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Abstract
Objective To investigate whether the Victorian mandatory personal flotation device wearing regulations that came into effect on 1 December 2005 reduced drowning deaths among recreational boaters in Victoria, Australia.
Design A retrospective population-based ‘before and after’ study using Victorian coronial data on drowning deaths of occupants of recreational vessels operating in Victorian waters.
Methods The annual numbers of deaths in the 5 years after the transition year of the regulations (2005) was compared with the annual numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test.
Results There were 59 recreational boating drowning deaths in the 6-year preintervention period (1 December 1998 to 30 November 2004) compared with 16 in the 5-year postintervention period (1 December 2005 to 30 November 2010). The analysis showed a significant decrease in drowning deaths among all recreational boaters (U=30.0, p=0.01) and among these strata: vessel occupants aged 0–29 years (U=28.0, p=0.02) and 30–59 years (U=27.5, p=0.02), vessel occupants engaged in pleasure cruising (U=29.0, p=0.01) and in ‘other’ boating activities (U=25.0, p=0.04), boaters on small powerboats ≤4.8 m in length (U=29.5; p=0.01), boaters on motorised (U=29.5; p=0.01) and sail-powered vessels (U=26.0; p=0.04), and occupants of vessels operating in inland waterways (U=30.0; p=0.01).
Conclusions These findings provide further support for the adoption of a regulatory approach to personal flotation device wearing to reduce drowning among recreational boaters.
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Introduction
Boater drowning deaths are a major contributor to all drowning deaths in Australia and other developed countries.1 Personal flotation devices (PFDs), also known as life jackets and life or buoyancy vests, are designed to keep wearers afloat for a period of time to increase their chances of rescue and survival in the event of immersion. Emerging evidence indicates that PFD wearing reduces the risk of fatal drowning among recreational boaters.2 ,3
There is sparse evidence to show that the promotional campaigns undertaken in a number of countries since the early 1990s increased PFD wearing among recreational boaters. Presurveys and postsurveys evaluating the impact of PFD wearing campaigns conducted in King County in Washington found that the 12-month campaign targeting all recreational boaters significantly increased their PFD wear,4 whereas the 3-year campaign targeting children in three recreational aquatic settings did not significantly increase wear by child boaters.5 A recent longitudinal survey of life jacket use by boaters across the USA over 12 years,6 and an observational survey of life jacket use in Washington state in 2010,7 demonstrate low life jacket use and little change in usage rates over more than a decade despite educational efforts.6 ,7 National wear rates in the USA hovered between 14% and 17% over the 12-year study period,6 and increased slightly (from 25% in 1995 to 31% in 2010) in Washington State.7 The before and after evaluation of a PFD wearing promotion campaign conducted in Victoria in 2002/2003 found it did not shift the overall preintervention boater wearing rate from 13%.8
Tasmania, the smallest of the six Australian states, was the first jurisdiction in the world to mandate PFD wearing for recreational boaters.9 From 2001, all persons on powered recreational vessels less than 6 m (19.7 feet) in hull length are required to wear an approved PFD when the vessel is under power.9 An unpublished prestudy and poststudy of the effectiveness of this measure showed a non-significant reduction in the mean number of boater drowning deaths, but a statistically significant reduction in the drowning rate per 100 000 registered recreational vessels in the postintervention period (2001–2010) compared with the preintervention period (1985–2000). (Personal Communication, P Hopkins, Manager Recreational Boating, Marine Safety Tasmania)
More stringent PFD wearing regulations came into effect in Victoria (population 5.1 million), the second largest state of Australia on 1 December 2005, 5 months later than originally planned.10 Prior to this date, Victorian regulations required that: all recreational vessels carry sufficient PFDs for every occupant on board for use in emergencies; child boaters aged under 10 years and persons being towed by power vessels (eg, water-skiers and wakeboard riders) wear PFDs; and the carrying of PFDs on personal watercraft was waived if all riders wore them.11
The Marine (Personal Flotation Devices and Other Safety Equipment) Regulations 2005 (Vic), administered by the state's marine authority—Marine Safety Victoria (MSV), required all occupants of recreational vessels to wear a specified type of PFD at certain designated times, based on international standards for vessel buoyancy and stability that recognised that vessels 4.8 m (15.7 feet) or less in hull length are more susceptible to swamping and capsize.
Occupants of ‘small’ recreational vessels were required to wear a PFD when in an open area of the vessel when the vessel was under way that is, not at anchor, made fast to the shore, aground or drifting.10 ‘Small’ vessels include power driven vessels ≤4.8 m in hull length, off-the-beach sailing yachts, personal watercraft, canoes, kayaks, rowing boats, pedal and fun boats, kite boards and sailboards.10 Occupants of ‘larger’ recreational vessels were required to wear a PFD at defined times of ‘heightened risk’ (eg, at night, when crossing a bar and by sole operators) when the vessel was under way and the occupant was in an open area of the vessel.10 ‘Larger’ vessels were power driven vessels >4.8–12 m in hull length and yachts, including monohull, trailerable and multihull yachts.10 The type of approved PFD to be worn—Type 1 (life jacket), Type 2 (buoyancy vest in high visibility colours) or Type 3 (buoyancy vest in other colours)—was specified for each vessel type and waterway classification (inland, enclosed and coastal). The Victorian water police were responsible for enforcement.
Factors influencing the Victorian government's decision to review12 and then strengthen PFD wearing regulations included: coroners’ recommendations that PFD wearing should be mandatory for recreational boaters13; the high involvement of recreational boaters in drowning deaths in Victoria13; the findings of the study of coronial investigations into 40 recreational vessel drowning deaths that identified that non-wearing of available PFDs, hazardous environmental conditions and sudden and unexpected entry of vessel occupant/s into the water were common contributory factors to drowning13; a report on recreational boating-related incidents and injuries in Victoria14; and the lack of impact of MSV's statewide PFD wearing promotion campaign, ‘Life Jackets Save Lives’, conducted in 2002–2003.8 The study aimed to investigate whether the 2005 PFD wearing regulations reduced drowning deaths among recreational boaters in Victoria.
Methods
Research design
This is a retrospective population-based ‘before and after’ study of Victorian coronial data on all drowning deaths of occupants of recreational vessels operating in Victorian waters. For the purposes of this study a ‘year’ ran from December 1 to November 30 as the compulsory PFD wearing regulations came into force on 1 December 2005.
The ‘year’ the regulations were introduced (1 December 2004 to 30 November 2005) was not included in the preintervention period. This was because of concern that the late postponement by government of the effective start date from 1 July to 1 December 2005 resulted in public confusion. The preintervention period covered the 6 ‘years’ before the year the regulations came into force (1 December 1998 to 30 November 2004). The postintervention period covered the 5 ‘years’ after the regulations came into force (1 December 2005 to 30 November 2010). At the time of writing, coronial investigations on boating drowning deaths in the 2010/2011 ‘year’ were not complete.
Data sources and case selection
The Coroners Act 2008 (Vic) and the prior Coroners Act 1985 (Vic) that was in force until 1 November 2009 require all deaths from external causes occurring in Victoria to be investigated by the coroner.15 ,16 Data on drowning deaths were sourced from paper-based records generated for the coroner's investigation. These mostly included: the police report on the death and their brief of evidence containing statements and photographs; postmortem reports (autopsy and forensic toxicology); a marine death report compiled by MSV; and the coroner's finding.
Case identification
Deaths were identified by searching the coroner's electronic case management system using the incident code for drowning (‘DRW’) and key words ‘immers*’ and ‘drown*’. The coroners’ findings on extracted cases were independently reviewed by two authors (LB and LRB) to identify eligible cases. Disagreement on eligibility was resolved in discussion with the second author (EC). Cases and case details were verified by cross-referencing eligible deaths found on the coroners’ case management system against drowning deaths independently recorded in Transport Safety Victoria's Marine Incident Database (MID).
Inclusion criteria
Cases were included if:
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the death of the vessel occupant was ‘reportable’;
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the fatal incident occurred between 1 December 1998 and 30 November 2004 (preintervention period) and 1 December 2005 and 30 November 2010 (postintervention period);
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the underlying cause of death was determined by a coroner as either ‘drowning’ or ‘immersion’ even if other factors such as hypothermia, trauma or a natural disease were found by the Coroner to have contributed or be present;
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the vessel involved was being used for the purposes of recreation (including hire and drive vessels) and not for commercial gain; and
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the deceased did not enter the water intentionally for pleasure or for a non-emergency related reason
The paper-based coroner's record for each eligible death was reviewed and variables of interest were recorded for analysis in Statistical Package for the Social Sciences (SPSS) V.15. Recorded variables included: demographic and person-based characteristics (age, sex, swimming ability); incident details (date and time, reason for entering water); vessel details (type, make, model, length); physical environment of the incident including type of waterway, distance from shore and weather conditions; presence and use of safety equipment on the vessel—marine radio, flares, Emergency Position Indicating Radio Beacon (EPIRB), PFD availability and type and use at time of immersion by decedent; rescue details; and up to four contributory factors to the drowning. The MID was used as a supplementary source of data on missing variables.
Data analysis
To examine the impact of the 2005 PFD wearing regulations on boating drowning deaths, the numbers of deaths in each of the 5 years after the transition year of the regulations was compared with the numbers of deaths in the 6 years prior to the transition year, using the Mann-Whitney U test.
Sensitivity analyses were performed to explore the effect of excluding the two drowning deaths that occurred in the transition year from the preintervention period.
Results
There were 59 recreational boating drowning deaths in the 6-year preintervention period compared with 16 in the 5-year postintervention period (table 1). Half of the decedents were fishers and a further third were engaged in pleasure cruising. All but one of the decedents were male. There was a highly significant decrease in drowning deaths overall and among vessel occupants aged 0–29 years and 30–59 years, but the decrease in drowning deaths among boaters aged 60 years and older did not reach statistical significance. Drowning deaths decreased significantly among boaters engaged in pleasure cruising (and also in those engaged in ‘other’ boating activities), however the decrease in drowning deaths among fishers was not statistically significant.
Precomparison and postcomparison of the frequency of drowning deaths of recreational vessel occupants, overall and by demographic and other characteristics—Victoria, 1 December 1998 to 30 November 2004 and 1 December 2005 to 30 November 2010
Analysis of data by vessel characteristics showed a highly statistically significant decrease in drowning deaths among occupants of small powerboats (ie, vessels measuring 4.8 m or less in length). Drowning deaths also decreased among occupants of larger vessels but the decrease was not statistically significant. Analysis by vessel type, independent of size, revealed significant decreases in drowning deaths among occupants of motorised and sail-powered vessels. Decreases in drowning deaths were evident for all waterway types (enclosed, coastal and inland) but the only significant decrease was found for boaters on inland waterways.
Cell numbers in some groups were too small to make estimations. Running the analysis again to include the two deaths that occurred in the transition year (2004/2005) in the preintervention period did not substantially affect the results.
PFD wearing status and other contributory factors to drowning deaths
Preintervention
In the 6-year preintervention period, 11 of the 59 decedents (18.6%) were wearing a PFD at the time of immersion (table 2). Of the 11 who drowned wearing a PFD, two were wearing their PFD incorrectly and two others were wearing inadequate PFDs for the waterway type. The most common contributory factor to drowning recorded for the 11 PFD wearers was that the alarm was not raised immediately (n=8)—due to unavailability (n=5) or non-use (n=1) of available distress signalling radio equipment or unknown reasons (n=2)—which led to delays in activating search and rescue procedures by authorities. Other contributors were that the decedent suffered a head injury or cardiac event prior to immersion (n=3), was exposed to cold water temperature (n=2), had poor swimming ability (n=1), was operating the vessel alone (n=1), was trapped under a wedged vessel and could not be rescued (n=1) and/or was affected by alcohol (n=1). The PFD wearing status of two decedents (3.4%) was not known as there was no witness to the incident and their bodies were not recovered.
Personal flotation device (PFD) wear by vessel length and type for fatal drowning of recreational vessel occupants before and after the introduction of mandatory PFD wear regulations Victoria 1998–2004 and 2005–2010
Forty-six (78.0%) of the 59 boaters who drowned in the preintervention period were not wearing a PFD and in 20 of these cases search and rescue efforts were delayed as the alarm was not raised immediately due to the unavailability (n=10) or non-use (n=4) of available distress signalling radio equipment or unknown reasons (n=6). Other contributory factors to drowning among non-PFD wearers included: adverse environmental (weather and marine) conditions (n=13 cases); decedent was a sole operator (n=8); decedent was affected by alcohol (n=6); decedent suffered from a medical condition/event or injury prior to immersion (n=6); decedent had poor swimming ability (n=6); decedent was wearing waders (n=5); cold water temperature (n=5); decedent experienced postincident shock and disorientation (n=2); and decedent attempted to swim to shore (n=2).
Postintervention
In the 5-year postintervention period, 5 of the 16 decedents (31.3%) were wearing PFDs. In two cases the PFDs being worn were legal and correctly fastened, in another two cases the PFDs used were illegal, that is, not approved for the waterway type, and in one case the PFD was worn incorrectly. Factors contributing to drowning among PFD wearers were: sole operator (n=4); alarm not raised immediately (n=3); delay in search and rescue (n=4); cold water temperature (n=1); and decedent was trapped under an overturned vessel (n=1). The PFD wearing status of two others (12.5%) was not known as their bodies were not recovered.
Nine of the 16 (56.2%) decedents in the postintervention period were not wearing PFDs. Seven of the nine non-wearers should have been wearing a PFD at the time of their immersion under the 2005 regulations because of the type of vessel they were occupying. In four of these cases, a PFD Type 1 was being carried in the vessel from which they fell or were ejected. Other factors contributing to drowning of the seven non-wearers were: delay in search and rescue (n=4); operating vessel alone (n=3); poor swimming ability (n=2); alcohol/illicit drug use (n=2); alarm not raised immediately (n=1); decedent suffered a non-fatal cardiac event (n=1); decedent's leg was entangled in the rope from a craypot holding him underwater (n=1); and fatigue due to attempted swim to shore (n=1).
Discussion
This study showed a highly significant reduction in drowning deaths following the introduction of compulsory PFD wearing regulation in Victoria in late 2005, heavily influenced by the significant decrease in drowning deaths among occupants of small powerboats. The results were robust across multiple factors (age of boaters, vessel characteristics and purpose of the boating trip).
Strong supporting evidence for an association between these results and increased PFD wearing is provided by the before and after observation study of PFD use by recreational boaters in Victoria.17 The observation study, focused only on use by occupants of small (≤4.8 m in hull length) motorised vessels, found that their wearing rate increased from 22% preregulation (January to March 2005) through 54% in the transition year (January to March 2006) to 63% postregulation (January to March 2007).17 Regression analysis indicated there was a highly significant eightfold increase in the odds of occupants of small motorised vessels wearing PFDs during January to March 2007 compared with January to March 2005 (OR 8.17, p<0001, CI 6.6 to 10.1). PFD wearing data on occupants of large vessels at defined times of heightened risk were not collected.17
The new PFD wearing requirements were widely publicised in a MSV public awareness campaign that ran from December 2005 to June 2006.18 The multistrategy campaign used all communications media with good reach to boaters and a direct mail-out of an information brochure to all registered vessel owners.18 The campaign evaluation survey of a representative sample of 400 recreational vessel licence holders conducted in mid-2006 found that 81% of respondents were aware that PFD wearing requirements had changed and a substantial proportion reported PFD-related behaviour change postregulation including wearing their life jackets more often (46%), checking their life jackets (77%) and buying/obtaining new life jacket/s (36%).18 An educational, rather than a punitive, approach to enforcement was employed in the 2005/2006 and 2006/2007 boating seasons. Patrolling MSV-employed Boating Safety Officers were instructed to inform non-complying boaters of the new regulations rather than issue infringement notices and MID records show that marine police also issued few PFD-related infringement notices over this period (Personal communication, Greg Darby, Senior Maritime Safety Officer, Transport Safety Victoria—Maritime, 24 March 2014).
Two previous studies also provide evidence on the effectiveness of PFDs in reducing the risk of fatal drowning among recreational boaters,2 ,3 but one was of weak design2 and the other, of sound design, had substantial missing data.3 A recent study that evaluated the effectiveness of two approaches to changing life jacket wearing behaviour—a target marketing campaign in the California Delta region and a pilot of mandatory wear regulations at four lakes in the state of Mississippi—reported that the marketing campaign had only a small effect on adult wear rates whereas the mandatory regulations increased wear from 14% to 76% during the 1st year with only a 6% deterioration in wear 3 years postintervention.19 The current study is the first to indicate that mandatory PFD wearing regulations (that were shown by observation to significantly increase use) led to decreased drowning deaths among recreational boaters. These results mirror the successes experienced in Victoria and elsewhere in the road safety field in the areas of motorcycle and bicycle helmet legislation where evaluations showed that legislation mandating personal protective equipment use were effective in increasing use and decreasing related injury.20–22
In the postintervention period of the present study, two decedents drowned when wearing the prescribed (and properly fitted) PFD. In these two cases, the presence of other risk/contributory factors influenced outcome. The major contributory factor to fatal drowning of PFD wearers and non-wearers alike in the preintervention and postintervention periods was delayed search and rescue due to boaters not carrying or activating available distress signalling equipment at the time of the emergency (radio and/or EPIRB) and/or not following safety rules about letting someone on shore know their trip plan including point of departure and planned time of return before embarking on the trip.
The cost of high quality EPIRBs and personal location beacons has reduced over time and consideration should be given to their mandatory carriage on recreational vessels on a wider range of waterways. Current Victorian legislation only requires specified recreational vessels operating more than 2 nautical miles from the coast to be equipped with a marine radio (powerboats and yachts) and/or registered EPIRB (powerboats, yachts and human powered vessels).
The Victorian PFD wear observation study17 and the current study showed that a third of boaters on small powered vessels and half of the recreational boating drowning victims, respectively, were not complying with PFD wearing regulations in the postintervention periods studied. Ongoing enforcement and targeted public awareness are necessary to maintain the apparent effectiveness of Victoria's 2005 PFD wearing regulations. The impact of PFD wearing regulations on wearing rates and fatal drowning should be continually monitored.
The major strength of this study was that detailed information was available on all recreational boating drowning deaths that occurred over the study period, generated from records of coroners’ investigations cross-checked against deaths recorded on the MID. Cross referencing coroners’ records with those held on the MID indicated full case capture in this study and using both sources ensured there was little missing data on variables of interest.
There were study limitations. This was a ‘real world’ evaluation with no comparison community so other factors such as the increasing carriage of EPIRBs and mobile phones and decrease in alcohol use by boaters may have contributed to the decrease in deaths. Exposure to risk in recreational boating may have decreased in the postintervention period due to the severe drought in Victoria (that began in 2003 and broke in 2010) that led to the progressive curtailment of recreational boating on inland waterways. However, there was some anecdotal evidence of an increase in vessel traffic in viable inland waterways and vessel registrations (which is compulsory in Victoria for motorised recreational vessels) increased from 160 103 in 2005/2006 to around 167 000 in 2010/2011.23 MID vessel registration data indicate that registrations increased steadily over the entire period of the current study, from 134 589 vessels in 1999/2000 through 150 478 in 2003/2004 and 160 163 in 2005/2006 to 168 712 in 2010/2011 (Personal communication, Greg Darby, Senior Maritime Safety Officer, Transport Safety Victoria, 21 March 2014).
These findings provide further support for the adoption of a regulatory approach, supported by visible promotion and enforcement, to increase PFD wearing in other jurisdictions. Consideration should be given to adopting the more stringent regulations in force in Tasmania, where mandatory wear applies to occupants of motor boats under 6 m in hull length as this measure has the potential to save more lives.
What is already known on the subject
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Recreational vessel occupants comprise a sizeable proportion of drowning deaths in Australia and other high-income countries.
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Personal flotation devices (PFDs), generally called life jackets, are a recommended drowning prevention measure but current evidence indicates that PFD wearing education and promotion campaigns targeting boaters have had only a small impact on wearing rates. Victoria was the second jurisdiction in the world to introduce mandatory PFD wearing regulations for boaters; the regulations came into effect on 1 December 2005.
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An observational study showed that the prevalence of PFD use increased from 22% (prelegislation) to 63% (postlegislation) on small power vessels in Victoria.
What this study adds
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This is the first published study to investigate the effectiveness of regulations mandating PFD wear on drowning deaths of recreational boaters.
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There were 59 recreational boating drowning deaths in the 6-year preintervention period compared with 16 in the 5 year postintervention period.
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Statistical analysis showed a significant decrease in recreational boating drowning deaths overall and among vessel occupants aged 0–59 years, boaters engaged in pleasure cruising, boaters on small power vessels, all motorised vessels and sail powered vessels and occupants of vessels operating on inland waterways.
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These findings provide support for the adoption of mandatory PFD wearing regulations in other jurisdictions.
India and the USA join to control injuries
The US Department of Health and Human Services and India's Ministry of Health have signed a Memorandum of Understanding on Environmental and Occupational Health and Injury Prevention and Control. The Memorandum encourages further cooperation in research efforts, education, training and capacity-building activities in a number of areas including public health aspects of … road safety and burn injuries. (noted by IBP).
Acknowledgments
The authors acknowledge Emma Flatman and Heather Hoare from the Coroners Court of Victoria for their assistance with providing access to records. The authors thank Peter Corcoran, Greg Darby and Astrid Kaufman from Transport Safety Victoria—Maritime (formerly Marine Safety Victoria) for providing missing data, validating data gathered from the coroners records and their expert comments on the variables and the manuscript. The authors also acknowledge Mr Graeme Johnstone, State Coroner of Victoria (1994–2007), whose investigations and recommendations on ways to reduce recreational boating drowning deaths made a major contribution to strengthening marine safety regulations in Victoria.
References
Supplementary materials
Press release
Files in this Data Supplement:
Footnotes
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Contributors LB, EC and LRB conceived of the study and its design. LB and LRB acquired the data. All authors contributed to data analysis, interpretation, manuscript development, revision and final approval.
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Competing interests EC was a recipient of a research programme grant from Marine Safety Victoria but this study was not a component of this programme and was undertaken after the MSV-funded research period ended. LB and LRB work in the Prevention Unit of the Coroners Court of Victoria but completed this project outside work hours.
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Ethics approval Ethical approval to access coroners’ records was granted by the Victorian Department of Justice Human Research Ethics Committee and the research was endorsed by the Victorian State Coroner.
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Provenance and peer review Not commissioned; externally peer reviewed.