TABLE 2

Haddon Matrix for Drowning-Prevention Strategies

PersonalEquipmentPhysical EnvironmentSocial Environment
Before the eventProvide close, constant, and attentive supervision of children and poor swimmersInstall 4-sided fencing that isolates the pool from the house and yardSwim where lifeguards are presentMandate 4-sided residential pool fencing
Clear handoff supervision responsibilitiesInstall self-closing and latching gatesAttend to warning signageMandate life jacket wear
Develop water competency, including water-safety knowledge, basic swim skills, and ability to recognize and respond to a swimmer in troubleWear life jacketsSwim at designated swim sitesAdopt the Model Aquatic Health Code
Evaluate preexisting health conditionInstall compliant pool drainsRemove toys from pools when not in use to reduce temptation for children to enter the poolIncrease availability of lifeguards
Know how to choose and fit a life jacketInstall door locksEmpty water buckets and wading poolsIncrease access to affordable and culturally compatible swim lessons
Avoid substance useEnclosures for open bodies of waterClose high-risk waters during high-risk times
Know the water’s hazards, conditionsPromote life jacket–loaner programsDevelop designated open-water swim sites
Swim at a designated swim siteRole model life jacket use by adultsEnforce boating under the influence laws
Learn CPRMake rescue devices available at swim sites
Take a boater education coursePhone access to call for help
Ensure functional watercraft
EventWater-survival skillsRescue device availableEMS system
After the eventEarly bystander CPRAEDAdvanced medical care
Bystander responseRescue equipment
  • The Model Aquatic Health Code provides guidelines and standards for equipment, for staffing and training, and for monitoring swimming pools. Bold indicates the most evidence-based interventions. AED, automated external defibrillator.