1297: RISK FACTORS AND OUTCOMES: A 10-YEAR RETROSPECTIVE ANALYSIS OF SUBMERSION INJURY DATA

Abstract

Learning Objectives: Submersion injuries often end in death or severe irreversible neurologic morbidity. Pre-hospital care by Emergency Medical Systems records data of drowning/neardrowning injuries on Submersion Incident Report Forms (SIRF). This information captures “scene” data prior to transportation to local hospitals and is useful in prevention and advocacy planning for San Bernardino County (SBC). The hypothesis is that there are certain preventable risk factors associated with these cases. Methods: A retrospective SIRF data analysis from 08/07 to 04/17 in SBC was done. All data was compiled through OK KIDS, Pediatrics, and Safe Kids, Inland Empire. Data was stratified by age groups and compared against risk factors. A separate retrospective outcome analysis was done on all submersion injuries admitted to the Loma Linda University Children's Hospital Pediatric Intensive Care Unit during this same time period. Results: The SIRF data from SBC showed 400 EMS responses; mean age of 13.02 yr, SD+/-20.5 yr (77% < 18 yr: 23%> 18 yr) during 2007 to 2017. 237 submersions (59%) occurred in the 1 to 4 year old age group. Female: male ratio was 1:2. All submersions with scene cardiopulmonary resuscitation (CPR) showed 70% of adults receiving CPR compared to only 57% of children. 95% of all injuries had some form of barrier present. The place of submersion for children was; 6% public pool, 62% house, and 15% multi-unit housing. There was no direct correlation between poverty and submersion injury. For all incidents 27% were supervised by multiple people, 41% by a single supervisor. For outcomes at LLUCH PICU, 125 children were admitted with 29 deaths (23%). Of those that survived, 84% received CPR, with 79% receiving CPR from a caretaker or family member. In this CPR group 11% of children were either tracheotomy/ventilator/gastrostomy tube dependent, sustained intellectual disability, or were transferred to a skilled nursing facility. Conclusions: Males are at an increased risk for submersion injury. CPR is delayed in young children. Most injuries occurred when barriers were present. Multiple person supervision is safer for children. The majority of submersions occurred in the 1 to 4 year old age group. Early CPR is directly correlated with a decrease in adverse outcomes. Scene CPR initiation by caretakers, multiple attendant supervision, and additional safety mechanisms are advocacy issues for submersion reduction. Standardization of SIRF data is paramount for the eradication of these preventable tragedies.