Students Preventing Unintentional Drowning

State: FL Type: Promising Practice Year: 2019

Broward County is in the southeastern portion of the State of Florida, with Miami-Dade County to the south, and Palm Beach County to the north.  In 2016, Broward County was the second most populous county in Florida, and the seventeenth largest county in the nation. Broward County has a diverse population with residents representing more than 200 countries that speak over 130 languages 31.4% of the residents are foreign-born.  Broward County is a minority/majority county demonstrated by its 2016 population by race (Black 28.5%, Asian 3.6%, Hispanic 26.9%, more than one race 0.2%, and White 40.8%). According to CDC, the age groups 1-4 and 15-24 are at a greater risk for drowning, 5.9% of Broward County's population is under the age of 5 and 12.5% of population falls between 15-24 years.

Drowning is the process of experiencing respiratory impairment from submersion /immersion in liquid. Submersions can be fatal or nonfatal with a potential for hypoxic brain injury. Drowning is the leading cause of death of children ages 1-4 years in Broward County.  In 2017, the death rate for ages 1-4 was at 7.9 which was comparatively higher than the Florida rate of 6.8. The 2014 data for hospitalizations ages 1-5 for near drownings indicates that Broward County's rate was at 16.2, while the State rate was at 12.7. While primary prevention such as four-sided isolation pool fencing or other adjunctive barriers prevent children from water entry, secondary prevention such improving swim ability and water safety training prevents injury. The Florida Department of Health in Broward County (DOH-Broward) initiated the Students Preventing Unintentional Drowning (S.P.U.D) in response to the increasing drowning deaths among the age group 1-4.

SPUD is a water smart ambassador club. The primary goal of the water smart ambassador club is to engage and equip youth with tools and knowledge to prevent unintentional drowning, where they live, learn and play. The SPUD program, led by high school students, utilizes innovative ways such as social media, water safety assemblies and presentations to educate elementary and middle school students on water safety and drowning prevention. The students also provide presentations to authoritative figures such as principals, city officials, county school board, and community partners to create awareness on SPUD and water safety.


DOH-Broward's existing relationship with the schools aided in recruiting highs school students for the SPUD clubs. The DOH-Broward employee who functions as the advisor of the club oversee the club activities. A day is allocated for each school to host the inaugural ceremony where the students learn more about club and member expectations. Incentives such as certificates, service hours, graduation cord and limited scholarships are provided to members who excel in club activities at the end of the school year. Members are educated on water safety and drowning prevention through innovative group activities and projects. Members put their knowledge into practice through educating their peers and community.

Florida is home to over 100,000 swimming pools plus miles of beaches, canals, lakes and other waterways, increasing the risk of drowning. According to Florida Violence and Injury Prevention 2014 surveillance data, there were 297 hospitalizations for non-fatal drowning. Children ages 1-4 make up 14.0% of the deaths and 41% of the hospitalizations. According to the National Consumer Product Safety Commission 2018 Pool or Spa Submersion report, 76 % of the victims of the reported pool- or spa-related childhood submersion fatalities were younger than 5 years of age. Victims in this age category also accounted for an average of 73% of the childhood submersion injuries related to pools or spas between 2015 and 2017. Residential locations dominated reported incidents involving victims younger than 5 years of age. In 2017, unintentional drowning claimed 43 lives in Broward county. The drowning death rates may vary by age, location, gender, race/ethnicity, ability and exposure. The death rate from unintentional drowning was at 2.9 for 2016 and showed slight improvements in 2017 with a rate of 2.2 (FL Charts). However, the unintentional drowning death rate among the age group 1-4 is increasing and it is the leading cause of death for that age group. The death rate increased from 4.6 (2016) to 6.4 (2017) and is comparatively higher than the state rate for the corresponding years. The 2017 data suggest racial disparities in the unintentional drowning deaths rates: White 3.4, Black 7.3, Hispanic 2.7, and Non-Hispanic 5.5. These disparities might be associated with differences in swim skills in the minority population. Gender differences in the death rate were also noted: Male 8.9 and Female 7.0 with males at high risk for drowning. The CDC reports that for every child who dies from drowning, another five receive hospital emergency department care for nonfatal submersion injuries. In addition, more than 50% of the drowning victims treated in emergency departments require hospitalizations or transfer for further care. These nonfatal drownings can also result in severe brain damage that may cause long term disabilities. Further, the median admission charge for drowning-related, nonfatal injury hospitalizations were $16,705. Medicaid paid 31% and commercial insurance paid 31% (Florida Violence and Injury Prevention Surveillance Data, 2014).

The Students Preventing Unintentional Drowning (S.P.U.D) was formed in the Spring of 2017 response to the increased drowning deaths among the age group 1-4, modeled after the successful tobacco prevention program Students Working Against Tobacco (SWAT). S.P.U.D is a teen Water Smart Ambassador club devoted to advocating for water safety. The primary goal of the program is to a create ripple effect in the community by building a network of empowered young advocates for water safety and drowning prevention. The club members are educated on water safety practices and actions that can be taken to prevent future drownings. Through the participation in the Water Smart Ambassador club, members engage in various activities that contribute to leadership enhancement and character development. Each club is overseen by an Advisor, a DOH-Broward employee who is responsible for the club meetings and activities. The Advisor coordinates with local elementary and middle schools and the community for the club members to conduct water safety outreach activities. The club leadership includes a President, Vice-President, Secretary, Social Media Coordinator and treasurer. The elections are conducted once a year in the month of September or October. The members of the club are required to attend at least 13 of the 15 meetings as well as two outreach activities to maintain the active status and to be eligible for the incentives. The incentive includes certificates, service hours, a cord for graduation, free swim lessons and possibly a Lifeguard scholarship for those students who excel in the program. The proposed practice supplements the drowning prevention efforts in Broward County. The S.P.U.D program mobilizes, educates and equips Broward County youth to be advocates for drowning prevention. The two components of the program are education and social media campaign. The students educate the community through outreach activities and by delivering presentations to elementary and middle school students on water safety. Students also educate authoritative figures such as principles, city officials, city school board members and community partners on drowning issues. Further, social media, posters, videos and other creative means is utilized to reach their peers as well as the community. The initial year was a great success with nine schools and over 100 students participating in the S.P.U.D program. Seven authoritative figures were educated on drowning issues within Broward County and 12 collaborative events with the club members were organized. The events included a Water Safety Symposium where the focus was on drowning in South Florida, drowning statistics and the proactive methods that are being developed to address this issue. A career fair in collaboration with community partners was also hosted for the club members where they learned more about various aquatics-related job opportunities. The S.P.U.D program is a revolutionary prevention program and is unique in the drowning prevention field. A decrease in drowning deaths can only be achieved through education, environmental engineering and enforcement. S.P.U.D compliments the drowning prevention efforts in Broward County through educating youth, subsequently creating a generation of advocates for drowning prevention.

The goal of the S.P.U.D program is to mobilize, educate and equip Broward County youth to be advocates for drowning prevention. The objectives of the S.P.U.D are: 1) collaborate with club members to educate their community on water safety during different outreach events, 2) utilize innovative ways to reach their peers and public on water safety topics by using social media, poster, video and other creative means, 3) coordinate a water safety assembly, and 4) educate authoritative figures on drowning issues within Broward County.

An informational handbook which includes the vision, mission, goals, student organization membership roles and responsibilities and S.P.U.D member's agreement form was developed by DOH-Broward. In addition, a work plan was developed so that qualitative progress on the goals and objectives can be captured. Utilizing the existing relationships with the Broward County Public Schools, DOH-Broward Health Educators set-up an information table to recruit students to the S.P.U.D club. At the information table, the students have the opportunity to learn about the club as well as to register. A date is set for the inaugural ceremony of the clubs where a formal information session on the club is provided. Once registered, the members are required to sign the S.P.U.D Ambassador Member Agreement form which is a non-formal agreement to abide with the S.P.U.D club guidelines. The meeting dates are set for the year and the activities are carried out in accordance to the work plan which includes social media, water safety assembly/presentations to educate elementary and middle school students on water safety and drowning prevention. The students also provide presentations to authoritative figures such as principals, city officials, city, county school board, and community partners to create awareness on S.P.U.D and water safety. The program was implemented during the Fiscal year 2016-2017.

To overcome transportation barriers, the program collaborated with various aftercare school programs such as 21st Century and TOPS to provide transportation to S.P.U.D club members. Further, swim lessons and lifeguard certification are provided to the club members in partnership with the pool industry and SWMIS foundation. Collaboration with community partners facilitated financial support for the start-up cost of $500 for program initiation. These funds were used to purchase supplies and incentives.

The S.P.U.D workplan was reviewed on a quarterly basis to ensure the program meets the annual target. The reach of the program was calculated using the number of clubs formed in schools and the number of club memberships. After launching the initiative in 2016, nine S.P.U.D clubs were formed in schools. More than 100 high school students were engaged in S.P.U. D activities during the fiscal year 2016-2017.Other indicators that was tracked by the program include:1) The number of outreach activities conducted by the club members 2) Number of posters /media content provided by the club members on water safety topics 3) Number of authoritative figures educated 4) number of water safety assembly conducted. Club members educated seven authoritative figures and participated in 12 outreach events.

The program is currently sustained through funding received from the Children Services Council which is an indication of the community-wide acceptance of the program. The program has made great impact in the community by educating youth on drowning prevention. The goal of the program is to expand the S.P.U.D program to 33 high schools in Broward County. The program is targeting additional 10 schools for FY 17-18 and intends to maintain the current S.P.U.D. clubs. As the program expands more staff and staff time are required to sustain at a level that the program was initiated and the program is seeking additional funding through grants.

Colleague from another public health agency