Water safety data; what are the figures telling us? Holly Henderson RoSPA Research Manager and Postgraduate of the Department of Public Health and Epidemiology, University of Birmingham

Statistics Overview: Accidental injury is a leading cause of death and disability and by 2020 injury will be the largest single reason for the loss of healthy human life years (WHO 2001; Towner 2001). Drowning is the second leading cause of unintentional injury mortality globally behind road traffic injuries. WHO (2002) estimates globally that there are almost half a million drownings annually Global Fatality Rate of 7.4 per 100, 000 Historically the UK has published a drowning fatality rate of 1.0 per 100,000

What new research has occurred in 2004? SAPC and the University of Strathclyde: Scottish Water Based Accidents: The development of an accurate database University of Wales College of Medicine: A retrospective study of childhood swimming pool drowning deaths in the UK and abroad SWIM Group: Bath Seat Study University of Birmingham: An investigation into the epidemiological surveillance of inland water incidents in the UK RYA: Entrapment Study

Scottish Water Based Fatalities: The Development of and accurate database Retrospective data collected from 1997 – 2003 Four Data Sources Data includes suicides, homicides, coastal, offshore, inland and domestic fatalities Number of Notifications – 1490 fatalities Total after data linkage – 1116 fatalities New data collected 2.5 times more fatalities than previously known

SAPC and University of Strathclyde Results (1) Year RoSPA / RLSS Database SAPC Database (est.) Mean72165

SAPC and University of Strathclyde Results (2)

SAPC and University of Strathclyde Results (3)

SAPC and University of Strathclyde Results (4)

Research Summary Over 100 additional drownings reported annually Males accounted for 80.5% Age groups of concern: 35 – 39 (8.6%) and (8.3%) Drownings peaked in August (10%) 58.3% of fatalities at inland water locations 33.4% land based activities, 27.7 on the water Fishing accounted for 19.3% 13.3% of fatalities in the Highlands Region 34.1% intent undetermined, 26.1% no information available New rate of 3.2 per 100,000

A retrospective study of childhood swimming pool drownings in the UK and Abroad Data sourced from 1993 – 2003 Domestic, Private and Public Pools Total of 137 children (under 15) died 69.3% Males Average age 6.1 years Average of 12 per year

University of Wales College of Medicine (1)

University of Wales College of Medicine (2)

University of Wales College of Medicine (3)

University of Wales College of Medicine (4)

Research Summary: Drowning in the UK: –Starting to decline but age increasing –Managing of Health and Safety of Swimming Pools –Overhaul of Pool Life guarding –Child Admissions Policy Drowning Abroad: –On the increase –Exposure –ANEC Research 2005

Drowning of babies in bath seats: Children under the age of two Case Study of drowning and near drowning episodes from 1989 – 2003 All males (n = 6) 5 under a year old Bath seats appear to give a false sense of security to parents Further research required to look at and address exposure to risk

An Investigation into the Epidemiological Surveillance of Inland Water Incidents in the UK 2545 notifications 2068 isolated incidents Related to 2743 people 89.4% (2453) rescued, 10.6% (290) died 79.0% involved were male (7.6 per 100, 000) 88.9% who died were male (0.9 per 100, 000) Males had a 7.6 fold increased risk of dying at an inland water location in the UK Males had a 3.9 fold increased risk in needing rescue at an inland water location in the UK

Gender and Age - Survivability Adults accounted for 80.8% of involvement and 88.6% of fatalities Teenagers had the highest population based rate of involvement (8.1 per 100, 000) Once involved in an inland water incident males were twice as likely to die

Incidents Resulting in a Fatality – Monthly Trends

Incident Start Time and Month by the Number of People Involved

Incidents Resulting in a Fatality – Day of Week Trends

Incident Day of Week and Month by the Number of People Involved

Incident Day of Week and Incident Start Time by the Number of People Involved

By Location

By Activity

Multivariate Analysis: Predictive model used by NHS and Public Health Specialists Considers factors associated and predictors Model predicted 98.8% of outcomes of the research LOGODDS = – * AGR (2) – * AGR (3) – * WKD (6) – 1.837* WKD (5) – * WKD (4) * WKD (3) – * WKD (2) – GEN (1) * LT (2) * LT (1)

Research Summary: First time incident data analysed for the UK Use of descriptive epidemiology Capture Recapture Analysis (n = 228) New use of relative risk, odds ratios and multivariate analysis Creates a new population based rate for inland waters in the UK Identification of Population most at risk Provides a baseline for prevention and intervention strategies through education and resource deployment

Entrapment Study: Study started in 2003 –Due to the public concern regarding the risk of getting trapped in inverted or partially inverted dinghy –Well publicised “near misses” Process –Logging entrapment incidents (Web Report) –Discussions with major dinghy manufacturers –Air gap tests –Rescue Techniques –Methods of Prevention

Incident Records: 44 incidents logged during 2003 and % of these reported incidents were serious and a potential threat to life Biggest risk results from complete inversion of the boat with the sailor tangled or stuck underneath Probability of inversion occurring unaffected by conditions Major Factor - Speed of Inversion –Depends on design –Capsizing to windward whilst sailing downwind

NWSF Information Group Aim: To bring together in one place, information and research about incidents, casualties and fatalities in water Improve the quality of information and data available enabling it, for the first time, to develop strategies and policies based on statistics, analysis and research Objectives: To encourage the gathering, monitoring and evaluation of drowning/incident data and relevant research To assess the need for intervention To assess the need for better information and data

NWSF Information Group Outputs: Improvements to statistics and levels of analysis Regular reporting to the Co-ordinating committee A data led approach to drowning prevention Contributors: Nominated person from each of the NWSF Advisory Groups Academics with specialist interest in water safety

Finally: Each of the research projects has brought new valid and credible knowledge into the water safety community Collecting data routinely and the appropriate analysis is key to success –Organisational understanding of data and statistical analysis –Dataset Development –Data Linkage Strategy –Reporting Mechanisms –Population based and risk based analysis –Development of a Hierarchy of Evidence The NWSF Information Group will help co- ordinate and facilitate research like this in the future