Conclusion: Indications for effectiveness
In a narrative review of the literature on lifejackets by Turner et al. (2009) evidence was found that lifejackets are effective in reducing the risk of drowning.
Other reports on child safety and drowning also indicate that there is reason to assume the effectiveness of personal flotation devices to prevent drowning;
- In a report on child injury prevention (Peden et al., 2008) the World Health Organisation states; "Although not yet thoroughly evaluated, wearing a properly-fitted personal flotation device, such as a lifejacket, is a promising strategy to prevent drowning. Flotation devices such as life jackets are indispensable on all vessels, whether used for transport or for pleasure. In addition to the lack of flotation devices, the poor maintenance of such equipment is an additional risk. Only approved safety equipment should be used for children and it should not substitute adequate supervision."
- The safety guideline of the Child Safety Alliance states that; expert opinion states that the use of a personal flotation device (PFD) for boating and other water recreational activities is a recommended preventive strategy in the prevention of drowning (Norman & Vincenten, 2008).
- A recent technical report on drowning concluded the use of an approved PFD, although not well evaluated, seems likely to decrease drowning morbidity and mortality (Weiss, 2010).
Although not based on randomised control trials the overall conclusion is that there are indications for effectiveness of personal flotation devices to prevent drowning when correctly used. This is based on scientific literature as well as on expert opinion.
Recommendations (for research & practice)
Recommendations for practice
Training on Personal Flotation Device fitting and maintenance is important because there are indications that when used incorrectly, death can occur despite of wearing a PFD (Turner et al., 2009). Air filled swimming aids (such as inflatable arm bands) are toys that can deflate and should not be used in place of PFDs.
Only approved safety equipment should be used for children and it should not substitute adequate supervision (Peden et al., 2008).
A PFD for a child/infant must be simple, intuitive design and fall naturally into the anatomical shape of the child. A minimum number of ties, zips and clips should be used in the design, and if such connectors are used they should be color coded or of different shapes and sizes to avoid confusion. (MacDonald et al., 2010)
Recommendations for research
Additional research on the effectiveness of personal flotation devices would be useful. The possible increase in risk taking behaviour when wearing a PFD should be assessed. Also the risk of mortality from cold water shock and swimming failure should be studied in order to know more about the potential effectiveness of PFDs in these conditions.
Review Date: 15/12/2010
Articles (reviews) and reports were included that were published between 1990 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in the spring of 2011.
MCA lifejacket wear : behavioural change (version 1.1)
Sally Turner, Julie Wylde, Martin Langham ...[et al.] (2009)
A new definition of drowning : towards documentation and prevention of a global public health problem (version 1.0)
E.F. van Beeck, C.M. Brache, D. Szpilman ... [et al.] (2005)
Protecting children and youths in water recreation : safety guidelines for service providers (version 1.4)
N. Norman, J. Vincenten (2008)
Technical report : prevention of drowning (version 1.0)
Jeffrey Weiss (2010)
A guide to personal flotation devices and basic open water safety for pediatric health care practitioners (version 1.1)
P. Yuma, J. Carroll, M. Morgan (2006)
An ergonomic evaluation of infant life jackets : donning time & donning accuracy (version 1.1)
C.V. MacDonald, C.J. Brooks, J.W. Kozey ...[et al.] (2010)