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.