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Objectives Heatwaves have been linked to increased levels of health service demand in Australia. This systematic literature review aimed to explore health service demand during Australian heatwaves for hospital admissions, emergency department presentations, ambulance call-outs, and risk of mortality. Study design A systematic review to explore peer-reviewed heatwave literature published from 2000 to 2020. Data sources Articles were reviewed from six databases (MEDLINE, Scopus, Web of Science, PsychINFO, ProQuest, Science Direct). Search terms included: heatwave, extreme heat, ambulance, emergency department, and hospital. Studies were included if they explored heat for a period of two or more consecutive days. Studies were excluded if they did not define a threshold for extreme heat or if they explored data only from workers compensation claims and major events. Data synthesis This review was prospectively registered with PROSPERO (# CRD42021227395 ). Forty-five papers were included in the final review following full-text screening. Following a quality assessment using the GRADE approach, data were extracted to a spreadsheet and compared. Significant increases in mortality, as well as hospital, emergency, and ambulance demand, were found across Australia during heatwave periods. Admissions for cardiovascular, renal, respiratory, mental and behavioural conditions exhibited increases during heatwaves. The most vulnerable groups during heatwaves were children (< 18 years) and the elderly (60+). Conclusions Heatwaves in Australia will continue to increase in duration and frequency due to the effects of climate change. Health planning is essential at the community, state, and federal levels to mitigate the impacts of heatwaves on health and health service delivery especially for vulnerable populations. However, understanding the true impact of heatwaves on health service demand is complicated by differing definitions and methodology in the literature. The Excess Heat Factor (EHF) is the preferred approach to defining heatwaves given its consideration of local climate variability and acclimatisation. Future research should explore evidence-based and spatially relevant heatwave prevention programs. An enhanced understanding of heatwave health impacts including service demand will inform the development of such programs which are necessary to promote population and health system resilience.

Fatal and non-fatal drowning is a significant public health issue, which disproportionately impacts children and young people. In Australia, the highest fatal and non-fatal drowning rates occur in children under five years of age. To date, little qualitative research has been conducted on non-fatal drowning, with causal factor analysis generally conducted using coronial and hospital data. This study’s aim was to identify causal factors in hospital treated cases of non-fatal drowning in children as qualitatively self-reported by parents and caregivers. Cases of unintentional child (0–16 years) non-fatal drowning admissions and Emergency Department presentations to three tertiary care paediatric hospitals in New South Wales, Australia were identified via International Classification of Diseases (ICD) coding. Parents and caregivers of drowning patients were invited to participate in a semi-structured interview. Data were thematically coded using an inductive approach, with a focus on causal factors and recommendations for preventive approaches. Of 169 incidents, 86 parents/caregivers were interviewed. Children hospitalised for drowning were more often male (59.3%), aged 0–4 years (79.1%) and 30.2% were from household who spoke a language other than English. Qualitative incident descriptions were coded to five themes: lapse of supervision, unintended access (commonly in home swimming pools), brief immersion (usually young children bathing), falls into water and ongoing impacts. Drowning prevention recommendations were grouped under supervision, pool barriers and maintenance, cardiopulmonary resuscitation (CPR) training and emergency response, drowning is quick and silent, and learning swimming. Parents and caregivers of young children require ongoing education regarding supervision distractions and pool barrier compliance. Additional challenges are faced by those in rental properties with pools, parents/caregivers who cannot swim, and parents/caregivers from culturally and linguistically diverse backgrounds. Affordable, accessible, and culturally appropriate swimming lessons, water safety education and CPR training should be made more available for adult caregivers, particularly in languages other than English.

Surfing and bodyboarding (SAB) are popular activities, but not without risk. Limited SAB mortality and exposure risk explorations exist, so this cross-sectional study explores epidemiology and risk factors for SAB deaths (1 July, 2004–30 June,2020) in Australia: including decedent and incident profiles, causes of death, differences between fatalities during SAB and other coastal activities; and the impact of exposure on SAB mortality risk. Fatality data were sourced from the National Coronial Information System, incident and media reports. Tide-state data, population data and participation data were sourced from relevant authorities. Analyses included chi-square testing and simple logistic regression with odds ratios. There were 155 SAB deaths (80.6% surfing; 96.1% male; 36.8% aged 55+years; 0.04/100,000 residents; 0.63/100,000 surfers). Drowning was the most common cause of death (58.1%; n = 90), but higher in bodyboarding, with bodyboarders 4.62 times more likely to drown than surfers (95%CI: 1.66–12.82; p = 0.003). Almost half (44.5%; n = 69; χ 2 2 = 9.802; p = 0.007) were with friends/family, and the largest proportion occurred during a rising tide (41.3%; n = 64; χ 2 3 = 180.627; p<0.001) followed by a low tide (36.8%;n = 57). Australians surf 45.7 times each year, for 1.88 hours each visit equalling 86.1 ‘exposed’ hours. With exposure-time considered, exposure-adjusted surfer mortality rate (0.06/1 million hours) is lower than other in-water activities (0.11/1 million hours). Younger surfers (14–34 years) surfed more yet had the lowest mortality rate (114.5 hours/year; 0.02/1 million hours). Older surfers (55+ years) had a lower SAB mortality rate (0.052) than the all-cause crude mortality rate of their average population counterparts (1.36). Cardiac conditions were identified in 32.9% (n = 69) of SAB deaths. SAB are relatively safe, with lower exposure mortality rates than other activities. Prevention should target older surfers, inland residents, and identification of surfers with risk factors for cardiac events.

Describe unintentional drowning deaths in rivers, creeks and streams (rivers) in Australia and identify risk factors to inform prevention. This study is a cross-sectional, total population audit of all unintentional fatal drownings in Australian rivers between 1-July-2002 and 30-June-2012 using Australian coronial data. A modified Bonferroni test has been applied, deeming statistical significance p<0.03 and p<0.04 respectively. Rivers (n = 770; 26.6%) were the leading location among the 2,892 people who died from unintentional fatal drowning. This is a rate of 0.37/100,000 people / annum. Within river drowning deaths common groups include; males (80.4%), adults (85.3%), adults who have consumed alcohol (25.5%), people who fell in (21.3%), people involved in non-aquatic transport incidents (18.2%) and locals (74.0%). Children were 1.75 times more likely than adults (p<0.04) to drown in rivers as a result of a fall and adults 1.50 times more likely to drown in rivers as a result of watercraft incidents when compared to children. When compared to males, females were 2.27 and 4.45 times respectively more likely to drown in rivers as a result of incidents involving non-aquatic transport (p<0.04) and being swept away by floodwaters (p<0.04). Males were 2.66 and 4.27 times respectively more likely to drown in rivers as a result of watercraft incidents (p<0.04) and as a result of jumping in (p<0.04) when compared to females. While rivers are the leading location for drowning in Australia, little is understood about the risks. This study has identified key groups (males, adults, locals) and activities. While males were more likely to drown, the risk profile for females differed.

Introduction Drowning is a public health problem in Türkiye, as in the rest of the world. This study aims to systematically review the literature on drowning in Türkiye with a focus on data sources, epidemiology, risk factors and prevention strategies. Methods: Literature searches were conducted using PubMed, SPORTSDiscus, Scopus, Web of Science, Turk MEDLINE, Google Scholar and Google Akademik (Turkish language). Studies (limited to original research written in English and Turkish) reporting drowning (unintentional and intentional; fatal and non-fatal) of residents and tourists in Türkiye were independently dual screened at the title and abstract and full text stages. Study quality was assessed using JBI checklists and evidence level assessed based on study design. Results: From a total of 917 studies, 49 met the inclusion criteria. Most (51%) focused on unintentional fatal drowning. Included studies were most commonly analytical cross-sectional studies ( n  = 23) and case series ( n  = 20) meaning the evidence level was low or very low for 48 (98%) studies. Fifteen studies examined drowning at the national level, while sub-national studies ( n  = 30) focused on urban areas across three provinces: Antalya ( n  = 6), Istanbul ( n  = 6), Izmir ( n  = 4). There was little consensus on risk factors beyond male drowning risk, and no data reported on implemented or evaluated drowning prevention interventions. Discussion: There is a need for more national-level studies to identify the causes of drowning and to guide intervention implementation and evaluation to inform policy makers and donors. Currently official data is limited in its detail, providing age and gender data only, hampering efforts to identify, and thus address, causal factors for drowning. Practical applications: There is currently very little evidence to inform investment in effective drowning prevention interventions in Türkiye. To improve this, data collection systems on drowning in Türkiye need to be strengthened via the development a national drowning registry. Trial Registration #CRD42022382615.

Unintentional drowning deaths are only part of the drowning profile, with little attention being paid to intentional drowning in Australia. Strategies for the prevention of intentional drowning deaths are likely to be different from unintentional. Quality documentation, analysis and dissemination of intentional deaths data is crucial for developing appropriate strategies for prevention. To conduct a systematic literature review to investigate the mortality rates and risk factors of intentional drowning deaths in Australia. A systematic search guided by PRISMA was performed using Ovid MEDLINE, CINAHL, PsycINFO (ProQuest), Scopus, Google Scholar, and BioMed Central databases to locate relevant original research articles published between 2007 and 2018. Ten papers reporting the mortality rates and risk factors of intentional drowning deaths in Australia published between 2007 and 2018, with study periods of the included articles spanning from 1907 to 2012, were reviewed. Most studies investigated suicidal drowning deaths in Australia, none reported homicidal drowning deaths. The downward trend of fatal suicide drowning was identified in Australia. The annual rate of intentional drowning between 1994 and 2012 can be inferred from eight studies, ranging from 0.06 to 0.21 for nation-wide mortality rates. The highest annual state-wide mortality rate was identified in the state of Queensland, ranging from 0.02 to 0.11 per 100,000 individuals. Of four studies examining the risk factors of fatal intentional drowning in Australia, being of older age groups, being female, and the presence of substance use were identified as important factors for suicidal drowning deaths. The national-scale proportion of suicide drowning in Australia, ranging from 2% to 3% of all intentional self-harm deaths, was also identified. Limited publications reporting the mortality rates and risk factors of intentional drowning deaths in Australia were identified. Being of older age groups and being female were recognised as factors for suicide drowning deaths, and psychoactive substances were widely identified amongst cases. Future research on improving death reporting systems and the legal framework for medico-legal death investigation, along with the investigation of the risk factors of intentional drowning, are required to inform the planning, implementation, and evaluation of prevention interventions for intentional drowning deaths in Australia.

Background Drowning is a leading and preventable cause of death that has suffered an attention deficit. Improving drowning data in countries would assist the understanding of the full extent and circumstances of drowning, to target interventions and evaluate their effectiveness. The World Health Organization identifies data collection as a key strategy underpinning effective interventions. This study compares unintentional fatal drowning data collection, management and comparison using the databases of Australia, Canada and New Zealand. Methods Cases of fatal unintentional drowning between 1-January-2005 and 31–December-2014 were extracted. Cases were combined into a single dataset and univariate and chi square analysis ( p  < 0.01) were undertaken. Location and activity variables were mapped and combined. Variables consistently collected across the three countries were compared to the ILCOR Drowning Data Guideline. The authors also recommend variables for a minimum core dataset. Results Of 55 total variables, 19 were consistent and 13 could be compared across the three databases. When mapped against the ILCOR Drowning Data Guideline, six variables were consistently collected by all countries, with five compared within this study. The authors recommend a minimum core dataset of 11 variables including age, sex, location, activity, date of incident, and alcohol and drug involvement). There were 8176 drowning deaths (Australia 34.1%, Canada 55.9%, New Zealand 9.9%). All countries achieved reductions in crude drowning rates (Australia − 10.2%, Canada − 20.4%, New Zealand − 24.7%). Location and activity prior to drowning differed significantly across the three countries. Beaches (X 2  = 1151.0; p  < 0.001) and ocean/harbour locations (X 2  = 300.5;p < 0.001) were common in Australia and New Zealand, while lakes/ponds (X 2  = 826.5; p  < 0.001) and bathtubs (X 2  = 27.7;p < 0.001) were common drowning locations in Canada. Boating prior to drowning was common in Canada (X 2  = 66.3;p < 0.001). Conclusions The comparison of data across the three countries was complex. Work was required to merge categories within the 20% of variables collected that were comparable, thus reducing the fidelity of data available. Data sources, collection and coding varied by country, with the widest diversity seen in location and activity variables. This study highlights the need for universally agreed and consistently applied categories and definitions to allow for global comparisons and proposes a core minimum dataset.

Drowning claims 7% of the global burden of injury-related deaths. Lifejackets are routinely recommended as a drowning prevention strategy; however, a review of related factors regarding lifejacket wear has not previously been investigated. This systematic review examined literature published from inception to December 2016 in English and German languages. The personal, social, and environmental factors associated with lifejacket wear among adults and children were investigated, a quantitative evaluation of the results undertaken, and gaps in the literature identified. Twenty studies, with sample sizes of studies ranging between 20 and 482,331, were identified. Fifty-five percent were cross-sectional studies. All studies were scored IV or V on the Australian National Health and Medical Research Council (NHMRC) grading system indicating mostly descriptive and cross-sectional levels of evidence. Factors associated with increased wear included age (mostly children), gender (mostly female), boat type (non-motorised), boat size (small boats), role modelling (children influenced by adult lifejacket wear), and activity (water-skiing, fishing). Factors not associated or inconsistent with lifejacket wear included education, household income, ethnicity, boating ability, confidence in lifejackets, waterway type, and weather and water conditions. Factors associated with reduced lifejacket wear included adults, males, discomfort, cost and accessibility, consumption of alcohol, and swimming ability. Three studies evaluated the impact of interventions. This review identified factors associated with both increased and decreased lifejacket wear. Future research should address the motivational factors associated with individuals' decisions to wear or not wear lifejackets. This, combined with further research on the evaluation of interventions designed to increase lifejacket wear, will enhance the evidence base to support future drowning prevention interventions.

ObjectivesThis study explored unintentional fatal drowning among children and adolescents (0–19 years) diagnosed with autism spectrum disorder (ASD) in Australia.DesignThis total population, cross-sectional audit used data from the Royal Life Saving National Fatal Drowning Database to explore demographic and causal factors in ASD drowning cases between 1 July 2002 and 30 June 2018. Rates and relative risk (RR) with a 95% confidence interval (CI) were calculated for drowning cases with and without ASD, using estimated population-level prevalence data.ResultsOf the 667 cases of drowning among 0–19 year olds with known medical history, 27 children and adolescents (4.0%) who drowned had an ASD diagnosis. Children and adolescents with ASD were three times more likely to drown than those without ASD (RR=2.85; CI 0.61 to 13.24). Among those with ASD, 0–4 year olds record the highest rate (11.60/100 000 diagnosed). Children and adolescents with ASD were significantly more likely to drown when compared with those without ASD: if aged 5–9 years (44.4% of ASD-yes cases; 13.3% of ASD-no cases); in a lake or dam (25.9% vs 10.0%) and during winter (37.0% vs 13.1%).ConclusionHeightened awareness of drowning risk for children and adolescents with ASD is required, including adult supervision and barriers restricting water access. Further evaluation of the effectiveness of personal alarms to alert caregivers to an unsupervised child is warranted. Challenges exist regarding accurate estimates of population-level ASD prevalence and identification of ASD in coronial files. As the diagnosis of ASD does not often occur until age five, results may be an underestimate.