title: Relationship between drowning location and outcome after drowning-associated out-of-hospital cardiac arrest: nationwide study.
abstract: OBJECTIVE
  Accidental drowning can cause out-of-hospital cardiac arrest (OHCA). We investigated the effect of drowning location on outcomes of individuals who experienced drowning-OHCA.
  
  
  METHODS
  All cases of emergency medical service-treated drowning-OHCA in South Korea from January 2006 to December 2013 were analyzed. Cases were excluded if there was a preceding injury, no information on event location, or suicide. Cases were divided into 4 groups: recreational water with mandatory safety regulations (group 1, public swimming pool; group 2, beach) and nonrecreational water without mandatory safety regulations (group 3, natural freshwater; group 4, seawater). The main outcome was survival to hospital discharge. Multiple logistic regression analysis was conducted using natural freshwater as the reference location.
  
  
  RESULTS
  We analyzed 1691 drowning-OHCAs (public swimming pools, 3.4%; public beaches, 5.2%; unsupervised seawater, 33.8%; and unsupervised open freshwater, 57.6%). The rate of survival to discharge was 4.6% for all cases, 17.5% for cases in public swimming pools, 9.1% for cases in public beaches, 4.9% for cases in unsupervised seawater, and 3.3% for cases in unsupervised open freshwater (p<0.01). The adjusted odds ratios (95% confidence intervals [CIs]) for survival relative to natural freshwater were 3.97 (95% CI, 1.77-8.89) for public swimming pools, 2.81 (95% CI, 1.22-6.45) for public beaches, and 1.54 (95% CI, 0.88-2.70) for unsupervised seawater.
  
  
  CONCLUSIONS
  Individuals who experience drowning-OHCA in public locations with safety regulations had a better rate of survival. There should be improved public awareness of the significantly greater risk of drowning-OHCA in locations that have no safety regulations.
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: yukijeje@gmail.com.
authors.forename: Joo
authors.initials: J
authors.lastname: Jeong
authors.affiliation: Department of Emergency Medicine, Seoul National University Boramae Medical Center, Seoul, South Korea. Electronic address: emkjhong@gmail.com.
authors.forename: Ki Jeong
authors.initials: KJ
authors.lastname: Hong
authors.affiliation: Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea. Electronic address: shinsangdo@medimail.co.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea. Electronic address: Ro.youngsun@gmail.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea. Electronic address: ironlyj@gmail.com.
authors.forename: Eui Jung
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, National Medical Center, Seoul, South Korea. Electronic address: eyeblack99@gmail.com.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea. Electronic address: arendt75@gmail.com.
authors.forename: Ki Ok
authors.initials: KO
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D001493:Bathing Beaches; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004332:Drowning / Q000401:mortality*; D005260:Female; D005618:Fresh Water; D006323:Heart Arrest / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D011640:Public Policy; D056910:Republic of Korea / Q000453:epidemiology; D012449:Safety; D012623:Seawater; D015996:Survival Rate; D013551:Swimming Pools; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000453:epidemiology; D055815:Young Adult