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  Supervision and surveillance of any child in proximity to any aquatic environment, including swimming pools, baths, beaches, buckets containing water, etc., is an essential strategy for the prevention of drownings.1,11 Proper supervision implies that the distance to the child is less than the length of the caregiver's arm; in other words, literally keeping children within arm's reach.

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  The presence of a lifeguard is the best way to avoid water accidents that end in drowning. However, a lifeguard cannot supervise all bathers at the same time, and it is therefore essential to keep children under constant surveillance. Although deaths are infrequent when there is a lifeguard present, they can happen.1,5

With respect to swimming pools:

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  Complete fencing of pools around their entire perimeter, so that the pool is totally isolated from the garden and the house, is effective in preventing many drownings of children in pools.1,8,10,13

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  The fencing must enclose the entire perimeter of the pool, it must be high enough to prevent children from climbing or jumping over it, and the distance between the bottom edge of the fence and the ground must be less than 10cm to avoid children squeezing underneath it. The gate is the most important component of the fence. It must be self-latching and self-closing and the latch must be out of the reach of children (at a height of at least 1.34m from the ground). The fencing must never block the view of the pool.1

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  If pool covers are used, they must be rigid and cover the whole length and breadth of the pool to prevent children from walking across them or slipping in at the sides of the pool and being trapped under the cover and unable to get out.

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  The depth of the pool must be indicated at the sides.

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  Diving must be prohibited if the depth is less than 1.20m and permitted only if the water is over 1.80m deep. However, children should be advised to jump into the pool feet first.1

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  Children's pools or paddling pools must also be fenced off to prevent children having access to them on their own. If they are recreational or multipurpose pools they must include arrangements to prevent collisions.

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  The drains of both public and private swimming pools, including jacuzzis, must have safety devices to prevent suction and hair entanglement or entrapment of other parts of the body (drain covers or any other anti-entrapment mechanism).12

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  If pool alarms are used (alarms in the pool to detect movement, infrared perimeter alarms, etc.), both owners and other users must be familiar with how to operate them correctly. Alarms are insufficient if they are used as the only preventive measure.1

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  Swimming lessons and learning water survival skills can reduce rates of drowning in children. It is advisable for children to learn to swim, particularly from the age of 4. However, the decision on when a child should begin such lessons must be made on an individual basis. There are studies that maintain that beginning lessons between the ages of 1 and 4 reduces drowning rates. Parents must take into account the frequency of the child's exposure to water emotional maturity, physical limitations and other health concerns, such as hypothermia, infectious illnesses, lung damage from pool chemicals, etc. Parents have to be aware that swimming lessons for small children small children or those who have not acquired sufficient skills will not prevent drowning or provide complete protection, and that constant supervision must therefore be maintained. Knowing how to swim well in a swimming pool does not necessarily make a child safe in natural water environments, so children should never swim without adult supervision.1

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  The use of personal flotation devices (PFDs) when riding in any kind of recreational watercraft is an important preventive measure against drownings. In a study of boating-related deaths carried out in the United States, 86% of those who died were not wearing a flotation device, whereas the remaining 14%, who were wearing one, died from other causes, such as hypothermia.14 Children should not wear air-filled swimming aids that can be deflated (such as armbands or water wings) as these represent a risk. Life jackets are preferable.

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  Training in CPR procedures, for parents adolescents and older children, is also an effective measure. Appropriate cervical protection, the time elapsed since drowning and prompt application of CPR by trained personnel are crucial for improving the prognosis in a drowning.2

Current legislation on swimming pools in Spain has remained almost unchanged since the Ministerial Order of 31 May 1960 issued by the former Ministerio de la Gobernación. Although it has been updated by a Royal Decree (RD 742/2013 of 27 September 2013, establishing technical and health standards for swimming pools),15 family swimming pools, where the largest numbers of drownings are recorded, remain exempt from compliance with safety standards, which are applicable only to public pools.15 Moreover, pools belonging to private communities of homeowners (where the number of drownings is currently increasing more rapidly) are not subject to standarized regulations in Spain's different regions, in terms of whether they are regarded as public or private.

We on the Committee therefore consider that the actions required to improve water safety and prevent drownings should include:

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  Establishing minimum safety requirements at a national level so as to harmonise the legislation of the different regions and increase safety measures at swimming pools, making it compulsory, among other things, for both public and private pools to be completely fenced.16–18

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  Developing European standards for public swimming pools, including signs to indicate the water depth, coloured edging on steps, life-saving equipment and covers on suction drains.9,11

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  Making it obligatory to employ lifeguards who should be regularly re-certified.

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  Establishing compulsory use of personal flotation devices/life jackets while practising any water sport or aquatic activity.

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  Implementing the use of standardised safety signs and symbols (such as diving not permitted, a red flag indicating that bathing is prohibited, etc.) in all aquatic environments.

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  At public beaches and swimming pools appropriate and sufficient information should be provided regarding preventive safety measures and include situations that could pose a health risk, on prevention of drowning and of other injuries, such as traumatic brain injuries and spinal cord injuries, among others.

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  Information should also include the location of the lifeguard, as of the first-aid post and the addresses and telephone numbers of the nearest health care centres and accident and emergency departments.