Tessa Clemens - Understanding the Burden of Drowning in ......Global report on drowning: Preventing a leading killer Healthier Children. A Better World. Unintentional Fatal Drowning

Healthier Children. A Better World.

Understanding the true burden of drowning in Canada: The epidemiology and prevention of

non-fatal drowning

Tessa ClemensBCIRPU Webinar series

November 23, 2017


Outline

• Key facts about drowning

• Non-fatal drowning

• The Canadian Drowning Prevention Coalition

• Questions



A Few Key Facts About Drowning


Source: World Health Organization. (2014). Global report on drowning: Preventing a leading killer








The True Burden of Fatal Drowning is Unknown



Unintentional Fatal Drowning in Canada

Source: Clemens, T. & Simoes, L. (2017). Canadian Drowning Report. ON: Lifesaving Society.



Source: Clemens, T. & Simoes, L. (2017). Canadian Drowning Report. ON: Lifesaving Society.


↑ pools and bathtubs↑ alone↑ rescue attempted

0-4

5-14


↑ pools↑ summer ↑ recreational swimming↑ PFD use

15-19

↑ swimming or boating in the summer ↑ alcohol involvement ↑ with others↓PFD use

Source: Clemens, T. Tamim, H., Rotondi, M., & Macpherson, A. (2017).


↑ boatingslightly ↑ PFD use ↑ alcohol involvement

35-64

65+

↑ pools and bathtubs (especially in oldest victims) ↑ urban areas↑ alone


↑ males ↑ natural bodies of water > 50% alcohol involvement↑ transportation deaths↓PFD use

20-34

Source: Clemens, T. Tamim, H., Rotondi, M., & Macpherson, A. (2017).


Unintentional Fatal Drowning in British Columbia

Source: Clemens, T. & Simoes, L. (2017). British Columbia Drowning Report. ON: Lifesaving Society.








Key Facts About Drowning: Summary

• Drowning is a serious but neglected public health concern

• 372,000 people die from drowning every year – this is an underestimate

• Close to 500 people die from unintentional drowning in Canada every year

• The characteristics of fatal drowning incidents differ by age


Non-fatal Drowning


~500


Definition of Drowning

Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid. Drowning outcomes should be classified as death, morbidity, and no morbidity

- World Congress on Drowning 2002


Non-fatal Drowning

• The epidemiology of fatal drowning in high-income countries has been well described

• Less is known about the scope of the non-fatal drowning problem

• Estimates of the ratio of fatal to non-fatal drowning vary widely in the literature

Clemens, Tamim, Rotondi & Macpherson, 2016, Lunetta, Smith, Penttila & Sajantila, 2004; Peden & McGee, 2003; Quan & Cummings, 2003; Salomez & Vincent, 2003; Schyllander, Janson, Nyberg, Eriksson, & Ekman, 2013; Sheikhazadi & Ghadyani, 2009; Shetty & Shetty, 2007; Tan, 2004; WHO, 2014


Non-fatal Drowning

• Most epidemiological studies of drowning have focused on fatalities only

• The majority of the existing non-fatal studies are limited to children and adolescents, and do not include water transport related drowning events

• In those studies there was some indication that the characteristics of non-fatal drowning may differ from those of fatal drowning incidents

CDC, 2004; Felton, Myers, Liu, & Winders Davis, 2015; Jensen, Williams, Thurman, & Keller,1992; Moran, 2010; Pearn, 1979; Quan, Gore, Wentz, Allen, Novack, 1989; Ross, Elliott, Lam & Cass, 2003; Wallis et al., 2015; Williamson & Schmertmann, 2002


Study Purpose

1. To describe non-fatal drowning in Canada

2. To identify which characteristics, if any, differ significantly between non-fatal and fatal drowning incidents


Method

• Retrospective study conducted using data collected on drowning incidents in Canada over a five-year period (2008/09 to 2012/13)

• Non-fatal drowning patients who required ambulatory care or who were discharged by an acute care facility in Canada were compared to unintentional fatal drowning cases


Method – Fatal Data Collection

• Data on fatal drowning cases were obtained from the Drowning Prevention Research Centre database

• Deaths were classified as drowning and data collected if drowning was included as a cause of death in the coroner’s report, based on the autopsy or other findings

• Trained local data collectors fill out questionnaires using files in Coroner’s office


Method – Non-fatal Data Collection


MeasuresCode DescriptionV90 Accident to watercraft causing drowning and

submersionV92 Water-transport related drowning and submersion

without accident to watercraftV94 Other and unspecified water transport accidentW65 Drowning and submersion while in bath-tubW66 Drowning and submersion following fall into bath-

tubW67 Drowning and submersion while in swimming-poolW68 Drowning and submersion following fall into

swimming-poolW69 Drowning and submersion while in natural waterW70 Drowning and submersion following fall into

natural waterW73 Other specified drowning and submersionW74 Unspecified drowning and submersionX38 FloodX71 Intentional self-harm by drowning and submersionX92 Assault by drowning and submersionY21 Drowning and submersion, undetermined intent

AgeSex

ProvinceUrban vs rural

External Cause


Results


Non-Fatal Drowning

• 19% of non-fatal drowning patients who were seen in an emergency department were hospitalized

• The characteristics of non-fatal drowning differed significantly across: age, sex, province, urban/rural residence and external cause


Characteristics of Non-fatal DrowningYounger

Rural for ED

Female

BoatingPools

Differed by Province


Implications

• Prevention initiatives should target both non-fatal and fatal drowning incidents

• The characteristics of non-fatal drowning differ significantly from those of fatal drowning

• Further research is warranted

• Drowning prevention organizations may need to expand their approaches to target non-fatal drowning in addition to drowning fatalities


Limitations

• Some deaths may still have been under investigation

• Estimated ratio may not be nationally representative

• Groups may not be completely mutually exclusive


Non-Fatal Drowning: Summary

• Fatal drowning is just one small part of the drowning problem

• For every one fatal drowning that occurs in Ontario it is estimated that at least three non-fatal drowning events occur

• The epidemiological characteristics of non-fatal drowning differ significantly from those of fatal drowning

• Prevention initiatives should target both non-fatal and fatal drowning


Non-fatal Drowning Surveillance System

• The Drowning Prevention Research Centre Canada has announced the creation of a non-fatal drowning surveillance system


Canadian Drowning Prevention Coalition


• November 2014

• First ever global report dedicated to drowning





Key Focus Targets for the First Edition of the Plan

• Children 1-4• New Canadians• Unintentional water entry• Young adult males• Water transport related drowning• Indigenous peoples• People living in Northern and rural

areas and cold water immersion• Drowning in supervised settings

Canadian Drowning Prevention Plan

First Edition: October 2017


The Canadian Drowning Prevention Plan

• Section one: provides an overview of the structure of the Coalition and the context, scope and vision of the Plan• Goal: zero morbidity and mortality from drowning

• Section two: provides a summary of the drowning issue in Canada

• Section three: identifies eight key focus targets for drowning prevention in Canada


Recommendations

• The Government of Canada should increase their engagement with the Canadian Drowning Prevention Coalition and Plan

• Multisectoral collaboration should increase in all areas of drowning prevention

• Community-based coalitions and drowning reduction groups should be formed

• Canadian drowning data collection and research should expand


How Can You Get Involved?

• We need the engagement of all stakeholders for the effective engagement of the Canadian Drowning Prevention Plan and YOU are a stakeholder!

• Join us on Facebook and download a copy of the Plan!

https://www.facebook.com/cdpcoalition.ca/


Conclusions


In Conclusion

• Drowning is a serious but neglected public health threat

• The true burden of drowning includes non-fatal drowning

• Preventing ALL drowning may require targeted non-fatal drowning prevention strategies


Thank you!

Questions/Comments:

[email protected]

Acknowledgments:• York University• Dr. Alison Macpherson• Canadian Institute for Health

Information• Drowning Prevention

Research Centre Canada

Documents

Tessa Clemens - Understanding the Burden of Drowning in ......Global report on drowning: Preventing a leading killer Healthier Children. A Better World. Unintentional Fatal Drowning