Risk of Drowning: The "Iceberg Phenomenon" Re-visited

Abstract

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