P2A003: A Retrospective Analysis of Submersion Injury Data for San Bernardino County from 8/07 to 12/22

Background: Submersion injuries often end in death or severe irreversible neurologic morbidity.  Pre-hospital care by Emergency Medical Systems (EMS) records data of drowning/near-drowning injuries on Submersion Incident Report Forms (SIRF).  This information captures the “scene data” prior to transportation to local hospitals and is useful in prevention and advocacy/policy planning for San Bernardino County (SBC). Our goal is to determine risk factors associated with submersion injuries to identify regional prevention projects.

Methods: A retrospective data analysis from 8/07 to 12/22 of Submersion Incident Report Forms (SIRF) submitted by Emergency Medical Services (EMS) in San Bernardino County (SBC) was done and compiled through OK KIDS, Pediatrics, and Safe Kids, Inland Empire. Data was stratified by age groups and compared against risk factors: gender, location, supervision, and water type. The total number of incidents in this time period was 646 with ages ranging from 0.07 to 97 years. There were 418 confirmed males and 225 confirmed females.

Results: The SIRF data showed 576 EMS responses; mean age of 14.85, SD+/- 22.38 (72.74% < 18 yr: 26.54%(168) >18 yr) and 394 (62.5%) submersions in the 1 to 4 year old age group during 2007 to 2023. Female: male ratios showed adults 47/155(30.32%) F 108/155(69.67%) M, A total of 481 children ( < 20 yr) 176(36.59%) F 305(63.41%) M. All submersions with scene cardiopulmonary resuscitation (CPR) showed 70.5% (81/132) adults receiving attendant(s) CPR compared to children ( < 5 years) where only 66.25% (214/323) received attendant(s) CPR. Perimeter or pool fence present in 64.83% (271/418) of children's injuries (19.62% (82/418) had both). Place of submersion for children occurred; 15.31% (64/418) public pool, 69.85% (292/418) house, and 19.14% (80/418) multiunit housing. Adult's submersion injuries occurred; 25.34% (37/146) in open water. For children, there were 56% (42/75) injuries in hot tubs, 44% (33/75) injuries in bathtubs. In youth, 39.45% (144/365) were supervised by multiple people, 60.54% (221/365) by a single supervisor (1:1.67).

Conclusion: Males are at increased risk. CPR is delayed in young children. Most injuries occurred when fencing was present. Multiple person supervision is safer for children. Hot tub and bathtub submersions occurred in younger children. Majority of submersions occurred in the 1-4 year old age group. Early CPR initiation by attendants, multiple attendant supervision, and additional safety mechanisms are advocacy issues for submersion reduction.