Drowning in swimming pools: clinical features and safety recommendations based on a study of descriptive records by emergency medical services attending to 995 calls

<p><b>INTRODUCTION</b>This study was a descriptive analysis of national ambulance case records and aimed to make practical safety recommendations in order to reduce the incidence of drowning in swimming pools.</p><p><b>METHODS</b>A search was performed of a national database of descriptive summaries by first-responder paramedics of all 995 calls made to the Singapore Civil Defence Force between 1 January 2012 and 31 December 2014. We included all cases of submersion in both public and private pools for which emergency medical services were activated.</p><p><b>RESULTS</b>The highest proportion of drowning cases occurred in the age group of 0-9 years. Males accounted for 57.0% (61/107) of cases. Bystander cardiopulmonary resuscitation (CPR) was performed in 91.3% (21/23) and 68.6% (48/70) of cases of cardiac/respiratory arrest from drowning in public and private pools, respectively; the rate of bystander CPR was higher when a lifeguard was present (88.5%, 23/26 vs. 68.7%, 46/67). The majority (72.0%, 77/107) of drowning incidents occurred in private pools, most of which had no lifeguards present.</p><p><b>CONCLUSION</b>To our knowledge, this study was the first in Singapore to examine data from emergency medical services. Since the majority of incidents occurred in private pools without lifeguards, it is recommended that a lifeguard be present at every pool. For pools that are too small to justify mandatory lifeguard presence, safety measures, such as guidelines for pool design and pool fencing with latched gates, may be considered. As strict enforcement may not be possible, public education and parental vigilance remain vital.</p>

Aislamiento e identificación de Pseudomonas sp. y Aeromonas sp. en aguas de piscinas públicas de Bogotá - Colombia / Isolation and identification of Pseudomonas sp. and Aeromonas sp. In public swimming pool waters of Bogotá - Colombia

Resumen Objetivo. Analizar la calidad del agua de piscinas públicas de Bogotá mediante el recuento de Pseudomonas sp. y Aeromonas sp. Método. Se tomaron 48 muestras de agua de 8 piscinas públicas, durante 3 meses. Se realizó el método de filtración por membrana para el recuento de estos dos géneros bacterianos. Resultados. El 100% de las piscinas analizadas presentan recuentos de Pseudomonas sp. por encima de lo contemplado en la Resolución 1618 de 2010 (Colombia) y 63% de las piscinas presentaron recuentos de Aeromonas sp.

Abstract Objective. To determine the quality of the water of public swimming pools of Bogota by means of the count of Pseudomonas sp. and Aeromonas sp. Method. It took 48 water samples from eight public pools, for 3 months, was performed by membrane filtration method for the enumeration of these two bacterial genera. Results. The results show that 100% of the tested pools present counts of Pseudomonas sp. above that provided for in the Resolution 1618 and 63% of the pools had counts of Aeromonas sp.

Uso da ventilação não invasiva em síndrome do desconforto respiratório agudo grave por inalação acidental de cloro: um relato de caso / Use of noninvasive ventilation in severe acute respiratory distress syndrome due to accidental chlorine inhalation: a case report

RESUMO A síndrome do desconforto respiratório agudo é caracterizada por lesão pulmonar inflamatória difusa, classificada em leve, moderada e grave. Clinicamente observam-se hipoxemia, opacidades bilaterais na imagem pulmonar e diminuição da complacência pulmonar. A sepse está entre as causas mais prevalentes (30 - 50%). Dentre as causas diretas de síndrome do desconforto respiratório agudo, a inalação de cloro é uma causa incomum, gerando, na maior parte dos casos, irritação de mucosas e vias aéreas. Apresentamos um caso de síndrome do desconforto respiratório agudo grave após inalação acidental de cloro em piscina, sendo utilizada ventilação não invasiva como tratamento com boa resposta neste caso. Classificamos como síndrome do desconforto respiratório agudo grave baseado na relação pressão parcial de oxigênio/fração inspirada de oxigênio < 100, embora a classificação de Berlin seja limitada em considerar pacientes com hipoxemia grave manejados exclusivamente com ventilação não invasiva. A taxa de falha da ventilação não invasiva nos casos de síndrome do desconforto respiratório agudo está em torno de 52%, estando associada à maior mortalidade. As possíveis complicações do uso da ventilação mecânica não invasiva com pressão positiva na síndrome do desconforto respiratório agudo seriam o atraso para a intubação orotraqueal sendo a mesma realizada em uma condição clínica pior e um alto nível de pressões de suporte, somados a esforços inspiratórios profundos, gerando elevados volumes correntes e pressões transpulmonares excessivas, que contribuem para injúria pulmonar associada à ventilação. Apesar disto, alguns estudos mostraram diminuição nas taxas de intubação orotraqueal em pacientes com síndrome do desconforto respiratório Agudo com baixos escores de gravidade, estabilidade hemodinâmica e ausência de outras disfunções orgânicas.

ABSTRACT Acute respiratory distress syndrome is characterized by diffuse inflammatory lung injury and is classified as mild, moderate, and severe. Clinically, hypoxemia, bilateral opacities in lung images, and decreased pulmonary compliance are observed. Sepsis is one of the most prevalent causes of this condition (30 - 50%). Among the direct causes of acute respiratory distress syndrome, chlorine inhalation is an uncommon cause, generating mucosal and airway irritation in most cases. We present a case of severe acute respiratory distress syndrome after accidental inhalation of chlorine in a swimming pool, with noninvasive ventilation used as a treatment with good response in this case. We classified severe acute respiratory distress syndrome based on an oxygen partial pressure/oxygen inspired fraction ratio <100, although the Berlin classification is limited in considering patients with severe hypoxemia managed exclusively with noninvasive ventilation. The failure rate of noninvasive ventilation in cases of acute respiratory distress syndrome is approximately 52% and is associated with higher mortality. The possible complications of using noninvasive positive-pressure mechanical ventilation in cases of acute respiratory distress syndrome include delays in orotracheal intubation, which is performed in cases of poor clinical condition and with high support pressure levels, and deep inspiratory efforts, generating high tidal volumes and excessive transpulmonary pressures, which contribute to ventilation-related lung injury. Despite these complications, some studies have shown a decrease in the rates of orotracheal intubation in patients with acute respiratory distress syndrome with low severity scores, hemodynamic stability, and the absence of other organ dysfunctions.

Calidad fisicoquímica y microbiológica del agua de piscinas de dos complejos recreacionales del Estado Zulia / Physicochemical and microbiological quality of swimming pool water of two recreational complexes in Zulia State

La presente investigación tuvo como objetivo analizar la calidad fisicoquímica y microbiológica del agua de piscinas de dos complejos recreacionales ubicados al oeste de la ciudad de Maracaibo, estado Zulia, de acuerdo con lo establecido en las normas sanitarias venezolanas (Gacetas Oficiales 4044 y 36395). Se realizó un muestreo en veinte (20) piscinas destinadas a actividades recreativas ubicadas en dos complejos. Los parámetros que se midieron para analizar la calidad sanitaria del agua de piscinas fueron: color verdadero, conductividad eléctrica, sólidos totales, sólidos disueltos totales, turbidez, alcalinidad total, cloro libre residual, dureza total, pH, coliformes totales, coliformes fecales y organismos heterótrofos. Los parámetros fisicoquímicos sólidos disueltos, turbidez y color verdadero presentaron concentraciones promedios menores a los establecidos por las normas sanitarias vigentes; sin embargo, los valores promedios de cloro residual y pH se encontraron fuera de los rangos recomendados. Los parámetros microbiológicos mostraron que un 30% de las piscinas analizadas presentaron un valor promedio de organismos heterótrofos de 1107 UFC/mL, mayor al límite establecido por la normativa venezolana. Con respecto a los coliformes, un 75 y 60% de las piscinas presentaron al menos un tubo positivo durante la prueba de coliformes totales y fecales, respectivamente.

The present study had as objective to analyze the quality physical-chemical and microbiological of the water of swimming pools of two recreational complexes located in west of the city of Maracaibo, Zulia state, in accordance with the established in the sanitary Venezuelan procedure, the official gazettes 4044, and 36395. Sampling was conducted in twenty (20) aimed at recreational pools located on two recreational complex. The parameters were measured to analyze the quality of water in swimming pools were true color, electrical conductivity, total solids, total dissolved solids, turbidity, total alkalinity, residual free chlorine, total hardness, pH, total coliforms, fecal coliforms and heterotrophic organismes. The physicochemical parameters: dissolved solids, turbidity and electrical conductivity presented average concentrations less than those established by the sanitary standards; however, the mean values of residual chlorine and pH were found outside the recommended ranges. The microbiological tests showed that 30% of the pools tested had an average value of heterotrophic organisms of 107 CFU / mL, higher than the limit set by Venezuelan law. 75 and 60% of the pools presented at least one positive test tube for total and fecal coliforms, respectively