Haddon Matrix for Drowning-Prevention Strategies
| . | Personal . | Equipment . | Physical Environment . | Social 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 | — | — |
| . | Personal . | Equipment . | Physical Environment . | Social 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.