Each year, some 500 tots under age 5 die and nearly 3,000 suffer permanent neurological damage in some of the 14.7 million pools, hot tubs and spas that bedeck American backyards, the federal government reckons.

Arizona, Florida, Texas, California and New York carry the distinct dishonor of leading the nation in drownings, with 133 reported in the five states by June 17 -- four days before the official start of summer.

"The family swimming pool is supposed to be the center of fun and recreation," said Todd Appleman, president and founder of eSafetyAlert.com, marketer of the Safety Turtle, an immersion alarm that starts shrieking the minute a child's wristband sensor hits the water.

"Despite extensive local public-awareness efforts, and well-funded national public-education campaigns aimed at teaching parents, grandparents and other adults about pool safety and active adult supervision, the number of children drowning each year has remained constant."

The danger looms large as the $20 billion hot-tub and pool industry rides a wave of popularity that has sent sales soaring 11.4 percent in two years, according to the National Pool and Spa Institute.

An Arizona study found an 18 percent increase between 2002 and 2003 in injurious incidents in a relative's or neighbor's pool. Yet, only 41 percent of adults surveyed in a 2003 Harris Interactive national poll had installed "layers of protection" to keep children out of harm's way.

These can include chimes set off by the opening of doors leading to the swim area, fences with self-closing access gates equipped with child-proof alarms and automatic or retracting pool safety covers.

No amount of bells and whistles, however, can replace human vigilance. The Harris poll shows a mere 19 percent of adults are aware drowning is the leading cause of accidental death among youngsters under 5. Other studies indicate nine of 10 pool fatalities occur with a grownup nearby.

An inattentive instant can make a life-long difference to a child struggling for air. The American Pediatrics Association draws the following harrowing timeline:

--After 45 seconds, a child underwater needs medical assistance.

--At two minutes, he or she loses consciousness, requires emergency treatment and faces a 33 percent chance of suffering some neurological harm.

--At five minutes, even poolside cardiopulmonary resuscitation may not be enough to prevent irreversible brain damage or, in 15 percent of cases, death. If the child lives, he or she may require an initial $75,000 emergency-room visit and subsequent $230,000 a year long-term care.

--After 10 minutes, the odds of survival plunge to 1 in 10.

To minimize the risk of disaster, parents should:

--Never let a child near the water without adult supervision.

--Always look in the pool first for a missing child.

--Keep a phone poolside in case of an emergency.

--Secure, lock or remove access to an above-ground pool when not in use.

--Secure patio furniture that could be rearranged into a roadway to the pool.

--Remove toys that may lure youngsters to the water.

Parents also should clear away sharp objects from areas the barefoot might tread.

"Any nail puncture wound requires immediate cleansing with soap and water, followed by evaluation at the local emergency room," advised James Thomas, a podiatrist at the University of Alabama at Birmingham. "Further wound care may be necessary, along with X-rays, antibiotics and possible tetanus update."

Infection with tetanus -- bacteria that attack the nervous system -- can lead to muscle spasms and a locked jaw that prevents the mouth from opening or swallowing and, in 15 percent of cases, results in death.

"Going barefoot heightens risk for puncture wounds, which require different treatment from cuts because the tiny holes often harbor foreign matter under the skin," said Matthew Roberts, an Oklahoma foot and ankle surgeon. "Glass, nails, needles and seashells are common offenders."

Noting 10 percent of puncture wounds become seriously infected, the American College of Foot and Ankle Surgeons recommends medical treatment within 24 hours of injury.

"Studies show 60 percent of patients who required incision and drainage of a puncture wound had something embedded," Roberts noted. "With the increasing prevalence of drug-resistant bacteria, even healthy people are getting potentially life-threatening staph infections."

The common microbe, which dwells harmlessly in the skin of 30 percent of healthy individuals, can penetrate cracks, causing inflammation, and infesting bones (osteomyelitis), lungs (staph pneumonia), blood (sepsis), heart (endocarditis) and other organs. U.S. hospital officials blame antibiotic-resistant staph bacteria for up to 40 percent of all soft-tissue infections.

The findings seem to reaffirm one of life's painful lessons: Without taking proper precautions, children or adults baring their soles can expose them to getting seriously hurt.

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