Risk of Drowning: The "Iceberg Phenomenon

International Journal of Aquatic Research and Education Volume 4 | Number 2 Article 3 5-1-2010 Risk of Drowning: The "Iceberg Phenomenon" Revisited Kevin Moran The University of Auckland, Follow this and additional works at: https://scholarworks.bgsu.edu/ijare Recommended Citation Moran, Kevin (2010) "Risk of Drowning: The "Iceberg Phenomenon" Re-visited," International Journal of Aquatic Research and Education: Vol. 4 : No. 2 , Article 3. DOI: 10.25035/ijare.04.02.03 Available at: https://scholarworks.bgsu.edu/ijare/vol4/iss2/3 This Research Article is brought to you for free and open access by ScholarWorks@BGSU. It has been accepted for inclusion in International Journal of Aquatic Research and Education by an authorized editor of ScholarWorks@BGSU. Moran: Risk of Drowning: The "Iceberg Phenomenon" Re-visited Research International Journal of Aquatic Research and Education, 2010, 4, 115-126 © 2010 Human Kinetics, Inc. Risk of Drowning: The “Iceberg Phenomenon” Revisited Kevin Moran Three decades ago, Schuman and colleagues (1977) used the visual metaphor of an iceberg whose underwater base contained a substantial layer of self-reported incidents that posed a serious threat to life so as to illustrate the true extent of the risk of drowning. This present study uses the iceberg metaphor to explore the magnitude of that risk among youth. In addition to describing the fatal and nonfatal drowning incidents at the visual tip of the iceberg, the study presents data from surf rescue records and survey data on exposure to risk and incidence of a life-threatening submersion experience. Most youth had participated in some swimming (98%) or other aquatic activity (94%), and more than one third (37%) reported having had a life-threatening submersion experience. Significantly more females had experienced such an incident (females 41%, males 34%). For one third of youth (30%), the experience had made them more cautious around water, but most (66%) reported no aversive effect. The author discusses the value of the iceberg phenomenon as a visual metaphor of the risk of drowning and its implications on the education of young people. Fatal and nonfatal drowning statistics are often used in drowning prevention advocacy as indicators of the magnitude of the problem and its cost to society. Globally in 2004, 175,000 children under the age of 20 years drowned and, for children under the age of 14 years, WHO global annual estimates for nonfatal drowning range from two and three million (World Health Organisation, 2008). It has been estimated that for each fatal drowning, between one and four nonfatal events are serious enough to warrant hospitalization (Meyer, Theodorou, & Berg, 2006). The true extent of submersion incidents that may precipitate or constitute a drowning episode is probably much higher than estimates based on mortality and morbidity alone. While the WHO recommends that outcomes of submersion injury be classified as death, morbidity, and no morbidity (Van Beeck, Branche, Szpilman, Modell, & Bierens, 2005), little is known about the latter category, those who experience a life-threatening drowning incident but who are not hospitalized or who are released from medical care before becoming a public health statistic. Some evidence of the extent of no-morbidity submersion injury is available from rescue statistics. For example, Szpilman (1997) reported that 94% of surf rescue victims requiring medical treatment postrescue were released directly from the site after initial medical The author is with the Faculty of Education at the University of Auckland in Auckland, New Zealand. Published by ScholarWorks@BGSU, 2010 115 1 International Journal of Aquatic Research and Education, Vol. 4, No. 2 [2010], Art. 3 116   Moran care. Little is known about those victims who experience a life-threatening incident yet are never reported as “public health” or “rescue” statistics. From the outset, it is important to note that recent changes in terminology around the concepts of drowning and near-drowning impact on this study and current definitions necessitate reemphasis before proceeding. As a consequence of much expert debate, notably at the World Congress on Drowning in Amsterdam, 2002 and via its associated World Task Forces on Drowning, the WHO adopted recommendations that defined drowning as a process rather than an outcome (Idris et al., 2003; Van Beeck et al., 2005). In adopting a new definition of drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid” (Van Beeck et al., 2005, p. 854), the term near-drowning previously used to describe a nonfatal drowning incident was no longer recommended for use. Unfortunately, the term near drowning is still frequently and inappropriately used in the media and in public parlance to describe potentially fatal, drowning-related incidents. For the purpose of this study that seeks to illustrate the true extent of risk of drowning using nonreported as well as “official” data, incidents where victims were at serious risk of drowning are to be referred to as life-threatening submersion experiences (LTSEs). More than 30 years ago, Schuman, Rowe, Glazer, and Redding (1977) used the visual metaphor of an iceberg to explore just how many people are subjected to serious risk of drowning without necessarily experiencing submersion, aspiration, or hypoxia (see Figure 1). The illustration identifies mortality and morbidity as the visual tip of the iceberg above water, underpinned below the water surface by rescue statistics, and nonreported, no-morbidity drowning episodes that further define the extent of risk of drowning. Schuman et al. (1977) noted that 15% of South Carolina school children reported experiencing a “near miss” at least once in the previous year. Others (Verbrugge, 1986; Verbrugge & Ascione, 1987) have used the iceberg metaphor to describe people’s health and injury morbidity, with data that included not only deaths and hospital treatment but also visits to health professionals, self-treated symptoms, and daily symptoms. Kelly and Miles-Doan (1997) used Verbrugge’s “iceberg of morbidity” concept to explore the impact of social inequality on the base of the iceberg (representing day-to-day injuries that prompt self-care or no care). Recent evidence suggests that the risk of drowning may be greater than that described by Schuman et al. (1977). A recent water safety survey of 1,000 American adults found that almost half (48%) of the respondents reported an experience where they “nearly drowned” (American Red Cross, 2009). McCool, Moran, and Ameratunga (2006), investigating perception of drowning risk among more than 3,000 adult beachgoers in the Auckland region, found that one third (30%) reported having had a life-threatening submersion experience. Gulliver and Begg (2005) noted that males reported most (63%) of the 141 self-reported submersion incidents among 1,000 21-year-old New Zealand (...truncated)