TABLE 3

Haddon Matrix for Drowning Prevention Strategies With Associated Levels of Evidence

PersonalEquipmentPhysical EnvironmentSocial Environment
Pre-event Provide close, constant, attentive supervision of children and poor swimmersa Install 4-sided fencing that completely isolates the pool from the house and yardb Swim where there are lifeguardsa Mandate 4-sided residential pool fencingb 
 Evaluate preexisting health conditionc Install self-closing and latching gatesb Attend to warning signagec Mandate life jacket wearb 
 Develop water competency, including swim abilitya Wear life jacketsb Swim at designated swim sitesc Adopt the Model Aquatic Health Codec 
 Know how to choose and fit a life jacketc Install compliant pool drainsa Remove toys from pools when not in use to reduce temptation for children to enter the poolc Increase availability of lifeguardsa 
 Avoid substance usea Install door locksc Empty water buckets and wading poolsc Increase access to affordable and culturally compatible swim lessonsc 
 Know the water’s hazards and conditionsc Enclosures for natural bodies of waterc Lakefront slope gradientd Close high-risk waters during high-risk timesd 
 Swim at a designated swim sited Promote life jacket loaner programsc  Develop designated natural water swim sitesd 
 Learn CPRb Role model life jacket use by adultsa  Enforce Boating Under the Influence lawsb 
 Take a boater education coursec Make rescue devices available at swim sitesc   
 — Provide ability to call for helpb   
 — Ensure functional watercraftc   
Event Water survival skillsc Rescue device availablec Lifeguard or bystander responseb Emergency Medical Systemb 
Postevent — AEDc Early bystander CPRb Advanced medical carec 
 — Rescue equipmentc EMS responseb  
PersonalEquipmentPhysical EnvironmentSocial Environment
Pre-event Provide close, constant, attentive supervision of children and poor swimmersa Install 4-sided fencing that completely isolates the pool from the house and yardb Swim where there are lifeguardsa Mandate 4-sided residential pool fencingb 
 Evaluate preexisting health conditionc Install self-closing and latching gatesb Attend to warning signagec Mandate life jacket wearb 
 Develop water competency, including swim abilitya Wear life jacketsb Swim at designated swim sitesc Adopt the Model Aquatic Health Codec 
 Know how to choose and fit a life jacketc Install compliant pool drainsa Remove toys from pools when not in use to reduce temptation for children to enter the poolc Increase availability of lifeguardsa 
 Avoid substance usea Install door locksc Empty water buckets and wading poolsc Increase access to affordable and culturally compatible swim lessonsc 
 Know the water’s hazards and conditionsc Enclosures for natural bodies of waterc Lakefront slope gradientd Close high-risk waters during high-risk timesd 
 Swim at a designated swim sited Promote life jacket loaner programsc  Develop designated natural water swim sitesd 
 Learn CPRb Role model life jacket use by adultsa  Enforce Boating Under the Influence lawsb 
 Take a boater education coursec Make rescue devices available at swim sitesc   
 — Provide ability to call for helpb   
 — Ensure functional watercraftc   
Event Water survival skillsc Rescue device availablec Lifeguard or bystander responseb Emergency Medical Systemb 
Postevent — AEDc Early bystander CPRb Advanced medical carec 
 — Rescue equipmentc EMS responseb  
a

Trials or diagnostic studies with minor limitations; consistent findings from multiple observational studies.

b

Well-designed and conducted trials, meta-analyses on applicable populations.

c

Expert opinion, case reports, reasoning from first principles.

d

Single or few observational studies or multiple studies with inconsistent findings or major limitations.

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