The Australian Water Safety Council (AWSC) was officially formed in February 1998 as a result of strong industry consultation and Federal Government support. The Council acts as a consultative forum comprising the major water safety and related government agencies and focuses on the presentation of key water safety issues to governments, industry and the community.

Organisations represented on the Council include:

• Royal Life Saving Society - Australia (RLSSA)
• Surf Life Saving Australia (SLSA)
• Australasian Council for the Teaching of Swimming and Water Safety (AUSTSWIM)
• Australian Leisure Facilities Association (ALFA)
• Australian National Sports Fishing Association (ANSFA)
• Australian and New Zealand Safe Boating Education Group (ANZSBEG)
• Australian Swimming Coaches and Teachers Association (ASCTA)
• Australasian Diving Safety Foundation (ADSF)
• Farmsafe Australia
• Surfing Australia
• Swimming Australia
• The Child Accident Prevention Foundation of Australia (Kidsafe)
• Government Observers: Department of Health and Bureau of Meteorology

The AWSC is committed to improving water safety in Australia as demonstrated through the production and implementation of four National Water Safety Plans. The first plan was released in 1998, the current plan was released in March 2021. These plans have generated bipartisan support for water safety in Australia and have seen the improvement of water safety throughout the country.

The Australian Water Safety Strategy 2030: Towards a Nation Free From Drowning (2021) identifies five priority areas which are key to reducing drowning by 50% by 2030. The priority areas are: People; Places; Activities; Risk factors; and, Populations. It then identifies three areas of focus in each priority area based on research and consultation, fifteen in total. Supported by guiding principles and enablers, continued focus on these priorities will help to achieve the strategy's goal of reducing drowning and building water safe communities.

Key Findings - Australian Water Safety Strategy 2030

• For every fatal drowning there are three non-fatal drowning incidents
• Males drown at a rate 4 times that of females
• One-year-old toddlers record the highest drowning rate of any age
• Rivers and lakes account for 36% of drowning deaths
• Coastal environments (beaches, ocean and rocks) account for 41% of drowning deaths
• 23% of drowning deaths occur while swimming and recreating
• 61% of drowning deaths occur outside of major cities
• Fatal drowning rate has reduced by 26% over the last ten years
• Child (0-4 years) fatal drowning rate has reduced by 50% over the last ten years

To stay safe around water, the Australian Water Safety Council urges all Australians to:

• Supervise children at all times in, on and around water
• Learn Swimming, water safety and lifesaving skills
• Wear a lifejacket when boating, rock fishing or paddling
• Swim at a patrolled beach between the red and yellow flags
• Avoid alcohol and drugs around water

Royal Life Saving Australia is a not-for-profit organisation dedicated to the prevention of drowning and advocacy for water safety; including education, training, risk management, leadership, and research.

The organisation provides a range of key resources, research, guidelines, campaigns and programs on their website with a strong focus on best practice and staying safe and active in the water.

The National Swimming and Water Safety Framework (2019) aims to enable individuals to develop the skills, knowledge, understanding, attitudes and behaviours required to lead safe and active lives in, on and around a range of aquatic environments. The following six key principles underpin the Framework:

1. Everyone should have the opportunity to a swimming and water safety education.
2. Entry and progression may occur at different stages and rates through the Framework.
3. The Framework is adaptable to support achievement.
4. Structured programs are essential; however, aquatic play and recreation are also important.
5. Learning should transition skills and knowledge to a range of aquatic environments and water-based activities.
6. The language of the Framework aims to be accessible to all facilitators, educators and parents.

Since 1995, Royal Life Saving has produced an annual National Drowning Report. This report looks at the factors that contribute to drowning deaths in Australia by examining who, where, when and how people have drowned over the last year.

National Drowning Report 2021

The current report states that 294 people drowned in Australian waterways during the 2020-21 financial year. This figure represents a 20% increase on the previous year, and an 8% increase on the 10 year average. Two key trends emerged - spikes in drowning deaths immediately following large-scale lockdowns; and more Australians holidaying domestically and swimming in unfamiliar (and often unpatrolled) locations. Some other key findings in the report include:

• 80% of drowning deaths were male (a continuing trend).
• The 25-34 year-old age group recorded the largest number of drowning deaths.
• 25 drowning deaths occurred among children aged 0-4 years; a 108% increase on last year and a 9% increase on the 10-year average.
• Rivers and creeks were the leading location for drowning (26%), followed by beaches (22%), and ocean/harbour locations (15%).
• 75 drowning deaths in rivers and creeks; a 53% increase on last year and a 3% increase on the 10-year average.

Access to previous reports is also available on the RLSSA website.

Non-fatal drowning describes a drowning incident where the individual survives.

In some cases an individual may not suffer any serious health complications following a non-fatal drowning. In other cases, non-fatal drowning can significantly impact an individual’s long-term health and quality of life. This may result in brain or other organ damage, the effects of which might be mild to severe. This is also known as hypoxic brain injury (brain damage due to lack of oxygen).

Children aged 0 to 4 years are at the highest risk of non-fatal drowning. The largest number of non-fatal drowning incidents are recorded in swimming pools, especially among young children. Teenagers and adults are more likely to get into difficulty in natural bodies of water such as in rivers, lakes, and at beaches.

Royal Life Saving is committed to strengthening non-fatal data collection to investigate the long-term health, social and economic impacts. This will help to pinpoint specific trends to support the development of targeted drowning prevention campaigns.

Research and resources relating to non-fatal drowning:

• Non-Fatal Drowning in Australia, Part 1: Non-fatal drowning trends over time, Mahony, A, Pidgeon, S., Royal Life Saving Society – Australia, (2021). This study examines hospitalisations in Australia over a 15-year period, revealing trends in sex, age, location, remoteness classification and activity. Some key findings include:
  • 3 non-fatal drowning incidents occur for every 1 fatal drowning.
  • The incidence of non-fatal drowning is rising, with hospitalisations increasing by 50% between 2002/03 and 2016/17. By comparison, fatal drowning has decreased over this time.
  • 8 non-fatal drowning incidents occur for every 1 fatal drowning among children aged 0-4 years.
  • 42% of non-fatal drowning incidents involve children aged 0-4 years. Adults aged 55 years and over accounted for the smallest proportion of incidents (11%)
  • Over the 15 years of the study, males accounted for 66% of all non-fatal drowning cases.
  • Swimming pools were the leading location for non-fatal drowning (35%), followed by natural water (26%). The location of non-fatal drowning was classified as ‘other or unspecified’ in 32% of cases.
  • Almost two thirds of non-fatal drowning incidents occurred in major cities (65%). Information on remoteness was not available in 5% of cases
• Non-Fatal Drowning in Australia, Part 2: Impact of non-fatal drowning, Mahony, A, Pidgeon, S., Royal Life Saving Society – Australia, (2021). In addition to hospitalisation figures in Australia over a 15-year period, this study examines the mean length of hospital stay, number of patient days, time in an Intensive Care Unit (ICU) and the number of hours of Continuous Ventilatory Support (CVS) received over a 4- or 5-year period.
• A 13-year national study of non-fatal drowning in Australia: Data challenges, hidden impacts and social costs, Royal Life Saving Society Australia, (2017)
• Reducing the burden of non-fatal drowning: Symposium Declaration, Australian Water Safety Council, (2017)
• Understanding the Full Burden of Drowning: A Retrospective, Cross-Sectional Analysis of Fatal and Non-Fatal Drowning in Australia, Amy Peden, Alison Mahony, Paul Barnsley, et.al., BMJ Open, Volume 8(11), (2018).
• Keep Watch Campaign, Royal Life Saving Australia, (accessed 27 January 2022). When implemented together, these Keep Watch drowning prevention actions help to maximise child safety around water: Supervise; Restrict; Teach; Respond.
• Samuel Morris Foundation (established in March 2007) is Australia’s first charity providing support services to children disabled by non-fatal drowning (or other hypoxic brain injuries), supporting their families, and preventing future drowning deaths and disabilities through drowning prevention education and awareness.

Surf Life Saving Australia (SLSA) is Australia’s peak coastal water safety, drowning prevention and rescue authority. SLSA exists to save lives, and they are committed to reducing the coastal drowning rate by 2025.

BeachSafe. SLSA maintains a web and mobile app based information service as part of their commitment to education and safety in the aquatic environment. The website provides current information and conditions for the beach you would like to visit, hazards you might find, and services available to assist in your beach choice. There’s also safety advice and information about flags, signs, rips, waves and more.

The National Coastal Safety Report provides a detailed analysis of annual and long-term coastal drowning deaths. As the nation’s peak coastal water safety, drowning prevention and rescue authority, SLSA undertakes research to understand what, where and when these coastal drowning deaths occur.

National Coastal Safety Report 2021

In 2020-21, there were 136 coastal drowning deaths, 48% on beaches, 22% offshore and 16% at rock/cliff locations. This was above the past 17 year average of 114 drowning deaths a year. 90% of people who drowned were male. There were a further 105 fatal coastal incidents (from non-drowning causes) recorded.

A key report released by SLSA documents the contribution of surf life saving to community safety and wellbeing.

Between the red and yellow flags: The social and economical value of Surf Life Saving Australia, Deloitte Access Economics, (August 2020). Through its coastal safety, lifesaving, education, sport and recreation programs and services, SLSA generates significant social and economic benefits for the Australian community each year. In generating these benefits, the organisation receives a significant proportion of its funding from external sources. These include government grants, fundraising, corporate sponsorships and community donations. To promote understanding about the outcomes achieved with the support of these funding sources, SLSA has periodically undertaken and commissioned work to estimate the contribution, or value, generated by its activities for the Australian community.

• The total net benefit of SLSA to the Australian community is AU$97 billion over 15 years.
• For every AU$1 invested into SLSA, a return of AU$20.20 is achieved for the Australian community.

SLSA also serves as the National Sporting Organisation for surf sports as competitive and recreational activities.

In 2015-16 SLSA undertook a national review and consultation process to understand how sport and recreation programs and products can be better leveraged to increase the effectiveness of our surf lifesavers to deliver on the Surf Life Saving (SLS) core purpose to save lives, create great Australians and build better communities. As a result of the review, four key components were recommended to enable both sport and recreational participants to flourish as members of SLS, and therefore strengthen the physical competence of surf life savers around Australia:

• Reset surf sports as the competitive edge of SLS as being a sporting community that raises the
  SLSA profile, inspires young athletes to achieve, and is supported by the broader SLS community as a pinnacle of surf based athleticism.
• Launch recreational memberships to attract less competitive ‘coastal lifestylers’ and families, with supporting professional programs for primary and secondary schools and for fitness programs of all communities and ages, and a range of potential coastline activities.
• Re-package, re-energise and present surf sport and recreation to members and the public with user driven and engaging modern digital media and information technology platforms.
• Develop and reinforce the SLSA culture as one that celebrates the diverse capacities, ambitions and skills that make for strong surf communities and safe beaches.

Several reports are available from the process:

• Sport Review Summary, (July 2016).
• A Sport and Recreation Game Plan for Surf Life Saving Australia: Executive summary, (February 2016).
• A Review of Sport and Recreation in Surf Life Saving Project Update - Summary (November 2015).

Data and trends relating to the prevalence and burden of fatal and non-fatal drowning.

• Injury in Australia: drowning and submersion, Australian Institute of Health and Welfare (AIHW), (last updated 9 December 2021). This report summarises key data on unintentional (accidental) drowning and submersion hospitalised injuries and deaths.
  • In 2018–19, drowning and submersion accidents resulted in 625 hospitalisation cases (2.5 per 100,000 population); 255 deaths (1 per 100,000 population).
  • 63% of hospitalisations were for males; and 81% of deaths.
  • Children aged 0–4 had the highest rate of hospitalisation, compared with other life-stage age groups.
  • The age-standardised rates of hospitalisations were 3.2 cases per 100,000 males and 1.9 per 100,000 females.
  • The age-standardised rates of drowning deaths were 1.6 per 100,000 males and 0.4 per 100,000 females.
• National Drowning Report 2021, Royal Life Saving Australia, (September 2021). The current report states that 294 people drowned in Australian waterways during the 2020-21 financial year. This figure represents a 20% increase on the previous year, and an 8% increase on the 10 year average. Some key findings in this year's report:
  • 294 drowning deaths in Australia in 2020/21; this is a 20% increase on last year (245 deaths) and an 8% increase on the 10-year average (273 deaths)
  • 80% of drowning deaths were males
  • 25 drowning deaths among children aged 0-4 years; this is a 108% increase on last year and a 9% increase on the 10-year average
  • People aged 25-34 years accounted for 17% of all drowning deaths, the most of any age group
  • Rivers and creeks were the leading location for drowning (26%), followed by beaches (22%) and ocean/harbour locations (15%)
  • 75 drowning deaths in rivers and creeks; this is a 53% increase on last year and a 3% increase on the 10-year average
  • Swimming and recreating was the leading activity prior to drowning (25%), followed by boating (15%) and falls into water (14%)
• National Coastal Safety Report 2021, Surf Life Saving Australia, (September 2021). In 2020-21, there were 136 coastal drowning deaths. This was above the past 17-year average of 114 (19% increase) drowning deaths a year and 10-year average of 120 (13% increase). Some key findings in this year's report:
  • 241 deaths across Australia’s coastline
  • Males represent 90% of coastal drowning deaths recorded for 2020/21
  • 31% of all coastal drowning deaths were aged 20-34 years of age.
  • 25-34yo and 65-69yo men were the most at risk demographic
  • 51% of drowning deaths occurred more than 5km from a surf lifesaving service, a 6% increase from the 17-year average
  • Coastal drowning deaths due to attempting to rescue someone in distress (bystander rescues) increased this year by 150% from the 17-year average, with a clear association with rip currents at unpatrolled locations
  • During the past 12 months, Surf Life Saving services conducted more 8,000 rescues, treated over 53,000 people for first aid and performed 1.75 million preventative actions
• Analysis of fatal unintentional drowning in Australia 2008–2020: implications for the Australian Water Safety Strategy, Amy Peden, Justin-Paul Scarr, Alison Mahony, Australian and New Zealand Journal of Public Health, Volume 45(3), pp.248-254, (June 2021). A national analysis of unintentional fatal drowning rates per 100,000 population over 16 years (2004/05–2019/20) was conducted. Baseline rates (three-year average 2004/05–2006/07) were compared to the current three-year average (2017/18–2019/20) by sex, age group, drowning location and jurisdiction. The overall rate of unintentional fatal drowning during the period decreased by 28%. Substantial reductions were observed in children 0–4 years (−63%) and 5–14 years (−56%). Progress has been less pronounced among people aged 75 years and over (−11%) and 15–24-year-olds (−14%). All locations and jurisdictions recorded reductions, aside from rocks (+46%). Although the strategy fell short of its aspirational target of a 50% reduction in drowning by the year 2020, this target was exceeded in key age groups, including children.
• Epidemiology of unintentional fatal drowning among migrants in Australia, Stacey Willcox-Pidgeon, Richard Franklin, Peter Leggat, et.al., Australian and New Zealand Journal of Public Health, Volume 45(3), pp.255-262, (June 2021). This study aimed to describe the epidemiology and risk factors contributing to drowning among migrants in Australia. There were 572 migrant deaths over the study period, 28.9% of total drowning deaths, 82.9% were male. Twenty-one per cent were aged 25–34 years and 40.8% had lived in Australia for 20+ years. Migrants at highest risk of drowning were from: South Korea (2.63/100,000), Taiwan (2.29/100,000), and Nepal (2.15/100,000). Migrants were more likely to drown when around rocks compared with Australian-born people, who most frequently drowned in rivers. Migrants are not over-represented in drowning statistics. However, unique trends were found for drowning among migrants based on country of birth and length of time in Australia.
• Non-Fatal Drowning in Australia, Part 1: Non-fatal drowning trends over time, Mahony, A, Pidgeon, S., Royal Life Saving Society – Australia, (2021). This study examines hospitalisations in Australia over a 15-year period, revealing trends in sex, age, location, remoteness classification and activity. Some key findings include:
  • 3 non-fatal drowning incidents occur for every 1 fatal drowning.
  • The incidence of non-fatal drowning is rising, with hospitalisations increasing by 50% between 2002/03 and 2016/17. By comparison, fatal drowning has decreased over this time.
  • 8 non-fatal drowning incidents occur for every 1 fatal drowning among children aged 0-4 years.
  • 42% of non-fatal drowning incidents involve children aged 0-4 years. Adults aged 55 years and over accounted for the smallest proportion of incidents (11%)
  • Over the 15 years of the study, males accounted for 66% of all non-fatal drowning cases.
  • Swimming pools were the leading location for non-fatal drowning (35%), followed by natural water (26%). The location of non-fatal drowning was classified as ‘other or unspecified’ in 32% of cases.
  • Almost two thirds of non-fatal drowning incidents occurred in major cities (65%). Information on remoteness was not available in 5% of cases
• National Coastal Safety Report 2020, Surf Life Saving Australia, (September 2020). In 2019-20, there were 125 coastal drowning deaths, which included 45 on beaches, 41 offshore and 26 at rock/cliff locations. This was above the past 16 year average of 112 drowning deaths a year. 86% of people who drowned were male. There were an further 110 other fatal coastal incidents were recorded.
• Drowning deaths among Aboriginal and Torres Strait Islander peoples: A 10-year analysis 2008/09 to 2017/18, Royal Life Saving Australia, (2020). Aboriginal and Torres Strait Islander people are considered to be at higher risk of drowning. This report presents an analysis of fatal drowning among Aboriginal and Torres Strait Islander people across Australia between 1st July 2008 and 30th June 2018. During this time, 152 people lost their lives to drowning.
• Exploring the burden of fatal drowning and data characteristics in three high income countries: Australia, Canada and New Zealand, Amy E. Peden, Richard C. Franklin, Tessa Clemens, BMC Public Health, Volume 19, article 794, (June 2019). There were 8176 drowning deaths (Australia 34.1%, Canada 55.9%, New Zealand 9.9%). All countries achieved reductions in crude drowning rates (Australia − 10.2%, Canada − 20.4%, New Zealand − 24.7%). Location and activity prior to drowning differed significantly across the three countries. Beaches and ocean/harbour locations were common in Australia and New Zealand, while lakes/ponds and bathtubs were common drowning locations in Canada. Boating prior to drowning was common in Canada. This study highlights the need for universally agreed and consistently applied categories and definitions to allow for global comparisons and proposes a core minimum dataset.
• Unintentional fatal child drowning in the bath: A 12-year Australian review (2002–2014), Amy E Peden, Richard C Franklin, John H Pearn, Journal of Paediatrics and Child Health, Volume 54(3), pp.153-159, (February 2018). We report a total population study of all childhood (0–17 years) unintentional drowning fatalities in baths (bathtubs, spa baths and showers) in Australia between 1 July 2002 and 30 June 2014. Demographic, forensic and aetiological data (including co-bathing, use of bath aids, supervision and enactment of cardiopulmonary resuscitation) were documented for each victim. On average, 6.5 children drown every year in baths in Australia. Children aged younger than 1 year are most affected, with both genders equally represented. Infants and toddlers left unsupervised, false confidence in the preventive role of bath aids, unrealistic expectations in the supervisory capabilities of co-bathing children and epilepsy remain threats to children in the bath.
• The Hidden Tragedy of Rivers: A Decade of Unintentional Fatal Drowning in Australia, Amy E. Peden, Richard C. Franklin, Peter A. Leggat, PLOS One, (August 2016). This study is a cross-sectional, total population audit of all unintentional fatal drownings in Australian rivers between 1-July-2002 and 30-June-2012 using Australian coronial data. Rivers (n = 770; 26.6%) were the leading location among the 2,892 people who died from unintentional fatal drowning. Within river drowning deaths common groups include; males (80.4%), adults (85.3%), adults who have consumed alcohol (25.5%), people who fell in (21.3%), people involved in non-aquatic transport incidents (18.2%) and locals (74.0%). Children were 1.75 times more likely than adults to drown in rivers as a result of a fall and adults 1.50 times more likely to drown in rivers as a result of watercraft incidents when compared to children. When compared to males, females were 2.27 and 4.45 times respectively more likely to drown in rivers as a result of incidents involving non-aquatic transport and being swept away by floodwaters. Males were 2.66 and 4.27 times respectively more likely to drown in rivers as a result of watercraft incidents and as a result of jumping in when compared to females.
• International travelers and unintentional fatal drowning in Australia—a 10 year review 2002–12, Amy Peden, Richard Franklin, Peter Leggat, Journal of Travel Medicine, Volume 23(2), (March 2016). Between 1 July 2002 and 30 June 2012 drowning deaths among people known to be international travelers accounted for 4.3% (N = 123) of the 2870 drowning deaths reported in Australian waterways. Key locations for drowning deaths included beaches (39.0%), ocean/harbour (22.0%) and swimming pools (12.2%). Leading activities prior to drowning included swimming (52.0%), diving (17.9%) and watercraft incidents (13.0%).
• Drowning in Aboriginal and Torres Strait Islander children and adolescents in Queensland (Australia), Belinda Wallis, Kerrianne Watt, Richard Franklin, et.al., BMC Public Health, Volume 15, Article number: 795, (2015). This study identifies the previously unpublished incidence and characteristics of fatal and non-fatal drowning in Indigenous children and adolescents. There were 87 (6.7 % of all events) fatal and non-fatal (combined) Indigenous drowning events yielding a crude Incidence Rate of 16.8/100,000/annum. This is 44 % higher than the incidence rate for Non-Indigenous children. For every fatality, nine others were rescued and sought medical treatment (average 12 per year). The apparent over-representation of Indigenous adolescent females should be weighed against the absence of drowning among Indigenous male adolescents in the same age group in consecutive years of the study. Further investigation around behaviour and culture may highlight protective factors.
• Drowning Mortality and Morbidity Rates in Children and Adolescents 0-19yrs: A Population-Based Study in Queensland, Australia, Belinda Wallis, Kerrianne Watt, Richard Franklin, et.al., PLOS One, (February 2015). Retrospective population-based study used data linkage to capture both fatal and non-fatal drowning cases (N = 1299) among children aged 0-19years in Queensland, from 2002-2008 inclusive. Patient data were accessed from pre-hospital, emergency department, hospital admission and death data, and linked manually to collate data across the continuum of care. Drowning death to survival ratio was 1:10, and two out of three of those who survived were admitted to hospital. Incidence rates for fatal and non-fatal drowning increased over time, primarily due to an increase in non-fatal drowning. There were non-significant reductions in fatal and admission rates. Rates for non-fatal drowning that did not result in hospitalisation more than doubled over the seven years. Children aged 5-9yrs and 10-14yrs incurred the lowest incidence rates 6.38 and 4.62 (expressed as per 100,000), and the highest rates were among children aged 0-4yrs (all drowning events 43.90; fatal 4.04; non-fatal 39.85–comprising admission 26.69 and non-admission 13.16). Males were over-represented in all age groups except 10-14yrs. Total male drowning events increased 44% over the seven years. This state-wide data collection has revealed previously unknown incidence and survival ratios. Increased trends in drowning survival rates may be viewed as both positive and challenging for drowning prevention and the health system. Males are over-represented, and although infants and toddlers did not have increased fatality rates, they had the greatest drowning burden demonstrating the need for continued drowning prevention efforts.
• Drowning deaths in Australian rivers, creeks and streams: A 10 year analysis, Peden, A and Queiroga, AC, Royal Life Saving Society Australia, (2014). This report details the number of drowning deaths in Australian rivers, creeks and streams across the last 10 financial years and the circumstances around those deaths.
  • Between 1 July 2002 and 30 June 2012, a total of 2,965 people died as a result of drowning in Australian waterways. Of these 735 people drowned in rivers, creeks and streams, accounting for 25% of all drowning deaths experienced in Australian waterways across this ten year period.
  • Males accounted for 80% of all river drowning deaths across the period of this study. The male burden in river drowning deaths was most prominent in the 25-34 years age group where males accounted for 92% of all drowning deaths experienced in people in that age group.
  • Almost three quarters (74%) of people who drowned in rivers, did so within 100kms of their home postcode. This provides strength to the argument that public awareness and drowning prevention strategies should be targeted at the local community level to ensure greatest efficacy.
  • Analysis of the data showed that 17% of all river drowning deaths were known to be related to flooding.
  • Indigenous people drowned at a rate of 1.58 per 100,000 population in rivers, a rate that is 4.4 times that of the general population.
  • Alcohol was known to be involved in 37% of all river drowning deaths. There were a further 252 cases (representing 35% of all river drowning deaths) where information on the involvement of alcohol was not available. This suggests the involvement of alcohol in river drowning deaths could be larger than currently known.
  • This report makes a number of recommendations aimed at expanding our knowledge of river recreational patterns and to reduce drowning deaths in Australian rivers. These include enhanced understanding of the risks of floodwaters, increased awareness and enforcement of legislative requirements regarding use of watercraft whilst under the influence of alcohol in rivers and improving CPR and first aid skills in Remote and Very Remote areas.

Some population groups, activities, and locations have higher risks for drowning.

• Exploring a Hidden Epidemic: Drowning Among Adults Aged 65 Years and Older, Tessa Clemens, Amy Peden, Richard Franklin, Journal of Aging and Health, Volume 33(10), pp.828-837, (December 2021). Total population retrospective analysis of unintentional fatal drowning among people aged 65 years and older in Australia, Canada and New Zealand (2005–2014) was conducted. 1459 older adults died. Rates ranged from 1.69 (Canada) to 2.20 (New Zealand) per 100,000. Trends in crude drowning rates were variable from year to year. A downward trend was observed in New Zealand (y = −.507ln(x) + 2.9918), with upward trends in Australia (y = .1056ln(x) + 1.5948) and Canada (y = .1489ln(x) + 1.4571). Population projections suggest high annual drowning deaths by 2050 in Australia (range: 120–190; 1.69–2.76/100,000) and Canada (range: 209–430; 1.78–3.66/100,000). Significant locations and activities associated with older adult drowning differed by country and age band. The authors conclude that drowning among older adults is a hidden epidemic claiming increasing lives as the population ages. Targeted drowning prevention strategies are urgently needed in Australia, Canada, New Zealand and other similar countries.
• “I never had a thought about drowning”. Exploring water safety attitudes and practices among older adults in Western Australia, Meg Abercromby, Gemma Crawford, Lauren Nimmo, et.al., Health Promotion Journal of Australia, (19 July 2021). This paper was concerned with illuminating older adults experience and perspectives of water safety and drowning prevention. The study used in-depth, semi-structured interviews (n = 15) to examine knowledge, attitudes, beliefs and behaviours. This study provides insights into perceptions and experiences of water safety as individuals’ age. The findings suggest individuals who perceived themselves as strong swimmers had a decreased perception of risk, while participants who self-identified as weak swimmers were more likely to avoid risks and modified their behaviour accordingly. Findings highlighted low water safety literacy and suggest that older people not only underestimate their drowning risk, but also lack an understanding of the risk factors for drowning. The findings from this study will have a direct impact on the development of a WA health promotion program to prevent drowning among older adults.
• A scoping review of female drowning: an underexplored issue in five high-income countries, Kym Roberts, Ogilvie Thom, Susan Devine, et.al., BMC Public Health, Volume 21, article 1072, (June 2021). The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water.
• Epidemiology of unintentional fatal drowning among migrants in Australia, Stacey Willcox-Pidgeon, Richard Franklin, Peter Leggat, et.al., Australian and New Zealand Journal of Public Health, Volume 45(3), pp.255-262, (June 2021). This study aimed to describe the epidemiology and risk factors contributing to drowning among migrants in Australia. There were 572 migrant deaths over the study period, 28.9% of total drowning deaths, 82.9% were male. Twenty-one per cent were aged 25–34 years and 40.8% had lived in Australia for 20+ years. Migrants at highest risk of drowning were from: South Korea (2.63/100,000), Taiwan (2.29/100,000), and Nepal (2.15/100,000). Migrants were more likely to drown when around rocks compared with Australian-born people, who most frequently drowned in rivers. Migrants are not over-represented in drowning statistics. However, unique trends were found for drowning among migrants based on country of birth and length of time in Australia. Holistic drowning prevention strategies and policies are required to effectively lower drowning risk among migrant communities.
• Coastal drowning: A scoping review of burden, risk factors, and prevention strategies, William Koon, Amy Peden, Jasmin Lawes, PLOS One, (1 February 2021). Of the 146 included studies, the majority (76.7%) were from high income countries, 87 (59.6%) reported coastal drowning deaths, 61 (41.8%) reported risk factors, and 88 (60.3%) reported prevention strategies. Populations, data sources and coastal water site terminology in the studies varied widely; as did reported risk factors, which most frequently related to demographics such as gender and age. Prevention strategies were commonly based on survey data or expert opinion and primarily focused on education, lifeguards and signage. Few studies (n = 10) evaluated coastal drowning prevention strategies.
• Fatal drowning among tourists and recently arrived individuals from overseas at South Australian Metropolitan beaches, Lilli Stephenson, Roger Byard, Corinna van den Heuvel, et.al., Australian Journal of Forensic Science, Volume 53(5), pp.535-542, (2021). As 17% of all drownings occur at beaches, a study of unintentional fatal drownings at South Australian (SA) metropolitan beaches was undertaken, specifically evaluating the risk for individuals born overseas. All cases of fatal unintentional drowning between July 2002-June2018 at SA beaches were sourced from the Royal Life Saving National Fatal Drowning Database. Demographics and causal factors were analysed for all SA drownings and specifically for those at metropolitan beaches amongst those known to be born overseas. Fifty-seven drowning deaths at SA beaches were identified. Of the 54% (n=31) of beach drownings which occurred at metropolitan beaches, 36% (n=11) of decedents were overseas-born. Risks were highest for individuals from Burundi and lowest for those from the United Kingdom. Drowning deaths at SA metropolitan beaches among overseas-born most commonly involved children who were swimming or merely playing at the water’s edge, in summer and during afternoons. Preventive efforts aimed at reducing beach drowning among at-risk groups should also include culturally-appropriate campaigns.
• Next steps for drowning prevention in rural and remote Australia: A systematic review of the literature, Danielle H. Taylor, Amy E. Peden, Richard C. Franklin, Australian Journal of Rural Health, Volume 28(5), pp.530-542, (December 2020). Thirty-two studies satisfied inclusion criteria (66% reporting epidemiology; 59% risk factors; and 44% prevention strategies). All (100%) included studies were assessed very low against Grading of Recommendations Assessment, Development and Evaluation. Findings indicate rural populations (ie, excluding major cities) have higher rates of drowning positively correlated with increasing remoteness. Common factors included age (child), natural water bodies, undertaking boating and watercraft activities and alcohol consumption. While a range of prevention strategies has been proposed, only one study outlined a rural drowning prevention strategy which had been implemented and evaluated. Strategies were generally low on the hierarchy of control.
• Causes of distraction leading to supervision lapses in cases of fatal drowning of children 0–4 years in Australia: A 15-year review, Amy Peden, Richard Franklin, Journal of Paediatrics and Child Health, Volume 56(3), pp.450-456, (March 2020). This study has identified common scenarios for distractions leading to supervision lapses including the link between indoor household duties and bathtub drowning deaths and talking/socialising for deaths in swimming pools and at rivers. Challenges include medical issues impacting sole carers. The 7% of cases where a supervision lapse occurred due to miscommunication are opportunities to further reinforce the need for a designated supervisor, particularly with two or more adults present. Study findings on distraction causes, and strategies to minimise them, should be incorporated into national public awareness campaigns aimed at parents and care givers of this at-risk group.
• Identifying a gap in drowning prevention: high-risk populations, Stacey Willcox-Pidgeon, Richard Charles Franklin, Peter Leggat, et.al., Injury Prevention, Volume 26(3), pp.279-288, (2020). Some populations have been less susceptible to reductions in drowning than others. It has been hypothesised that this is due to prevention strategies failing to account for the influence of social determinants (such as ethnicity, socioeconomic status). Populations such as ethnic minorities have been over-represented in injury statistics, however this is not well explored in drowning. This study aims to identify high-risk populations for drowning, risk factors and prevention strategies. In total, 35 articles were included. High-risk populations identified were: ethnic minorities, First Nations/Aboriginal people, migrants and rural residents. Over half (51%) focused on children (0–18 years). Risk factors included social determinants, swimming ability and knowledge, attitudes and behaviour.
• Drowning deaths among Aboriginal and Torres Strait Islander peoples: A 10-year analysis 2008/09 to 2017/18, Royal Life Saving Australia, (2020). Aboriginal and Torres Strait Islander people are considered to be at higher risk of drowning. This report presents an analysis of fatal drowning among Aboriginal and Torres Strait Islander people across Australia between 1st July 2008 and 30th June 2018. During this time, 152 people lost their lives to drowning.
• Identifying Risk Factors Associated with Fatal Drowning Accidents in the Paediatric Population: A Review of International Evidence, Martin Davey, Sean Callinan, Leona Nertney, Cureus, Volume 11(11), (November 2019). Evidence suggests that boys are at highest risk of drowning (1-4 yrs in swimming pools; adolescents in freshwater) with inadequate surveillance, inadequate availability of first responders, certain clinical diagnoses (developmental delay and seizure disorders), lack of swimming ability, and substance misuse in adolescents all posing an increased risk. Formal swimming education in those aged 4+ years, training of supervising adults in safe rescue, installation of isolation barriers, enforcing water safety guidelines, and regulations are all recommended by International Advisory Groups for prevention of drowning.
• Behavioural Water Safety and Autism: a Systematic Review of Interventions, Catriona Martin and Karola Dillenburger, Review Journal of Autism and Developmental Disorders, Volume 6, pp.356–366, (2019). People with autism are approximately twice as likely to die from drowning than members of the general population. Drowning can take place in quite small bodies of water. Therefore, acquiring good water safety skills is of the utmost importance. A systematic review of research into effective behavioural interventions for water safety and swim skills was conducted. In total, 11 studies were identified. Findings suggest that behaviourally based interventions can improve a range of water safety and swim skills in individuals with autism.
• Epidemiology, risk factors and strategies for the prevention of global unintentional fatal drowning in people aged 50 years and older: a systematic review, Amy E Peden, Richard C Franklin, Ana Catarina Queiroga, Injury Prevention, Volume 24, pp.240-247, (2018). Drowning is a global public health issue and prevention poses an ongoing challenge for all countries. Many nations are experiencing ageing populations, and little is known about the epidemiology, risk factors and prevention of drowning deaths among older people. This paper reports on a systematic review of literature published on drowning among older people. Thirty-eight papers were deemed relevant to the study design, including 18 (47%) on epidemiology, 19 (50%) on risk factors and 9 (24%) on strategies for prevention. Risk factors identified included male gender, ethnicity, rurality and increasing age. Prevention strategies commonly proposed were education and wearing life jackets. Gaps identified in the published literature include a lack of consistency around age groupings used for epidemiological studies; a lack of consensus on risk factors; a lack of total population, country-level analysis; and the need for older age-specific prevention strategies that have been implemented and their effectiveness evaluated. This review identified drowning deaths among older people as a global issue. Further work is required to reduce drowning in this cohort. High-quality epidemiological studies identifying risk factors using standardised age groupings to allow for international comparisons are required, as are implementation and evaluation of older age-specific prevention strategies.
• Causal pathways of flood related river drowning deaths in Australia, Peden, Amy, Franklin, Richard, Leggat, Peter, et.al., PLoS Currents Disasters, pp.1-24, (2017). There were 129 (16.8%) deaths involving river flooding, representing a crude drowning rate of 0.06 per 100,000 people per annum. Half (55.8%) were due to slow onset flooding, 27.1% flash flooding and the type of flooding was unknown in 17.1% of cases. Those at an increased risk were males, children, driving (non-aquatic transport) and victims who were swept away (p<0.01). When compared to drownings in major cities, people in remote and very remote locations were 79.6 and 229.1 times respectively more likely to drown in river floods. Common causal factors for falls into flooded rivers included being alone and a blood alcohol content ≥0.05% (for adults). Non-aquatic transport incident victims were commonly the drivers of four wheel drive vehicles and were alone in the car, whilst attempting to reach their own home or a friend’s. Flood related river drownings are preventable. Strategies for prevention must target causal factors such as being alone, influence of alcohol, type/size of vehicle, and intended destination. Strategies to be explored and evaluated include effective signage, early warning systems, alternate routes and public awareness for drivers.
• Alcohol and its contributory role in fatal drowning in Australian rivers, 2002–2012, Amy Peden, Richard Franklin, Peter Leggat, Accident Analysis and Prevention, Volume 98, pp.259-265, (January 2017). Cases of unintentional fatal river drowning in Australia, 1-July-2002 to 30-June-2012, were extracted from the National Coronial Information System. Alcohol was known to be involved in 314 cases (40.8%), 279 recorded a positive BAC, 196 (70.3%) recorded a BAC of ≥0.05%. 40.3% of adult victims had a BAC of ≥0.20%. Known alcohol involvement was found to be more likely for victims who drowned as a result of jumping in (χ2 = 7.8; p < 0.01), identify as Aboriginal and Torres Strait Islander (χ2 = 8.9; p < 0.01) and drowned in the evening (χ2 = 7.8; p < 0.01) and early morning (χ2 = 16.1; p < 0.01) hours.
• The Hidden Tragedy of Rivers: A Decade of Unintentional Fatal Drowning in Australia, Amy Peden, Richard Franklin, Peter Leggat, PLOS One, (August 2016). This study is a cross-sectional, total population audit of all unintentional fatal drownings in Australian rivers between 1-July-2002 and 30-June-2012 using Australian coronial data. Rivers (n = 770; 26.6%) were the leading location among the 2,892 people who died from unintentional fatal drowning. Within river drowning deaths common groups include; males (80.4%), adults (85.3%), adults who have consumed alcohol (25.5%), people who fell in (21.3%), people involved in non-aquatic transport incidents (18.2%) and locals (74.0%). Children were 1.75 times more likely than adults to drown in rivers as a result of a fall and adults 1.50 times more likely to drown in rivers as a result of watercraft incidents when compared to children. When compared to males, females were 2.27 and 4.45 times respectively more likely to drown in rivers as a result of incidents involving non-aquatic transport and being swept away by floodwaters. Males were 2.66 and 4.27 times respectively more likely to drown in rivers as a result of watercraft incidents and as a result of jumping in when compared to females.
• International travelers and unintentional fatal drowning in Australia—a 10 year review 2002–12, Amy Peden, Richard Franklin, Peter Leggat, Journal of Travel Medicine, Volume 23(2), (March 2016). International travellers pose a unique challenge from a drowning prevention perspective. The ability to exchange information on water safety is complicated due to potential language barriers, possible differences in swimming ability, different attitudes to safety in the traveler’s home country and culture, a lack of opportunities to discuss safety, a relaxed attitude to safety which may result in an increase in risk taking behaviour and alcohol consumption.
• Interacting Factors Associated with Adult Male Drowning in New Zealand, James Croft, Chris Button, PLOS One, (June 2015). Numerous interacting factors are responsible for male drownings. In New Zealand, drowning locations and activities differ by age and ethnicity which require targeted intervention strategies. Alcohol was involved in a high proportion of Accidental Immersion drownings (61%) and was highest for males aged 20-24 years. When alcohol was involved there were proportionally more incidences where a life jacket was Available But Not Worn and less incidences where a life jacket was Worn. Many 30-39 year old males drowned during underwater activities (e.g., snorkeling, diving). Older men (aged +55 years old) had a high incidence of drowning while boating. Different ethnicities were over-represented in different age groups (Asian men aged 25-29, and European men aged 65-74) and when involved in different activities.
• Drowning in Aboriginal and Torres Strait Islander children and adolescents in Queensland (Australia), Belinda Wallis, Kerrianne Watt, Richard Franklin, et.al., BMC Public Health, Volume 15, Article number: 795, (2015). Aboriginal and Torres Strait Islander (Indigenous) children are at greater risk of drowning than other children, however little is known about drowning of Indigenous children. This study identifies the previously unpublished incidence and characteristics of fatal and non-fatal drowning in Indigenous children and adolescents. There were 87 (6.7 % of all events) fatal and non-fatal (combined) Indigenous drowning events yielding a crude Incidence Rate of 16.8/100,000/annum. This is 44 % higher than the incidence rate for Non-Indigenous children. For every fatality, nine others were rescued and sought medical treatment (average 12 per year). The apparent over-representation of Indigenous adolescent females should be weighed against the absence of drowning among Indigenous male adolescents in the same age group in consecutive years of the study. Further investigation around behaviour and culture may highlight protective factors. Culturally specific prevention strategies which take into account social and demographic indicators identified in this study should be delivered to carers and peers of vulnerable age groups who frequent specific locations. Females, swimming ability, supervision and the young are areas which need to be incorporated into Indigenous-specific interventions for drowning prevention.
• Drowning deaths in Australian rivers, creeks and streams: A 10 year analysis, Peden, A & Queiroga, AC, Royal Life Saving Society Australia, (2014). This report details the number of drowning deaths in Australian rivers, creeks and streams across the last 10 financial years and the circumstances around those deaths. Between 1 July 2002 and 30 June 2012, a total of 2,965 people died as a result of drowning in Australian waterways. Of these 735 people drowned in rivers, creeks and streams, accounting for 25% of all drowning deaths experienced in Australian waterways across this ten year period.
  • Males accounted for 80% of all river drowning deaths across the period of this study. The male burden in river drowning deaths was most prominent in the 25-34 years age group where males accounted for 92% of all drowning deaths experienced in people in that age group.
  • Almost three quarters (74%) of people who drowned in rivers, did so within 100kms of their home postcode.
  • Indigenous people drowned at a rate of 1.58 per 100,000 population in rivers, a rate that is 4.4 times that of the general population.
  • Alcohol was known to be involved in 37% of all river drowning deaths. There were a further 252 cases (representing 35% of all river drowning deaths) where information on the involvement of alcohol was not available. This suggests the involvement of alcohol in river drowning deaths could be larger than currently known.
• Rip current related drowning deaths and rescues in Australia 2004–2011, B. Brighton, S. Sherker, R. Brander, Natural Hazards and Earth System Sciences, Volume 14(4), pp.1069-1075, (2013). This study aims to quantify the incidence of rip current related drowning deaths and rescues in Australia from 2004 to 2011. In this time, rip currents were recorded as a factor in 142 fatalities of a total of 613 coastal drowning deaths (23.2%), an average of 21 per year. Rip currents were related to 44% of all beach-related drowning deaths and were involved in 57.4% of reported major rescues in Australian locations where rips occur. A comparison with international operational statistics over the same time period describes rip-related rescues as 53.7% of the total rescues in the US, 57.9% in the UK and 49.4% in New Zealand. The range 49–58% is much lower than 80–89% traditionally cited. The results reported are likely to underestimate the size of the rip current hazard, because we are limited by the completeness of data on rip-related events; however this is the most comprehensive estimate to date. Beach safety practitioners need improved data collection and standardized definitions across organisations. The collection of drowning data using consistent categories and the routine collection of rip current information will allow for more accurate global comparisons.

Research and reviews of strategies and interventions to help prevent drowning.

• ‘Keep watch’ around water: short-term impact of a Western Australian population-wide television commercial, Michael Casten, Gemma Crawford, Jonine Jancey, et.al., Journal of Public Health, Volume 30, pp.151-157, (2022). This study is one of few water safety media campaigns to provide insights into awareness, comprehension, intention and acceptability of mass-media campaigns to prevent drowning. Findings suggest traditional media continue to play a role in reinforcing drowning prevention messages to parents particularly in increasing awareness of how to keep children safe in and around water.
• Bush Nippers: Evaluating the effectiveness of the Nipper education program in regional inland Victoria, Australia, Hannah L. M. Calverley, Rhiannon Birch, Grace Strugnell, et.al., Health Promotion Journal of Australia, (20 December 2021). ‘Nippers’ programs provide coastal lifesaving and water safety knowledge and skills to children aged 5-14 years in Australia. However, a 49% increase in Victorian inland waterway drowning compared with the 10-year average, necessitated adapting the Nippers water safety program to inland regions: Bush Nippers. Overall, 105 participants from two age groups (under 9 and under 12) were involved across three Bush Nippers programs delivered at river and/or pool locations in regional Victoria, Australia. Significant increases in knowledge from pre to immediate post-test were recorded and water competencies were high post-test. Communities were grateful for the regional program delivery and understood the necessity of learning lifesaving skills, particularly in open water environments. Costs were akin to other similar programs indicating program replicability and enhancing likelihood of uptake.
  • Bush Nippers: An evaluation of the effectiveness of the Nippers program in a regional setting [year 2 report], Victorian Government/Life Saving Victoria, (2021).
• Correspondence of Beach User Perception, Lifesaving Strategies and Rip Currents: Implications for Beach Management, Summer Locknick and Chris Houser, Coastal Management, Volume 49(6), pp.598-616, (August 2021). The potential for drowning or rescue depends on a combination of physical and social factors, and this is the first study to examine the relationship amongst the presence and location of rips, beach user intentions and behavior, and the hazard level identified by the lifeguards. Results of a survey administered in the summer of 2019 at Cavendish Beach and Brackley Beaches along the north shore of Prince Edward Island (PEI), Canada, suggests that beach user intention and perception of the rip current hazard may not accurately reflect their actions. Despite being aware of beach hazards, most beach users and in particular the tourists to the area, did not observe beach warnings. Their activity on the beach also appears to be influenced by the design of the beach access and the presence of other beach users. Respondents who could not recall the hazard level defined by beach flags and signs on the boardwalk tended to sit further away from the access point and lifeguards. Most of the respondents were tourists who were at a higher risk of needing rescue or drowning caused by rip currents due to their lack of rip knowledge and familiarity with those beaches. It is argued that the potential for drownings and rescues can be mitigated through changes in the design of the beach access and the distribution of lifeguard resources, but further research into the correspondence of beach user perception, lifesaving strategies and rip currents is required.
• Exploring the impact of a student-centred survival swimming programme for primary school students in Australia: the perceptions of parents, children and teachers, Lauren Petrass, Kate Simpson, Jenny Blitvich, European Physical Education Review, Volume 27(3), pp.684-702, (August 2021). This study used a self-report questionnaire and practical testing procedures to examine the effectiveness of a 10-week student-centred aquatic programme designed for children aged 10–12 years. The study also determined whether the non-traditional swimming programme was accepted by swim teachers, school teachers and principals, and parents from a range of schools from different geographical regions in Victoria, Australia. A total of 204 students were enrolled in the programme. The pre-programme results indicated a good level of swimming, water safety and aquatic knowledge, but low swimming ability. Swimming ability significantly improved from pre-programme to post-programme, with no significant post-programme ability differences between male and female children or for participants from different programmes. Qualitative feedback collected through questionnaires, interviews and/or focus groups from students (n = 73) and parents (n = 69), school teachers and principals (n = 14), swim teachers and swim school managers (n = 21) indicated strong support from principals and swim teachers for the student-centred pedagogy, and all stakeholders valued the focus on survival swimming competencies. This research highlights the importance of including stakeholders when designing and implementing aquatics programmes. The study has resulted in a well-founded, effective programme with tailored resources and instructional materials that are available for swim centres and schools that would enable schools globally to adopt and implement this programme.
• Can child drowning be eradicated? A compelling case for continued investment in prevention, Amy Peden, Richard Franklin, Tessa Clemens, ACTA Paediatrica, Volume 110(7), pp.2126-2133, (July 2021). A total population analysis of unintentional fatal drownings among 0- to 19-year-olds in Australia, Canada and New Zealand from 2005 to 2014 was undertaken. A total of 1454 children drowned. Rates ranged from 0.92 (Canada) to 1.35 (New Zealand) per 100 000. Linear trends of crude drowning rates show both Australia (y = −0.041) and Canada (y = −0.048) reduced, with New Zealand (y = 0.005) reporting a slight rise, driven by increased drowning among females aged 15-19 years (+200.4%). Reductions of 48.8% in Australia, 51.1% in Canada and 30.4% in New Zealand were seen in drowning rates of 0- to 4-year-olds. First Nations children drowned in significantly higher proportions in New Zealand (X2 = 31.7; P < .001). Continual investment in drowning prevention, particularly among 0- to 4-year-olds, is contributing to a reduction in drowning deaths; however, greater attention is needed on adolescents (particularly females) and First Nation's children. Lessons can be learned from each country's approach; however, further investment and evolution of prevention strategies will be needed to fully eradicate child drowning deaths.
• Exploring children’s participation in commercial swimming lessons through the social determinants of health, Stacey Willcox-Pidgeon, Amy Peden, Justin Scarr, Health Promotion Journal of Australia, Volume 32(2), pp.172-181, (April 2021). Swimming and water safety lessons, in part, have reduced drowning in children, while also enabling healthy aquatic participation. Research suggests that some Australian children receive insufficient swimming and water safety education and are not achieving essential skills. Swim schools were more likely to teach freestyle (87%) and backstroke (83%); and less likely to teach water safety skills like treading water (53%), and survival backstroke (46%). Overall, 40% of 12-year-old children failed to achieve the National Benchmark of 50 metres freestyle, fewer were achieving minimum water safety skills. Children from low socio-economic areas and regional locations were less likely to be achieving 50 metres freestyle. Children in this study were commonly from major cities (94%) and of high socio-economic areas (53%). The authors conclude that stakeholders must prioritise holistic drowning prevention education strategies, ensuring all children can access swimming and water safety programs regardless of their socio-economic status or geographical location.
• Reducing inequities among adult female migrants at higher risk for drowning in Australia: The value of swimming and water safety programs, Stacey Willcox-Pidgeon, Richard Franklin, Sue Devine, et.al., Health Promotion Journal of Australia, Volume 32(S1), pp.49-60, (February 2021). This paper presents findings from a community-based qualitative evaluation of swimming and water safety (SWS) programs delivered to adults from migrant backgrounds in Sydney, Australia. Study participants were ≥25 years, first generation and most had lived in Australia for ≥10 years. Most were non-swimmers and were fearful of water prior to the program. Key themes were: direct SWS program outcomes, health and well-being; enablers and barriers to participation including: motivation, a program coordinator, fear and settlement priorities. Findings suggest that in order to increase SWS participation among migrant communities, the broader determinants of health need to be considered. Culturally appropriate strategies are required to enable both men and women equal opportunities to access SWS programs.
• Coastal drowning: A scoping review of burden, risk factors, and prevention strategies, William Koon, Amy Peden, Jasmin Lawes, PLOS One, (1 February 2021). Of the 146 included studies, the majority (76.7%) were from high income countries, 87 (59.6%) reported coastal drowning deaths, 61 (41.8%) reported risk factors, and 88 (60.3%) reported prevention strategies. Populations, data sources and coastal water site terminology in the studies varied widely; as did reported risk factors, which most frequently related to demographics such as gender and age. Prevention strategies were commonly based on survey data or expert opinion and primarily focused on education, lifeguards and signage. Few studies (n = 10) evaluated coastal drowning prevention strategies.
• Next steps for drowning prevention in rural and remote Australia: A systematic review of the literature, Danielle Taylor, Amy Peden, Richard Franklin, Australian Journal of Rural Health, Volume 28(5), pp.530-542, (December 2020). Thirty-two studies satisfied inclusion criteria (66% reporting epidemiology; 59% risk factors; and 44% prevention strategies). All (100%) included studies were assessed very low against Grading of Recommendations Assessment, Development and Evaluation. Findings indicate rural populations (ie, excluding major cities) have higher rates of drowning positively correlated with increasing remoteness. Common factors included age (child), natural water bodies, undertaking boating and watercraft activities and alcohol consumption. While a range of prevention strategies has been proposed, only one study outlined a rural drowning prevention strategy which had been implemented and evaluated. Strategies were generally low on the hierarchy of control.
• Identifying a gap in drowning prevention: high-risk populations, Stacey Willcox-Pidgeon, Richard Charles Franklin, Peter Leggat, et.al., Injury Prevention, Volume 26(3), pp.279-288, (2020). In total, 35 articles were included. High-risk populations identified were: ethnic minorities, First Nations/Aboriginal people, migrants and rural residents. Over half (51%) focused on children (0–18 years). Risk factors included social determinants, swimming ability and knowledge, attitudes and behaviour. Four intervention studies were found; two focused on upskilling adults from high-risk populations to increase employment opportunities within the aquatic industry; an evaluation of a 10-year rock fishing safety education project and a learn-to-swim programme for minority children. Proposed prevention strategies included education, practical skills, research, policy and engagement.
• Alcohol_Focused Drowning Prevention Campaigns: What Do We Know and What Should We Do Now? Hannah Calverley, Lauren Petrass, Jennifer Blitvich, International Journal of Aquatic Research and Education, Volume 12(2), (March 2020). This project aimed to: (i) review and assess all alcohol themed drowning prevention campaigns within high income countries (HICs); (ii) determine whether the campaign had undergone evaluation for effectiveness; and (iii) provide recommendations to improve the effectiveness of future interventions. For each of the eighty-one HICs identified for the 2019 fiscal year, searches of peer-reviewed literature (through academic databases) and grey literature (through webpages and emails to organisations) were conducted. Twelve alcohol focused campaigns were identified, with only two providing limited information about program evaluation. For most campaigns identified, there was a dearth of information available and therefore assessment of campaign quality was unfeasible. This brief report highlights a lack of alcohol themed drowning prevention campaigns in HIC, and an absence of evaluations on their effectiveness.
• Behavioural Water Safety and Autism: a Systematic Review of Interventions, Catriona Martin and Karola Dillenburger, Review Journal of Autism and Developmental Disorders, Volume 6, pp.356–366, (2019). People with autism are approximately twice as likely to die from drowning than members of the general population. Drowning can take place in quite small bodies of water. Therefore, acquiring good water safety skills is of the utmost importance. A systematic review of research into effective behavioural interventions for water safety and swim skills was conducted. In total, 11 studies were identified. Findings suggest that behaviourally based interventions can improve a range of water safety and swim skills in individuals with autism.
• Cardiopulmonary resuscitation and first-aid training of river users in Australia: A strategy for reducing drowning, Amy E. Peden, Richard C. Franklin, Peter Leggat, Health Promotion Journal of Australia, Volume 30(2), pp.258-262, (2019). Rivers are a leading location for fatal drowning worldwide, often geographically isolated from timely medical assistance. Cardiopulmonary resuscitation (CPR) benefits drowning victims and those who suffer cardiac arrests. This study explored CPR and first-aid training of river users in Australia. Current CPR qualifications are important, particularly among those visiting high-risk river drowning locations. System-level, upstream strategies that should be explored include compulsory CPR training in secondary schools and linking CPR updates to motor vehicle licence renewals.
• Epidemiology, risk factors and strategies for the prevention of global unintentional fatal drowning in people aged 50 years and older: a systematic review, Amy E Peden, Richard C Franklin, Ana Catarina Queiroga, Injury Prevention, Volume 24, pp.240-247, (2018). Drowning is a global public health issue and prevention poses an ongoing challenge for all countries. Many nations are experiencing ageing populations, and little is known about the epidemiology, risk factors and prevention of drowning deaths among older people. This paper reports on a systematic review of literature published on drowning among older people. Thirty-eight papers were deemed relevant to the study design, including 18 (47%) on epidemiology, 19 (50%) on risk factors and 9 (24%) on strategies for prevention. Risk factors identified included male gender, ethnicity, rurality and increasing age. Prevention strategies commonly proposed were education and wearing life jackets. Gaps identified in the published literature include a lack of consistency around age groupings used for epidemiological studies; a lack of consensus on risk factors; a lack of total population, country-level analysis; and the need for older age-specific prevention strategies that have been implemented and their effectiveness evaluated. This review identified drowning deaths among older people as a global issue. Further work is required to reduce drowning in this cohort. High-quality epidemiological studies identifying risk factors using standardised age groupings to allow for international comparisons are required, as are implementation and evaluation of older age-specific prevention strategies.
• Preventing river drowning deaths: Lessons from coronial recommendations, Amy Peden, Richard Franklin, Peter Leggat, Health Promotion Journal of Australia, Volume 29(2), pp.144-152, (2018). SMART coronial recommendations may be more successful in achieving the behavioural, social and societal change required to prevent future river drownings. The recommendations examined in this study can be used as a benchmark for what could be considered appropriate safety actions.
• Improving Pool Fencing Legislation in Queensland, Australia: Attitudes and Impact on Child Drowning Fatalities, Richard Franklin and Amy Peden, International Journal of Environmental Research and Public Health, Volume 14(12), (2017). Four-sided, non-climbable pool fencing is an effective strategy for preventing children from drowning in home swimming pools. In 2009, the Queensland Government introduced legislation to improve the effectiveness of pool fencing. This study explores community attitudes towards the effectiveness of these legislative changes and examines child (<5 years) drowning deaths in pools. Data from the 2011 Queensland Computer-Assisted Telephone Interviewing (CATI) Social Survey include results from questions related to pool ownership and pool fencing legislation. Fatal child drowning cases between 1 January 2005 and 31 December 2015 were sourced from coronial data. Of the 1263 respondents, 26/100 households had a pool. A total of 58% believed tightening legislation would be effective in reducing child drowning deaths. Pool owners were more likely to doubt the effectiveness of legislation when compared to non-pool owners. Perceptions of effectiveness did not differ by presence of children under the age of five. There were 46 children who drowned in Queensland home pools between 2005 and 2015. While pool owners were less likely to think that tightening the legislation would be effective, the number of children drowning in home swimming pools declined over the study period. Drowning prevention agencies have more work to do to ensure that the most vulnerable (young children in houses with swimming pools) are protected.
• A Review of Drowning Prevention Interventions for Children and Young People in High, Low and Middle Income Countries, Justine Leavy, Gemma Crawford, Francene Leaversuch, et.al., Journal of Community Health, Volume 40, pp.424-441, (2016). This review aimed to identify, assess and analyse public health interventions to reduce child drowning and investigate the use of behavioural theories and evaluation frameworks to guide child drowning prevention. Thirteen databases were searched for relevant peer reviewed articles. The systematic review was guided by the PRISMA criteria and registered with PROSPERO. Fifteen articles were included in the final review. Studies were delivered in high, middle and low income countries. Intervention designs varied, one-third of studies targeted children under five. Almost half of the studies relied on education and information to reduce drowning deaths, only three studies used a multi-strategy approach. Minimal use of behavioural theories and/or frameworks was found and just one-third of the studies described formative evaluation. This review reveals an over reliance on education and information as a strategy to prevent drowning, despite evidence for comprehensive multi-strategy approaches. Accordingly, interventions must be supported that use a range of strategies, are shaped by theory and planning and evaluation frameworks, and are robust in intervention design, delivery and evaluation methodology. This approach will provide sound evidence that can be disseminated to inform future practice and policy for drowning prevention.
• Fatal river drowning: the identification of research gaps through a systematic literature review, Peden AE, Franklin RC, Leggat PA, Injury Prevention, Volume 22(3), pp.202-209, (May 2016). Drowning is a leading cause of unintentional death. Rivers are a common location for drowning. Unlike other location-specific prevention efforts (home swimming pools and beaches), little is known about prevention targeting river drowning deaths. Twenty-nine papers were deemed relevant to the study design including 21 (72.4%) on epidemiology, 18 (62.1%) on risk factors and 10 (34.5%) that proposed strategies for prevention. Risk factors identified included age, falls into water, swimming, using watercraft, sex and alcohol. Gaps were identified in the published literature. These included a lack of an agreed definition for rivers, rates for fatal river drowning (however, crude rates were calculated for 12 papers, ranging from 0.20 to 1.89 per 100 000 people per annum), and consensus around risk factors, especially age. There was only one paper that explored a prevention programme; the remaining nine outlined proposed prevention activities. There is a need for studies into exposure patterns for rivers and an agreed definition (with consistent coding).
• Interventions associated with drowning prevention in children and adolescents: systematic literature review, Belinda Wallis, Kerrianne Watt, Richard Franklin, et.al., Injury Prevention, Volume 21(3), pp.195-204, (2015). Drowning remains a leading cause of preventable death in children across the world. This systematic review identifies and critically analyses studies of interventions designed to reduce fatal and non-fatal drowning events among children and adolescents or reduce the injury severity incurred by such incidents. Seven studies fulfilled the inclusion criteria. Interventions were categorised into three themes of Education, Swimming Lessons and Water Safety, and Pool Fencing. All are possible effective strategies to prevent children from drowning, particularly young children aged 2–4 years, but very little evidence exists for interventions to reduce drowning in older children and adolescents. There were methodological limitations associated with all studies, so results need to be interpreted in the context of these.
• Recreational Drowning Prevention Interventions for Adults, 1990–2012: A Review, Justine E. Leavy, Gemma Crawford, Linda Portsmouth, et.al., Journal of Community Health, Volume 40, pp.725-735, (2015). The aim of this paper is to systematically identify and analyse the evidence for drowning interventions with an adult focus. A systematic search was undertaken for peer-reviewed articles which were published in English between 1990 and 2012, focused on adults and described a drowning intervention. After quality appraisal by expert reviewers using a purposively tailored checklist, a final total of six studies were included for review. The six studies were all conducted in high income countries. Four were drowning interventions, two were retrospective analyses. The drowning interventions duration ranged from 10 days to 5 years, the analysis studies from 6 to 21 years. Two of the studies reviewed used behaviour change theory to inform development, and two reported formative evaluation. Prevention strategies included education (n = 3), technology (n = 1) and environmental (n = 1). Positive short term effects and significant behaviour change in life jacket use was reported (n = 2). A mixed effect was observed in the six studies. The complexity of the issues surrounding drowning requires the collection of robust data and evaluation of preventative measures to support the development of targeted and tailored prevention interventions. This review reinforces the need for a genuine and sustained global approach to addressing adult drowning prevention. Drowning is a serious public health issue and should receive the same attention as other public health priorities.
• Preventing adolescent drowning: Understanding water safety knowledge, attitudes and swimming ability. The effect of a short water safety intervention, Lauren Petrass, Jennifer Blitvich, Accident Analysis and Prevention, Volume 70, pp.188-194, (2014). Worldwide, epidemiological data indicate that children are a high-risk group for drowning and while progress has been made in understanding toddler drownings, there is a lack of empirical evidence regarding the drowning risk and protective factors inherent for adolescents and young adults. This study used a self-report questionnaire to establish swimming and water safety knowledge and attitudes of young adults and objectively measured their actual swimming ability using formal practical testing procedures. Participants then completed a short, 12-week intervention that encompassed swimming, survival and rescue skills, along with water safety knowledge applicable to a range of aquatic environments. Knowledge, attitudes and swimming ability were then re-measured following the intervention to evaluate its effectiveness. Results indicated that these young adults had a very low level of water safety knowledge pre-intervention, although the majority had sound swimming and water safety skills and attitudes. Overall, significant improvements were evident in knowledge and swim ability post-intervention, although no changes were observed in attitudes. Previous participation in formal swimming lessons and/or swimming within the school curriculum had no significant impact on water safety knowledge, skills or attitudes of these young adults, and there were few significant gender differences.
• Drowning deaths in Australian rivers, creeks and streams: A 10 year analysis, Peden, A and Queiroga, AC, Royal Life Saving Society Australia, (2014). This report details the number of drowning deaths in Australian rivers, creeks and streams across the last 10 financial years and the circumstances around those deaths. Between 1 July 2002 and 30 June 2012, a total of 2,965 people died as a result of drowning in Australian waterways. Of these 735 people drowned in rivers, creeks and streams, accounting for 25% of all drowning deaths experienced in Australian waterways across this ten year period. This report makes a number of recommendations aimed at expanding our knowledge of river recreational patterns and to reduce drowning deaths in Australian rivers. These include enhanced understanding of the risks of floodwaters, increased awareness and enforcement of legislative requirements regarding use of watercraft whilst under the influence of alcohol in rivers and improving CPR and first aid skills in Remote and Very Remote areas.
• An analysis of stratagems to reduce drowning deaths of young children in private swimming pools and spas in Victoria, Australia, Lyndal Bugeja and Richard Franklin, International Journal of Injury Control and Safety Promotion, Volume 20(3), pp.282-294, (2013). This population-based retrospective case series study examined the frequency and distribution of protective stratagems (legislatively compliant safety barrier, adequate caregiver supervision, water familiarisation and early administration of cardiopulmonary resuscitation [CPR]) amongst drowning deaths of young children (0–4 years) in private swimming pools or spas in Victoria, Australia. In 65.0% (52/80) of deaths, none of the four protective stratagems were known to be present and there was only one case where all four were known to be present. This indicates that if the presence of all four stratagems is increased, this may reduce drowning in this age group and setting. While these results are positive, further examination of the presence and interaction of these stratagems for effectiveness is required. Further research is also warranted to explore the impact of enforcement of pool fencing legislation and potential associations between water familiarisation and drowning risk. In addition, a consensus on the definition of adequate supervision in needed.

Drowning (fatal or non-fatal) has health, social, and economic impacts for individuals and society.

• Non-Fatal Drowning in Australia, Part 2: Impact of non-fatal drowning, Mahony, A, Pidgeon, S., Royal Life Saving Society Australia, (2021). In addition to hospitalisation figures in Australia over a 15-year period, this study examines the mean length of hospital stay, number of patient days, time in an Intensive Care Unit (ICU) and the number of hours of Continuous Ventilatory Support (CVS) received over a 4- or 5-year period.
• Calculating the economic burden of fatal drowning in Australia, Paul Barnsley, Amy Peden, Justin Scarr, Journal of Safety Research, Volume 67, pp.57-63, (December 2018). Aquatic activities provide physical and social benefits, while the risk of drowning generates countervailing social costs. Drawing on estimates of fatal drowning gathered by Royal Life Saving Society – Australia, this paper outlines a method for estimating the economic burden attributable to fatal drowning. The study covers 4285 cases of unintentional fatal drowning over 15 years. Based on this sample and estimates for the Value of a Statistical Life Year (VSLY) ($203,000), the economic burden of fatal drowning for Australia over this 14 year period was $18.63 billion in 2017 Australian dollars, averaging $1.24 billion annually.
• Understanding the full burden of drowning: a retrospective, cross-sectional analysis of fatal and non-fatal drowning in Australia, Peden AE, Mahony AJ, Barnsley PD, BMJ Open, Volume 8, (November 2018). The epidemiology of fatal drowning is increasingly understood. By contrast, there is relatively little population-level research on non-fatal drowning. This study compares data on fatal and non-fatal drowning in Australia, identifying differences in outcomes to guide identification of the best practice in minimising the lethality of exposure to drowning. 2272 fatalities and 6158 hospital separations occurred during the study period, a ratio of 1:2.71. Children 0–4 years (1:7.63) and swimming pools (1:4.35) recorded high fatal to non-fatal ratios, whereas drownings among people aged 65–74 years (1:0.92), 75+ years (1:0.87) and incidents in natural waterways (1:0.94) were more likely to be fatal. This study highlights the extent of the drowning burden when non-fatal incidents are considered, although coding limitations remain. Documenting the full burden of drowning is vital to ensuring that the issue is fully understood and its prevention adequately resourced. Further research examining the severity of non-fatal drowning cases requiring hospitalisation and tracking outcomes of those discharged will provide a more complete picture.
• A 13-year national study of non-fatal drowning in Australia: Data challenges, hidden impacts and social costs, Royal Life Saving Society Australia, (2017). The total cost of non-fatal drowning over the study period was $2.45 billion, an average $188 million per year. These costs depend heavily on the average age of victims as well as the frequency of non-fatal drowning incidents, with younger victims and those activities where victims tend to be younger on average, generating a disproportionate share of the overall burden. Victims under 25 years of age generated 78% of the total burden of non-fatal drowning. The rising average age of victims over the study period leads to a slight fall in the average cost per incident between 2002/03 and 2014/15, partially offsetting a rise in the overall frequency of non-fatal drowning. On average, the per-incident cost of non-fatal drowning is much lower than the cost of a fatal drowning, but non-fatal drowning incidents where the victim experiences long term effects (estimated at 5% of all incidents) are more costly than fatalities and account for 88% of the total costs of non-fatal drowning.
• Reducing the burden of non-fatal drowning: Symposium Declaration, Australian Water Safety Council, (2017). Non-fatal drowning is often a hidden issue, overshadowed by a focus on fatal drowning and rescues - The individuals and their families have unique needs and are often either unable to find the support they require, or are unwilling to ask for help due to the grief and guilt associated with their experience. A study undertaken at the Children’s Hospital at Westmead found that 22% of children (out of 23 participants) who showed no obvious neurological impairment when discharged from hospital after a non-fatal drowning, showed behavioural problems, learning difficulties or poor fine motor skills within five years post the non-fatal drowning incident. Although a small sample size, this is double the prevalence estimated in the general child (under 12 years) population for behavioural and learning difficulties (10%). The economic costs of non-fatal drowning are approximately $188 million per year. While the average cost per incident is low, the 5% of incidents leading to long-term disability generate 88% of the total cost burden of non-fatal drowning, with each incident leading to average costs of $6.91 million. The impacts on individuals, families and communities are in many cases immeasurable.

Toolkits and good practice guides to help prevent drowning.

• Water safety toolkit, Local Government Association [UK], (accessed 27 January 2022). The LGA has produced a water safety toolkit for councils, to ensure both locals and visitors enjoy the natural environment safely whether on the coast or inland. In 2020, 254 people lost their lives in accidental drownings in the UK, with hundreds more having near drowning experiences, sometimes suffering life-changing injuries. Children can be particularly at risk. One of the striking characteristics of the data on accidental drownings is that a large proportion of victims did not leave home on the day they died intending to go into water of significant depth. In 2020 nearly twice as many deaths happened whilst people were out walking, running or cycling compared to those who died whilst swimming which shows the importance of everyone being aware of the risks posed by water.
• Drowning and aquatic injuries dictionary, David Szpilman, Jose Palacios Aguilar, Roberto Barcala-Furelos, et.al., Resuscitation Plus, Volume 5, (March 2021). The objective of this study was to develop a standardised drowning dictionary using a consensus-based approach. The drowning dictionary included more than 350 terms. Of these, less than 10% had been previously published in peer review literature. The drowning dictionary provides a common language, and the authors envisage that its use will facilitate collaboration and comparison across prevention sectors, education, research, policy and treatment. The dictionary will be open to readers for discussion and further review at www.idra.world.
• Drowning Prevention Toolkit, Injury Matters, (2020). Through the Know Injury program, Injury Matters provides knowledge, training, resources, and networking opportunities for health professionals, local government, not-for-profit and community organisations to prevent injuries. This toolkit provides information, resources and guidance to support Local Governments, health and community professionals in increasing community awareness of the importance of preventing drowning among toddlers.
• Australian Adventure Activity Standard and related Good Practice Guides, Outdoor Council of Australia, (version 1: 23 September 2019). The Australian Adventure Activity Standard (AAAS) and related Good Practice Guides (GPGs) provide a voluntary good-practice framework for safe and responsible planning and delivery of led outdoor adventure activities with dependent participants. The formation of the Aust. AAS and GPG’s have been supported and funded 2016-2019 by a meeting of the State and Territory Sport and Recreation Ministers of Australia. Water based activity good practice guides include:
  • Enclosed and coastal waters paddle-craft – Canoeing, sit in and sit on top kayaking and stand up paddleboarding on enclosed and coastal waters.
  • Inland water paddle-craft – Canoeing, inflatable, sit in and sit on top kayaking, rafting and stand up paddleboarding on inland waters.
  • Snorkelling – Snorkel swimming and snorkel diving.
• Preventing drowning: an implementation guide, World Health Organisation, (1 May 2017). This guide provides practical steps to reduce drowning – one of the world’s most preventable, neglected and pressing public health issues. Through 10 evidence-based interventions and strategies it is designed to help drowning-prevention practitioners – from nongovernmental organizations (NGOs) and researchers to government officials and policy-makers – approach drowning prevention in a strategic, evidence-based and multisectoral way. It also highlights ways to harness public awareness and engagement to strengthen drowning prevention interventions.