Survival of immersions during recreational boating events in Alaska, 1999-2004.

OBJECTIVE: This retrospective study analyzed records of boating or other watercraft-related events in Alaska from 1999-2004, where at least one drowning occurred, to identify factors associated with survivors of these same events. DATA: Records of recreational boating events involving at least one fatality were obtained through the U.S. Coast Guard. Group rescue responses and rescue assistance responses by others outside the parties were categorized and analyzed. We conducted t tests and odds ratios to analyze inter-group differences. RESULTS: There were 32 immersion events involving 36 fatalities (F-group members) and 72 immersed survivors (S-group.) Analysis of behaviors during and after immersion events showed that two-thirds of the S-group avoided submersion. Most survivors (59%) demonstrated effective exit strategies. Rescue attempts by members of a traveling party resulted in the greatest number of survivors, followed by self rescue attempts. MAJOR CONCLUSIONS: This study helps build a case for the need for more detailed surveillance systems to identify factors that contribute to submersion avoidance. This study also points out the need for enforcement, education, and engineering controls to help improve survival of cold water immersions.

Economic analysis of injury prevention--applying results and methodologies from cost-of-injury studies.

Injuries pose an economic problem of immense proportion to communities in every society. The economic burden from injuries can be quantified through cost-of-injury studies, using techniques adopted from cost-of-illness research. This study explores the feasibility of applying results and methodologies from existing cost-of-injury studies in economic analyses of injury prevention interventions and programmes. The literature on cost-of-injury studies and economic appraisals of injury prevention efforts was examined to elicit studies that calculated injury costs. Studies were accepted for inclusion if they included an analysis of the costs of all injuries occurring in a geographical area (community, region or country) during a specific time period, employed a societal perspective and an incidence-based costing approach and were conducted in industrialized countries. There were 12 studies that met the inclusion criteria. The average total cost per injury case was USD $3536, while the average share of indirect to total cost per injury case was 71%. However, the cost figures showed wide variation across the studies. Based on the limited similarity of findings from the studies, it was concluded that it is not feasible to apply results and methodologies from existing cost-of-injury studies. The cost estimators described in this study could possibly be adapted for use as reference points in economic analyses of existing programmes, but any other uses should be approached with caution. Locally obtained data are needed for reliable economic analyses of injury prevention interventions and programmes.

Strategies and goals of community-based injury prevention programmes--a mixed-methods study of 25 Scandinavian WHO Safe Communities.

Documentation and analysis of prevention goals and interventions employed by community-based injury prevention programmes is vital to advance the knowledge and understanding of synergistic multi-strategy injury prevention programmes. This study examined the goals and interventions of 25 Scandinavian community-based injury prevention programmes in WHO-designated Safe Communities. Collection and analysis of quantitative data from survey questionnaires to the programme coordinators was followed by collection and analysis of qualitative data from structured interviews with programme coordinators from eight of the programmes. The results demonstrated that the programmes under study predominantly relied on "intuitive" and subjective methods for selecting interventions. The programmes largely failed to transform injury surveillance data into information and knowledge that could prioritize community safety strategies and measures, due to insufficient time and personnel resources. The results demonstrated the importance of combining passive approaches with active interventions. Educational efforts were considered essential to the programmes. The programmes preferred to rely on broadly stated goals rather than specific objectives.

Factors associated with injuries occurring aboard vessels in Alaska: differences between residents and nonresidents.

BACKGROUND: Over the past decade, visitors to Alaska have spent increasing amounts of time engaged in water-based recreational activities aboard vessels of various sizes. Serious vessel-related injuries to travelers in Alaska involve not only medical care from unfamiliar health care providers and facilities but also entail the loss of vacation time and the need for injured travelers to return to their homes under less than optimal traveling conditions. METHODS: This study employed a retrospective, case-comparison analysis to identify differences in factors associated with recreational injuries acquired aboard watercraft that resulted in hospitalizations of residents and nonresidents of Alaska during 1991 to 2000. Tests of proportions were conducted to elucidate differences in demographic characteristics and injury precursors between the two subgroups. Specific injury outcomes were then tested for significance using odds ratios. RESULTS: Alaska residents and nonresidents demonstrated significant differences for both demographic factors and factors describing events leading to injuries, and for injury outcomes. Nonresidents were more likely to be 65 years or older, female, and aboard cruise ships when injuries occurred. Nonresidents were more likely to suffer fracture injuries, to suffer injuries with Abbreviated Injury Scores greater than 2, to experience posthospital discharges to sites other than their homes, and to experience postinjury disabilities. CONCLUSIONS: Alaska residents and nonresidents in this study showed significant differences in demographics, precipitating events, and injury outcomes. The findings lend support for targeted safety promotion programs.

The role of hypothermia and drowning in commercial fishing deaths in Alaska, 1990-2002.

OBJECTIVES: To describe the patterns associated with cold-water immersion and drowning in commercial fishermen in Alaska from 1990 through 2002. STUDY DESIGN: This is a retrospective study using data from the Alaska Occupational Surveillance System (AOISS), a database with records from all occupational mortalities occurring in Alaska from 1990 on. METHODS: We extracted and analyzed all records describing deaths from drowning or hypothermia to commercial fishermen in Alaska from 1990 through 2002 that were registered within AOISS. We also used a subset of records from AOISS to compare use of Personal Flotation Devices (PFDs) between the target population and survivors of fatal events. RESULTS: There were 228 deaths resulting from cold-water immersion and subsequent drowning in the target population for the time period studied. Victims were far less likely to have used PFDs than were survivors of events where cold-water drowning occurred. CONCLUSION: The strong protective association seen with the use of PFDs, particularly immersion suits, in surviving cold-water events indicates that many of the events that led to deaths in the target population could well have been survivable.