Discussion
The frequency of the events described above is unknown; there is no national registry of pediatric drownings which includes causation.24 Drowning is the leading cause of injury and death in the USA between the ages of 1-4 and the 3rd leading cause in the ages from 5-19 years of age.24 Supervision remains the most essential means of protection, but the Model Aquatic Health Code developed by the CDC is both based on science and standards for safety of operation. The code states maximum temperature “shall not exceed 104°F.”25 The policy statement from the American Academy of Pediatrics referenced fails to mention hyperthermia risk from hot tub use.24 In the case scenario, these standards were not met: the hot tub temperature was substantially in excess of this code, and in actuality signage within the pool area failed to describe risks of overheating. There were no depth markers thus leaving visitors little forewarning of such risk. While the age of the case described was over the age of 5, below which hot tub use is warned against by the CDC, she was close enough to have raised concerns. The presence of a hot tub with heater set to 104°F did not include any means of cooling should that temperature be exceeded, and it is unclear as to whether there was any means of alerting operators if this temperature was exceeded. There were no thermometers in the hot tub. While the mother did not accompany the child into the tub, she had believed that the tub was off, as the jets were not working, and her child was a skilled swimmer.
Hyperthermic syncope can occur suddenly in both children and adults, with potentially catastrophic results. It is poorly recognized as a risk by medical professionals, aquatic facility supervisors, lifeguards, and the general public. This case demonstrated the risks, the unfortunate outcome and the underlying physiology behind those risks.