Using coronial data to investigate drowning deaths

Country: Australia
Authors: Amy Peden and Justin Scarr
Organisation: Royal Life Saving Society, Australia

Aims

To use coronial data for drowning prevention research, policy and advocacy. 

Background

In Australia, an average of 282 people die as a result of unintentional drowning every year. Drowning occurs across the lifespan in a variety of aquatic locations while undertaking a range of activities, most commonly recreational. Understanding the causal factors that lead to drowning can assist in the development of evidence-based drowning prevention strategies. The use of coronial data can provide rich information on the circumstances leading to the drowning incident. Toxicological and autopsy reports offer information on drug and alcohol involvement as well as contributory pre-existing medical conditions. In Australia we are fortunate to have the National Coronial Information System (NCIS), an internet based data storage and retrieval system for Australian coronial cases. 

Methods

Royal Life Saving Society Australia has been involved in the development of the NCIS since its inception. We have secured national ethical approval to access the NCIS for the purposes of drowning prevention research, policy and advocacy. Data on unintentional fatal drowning is sourced each year and used to produce the Royal Life Saving National Drowning Report annually. This report generates significant media attention and is used to advocate drowning risk factors and prevention strategies to the community.  

The data from the NCIS is cross-referenced with year-round media monitoring that identifies cases of unintentional fatal drowning reported in the media. The two data sources are used to construct a case history which is then inputted into the Royal Life Saving National Fatal Drowning Database. The Database has over 100 variables that are collected for each case, and has a companion definitions and a coding manual. Example of variables collected include age, sex, location of drowning incident, activity being undertaken immediately prior to drowning, alcohol and drug involvement, geographical location of drowning incident, and pre-existing medical conditions among many others. The Database currently includes over 3,700 cases of unintentional fatal drowning. 

Impact

The use of coronial data and the establishment of the Royal Life Saving National Fatal Drowning Database has been beneficial in many ways. The use of coronial data through the NCIS has brought increased rigour to the research outputs of the organisation. The collection of drowning data has allowed for long-term trends in drowning to be monitored and the impact of interventions evaluated.

Research outputs using coronial data have been used to draw political attention to a neglected drowning issue and have resulted in funding to develop interventions. Coronial data has been used to guide the development of the Australian Water Safety Council’s Australian Water Safety Strategy documents, which aim for a 50% reduction in drowning by the year 2020 through the identification of a series of goal areas.  

Recently released research using the Database has covered the topics of drowning in rivers and the contributory role of alcohol, flooding, and the role of pre-existing medical conditions on drowning risk in children and older people, and hypoxic blackout. 

Challenges

There are challenges associated with using coronial data to investigate drowning deaths. The Royal Life Saving National Fatal Drowning Database is constantly evolving and cases within the database regularly need to be checked against the NCIS until such time as the case is closed and the coroner has concluded the investigation. The timeliness of reporting can also be an issue, with cases going to inquest sometimes taking several years to be finalised and for associated coronial recommendations to be handed down.  

There are limitations with the NCIS and its online system, whereby all available documentation (coroner’s finding, autopsy report, toxicology report and police report) may not be attached to each drowning case. Families may also oppose the autopsy which results in external-only reports; these may not include information on pre-existing medical conditions. Drowning incidents can result in a body not being recovered which can pose challenges with respect to determining cause of death and the inability to conduct autopsy and toxicology testing. When a body is not recovered, it causes a delay in information being made available about the case due to the investigation taking longer to be completed. 

Lessons learned

Although the maintenance of the Royal Life Saving National Fatal Drowning Database is an ongoing process, the benefits and uses are endless. Key lessons learnt over the 14 years that the database has been evolving include:  

• The commitment of adequate resources and time to ensure cases are regularly updated against the NCIS as available information can change over time. 
• To collect all key variables at the beginning when building the database. It may be unavoidable, as new research questions arise and new variables are added, but the more that can be defined at the beginning, the less time is required to continually revisit closed coronal cases.  
• Similarly, the use of a coding and definitions document at the outset of the establishment of the database can ensure data is collected and coded consistently over time which makes analysis of multiple years of data easier. 

Costs and replicability

The Royal Life Saving National Fatal Drowning Database can be replicated using a data storage system such as SPSS or Excel. The development of a data definitions and coding manual would be beneficial to ensure all usable variables are collected and coded in a consistent manner. For countries without a coronial system, information on drowning deaths can be recorded from the media and a minimum core set of variables could be collected.