12 years of Brazilian Lifesaving Society (SOBRASA): Did we make any difference?

Title12 years of Brazilian Lifesaving Society (SOBRASA): Did we make any difference?
Publication TypeConference Paper
Year of Publication2007
AuthorsDr Szpilman, MD, D
Conference NameWorld Conference on Drowning Prevention
Date Published09/2007
PublisherInternational Life Saving Federation
Conference LocationPorto, Portugal
Other Numbers01-17

Introduction: Brazil, at 8.5 Million square kilometers, is the fifth largest country in the world, and also the fifth most populous nation with 188 million inhabitants (2006). The water surface is huge in size and exposes most of the inhabitants to water accidents every day. Drowning became a public health problem in Brazil in 1910, when the population started to use the beach for leisure. At that time fisherman were responsible for preservation of life in and on the water. The first organized lifesaving service was founded in 1918, in Rio de Janeiro. Since then, many other services have been created around the country, and from 1984, the military firefighters took over the responsibility for lifesaving in each state of the Federation. Among rare exceptions of civilian lifesaving services and pool lifeguards, Brazil has these unique characteristics of military firefighter lifeguards. In 1991, Brazilians lifeguards made their first official international contact with other countries representative, Dr Ian Mackie from Australia. At that time contact was by mail with information often slow to reach South America. The mail exchange resulted in a first Brazilian participation in an international event - 1994 World Lifesaving Championship and the foundation of International Life Saving Federation - ILS, where the idea and the importance of the concept of a truly global lifesaving organization was conceived. A Brazilian Lifesaving Society (SOBRASA) was created in 1995 by some water safety expert firefighters. The main goal was to reduce drowning mortality by using preventive actions. Since then, many different prevention programs were created or promoted around the country by SOBRASA and its representatives. Our purpose is to evaluate if the prevention concept of ILS and SOBRASA makes any difference to drowning mortality in Brazil.

Methods: Drowning death rates among Brazilian residents were calculated from death certificates (1979-2003) based on DATASUS - Mortality System Information www.datasus.gov.br using International Classification of Disease (CID10), in all 27 States of the Brazilian Federation. We based our evaluation in 2 different periods, 1987 to 1995 and 1995 to 2003 using median death rate/100.000 inhabitants in each period, including both 1995 to reduce bias. We considered a relevant change in death rates if it was greater than 10% from one period to another. State Firefighter Services join SOBRASA as a Full Member (FM)(at least running 3 prevention programs), others as Associate Members (AM)(at least one prevention program), a few just as Correspondent Members(CM) (at least lifeguard on duty)and others have established No Contacts until 2007(NC).

Results: At general, there was a total reduction on mortality rates of 30,2% from 1979(5,42/100.000) to 2003(3,78) (graphic 1). There was no important difference from 1979(5,42) to 1987(5,35/100.000). We found an 8,3% mortality reduction from 1987 (5,35) to 1995 (4,91/100.000) and a decrease of 23% from 1995 (4,91) to 2003 (3,78/100.000) in Brazil. Table 1 shows all Brazilians States and their median death rates mortality for both periods evaluated. Brazilian population grew from 117 (1979) to 177 (2003) millions.

Discussion: Evaluation of a prevention campaign on drowning using only the worst endpoint – death - is much more complicated than we thought at the beginning of this research, although it is the most trustful outcome. Prevention measures take time to produce an effect on rates, especially death, to evaluate and compare correctly and it does not take into consideration factors as seasonality and disasters. Another important point was the fact that 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, but in fact are included in the State death rates. In this research a significant reduction in mortality from 1979 to 2003 was demonstrated. Before 1987 the mortality death rates was unchanged but a decrease in the two periods evaluated. Reduction on death rates was more positive from 1995 to 2003 (73%) which is a significant demonstration that death rates dropped during this period. This reduction was related especially to Full Members States. Many factors are related to these results, for example: The improvement on the firefighter’s lifesaving service on rescue and prevention, the increase on propaganda on drowning prevention, the increase on prevention programs to children, and an improvement on pre-hospital attendance. It is very important to each lifeguard State service to evaluate their own area to determine where exactly the problem is and find out the solution to reducing death by drowning. 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 communication and exchange of information about this important subject was definitely a landmark on drowning in our country and will in the near future reduce more dramatically the trends on drowning.

Learning Outcomes
  1. Do our prevention projects make any difference in mortality?
  2. Do our prevention proposals have good support from lifesaving services?
  3. We analysed mortality in all lifesaving services in Brazil and evaluate which one improve with prevention project.