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TABLE 2

Haddon Matrix for Drowning-Prevention Strategies

PersonalEquipmentPhysical EnvironmentSocial Environment
Before the event Provide close, constant, and attentive supervision of children and poor swimmers Install 4-sided fencing that isolates the pool from the house and yard Swim where lifeguards are present Mandate 4-sided residential pool fencing 
Clear handoff supervision responsibilities Install self-closing and latching gates Attend to warning signage Mandate life jacket wear 
Develop water competency, including water-safety knowledge, basic swim skills, and ability to recognize and respond to a swimmer in trouble Wear life jackets Swim at designated swim sites Adopt the Model Aquatic Health Code 
Evaluate preexisting health condition Install compliant pool drains Remove toys from pools when not in use to reduce temptation for children to enter the pool Increase availability of lifeguards 
Know how to choose and fit a life jacket Install door locks Empty water buckets and wading pools Increase access to affordable and culturally compatible swim lessons 
Avoid substance use Enclosures for open bodies of water — Close high-risk waters during high-risk times 
Know the water’s hazards, conditions Promote life jacket–loaner programs — Develop designated open-water swim sites  
Swim at a designated swim site Role model life jacket use by adults — Enforce boating under the influence laws  
Learn CPR Make rescue devices available at swim sites — — 
Take a boater education course Phone access to call for help — — 
— Ensure functional watercraft — — 
Event Water-survival skills Rescue device available — EMS system 
After the event Early bystander CPR AED — Advanced medical care 
Bystander response Rescue equipment — — 
PersonalEquipmentPhysical EnvironmentSocial Environment
Before the event Provide close, constant, and attentive supervision of children and poor swimmers Install 4-sided fencing that isolates the pool from the house and yard Swim where lifeguards are present Mandate 4-sided residential pool fencing 
Clear handoff supervision responsibilities Install self-closing and latching gates Attend to warning signage Mandate life jacket wear 
Develop water competency, including water-safety knowledge, basic swim skills, and ability to recognize and respond to a swimmer in trouble Wear life jackets Swim at designated swim sites Adopt the Model Aquatic Health Code 
Evaluate preexisting health condition Install compliant pool drains Remove toys from pools when not in use to reduce temptation for children to enter the pool Increase availability of lifeguards 
Know how to choose and fit a life jacket Install door locks Empty water buckets and wading pools Increase access to affordable and culturally compatible swim lessons 
Avoid substance use Enclosures for open bodies of water — Close high-risk waters during high-risk times 
Know the water’s hazards, conditions Promote life jacket–loaner programs — Develop designated open-water swim sites  
Swim at a designated swim site Role model life jacket use by adults — Enforce boating under the influence laws  
Learn CPR Make rescue devices available at swim sites — — 
Take a boater education course Phone access to call for help — — 
— Ensure functional watercraft — — 
Event Water-survival skills Rescue device available — EMS system 
After the event Early bystander CPR AED — Advanced medical care 
Bystander response Rescue 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.

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