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Water Hazards
Patterns of drowning in Australia, 1992-1997
Ian J Mackie
MJA 1999; 171: 587-590
For editorial comment, see Walker
Abstract -
Introduction -
Methods -
Results -
Discussion -
Acknowledgements -
References -
Authors' details
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Abstract |
Objective: To determine patterns of victims,
circumstances and locations of drownings in Australia in 1992-1997,
inclusive.
Methods: 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.
Results: 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.
Conclusions: 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".
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| | Introduction |
Accidental drowning is a largely preventable cause of death. Water
safety organisations, the general public and legislators need
adequate information about the circumstances of drowning to target
preventive action effectively. While the 1993 National Drowning
Study concluded that the risk of accidental drowning in Australia and
other countries has steadily decreased since 1920,1 that study and a
later report2 did not provide detailed
national information on where drownings occurred.
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.
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Methods |
Figures on accidental drownings in Australia from 1992-1997,
inclusive, were obtained from the ABS. Accidental non-boating
drownings (ICD E910: "Accidental drowning and submersion") were
divided into locations and activities, which were then examined
separately for age and sex distribution. Boating incidents
(E830-832), homicide (E964), suicide (E954), and other deaths
without a drowning E code but with the drowning flag applied were also
studied. Implementation issues in 1992 and 1993 resulted in very
slight discrepancies in drowning figures between the "E" code and
"flag" systems.
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.
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Results |
Overall, 2673 people drowned in Australia in 1992-1997. These
included 1551 non-boating drownings (E910; see Box 2), 292 drownings
in boating incidents (E830-832; see Box 3), 390 suicides in the water
(E954), and 28 homicides (E964), as well as several accidental
drownings that appeared under a "drowning flag" rather than an E code
(46 people with epilepsy who drowned, 13 who drowned because they had a
heart attack or stroke while in the water, and 86 who drowned in motor
vehicles accidents in the water). The remaining 267 deaths were
"incidental" drownings -- generally those for which the coroner
could not decide on a classification.
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.
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Discussion |
Overall, this study shows that children aged under five years are most
vulnerable to drowning in Australia. It also shows, with data not
previously presented, that a considerable number of overseas
tourists drown in our waters, and that the frequency of drownings of
Indigenous people is disproportionately high, with an unusual
number of drownings in young men.
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.
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Acknowledgements | |
I received great assistance from the officers of the Australian
Bureau of Statistics, the executive officers of the Royal Life Saving
Society Australia and Dr George Stathers. Purchase of the
statistical computer disk with relevant data was funded by the Royal
Life Saving Society Australia.
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| |
References |
- Mackie I, Tebb N, Eady T. National drowning study, Parts 1 to 4.
Sydney: Royal Lifesaving Society Australia, 1993.
-
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.
-
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).
-
Smith G, Langley J. Drowning surveillance: how well do E codes
identify submersion fatalities. Injury Prevention 1998; 4:
135-139.
-
Australian Bureau of Statistics. Population by age and sex.
Canberra: ABS, 1997. (Catalogue no. 3201.0.)
-
Dietz P, Baker S. Drowning: epidemiology and prevention. Am J
Public Health 1974; 64: 303-312.
-
Branche C. Who drowns in the United States? Proceedings of
International Medical-Rescue Conference. San Diego:
International Lifesaving Federation, 1997.
-
Mael F. Staying afloat: within-group swimming proficiency for
whites and blacks. J Appl Psychol 1995; 80: 479-490.
(Received 5 May, accepted 28 Oct, 1999)
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| | Authors' details |
Royal Life Saving Society Australia, Sydney, NSW.
Ian J Mackie, AM, FRACP, National Medical Adviser.
Reprints: Dr I J Mackie, PO Box 280, Cronulla, NSW 2230.
ianmackieATmsn.com.au
©MJA 1999
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| | 2: Accidental non-boating drownings in Australia in 1992-1997 (E910)
 | Overall
- There were 1551 drownings, a national rate of 1.44 per 100000 population per year (based on 1996 population data
5)
- 77% of victims were male.
- Of 1096 victims aged over 14 years, the presence of drugs including alcohol
was recorded in 148 (14%); 117 of these were male.
- The highest prevalence was in the 0-4 years age group
- Males made up 64% of the 0-4 years age group and 62% of people aged over
64 years who drowned.
Locations of drownings
- Most non-boating drownings (22%) occurred in ocean/estuary (tidal) sites.
- 90% of the victims were male and very few were aged under 15 years.
- 17% of drownings occurred in private swimming pools.
- 64% involved children aged under four years, two-thirds of whom were male.
- Of all those aged over 34 years who drowned in private pools, 63% were female.
- Only 3% of accidental drownings occurred in public and "other" pools (28 drownings in public pools [20 males] and 18 in "other" pools [11 males]).
- 17% of drownings occurred in non-tidal lagoons and lakes.
- 82% of victims were male, and there was a high frequency of drownings in
0-4-year-olds.
- 10% of drownings (162) occurred at surfing beaches.
- 144 victims (89%) were male.
- No one aged less than 5 years and few aged 5-14 years drowned at a surfing beach.
- 5.8% of drownings occurred while victims were fishing.
- They comprised 54 victims (one female), all aged over 15 years, who were washed from rocks, and another 36 people (35 male) who drowned in tidal water.
- The only female was 10 years of age, one male was four years old; there were no drownings in males aged 5-14 years, then deaths were relatively evenly distributed for age, with the greatest number, eight, in the over 65 years age group.
- 3.6% of the 1551 people drowned while using scuba equipment.
- 44 (79%) were male, 15 (27%) were overseas tourists.
- 36% of scuba deaths occurred in Queensland, 21% in Western Australia and 18% in New South Wales.
- 15 people drowned while snorkelling (11 males, 3 overseas tourists).
- 36 people (34 males) drowned while attempting rescues; 12 in surf, one in a public pool and 23 at other sites.
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4: Drownings in selected groups
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Children aged <5 years
- There were 353 drownings in this group (64% boys), a rate of 4.6 per 100000 population/year.
- In addition to the locations shown, 6% of toddlers drowned in an object such as a bucket and 2% drowned in an irrigation canal.
- 37 infants (22 boys) drowned in their first year of life, 26 in the bathtub, 4 in a private pool, 3 in an object such as a bucket, 2 in a lake, 1 in the ocean and 1 in an irrigation canal.
People aged 65+ years
- 12% of all accidental drowning victims were in this group (38% were women), a rate of 1.5 per 100000 population/year.
- More women than men drowned in pools (22 v.11) and bathtubs (18 v. 4).
Indigenous people
- The 63 non-boating drownings of Aboriginals and Torres Strait Islanders represent 4.2% of the national total, while they constitute only 1.8% of the population.
- 30% of all Indigenous drownings were in the 25-34 years age group (95% of these male).
- Only 7 Indigenous people drowned in boating incidents. All victims except one were in motorised craft; all were male.
Overseas tourists
- 88 tourists from 12 countries drowned in Australia during 1992-1997 (age range, 3-78 years; 16 female)
- 73 drowned in non-boating incidents, 5 in boating incidents and 10 in unspecified circumstances.
- 38 tourists came from Europe (15 from the United Kingdom, 10 from Germany), 35 from Asia (17 from Japan), 7 from the United States and 8 from other countries.
- 89% of tourists drowned in the ocean and 11% drowned in fresh water. 61% drowned at surfing beaches or elsewhere in the "ocean" and a further 24% drowned while scuba diving or snorkelling.
- Tourist drownings comprised 4.7% of non-boating drownings, 18% of surf and ocean drownings, 25% of scuba and snorkelling drownings and 1.6% of boating drownings.
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5: Bathtub drownings in Australia, 1992-1997
 | - There were 112 bathtub drownings (64 female [57%]).
- Bathtub drownings comprise 7% of all drownings.
- 47% of victims were aged <5 years.
- 20% of victims were aged over 64 years.
- Alcohol was present in 14% of victims aged over 15 years. Of these, all except one were aged over 60 years.
- An unspecified drug (but no alcohol) was detected in three younger people who drowned in the bathtub.
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