Saving Little Lives: Pediatric Drowning Advocacy in the Emergency Department

Stephanie Radu, MD MCR

Emergency medicine residents are trained to manage the most acute and devastating presentations of illness and injury.  In the specialty where we see it all, few cases rival the profound weight of losing a child due to a traumatic event.  Some of the most impactful lessons in graduate medical education (GME) extend beyond resuscitation and clinical decision making, into advocacy, prevention and systems-level change.

As emergency physicians, we are uniquely positioned at the intersection of preventable injury and significant loss. In coastal and water dense communities, pediatric drowning remains one of the most devastating and recurrent tragedies that local emergency departments encounter. Nationally, drowning remains the leading cause of death for children under five years old (1). For every fatal drowning, there are many more nonfatal cases resulting in lifelong disability and multifactorial trauma for families and communities. Drowning is typically silent, rapid, and unwitnessed, yet almost always preventable. Emergency departments (EDs) are often the final point of contact in these tragedies, uniquely positioning emergency physicians and trainees to identify patterns, disparities and opportunities for prevention. 

Clinical exposure as a catalyst for advocacy

As a case example, one tourism-rich, and socioeconomically diverse beach town experiences pediatric drownings with alarming frequency. During peak season (April to September), the ED regularly resuscitates children found unconscious in local pools, community retention ponds, and in coastal and inland waterways. Each case leaves a lasting emotional impact on families, providers, EMS, and the broader community. While this is felt deeply locally, these tragedies reflect a national crisis that emergency departments across the country continue to face.

Growing up as a competitive surfer and swimmer, drowning prevention felt personal. Witnessing both the frequency and preventability of these events, I was motivated to restart a local pediatric drowning initiative. Collaborating with the local police department revealed staggering numbers: there were over 100 drowning events involving children under 18 in a single year. The question became unavoidable. If us emergency physicians would not advocate for prevention, then who would?

A multidisciplinary, education-centered initiative

The pediatric drowning initiative—centered on the “Water Watcher” concept—was revitalized at this tertiary-care, academic-community hybrid hospital. This advocacy effort extended beyond the ED and brought together trauma surgery, law enforcement, fire rescue, water patrol, city leadership, neighboring emergency departments, and other invested parties.  Following fatal pediatric drowning events, structured interdisciplinary debriefings were implemented.  These sessions served dual purposes: addressing the emotional toll on responders and reinforcing a culture of reflection, quality improvement and prevention. For trainees, these debriefings provided structured opportunities to process grief – critical yet often underdeveloped components of professional identify formation.

Identifying disparities through clinical pattern recognition

Midway through implementation, a notable pattern emerged: a disproportionate number of drowning events involved neurodivergent children. Children with autism spectrum disorder are at increased risk of drowning due to attraction to water and higher risk of elopement (2). Advocacy efforts were emphasized on addressing this disparity through targeted education and partnerships with local autism support organizations and collaboration with local media to increase awareness. Residents were directly involved in developing outreach efforts in partnership with local autism advocacy organizations and media outlets.

Educational tools and GME integration

One of the most visible components of the initiative was the creation and distribution of over 1,000 “Water Watcher” wristbands. These brightly colored, tie-dye silicone bands were attached to educational pamphlets handed out to every pediatric patient’s caregiver in the ED. Messaging emphasized responsible and constant supervision, proper life jacket use, bystander CPR, home pool fencing, and brightly colored swimwear. Using these strategies supported by national drowning prevention recommendations (3), the wristbands offered a popular and tangible reminder of responsibility and shared vigilance within our community. 

This initiative was deliberately embedded within residency education. Emergency medicine residents received lectures on drowning management, prevention counseling, and advocacy. Community members whose children survived drowning with anoxic brain injury shared their stories, grounding medical education in lived experience. Collaboration with EMS was strengthened through shared debriefings and ongoing dialogue. During intern orientation, residents were informed they would likely resuscitate a critically ill child due to drowning in their first year of training. This prediction proved accurate for multiple interns within their first week, underscoring the importance of early preparation – for both clinical and emotional resilience.

Advocacy is a component of professional identify formation.

For many providers, advocacy represents a natural extension of clinical care once they witness recurrent patterns of preventable harm. Emergency physicians and trainees intuitively serve as connectors between medical institutions and communities, translating bedside experience into prevention-focused action.

The “Water Watcher” initiative has become a tangible symbol of that collective responsibility. Many ED Staff and EMS clinicians proudly wear a wristband on their badge, not only as an educational tool, but as a quiet acknowledgment of the children we have lost and the lives we continue to fight for. They serve as a team badge and as a remembrance of collective grief and an ongoing commitment to prevention.

Conclusion

A child lost to drowning is far more than a statistic or a clinical outcome. It is a void in a family, a school, and an entire community. As emergency physicians and residents, we bear witness to the most devastating moments of these families’ lives, and with that proximity comes responsibility.

Transforming the pain experienced in the ED into momentum for prevention is one way we honor those losses. For those interested in implementing pediatric drowning prevention efforts in their own emergency departments, collaboration and shared strategies can help extend this impact. If this advocacy prevents even one drowning and keeps a child safe at home with their family, it will have been worth it.

Acknowledgements

Special thanks to my residency program director Dr. Casey Wilson, my mentor and a huge part of the water watcher and drowning prevention initiative- also a reviewer of this piece! To start your own drowning prevention initiative in your local ED, please feel free to reach out for shared resources! 

References (AMA)

1. Centers for Disease Control and Prevention. Drowning facts. CDC website. Updated May 15, 2024. Accessed January 18, 2026. https://www.cdc.gov/drowning/data-research/facts/index.html
2. Centers for Disease Control and Prevention. Unintentional drowning: get the facts. CDC website. Updated May 15, 2024. Accessed January 18, 2026. https://www.cdc.gov/injury/features/drowning/index.html
3. Denny SA, Quan L, Gilchrist J, et al; Council on Injury, Violence, and Poison Prevention. Prevention of drowning. Pediatrics. 2021;148(2):e2021052227. doi:10.1542/peds.2021-052227