A Wet End for Scott?

The Louisiana Health Department has made child drowning prevention a priority for 2017, since our state has the second highest rate in the nation.  Though I always cared deeply about this, it’ now more important for me since I recently almost drowned off Grand Isle.

On a beautiful day at the beach, our teenagers were congregating off shore on their inflatable “island.”  They insisted on dragging it out to the second sandbar, requiring a swim to reach .  After quaffing a beer, I decided to swim out to visit them.

Though I’m in pretty good shape, I’m not a strong swimmer (“suck” best describes my aquatic prowess).  As I paddled out the wind was blowing against me.  I rolled on my back to rest, but waves kept breaking over my face.  I was running out of gas and beginning to struggle and still wasn’t near where I could touch bottom.

Let’s pause and examine what I did wrong.  Being in the water is fun, but for some their desire outmatches their abilities.  Some kids will jump into the water even if they can’t swim.  Some, like me, overestimate their ability and go too far. Drinking and swimming is also a bad idea.  Alcohol impairs judgement, whether you’re going for the swim, or if you’re tasked with keeping the toddlers safe around a pool.

Here’s what I did right, postponing my funeral. Out on the party island was my friend Dayle.  Dayle grew up swimming on swim teams, and worked every summer as a life guard.  I knew that if I did have trouble, help was 30 yards away. So when I began to splutter and panic that the end was near, I yelled “Dayle, help!” and in seconds he was buoying me up and towing me to safety.

The lessons are clear.  Know how to swim; get your kids lessons.  Swim within your abilities.  Don’t drink and swim.  Make sure there’s a lifeguard, though it doesn’t have to be your best friend Dayle.

More than I hate drowning myself, I hate it happening to kids.  When a child comes in in full arrest from drowning, we almost never get them back, and it’s horrible to have to tell a family that their child’s dead. When a child survives an episode, it’s called “near-drowning.”

Last month I had this case of near-drowning:  The 4 year-old child was home in the pool with friends.  Later they came in the house to mom, yelling that the child had choked when his face went in the water.  Fortunately, he got out of the pool and seemed alright. But mom had heard about “secondary drowning,” and brought the child to us.

Secondary drowning is when a child almost drowns, but is plucked out, revived, and seems fine. However, the child gets a little bit of water down their windpipe (a teaspoon is enough), and goes awhile without oxygen. This combination can injure lung tissue, where fluid weeps into the airways, a process called pulmonary edema.  The patient begins to have trouble breathing through that fluid, needs oxygen support, and is admitted into the hospital for observation.

I examined the child and thought: I could declare him fine, which he probably was, and send him home, but run the risk that he could get sicker.  I could admit him for observation, which was probably overkill, when the kid’s fine and will just jump up and down on the hospital bed all night.

I took a middle route.  After hearing no sounds of lung wetness with my stethoscope, I did a chest xray.  When there were no signs of pulmonary edema, I reviewed the risks. By report this kid didn’t go without oxygen- never turned blue, didn’t stop breathing. His mom was cool-headed, and could be trusted to come back if he worsened.  And pulmonary edema onset is slow- mom would have plenty of warning that the child needed to return to the hospital.

Never let drowning happen to your kids.  Get them swimming lessons.  Don’t have a pool or pond that toddlers could slip into unnoticed, or gate it if you do. Have someone remain sober at pool parties, whose only job is to watch the kids and not be distracted by conversation and beer.  And know CPR- near-drowning survivors are resuscitated at pool side.  Not in the ER.

Stay Outdoors This Summer!

My college required students to take four blocks of Physical Education, much like high school, except we chose the sports.  We also had to pass a swim test to graduate.  My roommate Brian, who’d never learned to swim, had to use his PE blocks to take swim lessons until he passed that test.  So while the rest of my buddies and me were horsing around in floor hockey or golf lessons, Brian was off to the campus pool in swim trunks, towel around his neck, trailed by jokes about playing in the “kiddie pool,” and “don’t forget your water wings.”

Learning to swim and playing in the pool are great ways to spend the hot summer. It’s good exercise and though kids are outdoors, they stay cool.  And they have fun!  More importantly for we in Emergency services, knowing how to swim is good drowning prevention.

Proper swim lessons, like in the Boy Scouts, don’t only teach swimming.  They also teach water safety, because even good swimmers can get into trouble, like my buddy Walt. Walt is an ER doctor who had been in the Air Force Pararescue, or “PJs.” This elite team’s mission is to rescue downed pilots, particularly in water. Needless to say, Walt was as capable in water as any Navy Seal.  One day at the beach, however, he and his 8 year-old son got caught in a riptide and were taken out to sea.

Hundreds of yards off shore, Walt saw a current that would sweep them back, but the stream he was in prevented him from swimming there.  After hours of trying to break through while holding up his son, growing exhausted, he resigned himself to throwing his son to the beach-bound current before he himself drowned.  Just then a rogue wave slapped them into that good current and they got home.

After that, Walt never went to the beach without numerous flotation devices and a long rope.  Good swim lessons likewise teach about safety and rescue strategies like having flotation and other equipment handy.  They also teach the buddy system so everyone is accounted for in a crowd.

Playing outdoors in the summer is great exercise too, though not as cooling as swimming.  Kids can get overheated, especially if they are in sports practices.  Several times in July and August we get football players in the Emergency Department with heat exhaustion.  The boys start to get muscle cramps, and then can become sleepy and sometimes confused.  When they are confused or difficult to arouse, we worry about heat stroke, a life-threatening emergency.

Dr. James Andrews, a famed sports orthopedic surgeon, wrote a book called “Any Given Monday: Sports Injuries and How to Prevent Them.”  In that book he advocates kids cutting back on organized sports when they are young, to avoid repetitive injuries that he used to see only in college and professional athletes.  This allows for more unstructured outdoor play for kids that’s easier on their joints.  Kid-driven play also helps avoid heat injury.

In regular play, there’s no training agenda to drive kids past their comfort zone.  Kids can goof around outside all they want, and when they get hot and thirsty come in to get drinks and cool off.  They take breaks whenever they want.  In coach-driven sports, kids are pushed to the limits of their endurance to improve performance.  Sometimes they are pushed too far, and get over-heated.

However, organized sports practice can be made safer. Coaches should allow unlimited water breaks.  Heat injury happens with temperature and dehydration working together to punish; plenty of fluids prevents that.  Breaks should be in the shade.  Teams should practice in cooler times of day, early morning and late afternoon or evening.  Football practice should start with shorts and tee-shirts, with endurance and equipment gradually added in following weeks.  Finally, coaches should watch players for signs of heat exhaustion, just like they watch for signs of concussion.  If players acts groggy, they should be rested and hydrated in the shade.

So let your kids play freely outdoors. They should get swimming lessons and have lots of pool time to play and exercise.  If they are outdoors in the yard, be sure they take plenty of water and cooling-off breaks, and have sprinklers to play in.  Come to think of it, maybe football practices should have lots of running through the sprinklers too!

Let’s Go For A Swim!

This week’s guest columnists are Dr. Kevin Morris and Dr. Richard Pearson, Family Practice residents at the University Health Center here in Lafayette.  Dr. Morris is a former paramedic, and knows of what he speaks:

It’s warming up and sunny, let’s go swimming!  ”Rescue 51, respond to the swimming pool in the Sunset neighborhood, 3 year-old drowning.”  This request no paramedic likes to hear.  Upon arrival, the girl is found lying next to the pool, having been pulled out by her parents.  She is unresponsive and has no pulse.  We work frantically to save her.  The family tells us they were having a reunion, with twelve children and thirty adults.  No one saw her go into the pool.  This potentially tragic event is avoidable, with simple steps.

As temperatures rise, we begin to think about staying cool and having fun.  Both needs are met by jumping in the pool and we’re all for it!  It’s great exercise and play, and gets the kids outside.  And they certainly can’t bring a phone or video game in with them!  However, we all need to be aware of the danger.

According to the Centers for Disease Control (CDC), every day two children in the US die from drowning, and another ten go to the Emergency Department for non-fatal submersion.  Drowning is the second leading cause of death in ages 1 to 14 years, only behind car crashes.  There are many, easy ways to dramatically improve safety.

One of the most common reasons drownings occur is a lapse in supervision.  We all enjoy the poolside- barbequing, drinking, visiting, swimming, and making big splashes. All this distracts from the young non-swimmers.  When children are there, it’s important for one supervising adult to be distraction-free to watch the kids. The American Academy of Pediatrics recommends “touch supervision,” meaning that children are always within touching distance at the pool.

When it’s a party at the pool with adults and kids milling around, it’s impossible for any adult to stay 100% vigilant.  That’s how tragedies like our child above happen, even with a designated watcher.  Therefore life jackets are great for non-swimmers in the group. They are easy to use and really help.  Air-filled toys and “floaties” are adorable and fun, but just aren’t safe enough.

The girl from above had been at a pool that was fenced, but went through the gate unnoticed.  It’s not unusual to accidentally leave a gate open, so a self-closing and self-latching gate may save a life.  Sometimes children impress us with their craftiness and do things we never thought possible, like opening “child-proof” locks. Thus the gate latch should be at the top of the fence where small children can’t reach.  Also, pool fences should be on all four sides of the pool: having the pool open to a patio door invites disaster.  To see what your pool fence and gate should look like, check out hotel pools- many have great fence systems.

One of the best ways to protect children from drowning is teaching them to swim. Kids who have formal swimming lessons are safer from drowning.  Lessons are recommended for age 5 and up, but can be started earlier depending on the child’s maturity. The Boy Scouts have one of the best swimming programs, because it drills kids in pool and water safety as it teaches the actual swimming.

A word about another big group at risk for drowning: teenagers.  Teens, like toddlers, are natural risk takers.  They don’t think ahead, and spend time with their friends at bayous and lakes.  They may be drinking, jumping into unknown bodies of water, boating, and yet not know how to swim.  No teen should be at a pool, lake, bayou, or any body of water without being able to swim.  Talk to your teens about safety- not drinking, wearing life jackets, and not diving into shallow water, or water where you can’t see the bottom. Here in Louisiana everyone has a tragic story about water and a careless teen.

With these simple steps, playing in the water can be much safer for the kids and less stressful for parents.  Get out, stay active, enjoy the weather, and laissez les bon temps rouler!

Water Safety In The Wettest State In The Union

One day the ambulance brought in a 13 year-old who had almost drowned in a local hotel pool.  He was awake on arrival, but everyone had a good scare.  The pool had a deep end but no lifeguard.

The boy could not swim, the parents told us, but enjoyed bobbing in the shallow end, going to the bottom and then pushing up out of the water.  This time he had bobbed and bobbed is way into the deep end until he couldn’t bob up high enough to reach the surface.  The boy remembers looking up and seeing his parents helplessly looking back down at him.  They could not swim either.

All the parents could do was shout from above: “Get out of the pool!”  I guess they could not make the connection that “can’t swim” means “can’t get himself out of the pool.”  Eventually a more capable adult jumped in and hauled the boy out. 

This story illustrates several points for swimming safety.  Water is fun and inviting.  If you don’t know how to swim, however, water is deadly when you get in (literally) over your head.  Being safe means knowing how to swim.  Summer is coming and it is time to sign your kids up for lessons.  The Boy Scouts and Girl Scouts have excellent swimming programs.  One of the first things a Boy Scout learns is not just how to swim, but how to swim safely.  The lessons l learned at Scout Summer Camp stick with me today.

The first safety principal is swim at a pool with a lifeguard.  Lifeguards have training to save drowning kids without endangering others.  There are too many stories in the news about people who jump in to save a foundering child, and end up drowning too.  It takes training and equipment to safely rescue a swimmer in trouble. 

Next, swim with a buddy.  That way if one gets in trouble, the other one is there to help.  It is also just good sense to have someone account for you.  Lastly, have flotation devices at the pool.  If someone gets in trouble, throwing them a float to hang on to is better than offering your hand.  You don’t want to get pulled into the water and taken to the bottom by a panicking victim. 

There are two groups of kids that tend to drown more: toddlers in water at home, and teenagers in open water like lakes and rivers.  The best way to prevent a toddler from drowning is not to have a pool or pond on your property.  Everyone loses track of their little one sometime.  It is impossible to prevent.  They are natural explorers, and poor listeners (they barely speak English yet!).  They are going to get out and into things- the street, the cleaning products, the backyard pool.  If you don’t have a body of water at home to fall into, you eliminate the risk of them falling in and not being able to get back out- a pond doesn’t even have to be over the child’s head to be deadly!

If you already have a pool or pond, the next best thing is to fence it on all four sides.  No back door access to the pool!  The fence should be toddler proof.  This means a fence that can’t be climbed, with a lock too high for the toddler to reach.  If you haven’t seen that kind of fence before, visit a local hotel pool.  They will have one.

Talking to your toddler only helps a little, but talking to your teenager works (somewhat) better.  Despite what we all say about teens, they do listen, particularly when we talk directly to them about safety.  It helps to talk to them earlier- at ages 10-12, about not drinking while swimming or boating, about not diving into shallow water, about swimming with buddies who are also safe and responsible.  Talk to them nicely!  Tell them you trust them to do the right thing, but as a parent you have to remind them to be safe.  Take the eye rolling and “you’ve told me this a thousand times” in stride.  Teens do this even when they are listening. 

Drowning is preventable- do your part.  Secure any water at home, get the kids swimming lessons, and talk to those teens.  Let them get wet this summer, but safely!       

 

Its Summer- Get Wet! Safely!

My wife grew up here in Lafayette, and has more than one story about teenage friends and acquaintances dying in boating accidents.  With teenagers, of course there was alcohol involved.  As a Pediatric Emergency Medicine doctor, I have seen more than my fair share of toddlers who drowned.  The stories are all the same- there was a pool or pond or coolie or river in the yard, the parents lost track of the child for just a few minutes, and tragedy happened. 

Drowning is the second leading cause of accidental child death, after car crashes.  With kids, “accidental” is another way of saying “preventable.”  As I hinted at above, there are two main groups of kids that drown: toddlers in bodies of water near the home, and teens in open water like lakes and rivers.  We in Louisiana need to be extra careful because in case you haven’t heard, we have lots of water around here. 

The best way to prevent toddler drowning is not to have a pool or pond on your property.  Everyone loses track of their toddler sometime.  It is just about impossible to prevent that.  They are natural explorers, and poor listeners (they barely speak english yet!).  They are going to get out and get into things- the street, the cleaning products  under the sink, the backyard pool.  If you don’t have a body of water to fall into, you eliminate that risk.  If you already have one, the next best thing is to fence it in on all four sides.  No back door patio access to the pool!  Have a toddler-proof fence.  That means a fence that can’t be climbed, with a lock too high for the toddler to reach.  If you haven’t seen that kind of fence before, visit a local hotel.  They will have one.

It isn’t helpful to just talk to your toddler about staying away from water.  They aren’t good listeners.  However, you can talk to your teenager.  Despite what we all say about teens they do listen, particularly when we talk directly to them about their safety.  But you have to talk to them early- age 10-12, about not drinking and boating,  about not diving in shallow water, about swimming with buddies who are also safe and responsible.  Talk to them nicely!- tell them you trust them to do the right thing, but as a parent you can’t help yourself to remind them to be safe.  Take the eye-rolling and the “you’ve told me this a thousand times” in stride.  Teens do this even when they are listening.

Drowning is preventable.  Do your part.  Secure that pool and talk to those teens.  Let them get wet this summer, but safely.

Get Wet Safely!

This morning Tracy Wirtz and I talked about drowning prevention.  Whenever I talk about drowning the worst cases I have seen come to mind, but also the silliest.  One day I was in the Emergency Room when the ambulance brought in a 13 year-old who came close to drowning in a local hotel pool.  He was awake and alert on arrival, but everyone was understandably shaken.  The hotel pool had a deep end but no life guard. 

The 13 year-old could not swim, the parents told us,  but enjoyed bobbing in the shallow end, going to the bottom and then pushing up out of the water.  Well, he bobbed and bobbed his way unwittingly to the deep end until he could no longer bob up high enough to reach the surface.   The boy described to us looking up at the surface, seeing his parents helplessly looking back down on him.  They could not swim either.

If it is not apparent by now that this was not a group of deep thinkers, here came the kicker: to try to rescue their boy, the parents told me that they shouted down to him “Get out of the pool!”  They could not make the connection that “not being able to swim” means “he can’t get himself out of the pool.”  Eventually a more capable adult jumped in and hauled the boy out.  

This story illustrates several drowning prevention points.  Water is inviting and fun.  If you do not know how to be safe, though, water is deadly when you get (literally) in over your head.    Being safe means knowing how to swim, swimming where there are lifeguards, and knowing what to do if there are kids by the water who do not know how to swim.

No toddler should be left alone by any water, including tubs and wading pools and shallow ponds.  Like our goofy parents above, toddlers can not tell what is safe and what isn’t.  Then it is easy for them to stumble, hit their head on hard tub sides or rocks, and go face down and unconscious into the water.  All home pools should be fenced on all four sides with unclimbable fences and toddler-proof latches (too high for them to reach).  Having the pool open to the back sliding door is an invitation for disaster. 

Toddlers thus need to be watched all the time near water.  It is impossible to watch a toddler always and everywhere, but near water you can not slip.  My last drowning death was a two-year old whose parents lost track of him at home and he was found face down in the backyard pond.  Near deeper water, toddlers should wear life jackets.

Older kids should have swimming lessons, always swim with a buddy, and swim in guarded pools or with alert, capable adults.  Throwable rescue floats , like life rings with rope, should be handy.  Ideally, adults should know CPR.  Drowning victims are only saved when their breathing is restored at water-side.  Bystander CPR is the key to survival- brains die of lack of oxygen before most ambulances have a chance to get to the scene.  The only time in my experience that an ambulance crew revived a drowned toddler was when the firehouse was across the street from the scene.  

Besides toddlers, the other group at high-risk for drowning is teenagers.  Their tragedies often begin with drinking, and then swimming, boating, or diving in unguarded lakes or rivers.  Since teenagers are such bad listeners, the time to warn them about this is when they are still young elementary school kids.  That is the time of life when kids absorb the lessons they need for later.

If any of you readers have any other tips or exciting stories of drowning survival, feel free to comment!