Use of a consensus-based process to develop international guidelines to decrease recreational open water drowning deaths

Many drowning deaths in high income countries occur while recreating in open water. Multiple agencies, often working in isolation, promote a plethora of messages to address this health issue. Our objective was to develop a consensus-based set of simple, generic guidelines, applicable to the general public, to standardize international recreational open water drowning prevention messages. We describe the processes of forming a Task Force of 18 international drowning prevention experts, of defining the scope of the guidelines and their development, of using a modified Delphi technique to prioritize, and of achieving approval of final wording of each guideline by consensus. Task Force participants agreed to develop guidelines for primary prevention of non-craft or competition-related recreational water activities in generic open water settings and to base guidelines on best practice and evidence. After compiling 125 guidelines, a modified Delphi technique was used to prioritize the guidelines into two categories: Keep yourself Safe and Keep others safe. Task Force participants agreed on eight key guidelines for each category. In both categories, Learn swimming and water safety survival skills was the highest priority guideline; other guidelines given high priority included Swim in areas with lifeguards, Know how and when to use life jackets, and Obey safety signs and flags. Use of consensus-based processes, including a modified Delphi technique, by a Task Force of diverse international drowning prevention experts, led to a set of simple, concise drowning prevention guidelines that promote uniform and consistent educational messages to the public. The process led to expanded definitions of supervision, provided a research agenda and basis for a policy agenda on open water drowning prevention, and maximized dissemination of the guidelines to decrease open water drowning deaths. Moreover, the processes represented a step toward coordinating drowning prevention efforts internationally to focus efforts on decreasing open water recreational drowning.