Dead in the water: how safe are our water sports? We now have the Australian Water Safety Council and its National Water Safety Plan: the impact of these initiatives remains to be seen | 
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| MJA 1999; 171: 584-586 | |||
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The quintessential Australian scene, recognised worldwide, is that
of the sun-bronzed lifesaver on Bondi Beach. Water sports are one of
our most popular recreational activities, yet over 300 deaths from
drowning occur each year and drowning is the third-largest cause of
accidental death in Australia.1 It is sobering to note that,
over 30 years ago in this Journal, an annual loss of nearly 500 citizens
to drowning was reported as a tragedy requiring immediate
rectification.2 Three articles in this issue
of the Journal show that we still have a long way to go.
Mackie reports that the rate of drownings in children aged 0-4 years in 1992-1997 (4.6 per 100 000 population per year) changed little from that for 1986-1990 (4.7 per 100 000 population per year). Drownings in this age group may be preventable. However, current knowledge indicates that swimming lessons for children under four years of age will not provide "drown proofing" and may lead to a false sense of security. In fact, toddlers taught not to fear water have been observed failing to struggle, holding their breath and making automatic, ineffectual paddling movements as they sink.3 Parents, childcare supervisors and the public at large need education about the importance of close supervision of young children in water. Mackie also identifies young adult males as another high-risk group, with alcohol as a contributing factor.4 It seems we should be educating this age group about the dangers of combining alcohol consumption and water activities. Both Mackie4 and Edmonds and Walker 5 report the relatively high number of Australian drowning deaths involving overseas tourists. This is cause for great concern, as many of these deaths occur during organised, supervised activities such as snorkelling or scuba diving. Instruction in the use of snorkelling equipment and initial supervision should be mandatory. Australian ocean conditions are deceptively treacherous and may change from minute to minute -- too little emphasis is often placed on environmental conditions during formal scuba instruction and snorkelling safety briefing. It is also obvious that a tourist who speaks no English will have difficulty with a diving or safety briefing. The unacceptably high number of tourist drownings has resulted in the development of a program to provide all inbound tourists with information about water safety.6 Cardiac events resulting in drowning appear to be increasing in both recreational scuba divers and snorkellers.7 The strenuous physical nature of recreational scuba diving or snorkelling is probably poorly understood by both doctors and people wishing to undertake these pursuits. Further, it is unlikely that most tourists on a day trip to the Reef consider their pre-existing medical factors and physical fitness levels. While people who begin scuba diving are required to have a medical examination before they start their training, there is no legal requirement to ever have it repeated. Medical examinations are not considered necessary for snorkellers, and, while information about medical risks and safety factors should be valuable, it is rarely offered. Medical examinations for scuba diving also come into question in this issue. Simpson and Roomes suggest there is little consensus among doctors who perform such examinations as to what constitutes fitness to dive.8 All the doctors who participated in their survey had completed either the basic or advanced course approved by the South Pacific Underwater Medicine Society (SPUMS). However, Simpson and Roomes made no attempt to define the experience of the participating doctors. A general practitioner who does one or two diving medical examinations a month may well be expected to arrive at a different conclusion than someone with extensive knowledge in the area. The aim of most diving medical courses is that doctors do not compromise a diving candidate's safety. Certainly, the SPUMS-approved diving medicine courses do not claim to produce diving medicine experts. They fill a gap in medical training by providing basic instruction in diving medical fitness and encourage practitioners to seek assistance from more experienced colleagues. Thus, the data of Simpson and Roomes could be interpreted as showing that most doctors avoided making the "wrong" decision by being more conservative than the Australian Standards medical guidelines (AS 4005.1-1992) for diving fitness,9 or by seeking further information. Simpson and Roomes8 conclude by suggesting that medical examinations for scuba divers should no longer be prescriptive (as in accordance with AS 4005.1-19929), but should be based on risk assessment and education, and thus place the onus of responsibility on the prospective diver. This implies the examining physician will have the knowledge, experience and time to inform the candidate of all risks of diving and, more importantly, to ensure the candidate understands and accepts these risks. While this approach is supported in a climate where all doctors have the necessary training in diving medicine, this is not the case in Australia. Fitness to dive is a complex issue10,11 and most general practitioners have received no training in underwater medicine. The medical framework of the AS guidelines at least provides some level of protection for intending divers. A record number of drownings on Australian waterways in the summer of 1997-1998 highlighted the failure of effective water safety strategies in this country. In February 1998, the Australian Water Safety Council was formed as a result of extensive industry consultation and with the support of the Federal Government. Members of the Council include representatives from surf life saving and swimming associations, boating educational groups and local government representatives. Part of its purpose is to present key water safety issues to governments, industry and the community. This has resulted in the publication of a National Water Safety Plan,6 which aims to identify and prioritise major water safety issues, establish national water safety standards, endorse existing water safety programs and achieve best practice in water safety across the country. Targeted key result areas are listed in the Box. Unfortunately, there is no designated funding for water safety in Australia, and it is the responsibility of the water safety organisations to drive the implementation of the Water Safety Plan and enlist the support of government, with the Water Safety Council acting as the lead authority in lobbying for finance. Since the introduction of the Water Safety Plan, increased funding has been made available by State governments. The Water Safety Plan is a constructive approach to the issue of water safety and is endorsed whole-heartedly. However, only time will tell whether sufficient funding is available to implement the Plan in its entirety and to assess its effectiveness. We should not tolerate a further 30 years of inaction nor the preventable loss of Australian lives. Robyn M Walker
©MJA 1999
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