Mortality among drowning rescuers in China, 2013: a review of 225 rescue incidents from the press Yinchao Zhu1*dagger;, Xia Jiang2dagger;, Hui Li1, Fudong Li3 and Jieping Chen1
Abstract Background: Drowning is common worldwide. Rescue efforts attempted by untrained bystanders often lead to the death of the primary drowning victim (PDV), the rescuer or both. Our study aimed to inform prevention by identifying risk factors in rescuer drowning. Methods: Data on drowning rescue incidents reported online in mainland China, 2013, were reviewed. Information on the drowning incidents, PDVs and rescuers were retrieved for analysis. Results: A total of 225 rescue incidents were identified, of which 14 were victim-rescuer drowning incidents (VRDIs) (6.2 %). A person-to-person rescue by swimming to PDVs was the most commonly used method (58.9 %). Resuscitation was given immediately to 35.5 % of PDVs after rescue. The mortality rate of the rescuers (13.3 %) was similar to that of the PDVs (11.5 %) (chi;2 =0.5,p =0.49). Being an adult (OR=0.2, 95 % CI: 0.1–0.5) and other than the first rescuer (OR=0.4, 95 % CI: 0.2–0.9) decreased the risk of rescuers drowning. Conclusions: Most of the currently employed life-saving methods are dangerous and even potentially life threatening. The idea of “rescuersrsquo; safety first” should be embraced, especially with teenage and child rescuers, who should never be encouraged to rescue others without first guaranteeing their own safety. Promotion of basic rescue skills should be implemented in the general public. Keywords: Drowning, Rescue, Risk factors, Primary drowning victims, Victim-rescuer drowning incidents, Safety, China
Background Drowning has been defined as the process of experiencing respiratory impairment from submersion or immersion in liquid [1], with outcomes classified as death, morbidity, or no morbidity [2]. Some survivors are left with permanent neurologic impairment [3, 4] that inflicts a heavy burden on both their family and society [5]. Moreover, drowning is a major public health concern and a leading cause of unintentional injury deaths globally [6–8]. The worldwide estimate of 388,000 drowning deaths in 2004 [8] is believed to be under-approximated by 40–50 % [9]. Because of preventive measures, death rates from drowning among
high-income countries have declined over recent decades [6, 10, 11]. However, rates remain high among low- and middle-income countries [7, 8, 12, 13], and China ranks highest in the number of drowning deaths worldwide [8]. Drowning cases where bystanders were on the scene and made an effort to rescue (usually because of a sense of duty, supererogation and altruism [14]) often made a crucial difference in the victimsrsquo; survival [15]. Among the few studies focused on rescue-related drowning incidents in which the rescuers have drowned [14–17], the proportion of PDVs who survived has varied by population (43.9 % in Turkey and 93 % in Australia) [16, 17]. We actually do not know how many rescuers survived their rescue attempts. We only know those who lost their lives, but not an overall total number (rescuers who died plus rescuers who survived, as the baseline denominator); therefore, we cannot calculate the risk of drowning while attempting a rescue [14, 16, 17].
Moreover, given all the permutations of internal and external elements the rescuers would encounter, as well as the shortage of time to plan for a safe approach, untrained rescuers may not only fail to rescue victims, but may subject themselves to so-called victim-instead-ofrescuer syndrome [16] and cause multiple drowning incidents [17]. Therefore, the goal of this research was to inform development of preventive strategies by identifying the risk factors for drowning rescuers. The goal was addressed by examining the cases of drowning rescues reported online in the mainland Chinese media in 2013.
Methods This study was approved by the ethical committee of Ningbo Municipal Center for Disease Control and Prevention. The data collection process is shown in a flowchart (Fig. 1). lsquo;Baidursquo; (lsquo;百度rsquo; in Chinese), the worldrsquo;s largest Chinese language search engine, was used to search for Chinese news reports. All cases were retrieved from online news reports with at least two of the following keywords tagged: lsquo;drowningrsquo; ,lsquo;near-drowningrsquo; ,lsquo;fall into waterrsquo; , lsquo;rescuersquo; , lsquo;life-savingrsquo;, and lsquo;sacrificersquo; (lsquo;淹死rsquo; , lsquo;溺水rsquo; , lsquo;落 水rsquo; ,lsquo;救人rsquo; ,lsquo;救命rsquo; ,lsquo;牺牲rsquo; in Chinese). We covered both unintentional and intentional drowning cases. All the cases were from websites of national or regional newspapers, and police and fire departments. Owing to the lack of full information from a single report, related reports identified as having the same name of victims or rescuers or a similar news title were also searched further, with the aim of collecting the most complete information for each event.
The following variables were constructed: (1) Incidents: province, date, time, drowning locations; (2) PDVs: demographic characteristics, cause of drowning, whether reported by the news as being a swimmer, survival status, symptoms (for survivors) and whether first aid was provided; (3) Rescuers: demographic characteristics, whether reported by the news as being a swimmer, rescue rank (whether the rescuer was the first, second, or some subsequent person to attempt rescue), whether the rescuers called for othersrsquo; help and whether they undressed before the rescue, rescue measures, number of drowning victims in need, whether difficulties were experienced and the nature of such difficulties, and survival status. After excluding 25 cases that were missing more than half of the variables, we eventually obtained 91 cases of incidents, 99 PDVs, and 64 rescuers with virtually complete information, constituting 40.4 %, 36.5 % and 15.4 % of the total number of incidents (225), PDVs (271) and rescuers (416), respectively.
Terms and definitions The details on terms and their definitions are provided in Tab
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Mortality among drowning rescuers in China, 2013: a review of 225 rescue incidents from the press
中国溺水救援人员的死亡率，2013年:225起新闻报道的救援事件回顾
Abstract Background: Drowning is common worldwide. Rescue efforts attempted by untrained bystanders often lead to the death of the primary drowning victim (PDV), the rescuer or both. Our study aimed to inform prevention by identifying risk factors in rescuer drowning. Methods: Data on drowning rescue incidents reported online in mainland China, 2013, were reviewed. Information on the drowning incidents, PDVs and rescuers were retrieved for analysis. Results: A total of 225 rescue incidents were identified, of which 14 were victim-rescuer drowning incidents (VRDIs) (6.2 %). A person-to-person rescue by swimming to PDVs was the most commonly used method (58.9 %). Resuscitation was given immediately to 35.5 % of PDVs after rescue. The mortality rate of the rescuers (13.3 %) was similar to that of the PDVs (11.5 %) (chi;2 =0.5,p =0.49). Being an adult (OR=0.2, 95 % CI: 0.1–0.5) and other than the first rescuer (OR=0.4, 95 % CI: 0.2–0.9) decreased the risk of rescuers drowning. Conclusions: Most of the currently employed life-saving methods are dangerous and even potentially life threatening. The idea of “rescuersrsquo; safety first” should be embraced, especially with teenage and child rescuers, who should never be encouraged to rescue others without first guaranteeing their own safety. Promotion of basic rescue skills should be implemented in the general public. Keywords: Drowning, Rescue, Risk factors, Primary drowning victims, Victim-rescuer drowning incidents, Safety, China
译文： 背景:溺水在世界范围内都很常见。未经训练的旁观者试图进行的救援往往导致主要溺水者(PDV)、救援者或两者都死亡。我们的研究旨在通过识别救援人员溺水的危险因素来进行预防。方法:对2013年中国大陆网上报道的溺水救援事件数据进行分析。获取溺水事件、PDVs和救援人员信息进行分析。结果:共鉴定出225起救援事故，其中溺水事故14起(6.2%)。最常用的方法是人对人的游泳至PDVs进行抢救(58.9%)。抢救后35.5%的PDVs立即复苏。救援者的死亡率(13.3%)是类似于刚才(11.5%)(chi;2 = 0.5,p = 0.49)。成年(OR=0.2, 95% CI: 0.1-0.5)和非第一救援者(OR=0.4, 95% CI: 0.2 - 0.9)降低了救援者溺水的风险。
结论:目前使用的大多数救生方法是危险的，甚至有潜在的生命威胁。“救援人员安全第一”的理念应该被接受，尤其是在青少年和儿童救援人员中，不应该鼓励他们在没有首先保证自身安全的情况下救援他人。应向公众推广基本的救援技能。关键词:溺水;救援;危险因素。
Background Drowning has been defined as the process of experiencing respiratory impairment from submersion or immersion in liquid [1], with outcomes classified as death, morbidity, or no morbidity [2]. Some survivors are left with permanent neurologic impairment [3, 4] that inflicts a heavy burden on both their family and society [5]. Moreover, drowning is a major public health concern and a leading cause of unintentional injury deaths globally [6–8]. The worldwide estimate of 388,000 drowning deaths in 2004 [8] is believed to be under-approximated by 40–50 % [9]. Because of preventive measures, death rates from drowning among
译文： 溺水被定义为由于浸泡或浸泡在液体[1]中而发生呼吸障碍的过程，其结果分为死亡、发病或无发病[2]。一些幸存者留下了永久性的神经功能障碍[3,4]，这给他们的家庭和社会带来了沉重的负担。此外，溺水是一个主要的公共卫生问题，也是全球意外伤害死亡的主要原因[6-8]。据估计，2004年全球溺水死亡人数为38.8万人，但这一数字被低估了40 - 50%。由于采取了预防措施，溺水死亡率居高不下。
high-income countries have declined over recent decades [6, 10, 11]. However, rates remain high among low- and middle-income countries [7, 8, 12, 13], and China ranks highest in the number of drowning deaths worldwide [8]. Drowning cases where bystanders were on the scene and made an effort to rescue (usually because of a sense of duty, supererogation and altruism [14]) often made a crucial difference in the victimsrsquo; survival [15]. Among the few studies focused on rescue-related drowning incidents in which the rescuers have drowned [14–17], the proportion of PDVs who survived has varied by population (43.9 % in Turkey and 93 % in Australia) [16, 17]. We actually do not know how many rescuers survived their rescue attempts. We only know those who lost their lives, but not an overall total number (rescuers who died plus rescuers who survived, as the baseline denominator); therefore, we cannot calculate the risk of drowning while attempting a rescue [14, 16, 17].
译文： 近几十年来，高收入国家的收入一直在下降[6,10,11]。然而，低收入和中等收入国家的溺水死亡率仍然很高[7,8,12,13]，而中国是世界上溺水死亡人数最多的国家。溺水案中，旁观者在场并努力营救(通常是出于责任感、优越感和利他主义的[14])往往会对受害者的生存[15]产生至关重要的影响。在少数关注救援相关溺水事件的研究中，救援人员溺水[14-17]，幸存的PDVs比例因人口而异(土耳其为43.9%，澳大利亚为93%)[16,17]。我们实际上不知道有多少救援人员在他们的救援努力中幸存下来。我们只知道那些失去生命的人，但不知道总人数(死亡的救援人员加上幸存的救援人员，作为基线分母);因此，我们无法计算在尝试救援时溺水的风险[14,16,17]。
Moreover, given all the permutations of internal and external elements the rescuers would encounter, as well as the shortage of time to plan for a safe approach, untrained rescuers may not only fail to rescue victims, but may subject themselves to so-called victim-instead-ofrescuer syndrome [16] and cause multiple drowning incidents [17]. Therefore, the goal of this research was to inform development of preventive strategies by identifying the risk factors for drowning rescuers. The goal was addressed by examining the cases of drowning rescues reported online in the mainland Chinese media in 2013.
译文： 此外,鉴于所有内部和外部元素所有救援人员会遇到,以及很难短缺的时间来计划一个安全的方法,未经训练的救援人员可能不仅无法拯救受害者,但可能产生所谓victim-instead-ofrescuer综合症[16],造成多个溺水事件[17]。因此，本研究的目的是通过识别溺水救援人员的危险因素，为制定预防策略提供依据。通过对2013年中国大陆媒体在网上报道的溺水救援案例进行调查，这一目标得以实现。
Methods This study was approved by the ethical committee of Ningbo Municipal Center for Disease Control and Prevention. The data collection process is shown in a flowchart (Fig. 1). lsquo;Baidursquo; (lsquo;百度rsquo; in Chinese), the worldrsquo;s largest Chinese language search engine, was used to search for Chinese news reports. All cases were retrieved from online news reports with at least two of the following keywords tagged: lsquo;drowningrsquo; ,lsquo;near-drowningrsquo; ,lsquo;fall into waterrsquo; , lsquo;rescuersquo; , lsquo;life-savingrsquo;, and lsquo;sacrificersquo; (lsquo;淹死rsquo; , lsquo;溺水rsquo; , lsquo;落 水rsquo; ,lsquo;救人rsquo; ,lsquo;救命rsquo; ,lsquo;牺牲rsquo; in Chinese). We covered both unintentional and intentional drowning cases. All the cases were from websites of national or regional newspapers, and police and fire departments. Owing to the lack of full information from a single report, related reports identified as having the same na
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