A practical approach to identifying and counting cold-water immersion deaths, and assessing associated activities and risks

TitleA practical approach to identifying and counting cold-water immersion deaths, and assessing associated activities and risks
Publication TypeConference Paper
Year of Publication2007
AuthorsBarss, P, Mercier, M
Conference NameWorld Conference on Drowning Prevention
Date Published09/2007
PublisherInternational Life Saving Federation
Conference LocationPorto, Portugal
Other Numbers02-49

Introduction: Most cold immersion deaths are difficult to identify due to lack of a specific test and inexperience of many investigating police and coroners.  In order to assess the circumstances of such incidents, it was necessary to develop a practical epidemiologic approach to identification of cases.

Methods: Selection criteria developed for review of cases in the Canadian Surveillance System for Water-Related Injury Fatalities included:

  1. drowning with immersion hypothermia, opinion of coroner,
  2. immersion hypothermia without drowning, opinion of coroner,
  3. immersion hypothermia with other cause reported by autopsy;
  4. hypothermia and other cause, opinion of data collector;
  5. ice present, coroner or police;
  6. extremely cold water <10°C, coroner or police;
  7. very cold month (November-April);
  8. snowmobiling, coroner or police.

Selection is done in a descending manner, not counting or reselecting cases twice. Bath and hot tub and pool incidents are excluded, unless outdoors during winter.

Results: During 1991-2000, 2007 cold immersion deaths were identified; these deaths comprised 40% of  5006 immersion deaths; 758 tub and pool cases were excluded. 38% of cold immersions resulted from boating, 22% activities on ice, 15% land transport, 14% falls into water, 7% aquatic activities, air transport 1%, and other/unknown 3%. The purpose of these activities included recreation 55%, daily life/subsistence 27%, occupational 11%, rescue 1%, other/unknown 6%.

Conclusions: Pool vendors and owners have low levels of knowledge about evidence-based prevention of pool drowning and spinal cord injury, particularly automatic gates and safe depths and lengths for diving. Pool vendors have a more realistic perception of the risk of spinal cord injury from diving into home pools, but do not provide written information about this hazard. Mandatory safety training of pool vendors and owners together with strict regulations for childproof automatic gates are needed to protect the public from death and permanent injury.

Discussion: Cold immersions have been divided into four phases, including gasping and cold shock, swimming failure, hypothermia, and post-rescue collapse. At present, few death records provide this level of detail so one must rely on other criteria to provide an epidemiologic assessment of the incidence and risk factors for cold immersion deaths.

Learning Outcomes
  1. Understand meaning of cold immersion and difficulty in identifying fatal incidents
  2. Understand an approach to identifying cold immersion deaths in coroner/forensic files
  3. Understand frequent activities and risk factors for cold immersion deaths