'I actually thought that I was going to die': Lessons on the rip current hazard from survivor experiences.

BACKGROUND: Rip currents are strong, narrow, fast-flowing currents of water that occur on many beaches and in Australia contributing to 26 drowning deaths and several thousand lifeguard/lifesaver rescues each year. Educating the public about the rip current hazard is a primary focus of beach safety practitioners, but there has been a lack of qualitative research exploring the firsthand experiences of being caught in a rip current to assist in this regard. The aim of this study was to analyse interviews of rip current survivors to understand more about how people react when unintentionally caught in a rip current in order to help guide future public education to mitigate rip current drowning. METHODS: Semi-structured interviews were conducted with 56 individuals (primarily Australian-born) about their experience of being caught in a rip current. Interviewees were recruited via an online survey and varied in age and self-reported swimming ability. RESULTS: Thematic analysis revealed three key temporal elements to the rip current experience: Before the Rip in which lack of awareness and knowledge, complacency, over-confidence, and attitude were prevalent themes; During the Rip which identified panic and temporary inhibition of decision-making, physical response, prior experience, and relationships with other beach users as themes; and After the Rip where post-rip effects and rip safety messaging and education were key themes. The importance of experiential immersion was a prevalent thread throughout all phases of the thematic analysis. DISCUSSION: Our research shows that being caught in a rip current can be an intense and traumatic experience and that lessons learned from survivors have significant implications for improving existing and future rip current education efforts. In this regard, we provide several recommendations based on evidence-based insights gained from our interviews including the development of immersive rip current experience using virtual reality. SO WHAT: Despite the prevalence of rip currents causing drowning deaths and rescues, there has been a lack of qualitative research on firsthand experiences to aid in public education. These interviews emphasise the intense and traumatic nature of being caught in a rip current, underscoring the need for improved rip current education to aid in prevention of this, often harrowing, experience.

Burden of fatal drowning in California, 2005-2019.

OBJECTIVE: To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research. METHODS: This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water). RESULTS: California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period. CONCLUSIONS: California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.

Evaluating the impact of skill development for drowning prevention: a relationship-building approach to community engagement.

OBJECTIVE: Evaluate the impact of a broadened theoretical and empirical model of community engagement aimed at coastal drowning prevention via relationship building between lifeguards and beachgoers through the delivery of skill development sessions on the beach. SETTING: A lifeguard-patrolled beach in Lorne, Victoria, Australia, during the 2023 peak summer holiday season. METHODS: In total, 12 skill development sessions were delivered by teams of lifeguards and risk researchers to beachgoers. Sessions were codesigned by the research team and shared with lifeguards beforehand to review and include lifeguards' interpretations of localised risk during delivery. In total, 85 survey interviews were conducted with self-selecting beachgoers post participation. RESULTS: In total, 79 participants (93%) enjoyed participating in the session(s) and 77 participants (91%) reported learning something new. Learning how to identify rip current (n=59) and escape a rip current (n=40) were the two most commonly learnt skills. Participants' intended changes in future beachgoing behaviours (n=46) include asking lifeguards at patrolled beaches how to identify site-specific (rip current) risk (n=11) and attempting to identify a rip current before entering the water (n=10). The spillover effects of participation include sharing what participants had learnt with family and friends. CONCLUSIONS: Creating a dialogic model of collaboration via participatory community engagements between lifeguards and researchers with the beachgoing public can successfully prompt learning drowning prevention skills. These skills are required when navigating dynamic coastal hazards at unpatrolled beaches. Supporting lifeguards and life-savers to provide skill development expands the ways that life-saving services can engage the public, including measurement of lifeguards' contributions to coastal drowning prevention.

Impact of a surfer rescue training program in Australia and New Zealand: a mixed methods evaluation.

BACKGROUND: Surfers play a critical role in coastal drowning prevention, conservatively estimated to make as many rescues as beach lifeguards. The Surfer Rescue 24/7 (SR24/7) program is a coastal safety intervention in Australia and New Zealand that teaches surfers safe rescue skills and promotes prevention activities. This multi-part, mixed-methods study aimed to evaluate the impact of the SR24/7 program. METHODS: The study consisted of three parts employing quantitative and qualitative methods: a retrospective survey of course participants, in-depth interviews with course participants who had conducted rescues, and an analysis of self-reported skills confidence ratings before and after the program. RESULTS: Triangulated results from the three study components indicated that after the course, participants exhibited high levels of satisfaction with their experience in the program and would encourage others to attend, were more observant and aware of safety concerns while surfing, had a better understanding of ocean conditions and hazards, learned new rescue techniques and skills, grasped important course concepts related to their own personal safety, and improved their confidence in responding to an emergency situation. Several participants had conducted rescues in real life and indicated that the course was effective in providing them with the baseline knowledge and skills to keep safe while helping others in the ocean. This study also provides new insight on the role of surfers in coastal safety, specifically that surfers are engaged in a range of prevention activities before rescue is required. CONCLUSIONS: Despite persistent challenges in combating coastal drowning rates, the SR24/7 program is an effective intervention that helps save lives. Importantly, this study provides evidence that the course successfully equips surfers with techniques to act responsibly and safely. Expanding coastal safety focus and resources towards surfers, an often-overlooked demographic in beach safety strategies, could substantially enhance community-level capacity to prevent and respond to ocean emergencies.

Selfie-Related Incidents: Narrative Review and Media Content Analysis.

BACKGROUND: Selfie-related injury has become a public health concern amid the near ubiquitous use of smartphones and social media apps. Of particular concern are selfie-related deaths at aquatic locations; areas often frequented because of their photogenic allure. Unfortunately, such places exhibit hazards inherent with their environment. OBJECTIVE: This study aimed to ascertain current evidence regarding selfie-related injuries and recommended risk treatment measures in the academic literature as well as how selfie-related injuries and deaths were being reported by the media, allowing us to identify key challenges facing land managers and public health practitioners in mitigating selfie-related injuries and deaths. METHODS: Between October and December 2022, we performed a narrative review of peer-reviewed literature published since January 2011. Literature was screened to identify causal factors implicated in selfie-related deaths and injuries, as well as risk treatments recommended. Furthermore, we used an environmental scan methodology to search for media reports of selfie-related injuries and deaths at aquatic locations in Australia and the United States. Individual cases of selfie-related aquatic injuries and deaths sourced from news reports were analyzed to assess epidemiological characteristics, and a thematic content analysis was conducted to identify key themes of news reporting on selfie-related deaths and injuries. RESULTS: In total, 5 peer-reviewed studies were included. Four studies identified falls from height as the most common injury mechanism in selfie incidents. Drowning was the second most common cause of death. Recommended risk treatments were limited but included the adoption of "no selfie zones," physical barriers, signage, and provision of information on dangerous locations to social media users. In total, 12 cases were identified from media reports (4 injuries and 8 fatalities; 7 in Australia and 5 in the United States). The mean age of the reported victims was 22.1 (SD 6.93) years with victims more likely to be female tourists. Content analysis revealed 3 key themes from media reports: "blame," "warning," and "prevention and education." Few media reports (n=8) provided safety recommendations. CONCLUSIONS: The selfie-related incident phenomenon should be viewed as a public health problem that requires a public health risk communication response. To date, little attention has been paid to averting selfie-related incidents through behavior change methodologies or direct messaging to users, including through social media apps. Although previous research has recommended "no selfie zones," barriers, and signage as ways to prevent selfie incidents, our results suggest this may not be enough, and it may be prudent to also engage in direct safety messaging to social media users. Media reporting of selfie incidents should focus on preventive messaging rather than blame or warning.

Lessons learned from co-designing a high school beach safety education program with lifeguards and students.

ISSUE ADDRESSED: School-based beach safety education programs are common, but best practice guidance and information on their design and development is limited. METHODS: Researchers, professional ocean lifeguards and students participated in a co-design process to inform a lifeguard-delivered, school-based beach safety education program for a coastal community in New South Wales, Australia. Lifeguards and researchers (experts) provided structured feedback about the program in a survey and facilitated workshop; students (n = 26) aged 11 to 13 years participated in focus group sessions intended to garner in-depth understanding of their experiences at the beach and knowledge of, and attitudes towards, beach safety. RESULTS AND DISCUSSION: The co-design process provided a novel and inclusive model for beach safety education program development, and valuable lessons for future efforts. Specifically, student focus groups identified several facets of pre-teens and younger teenagers' beach experience that prompted revision of the education program, primarily framing of program content and safety messages. Peers are a primary motivator for this age group and students' burgeoning independence emerged as an important theme. While knowledgeable about beach hazards and risks, students conveyed mixed safety attitudes and self-reported safety practices, highlighting the importance of designing programs to motivate behaviour and promote safe decision-making vs raising awareness alone. Findings illustrate the value of adopting co-design processes for all beach safety programs, school or otherwise. SO WHAT?: Beach safety programs may not be delivering information that is needed, wanted or useful. Structured consultation with the priority population must become standard practice in beach safety and drowning prevention education program development.

Need for consistent beach lifeguard data collection: results from an international survey.

BACKGROUND: Lifeguards are integral to beach safety and collect data which is used for a variety of purposes, although guidelines and best practice have yet to be established. This study served to identify and characterise existing beach lifeguard service provider (BLSP) data collection procedures in order to identify the degree of uniformity and areas for improvement. METHODS: The 'International Beach Lifeguard Data Collection and Reporting' online survey was distributed via the International Drowning Researchers' Alliance to BLSP supervisors and managers. The survey included questions on beach conditions and lifeguard activity data collection practices, and respondent's opinions on their own BLSP's methods. RESULTS: Variability in data collection practices was evident in surveys obtained from 55 lifeguard leaders in 12 countries. Discrepancies exist in definitions for 'rescue' among BLSPs, a significant amount of information related to beach conditions are recorded and beach visitation is primarily obtained by visual estimate. Respondents expressed challenges with getting frontline staff to collect information in the field and ensuring reporting consistency between recorders. They identified rescue victim demographic factors as key data they would like to collect in the future. CONCLUSIONS: Inconsistencies in lifeguard data collection present challenges to operations, safety education and prevention efforts, research and policy relying on these data. Variation in definitions, methods and collected variables generally restricts analysis to a single BLSP with limited generalisability to other beach settings. Some gaps in lifeguard data collection may soon be addressed by technology, but developing uniform, internationally acceptable standards and definitions should be prioritised.

Is further investment in shark management in New South Wales worthwhile? Surfer views on coastal public health issues.

OBJECTIVE: To explore the views of surfers on investment in shark management compared to other coastal public health issues. METHODS: We examined the responses of 672 New South Wales (NSW) resident surfers to the Global Surfer Survey, which collected demographic information and asked surfers about which topics they believe additional funding should be devoted to. RESULTS: Half of surfers in NSW (50%) are worried about sharks while surfing only a very small proportion (16%) are supportive of additional funding for shark detection and management programs, with most being in favour of funding directed at ocean cleanliness (40%) and drowning prevention (29%). CONCLUSIONS: Findings indicate surfers are more supportive of investment in ocean cleanliness and drowning prevention measures, as compared to shark mitigation. IMPLICATIONS FOR PUBLIC HEALTH: Ocean users in general face a significantly greater risk (48 times) of drowning than shark bites. Given the relative public health burden of the two issues, is the significant financial investment in shark mitigation worth it?

Preventing selfie-related incidents: Taking a public health approach to reduce unnecessary burden on emergency medicine services.

Unintentional deaths from selfies have received limited exposure in emergency medicine literature; yet trauma remains the leading cause of death and disability in children and young adults, and most of those implicated in a selfie incident are in this demographic. Selfie-related injuries and deaths may be a relatively new phenomenon, but data suggest they are a public health hazard that is not going away. Emergency medicine practitioners may have a role to play in the primary and secondary prevention of selfie incidents, including delivering opportunistic behaviour change messaging to those who are at risk of being injured or killed in a selfie-related incident, particularly young (14-25 years) males. Emergency medicine specialists should be aware of the dangers of selfie-related incidents and understand their polytraumatic presentation.

Mortality trends and the impact of exposure on Australian coastal drowning deaths, 2004-2021.

OBJECTIVE: The aim of this study is to characterise Australian coastal drowning trends and evaluate impact of exposure on drowning risk. METHODS: Descriptive epidemiological analysis of unintentional fatal drowning occurring July 2004-June 2021 at Australian coastal sites (beaches, rock platforms, bays, harbours, offshore locations etc.). Total population, exposed-person and exposed-person-time rates per 100,000 population were calculated by age, sex, socio-economic status, remoteness category and pre-submersion activity. Annual trends were assessed using joinpoint regression. Exposure-based rates used estimates from Surf Life Saving Australia's National Coastal Safety Survey. RESULTS: The cumulative unintentional coastal fatal drowning rate was 0.43 per 100,000 Australian residents (95%CI: 0.41-0.45) and did not change throughout the study period (p=0.289). The exposed-person rate was 0.67 per 100,000 coastal visitors (95%CI: 0.62-0.72), and there were 0.55 coastal drowning deaths per 10 million coastal visitor hours (95%CI: 0.51-0.59). Men, older people and residents of lower socio-economic and remote areas had higher drowning rates; rock fishing and scuba diving had the highest activity exposure-based rates. CONCLUSIONS: Education- and policy-based coastal safety interventions should focus on identified risk factors to reduce annual coastal drowning rates. IMPLICATIONS FOR PUBLIC HEALTH: Exposure-based risk measurements are important for developing and prioritising interventions; assessments based on counts or total population measures alone may misinform prevention efforts.

The characteristics of drowning among different types of international visitors to Australia and how this contributes to their drowning risk.

OBJECTIVE: Australia is a popular destination for international visitors. This study reviews international visitor drowning deaths in Australia and analyses drowning by visitor type. METHODS: A total population retrospective study exploring drowning deaths of international visitors was conducted between 2008 and 2018. Data were extracted from the Royal Life Saving National Fatal Drowning Database and categorised into four subgroups: overseas tourists, international students, working holiday makers and work-related visitors. Descriptive statistics, non-parametric tests and relative risk (RR) were calculated. RESULTS: In total, 201 international visitors drowned in Australia, 7% of all drowning deaths; a crude drowning rate of 0.27/100,000 visitors versus 0.95/100,000 for residents (RR=0.19 [95% CI: 0.16-0.22]). Most deaths were males (79%) and people aged 18-34 years (50%). Visitors frequently drowned at beaches (33%), and when swimming (41%). Thirty-five percent recorded a pre-existing medical condition. Overseas tourists on holiday were the most likely to drown compared to other subgroups. CONCLUSION: International visitors represent a small but increasing proportion of people drowning in Australia. The circumstances of which visitors drown vary by travel purpose, age, country of origin, location of drowning and activity. IMPLICATIONS FOR PUBLIC HEALTH: International visitors have unique safety needs, requiring tailored prevention based on the purpose of travel and country of origin.

Identifying risk factors and implications for beach drowning prevention amongst an Australian multicultural community.

Multicultural communities in Australia are recognised as a priority area for drowning prevention, but no evidence-based study has addressed their knowledge of beach safety. This study used an online survey tool to identify and examine risk factors relating to swimming ability, beach visitation characteristics and behaviour, and beach safety knowledge of the Australian Southern Asian community to assist in the development of future beach safety interventions. Data was obtained through 249 online and in-person surveys of people aged > 18 years. Most respondents reported poor swimming ability (80%), often swam in in the absence of lifeguards (77%), did not understand the rip current hazard (58%), but reported that they entered the water (76%) when visiting beaches. Close to one-quarter (28%) had not heard, or didn't know the purpose, of the red and yellow beach flags, which identify lifeguard supervised areas on Australian beaches. Length of time living in Australia is an important beach safety consideration for this community, with minimal differences in terms of gender and age. Those who have lived < 10 years in Australia visit beaches more frequently and are less likely to have participated in swimming lessons, be able to swim, heard of the flags or swim between them, understand rip currents, or have participated in a beach safety program. Very few (3%) respondents received beach safety information from within their own community. The importance of beach safety education and swimming lessons within the Southern Asian community should be prioritised for new and recent migrants to Australia.

Awareness without learning: A preliminary study exploring the effects of beachgoer's experiences on risk taking behaviours.

Most drowning deaths on Australian beaches occur in locations not patrolled by lifeguards. At patrolled locations, where lifeguards supervise flagged areas in which beachgoers are encouraged to swim between, the incidence of drowning is reduced. To date, risk prevention practices on coasts focus on patrolled beaches, deploying warning signs at unpatrolled locations with the aim of raising public awareness of risk. What remains unexplored is the potential for learning and behaviour change that can transfer from patrolled to unpatrolled beaches through beachgoer's experiences and interactions with lifeguards. The aim of this preliminary study is to explore the risk perceptions of beachgoers at a patrolled beach to establish if and how their experiences of beach risk and interactions with lifeguards affect their behaviours. Data was collected in Gerroa, Australia by engaging 49 beachgoers using a mixed survey-interview methodology. Results show that beachgoers are aware that they should 'swim between the flags', but many did not know the basis for the positioning of safety flags. A key finding is that beachgoer's express a clear desire for a skills-based model of community engagement that enables learning with lifeguards. This demonstrates a reflective public that desires skill-development, which may transfer from patrolled to unpatrolled beaches to affect broader risk reduction on the Australian coast. Learning how to avoid site-specific rip hazards with lifeguards at the beach presents a promising, and previously unexplored model for beach drowning risk prevention that has the potential to affect behaviour at unpatrolled beaches, providing an empirically-supported alternative to prevailing deficit-based awareness raising methods.

Coastal drowning: A scoping review of burden, risk factors, and prevention strategies.

OBJECTIVE: Coastal drowning is a global public health problem which requires evidence to support safety initiatives. The growing multidisciplinary body of coastal drowning research and associated prevention countermeasures is diverse and has not been characterised as a whole. The objective of this scoping review was to identify key concepts, findings, evidence and research gaps in the coastal drowning literature to guide future research and inform prevention activities. METHODS: We conducted a scoping review to identify peer reviewed studies published before May 2020 reporting either (i) fatal unintentional coastal drowning statistics from non-boating, -disaster or -occupational aetiologies; (ii) risk factors for unintentional fatal coastal drowning; or (iii) coastal drowning prevention strategies. Systematic searches were conducted in six databases, two authors independently screened studies for inclusion and one author extracted data using a standardised data charting form developed by the study team. RESULTS: Of the 146 included studies, the majority (76.7%) were from high income countries, 87 (59.6%) reported coastal drowning deaths, 61 (41.8%) reported risk factors, and 88 (60.3%) reported prevention strategies. Populations, data sources and coastal water site terminology in the studies varied widely; as did reported risk factors, which most frequently related to demographics such as gender and age. Prevention strategies were commonly based on survey data or expert opinion and primarily focused on education, lifeguards and signage. Few studies (n = 10) evaluated coastal drowning prevention strategies. DISCUSSION: Coastal drowning is an expansive, multidisciplinary field that demands cross-sector collaborative research. Gaps to be addressed in coastal safety research include the lack of research from lower resourced settings, unclear and inconsistent terminology and reporting, and the lack of evaluation for prevention strategies. Advancing coastal drowning science will result in a stronger evidence base from which to design and implement effective countermeasures that ultimately save lives and keep people safe.

Understanding a population: A methodology for a population-based coastal safety survey.

Drowning is a global public health problem, but accurately estimating drowning risk remains a challenge. Coastal drowning comprises a significant proportion of the drowning burden in Australia and is influenced by a range of behavioural factors (e.g. risk perception, knowledge, attitudes and behaviours) that are poorly understood. These factors, along with those that impact exposure (e.g. coastal visitation and activity participation) all impact on drowning risk. While excellent mortality and morbidity data exists in Australia, a lack of coastal participation data presents challenges to identifying high-risk groups or activities and prioritising prevention efforts. This methods paper describes the development and evolution of an ongoing, annual, nationally representative online survey as an effective tool used to capture valuable data about the Australian population's relationship with the coast. This paper explores how the survey is structured (12-14 sections spanning multiple topics and themes), the different question types used (including open text, 4-digit responses and categorical questions), the sample size (1400-1600 respondents), sampling strategy (using demographic quota sampling which can then be post-weighted to the population if required) and how topics and themes have changed over time to enhance the quality of data collected (i.e., wording changes to enhance participant comprehension or data usability and changing issue-specific 'feature' topics of interest such as campaign evaluation). How the survey is implemented online is described, both practically through to third-party recruitment processes and ethically to maximise anonymity of respondents and ensure data quality. Interim analyses indicate the impact of considering exposure when calculating fatal drowning rates, especially by activity (e.g., crude boating drowning rate 0.12 per 100,000 population vs 0.95 per 100,000 exposed population [relative risk = 8.01; 95% confidence interval: 4.55-14.10]). This study highlights lessons learned in the process of conducting a nationally representative coastal participation survey as well as the strengths and limitations of adopting this approach. Data collected will provide more detailed information on the skills, behaviours, knowledge and attitudes of coastal activity participants. Analyses of this unique dataset will inform research that will underpin development and evaluation of coastal drowning prevention initiatives prioritising those most at risk. It is hoped that the methods detailed within this study may be useful for other countries to develop similar approaches to understanding their own population.

Dying to help: Fatal bystander rescues in Australian coastal environments.

Bystanders who drown during a rescue attempt in aquatic waterways are becoming an increasingly important issue within drowning prevention. In the Australian context, the majority of these incidents occur in coastal water ways. This study documents and characterizes bystander rescuer fatalities within Australian coastal waterways that occurred between 1 July 2004 and 30 June 2019 in order to provide suggestions for future public safety interventions involving bystander rescuers. Data was sourced through Surf Life Saving Australia's (SLSA) Coastal Fatality Database, which collates information from multiple sources. Sixty-seven bystander rescuer fatalities in coastal waterways were reported during the 15-year period, an average of 4.5 per year, which is a significant proportion of the five fatalities previously reported across all Australian waterways. The majority of coastal bystander rescuer fatality incidents occurred in the state of New South Wales (49%), at beaches (64%), in regional or remote areas (71%), more than 1 km from the nearest lifesaving service (78%), during summer (45%), in the afternoon (72%), in the presence of rip currents (73%), and did not involve the use of flotation devices to assist rescue (97%). The majority of coastal bystander rescuer victims were Australian residents (88%) born in Australia/Oceania (68%), males (81%), aged between 30-44 years old (36%), visitors to the location (55%), either family (69%) or friends (15%) of the rescuee(s), and were attempting to rescue someone younger than 18 years old (64%). Our results suggest future safety intervention approaches should target males, parents and carers visiting beach locations in regional locations during holiday times and should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches.

Who rescues who? Understanding aquatic rescues in Australia using coronial data and a survey.

OBJECTIVE: To examine fatal drowning associated with aquatic rescues and prior self-reported experience of undertaking an aquatic rescue in Australia. METHODS: Previous aquatic rescue experience was sourced through the 2013 Queensland Computer Assisted Telephone Instrument Survey and compared to data on rescue-related fatal unintentional drowning between 1 January 2006 and 31 December 2015. RESULTS: Twenty-three per cent (n=294/1291) of survey respondents had previously performed an aquatic rescue. Males (X2 =35.2; p<0.001) were more likely to have performed a rescue; commonly at a beach/ocean/harbour location (X2 =13.5; p<0.001). Females were more likely to have rescued a child (0-4 years of age) (X2 =29.2; p<0.001) from a swimming pool (X2 =34.3; p<0.001). Fifty-one people drowned while performing an aquatic rescue (Males=82.4%; 25-44 years of age=53.0%; beaches=54.9%). CONCLUSIONS: Drownings are prevented by bystanders; this is not without risk to the rescuer. Most people perform only one rescue in their life, often at a younger age, on an altruistic basis, of family members or young children. Community-wide rescue skills, taught at a young age, with consideration for coastal, inland and swimming pool environments, may prevent drowning. Implications for public health: There is a need to train people early in their life on how to undertake a safe rescue and provide resuscitation, including promoting regular updates, in particular if supervising children.

Characteristics of aquatic rescues undertaken by bystanders in Australia.

An issue of growing importance within the field of drowning prevention is the undertaking of aquatic rescues by bystanders, who sometimes drown in the process. The main objectives of this study were to describe characteristics of bystanders making rescues in different Australian aquatic environments, identify the role of prior water safety training in conducting bystander rescues and provide insights into future public education strategies relating to bystander rescue scenarios. An online survey was disseminated via various social media platforms in 2017 and gathered a total of 243 complete responses. The majority of bystander rescues described took place in coastal waterways (76.5%; n = 186), particularly beaches (n = 67), followed by pools (17.3%; n = 42) and inland waterways (6.2%; n = 15). The majority of respondents were males (64.2%; n = 156) who rescued on average approximately twice as many people in their lifetime (6.5) than female respondents (3.6). Most rescues occurred more than 1 km from lifeguard/lifesaver services (67%; n = 163), but in the presence of others (94.2%; n = 229). The majority of bystander rescuers had water safety training (65.8%; n = 160), self-rated as strong swimmers (68.3%; n = 166), conducted the rescue without help from others (60%; n = 146), did not use a flotation device to assist (63%; n = 153), but were confident in their ability to make the rescue (76.5%; n = 186). However, most considered the situation to be very serious (58%; n = 141) and felt they had saved a life (70.1%; n = 172). With the exception of pools, most bystanders rescued strangers (76.1%; n = 185).While Australia clearly benefits from having a strong water safety culture, there is no clear consensus on the most appropriate actions bystanders should take when confronted with a potential aquatic rescue scenario. In particular, more research is needed to gather information regarding bystander rescues undertaken by those without prior water safety training.

Rescues conducted by surfers on Australian beaches.

This study describes the demographics, occurrence, location, primary hazards and outcomes involved in rescues performed by surfers on Australian beaches. Conservative estimates suggest that the number of rescues conducted by Australian surfers each year is on par with the number conducted by volunteer surf lifesavers. Surfers perform a considerable number of serious rescues in both lifesaver/lifeguard patrolled (45%) and unpatrolled (53%) beach locations. Rip currents represent the major physical hazard leading to rescue (75%) and the dominant emotional response of people rescued is one of panic (85%). Most surfer rescue events occur during conditions of moderate waves and sunny, fine weather with the highest proportion of rescues occurring on quiet beaches with few people around (26%). Swimming is the activity associated with most rescue events (63%), followed by board riding (25%). Males aged 18-29 represent the largest demographic of people rescued. Surfers with prior water-safety training are more likely to perform a higher number of rescues, however ability to perform rescues is not associated with formal training, but rather number of years' experience surfing. Seventy-eight percent of surfers were happy to help, while 28% expressed feelings of annoyance or inconvenience, generally towards unwary swimmers. Results of this research suggest that 63% of surfers feel they have saved a life. This value may be enhanced through improved training of surfers in basic water safety rescue techniques.