in the majority of cases (n = 90, 55.6%). The most common implicated drugs were heroin (n = 53, 32.7%), alcohol (n = 46, 28.4%) and cocaine (n = 33, 20.4%).Over the last two decades in the United Kingdom there have been consistent numbers of unintentional drug‐related deaths each year where individuals were found in a bath or hot tub. Polysubstance, opioid and alcohol use are overrepresented. Targeted advice to avoid bathing while intoxicated would appear to be an appropriate harm reduction message. [ABSTRACT FROM AUTHOR]

• Graduated driver licensing can allow for flood safety education of learner drivers. • We audited publicly available learner driver handbooks for flood safety information. • We found no information in some jurisdictions; inconsistent information in others. • Auditing flood-related visual signage yielded significant gaps for learner drivers. • Learner driver handbooks represent a missed opportunity to educate on flood safety. Introduction: Vehicles driving, or being swept, into floodwaters is a leading cause of flood-related death. Establishing safe behaviors among learner drivers may reduce risk throughout their driving lifetime. Methods: An environmental scan of publicly available government issued learner and driver handbooks across the eight Australian jurisdictions was conducted to identify information provided regarding floodwaters. Search terms included 'flood,' 'rain,' 'water,' and 'wet.' A visual audit of flood-related signage was also conducted. Results : Twelve documents, across eight jurisdictions, were analyzed. Four jurisdictions' documents provided no information on flooding. Of the four jurisdictions that provided information, content varied. This included highlighting risks and discouraging entering floodwaters in a vehicle, including penalties associated with travel on closed roads, to advising depth and current checks if crossing a flooded roadway, with recommendations based on vehicle size (preference given to bigger vehicles, i.e., 4wds). Information on flood-related signage was found in one jurisdiction. Discussion : Learner and driver handbooks represent a missed opportunity to provide flood safety information. Currently, information is not provided in all jurisdictions, despite flood-related vehicle drowning deaths of drivers and passengers being a national issue. Where information is presented, it is limited, often lacks practical guidance on how to assess water depth, current, and road base stability, and could better use evidence regarding the psychological factors underpinning, and behavioral prompts for performing, or avoiding, risky driving behavior during floods. Conclusions : The provision and content of information in learner driver and driver handbooks must be improved, particularly within the context of increasing flooding and extreme weather associated with the effects of climate change. Practical applications : We encourage all jurisdictions to provide practical information that draws on evidence-based risk factors and empirically established psychological factors for behavioral change to help establish safe driver behaviors around floods in the formative years of learning to drive. [ABSTRACT FROM AUTHOR]

To date, synovial fluid has not been the subject of targeted analysis as a possible substrate to search for the presence of diatoms in the forensic context of drowning. However, its unique characteristics of production and isolation from the external environment could make it suitable for this purpose, similar to what has already been demonstrated in the literature for vitreous humor. By considering this, synovial fluid was analyzed in a specific case that came to our attention, where the coexisting signs of polytrauma and drowning were documented during autopsy, demonstrating a period of vitality during immersion. After a thin smear of the supernatant was obtained from the centrifugation of the synovial fluid sample, diatoms were successfully detected, consistent with those found in other organs and the water of the canal. The detection of diatoms in the synovial fluid was an objective finding, but its generalizability is limited because this was a pilot application. However, in cases where death by drowning is suspected and the body has multiple areas breached by trauma, the technique of analyzing diatoms in the synovial fluid could have great potential. Therefore, it is appropriate to further explore this technique in order to obtain more forensic evidence in such a setting. [ABSTRACT FROM AUTHOR]

Background: Finding a dead body in water raises an issue concerning determining the cause of death as drowning because of the complex pathophysiology of drowning. In addition, the corpse may be submersed postmortem. Objective: Evaluate the role of oxidative stress markers and NF-KB/iNOS inflammatory pathway as diagnostic biomarkers in drowning and whether they could differentiate freshwater from saltwater drowning. Methods: This study included forty-five adult male albino rats classified into five groups: control group (C), Freshwater-drowned group (FD), Freshwater postmortem submersion group (FPS), saltwater-drowned group (SD), and saltwater postmortem submersion group (SPS). After the autopsy, the rats' lungs in each group were prepared for histological, immunohistochemical (caspase 3, TNF-α, NF-kB, COX-2 & iNOS), biochemical studies; MDA, NOx, SOD, GSH, VCAM-1, COX-2; and RT-PCR for the relative quantification of NF-kB and iNOS genes expression. Results: Lung oxidative markers were significantly affected in drowned groups than in postmortem submersion groups. Inflammatory pathway markers were also significantly increased in the drowned groups, with concern that all markers were significantly affected more in saltwater than in freshwater drowned group. Conclusions: It is concluded that the tested markers can be used accurately in diagnosing drowning and differentiating it from postmortem submersion with a better understanding of the mechanism of death in drowning as both mechanisms, inflammatory and oxidative stress, were revealed and involved. [ABSTRACT FROM AUTHOR]

Aim: An evidence gap exists on sex and gender differences in drowning with previous research neglecting females. Drowning studies have largely focused on accidental drowning and submersion, excluding other classifications such as intentional, water transport-related, and undetermined drowning. This study examined all external causes of drowning deaths over a 13-year period in Australia disaggregated by sex. Drowning deaths were compared by sex with drowning classification, year, month, age, place of death, Indigenous status, socioeconomic, and visitor status. Subject and methods: This retrospective total population study included all females and males who died from drowning in Australia from 2006 to 2019. Data was extracted from the Australian Bureau of Statistics Cause of Death Unit Record Files. Australian population data were extracted to calculate the crude death rate and relative risk for drowning. Results: There were 4007 drowning deaths recorded, and females represented 25.2% of drowning fatalities. Females were less likely than males to drown, including by drowning classification, year, month, state, remoteness and visitor status, age, socioeconomic, and Indigenous status. The highest proportion of female drowning deaths were from intentional drowning, fall into swimming pools, and in natural water. Drowning deaths among females increased as age increased. Conclusion: There is a clear need for improved disaggregation of sex and gender in drowning research. Without the detailed exploration of females in drowning statistics there will be limited knowledge translation specific to females. The development of drowning prevention strategies targeted to females is required to reduce the incidence and risk of drowning. [ABSTRACT FROM AUTHOR]

Background: Trauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed. Methods: An international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75–85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2. Results: Twenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90–95%). The integral flowchart received strong consensus (93%). Conclusions: This study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess lifeguards' knowledge retention of airway management, oxygen administration, and ventilation interventions following certification and employer-provided training. Methods: This cross-sectional study was conducted using an online survey administered between February and May 2024. A total of 1322 responses from Canadian lifeguards certified in airway management and oxygen administration were deemed eligible for analysis. The survey included 15 knowledge assessment questions, with data analyzed based on lifeguard experience and the date of last certification or in-service training. Results: The mean knowledge assessment score was 10.4 ± 2.2 (69.3 ± 14.6%), with the highest scores in the airway management category and the lowest in the oxygen administration category. Lifeguard experience significantly increased knowledge retention, whereas recertification showed no significant impact, and employer-provided training significantly decreased knowledge retention. Conclusions: The findings underscore the importance of lifeguarding experience in knowledge retention among lifeguards. Optional airway management and oxygen administration recertification, coupled with inconsistent in-service training, have created significant gaps in lifeguard education. This study identifies the need for regular, competency-based training delivered by qualified facilitators. Addressing these gaps is crucial for enhancing the effectiveness of lifeguards in emergency response and ensuring high-quality care for drowning victims. [ABSTRACT FROM AUTHOR]

The present study sought to examine the gaze behaviours exhibited by lifeguards with different levels of experience while performing a task focused on detecting drowning incidents across extended periods. The results indicated a gradual decline in detection performance over time, regardless of the lifeguards' levels of experience. Analysis of the participants' gaze behaviours unveiled that this decline was associated with alterations in both the number and duration of fixations. The results indicated that lifeguards with greater experience maintained higher levels of detection performance and fixation numbers for extended durations, while exhibiting consistent fixation durations throughout the task, in contrast to their less experienced counterparts. These findings offer initial indications that lifeguards with more experience may possess an attentional advantage during tasks requiring sustained vigilance. [ABSTRACT FROM AUTHOR]

Child drowning is a significant public health issue in Indonesia, however, there is insufficient understanding of the issue and its associated risk factors within communities. This qualitative study aimed to explore parental and community perceptions and practices related to child drowning in Indonesian communities, and the perceived causes and risk factors. Seven focus group discussions (n  = 62) were conducted with parents of children aged under-5 years and village community leaders in seven villages across all districts of Lombok Island, West Nusa Tenggara Province of Indonesia. Participants were recruited using purposive and snowball sampling. The thematic analysis, guided by Braun and Clarke's framework, used both deductive approaches, utilizing the Health Belief Model's constructs and inductive approaches. Most participants were unaware of the susceptibility of their children and others in their community to drowning and of the potential severe outcomes of drowning such as injury, disability and death. Participants generally associated drowning with beaches or open seas. Unprotected wells, tubs and buckets were identified as notable risk factors for child drowning in and around the home, shaped by some experience of child drowning incidents in the community. Supervision was identified as protective factor, however, mothers were often unavailable to supervise children, and supervision responsibility was often delegated to other family and community members. This study highlights the urgent need to enhance public awareness regarding children's susceptibility to drowning. Further exploration of local contexts and social determinants of drowning in Indonesian communities is crucial for ensuring effective water safety and drowning prevention strategies. [ABSTRACT FROM AUTHOR]

Background. Homicide by drowning in adults is rare. Usually, marks of violence are found on both the victim and the perpetrator, unless the victim was under the influence of alcohol, drugs, or was unexpectedly forced or dragged into the water. Indeed, many cases of drowning in adults are believed to be accidental, but they may be the result of drunken fights or attempts to make the death appear accidental. In order to define the manner of death, cooperation between the forensic pathologist and the investigators is mandatory. Indeed, the autopsy is important to distinguish homicide by drowning from other kinds of drowning. The purpose of this study is to highlight the features of homicide by drowning. Materials and Methods. Literature search was conducted using PubMed databases, using the following keywords: "(homicide) and (drowning)". 3 articles were included in the systematic review, in addition to 3 cases observed in our institute. Conclusions. Both external examination and autopsy findings and the results of the investigation are essential to differentiate a homicide by drowning from accidental ones. The low specificity and variability of external and internal findings, the possibility of atypical asphyctic and nonasphyctic pathophysiological mechanisms, whose nature is not detectable at postmortem examinations, makes the diagnosis of cause of death difficult and often based on exclusion criteria only. In complex cases only using a strict forensic method allows to use the essential tools to identify the real manner of death. [ABSTRACT FROM AUTHOR]

Here we present newspaper accounts from the Sussex Advertiser to consider hitherto largely unknown Brighton doctors active between 1800 and 1809. This body of physicians, surgeons and apothecaries comprised Brighton's 'Gentlemen of the [medical] Faculty', whom the newspaper also dubbed the 'Disciples of Aesclepius'. Members are considered under three broad categories. First, are Brighton-based clinicians (Mr Barratt, Mr Bond, Charles Bankhead, Thomas Guy, John Hall, John Newton, Benjamin Scutt and Sir Matthew Tierney). Second are London clinicians, probably in attendance to the Prince of Wales (John Hunter and Thomas Keate), More widely, two dentists (Dr Durlacher and Mr Bew) and two Royal Navy surgeons (Robert Chambers and Thomas Thong) also recorded at Brighton are considered. Other aspects of medical life are described: recruiting an apprentice, anatomy training at Joshua Brooke's London museum, midwifery, a description of a surgeon's bag and the last reference to the Royal Sussex Jennerian Society (which disappears from the newspaper record in 1807). Clinical cases described include: resuscitation from near-drowning, post-mortem examinations, death from the 'gravel and stone' and accounts of suicide. The primary sources presented in this paper offer rare glimpses into medical life in Brighton at the very start of the nineteenth century. [ABSTRACT FROM AUTHOR]

Issue Addressed: To understand barriers to uptake of subsidised swimming lessons by children aged 3–6 years old ('preschool aged children'), including from priority populations, in New South Wales (NSW). Methods: A thematic analysis of 4191 qualitative responses from parents/carers of preschool aged children describing barriers that resulted in their child's non‐participation in subsidised swimming lessons in the past 12 months was conducted. Data, including parent/carer sociodemographic variables, were collected through registrations for the NSW Government's First Lap voucher program. Results: Seven overarching barriers to participation were identified: (1) child's disability or health needs; (2) swimming lesson affordability; (3) family or personal circumstances; (4) lack of or poor availability of swimming lessons; (5) parent/carer availability, including to fulfil participation requirements; (6) COVID‐19 and (7) deprioritisation of formal swimming lessons due to parent/carer perceptions relating to its importance. These may limit the uptake of swimming lessons in preschool aged children, particularly those who are Aboriginal and Torres Strait Islander, from culturally and linguistically diverse backgrounds, living with a disability, from low socioeconomic families and living in regional and remote areas. Conclusion: Structural barriers must be addressed to increase uptake of swimming lessons in preschool aged children, particularly in priority populations, to reduce drowning risk. So What?: Evidence‐based policy initiatives, with robust evaluation, should seek to address the availability and flexibility of swimming lessons, including for priority populations; complexities associated with supervision requirements; poor awareness of parents/carers of the importance of swimming for preschool aged children and the lack of continuity of swimming for children in out of home care. [ABSTRACT FROM AUTHOR]

This article, titled "Tips and tricks for underwater resection. How to swim without drowning in this technique," provides guidance on the underwater resection technique for removing colon polyps. The authors discuss the limitations of conventional endoscopic mucosal resection (CEMR) and the benefits of underwater EMR (UEMR), which has shown lower recurrence rates. The article offers dos and don'ts for successful underwater resection, including using antispasmodics, making marks to delineate the lesion, and using smart electrocautery units. The authors also recommend starting with small lesions and gaining familiarity with the underwater environment. [Extracted from the article]