Award Scheme

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Award Scheme

  1. 1. The potential use of an award scheme for drowning rescues to study prevention, rescue and resuscitation of drowning cases A.M. Venema 1,2 , J.W. Groothoff 1 , J.J.L.M. Bierens 2 <ul><li>University Medical Centre Groningen, University of Groningen, Netherlands </li></ul><ul><li>VU Medical Centre Amsterdam, Department of Anaesthesiology, Netherlands </li></ul>
  2. 2. Introduction: Drowning registration <ul><li>Mostly based on: </li></ul><ul><ul><li>Death statistics </li></ul></ul><ul><ul><li>Hospital statistics </li></ul></ul><ul><li>Sometimes additional registrations by: </li></ul><ul><ul><li>(national)lifesaving associations </li></ul></ul><ul><ul><li>Other organisations (Swimmingpools, etc.) </li></ul></ul>
  3. 3. Introduction: Methods of drowning registration <ul><li>International method: </li></ul><ul><ul><li>Based on Utstein Criteria for reporting drowning incidents </li></ul></ul><ul><li>Local or national initiatives </li></ul><ul><ul><li>Society to Rescue People from Drowning (MRD) </li></ul></ul>
  4. 4. Introduction: Utstein Criteria International consensus between experts in reporting drowning 0 1 Outcome 3 3 Disposition 2 1 Hospital course 2 5 Emergency department treatment 8 8 Scene information 3 5 Victim information Supplemental (n) Core (n) Subject Utstein
  5. 5. Introduction: Utstein Criteria Preexisting ilness Residence Race or ethnic category Precipitating event Date / time of day of incident Age Sex Victim indentifier Victim information
  6. 6. Introduction: Utstein Criteria Neurological status (GCS) Time of first EMS resuscitation attempt Initial vital signs (breathing, pulse) EMS called (yes/no) Resuscitation before EMS arrived Unconscious when removed from water Body of water Witnessed (submersion is observed) Scene information (1)
  7. 7. Introduction: Utstein Criteria Oxygen saturation, temperature, blood pressure, pupillary reaction Time of first EMS assessment EMS vehicle dispatched Who gave CPR Method of CPR Cyanosis (yes/no) Time of removal of victim from water Time of submersion if known Approximate water temperature (°C) Water, Liquid type Scene information (2)
  8. 8. Introduction: Methods of drowning registration <ul><li>International </li></ul><ul><ul><li>Based on Utstein Criteria for reporting drowning incidents </li></ul></ul><ul><li>Local or national initiatives </li></ul><ul><ul><li>Society to Rescue People from Drowning (MRD) </li></ul></ul>
  9. 9. Introduction: Society to Rescue People from Drowning (MRD) <ul><ul><li>Founded in 1767 </li></ul></ul><ul><ul><li>Award scheme for successful rescues </li></ul></ul><ul><ul><li>6900 awards between 1767 - 2005 </li></ul></ul><ul><ul><li>Initiator world congress on drowning in 2002 </li></ul></ul>
  10. 10. Introduction <ul><li>Data collected </li></ul><ul><ul><li>Fatal drownings </li></ul></ul><ul><ul><li>Non-fatal drownings </li></ul></ul><ul><ul><li>Victims age & gender </li></ul></ul><ul><ul><li>Locations </li></ul></ul><ul><ul><li>Causes?? </li></ul></ul>
  11. 11. Introduction <ul><li>Not normally registrated: </li></ul><ul><ul><li>Who are the (lay) people that rescue drowning victims? </li></ul></ul><ul><ul><li>How do rescuers save a drowning victim? </li></ul></ul><ul><ul><li>How often is resuscitation required and how is this performed? </li></ul></ul>
  12. 12. Introduction <ul><li>Aim of the study: </li></ul><ul><ul><li>Is the award scheme a potential source for research on prevention, rescue and resuscitation of drowning cases? </li></ul></ul>
  13. 13. Materials and methods <ul><li>Study period 1999-2004 </li></ul><ul><li>289 drowning cases </li></ul><ul><li>133 parameters </li></ul><ul><li>Utstein Criteria for reporting drowning </li></ul><ul><li>accidents </li></ul><ul><li>Threshold when parameter available in 60% </li></ul>Newspapers and magazines Police- and firefighter-reports MRD-reports / Letters
  14. 14. Results: 60% threshold <ul><li>26 variables available in > 60 % </li></ul><ul><li>343 drowning victims and 503 rescuers </li></ul>
  15. 15. Results: Known data <ul><ul><li>More male drowning victims (62%) </li></ul></ul><ul><ul><li>Most drownings between May and August (45%) </li></ul></ul><ul><ul><li>Most drownings in public open waters (68%) </li></ul></ul><ul><ul><li>Many drowning victims are under 10 years of age (46%) </li></ul></ul>
  16. 16. Results: New data about drowning victims <ul><ul><li>289 (84,3 %) were single victim rescues, 36 (10,5 %) were double victim rescues and in 18 ( 5,2 %) rescues three ore more victims had to be rescued. </li></ul></ul><ul><ul><li>Most drowning victims in swimmingpools are children under 10 years (72%) </li></ul></ul><ul><ul><li>In 18 rescues (5,4%) the victim was driving a vehicle for the disabled, of these 12 were (67%) above 70 years of age. </li></ul></ul>
  17. 17. Results: New data about rescuers (1) <ul><ul><li>There is often more than one rescuer (43%) </li></ul></ul><ul><ul><li>Most rescuers saw the immersion happen themselves and responded. (59%) </li></ul></ul><ul><ul><li>Children under 15 years of age are quite capable of rescuing a drowning victim (12%) </li></ul></ul>
  18. 18. Results: New data about rescuers (2) <ul><ul><li>Most rescuers are male (77%) </li></ul></ul><ul><ul><li>After most rescues more than one person provided first aid. (87%) </li></ul></ul><ul><ul><li>Resuscitation of drowning victims was performed after 209 rescues. (61%) </li></ul></ul>
  19. 19. Results: Resuscitation 100 209 Total 31,4 37 Unknown methods 1,7 2 Passive drainage (Face down) 5,9 7 Active drainage (Heimlich, tapping on back, letting victim vomit) 1,7 2 Compressing abdomen 5,1 6 Thorax compressions 15,3 18 Mouth to mouth 38,9 46 Thorax compressions + mouth to mouth % N Method
  20. 20. Results: Utstein based variables * 12 Utstein based variables available in more than 60 % of the cases 0 0 1 Outcome 0 3 3 Disposition 0 2 1 Hospital course 0 2 5 Emergency department treatment 6 8 8 Scene information 6 3 5 Victim information (n) Supplemental (n) Core (n) Subject This study * Utstein
  21. 21. Conclusions (1) <ul><li>26 of 133 parameters are available for analysis </li></ul><ul><ul><li>These data are largely consistent with existing (inter)national data </li></ul></ul><ul><li>The current MRD reports to reward bystanders are of some but limited use for analysis. </li></ul>
  22. 22. Conclusions (2) <ul><li>If the data-set is re-defined and the registration becomes more uniform and goal oriented, structured data collection and analysis seems possible and realistic. </li></ul><ul><li>The MRD reports are an important source for obtaining new and rarely gathered data on the role of (lay) bystanders during the rescue and resuscitation of drowning victims in addition to the Utstein criteria. </li></ul>
  23. 23. Learning outcomes (1) <ul><li>The role of bystanders in the rescue and resuscitation of drowning victims can be studied by the reward scheme of the ‘Maatschappij tot Redding van Drenkelingen’. </li></ul>
  24. 24. Learning outcomes (2) <ul><li>Not all Utstein criteria for drowning are available for analysis. </li></ul>
  25. 25. Learning outcomes (3) <ul><li>Research on the role of bystanders in rescue and resuscitation of drowning victims provides relevant information for the prevention of drowning, as well as the rescue and treatment of drowning victims. </li></ul>
  26. 26. <ul><li>Questions??? </li></ul>

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