The usual agent of drowning is water although other liquid media are occasionally involved. As the Ancient Mariner lamented "...Water, water, every where, Nor any drop to drink..." in Samuel Coleridge's poem (32), it is the ubiquity of water and its necessity for human survival and the quality of life that confronts public health with the difficulties in preventing drowning. Haddon's first strategy for the control of injuries, "Prevent the creation of the hazard in the first place", is thwarted by water's omnipresence (33). Absent removing the drowning hazard itself, public health must focus its efforts on Haddon's remaining nine strategies for larger artificial and all natural water bodies. Not filling small artificial water bodies (e.g., bathtubs, wading pools and water buckets) with water before they are to be used is an appropriate strategy if and then they are under continuous observation and control by alert and conscientious adults.

Table 3 addresses a variety of natural and artificial water body hazards in need of serious prevention, intervention and control strategies, which Robertson (2007) described in his epidemiological approach to injury control (¬33). Some of the many risk factors associated with unintentional injury by drowning are noted in the Haddon Matrix in Figure 6.



Figure 6. Haddon Matrix - Unintentional Drowning