Dr David Szpilman, MD - Brazil

12 YEARS OF BRAZILIAN LIFESAVING SOCIETY

SOBRASADid we make any difference?

12 YEARS OF BRAZILIAN LIFESAVING SOCIETY

SOBRASADid we make any difference?

Principal AuthorDr David Szpilman, MD

Head of Drowning Resuscitation Centre and Aeromedical Helicopter - Fire Department of Rio de Janeiro (CBMERJ) – GMAR; Head of Adult Intensive Care Unit - Hospital Municipal Miguel Couto;

Member of Brazilian National Resuscitation Council; Founder, Former President and Medical Director of Brazilian Life Saving Society – SOBRASA; BOD Member and Medical Committee

of International Life-Saving Federation; BOD Member of Sports Medical Council.

Paulo Moreira Goulart – Corpo de Bombeiros Militar do Estado do Rio de Janeiro and (*)Onir Mocellin - Corpo de Bombeiros Militar do Estado de Santa Catarina and (*)Alexandre da Silva - Corpo de Bombeiros Militar do Estado de Santa Catarina and (*) Osni Pinto Guaiano - Corpo de Bombeiros Militar do Estado do Rio de Janeiro and (*)Marcelo Barros - (*) and Physic Education Teacher.Alex Souza Alves - Corpo de Bombeiros Militar do Estado do Rio de Janeiro and (*)Sr Márcio Morato - Corpo de Bombeiros Militar do Distrito Federal and (*)Sr Jorge Cerqueira – Salvamar da Bahia and (*)Jefferson José Maciel Vilela – Polícia Militar do Estado de São Paulo - Corpo de Bombeiros and (*)Carlos Eduardo Smicelato – Polícia Militar do Estado de São Paulo - Corpo de Bombeiros and (*)Rodrigo Thadeu de Araújo - Polícia Militar do Estado de São Paulo - Corpo de Bombeiros and (*)Joel Prates Pedroso - Brigada Militar do Rio Grande do Sul – Corpo de Bombeiros and (*)Luís Krüger - Brigada Militar do Rio Grande do Sul – Corpo de Bombeiros and (*)Edmilson Barros - Polícia Militar do Estado do Paraná - Corpo de Bombeiros and (*)Alexandre Cerqueira – Corpo de Bombeiros do Estado do Espírito Santo and (*)Rômulo C. Sales – Corpo de Bombeiros do Estado do Ceará and (*)Neyff Souza da Silva - Corpo de Bombeiros do Estado de Pernambuco and (*)(*) Brazilian Lifesaving Society BOD Member

Other Authors: names and affiliations

David Szpilman, MD

Brazil - fifth largest and populous country in the world - 188 million inhabitants (2006)

BrazilianCoastline 8,000 Km

BrazilBrazil

One of the largest number of rescues

David Szpilman, MD

SOUTH AMERICA

7.000 death per year

Are you aware off?Drowning In Brazil

Source: Szpilman D. - 2003Date research based on DATASUS - death certificateSource: Szpilman D. - 2003Date research based on DATASUS - death certificate

Are you aware off?Drowning in Brazil

Each Year

260,000 hospitalizations1,300,000 rescues

600 victims not foundSource: Szpilman D. - 2003Date research based on DATASUS - death certificateSource: Szpilman D. - 2003Date research based on DATASUS - death certificate

Drowning is the 2º causeof death among1 to 14 years old

Source: Szpilman D. - 2003Date research based on DATASUS - death certificateSource: Szpilman D. - 2003Date research based on DATASUS - death certificate

Are you aware off?Drowning in Brazil

First Brazilian Lifeguard Tower

The first organized

lifesaving service was founded in 1918, in Rio de

Janeiro City

Since then, many other services have been created around the country.

From 1984, the military firefighters took over the responsibility for lifesaving in

each state of Brazil

Since then, many other services have been created around the country.

From 1984, the military firefighters took over the responsibility for lifesaving in

each state of Brazil

1991Brazilians lifeguards made their first official international contact

(Dr Ian Mackie from Australia)

1991Brazilians lifeguards made their first official international contact

(Dr Ian Mackie from Australia)

The mail exchange resulted in ourfirst international event - 1994

World Lifesaving Championship andFoundation of ILS, where the idea of a truly global

lifesaving organization was conceived.

The mail exchange resulted in ourfirst international event - 1994

World Lifesaving Championship andFoundation of ILS, where the idea of a truly global

lifesaving organization was conceived.

A Brazilian Lifesaving Society

(SOBRASA) was created in 1995.

Brazilian Lifesaving Society - SOBRASABrazilian Lifesaving Society - SOBRASA

Main goalTo reduce

drowning using preventive actions.

Main goalTo reduce

drowning using preventive actions.

Water SafetyWater SafetyHow lifeguarding works in BrazilHow lifeguarding works in Brazil

Lifeguarding Services – State Fire DepartmentLifeguarding Services – State Fire Department

National SocietyNon profit and non militaryFoundation 1995

National SocietyNon profit and non militaryFoundation 1995

Brazilian Life Saving SocietySince 1995

Once a year3 days competitionFrom 15 to over 65 years oldEvents:

4 Beach events2 Pool events

Once a year3 days competitionFrom 15 to over 65 years oldEvents:

4 Beach events2 Pool events

Spain (3), England, EUA (3), Belgium, Italy, Germany, Hungria, Uruguay(2), The

Netherlands, and Argentina (4).

Spain (3), England, EUA (3), Belgium, Italy, Germany, Hungria, Uruguay(2), The

Netherlands, and Argentina (4).

Certification Qualify Water Safety ProgramCertification Qualify Water Safety Program

Law recognized Lifeguard as aWater Safety Professional

To be aproved by Congress

Law recognized Lifeguard as aWater Safety Professional

To be aproved by Congress

www.sobrasa.orgwww.sobrasa.org

12 YEARS OF BRAZILIAN LIFESAVING

SOCIETY - SOBRASADid we make any difference?

12 YEARS OF BRAZILIAN LIFESAVING

SOCIETY - SOBRASADid we make any difference?

Our purpose were to evaluate if the prevention concept of ILS and SOBRASA makes any difference to drowning

mortality in Brazil.

Methods to test the hypothesis:• Brazilian drowning death rates from 1979 to 2003 (death certificates in States).

• 2 different 9 years periods: 1987 to 1995 and 1995 to 2003 (median death

rate/100.000 inhabitants).

• Relevant change in death rates > 10% from one period to another.

• State Services were classify:

• Full Member (FM) >= 3 prevention programs

• Associate Members (AM) >= 1 prevention program,

• Correspondent Members (CM) – No prevention program but at

least lifeguard on duty.

• No Contacts (NC) until early 2007.

Methods to test the hypothesis:• Brazilian drowning death rates from 1979 to 2003 (death certificates in States).

• 2 different 9 years periods: 1987 to 1995 and 1995 to 2003 (median death

rate/100.000 inhabitants).

• Relevant change in death rates > 10% from one period to another.

• State Services were classify:

• Full Member (FM) >= 3 prevention programs

• Associate Members (AM) >= 1 prevention program,

• Correspondent Members (CM) – No prevention program but at

least lifeguard on duty.

• No Contacts (NC) until early 2007.

Results• There was a total reduction on mortality rates of 30,2% from 1979 (5,42/100.000) to 2003 (3,78)

Results• There was a total reduction on mortality rates of 30,2% from 1979 (5,42/100.000) to 2003 (3,78)

DrowningDeath/100.000 inhabitants on Brazil States

1979 and 2003

Acre (A

C)

Alagoa

s (AL)

Amapá (

AP)

Amazon

as (A

M)

Bahia

(BA)

Ceará

(CE)

Distrito

Fed

eral

(DF)

Espírit

o San

to (E

S)

Goiás (

GO)

Maran

hão (

MA)

Mato G

ross

o (MT)

Mato G

ross

o do S

ul (M

S)

Minas G

erais

(MG)

Pará (

PA)

Paraíb

a (PB)

Paran

á (PR)

Perna

mbuco

(PE)

Piauí (

PI)

Rio de

Jane

iro (R

J)

Rio Gra

nde d

o Nor

te (R

N)

Rio Gra

nde d

o Sul

(RS)

Rondô

nia (R

O)

Roraim

a (RR)

Santa

Catarin

a (SC)

São P

aulo

(SP)

Sergip

e (SE)

Toca

ntins

(TO)

years

02468

101214

death/100.000 inhab

1979 2003

Graphic - All Brazilians States and their median death rates

There was no important difference from 1979 (5,42) to 1987

(5,35/100.000) and this period was excluded from analysis.

• 1987 (5,35) to 1995 (4,91) the mortality reduction was 8,3%

• 1995 (4,91) to 2003 (3,78) the mortality reduction was 23%.

There was no important difference from 1979 (5,42) to 1987

(5,35/100.000) and this period was excluded from analysis.

• 1987 (5,35) to 1995 (4,91) the mortality reduction was 8,3%

• 1995 (4,91) to 2003 (3,78) the mortality reduction was 23%.

Results

Tocantins (TO)79,63,762,09Tocantins (NC)

Sergipe (SE)3,15,55,33Sergipe (CM)

São Paulo (SP)20,34,545,7São Paulo (FM)

Santa Catarina (SC)15,75,786,86Santa Catarina (FM)

Roraima (RR)5,99,959,4Roraima (NC)

Rondônia (RO)31,46,769,86Rondônia (NC)

Rio Grande do Sul (RS)15,24,655,48Rio Grande do Sul (FM)

Rio Grande do Norte (RN)34,14,173,11Rio Grande do Norte (CM)

Rio de Janeiro (RJ)32,73,565,3Rio de Janeiro (FM)

Piauí (PI)16,02,982,57Piauí (NC)

Pernambuco (PE)4,54,844,62Pernambuco

Paraná (PR)12,84,95,63Paraná (PR) (FM)

Paraíba (PB)1,33,43,45Paraíba (CM)

Pará (PA)18,43,344,09Pará (CM)

Minas Gerais (MG)22,24,155,34Minas Gerais (AM)

Mato Grosso do Sul (MS)13,45,616,48Mato Grosso do Sul (CM)

Mato Grosso (MT)23,26,635,38Mato Grosso (NC)

Maranhão (MA)15,41,841,59Maranhão (CM)

Goiás (GO)10,44,565,09Goiás (CM)

Espírito Santo (ES)10,96,247Espírito Santo (FM)

Distrito Federal (DF)29,62,653,77Distrito Federal (FM)

Ceará (CE)59,74,112,57Ceará (AM)

Bahia (BA)3,53,884Bahia (FM)

Amazonas (AM)16,76,495,56Amazonas (CM)

Amapá (AP)15,99,6811,5Amapá (NC)

Alagoas (AL)11,44,33,86Alagoas

Acre (AC)4,16,426,7Acre (NC)

1995-20031987-1995 Percentual (%)Median death/100.000 inhabitants

Increase death in GreenDecrease in YellowUnchanged in Blue

Change means > or < 10%

Table shows Brazilians States and their median death rates

for both 9 years periodsevaluated.

Brazilian population grewfrom 117 (1979) to 177 (2003)

millions.

Table shows Brazilians States and their median death rates

for both 9 years periodsevaluated.

Brazilian population grewfrom 117 (1979) to 177 (2003)

millions.

Bias to be Considered• To evaluate a prevention campaign on drowning using only

the worst endpoint – death - is not an exact tool, although it is the most trustful.

• Prevention measures take time to produce an effect on rates, especially death.

• Death rates were considered for a whole State instead of counties or cities. This may be “unfair” or inexact with some lifeguard services that may accomplish an excellent result.

Bias to be Considered• To evaluate a prevention campaign on drowning using only

the worst endpoint – death - is not an exact tool, although it is the most trustful.

• Prevention measures take time to produce an effect on rates, especially death.

• Death rates were considered for a whole State instead of counties or cities. This may be “unfair” or inexact with some lifeguard services that may accomplish an excellent result.

Conclusion• A significant reduction in mortality from 1979 to 2003 = 30,2%.

• From 1979 to 1987 the drowning mortality death rates was unchanged.

• There was a decrease in death rates in the two period evaluated, but was much

more positive from 1995 to 2003 = 73%. This reduction was related especially to

Full Members States.

• Many factors are related to these improvement in death rates,

• The improvement on the firefighter’s lifesaving service,

• The increase on propaganda on drowning prevention,

• The increase on prevention programs to children, and

• An improvement on pre-hospital attendance.

12 YEARS OF BRAZILIAN LIFESAVING SOCIETYDid we make any difference?

Although we have no way to demonstrate how much knowledge

exchange and prevention programs done by ILS and SOBRASA

during these years (1995 to 2003) were responsible for these

positive results, we understand that SOBRASA was definitely a

landmark on drowning in our country and will in the near future

reduce more dramatically the trends on drowning.

One World, N

o Drowning

We Care About - ILS

One World, N

o Drowning

One World, N

o Drowning

We Care About

We Care About -- ILSILS