The water incident database (WAID) 2012 to 2019: a systematic evaluation of the documenting of UK drownings

Association between air temperature and unintentional drowning risk in the United Kingdom 2012-2019: A nationwide case-crossover study

OBJECTIVE

Drowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to examine risk factors to improve water safety policies. Weather conditions, have the potential to influence drowning risk behaviours as people are more likely to spend time around water and/or undertake risky activities in aquatic spaces as a behavioural thermoregulatory response (e.g., seeking coolth).

METHODS

A case-crossover approach assessed associations between changes in daily maximum air temperature (data from the nearest weather station to each drowning event) and unintentional drowning risk using anonymous data from the validated UK Water Incident Database 2012-2019 (1945 unintentional deaths, 82% male). Control days were selected using a unidirectional time-stratified approach, whereby seven and 14 days before the hazard day were used as the controls.

RESULTS

Mean maximum air temperature on case and control days was 15.36 °C and 14.80 °C, respectively. A 1 °C increase in air temperature was associated with a 7.2% increase in unintentional drowning risk. This relationship existed for males only. Drowning risk was elevated on days where air temperature reached 15-19.9 °C (Odds Ratio; OR: 1.75), 20-24.9 °C (OR: 1.87), and ≥ 25 °C (OR: 4.67), compared with days <10 °C. The greatest elevations in risk appeared to be amongst males and when alcohol intoxication was suspected. Precipitation showed no significant association with unintentional drowning risk.

CONCLUSIONS

Identifying such relationships highlights the value of considering weather conditions when evaluating environmental risk factors for drowning, and may inform water safety policy and allocating resources to prevention and rescue.

The Effects of a 6-Week Swimming Intervention on Gross Motor Development in Primary School Children

(1) Background: This study examines the effects of a 6-week swimming intervention on motor competence in children. (2) Methods: A total of 107 children (n = 52 boys, n = 55 girls) aged 7.8 ± 0.63 years that were recruited from five primary schools in central England participated in this study, undertaking either an aquatic intervention once a week for six weeks or acting as a control group completing their usual physical education program. Participants underwent pre- and post-assessments of general motor competence using the Test of Gross Motor Development, Third Edition (TGMD-3) (a process measure) and a composite of 10 m running sprint time and standing long jump distance (product measures). Aquatic motor competence was assessed via the Aquatic Movement Protocol (AMP). Fear of drowning and swimming opportunities were also assessed by implementing a questionnaire. (3) Results: Following a mixed-model ANOVA, an overall main effect was found from pre (40.05 ± 13.6) to post (48.3 ± 18.6) for TGMD-3 scores (p < 0.05) and pre (38.7 ± 31.7) to post (50.6 ± 36.8) for AMP scores (p = 0.001). A negative significant relationship was found between AMP scores with both fear of water (p = 0.01) and fear of drowning (p < 0.05). A positive significant relationship was found between swimming opportunities and AMP score (p = 0.001). (4) Conclusions: The aquatic-based intervention improves not only aquatic motor competence but also transfers improvements in dryland movement competencies. Future research should look to implement control groupings which do not participate in swimming to further investigate the difference between swimmers and non-swimmers; however, due to swimming being a part of the national curriculum in England, this may not be feasible.

Burden of fatal drowning in California, 2005-2019

OBJECTIVE

To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research.

METHODS

This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water).

RESULTS

California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period.

CONCLUSIONS

California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.

Lessons learned through the 20-year development of a national fatal drowning database in Australia

BACKGROUND

Co-ordinated, evidence-based policy and programmatic efforts are needed to respond to complex drowning prevention problems. Comprehensive, current, and robust data are vital for agenda setting, burden and risk factor identification, intervention design and evaluation, as well as setting policy. We aim to record methods used in, and identify impacts of, the development of a national fatal drowning database (NFDD) in Australia, including lessons learned across research, policy, and practice.

METHODS

We employ a case study method using process mapping and document review to explore the evolution, drivers and impacts of the NFDD. We analyse methodological approaches including those relating to data definitions, drowning case collection, and management, as well as tracking the various outputs of the NFDD. We describe a development timeline that presents impact of drowning prevention policy, and research agendas on database development, and research investments more specifically.

RESULTS

Our study identified that the collected variables grew 20-fold from 2002 to 2022, reaching 259 variables, and 5,692 unique cases of fatal drowning. The NFDD employs data triangulation methodology, combining keyword and targeted searches of coronial files, media report monitoring, and organisational data provision. Database development is influenced by the Australia Water Safety Strategy, policymaker and practitioner-initiated research agendas, and identification of knowledge gaps. We identified numerous outputs spanning publications, media, intervention development, and legislative submissions.

CONCLUSION

A comprehensive and robust NFDD informed by policymaker and practitioner input can enhance surveillance, policy, and intervention development for drowning prevention. Employing mixed data collection and validation methods can supplement weaknesses in official data sources. There is a need for the NFDD to continue to evolve in its application while maintaining rigorous case identification and data quality assurance processes. Despite significant investment, the outputs and influence on drowning prevention practice in Australia has been extremely valuable and contributed to sizeable reductions in Australia's fatal drowning rate.

Contribution of Drugs to Drowning in Scotland from 1996 to 2020

OBJECTIVE

Psychoactive substance use (including alcohol) can affect risk perception, leading to accidents and deaths. There is little detailed or up-to-date information on the role of drugs in drownings in the United Kingdom (UK). This Scottish case-study aimed to fill this knowledge gap.

METHODS

Anonymised data for individual drug-poisoning-related drowning registered from 1996 to 2020 were provided by the National Records of Scotland. Statistical analyses were performed for socio-demographics, ICD coding, cause of death, and substances implicated.

RESULTS

It has been reported that death registrations increased from 7 in 2017 to over 20 during 2019-20. These deaths (n=160) accounted for <1% of all drug-related poisoning deaths; this proportion rose to record levels (c.1.5%) during 2019-20. Most deaths (69%) involved males. The mean age was 39.8 (range 16-81, SD 15.0) years. The main drug classes implicated were: opiates/opioids (41%), benzodiazepines (31%), stimulants (19%), and antidepressants (14%). Moreover, 57% of benzodiazepines were 'designer' drugs.

CONCLUSION

Scottish drownings associated with drug consumption are increasing rapidly. It has been observed that central nervous system depressant drugs (e.g., opioids, benzodiazepines, alcohol) are often involved in drowning. 'Designer' benzodiazepines are a principal factor in increasing Scottish drug-related poisoning deaths; they may be partially responsible for increasing numbers of related drownings. Evidence-based strategies to further reduce the number of preventable drownings should include reference to the dangers of drugs.

Analysis of drowning fatalities in the Vistula River in years 2011-2020 in the Lesser Poland Voivodeship

Aim

The aim of the present study is to analyze drowning fatalities in the Vistula River from 2011 to 2020 in the Lesser Poland Voivodeship.

Material and methods

The material for the study consisted of autopsy protocols provided by the Department of Forensic Medicine in Cracow. Demographic data, results of post-mortem examinations and results of basic toxicological tests - levels of ethyl alcohol in the blood and urine of decedents were analyzed. The extracted data were subjected to statistical analysis using TIBCO Statistica® 13.3.0 software. χ2 and one-way ANOVA tests of independence (p < 0.05) were performed.

Results

79 cases were analyzed. The mean age was 44.2 years (SD = 16.81). The majority of the study group was male (73.1%). 57.9% of men were under the influence of alcohol (>0.5 per mille) at the time of drowning, compared to 23.8% of women (p = 0.008). Most bodies were found between the Kosciuszko and Dąbie barrages (57.0%). Spring and summer were the most common seasons for drownings (59.5%). 35.4% of victims suffered from psychiatric illnesses. Emphysema aquosum was more frequent in bodies that were not in an advanced state of putrefaction (p = 0.000). 23.1% of victims had head injuries, 14.1% - upper limb injuries, while 11.5% had lower limb injuries.

Conclusions

Inebriated men are more likely to be victims of drowning, which may be due to a greater tendency toward reckless behavior and irresponsible consumption of alcoholic beverages. Most drownings occur in the city center, which points to suicide as the cause of incident. The occurrence of external injuries is the result of jumping from a great height or the effect of carrying the corpse downstream.

Addressing a gap: a qualitative analysis of Scotland's Drowning and Incident Review process

OBJECTIVES

Drowning is a leading cause of fatalities worldwide and Scotland carries a disproportionate number of drownings compared with its UK neighbours. Drowning data captured in Scotland are often incomplete and the Drowning and Incident Review (DIR) is a new process designed to help improve the capture of data and help inform future preventative measures. The aim of this study was to explore the perspectives and views of key stakeholders on the facilitators and barriers of implementing the DIR as well as areas for its future sustainability.

METHODS

A qualitative approach was used with in-depth interviews using key participants. Participants were identified using purposive sampling, through use of a stakeholder analysis. Participants watched a hypothetical DIR and then participated in a semistructured interview. Questions focused on DIR facilitators, barriers and areas for future sustainability. Qualitative data were then analysed using thematic analysis.

RESULTS

A total of 14 participants took part in the study. Results found: three facilitator themes (addresses a gap, design of DIR, safe space), four barrier themes (representation, resource, legal concerns, control concerns) and four areas for future sustainability (the voluntary nature, framework agreement, political prioritisation and the human element). These themes were then discussed within this paper in relation to findings from research on similar review processes.

CONCLUSION

The research was the first of its kind and the findings are therefore extremely important to provide a first exploration and insight into facilitators and barriers of the DIR as well as areas for its future sustainability.