Shelley Dalke

PW 2659 Trend analysis for assessing remaining at-risk activities and environmental factors as toddler immersion mortality approaches target zero, canada 1991–2014

Background Toddler (ages 1–4) immersions appear a 1990s success story for Canadian drowning prevention. We reassess methods to indicate paths towards target zero. Objective To assess use of trends in activities and risk factors to study a category by age of high mortality reduction – in the interest of targeting remaining mortality. Methods The first national injury surveillance in Canada began in 1991, for water-related injury, and is now at the quarter century mark. Immersion data have been collected prospectively from coroners during 1991–2014. Incidence trends and evolving activities and risk factors among 1–4 year-olds were assessed by R and Excel. Trends were assessed by negative binomial modelling. Results There were 643 immersion deaths of toddlers. Total incidence reduction was −88% (p 0.000), IRR (incidence rate ratio) 0.94, 95% CI 0.92, 0.95 (Z=7.86, p=0.000) Average annual percent change −6.3%. Incidence fell from 2.98/100,000/year during 1991–95 to 2.21 in 1996–2000, to 1.45 in 2001–05, slowing to 1.06 in 2006–10, and edging up to 1.23 in 2011–14. Most immersions involved non-aquatic activity with falls into water while playing near water. Although a major reduction occurred, falls have remained the leading factor. Incidence began high in lakes and home pools and still remains highest there despite major improvements. Large reductions in immersions of indigenous peoples occurred. Sustained major rate reduction took place in the three largest provinces, while remaining high in the Prairies. Many toddlers drown alone or under care of other children. As toddlers age from 1 to 4 years, death increasingly results during delegation to other children. Conclusions Falls into water, pools, lakes and adult bathtubs should be targets. Increasing use of child caregivers as toddlers age suggest needs for subsidised community daycare, and barriers for play-area pools, or homes near water. Toddler drownings are unacceptable – target zero is within reach.

PW 1000 Deaths by immersion in and around homes in canada, twenty-three years of epidemiology and failed policy: a built environment issue

Background National population-based data on home drownings are scarce. They represent 17% (1995/11280) of submersion fatalities in Canada. Objective Assess circumstances of drownings in/around homes, i.e., activities, personal, equipment, environment. Methods Using structured questionnaires, coroners’ data were collected prospectively in 1991–2013 during national surveillance of water-related injury deaths. Population averaged 30 million. Findings 11 915 deaths included 11 280 immersions with drowning and/or hypothermia, 584 trauma 39 other 12 unknown. 18% (n=1,995) occurred at home and 5% (n=515) at cottages/cabins. Activities Bathing accounted for 43%(n=864), aquatic 23%(n=466), falls into water 28%(n=565), other knowns 6%(n=111), unknown 2%(n=36). Personal factors Victims were 60% male. 61% of females and 32% of males drowned in bathtubs. 32% of males drowned in swimming pools, 22% of females. Infants<1 year-old accounted for 3%(n=57) of deaths, toddlers 1–4 years-old 17%(n=344), 5–14 year-olds 5%(n=107), 15–24 year-olds 7%(n=140), 25–74 year-olds 51%(n=1014), and ≥75, 17%(333). 3% were indigenous peoples. Medical conditions included seizures 17%(n=353), mental disabilities 5%, depression 7%, alcoholism 10%, schizophrenia 2%, physical disabilities 5%, diabetes 5%, and acute medical condition such as cardiac 3%. For ≥15 years-olds, 29% were alcohol associated, 22% above 80 mg%, 5% below, 2% suspected, 48% zero; Illegal drugs 5%. 14% were non-swimmers, 3% weak. Environment 77% (n=1567) involved person-made structures: bathtubs 56%(n=877), swimming pools 36% (n=557), hot tubs 8%(n=119), ornamental ponds 1%(n=14). Flatwater, i.e., lakes, ponds, reservoirs and dugouts accounted for 11%(n=228), moving water, i.e., rivers and streams 5%(n=96), oceans<1%(n=6). Supervision/accompaniment For children 1–14 years old, 68% were alone, 22% with minors, and 10% with adults. Resuscitation CPR and/or rescue breathing was done for 55%. Trends There was a mean 87 deaths/year, 0.28/100,000 population/year and no significant change. Conclusion and policy implications Nearly all fatalities involved consumer products in built environments and should be avertable by design, eliminating or modifying pools and adult bathtubs. Alcohol and seizures were other modifiable hazards.

829 Review of recreational and occupational pfd wearing legislation at provincial, state, and municipal levels in Canada and internationally

Background With a few notable exceptions, national legislation requiring wearing of a personal flotation device or lifejacket by boaters is uncommon. As a result some municipalities and provinces or states have introduced their own regulations. Methods Information was obtained by searching of Safety Lit and other sources, including by contacting instigators of national legislation Results Regulations for recreational and occupational boating were obtained for all 13 Canadian provinces and territories as well as one city. Canadian laws were diverse and are relatively weak, with the notable exception of the city of Calgary. Information was also obtained for Australia, Ireland, New Zealand, and the United States. In the United States, state laws supersede the national law, which appears mainly oriented towards children. The Irish legislation is more comprehensive than most. The most comprehensive state law in Australia is in Victoria State and has had remarkable success in improving outcomes as measured by boating drowning fatalities. In New Zealand, 18 regions and cities have regulations, some of which were comprehensive in requiring mandatory wearing. Many regulation featured opt out clauses at the discretion of the operator. Conclusions Current legislation on wearing of flotation devices is variable. If the weak regulations in many jurisdictions were to be replaced by those such as in Victoria, Ireland and certain regions and cities in New Zealand, it is probable that many boating fatalities could be averted. Since children are uncommon victims of boating immersion in many high income countries, legislation targeting children will not be expected to be effective in such countries, with certain exceptions such as indigenous peoples. Rather the focus should be adult males

828 Non-wearing of flotation devices and swimming ability of boating immersion victims in Canada

Background Boating is the most frequent activity for water-related immersion deaths in Canada. Central in immersion/drowning is non-wearing of personal flotation devices (PFDs). Anecdotal observation of frequent non-wearing among victims led to quantitive assessment using negative binomial and Poisson regression models. Methods Annual Red Cross collection of 1991–2010 Canadian coroner data was by structured questionnaire. Analysis included ten variables in the final model. Results There were 2678 recreational and daily living boating immersion deaths during 1991–2010. Certain variables significantly increased the odds of properly wearing a PFD and others decreased them. Controlling for all other variables, victims with average swimming ability had 1.93 times the odds of wearing compared with non and weak swimmers combined (95% CI: 1.29–2.87). Strong swimmers had 1.90 times the odds of wearing compared with non/weak swimmers (95% CI: 1.06–3.40). Conclusion It was surprising that boating victims with low swimming ability were less likely than swimmers to have worn a flotation device. It is possible, but remains to be established, that poor swimmers were less likely to have participated in a swimming course, which included the main elements of water safety for boating and other activities.