Elizabeth A. Camp

Most drowning deaths in the United States occur in natural water. Natural water settings are diverse with a variety of risks. Drownings also impose economic burden on local governments. This study describes drowning deaths in natural waters in the Houston metropolitan region and identify associated risk factors.This was a cross-sectional study of drowning deaths involving persons of all ages in the Houston metropolitan region from 2016 to 2022. Information on drowning deaths was obtained from probabilistically-linked data. High-risk drowning locations were identified based on the number of drowning deaths per capita. Associated risk factors were examined. Fifty-two percent of drowning deaths occurred in natural water locations. More than one-third occurred in flood control structures. Next were drowning deaths along the Gulf of Mexico (the ”Gulf”), mostly beach drowning deaths, followed by those in bays, lakes, flood waters, and rivers. Drowning death risk was higher in recreational areas. Beach drowning deaths were more likely to occur along the Gulf coast while boat-related drowning deaths were more dispersed in the Gulf, bays and lakes. Eight high-risk drowning locations were identified. Poor swimming ability was identified among decedents at all eight locations. Alcohol or drug use among decedents was also documented. Local governments can work to reduce drownings. Actions include expanding swimming lessons for children, emphasizing life jacket use for children, boaters, and people with limited swimming skills. Targeting countermeasures at high-risk drowning locations is needed including better warning signage and community outreach. Better protective barriers are needed at flood control structures.

Drowning is the leading cause of death in children 1–4 years old in the USA. Paediatricians play an important role in giving anticipatory guidance on drowning prevention. This quality improvement initiative aimed to increase the rate of drowning prevention counselling with provision of educational materials to caregivers of children aged 0–10 years during clinical encounters in an outpatient setting. We refined a previously published Texas state educational programme that included evidence-based counselling strategies across three Plan Do Study Act (PDSA) cycles, with the addition of preintervention baseline counselling phase during expansion of the programme nationally to 17 and 21 states in 2022 and 2023, respectively. All participating paediatricians in office-based, urgent care and emergency settings completed demographic, preintervention and postintervention and programme evaluation surveys. Paediatricians in office-based settings (majority of participants) tracked counselling rate across baseline and three PDSA cycles. Caregivers completed postintervention surveys on knowledge and anticipated behaviour change. Drowning prevention education was supplemented by materials provided to caregivers including brochures and wearable water watcher tags to promote adult supervision. During the first 2 years of national expansion, 120 physicians and 7886 caregivers participated in the programme. Provision of drowning prevention educational materials to caregivers significantly closed an existing gap. Less than 25% of caregivers reported receipt of brochure/checklist and only 6% water watcher tag at baseline; compared with 98% and over 90%, respectively, after PDSA 3 in both years. 69.3% of physicians were able to efficiently counsel on drowning prevention within 2 mins in 2022 versus 82.1% in 2023 (p value<0.001). Most caregivers found the counselling helpful and planned to use the water safety strategies. We demonstrated a significant increase in mean counselling rate from preintervention phase (26.8%) through end of PDSA 3 (64.9%) in this national programme.

Objective: Emergency department observation units (EDOUs) are used to manage common pediatric illnesses and reduce the admission rate to the hospital. Most of these patients require a short duration of observation before a determination can be made whether they need to be admitted to the hospital or safely discharged home. The purpose of this study was to determine the characteristics of...

Background: The relationship between childhood sexual abuse (CSA) and childhood obesity (CO) is unclear with studies reporting conflicting results in female populations. This study aims to assess the association between suspected CSA and current emergency department (ED) weight status when compared with trauma patients. Methods: This is a single-center retrospective case–control study that utilized pediatric ED data (2016–2018) from identified female patients (6–17 years old) with a chief complaint of sexual assault and trauma registry patients. Focus was on female patients for literary comparisons. Two weight measurements were calculated based on available height data: BMI-for-age and weight-for-age. Nonparametric testing and binary logistic regression were utilized. Results: There were 2044 study participants: 1454 (71.1%) cases and 590 (28.9%) controls. Cases were older, underrepresented minorities (URMs), and carried public insurance (all p -values p -value = 0.03], whereas the weight-for-age metric increased the aOR odds by 58% [aOR = 1.58 (95% CI 1.14–2.17); p -value = 0.01] when compared with pediatric trauma patients. Similar results were found in a sensitivity analysis using patients matched on age and URM. Conclusion: Our data demonstrated an association between suspected CSA and CO. More research is needed to identify the biopsychosocial implications for this relationship and the potential to augment clinical care.

Background: Debriefing clinical events in the emergency department (ED) can enhance team performance and provide mutual support. However, ED debriefing remains infrequent and nonstandardized. A clinical tool (DISCERN—Debriefing In Situ Conversation after Emergent Resuscitation Now) was developed to facilitate ED debriefing. To date, there are no studies providing qualitative analysis of clinical event debriefs done using such a tool. Our goal was to explore common themes elicited by debriefing following implementation of DISCERN.Methods: This was a retrospective mixed‐methods study analyzing DISCERN data from 2012 through 2017 in a pediatric ED. Quantitative data were analyzed using descriptive statistics. With constant comparison analysis, themes were categorized when applicable within the context of crisis resource management (CRM) principles, previously used as a framework for description of nontechnical skills. Member checking was performed to ensure trustworthiness.Results: We reviewed 400 DISCERN forms. Overall, 170 (41.6%) of target clinical events were debriefed during the study period. The number of clinical events debriefed per year decreased significantly over the study period, from 118 debriefed events in 2013 to 20 debriefed events in 2017 (p < 0.001). Events were more likely to be debriefed if cardiopulmonary resuscitation was needed (odds ratio [OR] = 11.8, 95% confidence interval [CI] = 4.1–33.8]) or if the patient expired (OR = 8.9, 95% CI = 2.7–29.1]). CRM principles accounted for 81% of debriefing statements, focusing on teamwork, communication, and preparation, and these themes remained consistent throughout the study period.Conclusions: Use of the DISCERN tool declined over the study period. The DISCERN tool was utilized more commonly after the highest‐acuity events. Clinical event debriefs aligned with CRM principles, with medical knowledge discussed less frequently, and the content of debriefs remained stable over time.

Background: The optimal structure of simulation to train teams to perform pediatric advanced life support (PALS) requires further research. Most simulation is structured with an uninterrupted scenario with postsimulation debriefing (PSD). Rapid‐cycle deliberate practice (RCDP) is structured with a series of simulations with microdebriefing quickly switching within action targeting specific performance goals.Objective: The objective was to compare team performance immediately after training, as well as learner workload, for teams trained using either PSD or RCDP.Methods: In 2018–2019, a total of 41 interprofessional teams of 210 residents and nurses were recruited from 250 eligible participants (84%) and randomized into either arm (RCDP or PSD) teaching the same objectives of resuscitation of a patient in PEA arrest, in the same time frame. The structure of the simulation varied. Demographic surveys were collected before training, the National Aeronautics and Space Administration‐Task Load Index (NASA‐TLX) was administered immediately after training to assess workload during training and performance was assessed immediately after training using a pulseless ventricular tachycardia arrest with the primary outcome being time to defibrillation.Results: Thirty‐nine teams participated over a 16‐month time span. Performance of teams randomized to RCDP showed significantly better time to defibrillation, 100 s (95% confidence interval [CI] = 90–111), compared to PSD groups, 163 s (95% CI = 120–201). The workload of the groups also showed a lower total NASA‐TLX score for the RCDP groups.Conclusions: For team‐based time‐sensitive training of PALS, RCDP outperformed PSD. This may be due to a reduction in the workload faced by teams during training.