There are five links in the Drowning Chain of Survival that cover three domains – Prevention, Rescue, and Treatment. These links are inter-connected and require diverse approaches to reduce the morbidity and mortality of drowning.

In 2014, the World Health Organization (WHO) issued a report on drowning titled “Preventing a Leading Killer.” This landmark report brought to the forefront the harsh reality that more than 90% percent of the world’s drowning deaths occur in low and middle income countries (LMIC) and there is great disparity in how drowning prevention programs are developed and implemented. The WHO sought to raise awareness of this neglected public health issue by setting out 10 actions that could be taken to prevent drowning (Table 1). One of these was to develop a National Water Safety Plan. This was re-affirmed in the 2017 follow-up, “Preventing Drowning: An Implementation Guide.”

Even within a High Income Country (HIC) like the United States, there are racial and wealth gaps in the burden of drowning. African American children aged 5-19 are 5.5 times more likely to drown in a swimming pool than their white counterparts. The myriad social determinants of health are beyond the scope of this discussion. The strategies used to address drowning in different communities are often as diverse as the people they serve. Small cities or counties often lack funding for dedicated drowning prevention activities and they may not be connected to regional or national drowning prevention agencies. This often leaves them to reinvent the wheel each if they choose to develop drowning prevention programs. A scalable national drowning prevention plan can serve as a best practices “playbook.”

As you can see, drowning is multifactorial and requires stakeholders across many diverse sectors. Take something as seemingly simple as a backyard swimming pool. Stakeholders across the drowning chain of survival include:

•  Pediatricians discussing water safety with parents

•  Persons taking CPR classes

•  Swim Instructors

•  Manufacturers of the pool itself, fences, alarms, and life jackets

•  Local government that develops pool construction and fencing codes

•  Code enforcement officials

•  Non-governmental water safety organizations

•  Fire, EMS, and Police that respond to emergency calls

• Doctors, Nurses, and Ancillary hospital staff

•  Families of persons who have drowned

This is just for a backyard swimming pool; imagine how quickly this swells up to dozens of stakeholders for something as complex as a whitewater trip, visit to the beach, flood, or hurricane. Fortunately, Water Safety USA has taken the reigns to bring these stakeholders together by leading the development of the U.S. National Water Safety Action Plan. This two-year process is currently in the second of three stages. 

The first stage was to develop a framework for a 10-year, evidence-based drowning prevention strategy for model water safety programs that are scalable from the community to national levels.

While there is no “one size fits all” approach to water safety, there are common themes. These serve as the basis for Stage 2 – establishing six working groups to identify best practices; data and gaps at national, state, county, and community levels to guide goals; objectives; and actions for recommended models at all levels:

1. Data/Surveillance will focus on what is needed to develop comprehensive drowning data surveillance to inform the prevention of fatal and nonfatal drownings. This will allow communities and key groups, including lifeguards, to better identify risk groups and develop and monitor data driven prevention interventions.

2. Water Safety/Swimming Lessons/Water Competency will identify needed priorities among the components of water competency including development of standards, policies/legislation and implementation models for all ages. Water competency includes swimming competencies, water smart behaviors and attitudes, hazard recognition, and self-assessment.

3. Supervision/Lifeguards will focus on how to improve protection and supervision of those near and in all types of open waters, pools, and around the home by parents, group leaders and lifeguards. This includes the development of minimum standards, developing recommendations on how to increase the public’s use of lifeguarded facilities, a review of emerging drowning prevention technology and workforce planning. Minimum standards will include supervision, lifeguard training, recertification, and more. Given the wide range of water hazards, sub-working groups may be established to address the complexities of this issue.

4. Rescue/CPR will identify what is needed to promote and improve Rescue and Resuscitation of the drowning victim by laypersons, lifeguards and Emergency Medical Services (EMS). I am fortunate to serve as a co-chair of this working group.

5. Pool Fencing & Other Barriers will identify ways to increase the use of fencing, barriers, alarms, and emerging technologies that reduce unsupervised access to water. This includes a comprehensive review of standards, codes, regulations, and legislation.

6. Lifejackets/PFD will focus on how to increase the use of Coast Guard approved life jackets by boaters, as well as by those recreating in or near the water.

Stage 3 is expected in Spring of 2022 and will convene a high-level panel of experts to discuss and fine tune the recommendations, with a careful eye on inclusivity and diversity.

I strongly believe that drowning is preventable, but solutions require multi-sectorial engagement across diverse populations. The ultimate goal is to create a long lasting, living plan that comprises evidence-based best practices that can be adopted and scaled from an individual community to a state or nation. The working groups have formed, but we are still looking for key informants, reviewers, and stakeholders who we may have overlooked.