Method			Comments
Physical
Pools
	Fencing		Odds ratio for drowning in a fenced vs. an unfenced pool = 0.27 (95% confidence interval, 0.16 to 0.47)29
			Four-sided fencing completely surrounding pool (not attached to house on one side)
			Gates should open away from the pool, be self-closing and self-latching, with the latching mechanism at least 58 inches above the ground
			Fence composition should not be climbable (e.g., not chain link)
			Fence should be at least 4 feet high with no more than 4 inches between vertical aspects and no more than 4 inches between the bottom of the fence and the ground
	Drain covers, safety vacuum release systems, multiple drains to displace pressure		Prevents entrapment and entanglement of hair or body parts; other filter techniques that provide pressure venting should be implemented
	Rescue equipment		U.S. Coast Guard–approved water rescue equipment (such as a reaching pole or shepherd's crook and life buoys) should be readily available poolside, in addition to a working telephone
	Pool alarms (multiple types, such as floating, subsurface, and wristband alarms)		No evidence that alarms are of benefit; may provide a false sense of security; not a substitute for adequate supervision or adequate pool fencing
Personal flotation devices			According to a 2008 report from the U.S. Coast Guard, 91% of drowning victims (464 of 510) were not wearing personal flotation devices31
			There is little evidence on effectiveness, but use likely decreases morbidity and mortality; proper use is based on the individual and the setting
			See U.S. Coast Guard guidelines at http://www.uscg.mil/hq/cg5/cg5214/pfdselection.asp
Floatable swimming aids			Not approved as personal flotation devices; do not replace adequate supervision
			Air-containing types can deflate
Bath stands			Drownings associated with bath stand use were caused by product defect in < 10% of cases33
			May give caregivers the false perception that the infant needs less attention; cannot substitute for adequate direct supervision
Behavioral
Avoid alcohol use			30% to 70% of adults who die from drowning have positive blood alcohol levels11
			Discourage the use of alcohol or other drugs for all boaters and participants in water recreation
			Adults supervising children should not be using alcohol or drugs
CPR			Immediate on-the-scene care is important for survival
			All adults and caregivers should be trained in CPR and understand the rationale for using the ABC order of resuscitation (not the CAB order)
Supervision
	Lifeguards		Encourage use of water recreation areas staffed by lifeguards with certification in CPR
	Adults/caregivers		Knowledge of CPR should be mandatory for supervising children
			Direct supervision should be employed with any age swimmer; adult “water watchers” should avoid distracting activities
			Touch supervision must take place with nonswimmers; adult should be in the pool and within arm's reach of nonswimmer at all times
Avoid rip currents			Learn characteristics of rip currents (e.g., reverse bubbles moving away from beach, broken waves between sandbars)
			Encourage use of beaches with lifeguards and heed warnings of posted surf conditions
			To escape, do not battle current; swim perpendicular to current (parallel to shore) until cleared from rip current and then swim at an angle, away from the current and toward the shore
			For safety tips about rip currents, see http://www.ripcurrents.noaa.gov/
Open bodies of water and other natural swim areas
		Approach water with an unknown depth and/or hazards with caution		Even in clear water, depths may be uncertain, so entering feet first the first time is advised
		Assess for currents		Swift currents can trap persons underneath rocks, trees, or other debris, and can overwhelm even strong swimmers
Standing water
		Monitor water-containing objects		Buckets, inflatable pools, and natural standing water should never be left unattended; buckets and inflatable pools should be emptied when not in use
				Restrict toddlers' access to bathrooms and toilets with childproof latching systems
Education
		Swimming and water safety lessons		Possibly effective in children two to four years of age
				American Academy of Pediatrics supports swimming lessons for children four years and older
Medical
Monitor children with seizure disorders				Children with seizure disorders should always have direct supervision when swimming or bathing
				Showering is preferable to bathing when supervision cannot take place because of privacy concerns
Monitor children with autism spectrum disorder and cardiac channelopathies (long QT syndrome and catecholaminergic polymorphic ventricular tachycardia)				There is slight evidence that children with these disorders have increased rates of drowning and thus may require increased supervision
Community/government
Office-based interventions				Can be implemented by physicians and support staff
				Identify families with access to residential pools for targeted drowning prevention counseling
				Ensure adequate counseling and support services for drowning victims
Legislation to prevent drowning				Safe pool fencing
				Proper staffing of pools or public swimming areas with CPR-certified lifeguards
				Strict boating laws regarding alcohol consumption
Drowning awareness campaigns; educational materials				CPR training
				Swimming lessons
				Drowning prevention techniques