12 YEARS OF BRAZILIAN LIFESAVING SOCIETY SOBRASA Did

12 YEARS OF
BRAZILIAN LIFESAVING SOCIETY
SOBRASA
Did we make any difference?
Dr David Szpilman, MD - Brazil
Principal Author
Dr 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.
Other Authors: names and affiliations
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
Brazil - fifth largest and populous country in the
world - 188 million inhabitants (2006)
David Szpilman, MD
SOUTH AMERICA
Brazil
Brazil
Brazilian
Coastline
8,000 Km
David Szpilman, MD
One of the largest
number of rescues
Are you aware off?
Drowning In Brazil
7.000 death per year
Source:
Source: Szpilman
Szpilman D.
D. -- 2003
2003
Date
Date research
research based
based on
on DATASUS
DATASUS -- death
death certificate
certificate
Are you aware off?
Drowning in Brazil
Each Year
260,000 hospitalizations
1,300,000 rescues
600 victims not found
Source:
Source: Szpilman
Szpilman D.
D. -- 2003
2003
Date
Date research
research based
based on
on DATASUS
DATASUS -- death
death certificate
certificate
Are you aware off?
Drowning in Brazil
Drowning is the 2º cause
of death among
1 to 14 years old
Source:
Source: Szpilman
Szpilman D.
D. -- 2003
2003
Date
Date research
research based
based on
on DATASUS
DATASUS -- death
death certificate
certificate
The first
organized
lifesaving service
was founded in
1918, in Rio de
Janeiro City
First Brazilian Lifeguard Tower
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
1991
Brazilians lifeguards made their
first official international contact
(Dr Ian Mackie from Australia)
The mail exchange resulted in our
first international event - 1994
World Lifesaving Championship and
Foundation 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 - SOBRASA
Main goal
To reduce
drowning using
preventive actions.
How lifeguarding works in Brazil
Water Safety
Lifeguarding Services – State Fire Department
National Society
Non profit and non military
Foundation 1995
Brazilian Life Saving Society
Since 1995
9 Once a year
9 3 days competition
9 From 15 to over 65 years old
9 Events:
9 4 Beach events
9 2 Pool events
Spain (3), England, EUA (3),
Belgium, Italy, Germany,
Hungria, Uruguay(2), The
Netherlands, and Argentina (4).
Certification Qualify Water Safety Program
Law recognized Lifeguard as a
Water Safety Professional
To be aproved by Congress
www.sobrasa.org
12 YEARS OF
BRAZILIAN LIFESAVING
SOCIETY - SOBRASA
Did 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
(death certificates
certificates in
in States).
States).
• 2 different 9 years periods: 1987 to 1995 and 1995 to 2003 (median
(median death
death
rate/100.000
rate/100.000 inhabitants).
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)
Drowning
14
Death/100.000 inhabitants on Brazil States
1979 and 2003
death/100.000 inhab
12
10
8
6
4
2
0
)
)
)
) )
)
)
)
)
)
) )
)
)
)
) )
)
) )
)
)
)
)
) ) )
C AL AP AM BA CE (DF (ES
O MA MT (MS MG PA PB PR PE (PI (RJ (RN (RS RO RR (SC SP SE TO
(
(
(
(
( (
(
( o(
(
( a
(
( l
(
(A (
(G o ( o ( ul
í ro te ul
o pe ns
a
s
u
a rá ra nto
á
a
a
á
l
e as pá as
s
i
i
r
i
i
c
n
s
r
r
b
S
a
i
S ra
u
i
á ã
i e
h a e
c o
a aí ran bu
ôn raim tar Pa rgi nt
P an No do
oi nh ros do
A lag ma zon Ba Ce ed Sa
P
e
r
d
a
a
e
a P am
G ra G o
J o
G
n
o a
F o
A a
S oc
A
P
a to s
e e d de Ro R a C ão
s
n
o írit
m
t
r
T
d
a
s
n
i
S
M a o
t
A
e
d ra
tr sp
in
o
n
r
i
n
P
s
M
i
a
M
E
G
R ra
G
S
D
o
G io
t
a
R
io
M
R
Graphic - All Brazilians States
and their median death rates
years
1979
2003
Results
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%.
Median death/100.000 inhabitants
1987-1995
Acre (NC)
1995-2003
Percentual (%)
6,7
6,42
4,1
Alagoas
3,86
4,3
11,4
Alagoas (AL)
Amapá (NC)
11,5
9,68
15,9
Amapá (AP)
Amazonas (CM)
5,56
6,49
16,7
Amazonas (AM)
Bahia (FM)
4
3,88
3,5
Bahia (BA)
Ceará (AM)
2,57
4,11
59,7
Ceará (CE)
Distrito Federal (FM)
3,77
2,65
29,6
Distrito Federal (DF)
7
6,24
10,9
Espírito Santo (ES)
Goiás (CM)
5,09
4,56
10,4
Goiás (GO)
Maranhão (CM)
1,59
1,84
15,4
Maranhão (MA)
Mato Grosso (NC)
5,38
6,63
23,2
Mato Grosso (MT)
Mato Grosso do Sul (CM)
6,48
5,61
13,4
Mato Grosso do Sul (MS)
Minas Gerais (AM)
5,34
4,15
22,2
Minas Gerais (MG)
Pará (CM)
4,09
3,34
18,4
Pará (PA)
Paraíba (CM)
3,45
3,4
1,3
Paraíba (PB)
Paraná (PR) (FM)
5,63
4,9
12,8
Paraná (PR)
Pernambuco
4,62
4,84
4,5
Piauí (NC)
2,57
2,98
16,0
Piauí (PI)
5,3
3,56
32,7
Rio de Janeiro (RJ)
Rio Grande do Norte (CM)
3,11
4,17
34,1
Rio Grande do Norte (RN)
Rio Grande do Sul (FM)
5,48
4,65
15,2
Rio Grande do Sul (RS)
Rondônia (NC)
9,86
6,76
31,4
Rondônia (RO)
9,4
9,95
5,9
6,86
5,78
15,7
Santa Catarina (SC)
5,7
4,54
20,3
São Paulo (SP)
Sergipe (CM)
5,33
5,5
3,1
Tocantins (NC)
2,09
3,76
79,6
Espírito Santo (FM)
Rio de Janeiro (FM)
Roraima (NC)
Santa Catarina (FM)
São Paulo (FM)
Acre (AC)
Pernambuco (PE)
Roraima (RR)
Sergipe (SE)
Tocantins (TO)
Table
Table shows
shows Brazilians
Brazilians States
States
and
and their
their median
median death
death rates
rates
for
for both
both 99 years
years periods
periods
evaluated.
evaluated.
Brazilian
Brazilian population
population grew
grew
from
from 117
117 (1979)
(1979) to
to 177
177 (2003)
(2003)
millions.
millions.
Increase death in Green
Decrease in Yellow
Unchanged in Blue
Change means > or < 10%
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 SOCIETY
Did 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.
g
n
i
n
w
o
S
r
L
D
I
o
t
N
u
,
o
d
b
l
r
o re A
W
a
e
C
n
O We