Prevention
Water is a hazardous environment; everyone should be prepared for an emergency. Learn cardio-pulmonary resuscitation (CPR) and first aid before departing (2,3). Avoid alcohol and drug use before and during activities in or around the water or while supervising children. These substances can impair balance, coordination, and judgment (4-8). Young children, even those who have had swimming lessons, require constant supervision when in or near water; this responsibility should be delegated only to experienced, responsible swimmers who know CPR and know how to initiate help in an emergency (9,10). Ideally, choose swimming areas that are supervised by trained and certified lifeguards and obey rules, posted signs, and warning flags (3,11,12). Choose housing/hotel accommodations that do not permit direct access by children to any body of water without adult supervision. Swimming pools with fences that have self-closing, self-latching gates are preferable (13).
When planning outdoor water activities, select areas that have good water quality and safe natural conditions. Murky water, hidden underwater objects, unexpected drop-offs, and aquatic plant life are hazardous (11). If unable to check for hidden hazards and appropriate water depth, avoid diving; a feet-first entry is safer than head first (14). A properly fitted personal flotation device (life jacket or vest) should always be worn when boating, water skiing, or using personal watercraft, regardless of the distance to be traveled, the size of the craft, or swimming ability (7,12,15). Air-filled or foam objects such as “water wings” and “noodles” are toys and should not be used in place of life jackets as flotation devices (10,16). Be aware of local weather conditions and forecasts, and watch for large waves, strong tides, and signs of rip currents (e.g., water that is discolored and unusually choppy, foamy, or filled with debris). Strong winds and thunderstorms with lightning strikes are dangerous to swimmers and boaters. Strong water currents can carry even expert swimmers far from shore. Swimmers caught in a rip current should swim parallel to the shore until free of the current and then swim toward the shore (17). If planning to scuba dive, obtain appropriate training and certifications, heed safety recommendations, and remember the signs and symptoms of decompression illness (e.g., joint pain, rash, numbness/tingling, weakness, paralysis, impaired thinking, shortness of breath or cough, dizziness or loss of balance); prompt treatment can be effective in preventing further injury or illness (see Scuba Diving section) (3).
Marine plants and animals such as biting and stinging fish, corals, sea lice, and jellyfish can be hazardous if touched. Larger marine animals are not likely to cause injury unless deliberately or accidentally threatened. Wounds acquired in the marine environment can be contaminated with bacteria, often contain foreign bodies, and occasionally contain venom (18). Learn about the hazards in the area, wear protective gloves and footwear, avoid wearing shiny watches or jewelry, and avoid contact with corals and other marine animals (3,19). If traveling during winter months, avoid ice skating or ice fishing alone, and avoid unsafe ice (e.g., ice over moving water, ice less than a uniform 4 inches thick for skating, ice clouded with bubbles, and ice around partially submerged obstacles like stumps) (20).
