Mortality and Morbidity: Accidental drowning
The long-term trend in accidental drowning in Australia (since the 1920s) has been a decline.1 In the 1990s, accidental drowning was relatively rare, causing fewer than 2 deaths per 100,000 population per year and accounting for less than 1% of all deaths. Nevertheless, drowning is a focus of public concern because these deaths are often premature and avoidable. The National Water Safety Council is a coordinating body promoting water safety across areas and levels of government and to the general public. The Council’s Water Safety Plan promotes specific measures in the area of research, management of aquatic locations and water safety education. The plan also encourages a focus on key demographic groups, such as 1-4 year olds, known to have a higher risk of drowning.2
AVERAGE AGE-SPECIFIC ACCIDENTAL DROWNING RATES(a), BY SEX, 1992-1998
(a) Registered deaths, classified to codes E830, E832 and E910 (ICD–9). Age-specific death rate is the number of deaths per 100,000 of the estimated mid-year population. Age-specific death rates 1992–1998 were averaged over the period.
Source: Unpublished data, Causes of Death collection.
Magnitude and age pattern
Over the years 1992-1998, 2,199 people died from accidental drowning, including 343 who drowned as a result of water craft accidents. There was an average of 314 deaths per year, with four times as many males as females drowning (an average of 251 per year compared to 63). The age-standardised death rate from accidental drowning fluctuated annually, and ranged from 1.5 deaths per 100,000 (1998) to 2.0 (1992).
Children under five years had the highest average drowning rate of any age group (4.6 deaths per 100,000). The rate for males was 5.7 deaths per 100,000 and for females it was 3.4 per 100,000.
The average death rates were higher for males than for females in every age group. The difference was least in the 0-5 years age group in which the rate for males was 70% higher than that for females. It was greatest in the 15-24 and 25-34 years age group. In these two age groups the average rates for males were more than seven times higher than the average rates for females.
Drownings over 1992-1998 occurred in a variety of circumstances and locations, and highlighted diverse issues in water safety.
Drowning is seasonal, with a peak in December-January, the hottest months and also a holiday period. Of all drownings over the period, 13% took place in January and 13% in December while the trough occurred in May (4%). (Data was adjusted to take account of differences in the number of days per month).
Many deaths took place during recreational use of water. As well as 600 drownings while swimming, paddling or wading, there were 83 drownings while skin diving or spear fishing, 20 drownings while surfboard riding and 2 drownings while water skiing.
However, a substantial number of deaths resulted from people accidentally falling or wandering into water. Indeed, more deaths in swimming pools and in lakes, dams or lagoons, were attributed to people accidentally entering the water than to swimming, paddling or wading. Almost 40% of the 748 drownings due to falling or wandering into water were of children aged 1-4 years.
After deaths from falling or wandering into water, and while swimming paddling or wading, water craft accidents claimed the most lives through drowning.
Each year a small number of people drown while trying to save others; there were 41 such deaths over the period.
As well as the more common locations, (major types of natural water body and swimming pools), drownings occur in other sites. Bathtubs are a hazard for infants, people with certain medical conditions, and those prone to falls, such as the elderly. There were 131 drownings in bathtubs over the period. The hazards of ditches or shafts on building sites, and irrigation canals on farms, have been recognised in various regulations. Storm water drains are also a hazard, especially to children who play in them. There were 34 deaths in trenches, irrigation canals or storm water drains over the period. Dams, creeks and water holes are included in the location category with lakes. A recent report highlights drowning as a safety hazard on farms, especially for children.3 Over 1989-92 there was an average of 22 drownings a year on farms, with more than half occurring in dams. Children under 15 years made up 57% of farm drownings.
In most circumstances more males drowned, but more females drowned in bathtubs. The circumstances and locations of drowning also varied by age. Quite different reasons account for the peak in death rates at under five years, the predominance of male deaths, especially among younger adults, and the higher drowning rates among those aged over 64 years than among other adults.
LOCATION OF SELECTED DROWNINGS(a), 1992-1998
(a) Death registered to ICD–9 code E910 and which occurred while swimming, paddling or wading, or after falling or wandering into water.
Source: Unpublished data, Causes of Death collection.
Children under five
Children under five are physically vulnerable to drowning. They are also unaware of water hazards and are dependent on the vigilance of adults to protect them. International data shows that children of this age who drown tend to do so in whatever hazards are in or near their homes. For example, locations of drowning which are quite common in other countries but not in Australia include canals (the Netherlands), sunken bathtubs (Japan), ornamental garden ponds (the United Kingdom), and industrial buckets used in the home (the United States).4
In Australia, the most common location of drowning of children under five years over 1992-1998 was a private swimming pool (45%). The great majority of children of this age who drowned had fallen or wandered into water (72%). Only a small proportion drowned while swimming, paddling or wading (7%). This may reflect the fact that children of this age are not normally allowed to swim, paddle or wade without adult supervision. If they get into difficulties while supervised, an adult may often be able to rescue them, and if necessary, resuscitate them and call for medical assistance.
A study of drownings and near-drownings of children in Brisbane over a number of years identified several issues relating to supervision.4 As well as less common circumstances which were considered to show neglect, these included situations where the child was not supervised, or there was confusion about who was supervising the child at the time (dichotomy of care), or a degree of disruption to routine (vulnerable period for child or parent). The findings also suggest that there was some confusion about the degree of supervision necessary. While most children of five and over can understand parents’ instructions, some parents were unrealistic in thinking younger children could be trained not to go near a pool or that the presence of older children was sufficient supervision. The study also found some over-reliance on buoyancy aids (‘floaties’).
The major associated factors identified by the study, however, related to the adequacy of the pool fencing. Safety advocates regard isolation fencing, with a childproof gate which is kept closed by those who use it, as the most important measure to protect children in houses with private pools.5 While pool fencing legislation of some sort applies in most areas of Australia, isolation fencing is not always required. Other issues relating to the pool environment which arose in the Brisbane Drowning Study were the presence of attractive objects in the water and the misuse of safety features.
Youth and adults to age 64
Whereas the peaks in the age pattern of drowning among young children and older adults reflect physical vulnerability, the rise among youth (15-24 years), and the much higher rate among males than females sustained through adult years, are regarded as reflecting behavioural differences. Greater involvement in water recreation, less supervision than applies to those under 15, and a greater tendency to take risks may explain these patterns.
In contrast to the pattern for young children, only 3% of drownings of people aged 15-64 years that occurred between 1992 and 1998 were in private swimming pools. Drowning while swimming, paddling or wading was the most common circumstance (33%), while 30% followed falling or wandering into water, and 20% were due to watercraft accidents. The majority of both swimming, paddling and wading drownings (68%), and those which followed falling or wandering into water (56%) occurred in an ocean, coastal or river environment. Of the 1,377 people who drowned in this broad age group, 86% were male, and males made up at least 75% of deaths in all circumstances except for the 46 drowning in private pools (65% were males), and the 36 in bathtubs (33% were males).
In contrast to younger adults, the largest group of drownings of those aged over 64 years resulted from falling or wandering into water (41%). This was the most common circumstance among both men and women (78 and 35 deaths respectively). Among men, watercraft accidents (48 deaths), and drowning while swimming paddling and wading (40 deaths) were the next most common. Among women, bathtub drownings (17 deaths) and swimming, paddling or wading drownings (11 deaths) were the next most common circumstances. Only four men of this age drowned in a bathtub and only four women drowned in watercraft accidents.
Water-based recreations such as swimming, scuba diving or snorkelling attract tourists. The deaths of tourists undertaking some of these activities has generated concern about safety standards and contributed to discussion regarding the systems of medical checks which operate.6
In the period 1992-98 nearly all drownings were of Australian residents. Nevertheless there were 102 deaths of people whose usual residence was overseas. In contrast to the pattern for all drownings, 60% drowned while swimming, paddling and wading, with surf beaches the most common location (38 deaths). About 20% drowned while skin diving or spear fishing. In fact, overseas residents made up 24% of all skin diving or spear fishing drownings.
There has been concern voiced by water safety experts that alcohol may be involved in some drowning deaths, particularly in those resulting from boating accidents.4 Alcohol and drug abusers, and those on some medications, are also at risk of drowning after losing consciousness in a bath. These aspects of water safety cannot be investigated directly from statistical deaths data. However, the National Drug Research Institute has estimated that about 70 drownings were alcohol-related in 1997.7
Over 1992-1998, 291 deaths were noted as incidental drownings. There were 40 drownings due to floods, storms and earth movements. The medical conditions which were the most common underlying causes of incidental drownings were epilepsy and heart conditions. Motor vehicle accidents were prominent as the major accidental cause in this group. A variety of other types of accident were also represented including aircraft accidents and falls. Drownings due to machinery accidents or electrocution remind of the need for vigilance in using electrical and other equipment near water.
1 Mackie, I. and Tebb, N. 1994, National drowning study: Second report, The Royal Lifesaving Society Australia, Sydney.
2 Australian Water Safety Council 1998, National Water Safety Plan, Sydney.
3 Franklin, R., Mitchell, R., Driscoll, T. and Frager, L., (In press) Farm-related fatalities in Australia, 1989-1992, RIRDC & ACAHS, Moree.
4 Nixon, J., Pearn, J., Oldenburg, B. and Pitt, W.R. 1995, Review of countermeasures to reduce drowning, near-drowning and spinal injuries from diving into shallow water, Commonwealth Department of Human Services and Health, Canberra.
5 Mackie, I. J. 1999, 'Patterns of drowning in Australia, 1992-1997', Medical Journal of Australia, 171: pp. 587-590.
6 Walker, R. 1999, 'Dead in the water: how safe are our water sports?', Medical Journal of Australia, 171: pp. 584-586.
7 National Drug Research Institute 1999, National Alcohol Indicators Bulletin No. 1, National Drug Research Institute, Perth.