Drowning deaths in Australian rivers, creeks and streams: a 10 year analysis

735 people drowned in Australian rivers, creeks and streams between 2002 and 2012. Rivers claimed more lives than any other aquatic location across the same period. • Executive Summary 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. Rivers have consistently been the aquatic location with the highest number of drowning deaths in annual Royal Life Saving National Drowning Reports and subsequent Australian Water Safety Strategies have highlighted the importance of reducing drowning deaths in rivers in order to achieve a 50% reduction in all drowning deaths experienced in Australia by the year 2020. A review of drowning deaths allows for patterns to be identified and evidence-based strategies for drowning reduction can be developed. Data on all known drowning deaths in rivers across the last 10 financial years (1 July 2002 to 30 June 2012) has been sourced from the National Coronial Information System (NCIS), State and Territory Coronial Offices and the media. It has been collated and analysed by the Royal Life Saving Society – Australia. 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. New South Wales, as the most populous State, experienced the highest number of river drowning deaths across the 10 year period of this report, with 246 deaths or 34% of all river drowning deaths. When examining rates per 100,000 population, the Northern Territory experienced the highest average annual rate of river drowning deaths per 100,000 population, with a rate of 1.81 compared to a national annual average of 0.35 drowning deaths per 100,000 population. The Northern Territory’s drowning rate is also over 2.5 times greater than the next closest State, Tasmania, with a rate of 0.66 per 100,000 population. The male rate of drowning in the Northern Territory was the highest of any State or Territory with a rate of 3.19 males drowning per 100,000 population. The average rates per 100,000 population for female drowning deaths in rivers across the States and Territories of Australia were highest in the Northern Territory (0.30), followed by Queensland (0.26) followed by Tasmania (0.24). 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. The largest proportion of drowning deaths in rivers took place in areas deemed Inner Regional (29.7%). A concerning, 10% took place in areas considered to be Very Remote. By their very definition, areas deemed Very Remote are isolated from basic services such as medical services. Therefore first responder skills in CPR and first aid are vital, as is education among those living in Remote and Very Remote areas about how to minimise the risk of drowning in rivers. When river drowning deaths are segmented and analysed by drainage division, the North East Coast division of Queensland had the highest number of drowning deaths, with 27% of all river drowning deaths during the 10 year period of this study. This was followed by the Murray-Darling Basin (21%) and the South East Coast region of New South Wales (19%). By river system, the Murray River experienced the highest number of drowning deaths across the 10 years, followed by the Brisbane River and the Yarra River. Falls into water were the most common activity being undertaken immediately prior to drowning in rivers (20%), followed by accidents involving non- aquatic transport (18%) and swimming and recreating (15%). Males were more likely to drown as a result of intentionally interacting with water or intentionally entering the water as a result of fishing, jumping in, undertaking a rescue and using watercraft. Females were more likely to drown in rivers as a result of unintentionally entering the water, either as a result of being swept away by floodwaters or a non-aquatic transport accident. Summer experienced the highest proportion of river drowning deaths with 39% of the total number of deaths, followed by Spring (23%). Interestingly, Winter experienced one-fifth of all river drowning deaths (146 drowning deaths) and saw a greater number of drowning deaths than occurred in Autumn (131 drowning deaths). Analysis of the data showed that 17% of all river drowning deaths were known to be related to flooding. The State of Queensland experienced 56% of all known flood related drowning deaths in rivers. Over half (56%) of all drowning deaths that took place in flooded rivers were as a result of either being swept in or deliberately entering floodwaters in non-aquatic transport. Further work must be conducted within the community to highlight the dangers of flooded rivers. 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. Almost half (46%) of drowning deaths in Indigenous Australians occurred in the 25-44 years age range. Over half of all Indigenous people that drowned in rivers (54%) were known to have a positive reading for alcohol in their bloodstream when they drowned. Alcohol was also known to be a contributing factor in 64% of all cases where Indigenous people intentionally entered floodwaters. Culturally appropriate strategies to prevent drowning in Indigenous Australians should be developed that highlight the dangers of floodwaters and alcohol consumption whilst recreating in, on or near rivers. 6Alcohol 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. Drowning deaths known to involve alcohol accounted for almost half (49%) of all drowning deaths in the 45-54 years age group. A key issue identified during analysis of the data was the extremely large amounts of alcohol being consumed prior to drowning deaths in rivers. Half of all drowning victims whose blood alcohol concentrations were deemed to be contributory (i.e. a Blood Alcohol Content equal to or greater than 0.05g/L) had a Blood Alcohol Content of 0.2 or higher. This level of alcohol in the bloodstream is four times that of the legal driving limit. Twenty seven percent of all river drowning victims recorded some form of drug in their bloodstream when they drowned. In just over a third of these cases, the drugs were known to be illegal, the most common of which were cannabis and methamphetamine. Of the legal drugs detected, commonly occurring types were anti-depressants, anti-convulsants and cardiovascular agents such as anti-arrythmic drugs. The analysis of river drowning data, clearly indicates a significant issue related to alcohol consumption, in rivers across Australia. Although better reporting is required, drowning prevention strategies for rivers must include information on the risks of interacting with rivers when under the influence of alcohol, alcohol and medications and/or alcohol and illicit drugs. Linked to the issue of medication use is the finding that 37% of all river drowning victims were known to have an underlying medical condition. Logically underlying medical conditions were more common in middle aged and elderly people with people aged 45-54 and 75+ accounting for 38% of all drowning victims in rivers known to have underlying medical conditions. Further research is required around the true contribution of underlying medical conditions to river drowning risk. 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. Further research is also required around the recreational patterns and risk profiles of river drowning black spots and improving our understanding of river user’s attitudes towards the risks and hazards present in rivers

Medium factors affecting extracellular protease activity by Bacillus sp. HTS 102—A novel wild strain isolated from Portuguese merino wool

The synthesis of an extracellular protease by Bacillus sp. HTS102—a wild strain recently isolated from the wool of Portuguese Merino ewes, was optimized. This protease is thermostable and particularly resistant to harsh environmental conditions—and appears to bear a unique ability to hydrolyze keratin-rich solid materials. Following a preliminary screening for the most relevant medium factors involved in processing, a fractional factorial design (2VI 6-1) was applied to ascertain the effects of six relevant parameters— viz. yeast extract concentration, peptone level, inoculum size, stirring rate, temperature and pH. The concentrations of yeast extract and peptone, as well as the incubation temperature and pH were found to play significant roles; and the 2-factor interaction between yeast extract level and pH was also significant. A 2.2-fold increase in the overall level of protease synthesis was eventually attained, with the improved medium relative to the basal medium—which is noteworthy when compared with competing proteases and previous optimization efforts.info:eu-repo/semantics/publishedVersio

Association of Drowning Mortality with Preventive Interventions: A Quarter of a Million Deaths Evaluation in Brazil

In 2015, drowning in Brazil was responsible for 6,043 deaths and was the second leading cause of death in children. Although several prevention strategies have been promoted to reduce drowning, most are still based on low levels of evidence. This study evaluated the effectiveness of prevention and water safety interventions in reducing drowning mortality. Data obtained from the National Mortality System for 36 years were split in two time periods to allow the comparison of drowning mortality numbers before and after implementation of SOBRASA’s drowning prevention and water safety programs and to check for any positive effects attributable to such programs. To assess differences between the two periods, a “drowning water safety score” (DSS) was estimated and compared to mortality/100,000 of population. There were 258,834 drowning deaths over 36 years. A significant decrease of 27% in drowning rates (5.2 to 3.8/100,000;

Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis

Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient’s age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2–80) and 73 (Dechoker©, 5–84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms

World Conference on Drowning Prevention 2019, Durban, South Africa

No Abstract

Resuscitation of the drowned person in the era of COVID-19 disease: a common ground for recommendations, identification of research needs and a global call to action

The following recommendations were developed in April-May 2020 and based on the current knowledge of the SARSCoV-2 virus (COVID-19). As countries, regions and aquatic organisations are at different stages of the disease and have different approaches to reducing the impact of the virus, there may be variations in practice that need to be considered before their implementation. There is also a wide variety in drowning and drowning resuscitation settings around the world. In some drowning resuscitation settings, these recommendations can be easily implemented. In other settings, there will be national recommendations or laws that overrule the situation. It should be recognised that many settings will deserve urgent improvisation or decision making beyond or in conflict with these recommendations. This may be either in the interest of the drowned person or the aquatic rescuer. The COVID-19 places many common drowning resuscitation procedures into a different perspective. Alternative procedures are being implemented but have not yet been tested or validated for applicability. It is expected that during the next few months more information will become available which will further inform the evidence-base of these recommendations

The use of non-uniform drowning terminology: a follow-up study

Background: In 2002, the World Congress on Drowning developed a uniform definition for drowning. The aim of this study is to determine the prevalence of “non-uniform drowning terminology� (NUDT) and “non-uniform drowning definitions� (NUDD) in peer-reviewed scientific literature from 2010 to 2016, and compare these findings with those from our unpublished study performing a similar analysis on literature from 2003 to 2010. Methods: A systematic review was performed using drowning-specific search terms in Pubmed and Web of Science. Titles and abstracts published between July 2010 and January 2016 were screened for relevance to the study focus. Articles meeting screening criteria were reviewed for exclusion criteria to produce the final group of studies. These articles were reviewed by four reviewers for NUDT and NUDD. The Fisher exact test was used to determine any statistically significant changes. Results: The final group of studies included 167 articles. A total of 53 articles (32%) utilized NUDT, with 100% of these including the term “near drowning�. The proportion of articles utilizing NUDT was significantly less than reported by our previous study (p < 0.05). In addition, 32% of the articles included a definition for drowning (uniform or non-uniform), with 15% of these utilizing NUDD. Discussion: Our study reveals a statistically significant improvement over the past thirteen years in the use of uniform drowning terminology in peer-reviewed scientific literature, although year-to-year variability over the current study period does not yield an obvious trend. Conclusions: Of the articles reviewed during the 2010-2016 study period, 32% included outdated and non-uniform drowning terminology and definitions. While this reveals an absolute decrease of 11% as compared with the previous study period (2003-2010), there is still significant room for improvement

Drowning and aquatic injuries dictionary

Background Drowning is a significant public health issue with more than 320,000 deaths globally every year. These numbers are greatly underestimated, however, due to factors such as inadequate data collection, inconsistent categorization and failure to report in certain regions and cultures. The objective of this study was to develop a standardised drowning dictionary using a consensus-based approach. Through creation of this resource, improved clarity amongst stakeholders will be achieved and, as a result, so will our understanding of the drowning issue. Methodology A list of terms and their definitions were created and sent to 16 drowning experts with a broad range of backgrounds across four continents and six languages. A review was conducted using a modified Delphi process over five rounds. A sixth round was done by an external panel evaluating the terms’ content validity. Results The drowning dictionary included more than 350 terms. Of these, less than 10% had been previously published in peer review literature. On average, the external expert validity endorsing the dictionary shows a Scale Content Validity index (S-CVI/Ave) of 0.91, exceeding the scientific recommended value. Ninety one percent of the items present an I-CVI (Level Content Validity Index) value considered acceptable (> 0.78). The endorsement was not a universal agreement (S-CVI/UA:0.44). Conclusion 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

Novas enzimas bacterianas para aplicação na indústria dos lanificios

Doutoramento em Biologia / Instituto Superior de Agronomi

Epidemiology, risk factors and strategies for the prevention of global unintentional fatal drowning in people aged 50 years and older: a systematic review

Purpose: 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. Methods: A systematic literature review was undertaken using English-language, Portuguese-language and Spanish-language papers published between 1980 and 2015. The review explores gaps in the literature with a focus on the epidemiology, risk factors and strategies for the prevention of unintentional fatal drowning among people 50 years and over. Results: 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. Conclusion: 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