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Although the Australian Bureau of Statistics (ABS) has provided figures on accidental drownings in Australia dating from 1920, it has only reported the locations of accidental drownings since 1992.

Currently, drowning is classified under the International Classification of Diseases (ICD) Supplementary classification of external causes of injury and poisoning codes.³ The relevant "E" codes and brief descriptions are shown in Box 1. In addition to the E codes, in 1992 the ABS introduced a nationally consistent system of "flags" for all drownings and other conditions where drowning is cited as one of two or more causes of death, but not the primary cause. These flags form the basis of specialised drowning tables in which flags 1-36 are for non-boating drownings and flags 37-53 are for various boating deaths. In this study, I examined both the international E codes and the ABS flag system⁴ to present new data which may help target those most at risk in the different locations where drownings occur.

Five groups were subjected to detailed analysis. These were children aged under five years, people aged over 65 years, Indigenous people, overseas tourists, and those who drowned in the bathtub.

The distributions of locations of all Australian accidental non-boating drownings and for selected groups are shown in Box 4, as is a summary of features of drowning deaths for children aged under five years, people aged 65 or more years, Indigenous people and overseas tourists. The age and sex distribution and detailed findings for bathtub drownings are shown in Box 5.

Twenty-two per cent of all drowning victims are in the 0-4-years age group, although this group comprises only 7% of the population. The rate of drownings in this age group (4.6 per 100 000 population per year) for 1992-1997 has changed little from that for 1986-1990 (4.7 per 100 000 population per year).¹ It is thus clear that the high frequency of drowning in very young children is not improving. The figures provide strong backing for the recommendations of Nixon and colleagues,² which were compilation of better coronial information, better police investigation of toddler drownings to include information on fencing and other vital details, detailed study of adolescent drownings, investigation of surveillance methods, support for advocacy of fencing of swimming pools, community education on the dangers of mixing alcohol with aquatic activities, and making first aid training mandatory for all pool owners. In particular, legislation on fencing for private pools is inadequate -- it varies from State to State, and local government areas have their own rules which are not always enforced. There is a real need for uniform national legislation for pool fencing that complies with the recommendations of the Australian Standards Association to help arrest this high rate of drowning in very young children.

Details of drownings involving overseas tourists have not previously been published, and this is clearly an area in which government must work through the Water Safety Council to reduce the risk. Tourists and new migrants must be provided with suitable information and perhaps increased supervision when near the ocean. The ocean and recreational snorkelling or scuba diving present the greatest risks for tourists.

Drowning in Aboriginal and Torres Strait Islander people also requires urgent government action through the appropriate established organisations. Differences in drowning incidence in different racial groups have been previously documented.^6-8 The pattern of drownings in the Australian Indigenous population (Box 4) is quite different from that of the population as a whole, with a very high incidence in children under five years and in the 25 to 34 years age group. Further, ABS advice indicates that "death data for indigenous persons is undernumerated. While indigenous status is now a question on all State and Territory death forms, the ABS only regards data for South Australia, Western Australia and Northern Territory as having sufficient coverage to be of publishable standard" (ABS, personal communication).

Bathtub drownings are disturbingly common on a national basis and preventive approaches need to vary for different age groups. The frequency of infant and toddler bathtub deaths has been documented in State reports for two decades,¹ but this is the first national survey. The bathtub is the only site where female deaths predominate. This has been reported in previous studies,¹ but the reasons for this phenomenon are not apparent. Most bathtub deaths require much more careful forensic scrutiny than they have received to date in most countries. Carbon monoxide, epilepsy, drugs and alcohol, cardiac arrest, suicide, homicide and child abuse have all been implicated, and there is little doubt that death in the bathtub at any age should be investigated carefully to determine whether the cause was natural or deliberate. Confirmation of true accidental drowning in bathtubs may be less common with such an approach.

The quality of the information available needs to be improved to help target preventive action. For example, as pointed out previously,⁴ reliance solely on E codes would result in many drownings remaining unidentified. There were 80 drownings in motor vehicle accidents and a large number of suicides (390, making suicide more common than drowning in boating accidents [292]), and others, such as deaths from myocardial infarction, stroke and spinal injuries, where the involvement of drowning was only obvious from the ABS flag system. Further, there is a lack of detailed information on drownings listed within the E codes. "Lake, lagoon, dam and waterhole" and ocean/estuary drownings cover many different locations requiring different preventive measures -- this needs further investigation by the recently formed National Water Safety Council in conjunction with coroners, police and the National Injury Surveillance Unit.

The most comprehensive review of measures to prevent drowning in Australia was published in 1995 by the Commonwealth Department of Human Services and Health, and contains most of the references of importance up to that time.² The data for 1992-1997 in this study will provide the new National Water Safety Council with added information to assist more informed targeting of individual risk groups in specific areas.

1. Mackie I, Tebb N, Eady T. National drowning study, Parts 1 to 4. Sydney: Royal Lifesaving Society Australia, 1993.
2. Nixon J, Pearn J, Oldenburg B, Pitt W. Review of countermeasures to reduce drowning, near drowning and spinal injuries fron diving into shallow water. Canberra: Commonwealth Department of Human Services and Health, 1995.
3. Department of Health and Human Services. The international classification of diseases, 9th revision, clinical modification (ICD-9-CM). 5th ed. Vol. 1: Diseases tabular list, October 1994. Bethesda, Md: United States DHHS (Publication No. PHS 94-1260).
4. Smith G, Langley J. Drowning surveillance: how well do E codes identify submersion fatalities. Injury Prevention 1998; 4: 135-139.
5. Australian Bureau of Statistics. Population by age and sex. Canberra: ABS, 1997. (Catalogue no. 3201.0.)
6. Dietz P, Baker S. Drowning: epidemiology and prevention. Am J Public Health 1974; 64: 303-312.
7. Branche C. Who drowns in the United States? Proceedings of International Medical-Rescue Conference. San Diego: International Lifesaving Federation, 1997.
8. Mael F. Staying afloat: within-group swimming proficiency for whites and blacks. J Appl Psychol 1995; 80: 479-490.

©MJA 1999
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