| PATTERNS OF DROWNING IN AUSTRALIA | par 0 |
| AUTHOR: DR IAN J MACKIE AM MB FRACP | par 1 |
| National Medical Adviser, Royal Life Saving Society Australia, | par 2 |
| Suite 409 Henry Lawson Business Centre, Birkenhead Point Shopping Centre, Cary Street, DRUMMOYNE 2047 | par 3 |
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| This is the original submitted version of this article. Click here to see the final edited version. Click here to see the second revised version. Click here to see the first revised version. | par 5 |
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ABSTRACT |
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| Drownings in Australia for the six years 1992 to 1997 were reviewed using details from the Australian Bureau of Statistics. The 0 to 4 years age group comprised 22% of all drownings with a rate of 4.4 per 100,000 population. Commonest sites for drowning were non-tidal lakes and lagoons (19%), private swimming pools (17%), ocean/estuary (16%), surfing beach (10%) and bathtub (7%). Each site was profiled for age and sex with striking differences between ocean and still water sites. Overseas tourists were 4.7% of all non boating drownings with 89% of these drowning in the ocean; 25% of all scuba drownings were overseas tourists. The indigenous population had a much higher rate of drowning than the overall figure and their toddler rate was very high. Drowning due to suicide was more frequent than from boating incidents There were 80 persons drowned in motor vehicle accidents in the six year period. The relevant literature is reviewed and implications for preventive strategies discussed. | par 9 |
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INTRODUCTION |
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| par 11 |
| "Lord, Lord! methought what pain it
was to drown: | par 12 |
| What dreadful noise of water in mine ears! | par 13 |
| What sights of ugly death within mine eyes! | par 14 |
| Methought I saw a thousand fearful wracks; | par 15 |
| A thousand men that fishes gnaw'd upon:......." | par 16 |
| William Shakespeare | par 17 |
| King Richard III | par 18 |
| 1,iv,21 | par 19 |
| The history of swimming has been described in great detail by Maiello (Reference 1) and Pearsall ( Reference 2 ). It seems likely that homo sapiens learnt to drown long before learning to swim. While archaeologists have provided us with drawings of swimming 5,000 to 9,000 years ago no early depictions of drowning have been unearthed. Maiello describes the finding , in the Libyan desert, inside the Mount El Auenat caves, by the German scholar von Laszlo Edty Almasy, of ancient drawings of swimming. (These were shown in the 1996 film "The English Patient"). Pearsall provides some detail of the earliest descriptions of drowning and refers to Roman literature and Greek mythology in which the legendary Leander swam the Hellespont every night to be with the priestess Hero but eventually made the trip once too often and drowned in poetic style | par 20 |
| "But foamy waves choke up his
struggling voice Under the ponderous seas his body dips, And Hero's name dies bubbling on his lips" | par 21 |
| Icarus flew too close to the sun causing the sun to melt the wax holding his wings and he fell into the Aegian sea where he drowned. | par 22 |
| Clearly, drowning has been a common cause of death through the ages and those with an interest in water safety are wont to remind the medical profession that the wonders of modern resuscitation were first rationalised in 1767 with the formation in Amsterdam of the still active Maatschappij tot Redding van Drenkelingen to promote resuscitation of drowning victims. | par 23 |
| When Galvani in 1780 expressed the belief that electricity was a very proper remedy he was discussing drowning and not myocardial infarction. | par 24 |
| Visiting a graveyard such as in the former penal institution at Port Arthur, Tasmania, demonstrates the great frequency of drowning as a cause of death in the early part of the 18 th century in Australia. | par 25 |
| Although the literature on resuscitation of near drowned persons indicates that the water was a frequent place for death, the earliest published statistics are for Italy dating from 1887 (Reference 3). Pearsall, however, has recorded the remarkable fact that in London in 1665, there were 50 deaths from drowning and 68,596 from the plague. The International Lifesaving Federation has figures for Sweden dating from 1891 and for the United States of America since 1903. Because accidental drowning is an almost completely preventable cause of death it is of great importance that water safety organisations, the general public and legislators have a clear understanding of the results of their efforts over the years and furthermore have a clear understanding of which types of drowning incidents must attract the most preventive action now and in the future. | par 26 |
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METHODS |
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| The Australian Bureau of Statistics (ABS) has provided figures on accidental drownings in Australia dating from 1920. There have since been several variations in the systems of international classification but currently the International Classification of Diseases (ICD) Supplementary Classification of external causes of injury and poisoning codes includes: | par 28 |
| E830: Accident to watercraft causing submersion | par 29 |
| E832: Other accidental submersion or drowning in water transport accident | par 30 |
| E910: Accidental drowning and submersion | par 31 |
| E954: Suicide and self-inflicted injury by submersion ( drowning ) | par 32 |
| E964: Assault by submersion ( drowning ) | par 33 |
| E984: Submersion (drowning) undetermined whether accidentally or purposefully inflicted. Drowning is defined by the Medical Commission of the International Lifesaving Federation as death resulting from suffocation within 24 hours of submersion in a liquid medium. | par 34 |
| Currently, the ABS also provides drowning " Flags " for other conditions where drowning is one of two or more causes of death but is not cited as the primary cause. | par 35 |
| For Australia numbers of accidental non boating drownings (E910) are available from 1920 onwards but details for individual age groups are only available since 1935. Details of boating deaths are available only since 1959. These were all analysed in the four part National Drowning Study of the Royal Lifesaving Society Australia and Surf Lifesaving Australia 1993-94. (Reference 4) | par 36 |
| Locations of accidental drowning have only been reported by the ABS since 1992. There have now been six full years of these "specialist drowning tables" which form the basis and major purpose of this paper. The information was provided by the ABS on computer disc. | par 37 |
| The age groups described are 0-4 years (toddlers) then ten year groups up to and including the age of 64. All drownings from the age of 65 upwards are included as a single group. | par 38 |
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RESULTS |
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| Since 1920, Australia's population has risen from 5.6 million to more than 18.5 million persons. Figures from the ABS show that this increase has not been uniformly spread over all age groups. The rise in the older age groups in the past twenty years has been much greater than in persons under the age of 15 years. (Reference 4). | par 40 |
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NON BOATING DROWNING (ICD E910) |
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| In the six years reviewed, there were 1565 non boating accidental drownings, an average of 261 per year. Of these, 1200 were males (77%) and 365 were females (23 % ). The numbers classified as "Fell or wandered into" and "Swimming paddling or wading" were each 50% of the total. The presence of drugs including alcohol was recorded in 145 (13%) of 1162 persons over the age of 14 years. 79% of these were males. Using the ABS population figures for 1995, (reference 5) the drowning rate was 1.44 per 100,000 of population. | par 42 |
| The age and sex distribution for the 1565 persons is shown in Figure 1 and Figure 2. The age group 0 to 4 years clearly had the highest prevalence with a rate of 4.4 drownings per 100,000 of population. The proportion of males in accidental drowning was 77% for the entire population but only 64% in toddlers and 62% in the age group over 64 years. In two persons the age was unknown. They were both male, one drowning in the ocean and the other in a non tidal lake. | par 43 |
| Non tidal lagoons and lakes (19%) were the most frequent sites recorded with age and sex distribution shown in figure 3. Overall, 82% of these drownings were males. There was a high frequency of toddler drownings and variable male to female ratios in the different age groups. The presence of alcohol was reported in 30 of these victims and a further one had alcohol and another drug. An unspecified drug was present in one male aged 33 years and one female aged 65 years. | par 44 |
| Private swimming pools accounted for 17% of all drownings. 64% were toddlers, 66% of whom were male. (figure 4). The presence of alcohol was reported in 17 of these victims but there were no reports of other drugs or alcohol and drug combinations in the pool drownings. | par 45 |
| A significant feature in this group is that of all private pool drownings over the age of 34 years, 63% were females. | par 46 |
| Ocean and estuary (tidal) sites were 16% of the total (figure 5). The profile for age and sex shows that 92% of these were male and very few persons were under the age of 15 years. The presence of alcohol alone was recorded in 43 of these victims in addition to 6 persons in whom alcohol was present with another drug, not specified. There were a further 5 persons in whom a non specified drug was found. The drug total is therefore 54 persons. The age incidence of alcohol and drug related drownings overall almost exactly duplicated figure 5. | par 47 |
| Surfing beaches accounted for a further 10% of drownings with 162 persons; 144 were male (89%) and 18 were female. The age incidence reveals no surfing beach deaths under the age of five years and only seven between the ages of 5 and 14 (figure 6). The state by state comparison (figure7) is a reflection of population, tourism, climate, local culture and accessibility of the surf. The presence of alcohol alone was recorded in 11 of these victims and a further 2 persons had alcohol and another drug. Three persons were reported as having an unspecified drug detected. The drug total is therefore 16 persons. | par 48 |
| Comparison of the age/sex graphs for ocean versus still water drowning is striking in that ocean and surfing beach deaths were almost all over the age of 15 years with a much higher proportion of males than in still water. | par 49 |
| Bathtub drownings were 7% of total drownings and 57% of these were female. Toddlers (47%) and the over 64 age groups (20%) dominated the numbers (figure 8). Alcohol was present in 7 of these victims, one of whom also had another drug detected. The six persons with alcohol alone ranged in age from 61 to 76 years. The person with a second drug was aged 32 years. Three persons who drowned in the bathtub had an unspecified drug detected but no alcohol and these were aged 20, 23 and 40 years. | par 50 |
| 5% of accidental drownings were classified as having been washed from rocks , all of these into the ocean. They were in two distinct groups. Fifty four were fishing from the rocks and only one of these was female. All were over the age of 15 years. The second group comprised 21 persons not fishing (figure 9). | par 51 |
| A further 36 persons were described as having drowned while fishing in tidal water and of these, 35 were males. The one female was ten years of age. One male was four years old; there were none in the 5 to 14 year age group, then deaths were relatively evenly distributed for age with the greatest number, eight, in the over 64 age group. The total of all drownings while fishing, either from rocks or elsewhere in tidal water is therefore 5.8% of all non boating drownings (figure 10). | par 52 |
| There were twelve drownings in Public Pools (5 male and 7 female). | par 53 |
| "Other" swimming pools accounted for 28 drownings of whom 20 were male. | par 54 |
| 56 drownings occurred while using Scuba equipment. Of these 44 (79%) were male and 12 were female (figure 11). Fifteen (27%) of these 56 were overseas tourists. On a state by state basis, 36% of Scuba deaths occurred in Queensland waters, 21% Western Australia and 18% NSW (figure 12). | par 55 |
| Skindiving accounted for 15 deaths of whom three were overseas tourists, 11 were male and 4 female. | par 56 |
| 36 (34 male) persons drowned while attempting rescue; 12 in surf, one in a public pool and 23 at other sites. | par 57 |
| Four groups were subjected to detailed analysis. These were toddlers, the elderly, the indigenous population and overseas tourists. | par 58 |
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TODDLER DROWNINGS |
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| Children under the age of five years comprised 22% of all drownings but are only 7% of the population. There were 345 drownings in this age group and the most frequent locations were: | par 60 |
| Private pool | par 61 |
| 168 (49%) | par 62 |
| Lake (non tidal) 68 (20%) | par 63 |
| Bathtub | par 64 |
| 53 (15% ) | par 65 |
| Object eg bucket 20 (6%) | par 66 |
| Irrigation canal 7 (2%) | par 67 |
| Males comprised 64% of the total and the rate of 4.4 per 100,000 population (figure 1) for the six year period compares with 4.7 in the five years to 1990 and 9.5 in the five years to 1975. | par 68 |
| There were 37 drownings in infants in their first year of life. Of these, 26 incidents were in the bathtub , almost 2% of all Australian drownings. 22 were males and 15 females. The other locations were: private pool 4, object such as bucket 3, lake 2, ocean and irrigation canal 1 each. | par 69 |
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THE OLDER AGE GROUP |
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| 12% of all accidental drowning victims were over the age of 64 with a rate of 1.5 per 100,000 population (figures 1 and 2). Of these, 38% were females. The locations were: | par 71 |
| Ocean | par 72 |
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| 34 (18%) | par 74 |
| Male/Female 19/15 | par 75 |
| Private pool | par 76 |
| 33 (18%) | par 77 |
| Male/Female 11/22 | par 78 |
| Lake (non tidal) 29 (14%) | par 79 |
| Male/Female 21/8 | par 80 |
| Surfing beach | par 81 |
| 23 (12%) | par 82 |
| Male/Female 19/4 | par 83 |
| Bathtub | par 84 |
| 22 (12%) | par 85 |
| Male/Female 4/18 | par 86 |
| It is notable that females in this age group outnumbered males in the pool and bathtub. | par 87 |
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ABORIGINAL POPULATION |
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| Drowning in the aboriginal population was studied and it is clear that this group requires further examination. There were 67 non boating drownings representing 4.5% of the national total. The 1996 ABS census figures show that 1.8% of the population were classed as Aboriginal and Torres Strait Islanders. The age distribution for drowning was notably different from the overall national figures (figure 13). Like the national trends, toddler drowning was very common, comprising 34% of all aboriginal drownings. 65% of these toddlers were males. | par 89 |
| Sites for aboriginal toddler drownings were: | par 90 |
| Lake-non tidal | par 91 |
| 11 | par 92 |
| Bathtub | par 93 |
| 6 | par 94 |
| Private pool | par 95 |
| 2 | par 96 |
| Other pool | par 97 |
| 2 | par 98 |
| Ocean | par 99 |
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| 2 | par 101 |
| The State distribution was Western Australia 10, Northern Territory 7, Queensland 4, Victoria and NSW 1 each | par 102 |
| Unlike the overall national figures, there was a second peak in the 25 to 34 age group which comprised 30% of all aboriginal drownings. In this group, 95% were male and 40% had evidence of alcohol consumption. | par 103 |
| For the 25 to 34 age group, locations of the 20 drownings were: | par 104 |
| Lake-non tidal | par 105 |
| 9 | par 106 |
| Ocean | par 107 |
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| 7 | par 109 |
| Boardriding | par 110 |
| 2 | par 111 |
| Bridge/wharf | par 112 |
| 1 | par 113 |
| Unspecified | par 114 |
| 1 | par 115 |
| Of the eleven surfboard riders who drowned in 1992 to 1997, two were aboriginal and both drowned in NSW waters. | par 116 |
| Boating drownings in aboriginal people were much less common with only seven recorded in six years. The ages were 6, 12, 36, 45, 46, 50 and 60 years. All except one were in motorised craft. All were male | par 117 |
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OVERSEAS TOURISTS |
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| 87 overseas tourists from 24 different countries drowned in Australia during the six years. 74 were in non boating incidents, 5 were boating deaths and 8 were not specified. | par 119 |
| Most frequent countries of origin were: | par 120 |
| Japan 14, United Kingdom 11, Germany 6, Denmark 4, USA 4, China/Taiwan 3, New Zealand 2 and Korea 2. | par 121 |
| The locations of the 74 non boating deaths were: | par 122 |
| Surfing beach | par 123 |
| 30 persons | par 124 |
| Ocean | par 125 |
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| 15 | par 127 |
| Scuba | par 128 |
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| 15 | par 130 |
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| Private pool | par 132 |
| 4 | par 133 |
| Lake | par 134 |
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| 3 | par 136 |
| Skindiving | par 137 |
| 3 | par 138 |
| Other pool | par 139 |
| 1 | par 140 |
| In this group, 61% of deaths occurred at surfing beaches or elsewhere in "ocean" and | par 141 |
| 24% occurred while skindiving with or without Scuba equipment. | par 142 |
| 4.7% of all non boating drownings in Australia were overseas tourists, | par 143 |
| 18% of all surf/ocean drownings were overseas tourists and | par 144 |
| 25% of all scuba/skindiving drownings were overseas tourists. | par 145 |
| 89% of all tourist drownings occurred in the ocean and 11% in fresh water. 16 were female. The oldest tourist to drown was 78 years of age and the youngest three years.(figure 14) Tourists were 1.6% of boating drownings | par 146 |
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DROWNING IN BOATING INCIDENTS |
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| Drowning in boating incidents ( E830 and E832 ) was much less frequent than other accidental drownings. There were 289 Boating drownings , an average of 52 per year. Of these, 94% were males. Alcohol was reported in 19 of these boating drowning victims and a different drug in one person, a drug total of 20 persons. All were between the ages of 35 and 54 years. The rate for victims drowning in boating incidents was 0.29 per 100.000 population. Over the past 25 years the rate has declined from 0.77 to 0.29 per 100,000 of population ( figure 15 ). | par 148 |
| Drownings in boating incidents (Figure 16) differ from non boating deaths in the lower incidence, very low numbers of toddlers (1%) and the extreme male predominance. | par 149 |
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OTHER ACCIDENTAL DROWNINGS |
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| During the six years under review there were several other modes of drowning appearing in the details from the ABS but not included as any of the drowning E codes. These were deaths ascribed to other causes but to which the "drowning flag" was also applied. | par 151 |
| Forty six (46) persons with epilepsy drowned in these six years. | par 152 |
| Thirteen (13) persons drowned due to having suffered either heart attack or stroke while in the water. | par 153 |
| Eighty (80) drowned in motor vehicles accidents in the water. | par 154 |
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S UICIDE (E954) AND HOMICIDE (E964) |
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| There were 418 suicides in the water with an annual average of 70 persons. This makes suicide in the water more common than drowning in boating accidents ( 289 persons ). | par 156 |
| During the same period there were twenty six (26) homicides due to drowning. | par 157 |
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DISCUSSION |
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| Toddler drowning has long been recognised as a national disgrace yet in spite of the most strenuous efforts of a group led by Professor John Pearn, the figures in this report indicate relative failure of present strategies. | par 159 |
| The time is well overdue for legislators to address the issue of all drownings, in particular those involving toddlers. Education has been inadequately funded. Except for the boating area, legislation has been half hearted and the advice of experts largely ignored. Perhaps the time has come for private swimming pools to be either fenced according to Standards Association guidelines or banned. | par 160 |
| The figures on private pools come as no surprise except, perhaps for the numbers of older citizens involved. A person in a private pool is no further than three or four metres from the safety of the edge or steps which suggests either inability to swim even that short distance or physical illness as the cause. Many pools have shallow and deep ends with a very short drop-off point. This factor may provide a false sense of security as the person bathes in chest deep water and may well be the cause of some adult drownings as depicted in the educational video film "On Drowning" by Frank Pia in 1970 (ref 6). This brilliant film shows several people actually drowning at a river beach in New York while others are bathing within reaching distance, unaware of the plight of the silent victim who is shown being plucked to safety by the lifeguards. Drowning is a silent death. | par 161 |
| Detailed information on lake drownings needs further investigation by the recently formed National Water Safety Council in conjunction with Coroners, Police and the National Injury Surveillance Unit. There are many differing locations covered by the category "lake (non-tidal)" and effective preventive action is dependent on details of locations. | par 162 |
| Surfing beach and ocean drownings are extremely common and are largely a male phenomenon with a peak age proup of 15 to 24 years. As in lake drownings, the classification "ocean-tidal" includes many differing locations and needs further analysis by the Water Safety Council to enable targeting of educational efforts. Because, in Australia, most people live very close to the ocean and it is a very popular holiday destination for those who live inland, the sea is regarded as part of the National Park system (figures 5 and 6). All ocean beaches are fundamentally hostile and their nature poorly understood by at least 95% of the population. Those planning to use the ocean for their recreation should consider as essential a course of surf awareness as taught by Surf Lifesaving Australia since 1978. | par 163 |
| Bathtub drownings are shown to be disturbingly common and the preventive approaches need to vary according to the age group. The frequency of infant and toddler bathtub deaths has been documented in state reports for two decades (reference 7) but this is the first national survey. Most bathtub deaths require much more careful forensic scrutiny than they have received to date in most countries. The frequency of the bathtub for drowning in Japan, where it is the leading place for immersion deaths and near drowning has been described by Nixon but earlier reports from many countries indicate a wide variety of factors including carbon monoxide , epilepsy, drugs and alcohol, suicide, cardiac arrest, suicide, homicide and child abuse. Geertinger, writing in the Journal of Forensic Medicine in 1970 (Reference 8) referred to an English gentleman who succeeded in drowning three wives in the bathtub before being required to face a court. In his series of 42 adequately examined cases, over half were suicides and 78% were female. The series was drawn from deaths in Copenhagen and Gothenberg. There is little doubt that death in the bathtub at any age should be treated with great suspicion and careful investigation be directed at finding natural or deliberate causes. Confirmation of true accidental drowning in this location is likely to be less common with such an approach. | par 164 |
| Accidental drowning in any location is extremely uncommon amongst members of the water safety community and their families. Similarly those involved in aquatic sport rarely drown. There are two major reasons : first, they are acutely aware of their personal skills or lack of them in the water and secondly they have a deep sense of the potential perils of aquatic environments. Swimming ability is a factor in some but this is included in "personal skills". | par 165 |
| The importance of learn to swim campaigns has been questioned many times and varying definitions of ability to swim have been used. Strong swimmers never drown except in most exceptional circumstances and these have usually involved injury or illness. The case for learning to swim is strong even if only because preventive and survival skills are taught at the same time. This author who was awarded his Bronze Medallion in 1948 attributes the low rate of drowning in the 5 to 14 years age group to educational measures which include learning to swim. The low incidence of drowning in the 5 to 14 age group in this study continues the tendency shown in the 1993 National Drowning Study, updated to 1995. (figure 17). | par 166 |
| Water safety education programs at school would have little appeal if not conducted in conjunction with swimming lessons or classes in aquatic activities including a wide variety of sports. | par 167 |
| Details of tourist drownings have not previously been published and this is clearly an area in which government must work through the Water Safety Council to reduce the numbers. The vast majority of deaths occurred in the ocean while simply swimming or diving with or without Scuba apparatus. Tourists and new migrants must be provided with suitable information and perhaps increased supervision when near the ocean. As tourists are being increasingly encouraged, it is clear that the messages from the now proven drowning risks must be heeded and followed by educational and other preventive measures. The specific areas of greatest risk have been made very clear as being surf, ocean and recreational diving. | par 168 |
| Similarly, drowning in our indigenous people is a matter for concern and calls for urgent government action through the appropriate established organisations. The age graph is quite unique with very high incidence in toddlers and the 25 to 34 age group. Dietz and Baker | par 169 |
| ( reference 9) were the first to draw world attention to the variation in drowning incidence in different racial groups and the subject has been widely studied in USA since their paper. At the most recent Medical-Rescue Conference of the International Lifesaving Federation, Dr Christine Branche from the Centers for Disease Control (ref 10) and Dr. Fred Mael (ref 11) from the American Institutes for Research reviewed the American experience and scientific literature on the reasons for the well known increased incidence of drowning in African Americans, American Indians, Alaskan Natives and Hispanic citizens of the USA. Their studies are of significance to those proposing to study this problem in Australia. In the light of Mael's results, the Australian figures are not at all surprising but clearly present a challenge. | par 170 |
| Any approach to prevention of drowning is traditionally described as having three components; Education, Engineering or Science and Legislation. To these should be added supervision and policing. Action in all these areas is dependent on carefully compiled accurate information on many aspects of the problem. Those responsible for boating safety in Australia can point to great success in all areas. | par 171 |
| The most comprehensive review of preventive measures in Australia was published in 1995 by the Commonwealth Dept of Human Services and Health with Nixon, Pearn, Oldenburg and Pitt as authors, all tireless workers in the field.(Reference 7) Their publication which will be regarded as the standard text for many years contains most of the literature references of importance up to 1995, though Dr. Pitt acknowledges that some important material known to him is absent from the Medline list. There is much unpublished information within the archives of the major aquatic safety organisations. | par 172 |
| The National Water Safety Council was formed in 1998 with a specific charter to reduce Australia's drowning toll and their first conference was held in Melbourne in May 1998 (Reference 12). The details contained in the present study will provide the new Council with added information on details of age/gender profiles in the major drowning locations, assisting more informed targeting of individual risk groups in specific areas. As correctly pointed out by Smith and Langley in 1998 (Reference 13), reliance solely on E codes would result in many drownings remaining unidentified. The eighty drownings in motor vehicle accidents and the many suicides are the most clear examples of the point being made by these authors in surveying drowning incidence. | par 173 |
| Once all Australian drowning locations have been pinpointed, they will be entered on the same satellite mapping/computer program used by Professor Andrew Short to profile all beaches in Australia (Reference 14). Then the Council will have much more accurate information for educational efforts in every category of drowning. One of the pressing priorities of the Council is to obtain critical information on drownings at a much earlier stage than currently pertains . Preventive measures will then be much more effective. | par 174 |
| The multiple state and county reports from the USA emphasise the diversity of drowning causes in different regions demonstrating that drowning and its prevention are regional issues and therefore more complex than, say, prevention of coronary artery disease. As if to stress this point, Agocs Trent and Russell (Reference 15) write that statewide surveillance in California from 1980 to 1990 determined that the highest drowning rate was for rural, desert County Imperial with incredible numbers of illegal immigrants drowning in irrigation canals along with locals in land vehicles while their blood alcohol levels were very high. County Imperial's drowning rate was 21.9 per 100,000 population for that decade, ten times the rate for the state. | par 175 |
| Suicide by drowning is not normally within the brief of water safety organisations but Surf Lifesaving personnel work in a very wide surf zone and are called not only to all categories of accidental aquatic disasters but also to cases which are deliberate. Lester reported in 1989 (Reference 16) that the presence of an ocean greatly increases the risk of suicide specifically by drowning so those charged with ocean surveillance can expect to be confronted with this ever increasing problem. There were 2723 deaths by suicide in 1997 in Australia (Reference17) | par 176 |
| In preschool age children, water familiarisation is popular and desirable but any suggestion that commercialised ventures along these lines will reduce the drowning rate is misleading and dangerous and must be totally rejected. The Royal Lifesaving Society Australia strongly supports the concept of families introducing their children to water at an appropriate age which will vary with climate and many other variables but the emphasis is on parent child bonding, fun, education and safety. The concept of "drownproofing" is totally rejected as dangerous. | par 177 |
| The preventive principles for toddlers clearly set out in the Nixon Report (Reference7) are unchallengeable and are totally endorsed by the present study. In adults, the basic requirements are awareness of one's abilities and of the perils posed by all types of aquatic environment. In all age groups, common sense and education are paramount. Implementation of these principles will be assisted by targeting specific risk groups identified by this and future studies. | par 178 |
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ACKNOWLEDGEMENTS |
|
| The author has received great assistance from the officers of the Australian Bureau of Statistics, in particular Mr. Peter Burke, the executive officers of the Royal Lifesaving Society Australia and Dr. George Stathers. Purchase of the statistical computer disc was funded by the Royal Lifesaving Society Australia. | par 180 |
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REFERENCES |
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| 1. Maiello D, Cuccioletta C, Swimming from the beginning to the Roman Empire. Societa Editrice Nemi, Via Nomentana 923-00137 Roma | par 182 |
| 2. Pearsall R. Lifesaving The Story of the Royal Life Saving Society. The First Hundred Years. David & Charles, Newton Abbot, London | par 183 |
| 3. MaielloD, Sabatini A, Una Statistica Per La Vita. Societa Editrice Nemi, Via Nomentana 923-00137 Roma. | par 184 |
| 4. Mackie I, Tebb N, Eady T, National Drowning Study Parts 1 to 4 Royal Lifesaving Society Australia | par 185 |
| 5. Australian Bureau of Statistics - Population By Age and Sex-3201.0-June 1997 PO Box10 Belconnen ACT 2616 | par 186 |
| 6. On Drowning. Water Safety Films, Inc. 3 Boulder Brae Lane Larchmont,NY10538 | par 187 |
| 7. Nixon J, Pearn J, Oldenburg B, Pitt W , Review of countermeasures to reduce drowning, near drowning and spinal injuries fron diving into shallow water. Commonwealth Dept Human Services and Health GPO Box 9848 Canberra ACT 2601 | par 188 |
| 8. Geertinger P, Voigt J, Death in the Bath Journal of Forensic Medicine 17:4;1970 | par 189 |
| 9. Dietz,P and Baker,S.1974 Drowning: epidemiology and prevention. American Journal of Public Health 64:303-12 | par 190 |
| 10. Branche,C. Who Drowns in the United States? Proceedings of International Medical-Rescue Conference1997, ILS 2581 Quivira Court San Diego California | par 191 |
| 11. Mael,F Staying Afloat: Within-group Swimming Proficiency for Whites and Blacks. Journal of Applied Psychology 1995,Vol 80:4,479-490 | par 192 |
| 12. National Water Safety Conference Melbourne 5 May 1998 Secretary Leahy,S Surf Life Saving Australia, National Council | par 193 |
| 13. Smith G, Langley J, Drowning Surveillance: how well do E codes identify submersion fatalities. Injury Prevention 1998;4:135-139 | par 194 |
| 14. Short,A Australian Beach Safety and Management Program. Coastal Studies Unit, Dept. Geography, University of Sydney NSW 2006 | par 195 |
| 15. Agocs M, Trent R, Russell D, Activities associated with drownings in Imperial County, CA, 1980-89: implications for prevention. Public health Rep 1994 Mar-Apr; 109(2):290-5 | par 196 |
| 16. Lester D, The suicide rate by drowning and the presence of oceans. Perceptual and Motor Skills 1989 : 69 ;338. | par 197 |
| 17. Australian Bureau of Statistics-Causes Of Death-3303.0-1997 PO Box 10 Belconnen ACT 2616. | par 198 |
| Figure 1
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Figure 2
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Figure 3
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Figure 4
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Figure 5
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Figure 6
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Figure 7
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Figure 8
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Figure 9
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Figure 10
| par 208 |
Figure 11
| par 209 |
Figure 12
| par 210 |
Figure 13
| par 211 |
Figure 14
| par 212 |
Figure 15
| par 213 |
Figure 16
| par 214 |
Figure 17
|