Recommendations of the World Congress on Drowning, Amsterdam 26 – 28 June 2002

As a result of an interactive process of four years that was finalised during plenary sessions, expert meetings and research meetings at the World Congress on Drowning, the following recommendations were made by over 500 experts in the field of drowning prevention, rescue and treatment.

1. A new, more appropriate, world-wide uniform definition of drowning should be used
Uniformity in definition of drowning is important to appreciate the world-wide burden. The following definition was accepted: Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.
All organisations involved in epidemiological registration and research as well as rescue organisations and the medical community should accept this new definition and include this in their glossary. Further consultation of drowning experts is needed to uniformly classify morbidity and mortality.

2. More knowledge should be collected about drowning in low-income countries
Over 80% of all drownings occur in low-income countries or in low-income groups in high income countries. Yet hardly any epidemiological data about these risk groups are available. The WHO and epidemiological institutions, such as ECOSA, are advised to expand the research on drowning risk factors in these risk groups because this is expected to have a major impact in reducing the drowning risk

3. Preventive strategies are needed
Over 80% of all drownings can be prevented and prevention is the major intervention to reduce the number of drowning. The problem of drowning is however different among the various countries. Consumer product designers and prevention institutions, such as ECOSA, should collaborate to set up national and local prevention, education and training programs. The programs should be evaluated and the results of the evaluations should be published.

4. Rescue techniques should be investigated
Rescue techniques have evolved by trial and error and have hardly ever been investigated. Rescue organisations such as the ILS, ILF, IRCF but also the IMO should start evaluating the rescue techniques in their training programs in accordance with current scientific standards the effectiveness and efficiency. Based on the data, the best rescue techniques should be selected for education and training programs

5. All individuals, and most of all police officers and fire fighters, should learn to swim
Being able to swim is a major skill in preventing drowning. International organisations such as WHO, IRCF and ILS, and their national branches should emphasis at all levels the importance of swimming lessons. More specifically, all police officers and fire fighters should be able to swim for their own safety and for the safety of the public.

6. Resuscitation skills should be learned by all professionals who frequent aquatic areas
The instant institution of the optimal first aid and resuscitation techniques is the most important factor to survive after drowning has occurred. Rescue and resuscitation organisations, such as to ILCOR related organisations, as well as professional organisations and other groups who frequent aquatic areas, should initiate training programs in first aid and Basic Life Support.

7. Uniform reporting of drowning resuscitation
To increase the understanding in the dying process and resuscitation potential in drowning, a uniform reporting system should be developed and used for the registration of resuscitation of drowning.
International resuscitation organisations, such as ILCOR related organisations and medical groups, should establish such a uniform reporting system, facilitate its use, been involved in the analysis and support implementations of the advises based on the studies.

8. Hospital treatment of the severe drowning victim should be concentrated
Optimal treatment of drowning victims include specific severe complications such as Adult Respiratory Distress Syndrome, pneumonia, hypoxic brain damage, hypothermia and cervical spine injuries. For optimal treatment and promotion of clinical research, drowned victims should be treated in national specialised intensive care centres.

9. Optimalization of brain treatment should be based on appropriate studies
Brain damage in drowning occurs due to hypothermia while the circulation gradually decreases. The damage is therefore unlike other brain injuries such as in subarchnoidal bleeding, head trauma or strangulation. The scientific basis for understanding the effects of mild and severe hypothermia, hyperthermia and glucose modulation on brain damage is based on the extrapolation of the non-drowning situations. Consensus on several clinical aspects has been reached, based on the current knowledge, and recommendations for required research have been defined in this fascinating area.
Academic institutions should initiate drowning related research to better understand the effects of the brain injury during drowning and to find ways for better prevention and treatment of the neurological hypoxic damage.

10. An international data registration on immersion hypothermia is needed
Hypothermia enhances the risk of drowning even at body temperatures of 350C. Reduction of muscle powers at these temperatures have been observed, with underestimated consequences for self rescue.
The optimal rewarming strategy has not yet been defined. An international registration system should be established with the help of international bodies, such as WHO, ILF and IMO, to collect relevant data on cause, clinical course and rewarming strategies of hypothermic immersion and submersion victims. Based on the results of these studies, prevention, rescue and treatment of immersion hypothermia should be improved.

11. The balance between safety and profitability of diving should remain critically observed
It has been observed that there is a delicate balance between profitability and safety in commercial diving courses, but also in native diving in low income countries.
The international diving organisations, such as DAN, should support and execute all activities related to legislation, the designs of an adequate registration system and better working conditions

12. Several other recommendations have been proposed and need the full support of related organisations
Before and during the World Congress on Drowning, many important recommendations were made, in all the areas of attention. Many of these recommendations include research projects such as :

• Uniformity of beach signs and safety flags
• Determination of optimal visual scanning techniques
• Construction of the most adequate rescue boats, including alternatives as jet boats, hovercrafts, with minimum risk of injuries for the drivers
• Development of insulative garments for aquatic activities

• Risk assessment of beaches
• Treatment of hypothermia
• Legal aspects
• Evacuation planning of large passenger ships
• Uniformity in international academic training programs for life guards\
• Fund raising