Drowning is the second leading cause of death in children (in the age group 1-14) worldwide. Against this background, it becomes imperative to analyse the cause of fatalities in swimming pools and focus on effective measures to prevent them.
According to the World Health Organisation, “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.” In simple terms, drowning happens when a person is unable to meet the body’s oxygen demands when submerged in liquid. This process leads to a cascade of bodily changes that, if not stopped, result in death.
1-year-old child unsupervised near water-body.
5-year-old child who does not know swimming.
Head/neck trauma due to diving in shallow water.
Deaths in swimming pools may not be due only to drowning. There are two medical conditions that can result in sudden death even before drowning occurs. They are hypertrophic cardiomyopathy and cardiac channelopathies (e.g. Long QT syndrome).
Interestingly, hypertrophic cardiomyopathy and cardiac channelopathies are two notable causes of sudden death among people not just during swimming but during any exercise. And these need to be strongly considered a cause of death in a child aged over 5, who knows swimming and dies suddenly in a supervised pool.
In a study published by DJ Tester et al in the Mayo Clinic Proceedings (October 2011), nearly 30% of unexplained sudden deaths in the swimming pool were caused by cardiac channelopathies.
In an article published in the Journal of Paediatrics (2002), Batra et al reported sudden cardiac arrest due to the Long QT syndrome in a 12-year-old who dived into a pool. But these cardiac channelopathies cannot be identified by routine autopsy and require more sophisticated molecular testing & family genetic studies.
Preventable causes of death such as these during sports/exercise form the basis for pre-participation physical examination as mandated in developed countries such as the United States.
Prevention of deaths in swimming pools requires a global and concerted approach that includes diligent standards for supervision, adequate training of supervisory staff in rescue & cardiopulmonary resuscitation (CPR) and legislative action that makes pre-participation sports physical exams mandatory.
Pre-participation sports physical exam & thorough medical screening.
Buddy system while in water (pairing with another swimmer).
Adequate supervision, including the presence of coach/lifeguards.
Proper barriers, fencing, gates in pool.
Training of swimming pool staff in CPR.
Prohibition of diving in shallow water.
The recent death of a 9-year-old boy in a Chennai city school swimming pool is a matter of deep concern. It is important that the noise and din of media coverage, court cases, arrests and punitive action should not push to the back seat constructive action that needs to be taken to make swimming pools a safer place for our children. And larger lessons from the swimming pool tragedy must be drawn to cover the entire gamut of school safety and health.
In the United States, no child is allowed to enter school without an annual physical examination and medical clearance by the doctor. And every school is staffed by a nurse trained to deal with medical emergencies and to cater for other medical needs of children.
What can be more important for our vision of achieving a developed India than implementation of these best practices in our schools through legislative action? The need of the hour is a School Health Law that addresses the health and safety needs of schoolgoing children. For, after all, the future of our country depends on the health, wellbeing and safety of our children.
(Dr. P. Madhu, MBBS, American Board of Paediatrics, FAAP, Clinical Assistant Professor of Paediatrics, University of North Texas Health Science Centre, U.S. Email: firstname.lastname@example.org)