Karen Loftus (Host): This is Community Connect: presented by Tampa General Hospital. I'm Karen Loftus. Joining me is Dennrik Abrahan, pediatric critical care attending at Tampa General Hospital. Dr. Abrahan, welcome to the podcast.

Dennrik Abrahan, MD: Hello. Thank you. Thank you for having me. Appreciate it.

Host: We are going to cover a handful of topics on summer safety that are the most common, starting with pool and water safety Dr. Abrahan, what are the most common and most preventable causes of childhood drowning?

Dennrik Abrahan, MD: Drowning is the leading cause of unintentional injury-related death in the US, especially for children ages one to four years of age, and third leading cause for children ages five to 19. And most of those deaths, about 70 happen between May and August. So, that summertime, especially in Florida, is super important.

And we want to look at what are the settings and what are some of our prevention strategies that we can try to prevent this. This really differs by the age group. So for those toddlers ages one to four, most of those drownings occur in residential swimming pools. And this is occurring during just a brief lapse of supervision. Kids are quick. Kids are going to wander outside unnoticed.

There are some preventable factors that we can try to do to prevent that. Providing for supervision, identifying someone to not partake in being distracted, not imbibing in any alcohol. There are physical barriers like fencing that we definitely recommend, as well as advocating for swim skills in this age group.

We want to really advocate again for these swim lessons, especially for children age one and older. And we know this can reduce fatal drowning risk. And our parents need really need to understand that swim lessons alone is never going to drown-proof a child. So, you can't really reduce that supervision. So when there is a swim program, we want to make sure that there is education to correct that misconception. We want to make sure that we have multiple layers preventing that.

Again, the American Academy of Pediatrics supports swim lessons for all children older than one year, and we recommend that all children learn to swim by age four. And again, it's not just by age. We want to make sure that a child's physical, emotional, and cognitive development would be appropriate for a swimming lesson.

We also want to make sure that we have bystander CPR training. And this is associated with improved survival and neurological outcomes. So, I encourage folks who are listening, if you've not done CPR training, there's free classes in the community. I definitely advocate for that. This is something you could do for your family, your friends, and be readily available.

For teens, there are prevention messaging that should address peer pressure, avoiding alcohol near the water, as well as using a life jacket if they're going out in open water and on boats.

I'd like to point out that we want to make sure that, for parents especially, if you do see your child or someone who is drowning, I want to caution those who are untrained rescuers who enter the water to save that person, they are also at risk for drowning. So, a quick rule, for a pool or in the open water, reach, throw or row, and don't go. Call for the nearest person who can help or find a life jacket or a lifesaver to throw to that person if they're able to reach for it.

Host: A quick followup question to that. Can you explain what secondary or delayed drowning is, and what parents or caregivers should know about it?

Dennrik Abrahan, MD: Yeah I like to say that the secondary drowning, dry drowning, delayed drowning, we should really try to move beyond that, because it does cause some confusion and, I think, panic. I think if we just keep it simple and just call it drowning. And really, it's the process of experiencing respiratory distress after being submersed in liquid.

Now, with that said, respiratory complications after a water incident, they happen, but it's very uncommon. And if a child was going to get worse after a submersion event, it's almost always happening in the first four to five hours. And the key things, if there is a submersion event, you want to look out for if there is persisting coughing, difficulty breathing; if you hear weird different lung sounds or if your child starts to become very confused, they're super sleepy. And for any episode for loss of consciousness involving a water submersion, that child should go to the emergency room to be evaluated.

Otherwise, if there's mild coughs, they sound normal and are behaving normally. They could stay at home and be closely monitored by their parents over the next four to five hours. And again, seek help if anything new develops.

Host: Of course, another facet of water safety is watercraft safety. You touched a little bit about this on your first answer, Dr. Abrahan. Though what are the biggest mistakes people make on boats, jet skis, kayaks? And how do life jackets and boating under the influence laws save lives?

Dennrik Abrahan, MD: Yeah. The three biggest mistakes is not wearing a life jacket, drinking alcohol in the water, and then lack of boating education. I definitely advocate for US Coast Guard-approved life jackets. And the little floaties that goes around the arms and the little tubes really don't count.

And I would say that for the majority of boating drownings, these victims are not wearing a life jacket. And federal law requires life jackets for children under 13 on a recreational boat, and all states require them on personal watercraft. And so, you want to make sure that these life jackets are properly sized, they're approved, and the person who is driving the boat is sober. And to be wary of people who are imbibing alcohol. They are at risk for drowning. The risk is the same way as for passengers or operators. Having a sober driver doesn't protect from an intoxicated passenger falling overboard. Again, alcohol is going to impair balance, coordination, judgment, and the ability to survive once in the water.

So again, I think those are the three biggest mistakes: not wearing a life jacket, drinking alcohol in the water, and lack of boating education.

Host: We know summer months are the hottest times of the year, and that means an increased potential for heat-related illness and hot cars too. How fast can a car heat up on a summer day, Dr. Abrahan? And can you speak to the dangers of leaving kids or pets in a hot car?

Dennrik Abrahan, MD: Being from Florida, it gets hot. The average interior of a car rises about three Fahrenheit every five minutes, and 80% of that temperature rise occurs within the first 30 minutes. Even if it's a 70-degree day outside, interior can reach like 110, 115. We don't want to leave our children and pets in the car. Cracking windows isn't going to help. It doesn't reduce the maximum temperature. It doesn't slow the heating.

And why are children or small animals vulnerable? They have a higher surface area to their weight, meaning they could absorb heat faster. If kids are dehydrated, they do not have a robust system to regulate their own temperature, and they are not able to sweat, which helps with keeping ourselves cool. They don't have as much blood volume, because of the size. So, that, again, limits heat from dispersing from the body. And the core temperature of a child rises much faster than an adult.

Host: What's the difference between heat exhaustion and heat stroke? And what are the signs and symptoms to look for?

Dennrik Abrahan, MD: For heat and exhaustion and heat stroke, the thing that really defines it is that altered mental status, being very confused. Typically, heat exhaustion, your body temperature is going to be less than 104 degrees Fahrenheit. You're going to see clammy skin. Again, there might be perspiration, there might not if they're not able to perspire anymore.

But that key thing for you to take away is confusion. When there is confusion, then it's a true emergency. You've got to call 911, and you've got to cool that person as fast as you can. Get them to the shade, have them lie down, remove any excess clothing. And again, trying to get them, again, as cold as possible.

Host: During the summer months, kids are out on their bikes more, which makes this another key safety topic. Why do helmets matter so much? And what does a properly fitted bike helmet actually look like?

Dennrik Abrahan, MD: Yeah. Helmets protect your brain. They protect your head. Bicycle riding is one of the leading causes of head injuries in children. We see a lot of in our emergency departments, and I take care of these patients, unfortunately, too frequently. You know, helmets reduce the risk of head injury, and they reduce the risk of brain injury.

 Unfortunately, the majority of riders just don't wear helmets consistently. A properly fitted helmet, I think of eyes, ears, mouth, where for eyes, the helmet should sit level on the head, low on the forehead, about two finger widths above the eyebrow. For the ears, that strap should form like a V shape just below and in front of each ear. And for the mouth portion, when you've buckled up that chin strap and when you open the mouth, it should pull the helmet snugly on the head. And if it doesn't, you need to tighten that strap.

Now, I'd like to differentiate because there's a rise in e-bikes and e-scooters. The speed and the velocity of those devices are much faster than a pedal bike. So, you got to make sure that that bike helmet is graded for that speed of an e-bike or e-scooter. Again, I think wearing a helmet, having parents wear a helmet, and finally legislation, which is truly the the most effective intervention to increase its use and has been shown to decrease head injury rates.

Host: Finally, to wrap things up, Dr. Abrahan, this has been a wonderful discussion, if you could give families just one piece of advice to make this summer safer, what would it be?

Dennrik Abrahan, MD: Yeah, I would say supervision is really the most powerful safety device you own.

Host: Okay. A great piece of final advice. Thank you so much for being on our podcast.

Dennrik Abrahan, MD: Thank you. Thank you for having me.

Host: That has been Dr. Dennrik Abrahan. For more information, please visit www.tgh.org/childrens. If you have enjoyed this episode, please be sure to like, subscribe, and follow Community Connect: presented by TGH on your favorite podcast platform. I'm Karen Loftus, and this is Community Connect: presented by TGH. Thanks for listening.