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Descriptive epidemiology of drowning deaths in a surf beach swimmer and surfer population

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Abstract

Unlabelled: Retrospective data extraction from two complementary mortality datasets determined the descriptive epidemiology and population rates in unintentional drowning deaths at surf beaches (n = 129). The annual average crude surf beach drowning rate was 0.28 per 100 000 population for males and 2.36 per 100 000 population for international tourists. The study generated hypotheses for risk assessment to assist Intervention: adult males, international tourists, people with cardiovascular conditions, and exposure to rip currents.

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... This leads to a ridge and runnel system inducing rip currents (Castelle et al., 2007). These conditions can be encountered in other parts of the world, and it is known that most beach-related drowning are caused by rips ( Gensini & Ashley, 2010;Morgan et al., 2008). ...
... This could be explained by a riskier behavior among adult males. In Australia, similar findings have been reported regarding the propensity to swim outside flagged area , and death rate among surf beach swimmer population (Morgan et al., 2008). ...
... A previous study showed ( ) that these currents cause 79 % of drownings. Rip currents are CCCCCCCC 3 : MMMMMMMMMMMM MM MMMMMMMMM MMM MMMMMM the leading causes of rescues and drownings oo many surf coasts worldwide ( Gensini et al. 2010;Kumar et al. 2014;Li 2016;Morgan et al. 2008;). ...
Thesis
Les côtes girondines, dans le Sud-Ouest de la France, sont façonnées par les conditions océaniques. Les plages de sables y présentent des dangers tels que les courants d'arrachement et les vagues de bord. Ces phénomènes sont la cause de noyades et de traumatismes potentiellement graves, nécessitant des dispositifs de surveillance et de secours.Les objectifs de cette thèse étaient d'enrichir les connaissances utiles à l'intervention sur les noyades et traumatismes liés aux vagues selon plusieurs axes : en décrivant la population des victimes, en modélisant les risques et en déterminant les actions nécessaires à leur prévention.Dans un premier temps, les caractéristiques démographiques et la gravité des noyades et des traumatismes ont été décrites. En analysant les appels au Service d'Aide Médicale d'Urgence de la Gironde, 652 noyades et 814 traumatismes ont été recensés. À partir de ces données et en intégrant les observations météorologiques, un modèle de prévision du risque de noyade sur le littoral océanique girondin a été créé. Il a été ensuite validé, sur les données météorologiques prévisionnelles. Le risque de noyade liée aux courants d'arrachement peut ainsi être anticipé trois jours à l'avance. Les risques de traumatismes liés aux vagues de bord ont également fait l'objet de modélisation.Un cadre théorique de modélisation de l'histoire naturelle de la noyade à l'aide d'un processus de Markov à temps continu a été proposé. Il a permis, entre autre, de quantifier l'impact théorique d'une réduction du délai des secours sur la gravité des noyades. Une réduction du délai de médian des secours de 15 à 10 minutes permettrait une diminution de moitié des cas de noyade graves.Enfin, l'utilisation des prévisions du risque dans une action de prévention a été discuté à partir de concepts issus d'une revue de la littérature. Ces travaux permettront de mettre en place et d'évaluer une action de prévention de la traumatologie océane en Gironde.
... For the four-year period July 2001 to June 2005, five surf bather drowning deaths were recorded during the summer season (December to February) in Victoria (from summary coroner data; Morgan, Ozanne-Smith, & Triggs, 2008). Four of these drownings occurred on patrolled beaches during patrol times but at a location outside of patrolled zones. ...
... The method used and calculation are reported in the online data supplement. For comparison, the proportion of surf beach drowning for Victorian residents was calculated following methods described by Morgan et al. (2008). ...
... Also, accounting for non-systematic variations for pertinent factors over the time period and locations, including beach characteristics, beach remoteness or weather conditions, may require larger sample sizes with respect to time-duration and location to reduce potential sampling bias. With respect to the incidence rate numerator, Morgan et al. (2008) noted that at the time of reporting coronial data, open records were excluded from their data collection. It is therefore possible that cases closed subsequent to the reported study may have been included in the total surf bather drownings for the specified time-period. ...
Article
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Drowning risk factors may be identified by comparing drowning incidence rates for comparable at-risk populations but precise methods are lacking. To address this knowledge gap, an ecological study extrapolated crude time-duration exposure to water for a specified at-risk sample of surf bathers to estimate the bather population for all wave-dominated beaches in Victoria, Australia, over a four-year summer season period. An incidence rate was calculated using surf bather drowning deaths frequencies matched for time and location. For the sample, 47,341 hours of surf bathing were estimated from 177,528 bathing episodes. Generalising these results to Victoria, the crude drowning deaths incidence rate in the summer season was 0.41 per 1,000,000 person-hours of surf bathing (95% CI 0.37-0.45). Further application of the method, particularly in open water settings, may be used to identify candidate drowning risk factors to advance drowning prevention strategies.
... 105). [7,22,26] Gold standard comparison Drowning mortality Coronial records [25] In the present study, a drowning risk analysis applied mathematical models combining previously collected data to derive comparative drowning ratios (indicating relative risk) for surf bather risk-marker subgroups. To assess method validity a posed research question was: Does relative sub-group drowning risk derived from risk analysis align to a gold standard for comparative drowning rates? ...
... To specify comparative drowning rate between subgroups as the gold standard Information sources: Ratio of drowning frequency for subgroups from mortality data for a defined period [25] Outcome: Comparative rate of drowning frequency between selected subgroups ...
... The risk analysis relies on conflating compatible data across five discrete datasets collected for Australian surf bathers. Data collection methods provided matching variable measures collected over corresponding time-periods [7,22,23,25,26]. For step 1 ( Table 2), three factors (swimming ability, surf swimming experience and wave height) were ranked highest by an expert panel as causal risk contributors to surf bather drowning [26]. ...
Article
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The study assessed the utility of risk analysis for advancing knowledge on drowning risk factors. The setting was unintentional drowning of surf bathers in Australia. Bathers reported earlier exposure to selected risk factors (swimming ability, wave height associated with rip currents and surf bathing experience) and were observed for water exposure (in minutes). These data were then assembled in mathematical models. The analysis forecast relative drowning risk pertaining to risk markers representing selected surf bather subgroups (gender, age and water activity). Contextualized through previous study findings, comparison of results with a gold standard obtained from mortality data generated new surf bather drowning hypotheses suitable for future testing by rigorous analytical epidemiologic designs. The hypotheses were: (1) The male to female comparative surf bather drowning rate is explained primarily by differences in crude water exposure; (2) the association of cardio-vascular medical conditions with surf bather drowning is stronger for older surf bathers compared to younger surf bathers; and (3) other risk contributors to surf bather drowning are: Poorly calibrated perception of bathing ability (overconfidence) and use of alcohol. Nonetheless, drowning rates appear generally consistent with time exposure to water. The study findings may also support drowning prevention strategies targeting risk marker subgroups.
... Surf beaches provide a potential location for developing and testing new methods to measure water exposure. Surf bather drowning is a recognized problem in many countries with the epidemiology described for some (Morgan, Ozanne-Smith, & Triggs, 2008). Sufficiently-sized surf bather samples may be obtained from beaches near population centers given the high visitation levels sustained during amenable weather conditions. ...
... Across all 20 beaches each day, approximately 146 bathers were in the water at the peak-bathing time, based on the median score for time-period 1 data (Table 4). Comparable results were found for time-period 2. No drowning deaths were reported within the sampling frame (from data reported by Morgan et al., 2008). It is therefore not possible to estimate the sample's crude drowning risk from the study results, but by implication this rate would fall somewhere below 1 per 10,000 immersions measured at the peak-bathing period. ...
... Comparable results were found for the time-period 2 data collection. Morgan et al. (2008) reported just one out of 129 surf bather drowning deaths over a four-year period in Australia was recorded to have occurred between the flags. Fenner, Harrison, Williamson, and Williamson's (1995) statistical study of surf lifesaver resuscitations-for the Australian state of Queensland from 1972 to 1993-demonstrated that the likelihood of successful resuscitation increased closer to the lifesaver supervised zone. ...
Article
To better address drowning issues, risk assessment at the group and sample levels would be enhanced by precise measures of exposure to water. The aim of the study was to develop and pilot test a method of measuring exposure to water based on estimating immersions for surf bathers. Validated direct observation counts provided peak-bathing period point estimates and a daily bather immersion profile for an identified sampling frame comprising 20 beaches over 39 summer days. An estimated 10,089 water immersions occurred at the peak-bathing period in the sampling frame. Swimmers comprised 86.0% and surfers with equipment 14.0% of the observed bathing sample, respectively. For swimmers only on patrolled beaches, 77.1% bathed in the lifesaver supervised (flag) zones. The study has implications for the provision of organized bather supervision and provides a foundation for generation of hypotheses on the nature of drowning risk for selected surf bather groups.
... Surfing locations are often associated with potential hazards to ocean bathers including strong wave activity, rip currents and proximity to headlands, reefs and rocks (Schrope, 2006;Scarfe et al., 2009). These hazards are the primary causes of rescues and drowning fatalities along the Australian coastline (Short and Hogan, 1994;Morgan et al., 2008;Brighton et al., 2013;Kennedy et al., 2013;SLSA, 2014). Australian professional lifeguards and volunteer surf lifesavers typically make in excess of 10,000 surf rescues each year (SLSA, 2014) and in the 2013-2014 season, there were 84 coastal fatalities representing a major public health concern with significant personal, societal and economic costs (Sherker et al., 2008;AWSC, 2012;Pearn and Franklin 2012;SLSA, 2014). ...
... Males aged 18-29 represent the largest proportion of rescuees, which is consistent with rescue statistics (SLSA, 2014) and drowning fatality statistics of populations in natural, unsupervised aquatic locations (Morgan et al., 2008). Swimming was the predominant rescue activity prior to rescue with 88% of these being rip current related. ...
Article
This study describes the demographics, occurrence, location, primary hazards and outcomes involved in rescues performed by surfers on Australian beaches. Conservative estimates suggest that the number of rescues conducted by Australian surfers each year is on par with the number conducted by volunteer surf lifesavers. Surfers perform a considerable number of serious rescues in both lifesaver/lifeguard patrolled (45%) and unpatrolled (53%) beach locations. Rip currents represent the major physical hazard leading to rescue (75%) and the dominant emotional response of people rescued is one of panic (85%). Most surfer rescue events occur during conditions of moderate waves and sunny, fine weather with the highest proportion of rescues occurring on quiet beaches with few people around (26%). Swimming is the activity associated with most rescue events (63%), followed by board riding (25%). Males aged 18–29 represent the largest demographic of people rescued. Surfers with prior water-safety training are more likely to perform a higher number of rescues, however ability to perform rescues is not associated with formal training, but rather number of years’ experience surfing. Seventy-eight percent of surfers were happy to help, while 28% expressed feelings of annoyance or inconvenience, generally towards unwary swimmers. Results of this research suggest that 63% of surfers feel they have saved a life. This value may be enhanced through improved training of surfers in basic water safety rescue techniques.
... In addition, most previous studies focusing on traveller deaths have been drowning or water-related. 14,25,31,34,[38][39][40][41][42][43] While some previous studies have reported crude death rates, 2,41 or age-adjusted (incidence) rates, these have mainly related specifically to drowning studies. 25,31,40,42,44 No previous studies on all-cause traveller injury deaths presented age-standardised mortality rates or incidence rates. ...
... 14,25,31,34,[38][39][40][41][42][43] While some previous studies have reported crude death rates, 2,41 or age-adjusted (incidence) rates, these have mainly related specifically to drowning studies. 25,31,40,42,44 No previous studies on all-cause traveller injury deaths presented age-standardised mortality rates or incidence rates. The most comprehensive study published to date on tourist injuries in Australia was by Mitchell et al. 15 This compared the burden of injuries in international visitors to residents of New South Wales (NSW), and was based only on hospitalisation data. ...
Article
Objective: To explore injury deaths in international and domestic interstate travellers, together with those newly arrived to Australia. Methods: A population-based cohort study of all injury-related deaths between 1January 2006 and 31 December 2017 registered with Births Death and Marriages in Australia was conducted using Australian Bureau of Statistics' (ABS) Cause of Death information. Population data on travellers were obtained from Tourism Research Australia. Results: There were 4,503 injury-related traveller deaths (domestic interstate:3,055; international:934; new arrivals:514). The average annual age-standardised mortality rates in domestic interstate travellers was 0.75 per 100,000, compared with 2.22 per 100,000 in international travellers. Leading causes of injury-related death were land transport incidents (n=1495, 33.2%), self-harm (n=786, 17.5%) and falls (n=513, 11.4%), with differences in mechanism by state/territory, traveller type and age group. Intentional self-harm was common amongst all visitor types, however, it was the primary cause of death in new arrivals Conclusion: Age-standardised mortality rates were almost three-fold higher in international than domestic travellers. New arrivals, international and domestic travellers have different injury profiles, and each require specific prevention strategies. Implications for public health: While COVID has restricted travel to and within Australia, this has provided an opportunity for exploration, reflection, and consideration of risk factors for travellers, and to develop targeted injury prevention strategies for visitor types, so travel experience can be optimised and the magnitude of harm can be reduced.
... This leads to a ridge and runnel system inducing rip currents (Castelle et al., 2007). These conditions can be encountered in other parts of the world, and it is known that most beach-related drowning are caused by rips (Castelle et al., 2018;Gensini & Ashley, 2010;Morgan et al., 2008). ...
... This could be explained by a riskier behavior among adult males. In Australia, similar findings have been reported regarding the propensity to swim outside flagged area (Sherker et al., 2010), and death rate among surf beach swimmer population (Morgan et al., 2008). ...
Article
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Background: Drowning is the third cause of non-intentional injury death worldwide. Beaches of Gironde, in southwestern France, are exposed to strong environmental conditions, leading to rip currents and shore breaks. Bathing season usually lasts from April to October and is supervised from June till mid-September. The objective of this study was to study the characteristics of drowning victims along Gironde surf beaches and to identify peculiarities compared to national figures. Methods: All calls originating from beaches to the emergency call center of Gironde from 2011 to 2016 were analyzed. Patient data, filled by a physician based on information given by pre-hospital care team (lifeguards, paramedics or emergency physicians), were extracted from the emergency call center database. We used Szpilman classification (0 = rescue to 6 = cardiac arrest) to assess severity. Rescues are patients without respiratory impairment who needed lifeguards or helicopter intervention. We compared our findings with national studies carried every three years (2012 and 2015). Results: We analyzed 5680 calls from beaches and included 4398, 576 of which were rescued from the water, including 352 without respiratory impairment (stage 0). Among drownings, 155 had cough only (stage 1), 26 pulmonary rales (stage 2), 9 pulmonary edema (stage 3) and 1 had pulmonary edema with hypotension (stage 4). Five rescued people were in respiratory arrest and 28 were in cardiac arrest. 77.5% were bathers, others were mainly surfers or body-boarders. Drowning victims median age was 24 (quartiles: 17-40), and sex-ratio was 1.44 Male/Female. Men were significantly older than women (34 vs. 26 years old), and severity from stage 1 to 4 was positively associated with age. Compared to national data, Gironde drownings had a higher proportion of 15-44 year-old victims, and the case-fatality was lower in Gironde (11.5%) than at the national level (27.4%, p < 0.001). Conclusion: Along Gironde coast, drowning is rarely severe, concerns mostly young men; the age distribution could explain the different case-fatality. Further study is needed to identify environmental predictors of drowning.
... Over the 5 year period from 2005 to 2009 the US Lifesaving Association (2011) recorded an average of 96 beach drownings per year (recorded at 95% of ocean beaches and some non-ocean sites patrolled by lifeguards). In Australia, an estimated average of 32 people drowned annually at surf beaches during the years 2001-2005(Morgan et al., 2008. Further, it has been estimated that for every drowning death, between 4 and 10 neardrowning victims are hospitalised, and up to 10% of these cases suffer neurological damage (Australian Department of Health and Aged Care, 1999). ...
... Rip currents are responsible for 80-90% of the tens of thousands of surf rescues conducted by lifeguards in both the United States and Australia each year (Brewster, 2005;Short, 2007a). They are also involved in a very high proportion of beach-related drowning (Morgan et al., 2008;Short, 2007a;Gensini and Ashley, 2010). Thus there is a need for beach safety strategies that specifically target rip-related drowning (Sherker et al., 2008). ...
Article
Background Rip currents are involved in a high proportion of beach drowning and rescue incidents. The most common type of rips in Australia is a fixed rip that appears as a darker, calmer area between regions of breaking waves. People who swim in unpatrolled areas may be endangered by a lack of knowledge about rips – for example choosing to swim in a rip because it looked calm and safe. Aims This research aimed to develop and evaluate the ‘Don't get sucked in by the rip’ campaign to improve beachgoer knowledge and recognition of calm-looking rip currents, and to reduce intentions to swim in such rips. Methods In Study 1, beachgoers were interviewed in an intervention and a control area 1 year before, immediately after, and approximately 6 months after, print-based campaign materials were distributed in the intervention area. Study 2 compared i-pad presentations featuring photographs versus videos of calm-looking rips, using pre- and post-surveys with beachgoers. Results/Outcome Study 1 demonstrated reasonable penetration and resulted in improved knowledge and behaviours related to rip currents. These improvements were maintained at follow-up. Study 2 indicates whether video-based campaigns improve on the impacts of picture-based campaigns. Significance It appears to be common that people drown when they choose to swim in rips inadvertently because the rip looks calm and a safe place to swim. Such drowning might be avoided by relatively simple campaigns designed to improve knowledge and recognition of commonly occurring fixed rip currents.
... Gathering information on exposure is a challenge [30][31][32]. Using representative surveys goes some way towards knowing the true number of home swimming pools in the state of Queensland, however, this is still not an accurate reflection of exposure as we don't know the type of pool, status of fencing, how often the pool is used, etc. Nor do we know the biases of using a CATI survey to collect the data on home pool ownership. ...
Article
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Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation (p < 0.001) when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools (7.8/100,000 pools with children residing in the residence/annum) between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.
... 16 Specific locations such as beaches often comprise significant numbers of international travellers among drowning cases with one study finding international travelers comprised 25% of drowning cases. 17 In another study of traveler fatalities in National Parks in the United States, waterbased activities accounted for 23% of deaths. 18 As tourism is a vital part of Australia's economy, ensuring the safety of those who visit, including those who use our waterways, is important and must form part of broader prevention strategies aimed at reducing drowning in Australia. ...
Article
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Introduction . Drowning deaths of travelers are commonly reported in the media, creating a perception that they are at a higher risk of drowning than residents. This may be true, due in part to unfamiliarity with the risks posed by the hazard, however there is limited information about drowning deaths of travelers in Australia. This study aims to identify the incidence of drowning among international travelers in Australia and examine the risk factors to inform prevention strategies. Methods . Data on unintentional fatal drowning in Australian waterways of victims with a residential postcode from outside Australia were extracted from the Royal Life Saving Society—Australia National Fatal Drowning Database. Results . Between 1 July 2002 and 30 June 2012 drowning deaths among people known to be international travelers accounted for 4.3% ( N = 123) of the 2870 drowning deaths reported in Australian waterways. Key locations for drowning deaths included beaches (39.0%), ocean/harbour (22.0%) and swimming pools (12.2%). Leading activities prior to drowning included swimming (52.0%), diving (17.9%) and watercraft incidents (13.0%). Discussion . International travelers pose a unique challenge from a drowning prevention perspective. The ability to exchange information on water safety is complicated due to potential language barriers, possible differences in swimming ability, different attitudes to safety in the traveler’s home country and culture, a lack of opportunities to discuss safety, a relaxed attitude to safety which may result in an increase in risk taking behaviour and alcohol consumption. Conclusion . Prevention is vital both to reduce loss of life in the aquatic environment and promote Australia as a safe and enjoyable holiday destination for international travelers.
... [4][5][6][7][8] A focus on beaches has also seen prevention efforts in that space be successful. [9][10][11] Strategies which target specific aquatic locations may also prove to be successful, as they allow ownership of the issue. In Australia for example, local councils are responsible for beaches and publicly owned swimming pools, and individuals are responsible for private swimming pools. ...
Article
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Access full text Open Access article here- http://injuryprevention.bmj.com/content/early/2016/01/04/injuryprev-2015-041750.full Introduction Drowning is a leading cause of unintentional death. Rivers are a common location for drowning. Unlike other location-specific prevention efforts (home swimming pools and beaches), little is known about prevention targeting river drowning deaths. Methods A systematic literature review was undertaken using English language papers published between 1980 and 2014, exploring gaps in the literature, with a focus on epidemiology, risk factors and prevention strategies for river drowning. Results Twenty-nine papers were deemed relevant to the study design including 21 (72.4%) on epidemiology, 18 (62.1%) on risk factors and 10 (34.5%) that proposed strategies for prevention. Risk factors identified included age, falls into water, swimming, using watercraft, sex and alcohol. Discussion Gaps were identified in the published literature. These included a lack of an agreed definition for rivers, rates for fatal river drowning (however, crude rates were calculated for 12 papers, ranging from 0.20 to 1.89 per 100 000 people per annum), and consensus around risk factors, especially age. There was only one paper that explored a prevention programme; the remaining nine outlined proposed prevention activities. There is a need for studies into exposure patterns for rivers and an agreed definition (with consistent coding). Conclusions This systematic review has identified that river drowning deaths are an issue in many regions and countries around the world. Further work to address gaps in the published research to date would benefit prevention efforts.
... Recent studies, however, have demonstrated that poor swimming skills are a risk factor for both fatal and nonfatal drowning among children (Brenner et al., 2009;Ma et al., 2010). Similar data are lacking in the adult population and often inconsistent (Gulliver& Begg, 2005;Morgan, Ozanne-Smith, & Triggs, 2008). Regardless, major drowning prevention groups continue to advocate for the importance of swimming instruction for all age groups to decrease drowning risk (Centers for Disease Control & Prevention, 2009;International Life Saving Federation, 2009). ...
Article
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The objective of our study was to determine if rural residence was associated with an increased risk of drowning in Ontario, Canada. We conducted a retrospective cohort study of all unintentional drowning deaths in Ontario, Canada from 2004 to 2008. Age-adjusted mortality rates for males and females living in rural and nonrural areas were calculated using direct standardization, with non-rural residents as the reference population. We identified a total of 564 unintentional drowning deaths. The majority (89%) of fatal drowning victims were male, and 75% percent of victims were from non-rural areas. Excluding bathtub drowning deaths, the age-adjusted drowning mortality rate was significantly higher for both males (rate ratio 2.8; 95% CI, 2.3-3.4) and females (rate ratio 2.8; 95% CI, 1.5-5.0) from rural compared with non-rural areas. In Ontario, rural residence was associated with an increased risk of unintentional drowning.
... [4][5][6][7][8] A focus on beaches has also seen prevention efforts in that space be successful. [9][10][11] Strategies which target specific aquatic locations may also prove to be successful, as they allow ownership of the issue. In Australia for example, local councils are responsible for beaches and publicly owned swimming pools, and individuals are responsible for private swimming pools. ...
... Some experts mentioned the death rate of elder people in bath tub is very high in Japan. A confusion is also formed during diagnosis whether death in bath tub is accidental or from natural aspect [22].Morgan along with his team have studied the reasons of drowning deaths in swimmers [23].Now Forensic imaging and endoscopic autopsy techniques are combinedly used for postmortem examinations [24].Yukawa with his expert team used diatom examination test for supporting the conclusion of death by drowning [25].Lin and his team analyzed diatom species from sinus fluid and lungs after autopsy of persons died due to drowning. They also analyzed natural deaths as a control for examination [26].Some Forensic experts explained the drowning deaths differ from immersion deaths in other types of water bodies. ...
Article
Drowning is a very common type of asphyxial deaths occurred due to accidental and any other reasons. In it obstruction of air passage towards lungs occurred due to filling of water. Mainly it is of typical and atypical type. Drowning shows different symptoms in both freshwater and sea water deaths. After autopsy of drowning deaths found different types of body changes, death due to cardiovascular disease during swimming, analysis of sinus fluid, percentage of deaths in males or females, disorders in victim, age factor, alcohol percentage, poison in body, coronary arteriosclerosis, Myocardial scars, arterial gas embolism and bacterial analysis from the tissues of dead body. Whether death occurred due to drowning or not is studied by diatoms. Diatoms played a very important role in identification of drowning deaths. Diatoms played a very important role in identification of drowning deaths. Diatoms presence inside the organs of body helps the forensic expert in solving the drowning cases. Diatoms can be extracted from body organs through different methods like acid digestion, nitric acid method etc. Also explained the difficulties in analyzing drowning dead bodies.
... "intense, narrow, seaward flow of water from the surf zone." Anecdotal evidence, reported as observations from ecological studies, intimate that rip currents present a drowning hazard for surf bathers by moving them involuntarily to deeper water farther from shore (Blay, 2011;Gensini & Ashley, 2010;Harada et al., 2011;Houser, Barrett, & Labude, 2011;Morgan et al., 2008). ...
Article
In the absence of an established literature, identifying and quantifying surf batherdrowning risk factors requires a clearly defined problem-focused research strategy. To initiate this strategy, nominal group technique (NGT) was used to identify andrank risk and water exposure-related factors based on consensus of an expert panel. The results identified, in order, level of experience (encompassing swimmingability in surf conditions), lack of local knowledge (encompassing awareness ofsurf hazards, including rip currents), and surf conditions (encompassing prevailingwave height and rip currents) as the three most influential surf bather drowning riskfactors. Factors most influential on exposure to water were identified and ranked asprevailing weather geographic location (encompassing bather accessibility to thebeach), and infrastructure (encompassing the presence of artificial beach amenities). This study provides direction for future analytic epidemiological researchand complementary studies on drowning at surf beaches and other locations.
... Some studies have suggested that tourists are at greater risk of drowning because of unfamiliarity with local environmental hazards. In Australia, a study on beach drowning incidents suggested that a quarter of all fatalities from 2001-2005 were tourists (Morgan, Ozanne-Smith, & Triggs, 2008). Other Australian studies have suggested that the higher incidence of surf-related drowning among visitors reflects lack of water competency, surf safety knowledge, or experience of the beach (McKay, Brander, & Goff, 2014;. ...
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Brenner, Moran, Stallman, Gilchrist and McVan, (2006) recommended that “swimming ability be promoted as a necessary component of water competence, but with the understanding that swimming ability alone is [often] not sufficient to prevent drowning” (pg. 116). Tradition and expert opinion are no longer enough. Science can now help us select essential competencies. What does research evidence show us about the protective value of specific individual personal competencies? Since the term “water competence’’ was coined by Langendorfer and Bruya (1995), and adapted for drowning prevention by Moran (2013), it has gained in use. It is indeed more inclusive than “swimming skill’’ alone. It re-emphasizes the need for a broad spectrum of physical aquatic competencies as well as the integration of cognitive and affective competencies. The purpose of this article is to a) define water competence, b) support each competence recommended as essential with examples of research evidence, and c) suggest areas requiring further research.
... The physical environment, teacher pedagogical practices and structural characteristics of indoor and outdoor play equipment can impact on how children interact with their learning spaces (Bond & Peck, 1993). Although attention to the physical environment is very important, how children perceive the contents of their learning space and the extent to which they are aware of their environment may also affect their interaction (Morgan et al, 2008). When children own and master their learning spaces and play equipment, they are able to feel and stay safer than when they are 'aliens' to their spaces. ...
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Safe learning spaces allow children to explore their environment in an open and inquiring way, whereas unsafe spaces constrain, frustrate and disengage children from experiencing the fullness of their learning spaces. This study explores how children make sense of safe and unsafe learning spaces, and how this understanding affects the ways they engage with their learning spaces. Using a qualitative research method that employed auto-driven visual and observation approaches, this research conducted at one centre in the Mornington Peninsula in Victoria, Australia, examined children's movement and interaction within their learning spaces. The results suggest that the children felt safe in spaces that offered them the best opportunities for play. These are the spaces where they behaved well, laughed freely, reacted positively, and played without too much restriction and intimidation, keeping in mind the restrictions imposed on them by their teachers at other spaces. The implications for constructing and managing safe learning spaces for children are discussed.
... Wilks et al., 2007). In the Australian context, coronial/drowning/ rescue data and expert opinions have also corroborated these highrisk categories (Avramidis, Butterly, & Llewellyn, 2009;Brenner, Saluja, & Smith, 2003;Morgan et al., 2008;Wilks et al., 2007). Recent research has focussed on the identification of rip currents by beachgoers (Brannstrom, Trimble, Santos, Brown, & Houser, 2014;Caldwell, Houser, & Meyer-Arendt, 2013), and other studies have assessed the potential rip current hazards for swimmers and the pedagogic methods taken to prevent drowning (Avramidis et al., 2009;Sherker, Brander, Finch, & Hatfield, 2008;Short & Hogan, 1994). ...
... While this article has documented an increase in shark bites, it still represents an infrequent hazard for water users and a very low source of fatalities. For example on Australian surf beaches between 2001 and 2005, 129 people drowned (Morgan, Ozanne-Smith, and Triggs 2008) whereas during the same period fatalities from shark bites numbered five. In Senegal, Trape (2008) in shaping public attitudes, beliefs, and support or opposition for wildlife management activities. ...
Article
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An unprovoked shark bite is an extremely infrequent, but highly disturbing hazard for water sport participants in many parts of the world. Information was analysed on the total number of unprovoked shark bites between 1982 and 2011. In this period, unprovoked shark bite were recorded from 56 countries with 27 recording fatalities; however 84.5% occurred in only six countries - United States, Australia, South Africa, Brazil, Bahamas and Reunion Island. The three shark species commonly responsible for unprovoked bites are the white shark (Carcharodon carcharias), the tiger shark (Galeocerdo cuvier), and the bull shark (Carcharhinus leucas). Over the period examined, the total number of unprovoked shark bites and the number that were fatal increased in frequency. However, fatalities from unprovoked fatal shark bite still represented an infrequent hazard to people utilising the coastal zone for water-based leisure activities. The increase in unprovoked shark bite could not be explained entirely by increases in human population, and this article also concluded that changes in the population of relevant shark species were also unlikely to explain the increase. The paper concluded that both natural and anthropogenic factors may change the amount of spatial overlap between relevant shark species and areas of human use.
... Exposure to rips was implicated in 22% of drowning deaths in the Victorian surf beach study. 3 It is well established that rips are the main natural hazard for beachgoers at surf beaches around the world. [9][10][11] Their importance as a risk factor for drowning is reinforced by evidence on the protection afforded for swimmers in areas patrolled by lifesavers and lifeguards. ...
Article
Objectives: To compare attitudes and knowledge of beach safety in Australia of beachgoers, rural inland residents and international tourists. Method: This analysis is part of the 2007 baseline survey for the Science of the Surf project and involved interviews of 367 people on beaches in New South Wales (NSW), 62 rural residents of a moderate-sized inland town and 73 international tourists visiting Sydney beaches. Participants were asked about various aspects of beach safety and shown photographs of beaches and asked to indicate where they would swim and to identify the location of any rip currents. Logistic regression analysis was used to evaluate the predictors of swimming choice. Results: Most beachgoers were aware that swimming between flags indicating a patrolled section of beach was the safe swimming option, but a significant proportion chose not to swim there. Rural residents were more likely than the other two groups to make safe choices about where to swim in the presence of flags. The odds of international tourists making a safe swimming choice in the vicinity of a rip current were three times lower than usual beachgoers and rural inland residents. Conclusions and Implications: Improving beach safety will require more refined strategies for specific target groups rather than a series of one-size-fits-all approaches.
... The unfamiliarity factor may also explain why many countries (e.g., northern countries like the UK, Ireland, Norway, Sweden, and Finland with cold open waters year round) report that their residents' drowning fatality risks are higher while out of the country (Guse, Cortes, Hargarten, & Hennes, 2007;Cornall, Howie, Mughal, Sumner, Dunstan, Kemp, & Sibert, 2005;Garssen, Hoogenboezem, & Bierens, 2008). Concomitantly, countries with popular beach destinations, such as Australia and New Zealand, report that international visitors are overrepresented in their drowning statistics (Morgan, Ozanne-Smith, & Triggs, 2008). Furthermore, simply being out of one's own setting may be a risk factor; in Iran and China, tourists or immigrants within their own countries are at higher risk for drowning (Saberi Anary, Sheikhazadi, & Ghadyani, 2010;Wang, Smith, Stallones, & Xiang, 2010). ...
... In Australia, a study on beach drowning incidents suggested that a quarter of all fatalities from 2001-2005 were tourists (Morgan, Ozanne-Smith, & Triggs, 2008). Other Australian studies have suggested that the higher incidence of surf-related drowning among visitors reflects lack of water competency, surf safety knowledge, or experience at the beach (McKay, Brander, & Goff, 2014;Williamson, Hatfield, Sherker, Brander, & Hayen, 2012). ...
Article
Little is known about the water safety knowledge, attitudes, and behaviours of international tourists holidaying in New Zealand. An online survey was conducted among New Zealand residents (n = 413) and international tourists (n =181) in August 2015. Significantly more New Zealand residents (69%) than tourists (40%) reported swimming at a beach. Tourists were more likely to hold unsafe beliefs related to swimming and boating activity. More tourists agreed that they would swim at a non-patrolled beach. Both residents and visitors had a poor understanding of rip currents at surf beaches. Ways of promoting water safety messaging to address these shortcomings are discussed. Available at: http://scholarworks.bgsu.edu/ijare/vol10/iss1/5
... Tropical climates favor the use of beaches all year round , often leading to overcrowded and difficult to control situations (Stokes et al., 2017;Cervantes et al., 2015). However, even though some users expectations are met in terms of social experience, it is necessary that the beach also present adequate resources to increase their safety, including clear signs of rip current presence and risks (Bordehore et al., 2016;Williams and Micallef, 2009;Morgan et al., 2008;Jiménez et al., 2007). ...
... This indicates that, without detailed searching of all coronial reviews of unintentional drownings, the identification of supervision as a factor in child drownings would be significantly underreported. While the NCIS is continually being improved, 14,19 future researchers who rely on keyword searches should be aware of the potential for cases to be missed. Our study also identified an apparent lack of awareness among individuals responsible for reporting drowning deaths of what constitutes appropriate supervision of children around water and/or of the terminology and definitions of supervision reported in previous literature to describe this. ...
... Multiple reasons have been identified to explain this [3][4][5][6][7], including the absence in the national data of fatal drowning by suicide, transportation accidents, natural disasters such as floods [8][9][10][11], cyclones [12], tsunamis [13,14] as well as disasters with ferryboats, cruise ships and migrant crafts [14]. Another explanation for the lack of reliable national data is the exclusion of non-inhabitants such as foreign students, workers, tourists and migrants [15][16][17][18][19][20] in the national statistics and low quality of data registration and collecting systems [10,21,22]. The update in 1990 of the International Classification of Diseases (ICD) from ICD-9 to ICD-10 may have further limited the Page 2 of 19 Bierens and Hoogenboezem BMC Public Health (2022) 22:339 opportunities to obtain representative national and international data on drowning, although the effect is considered small [6,23,24]. ...
Article
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Introduction Incompleteness of fatal drowning statistics is a familiar problem impeding public health measures. Part of the problem may be that only data on accidental drowning are used and not the full potential of accessible data. Methods This study combines cause-of-death certificates and public prosecutor’s court documents between 1998 and 2017 to obtain an aggregated profile. Data are also used as a basis for a trend analysis. Results The dataset includes 5571 drowned persons (1.69 per 100,000). The highest risk group are persons above the age of 50. Demographic differences are observed between suicide by drowning, accidental drowning, and drowning due to transportation (0.72, 0.64, 0.28 per 100.000) and between native Dutch, and Dutch with western and non-western background (1.46, 1.43, 1.76 per 100.000). Non-residents account for another 12.2%. When comparing the periods 1998–2007 with 2008–2017, the Standard Mortality declines for suicide drowning and accidental drowning among persons with a native Dutch and non-western background. Single regression analysis confirms a decrease of drowning over the full period, breakpoint analysis shows an increase in the incidence of the total number of drowning, suicide by drowning and accidental drowning starting in 2007, 2008 resp. 2012. Discussion Compared to the formal number of fatal accidental drowning in the Netherlands (n = 1718; incidence 0.52 per 100,000), the study identifies 350% more drowning. Differences in demographic data and the recent increase needs to be explored for public health interventions.
... This highlights the need for a more focused effort to better understand the relationship(s) between the dynamic, highly variable, and often hazardous Australian coast and the people who interact with it. Epidemiological studies have provided the majority of our understanding of who drowns in Australian coastal environments and the risk factors implicated in these fatalities [7][8][9][10][11][12][13]. However, coastal drowning risk is also influenced by a range of factors where evidence is scant, including individuals' risk perception, knowledge, attitudes and behaviours, as well as factors that impact exposure such as coastal visitation and participation in various activities [8,10,11]. ...
Article
Full-text available
Drowning is a global public health problem, but accurately estimating drowning risk remains a challenge. Coastal drowning comprises a significant proportion of the drowning burden in Australia and is influenced by a range of behavioural factors (e.g. risk perception, knowledge, attitudes and behaviours) that are poorly understood. These factors, along with those that impact exposure (e.g. coastal visitation and activity participation) all impact on drowning risk. While excellent mortality and morbidity data exists in Australia, a lack of coastal participation data presents challenges to identifying high-risk groups or activities and prioritising prevention efforts. This methods paper describes the development and evolution of an ongoing, annual, nationally representative online survey as an effective tool used to capture valuable data about the Australian population’s relationship with the coast. This paper explores how the survey is structured (12–14 sections spanning multiple topics and themes), the different question types used (including open text, 4-digit responses and categorical questions), the sample size (1400–1600 respondents), sampling strategy (using demographic quota sampling which can then be post-weighted to the population if required) and how topics and themes have changed over time to enhance the quality of data collected (i.e., wording changes to enhance participant comprehension or data usability and changing issue-specific ‘feature’ topics of interest such as campaign evaluation). How the survey is implemented online is described, both practically through to third-party recruitment processes and ethically to maximise anonymity of respondents and ensure data quality. Interim analyses indicate the impact of considering exposure when calculating fatal drowning rates, especially by activity (e.g., crude boating drowning rate 0.12 per 100,000 population vs 0.95 per 100,000 exposed population [relative risk = 8.01; 95% confidence interval: 4.55–14.10]). This study highlights lessons learned in the process of conducting a nationally representative coastal participation survey as well as the strengths and limitations of adopting this approach. Data collected will provide more detailed information on the skills, behaviours, knowledge and attitudes of coastal activity participants. Analyses of this unique dataset will inform research that will underpin development and evaluation of coastal drowning prevention initiatives prioritising those most at risk. It is hoped that the methods detailed within this study may be useful for other countries to develop similar approaches to understanding their own population.
... As visitor use of parks and protected areas is increasing and diversifying, the potential for serious incidents and litigation is of growing concern (Buckley et al., 2001). National park visitors are susceptible to the risk of drowning (Flaherty, 2018;Morgan et al., 2008), hypothermia (Procter et al., 2018), falls from a height (Flaherty & Caumes, 2018), dangerous animals (Cherry et al., 2018) and disease (Dinc et al., 2017). Subsequently, minimising the occurrence of unintentional incidents and accidents remains a high priority for park managers (English, 2018). ...
Article
An important focus of risk management in national parks is the interplay between how risk is perceived and how visitors would like risks to be managed. This paper presents the results of a study that investigated visitors' expectations on how the risk of injury should be controlled by park management agencies, linking it with perceptions on park dangerousness and confidence to deal with unexpected adverse events. Results of our survey among visitors in two Western Australian national parks, Karijini and Stirling Range, suggest that visitors tend to approve risk management intervention. However, higher levels of risk control were linked to a lower likelihood that visitors thought that the park was dangerous. Visitors establish a sense of safety from the park management context when the park appears to be managed well. Given that national parks are never free of risk, the management challenge is to balance legal and moral obligations along with societal expectations, without reducing visitors' appreciation of risk.
... Rip currents are the leading causes of rescues and drownings off many surf coasts worldwide. 4 [6][7][8][9] Drowning is sudden; prevention is key when the aim is to reduce the incidence of drowning. [10][11][12] Primary prevention may modify beachgoer behaviour 13 ; lifeguards can impart preventative messages, 14 reducing the need for medical attention and cardiopulmonary resuscitation of drowning victims. ...
Article
Full-text available
Objective To predict the coast-wide risk of drowning along the surf beaches of Gironde, southwestern France. Methods Data on rescues and drownings were collected from the Medical Emergency Center of Gironde (SAMU 33). Seasonality, holidays, weekends, weather and metocean conditions were considered potentially predictive. Logistic regression models were fitted with data from 2011 to 2013 and used to predict 2015–2017 events employing weather and ocean forecasts. Results Air temperature, wave parameters, seasonality and holidays were associated with drownings. Prospective validation was performed on 617 days, covering 232 events (rescues and drownings) reported on 104 different days. The area under the curve (AUC) of the daily risk prediction model (combined with 3-day forecasts) was 0.82 (95% CI 0.79 to 0.86). The AUC of the 3-hour step model was 0.85 (95% CI 0.81 to 0.88). Conclusions Drowning events along the Gironde surf coast can be anticipated up to 3 days in advance. Preventative messages and rescue preparations could be increased as the forecast risk increased, especially during the off-peak season, when the number of available rescuers is low.
... 7 The risk of fatal SI is higher among tourists, likely related to the increased exposure to water when on holiday and to the unfamiliar environment. 1,8,9 Incidents of SI among tourists are not reported in Hong Kong. ...
... Between February of 2018 and 2019, there was a 3% increase in the number of short-term visitor arrivals to Australia 2 . International studies have highlighted an increased risk of drowning in the non-resident population [3][4][5][6][7][8][9][10][11] , with children and adult males identified as being at greatest risk 3,4,12,13 . A 10-year review of Australian fatal unintentional drownings found that international travellers accounted for 4.3% of such incidents in Australian waterways 14 . ...
Article
As 17% of all drownings occur at beaches, a study of unintentional fatal drownings at South Australian (SA) metropolitan beaches was undertaken, specifically evaluating the risk for individuals born overseas. All cases of fatal unintentional drowning between July 2002-June2018 at SA beaches were sourced from the Royal Life Saving National Fatal Drowning Database. Demographics and causal factors were analysed for all SA drownings and specifically for those at metropolitan beaches amongst those known to be born overseas. Fifty-seven drowning deaths at SA beaches were identified. Of the 54% (n=31) of beach drownings which occurred at metropolitan beaches, 36% (n=11) of decedents were overseas-born. Risks were highest for individuals from Burundi and lowest for those from the United Kingdom. Drowning deaths at SA metropolitan beaches among overseas-born most commonly involved children who were swimming or merely playing at the water’s edge, in summer and during afternoons. With increasing tourism forensic pathologists will encounter greater numbers of individuals from overseas who have drowned. This means that specific and different cultural processes and attitudes to medicolegal investigations will be encountered. Preventive efforts aimed at reducing beach drowningamong at-risk groups should also includeculturally-appropriate campaigns.
... Just over half all fatal and non-fatal drowning events occurred among male children (60%) (male incidence rate: IR=17. 33 . Approximately half (49%) of all drowning incidents occurred among children whose usual primary residence was 'major city', as defined by the Australian Bureau of Statistics (Accessibility / Remoteness Index of Australia, ARIA). ...
Technical Report
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This report documents the incidence and risk factors associated with drowning in children and young people in Queensland. It is one of a series of projects funded by the Queensland Injury Prevention Council (QIPC) after drowning was identified by the Queensland government as a research priority. Specifically, the aims of this study were to: 1. Undertake an applied research program to collate comprehensive data on fatal and non-fatal drowning episodes of children and young people aged 0-19 years in Queensland for the years 2002-2008. 2: Undertake an analysis of existing prevention strategies and their effectiveness, to provide recommendations including priorities and approaches to prevention of drowning deaths of children aged 0-19 years in Queensland. Between January 2002 and December 2008, there were 120 fatal and 1179 non-fatal drowning incidents (total = 1299) among 0-19 year olds in Queensland – this is approximately 3 incidents per week. The ratio of fatal to nonfatal drowning events was 1:10. Most (91%) of the drowning deaths occurred among children who resided in Queensland; only 6% involved children and adolescents who lived outside of Queensland but within Australia, and 3% of incidents involved children who were visiting Australia from an overseas country. The incidence rate among 0-19 year olds in Queensland over the duration of the seven year study period for fatal and non-fatal drowning events was 18.75 per 100,000 per annum. The incidence rate for non-fatal events was 13.63 per 100 000 per annum, which was nine times higher than for fatal events (1.50 per 100,000 per annum). Just over half all fatal and non-fatal drowning events occurred among male children (60%) (male incidence rate: IR=17.33 per 100,000, per annum; female incidence rate: 12.86 per 100,000 per annum). The majority of drowning events occurred in children aged 0-4 years (68%; incidence rate: 44.06 per 100,000 per annum). Approximately one in eight drowning events involved children aged 5-9 years (incidence rate: 6.38 per 100,000 per annum) or 15-19 years (incidence rate: 4.90 per 100,000). Approximately half (49%) of all drowning incidents occurred among children whose usual primary residence was ‘major city’, as defined by the Australian Bureau of Statistics (Accessibility / Remoteness Index of Australia, ARIA). However, 5% of incidents occurred in children who lived in remote/very remote areas of Queensland, and 43% occurred in regional areas. Over half of the drowning events occurred among children whose usual residence was in areas categorised as higher relative advantage1 (57%), and one-third of drowning events (33%) occurred in children living in areas reflecting greater relative disadvantage. Data on geographical residence and relative advantage/disadvantage relate to usual residential address. These data should be interpreted with caution because usual primary residence does not necessarily reflect where the incident occurred. Currently, no data are routinely collected regarding geographical location of incident, except for QAS data and Coroner’s data. The burden of non-fatal drowning proved larger than expected, and the impact on health services is much greater than previously thought. For each of the 120 fatal drowning events in Queensland from 2002-2008, there were ten non-fatal drowning incidents. The enhanced quality of data in relation to event and clinical characteristics presented in this report are crucial to accurately inform effective injury prevention stratagems, to reduce drowning among children in Queensland.
... Despite dedicated beach patrols and lifeguards supervising bathers, Australia's annual coastal drowning rate remains 0.14 swimmers and waders per 100,000 resident population [6]. Several causal drowning risk factors have been proposed for surf bathers, including rip currents, alcohol, tourists, and onset of medical conditions [7]. Several ecological studies also provide context for drowning circumstances and highlight putative drowning risk posed by environmental factors [8][9][10]. ...
Article
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Robust epidemiological studies identifying determinants of negative health outcomes require significant research effort. Expert judgement is proposed as an efficient alternative or preliminary research design for risk factor identification associated with unintentional injury. This proposition was tested in a multi-factorial balanced experimental design using specialist judges (N = 18), lifeguards and surfers, to assess the risk contribution to drowning for swimming ability, surf bathing experience, and wave height. All factors provided unique contributions to drowning risk (p < .001). An interaction (p = .02) indicated that occasional surf bathers face a proportionally increased risk of drowning at increased wave heights relative to experienced surf bathers. Although findings were limited by strict criteria, and no gold standard comparison data were available, the study provides new evidence on causal risk factors for a drowning scenario. Countermeasures based on these factors are proposed. Further application of the method may assist in developing new interventions to reduce unintentional injury.
... The author concluded that tourists and new migrants must be provided with suitable information and perhaps increased supervision when near the ocean. A more recent study has reported that international tourists were the victims in one quarter (25%; n=32) of all surf-related drowning in Australia in 2005 (Morgan, Ozanne-Smith, & Triggs, 2008). Further research is required to determine how best to inform temporary residents about staying safe in and around New Zealand waters. ...
Article
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This article examines the effects of the introduction of the market model on initial and ongoing professional development for staff supporting children and adults identified with disabilities in schools and services in New Zealand. It examines changing ideas of social inclusion and argues that a return to the belief that all human beings have intrinsic value is required to ensure professional development acknowledges and sustains a dynamic view of social diversity and that contributes to aspirations for inclusive schools and communities.
... Drowning is the result of a combination of factors -exposure to water 13,14 , the safety of the swimming area, condition of the water 15 , presence of lifeguards 16,17 , use of life preservers 18,19,20 , and a person's swimming ability 21,22,23 . Public policy often focuses on passive measures to reduce accidental exposure to water -for example fences or pool covers that keep children out pools 24,25,26,27 -and swimming instruction 28,29 . ...
Article
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Objectives To examine the change in the racial disparity in drowning in Florida from 1970 to 2015 and to analyse the contextual factors associated with white, black and Hispanic drowning rates in Florida from 2007 to 2015. Methods Our outcome variable is county-level annual drowning rates by race, ethnicity, sex and age group. We computed county-level contextual data, including emergency weather events, temperature, extreme weather, number of pools, quality of pools, coastline, swimming participation rates and prominent black competitive swim teams. Results Between 1970 and 1990, the disparity in drowning rates between white and black males in Florida decreased dramatically. By 2005, the overall age-adjusted drowning rates converged. This convergence was most striking for those aged 10–34 and 35–64. While the gap has declined dramatically, there remains a racial disparity in drownings among those aged 10–34. Conclusions Overall, racial disparities in drowning have disappeared in Florida. However, some disparities remain. There is a persistent disparity in drownings among those aged 10–34.
Article
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Background Major reductions in child drowning mortality rates have been observed historically in Victoria, Australia, for the period 1863–2000. Despite this trend, drowning remains the leading cause of unintentional child death in Victoria. This study investigates the residual fatal drowning problem in the Victorian child population (0–14 years) for the period 2001–2016. Aims Describe the epidemiology of child drowning deaths in the Victorian population in 2001–2016; investigate risk factors and direct antecedents to these deaths. Methods Population-based retrospective case data were extracted from the National Coronial Information System for 16 years (January 2001–December 2016), and case-by-case analysis was conducted. Associated factors were determined using univariate and Poisson analyses. Results 88 of 97 cases had information available for analysis, pools were the most frequent location (30%); 70% of all cases occurred between 08:00 and 17:00; most victims were not deliberately in the body of the water (73%), for example, the pool. Supervision lapses included carers leaving the room when the child was in the bath (16/18), siblings left to supervise the child in private pools (7/23), inadequate pool fences (8/23) or faulty/open gates (4/23), or neighbours’ pool spa (4/23). Delays in finding the child occurred when searches occurred elsewhere, before the body of water (21/88) and when carers were asleep (5/88). Fourteen of the 88 children had an intellectual disability or predisposing medical condition. The grouped Poisson analysis demonstrated that age 0–4 years, male gender and rural place of residence were significant. A downward trend in drowning rate continued in this period. Discussion and conclusions A case-by-case analysis of a drowned population of children identified details of risk factors and antecedents not previously described. Missing data on antecedents were common, likely resulting in undercounting. Further enhancements to systematic data collection are needed. The results support a systems approach to drowning prevention.
Chapter
The attitudes, behaviors, and knowledge of groups of people, in other words their culture, impact drowning risk. Recent studies describe how and which among the different aspects of cultural attitudes and behaviors contribute to drowning risk. These are unique to each culture and need to be recognized in order to identify, create, and implement drowning prevention approaches. Culturally appropriate drowning prevention will be more successful.
Article
Introduction: Alcohol and drug (illicit or prescription) intoxication impairs motor skills, coordination, decision making abilities, hazard perception, and is known to increase the risk of death in coastal environments. Prior coastal safety research has focused largely on the impact of alcohol on drowning, with less research on the influence of drugs and leaving a significant number of other non-drowning fatalities largely excluded, despite being preventable with mitigation of injuries or medical factors. Method: This retrospective cross-sectional study explored the impact of alcohol and drugs on unintentional Australian drowning deaths and other coastal fatalities over a 16-year period to identify higher-risk populations and coastal activity groups for which alcohol/drug use is increased. Results: It was found that alcohol, benzodiazepines/sedatives, and amphetamine usage was prevalent in coastal deaths. Of the 2,884 coastal deaths, 80.6% of decedents had known toxicological data. Alcohol and/or drug intoxication contributed to 23% of coastal drowning deaths and 19% of fatalities. For drowning and other fatalities combined, 8.7% were due to alcohol, 8.7% due to drugs, and 4.1% due to both alcohol and drugs. Australian-born decedents were more likely to involve alcohol (RR = 1.7, 95%CI = 1.26–2.3, p < 0.001), drugs (RR = 2.62, 95%CI = 1.85–3.7, p < 0.001), or both alcohol and drugs (RR = 4.43, 95%CI = 2.51–7.82, p < 0.001) with an increased risk identified in indigenous Australian populations (RR = 2.17, 95%CI = 1.12–4.24, p = 0.04). The impact of alcohol and drug intoxication varied by activity, with Personal Watercraft users more likely to die due to alcohol intoxication (RR = 2.67, 95%CI = 1.23–5.78, p = 0.035), while scuba divers (RR = 0, p < 0.001), snorkelers (RR = 0.14, 95%CI = 0.036–0.57, p < 0.001), and rock fishers (RR = 0.46, 95%CI = 0.22–0.96, p = 0.03) were less likely. Recreational jumping and fall-related coastal deaths were more likely to involve alcohol and alcohol/drugs combined. Practical Applications: This study identifies factors to further investigate or target with prevention strategies to decrease the holistic burden of mortality due to alcohol and/or drug usage on the Australian coast.
Article
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Although beaches can be hazardous environments, few studies have identified injuries in broad coastal areas. We performed a retrospective descriptive study of injuries and other services provided by lifeguards during 2012 along the Spanish Mediterranean beaches. The trend in jellyfish stings was also examined for the period 2008-2012 using a standardised Sting Index. Obtaining data relied on voluntary cooperation of local authorities, resulting in data provided from 183 cities out of 234 present in the study area and 760 beach lifeguard stations (LGS) out of about 1200. Lifeguard stations provided an average of 89 days of service per year, from late June to the beginning of September. A total of 176,021 injuries were reported, of which jellyfish stings were the main need for assistance with 59.7% (n=116,887) of the injuries and 257.0/LGS, followed by wounds (14.4%, 50.9/LGS), and sunburn (3.3%, 15.8/LGS). Apart from attending injuries, beach lifeguard services provided 21,174 other services such as help to disabled people (57.9/LGS), blood pressure measurements (12.7/LGS), rescues at sea (6.5/LGS), lost children (5.7/LGS), and transfers to the hospital (4.6/LGS). Official reported fatalities for all the beaches in 2012 were 24. We proposed a Sting Index (SI) to allow comparisons of the incidence of stings between years and/or localities by standardising jellyfish stings by the total of all injuries. Historical data were consistent enough to calculate SI between 2010 and 2012 and showed an oscillating pattern without a clear trend (2008: 2.4, 2009: 1.3, 2010: 2.4, 2011: 2.0, 2012: 2.6). Estimation of total number of jellyfish stings for all the beaches present in the area would reach 184,558 for 2012. There were very few fatalities in comparison with other coastal regions, probably due to the combination of a calm sea, a low number of high dangerous situations, and a high percentage of lifeguarded beaches during the bathing season. Nevertheless, although Spanish Mediterranean beaches could be described as low risk, we propose measures to facilitate a precautionary management to prevent injuries based on a real-time beach assistance database of injuries to identify high-incidence assistance categories.
Thesis
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Self-guided recreational visits to protected areas can involve exposure to a variety of environmental hazards and the risk of injury or death. Accidents and incidents occurring in these areas may be followed by litigation actions against managing authorities. If visits to national parks are framed as managed tourism and recreation products, do visitors expect that natural park experiences are safe? The thesis is a ‘PhD by publication’ comprising five original journal articles. The first paper explores responsibility for safety from the perspective of protected area management agencies in Australia, defining the context within which risk management decisions are made. The second and the third paper then focus on the examination of the extent and nature of visitor risk. First, trends and patterns of visitor incident occurrence in Western Australian protected areas are analysed. Aspects that contribute towards unintentional injuries are then identified and the importance of comprehensive incident reporting is discussed. The final two papers consider the visitors’ perspective of risk and responsibility for safety. Four visitor groups are identified that differed in their perceptions on responsibility-sharing in four Western Australian parks. The final paper examines visitors’ expectations of the level of risk management control and explores aspects that contribute to visitors feeling safe in parks. Adopting an interdisciplinary mixed-methods approach, the research includes an email-based Delphi study, an epidemiological approach to analyse visitor incident data, and a fieldwork component with data obtained through a visitor questionnaire. Each study was driven by an underlying curiosity about how visitors approach risk, how much management guidance is demanded by visitors in natural tourism settings and what elements affect individual efforts to staying safe. Park managers and visitors largely agreed that management agencies have some obligation to manage the safety of park experiences, albeit acknowledging that visitor behaviour is a significant driver of incident occurrences. Many of the visitors sampled in this research attributed at least some responsibility for safety to management agencies and responsibility-sharing perceptions affected some aspects of preparedness for risk. Results of this thesis suggest that risk management and control is a desired attribute of nature-based experiences in recreational protected areas, with the extent of management intervention affecting visitors’ confidence to deal with an emergency situation during their visit. However, park management agencies need to consider the wider implications when additional risk management measures are introduced if they affect people’s appreciation of danger and their perceptions on the requirement to prepare for risk. https://researchrepository.murdoch.edu.au/id/eprint/60279/
Chapter
After pre-existing illnesses, accidents and injury contribute greatly to the morbidity and mortality of travellers worldwide. Most accidents involve road trauma and drowning. Travel health advisers need to undertake an individual risk assessment of travellers' activities abroad and provide appropriate pre-travel safety and security advice and develop contingency plans, in particular advising on important safety nets, such as travel insurance with an emergency assistance service. Those travellers with serious illness and injury may need specialised medical evacuation services, which may involve an air ambulance and a specialised medical team.
Chapter
Non-infectious causes of death are common among travellers, with road injury and drowning the most common injury- related causes, together with cardiovascular and other chronic diseases. From what we know about the morbidity of travellers, they experience a range of musculoskeletal, dental, and other problems whilest travelling. An understanding of the epidemiology of non-infectious diseases is just as important as our understanding of infectious disease when undertaking a travel health risk assessment and providing pre-travel health advice. Often there is limited information on the exposure to non-infectious diseases in studies of travellers' health; however, some activities, such as driving and interacting with water, potentially pose a significant risk of injury and death. One of the ongoing challenges for the travel health adviser is to convey messages of prevention to a population who are more concerned about infectious diseases. With increasing global travel, there is a greater likelihood of people becoming ill during travel due to the presence of underlying medical conditions, and this needs to be considered by not only by travel health advisers, but also by those providing the means to travel and those travelling themselves.
Article
Water competency entails more than a perception of just being able to swim and an operational definition of water competency is necessary for learn-to-swim program evaluation and policy development. To devise an operational definition, members of the American Red Cross Scientific Advisory Aquatic subcouncil surveyed nine key national (United States) organizations, 14 international organizations, and 19 other key informants involved with water safety and swimming activities for their requirements for swimming in the "deep end." The most frequently reported variables included (a) distance swum, (b) floating or treading water, (c) entrance into water unassisted, and (d) exit from the water unassisted. The subcouncil proposed that water competency include the following: (1) entry with total submersion; (2) recovery to the surface and float or tread for at least 1 min; (3) turn 360° and orient toward an exit point, (4) level off and move on front and/or on back position for at least 25 yards; and (5) exit from the water. We note that water competency is influenced by conditions of the aquatic environment (e.g., water temperature, movement, depth) into which the person may be introduced, and that skills demonstrated in one aquatic environment may not transfer to another. Our proposed operational definition for water competency provides an initial framework for an expanded version that may be expanded to be used globally.
Article
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Surf zone injury and environmental condition data were collected concurrently during the summer of 2014 along the Delaware coast. Documented injury data included injury type, gender, age and activity, while measured environmental conditions included local wave height, wave period and foreshore slope. Daily water user counts were used to normalize injury rates relative to the number of beachgoers at risk. There were 280 injuries over 116 sample days along the entire Delaware coast and 169 injuries over 82 sample days within the 5-beach focused study area where water user count data were available. Injuries were not distributed randomly as tested against a Poisson distribution and occurred in clusters with up to 15 injuries occurring in a single day. There were 32 serious injuries (cervical fractures, spinal cord injuries) and 1 fatality. Water user counts throughout the course of a day exceeded 25,000 on busy weekends such that the mean injury rate was 0.02 %. Men were twice as likely to be injured relative to women, and the mean injury age was 32 years old. Tourists were six times more likely to be injured compared to local beachgoers. Wading (44 %) was the dominant injury activity followed by body surfing (20 %) and body boarding (17 %). Direct correlation between injury occurrence or injury rate and any environmental factors was weak (highest squared correlation coefficient <0.12), but the highest injury rates were associated with moderate wave height (0.6 m) with lower injury rates for both smaller and larger waves. Lack of direct correlation between injury occurrence or injury rate and environmental parameters suggests there was an important (and as yet undetermined) human element that also dictates the injury rate. Additionally, the high proportion of injuries to tourists may require alternate strategies in local beach safety and injury awareness campaigns.
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Introduction Drowning is a leading cause of unintentional death, especially for males. In Australian coastal waters, young male adults account for 25% of the burden of male drowning. This study aims to describe young male coastal drowning deaths and to examine the prevalence of risk factors, especially alcohol and drugs. Methods Characteristics of unintentional fatal drowning involving males (15–34 years) were compared with other adults (15 years and older). Data were sourced from the National Coronial Information System (Australia) and Surf Life Saving incident reports (2004/2005–2018/2019). Relative risk was calculated and χ ² tests of independence were performed (p<0.05). Blood alcohol and drug concentrations were analysed with permutational analyses of variance. Results Young males drowned more while jumping (9.85 times), swimming/wading (1.41 times), at rock/cliff locations (1.42 times) and on public holidays (1.8 times). Young males drowned less while boating (0.81 times), scuba diving (2.08 times), offshore (1.56 times) or due to medical factors (3.7 times). Young males drowned more (1.68 times) after consuming illicit drugs (amphetamines 2.26 times; cannabis 2.25 times) and less with prescription drugs (benzodiazepines 2.6 times; opiates 4.1 times; antidepressants 7.7 times). Blood serum concentrations of cannabis were higher in young males, while amphetamine and alcohol were lower. Discussion Unsafe behaviours alongside certain activities or locations create deadly combinations of risk factors. A relationship between age, activity, attitude and affluence is proposed, where young males drown more in affordable activities with fewer regulations. Our results support multilevel strategies (spanning life stages) to reduce young male coastal drowning.
Chapter
The nature of unintentional fatal drownings has changed over time in both Australia and New Zealand. As problems have been identified and managed, new problems have emerged. However, the cumulative effect of existing prevention measures and new solutions to emerging exposures and hazards is an ongoing downward trend in drowning death rates overtime in both countries. These trends are documented in various reports [1, 2]. Current issues and concern are presented and discussed here.
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In Biscay beaches, the Biscay Regional Council (BRC) is in charge of looking after the safety of beachgoers. Its aim is to reduce drownings and accidents to zero. Lifeguard services during the summer seasons should be enough to reach this target. But not everything depends on them. There is another key factor to consider: beach users and the extent to which they obey the rules for bathing. Beach users carry out different activities in the surf area, which increases the hazards and the disputes between them. Proactive action such as warning signage and environment education are useful tools to increase beachgoers awareness of the potential risks and how to avoid them. The motivation for this study is to analyze beachgoers’ environmental understanding, their signage perception and their behavior and safety education, from the point of view of the lifeguards. Methodology is based on a main survey for lifeguards and a secondary survey for users. The analysis of the results shows the need for a common safety educational plan and a standardized flag and signage plan supported by the Spanish Authorities.
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Swimming is a popular holiday activity in tropical tourism destinations but is not risk free. Aside from the obvious risks of drowning, tropical waters harbour a number of marine animals that have the potential to injure or even kill unwary swimmers. Sharks, marine jellyfish and crocodiles may pose threats. From a destination perspective, strategies need to be implemented that firstly reduce the risk of injury and secondly care for swimmers who are injured. This paper first reports on the results of a survey of swimmers that examines a range of swimming-related behaviours then proposes an action pathway model that may be implemented by destinations to reduce risk for swimmers.
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Objective To predict the risk of drowning along the surf beaches of Gironde, southwestern France. Methods Data on rescues and drownings were collected from the Medical Emergency Center of Gironde (SAMU 33). Seasonality, holidays, weekends, weather, and sea conditions were considered potentially predictive. Logistic regression models were fitted with data from 2011–2013 and used to predict 2015–2017 events employing weather and ocean forecasts. Results Air temperature, wave parameters, seasonality, and holidays were associated with drownings. Prospective validation was performed on 617 days, covering 232 events (rescues and drownings) reported on 104 different days. The area under the curve (AUC) of the daily risk prediction model (combined with 3-day forecasts) was 0.82 [95% confidence interval (95% CI) 0.79−0.86]. The AUC of the 3-hour step model was 0.85 (95% CI 0.81−0.88). Conclusions Drowning events along the Gironde surf coast can be anticipated up to 3 days in advance.Preventative messages and rescue preparations could be increased as the forecast risk increased, especially during the off-peak season, when the number of available rescuers is low.
Chapter
Rip currents are strong, narrow seaward flows found on many global beaches where waves break across a surf zone. They represent a major hazard to bathers contributing to hundreds of drownings and tens of thousands of rescues annually. Most rip currents occupy deep channels situated between shallow sandbars or against structures. Rip current flow is unsteady with mean velocities typically on the order of 0.3-0.5. m/s, but with instantaneous flows in excess of 2. m/s. Recent field, laboratory, and numerical modeling studies have challenged traditional views of rip current behavior and, in combination with lifeguard reports, have helped improve understanding of the physical environmental factors leading to maximum rip current risk. Although collaborative research efforts between rip current scientists and beach safety organizations are increasing, significant challenges remain for improving and communicating education and awareness of the rip current hazard to the beachgoing public.
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Beach hazards are aspects of the beach and surf that expose the public to injury. Risk involves an assessment of those hazards together with the type and level of public beach usage. While physical beach hazards are readily identifiable and predictable, assessing the type and behavior of beach users is more problematic. This chapter reviews both beach hazards and ways to assess beach risk levels.
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Drowning is a leading cause of injury related death in many countries. Strategies to prevent these deaths depend upon characteristics of the victim and the specific circumstances surrounding the event. One preventive strategy that may be beneficial for persons of all ages and under nearly all circumstances is increased swimming ability, through some form of swimming instruction. However, a clear protective relationship between increased swimming ability and the risk of drowning has never been demonstrated. Studies focused on children, suggest that swimming ability may confer some protection, although the data are far from conclusive. This paper (1) reviews the current evidence regarding the relationship between swimming ability, swimming lessons and the risk of drowning, (2) reviews the past and present recommendations for swimming instruction and (3) outlines future research needs.
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Heart failure (HF) may be defined as the inability of the heart to meet the demands of the tissues, which results in symptoms of fatigue or dyspnea on exertion progressing to dyspnea at rest. The inability to perform exercise without discomfort may be one of the first symptoms experienced by patients with HF and is often the principal reason for seeking medical care. Therefore, exercise intolerance is inextricably linked to the diagnosis of HF. It might be expected that a tight relationship would exist between indices of resting ventricular function and exercise capacity. Data indicate, however, that indices of resting ventricular function (such as ejection fraction [EF]) are only weakly correlated to exercise tolerance.1 Exercise intolerance is defined as the reduced ability to perform activities that involve dynamic movement of large skeletal muscles because of symptoms of dyspnea or fatigue. Many investigators have sought mechanisms to explain the source of exercise intolerance. The aims of this position statement are to review (1) factors that affect exercise tolerance, with specific emphasis on chronic HF due to systolic dysfunction; (2) data that support the role of exercise training in chronic systolic HF, including the risks and benefits; (3) data on exercise training in patients with HF due to diastolic dysfunction; and finally (4) the subgroups of patients with HF for which data are lacking, and (5) the subgroups of patients who should not be included in exercise training programs. We anticipate this report will stimulate appropriate use of exercise training in patients with HF when indicated and encourage further studies in those areas in which data are lacking. ### Cardiovascular The capacity for performing aerobic exercise depends on the ability of the heart to augment its output to the exercising muscles and the ability of these muscles to utilize oxygen from the delivered …
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All adult (age 18 or older) drownings in Dade County, Florida, during 1989 were examined to determine the circumstances and related factors. Each of the 89 case investigations included autopsy findings, blood alcohol concentrations, toxicology screening results, and information from both police reports and hospital records. The results indicated that 83.1% were classified as unintentional deaths. Nearly one fourth (23.1%) had a blood alcohol content greater than 0.10%, and 18.3% were positive for drugs (cocaine, tranquilizers, etc.) that could affect the central nervous system. Prevention programs must emphasize reduction of substance use. Only 38.2% of the victims received emergency resuscitative care beginning at the immersion site. CPR was most often initiated by a lay person (47.1%), emergency medical services personnel (23.5%), and life guards (14.7%). This trend emphasizes the importance of instructing lay people in techniques of CPR.
Article
Previous epidemiological studies of drowning in the United States have dealt primarily with children. The epidemiology and prevention of drowning in adulthood may be very different. To test this general hypothesis, we analyzed the 293 drownings occurring among Sacramento County residents 20 years of age and above during 1974 to 1985. Drowning rates were highest for men 20-29 years of age (11.5 per 100,000 population) and blacks (7.5 per 100,000 population). Swimmers, boaters, and motor vehicle occupants were most frequently represented. Alcohol use was involved in 48% of cases overall and 77% of those involving motor vehicle occupants. A history of seizure disorder was another contributing factor. Important differences do exist in drowning epidemiology between children and adults. Our results suggest that preventing drowning will be more problematic among adults than among children. The study was also used to test the sensitivity of two commonly used methods of case ascertainment for cases in Sacramento County. A manual review of coroner's records had a sensitivity of 96%. A computerized review of death certificate data from the state's vital statistics data base had a sensitivity of 79%. The sources and implications of these differences are discussed.
Article
Resuscitation report-forms of the Surf Life-Saving Association of Australia, for the period 1973-1983, were analysed. During this period there were 262 immersion victims at beaches that were patrolled by life-savers. Of these, 162 victims survived, some of whom received expired-air resuscitation (n = 61) or cardiopulmonary resuscitation (n = 29). Among those who drowned, none was younger than five years of age. Vomiting and regurgitation were major problems during resuscitation. Respiratory and cardiopulmonary arrest occurred after apparently-successful rescue; this highlights the necessity for the close observation of victims and the early administration of oxygen to all immersion victims. Resuscitation in deep water has been shown to be effective, and instruction in these techniques is now standard teaching within the Surf Life-Saving Association of Australia.
Article
During the 25-year period 1959 to 1983, autopsies were performed and blood alcohol concentrations were measured in 122 men and 13 women aged 15 years and older who died in the Geelong coroner's district after accidental submersion. Postmortem blood alcohol concentrations higher than 17 mmol/L (0.08 g/100 mL) were observed in none of the female victims, but were present in 37% of all male victims and in 51% of those in the 30-64 age group. Forty-two per cent of the latter group had blood alcohol concentrations higher than 33 mmol/L (0.15 g/100 mL). The direct and indirect roles played by alcohol in the accidental drownings of adults are discussed.
Article
Three hundred and forty-nine cases of accidental drowning or cooling in water occurring in Denmark from 1989 to 1993 have been studied. The incidence was highest in 0-4-year-old children, in middle-aged men, and in old people. A third of the children drowned in private pools. A quarter of all fatalities occurred during leisure boating. At least half of those that drowned in this way did not wear a life-jacket and could have been saved if they had been wearing one. Between a third and a half of the adult drownings were related to alcohol intake, and a large number of inebriated men fell into harbour basins and other water bodies. A few final remarks are made on the prospects for preventing accidental drowning in children, elderly people and adult males.
Article
To determine patterns of victims, circumstances and locations of drownings in Australia in 1992-1997, inclusive. Population figures and available details of all drownings were obtained from the Australian Bureau of Statistics. Accidental non-boating drownings (ICD E910), boating incidents (E830-832), homicide (E964), suicide (E954), and other deaths without a drowning E code but "flagged" because drowning was involved (although not the primary cause of death) were included. The overall accidental non-boating drowning rate was 1.44/100,000 population/year. The commonest sites for non-boating drowning were ocean or estuary (22%), private swimming pools (17%), non-tidal lakes and lagoons (17%), surfing beach (10%) and bathtub (7%). 22% of victims were aged under 5 years; this group had a drowning rate of 4.6/100,000 population/year. Very few young children drowned in the ocean or in boating incidents. The rate of boating drownings was 0.29/100,000 population/year. Overseas tourists comprised 4.7% of all non-boating drownings, 18% of surf and ocean drownings, and 25% of all scuba drownings. Indigenous people had a much higher drowning rate than the general population. Drownings in children aged less than 5 years continue to be the greatest challenge for water safety organisations and legislators. Drownings in the Indigenous community and among tourists requires more detailed study and action. To assist in developing preventive strategies, the National Water Safety Council will need to clarify the categories described as "ocean/estuary" and "lake, lagoon, dam and waterhole".
Article
Unintentional injury is a global public health problem. In 1990, an estimated 5 million people worldwide died as a result of an injury or poisoning. This accounted for 10% of deaths from all causes that year, and over half of the estimated 900 million years of life lost in 1990 due to premature death. Although mortality rates for ischemic heart disease, cerebrovascular disease, and cancer are higher, the majority of people dying of these causes are elderly, with far fewer potential years of life to live. Reasons for the increasing public health importance of injury include the decline of infectious disease, the processes of urbanization, industrialization, motorization, and increased opportunities to travel.
Article
The aim of this study was to derive a profile of drowning victims in Singapore in the 10-year period 1992-2001 and determine if there are any patterns, trends or factors which may affect the risk profile of victims. Another objective was to recommend measures for reducing deaths from drowning through a review of some of the current literature and studies on drowning prevention. Data for epidemiological analysis were studied and analysed. Data was primarily obtained from the annual drowning statistics reported in the annual reports of the Singapore Life Saving Society, which were in turn obtained from the Registry of Births and Deaths, and the Coroner's Court. The review of current literature and studies on drowning was concentrated on the publications of leading drowning experts and agencies and on the papers presented at two important international conferences, the International Drowning Symposium in May 1996 and the first World Congress on Drowning in June 2002. The review was done with a view to identify successful drowning prevention measures that may be adopted or enhanced in Singapore. The study revealed a few important findings. Firstly, Singapore had a drowning rate per 100,000 population that varied from a low of 0.88 in one year to a high of 1.72 in another in the period 1992-2001. Secondly, the male drowning mortality rate in Singapore was much higher than the female drowning mortality rate. Thirdly, persons in the age group of 20-29 years were at the highest risk. Fourthly, the sea, rivers and swimming pools were the locations with the highest number of drowning victims. The study also showed that the main measures of drowning prevention may be broadly divided into supervision, environmental design changes, legislation, swimming lessons and aquatic safety education. The situation in Singapore is generally comparable to that in high income or developed countries although there are some differences. Further studies and research need to be done to provide a better understanding of the epidemiology and prevention of drowning in Singapore. In the meantime, the main measures of drowning prevention should, as far as possible, be followed or enhanced.
Article
To examine the contribution of alcohol to drowning deaths in Australia. Drowning deaths that occurred in Australia (excluding Queensland) from 1 July 2000 to 30 June 2001 were identified using the National Coroners Information System (NCIS). The current analysis was based on those deaths for which the Coronial process was completed by March 2003 ('Closed' cases). Comparison was made with the Australian Bureau of Statistics (ABS) national deaths data and with currently used values of attributable fractions for alcohol and drowning in Australia (these values are based on USA data on drownings from 1980 to 1984). 289 drowning deaths were identified, 5% less than comparable ABS data. Of these deaths, 240 were 'Closed' cases, and valid blood alcohol measurements were available for 137 (58%) of these. Alcohol appeared to contribute to approximately 19% of these fatal drowning incidents (25% for recreational aquatic activity; 16% for incidental falls into water; 12% for drowning due to suicide). Using > or = 0.10 g/100 ml as the cut-off, the estimated all-ages proportions of unintentional drowning attributed to alcohol was 17% in the current study, compared to the 34% currently used for Australia based on data from North America. A high level of alcohol appears to be present less frequently among recent drowning deaths in Australia than has been assumed to be the case to date. Nevertheless, many drowning victims have high levels of blood alcohol, and public health efforts to minimize the use of alcohol in association with activity on or near water should be continued. Despite some deficiencies, the NCIS appears to be a very useful source of information on public health issues, and to provide a better basis for assessing and monitoring alcohol-related drowning deaths in Australia than the published attributable fractions used to date.
Article
Systematic data on the risk of fatal and non-fatal injury from external causes to those who travel abroad for purposes of business or pleasure are seldom recorded and are consequently hard to come by. In this paper, the risk of fatal injuries to foreign travellers using historical and newly acquired data from national databases is estimated. Overall, it appears from these data that the risk of fatal injury to foreign travellers lies in the range of 20 to 90 per 100 000 person-years of exposure for many destinations worldwide, although different rates may pertain in selected situations where special conditions apply, for example, where there is heavy participation in risky sports or increased driving. This level of fatal injury risk is not noticeably different from that of staying in one's home country if one lives in a Western-style industrial country, although the types of hazards responsible may vary in type and proportion. With increasing levels of travel, and the growing popularity of more adventurous pursuits, it is possible that risks could be increasing in this sector.
International visitors to Australia. Canberra: TRA
  • Tourism Research Australia
Tourism Research Australia. International visitors to Australia. Canberra: TRA, 2002-2006.
Top ten activities: international market tourism facts
  • Tourism Australia
Tourism Australia. Top ten activities: international market tourism facts, December 2006. http://www.tourism.australia.com/ (accessed 8 Oct 2007).
Travel by Australians
  • Research Tourism
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Tourism Research Australia. Travel by Australians. Canberra: TRA, 2002-2006.