aboriginal open water fatalities practices prevention march 2013

20 years of research and surveillance

Final March 2013

PAGE | 2

© The Canadian Red Cross, 2013 Analytical Report on Aboriginal Open Water Fatalities and Promising Practices for Prevention: Part 1 Immersions And Other Water-Related Injury Fatalities Among Aboriginal Peoples In

Canada: 20 Years Of Research And Surveillance Part 1 of this report was developed and written by Dr. Peter Barss and Karlyn Olsen, MPH Epidemiology Candidate, in collaboration with the Canadian Red Cross. Peter Barss coordinated the research and edited the report, and reviewed, coded, verified, and corrected data for each death in conjunction with Jane Hamilton, MSc. Epidemiology and Karlyn Olsen. Clara Reinhardt of the Canadian Red Cross was responsible for data entry and coordination of reporting across the provinces and territories; Jane Hamilton for data management including quality control; Karlyn Olsen for data analysis and preparation of figures and tables. Shelley Dalke of the Canadian Red Cross managed this project. Data collectors during 1991-2010 included provincial and territorial volunteers and staff of the Canadian Red Cross and the Lifesaving Society. Data collection was made possible through the assistance and co-operation of provincial and territorial coroners, medical examiners, their statistical staff, and the National Association of Coroners. Financing of the work was done collaboratively by sharing resources and staff. Data collection predominantly involved the Canadian Red Cross, the Lifesaving Society, provincial/territorial coroners and police. The Public Health Agency of Canada and the Canadian Red Cross funded data analysis and writing, as well as editing, and design. Data management was supported during 1991-2010 by the Canadian Red Cross and in earlier years by the Lifesaving Society. Isabelle Masson and Sophie Lapointe made important contributions to data management, data verification, and research during 1991-2004. Former managers who advanced the water-related injuries surveillance system included Cindy Lyon of B.C., Dawn Stegan of Nova Scotia, Caroline Gagnon of Quebec, and Rosemary Hong of Ontario. The Research Institute of the McGill University Health Centre provided administrative support for data management during the initial 15 years of the research. For the first six years, the National Drowning Report and related special interest reports were supported by the Injury Prevention Module of the Régie régionale de la santé et des services sociaux de Montréal-Centre, a member of the World Health Organisation’s Collaborating Centre for Injury Prevention and Safety Promotion. Part 1 of this report is based upon the Canadian Red Cross 20-year surveillance database.

Part 2 Promising Practices for Immersion Prevention Part 2 was conceptualized by Shelley Dalke, prepared by Dr Audrey Giles PhD, Matias Golob MHK, PhD Candidate, Francine Darroch MPH, MEd, PhD Candidate, Lauren Brooks MA Candidate and Kyle Rich MA Candidate, and edited by Shelley Dalke and Dr Peter Barss. This publication is available in English.

PAGE | 3

T A B L E O F C O N T E N T S

EXECUTIVE SUMMARY ...............................................................................................................4

PART 1: IMMERSIONS AND OTHER WATER-RELATED INJURY

...........................................................5 FATALITIES AMONG ABORIGINAL PEOPLES IN CANDA

INTRODUCTION ..........................................................................................................................6

METHODS ...................................................................................................................................7

RESULTS .....................................................................................................................................10

IMMERSIONS ................................................................................................................................... 10

Boating ......................................................................................................................................... 25

Aquatic Activities ......................................................................................................................... 38

Non-aquatic activities .................................................................................................................. 45

Land, ice and air transport ........................................................................................................... 53

Snowmobiling ........................................................................................................................................................ 61

Bathing ......................................................................................................................................... 68

TRAUMATIC INJURIES .................................................................................................................... 69

DISCUSSION & RECOMMENDATIONS .....................................................................................70

APPENDIX A Bathing immersions...............................................................................................77

APPENDIX B Water-related traumatic injury deaths ....................................................................79

APPENDIX C Aboriginal peoples population numbers ..................................................................82

PART 1 REFERENCES .................................................................................................................84

................................................................87 PART 2: PROMISING PRACTICES FOR PREVENTION

PART 2 REFERENCES .................................................................................................................95

PAGE | 4

E X E C U T I V E S U M M A R Y

Part 1 of this report was prepared to provide an epidemiologic profile of 20 years of surveillance and research data on water-related unintentional injury deaths among Aboriginal peoples in Canada. The data source was the Canadian Surveillance System for Water-Related Fatalities. Data have been collected annually since 1991 from the mandatory coroner and police reports for all water-related deaths. The Canadian Red Cross led this, in collaboration with appropriate partners.

During 1991-2010, more than 1200 Aboriginal peoples died of drowning and cold, and other water-related injuries such as trauma. Immersions accounted for 98% of deaths, and trauma 2%. The activities associated with immersion deaths included boating 39%, non-aquatic activities such as walking or playing near water or on ice 22%, aquatic activities such as swimming and wading 18%, ice and land transport mainly snowmobiles 18%, and bathing in bathtubs 3%. Overall, recreational activities accounted for about 55%, daily life/subsistence 35%, and occupational 5%.

Males 15-65+ years comprised 73% of victims and had much higher immersion death rates than women and children. Boys and girls 0-9 years were the next risk group accounting for 17% of deaths. Deaths in lakes and rivers predominated in inland provinces, while there was a mix of lakes, rivers, and oceans in coastal provinces and the Northern Territories. Rural peoples mainly drowned in rural locations, and urban in a mix of urban and rural. The Prairies, the Northern Territories, Ontario and B.C. had the highest numbers of deaths, and the Northern Territories the highest rate.

Immersion deaths of Aboriginal peoples frequently involved hazardous conditions such as strong current, high winds, waves, cold water, ice, and darkness. For victims of known swimming ability, 40% were weak or non-swimmers. Alcohol, often at very high levels, was associated with at least 60% of deaths. In more recent years, illegal drugs were involved in about 20% of immersion deaths. Use of flotation devices was reported for only 5% of boating victims.

Although there was variability in completeness of reporting for aboriginal ethnicity during 1991-2010, it appears the overall rate of Aboriginal water-related deaths declined during 1991-2000, but experienced no further change between 2001-2010. However, for boating, there was a steady decline during the entire 20 year period in all regions of Canada, with the exception of the Northern Territories. Nevertheless, far too many Aboriginal peoples continue to die from immersion and water-related injuries, with death rates several times higher than for other Canadians.

Boating deaths of Aboriginal and non-Aboriginal peoples could be greatly reduced by legislating and enforcing wearing of a flotation device during boating. Education and enforcement of non-consumption of alcohol and drugs before and during water-related activity could also be helpful in reducing water-related deaths. Of concern is that the sole region exempt from boating operator proficiency testing is that at greatest risk, the Northern Territories. Culture and environment specific education and training on causes and prevention of immersion could be delivered in high schools by well-trained peers and other respected role models.

Further to this, Part 2 of this report gives recommendations for drowning prevention from review of national and international research, programmes and initiatives. Examples of successful interventions include manufacturing flotation devices that meet the needs of Aboriginal hunters, creating safety messages that resonate with beliefs and attitudes of Aboriginal peoples, and loan programmes for safety and locator devices.

Water safety programmes would benefit from active involvement of Aboriginal peoples in conceiving, developing, and implementing ideas from the best of traditional and modern knowledge, attitudes, practices, safety and communications equipment, and boat design. Aboriginal peoples know the challenges and needs of their communities and adjacent waters, and should be empowered and trained as most influential in changing attitudes towards water and ice safety.

PAGE | 5

P A R T 1

PAGE | 6

I N T R O D U C T I O N

This report was prepared to provide an epidemiologic profile of research and surveillance on water-related unintentional injury deaths among Aboriginal peoples in Canada during 1991-2010. During those years, 1240 Aboriginal people reportedly died from water-related injuries but the true number is probably considerably higher. Such deaths occurred during immersion from drowning and/or cold, and from traumatic injuries. Readers may wish to refer to earlier 10-year Red Cross modules on water-related injury surveillance for all Canadians, since while there are differences, increasingly there are similarities.

According to the World Health Organisation, drowning is the third leading cause of unintentional injury death worldwide, accounting for 500,000 deaths each year (WHO, 2012). In Canada, drowning was the second leading cause of unintentional injury death for Canadians under the age of 19 and fifth for all ages in 2005 (Public Health Agency of Canada, 2010). Each incident was a tragedy for one or more families and our society, often with devastating long-term emotional and financial consequences. Canadian Red Cross estimates of the costs of 653 water-related injury deaths during 1993 was $330 million, including both direct and indirect medical costs but also the human capital costs of lost earning (Canadian Red Cross, 1994). An estimate of only direct and indirect costs of drowning in 2004 was about $106 million (SmartRisk, 2009). Human capital costs generally greatly exceed other costs.

While Aboriginal peoples account for around 4% of the Canadian population, they are overrepresented among victims of immersion deaths. This is partly due to greater exposure to natural bodies of water, and to the large proportion of young people in the Aboriginal population. In 1993, the overall immersion rate when adjusted for age was about 3 times greater among Aboriginal peoples. Previous research suggested that drowning rates amongst some rural Canadian Aboriginal populations were up to ten times greater than for the non-Aboriginal population (Damestoy, 1994). In some northern communities, the number of boating-related drownings has exceeded the number of road traffic deaths, although the overall situation is changing rapidly with more Aboriginal peoples living in urban rather than remote areas.

Aboriginal and other rural people’s high risk for drowning is attributable in part to the remote location of communities. Historically, lakes, rivers and oceans provided food and a means of transportation, with canoes or kayaks used to travel from one community to another. Today, water remains an important part of rural Aboriginal people’s lives. Motor boats are frequently used for recreation, daily travel and for hunting and fishing for food.

Among all Canadians, low wearing of flotation devices and use of alcohol have been important contributors to water-related injury deaths. The situation is similar among Aboriginal peoples, but differs in frequency. In the past, less than 5% of Aboriginal boating drowning victims were found wearing a flotation device, as compared with about 10% of all Canadians (Canadian Red Cross, 2001). Travel by snowmobile for recreation and daily life is also frequent; this sometimes involves travel over frozen bodies of water, putting individuals at risk for cold water immersion.

This report provides personal, equipment and environment risk factors associated with immersions and other water-related injury deaths among Aboriginal peoples in Canada. Trends are also included; however, changes in completeness of reporting means that it would be unwise to over-interpret trends. It is our hope that this report contains information to reduce human suffering, as well as the associated emotional and financial losses for Aboriginal families and communities as a result of preventable premature death of fathers, children, and others.

PAGE | 7

M E T H O D S

STUDY POPULATION AND TIME PERIOD

All drownings and other water-related injury deaths among Aboriginal peoples in Canada were monitored between 1 January 1991 and 31 December 2010.

According to the 2006 Census, the Aboriginal population was about 1.2 million persons in 2006, of whom 64% were First Nations, 30% Metis, and 4% Inuit. All together Aboriginal peoples represent about 4% of the Canadian population. The Aboriginal population in Canada is growing faster than the non-Aboriginal population; between 1996 and 2006 the Aboriginal population increased by 45%, compared to 8% for the non-Aboriginal population. About half of Aboriginals are less than 25 years of age, with the median age of the Aboriginal population being 27 years, compared to 40 years for the non-Aboriginal population. 60% of the Aboriginal population resides in the Western Provinces of Manitoba, Saskatchewan, Alberta and British Columbia, 20% in Ontario, 9% in Quebec, 6% in the Atlantic region, and 5% in the northern territories (Statistics Canada, 2006).

DEFINITIONS

ABORIGINAL PEOPLES

By definition ‘Aboriginal’ includes persons who identify as First Nations, Inuit or Metis both on and off-reserve. This report includes individuals who were identified as either definite or probable Aboriginal identity. Aboriginal status was considered definite if identified as such by the coroner, police or pathologist. Probable Aboriginal status was assigned if the address corresponded to a known reserve and if the family name was known to be Aboriginal. Since 1996, the province of Ontario has not consistently facilitated reporting on Aboriginal status; hence from 1996 such data are incomplete for the largest province for several years, affecting overall reporting. Due to this the true proportion of Aboriginal drowning is undoubtedly substantially greater than reported, especially since 1996, which affects the interpretation of trends. The Ontario Chief Coroner during 1991-1995, Dr. James Young, obtained permission from the Legislature for the Red Cross to record Aboriginal ethnicity and for an Ojibway staff person of the Red Cross to review all water-related injury deaths for that period to verify probable Aboriginal ethnicity based on community and family names. Hence data for Ontario are believed to be the most complete for that first five years.

IMMERSION DEATHS: DROWNINGS AND IMMERSION HYPOTHERMIA

For the purposes of this report, immersion death includes death by drowning and/or immersion hypothermia. An immersion death was classified as drowning if drowning was included in the coroner’s report, based on autopsy or other findings. Death was classified as immersion hypothermia without drowning if the coroner’s report excluded drowning as among the causes of death based on lack of autopsy findings of drowning. Reporting was done on immersions as a single category because as evident from the Canadian Red Cross 10-year module on cold immersion, cold is a factor in at least 35% of immersion deaths, and hypothermia is inconsistently reported due to lack of clear criteria for such a diagnosis, as well as lack of training on cold immersion for some coroners and police. In Canada, risk factors tend to be similar for both drowning and immersion hypothermia. Persons not wearing a flotation device may or may not survive long enough to die of hypothermia. The proportion of deaths attributable to drowning, drowning complicated by hypothermia, and hypothermia without drowning are reported in a footnote of the first graphic of each section of this report.

PAGE | 8

M E T H O D S

TRAUMA DEATHS

As in the World Health Organisation’s International Classification of Diseases (WHO 2013), trauma deaths have been reported as a separate category in this report. Types of trauma injuries include head and spinal injuries, fractures, severe lacerations and multiple injuries, mainly from various types of collisions and falls. Whereas the main agents of immersion deaths are lack of oxygen from drowning and/or the effects of cold, the major agent of trauma deaths is kinetic energy.

OTHER DEFINITIONS

Each year there are several deaths that are classified as unintentional by the coroner where suicide has been suspected but unproven. Most of these deaths are classified as the activity and the purpose of activity unknown, and so some deaths in these categories could have been suicides.

NATIONAL SURVEILLANCE DATABASE

The data source for this report was the Canadian Surveillance System for Water-Related Fatalities. This surveillance database was developed in the early 1990’s by the Canadian Red Cross in collaboration with public health injury prevention professionals in the McGill Public Health Unit of Montreal Public Health, all provincial and territorial coroners including the National Association of Coroners and Medical Examiners, and other water-safety organisations including the Canadian Coast Guard and the Lifesaving Society. The database serves to provide a sound research basis for national water safety programmes by monitoring the incidence and circumstances of all water-related injury deaths in Canada. The database includes all unintentional drownings and other water-related injury deaths investigated by coroners or medical examiners in Canada during 1991-2010.

DATA COLLECTION

The surveillance database relies upon annual structured reviews of the mandatory coroner and police reports for all water-related deaths. A questionnaire with 48 questions is used to obtain data on cause of death, activity and purpose of activity, along with personal, equipment and environment risk factors. Project managers supervise volunteer data collectors in each province. Data are collected for the previous year’s deaths in the fall of the following year, by which time the majority of coroners’ and medical examiners’ reports have been completed for the previous year. While a second visit is made to ensure complete data collection, there could still be some deaths not complete at that time, especially when the body was not recovered. Some such deaths are added to the database in subsequent years.

DATA VERIFICATION

Data are verified, corrected and entered centrally by a small team of trained public health injury researchers including an epidemiologist and public health physician to ensure validity and consistency across the country. Verification is highly structured and includes issues such as admissibility, completeness, internal consistency of responses, and consistency from year to year. Data entry is done with appropriate quality control, including double entry and compare.

PAGE | 9

M E T H O D S

POPULATION ESTIMATES

Population denominators used to calculate mortality rates were based on 1991, 1996, 2001 and 2006 Canadian Censuses and the 1991 Aboriginal Peoples Survey, all of which were conducted by Statistics Canada. A combination of the 1991 census and the 1991 Aboriginal Peoples Survey was used to obtain population estimates for 1991. This was necessary as data on Aboriginal populations were not consistently collected through the censuses over the entire study period.

In 1991 and previous censuses, the Aboriginal population was determined using a question regarding ethnic origin, based on an individual’s ancestry. On the 1996 census a new question was included, which asked respondents to define themselves as Aboriginal if they personally identified with at least one Aboriginal group (First Nations, Metis or Inuit). Unfortunately, Aboriginal ancestry data are not comparable with the self-reported identity data, as there are some people who have Aboriginal ancestors who do not see themselves as Aboriginal, and vice versa. The Aboriginal self-reporting count for 1996 was approximately 780,000, whereas the ancestry count was 1.1 million.

To obtain population estimates with consistent definitions over the study period, a combination of population estimates from the 1991 Aboriginal Peoples Survey and the Aboriginal ancestry question from the 1991 census were used. The 1991 Aboriginal Peoples Survey asked respondents to self-report if they identified at least one Aboriginal group (First Nations, Metis or Inuit). However, this survey was conducted among individuals 15 years of age and older. The population according to the 1991 Aboriginal ancestry question was used for the 0-14 years of age population. As a result, population estimates for the 0-14 population are overestimated for 1991, resulting in mortality rates for this age group being underestimated. Comparison between the 1991 census and the Aboriginal Peoples survey for adult age groups indicates that the 1991 census overestimated the self-reporting Aboriginal population by 32-40%. Sensitivity analyses indicate that the age-specific rates for 0-14 years are underestimated by 5-6% for rates calculated using 20 years of data. As such age-specific rates for 0-14 years of age presented in the graphics of this report are likely higher than what are shown. DATA ANALYSIS

For the purpose of this report, mortality rates by year were calculated using an average of two census estimates. For example, rates for 1996-2000 were calculated using an average of the 1996 and 2001 censuses, multiplied by five to represent 5 years of person-time. Age-specific rates were calculated in a similar manner. Data from the 2011 Canadian census had not been released at the time of publication, and as such rates for 2006-2010 were based on the 2006 census alone. All census data and data from the Aboriginal Peoples Survey were obtained from the Computing in the Humanities and Social Sciences (CHASS) Data Centre at the University of Toronto. Analyses were performed using SAS version 9.3 and Microsoft Excel spreadsheets. Percentages have been rounded to the nearest whole number. Hence the total percentage for some tables and graphics may add up 99% or 101%.

RESULTS

PAGE | 10

During 1991-2010, there were 1240 water-related deaths of Aboriginal peoples, including 1177 drownings (with or without hypothermia), 36 immersion hypothermia deaths without drowning, and 27 other water-related deaths where drowning nor hypothermia were major causal factors. These injury deaths included head and spinal injuries from diving into water, injuries from boating collisions, and air embolisms from scuba diving. Immersions accounted for 98% of all water-related fatalities among Aboriginal peoples. ACTIVITY

The largest category of activity for immersion deaths was boating, followed by non-aquatic activities, aquatic activities, and land, ice and air transportation (Figure 1).

Figure 1 PROPORTION OF IMMERSION DEATHS* OF ABORIGINAL PEOPLES BY ACTIVITY,

CANADA 1991-2010 (n=1213)

* 1039 (86%) of immersion deaths were due to drowning, 138 (11%) were drowning complicated by hypothermia, and 36 (3%) were hypothermia with no autopsy evidence of drowning. Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

O V E R V I E W O F I M M E R S I O N S

Boating (n=444)

Aquatic activities (n=208)

Non-aquatic activities (n=255)

Land, ice or air transportation

(n=203)

Bathing 3% (n=34) Unknown (n=69)

37%

17%

21%

17%

6%

PAGE | 11


PURPOSE OF ACTIVITY

Recreational activities were the most frequent purpose of activity, followed by daily life which includes subsistence activities and others such as bathing and travel from place to place (Figure 2). Only a small proportion of victims were engaged in occupational activities at the time of the incident.

Figure 2 PROPORTION OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY PURPOSE OF

ACTIVITY, CANADA 1991-2010 (n=1213)

Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

PERSONAL RISK FACTORS

AGE AND SEX

The main risk group for immersion deaths was males 15 years of age and older, with the greatest number of deaths occurring between 15 and 64 years (Figure 3). Females were mainly at risk as children 0-9 years old. Males accounted for 85% of immersion deaths.

Recreational (n=626)

Occupational (n=48)

Daily living (n=407)

Rescue 2%(n=28) Other 1% (n=11)

Unknown (n=93)

52% 34%

8%

4%

PAGE | 12


Figure 3 AGE-SPECIFIC RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL PEOPLES

BY SEX, CANADA 1991-2010 (n=1213; 1028 MALES, 185 FEMALES)*

Number of deaths in age group

<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ Males 6 67 41 25 104 250 207 169 112 42

Females 7 43 13 7 18 25 29 24 11 8 * This figure excludes 5 male victims; age was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

ALCOHOL

Alcohol was present or suspected in 64% of victims 15 years of age and older, with 12% unknown (Figure 4). If deaths with alcohol classified as unknown were excluded, alcohol would be present or suspected for 73% of deaths, and therefore the true proportion may lie between 64% and 73%.

DRUGS

Illegal drugs were present or suspected in 13% of deaths, while legal drugs were present or suspected in 6% (Figure 5). For victims where illegal drugs were detected in blood or other samples, marijuana was the most frequent at 62%, cocaine 19%, phencyclidine (PCP) 1%, and other illegal drugs not further defined 12%. For some victims, more than one illegal drug was detected, while for others the type of illegal drug was not reported.

SWIMMING ABILITY

Swimming ability was assessed for victims 5 years of age and older. Unfortunately, swimming ability was unknown for 74% of victims. For the remainder, 23% were non-swimmers, 12% were weak swimmers, 7% were intermediate, 6% were strong, and 38% were swimmers of unspecified ability. Swimming ability was reported to be irrelevant for the remaining 14% of deaths. ‘Weak’ swimmer refers to individuals with some ability to stay at the surface.

5.43

2.28

10.73

17.62

15.51 15.00

11.86 11.90

3.00 0.69

2.01 1.61 1.99 1.86 1.10

1.81

0

5

10

15

20

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years

Males (n=1028) Females (n=185)

PAGE | 13


Figure 4 PROPORTION OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY BLOOD

ALCOHOL LEVELS*, CANADA 1991-2010 (VICTIMS ≥ 15 YEARS OF AGE; n=1004)§

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces now have lower limits § This figure excludes 77 victims; decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 5 DRUG INVOLVEMENT FOR IMMERSION DEATHS OF ABORIGINAL PEOPLES, CANADA

1991-2010 (VICTIMS ≥ 15 YEARS OF AGE; n=1004)*

* This figure excludes 22 victims; decomposition rendered blood sample unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

9%

20%

23%

20%

24% >300 mg% (n=110)

101-150 mg% (n=39)

151-200 mg% (n=93)

201-250 mg% (n=106)

251-300 mg% (n=90)

81-100 mg% 2% (n=11)

49% 24%

12%

9% 6%

No drugs (n=407)

Known illegal (n=99) Suspected illegal

3% (n=25)

Known legal (n=51)

Suspected legal 1% (n=7)

Unknown (n=393)

41% 40%

10% 5%

9%

20%

23%

20%

24% >300 mg% (n=110)

Unspecified 2% (n=9)

101-150 mg% (n=39)

151-200 mg% (n=93)

201-250 mg% (n=106)

251-300 mg% (n=90)

81-100 mg% 2% (n=11)

Above limit (n=458)

Below limit (n=51)

Alcohol suspected

(n=86)

No alcohol (n=222)

Unknown (n=110)

49% 24%

12%

9% 6%

PAGE | 14


ENVIRONMENT FACTORS

BODY OF WATER

Lakes and rivers were the most frequent body of water for immersion death of Aboriginal peoples, followed by oceans and other sites such as bathtubs (Figure 6). In central inland provinces, lakes were most frequent, in the Atlantic Provinces, the ocean, and in B.C. and the Northern Territories, rivers and oceans were the most frequent sites for immersion deaths.

Figure 6 PROPORTION OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY REGION AND

BODY OF WATER, CANADA 1991-2010 (n=1213)*

* This figure excludes 4 deaths from the breakdown by region for which province was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

CURRENT

Moving water, such as strong current, rapids or whitewater, hydraulic current, dam spillways, waterfalls, ocean tide or undertow were associated with at least 24% of immersion deaths for all bodies of water. The true value is higher as current was unknown for 45% of all immersion deaths. For 429 fatalities involving rivers, current was unknown or irrelevant for 52%. In the remaining 205, fast/strong current was reported for 77%, rapids/whitewater 13%, other moving water 5%, waterfall 1%, and other 3%. It is clear that current was a factor in immersion deaths for all types of activities in rivers (Table 1).

19%

36%

60%

56%

20%

27%

44%

31%

40%

33%

31%

48%

36%

35%

46%

14%

25%

32%

11%

2%

4%

5%

3%

3%

2%

10%

7%

9%

3%

2%

6%

0% 20% 40% 60% 80% 100%

Atlantic(n=48)

Quebec(n=94)

Ontario(n=217)

Prairies(n=499)

B.C.(n=174)

Territories(n=177)

Canada(n=1213)

Percentage of deaths

Region Lake River Ocean Bathtub Other/Unknown

PAGE | 15


Table 1 NUMBER OF IMMERSION DEATHS IN RIVERS OF ABORIGINAL PEOPLES BY ACTIVITY

AND TYPE OF CURRENT, CANADA 1991-2010 (n=429)

Boating

Aquatic activities

Non-aquatic

activities

Land, ice and air

transport

Unknown activity

All immersions

Fast or strong current 52 44 41 14 7 158

Rapids, whitewater 18 5 3 1 0 27

Waterfall 0 1 2 0 0 3

Other moving water 2 6 6 2 1 17

Unknown 49 37 57 38 26 207

Irrelevant 2 3 2 8 2 17

Total 123 96 111 63 36 429


WATER TEMPERATURE

Water temperature was unknown for 56% of deaths. For the remainder, water temperature was reported to be very cold (<10°C) for 63%, cold or cool (10-20°C) for 26%, warm or hot (>21°C) for 2%, and irrelevant due to indoor settings for 9%.

LIGHT CONDITIONS

Light conditions were unknown for 22% of deaths. For the remainder, 29% occurred in the dark, 12% in twilight, 54% in daylight, and 5% occurred where light conditions were irrelevant.

SUPERVISION

Across all ages, 35% of victims were alone at the time of incident. Of concern is that 31% of children ages 0-9 years were alone at the time of incident, while 42% were with minors only. Therefore, 73% of immersion deaths of children ages 0-9 years occurred while there was no adult supervision. MONTH AND DAY OF WEEK

Immersion deaths occurred throughout the year, with the highest period during the summer, spring and fall and lowest during January and February (Figure 7). 48% of deaths occurred during the summer months of June, July and August, with 76% between May and October. The month of July was the most frequent month, representing 20% of immersion deaths. 20% of deaths took place on Saturday, and 49% on Friday, Saturday or Sunday.

REGION

The northern territories had the highest rate of immersion death of Aboriginal peoples (Figure 8). The rate was much lower and fairly equal among the rest of Canada’s regions. The Atlantic region had the lowest rate and the lowest number of deaths.

PAGE | 16


Figure 7 NUMBER OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY MONTH OF INCIDENT,

CANADA 1991-2010 (n=1213)*

* Month unknown for 34 deaths Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 8 RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY REGION,

CANADA 1991-2010 (n=1213)*

* This figure excludes 4 deaths from the breakdown by region for which province of incident was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

11 14

26

43

75

92

160

99

65 68

37 35

7 7 14

27

51

82 86

62

40 45

19 14

0

20

40

60

80

100

120

140

160

180

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

Nu

mb

er o

f d

eath

s

Month of incident

1991-2000 (n=747) 2001-2010 (n=466)

4.66

5.45

5.75

5.93

5.37

18.57

6.34

0 5 10 15 20

Atlantic (n=48)

Quebec (n=94)

Ontario (n=217)

Prairies (n=499)

B.C. (n=174)

Territories (n=177)

Canada (n=1213)

Deaths/100,000 population/year

Region

PAGE | 17


VICTIM’S RESIDENCE VERSUS LOCATION OF INCIDENT

77% of all immersion deaths among Aboriginal peoples occurred in rural locations where the closest town had a population of less than 1000 (Table 2). 97% of victims who resided in rural locations also died in rural locations. For victims who resided in urban locations, 62% died in urban locations and 36% died in rural locations. Hence nearly all rural residing victims died in rural locations, while for urban residing victims, about a third died in rural locations and two-thirds in urban locations.

Table 2 URBAN-RURAL LOCATION OF DEATH VERSUS RESIDENCE OF VICTIM FOR IMMERSION

DEATHS OF ABORIGINAL PEOPLES, CANADA 1991-2010 (n=1213)

Location of incident

Rural Urban Unknown Total

n % n % n % n Residence of deceased Rural 794 97 26 3 2 0.2 822 Urban 125 36 218 62 6 2 349 Unknown 14 33 13 31 15 36 42 Total 933 77 257 21 23 2 1213


SINGLE VERSUS MULTIPLE VICTIM INCIDENTS

Certain activities are more prone than others to involve more than one victim in a single incident. Hence for those activities an incident averted can spare two or more lives. Boating and ice transport, mainly snowmobiling, had the most incidents with more than one victim (Table 3). Excluding 17% unknowns, boating had 40% multiple victim deaths and land and ice transport 41%, compared with 11% for aquatic and 5% for non-aquatic.

Table 3 NUMBER OF SINGLE-MULTIPLE VICTIM IMMERSION DEATHS OF ABORIGINAL PEOPLES

BY ACTIVITY, CANADA 1991-2010

Boating Aquatic Non-

aquatic

Land, ice and air

transport Unknown Bathing

All immersions

Single 219 158 196 104 31 64 772 Multiple 149 19 10 71 0 2 251 Unknown 76 31 49 28 3 3 190 Total 444 208 255 203 34 69 1213 Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

PAGE | 18


TRENDS

TRENDS BY PURPOSE OF ACTIVITY

Between 1991-1995 and 2006-2010, there was no significant trend in the purpose of activity for immersion deaths (Figure 9).

Figure 9 PROPORTION OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY PURPOSE OF

ACTIVITY AND 5-YEAR PERIOD, CANADA (n=444)


57%

45%

49%

52%

52%

32%

37%

39%

28%

34%

4%

5%

4%

3%

4%

3%

4%

2%

4%

3%

5%

9%

6%

12%

8%

0% 20% 40% 60% 80% 100%

1991-1995(n=445)

1996-2000(n=302)

2001-2005(n=231)

2006-2010(n=235)

1991-2010(n=1213)


Recreational Daily living Occupational Other/Rescue Unknown

PAGE | 19


TRENDS IN AGE-SPECIFIC RATES

Decreases in rates of immersion death were observed for males 15 years of age and older between 1991-1995 and 1996-2000 (Figure 10). There also appears to have been a decline in the rate for 0-9 year-olds. For females, the rate for 0-9 year-olds also appears to have decreased (Figure 11). Numbers for other age groups of females are too small to interpret possible trends.

Figure 10 AGE-SPECIFIC RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL MALES

BY 5-YEAR PEROID, CANADA 1991-2010 (n=1028)*


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

1991-1995 3 35 16 3 39 98 72 56 36 21 1996-2000 0 19 9 10 22 62 59 34 24 9 2001-2005 2 4 6 5 24 44 39 42 20 7 2006-2010 1 9 10 7 19 46 37 37 32 5

* This figure excludes 5 male victims (1 in1991-1995, 3 in 1996-2000, and 1 in 2001-2005 ) for whom age was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

9.37

1.24

22.60

33.98

28.21

34.01

28.48

38.34

5.46 4.20

10.99

18.36 18.10

14.52 13.14 12.33

2.35 1.71

8.89

11.49 10.55 12.65

7.06

6.82

4.00 2.17 5.82

11.22 9.65

9.34

9.09

4.08

0

10

20

30

40

50

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years

1991-1995 (n=380) 1996-2000 (n=251)

2001-2005 (n=194) 2006-2010 (n=203)

PAGE | 20


Figure 11 AGE-SPECIFIC RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL FEMALES

BY 5-YEAR PERIOD, CANADA 1991-2010 (n=185)*


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ 1991-1995 2 20 4 4 7 3 8 8 4 5 1996-2000 2 15 6 0 4 10 7 2 4 1 2001-2005 2 6 1 2 3 5 9 6 1 2 2006-2010 1 2 2 1 4 7 5 8 2 0


TRENDS IN SEX-SPECIFIC RATES

There appears to have been a decline in the rate of immersion deaths for males between 1991-1995 and 2001-2005, but little change between 2001-2005 and 2006-2010 (Figure 12). Females were at a lower risk of immersion death compared to males. However, trends showing rates should be interpreted cautiously, as the changing demographics of the Aboriginal population with a decreasing proportion of young children by about a third and doubling of persons 40 and older during the 20 years of surveillance have not been taken into account by age-adjustment. Figure 13 shows an example of the magnitude of change to expect if immersion rates were age-adjusted to the population structure of the first five-year period. Adjustment for age resulted in about a 10% reduction in rates from 2006 onwards. For activities involving fatalities of small children or the elderly the effects may be greater. The time available for the report did not allow calculation of adjusted rates for other activities.

4.69

1.72

4.10

0.89

2.73

4.39

2.93

7.95

4.69

0.00

2.05

2.69

1.99

0.76

2.06

1.14

1.72

0.75 1.22

1.22

2.28

1.56

0.33

1.52

0.93 0.34

1.42 1.60

1.19

1.74

0.54

0.00 0

1

2

3

4

5

6

7

8

9

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years

1991-1995 (n=65) 1996-2000 (n=51)

2001-2005 (n=37) 2006-2010 (n=32)

PAGE | 21


Figure 12 RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY SEX AND

5-YEAR TIME PERIOD, CANADA 1991-2010 (n=1213; 1028 MALES, 185 FEMALES)

Number of deaths in each 5-year period

1991-1995 1996-2000 2001-2005 2006-2010

Males 380 251 194 203 Females 65 51 37 32


Figure 13 CRUDE AND AGE-ADJUSTED RATES OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

SEX AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=1213; 1028 MALES, 185 FEMALES)


20.20

11.92

7.63 7.22

3.30 2.34 1.39 1.08

0

5

10

15

20

25

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

5-year period


20.15

11.00

6.73 6.62

3.30

2.50 1.44

1.08

20.20

11.92

7.63

7.22

3.30

2.34 1.39 1.08 0

5

10

15

20

25

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

5-year period

Males age-adjusted Females age-adjustedMales crude Females crude

PAGE | 22


TRENDS BY ACTIVITY

The rate of immersion deaths of reported Aboriginal ethnicity did show a sustained decline for boating during the entire four five-year periods (Figure 14). There was no change for aquatic, non-aquatic and land, ice and air transport activities during the past 10 years. There was little or no change for immersion deaths during bathing or where activity was unknown.

Figure 14 RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY ACTIVITY

AND 5-YEAR PERIOD, CANADA 1991-2010 (n=1213)


1991-1995 1996-2000 2001-2005 2006-2010 Boating 189 103 82 70

Aquatic 69 55 42 42 Other non-aquatic 96 63 42 54 Land, ice or air transportation 73 47 40 43 Bathing 7 10 11 6 Unknown 11 24 14 20


TRENDS IN ALCOHOL INVOLVEMENT

There was no change in the high proportion of immersion deaths involving alcohol between 1991-1995 and 2006-2010 (Figure 15).

TRENDS IN DRUG INVOLVEMENT

The proportion of immersion deaths involving illegal drugs appears to have increased between 1991-1995 and 2006-2010; however, samples were not taken in 57% during 1991-95 (Figure 16). The proportion of unknowns was about three times higher than for alcohol during the latter three periods of surveillance, so the true involvement of drugs may have been higher.

4.91

2.41

1.58

1.21 1.79

1.28

0.81 0.73

2.49

1.47

0.81 0.94

1.90

1.10

0.77 0.74

0.18 0.23 0.21 0.10

0.29 0.56

0.27 0.35

0

1

2

3

4

5

6

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

5-year time period

Boating (n=444) Aquatic (n=208)

Other non-aquatic (n=255) Land, ice or air transportation (n=203)

Bathing (n=34) Unknown (n=69)

PAGE | 23


Figure 15 BLOOD ALCOHOL LEVELS* FOR IMMERSION DEATHS OF ABORIGINAL PEOPLES BY 5-

YEAR PERIOD, CANADA 1991-2010 (VICTIMS ≥ 15 YEARS OF AGE; n=1004)§

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 77 victims (13 in 1991-1995, 30 in 1996-2000, 18 in 2001-2005, and 16 in 2006-2010); decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 16 DRUG INVOLVEMENT FOR IMMERSION DEATHS OF ABORIGINAL PEOPLES BY 5-YEAR

PERIOD, CANADA 1991-2010 (VICTIMS ≥ 15 YEARS OF AGE; n=1004)*

* This figure excludes 22 victims (13 in 1996-2000, 4 in 2001-2006, and 5 in 2006-2010); decomposition rendered blood sample unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

19%

27%

26%

27%

24%

9%

11%

12%

5%

9%

6%

5%

7%

5%

6%

49%

48%

45%

55%

49%

17%

9%

9%

8%

12%

0% 20% 40% 60% 80% 100%

1991-1995(n=345)

1996-2000(n=211)

2001-2005(n=185)

2006-2010(n=186)

1991-2010(n=927)


No alcohol Alcohol suspected Below limit Above limit Unknown

31%

54%

47%

39%

41%

4%

8%

16%

19%

10%

3%

4%

2%

1%

3%

4%

4%

6%

8%

5%

1%

1%

1%

57%

29%

29%

32%

40%

0% 20% 40% 60% 80% 100%

1991-1995(n=358)

1996-2000(n=228)

2001-2005(n=199)

2006-2010(n=197)

1991-2010(n=982)


No drugs Known illegal Suspected illegal Known legal Suspected legal Unknown

PAGE | 24


TRENDS BY REGION

The highest numbers of immersion deaths occurred in the Prairies followed by Ontario. The highest rates were seen in the Northern Territories (Figure 17). Trends could be biased due to variable reporting of ethnicity in Ontario as discussed in the methods between 1991-1995 and 1996-2000 and changes to the B.C. coronarial information system reducing access to ethnicity during 2006-2010. However, even if there was improvement during that period for Canada as a whole, there was very little change between 2001-2005 and 2006-2010. The situation appears to have deteriorated somewhat in Ontario and the Territories during that period. There may have been progress in other regions but the numbers are small. The regions to concentrate on going forward are the Prairies, the Northern Territories, and possibly B.C. if B.C.’s past five years represent incomplete data.

Figure 17 RATE AND NUMBER OF IMMERSION DEATHS OF ABORIGINAL PEOPLES BY REGION

AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=1213)*

* This figure excludes 4 deaths from the breakdown by region for 1996-2000 for which province was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

5.74

9.15

13.79

9.81

10.24

30.77

11.56

7.06

6.79

5.67

6.37

6.85

17.26

6.96

4.39

4.21

2.11

4.63

4.65

11.96

4.43

2.87

3.10

3.93

4.15

1.57

16.22

4.05

0 5 10 15 20 25 30 35


Region 1991-1995 1996-2000 2001-2005 2006-2010

Atlantic (n=10)

(n=15)

(n=13) (n=10)

Quebec (n=34)

(n=24) (n=19) (n=17)

Ontario (n=103)

(n=46) (n=22) (n=46)

Prairies (n=166) (n=123) (n=106) (n=104)

B.C. (n=67)

(n=51) (n=41) (n=15)

Territories (n=65)

(n=39) (n=30) (n=43)

Canada (n=445)

(n=302) (n=231) (n=235)

PAGE | 25

B O A T I N G I M M E R S I O N S

Boating was the leading category of immersion deaths for Aboriginal peoples. During 1991-2010 there were 444 boating immersion deaths. Boating accounted for 36% of fatal immersions of Aboriginal peoples. PURPOSE OF ACTIVITY

Recreational boating represented 51% of boating immersion deaths, daily life activities 39%, occupational 7%, rescue 2%, and other/unknown 2% (Figure 18).

Figure 18 PROPORTION OF BOATING IMMERSION DEATHS* OF ABORIGINAL PEOPLES BY

PURPOSE OF ACTIVITY, CANADA 1991-2010 (n=444)

* 372 (84%) immersion deaths were due to drowning, 60 (14%) were drowning complicated by hypothermia, and 12 (3%) were hypothermia without autopsy evidence of drowning Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

TYPE OF ACTIVITY BY PURPOSE

Recreational boating activities included power boating, fishing, canoeing and hunting (Figure 19). The main daily living activities were boat travel, subsistence fishing, and ‘other’ daily living activities that were not further defined. Commercial fishing was the main occupational boating activity.



Occupational (n=32)

Rescue 2% (n=8) Other/Unknown 2% (n=7)

39% 51%

7%

PAGE | 26


Commercial fishing (n=15)

Marine shipping (n=4)

Fishing guiding or charter 6% (n=2)

Aquaculture 3% (n=1)

Other (n=10)

Occupational (n=32)

47% 31%

13% 6%

Figure 19 PROPORTION OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

PURPOSE OF ACTIVITY AND TYPE OF ACTIVITY, CANADA (n=444)*

* This figure excludes 1 victim who was engaged in ‘other’ activity, 8 victims who were attempting to rescue, and 6 with unknown activity Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Boat travel (n=80)

Subsistence fishing (n=51)

Other (n=41)


47%

24%

30%

Hunting (n=21)

Fishing from boat/canoe (n=59)

Power boating (n=91)

Canoeing (n=36)

Other non-power boating 3% (n=7)

Kayaking 1% (n=2) Other 4% (n=9)


40%

26%

16%

9%

PAGE | 27


TYPE OF INCIDENT

The main types of boating incidents were capsizing, falling or being thrown overboard, and swamping (Figure 20). OVERVIEW OF RISK FACTORS FOR BOATING INCIDENTS

Large waves and strong winds were the most frequently reported risk factors contributing to boating immersion deaths, followed by overloading and standing up (Figure 21).

Figure 20 PROPORTION OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY CAUSE

OF INCIDENT, 1991-2010 (n=444)



VARIOUS CONTRIBUTING RISK FACTORS, CANADA 1991-2010 (n=444)*

* Urinating is considered to be a risk factor as it often involves alcohol use, standing in boat, and capsizing Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Fell/thrown overboard (n=100)

Capsized (n=168)

Collision (n=22)

Swamped (n=64)

Other (n=22)

Jumped overboard to rescue

person/object 1% (n=6)

Unknown (n=62)

23%

38%

14%

14%

5%

5%

32%

30%

10%

9%

3%

2%

1%

1%

0%

0% 5% 10% 15% 20% 25% 30% 35%

Large waves (n=141)

Strong winds (n=134)

Overloaded boat (n=43)

Standing (n=39)

Dangerous maneuver n=(15)

Engine failure (n=9)

Embarking/disembarking (n=6)

Urinating* (n=5)

Collision (n=1)


Risk factor

PAGE | 28


PERSONAL FACTORS

AGE AND SEX

The highest numbers of boating deaths during 1991-2010 occurred among males 15 to 64 years old (Figure 22). Males 20 to 49 years had the highest rates. Males 65 years of age and older also had considerably high rates. In contrast, there were no boating immersion deaths among females 65 years of age and older. Males represented 93% of boating immersion deaths.

Figure 22 AGE-SPECIFIC RATE AND NUMBER OF BOATING IMMERSION DEATHS OF

ABORIGINAL PEOPLES BY SEX, CANADA 1991-2010 (n=444)


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ Males 3 5 9 5 39 100 91 82 54 21

Females 0 2 6 0 3 2 12 6 1 0 * This figure excludes 3 male victims for whom age was not reported Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

ALCOHOL

Just over half of boating immersion victims 15 years of age and older had alcohol present or suspected (Figure 23). Of those victims who were found to have a blood alcohol of above 80 milligram percent, 45% were found to have a blood alcohol of at least three times the legal limit for operating a motor vehicle. Recreational activities accounted for 61% of boating immersion deaths where alcohol was present or suspected, daily life 31%, occupational 3%, rescue 2%, and unknown 2%.

0.81 0.46

4.02

7.05 6.82

7.28

5.72 5.95

0.38 0.00

0.34 0.13

0.82 0.46

0.10

0.00 0

1

2

3

4

5

6

7

8

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years


PAGE | 29


Figure 23 PROPORTION OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY BLOOD


* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 40 victims; decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

SWIMMING ABILITY

Swimming ability was unknown for 79% of boating immersion victims 5 years of age and older. For the remainder, swimming ability was reported as non-swimmer for 37%, weak swimmer for 15%, intermediate for 5%, strong for 8%, and swimmer, skill level unknown for 34%.

8%

24%

20%

23%

21% >300 mg% (n=32)


101-150 mg% (n=13)

151-200 mg% (n=37)

201-250 mg% (n=30)

251-300 mg% (n=35)

81-100 mg% 2% (n=3)

Above limit (n=153)

Below limit (n=15)

Alcohol suspected

(n=39)

No alcohol (n=110)

Unknown (n=57)

41%

15%

29%

10% 4%

PAGE | 30


EQUIPMENT FACTORS

TYPE OF BOAT

Small powerboats followed by canoes were the most frequent type of boat for recreational activities, while small powerboats and canoes were about equal for daily living activities (Figure 24). Canoes represented a quarter of all boating immersion deaths for both recreational and daily living activities. Large power boats were more common during occupational boating.


PURPOSE OF ACTIVITY AND TYPE OF BOAT, CANADA 1991-2010 (n=444)*


Large power boat (>5.5 m) (n=18)

Small powerboat (<5.5 m) (n=78)

Powerboat size unknown (n=37)

Canoe (n=59)

Rowboat 1% (n=2)

Kayak 1% (n=3)

Non-powered inflatable 1% (n=2)

Personal watercraft 0% (n=1)

Other 4% (n=8)

Unknown (n=17)


35%

16%

26%

8% 8%


Small powerboat

(<5.5 m) (n=7)

Powerboat size

unknown (n=5)

Canoe (n=3)

Rowboat 6% (n=2)

Other 3% (n=1)

Unknown 3% (n=1)

Occupational (n=32)

41%

22%

16%

9%


Small powerboat (<5.5 m) (n=49)

Powerboat size unknown (n=26)

Canoe (n=46)

Rowboat 3% (n=6)

Kayak 1% (n=1)

Other 3% (n=5) Unknown (n=13)


28%

15%

27%

15% 8%

PAGE | 31


FLOTATION

Only 5% of boating immersion victims were correctly wearing a flotation device during 1991-2010 (Figure 25). At least 72% of victims were not wearing a flotation device, with the true proportion likely higher due to 22% unknown. At least 38% did not have a flotation device in the boat, normally a legal requirement.

Figure 25 PROPORTION OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY USE OF

A PERSONAL FLOTATION DEVICE, CANADA 1991-2010 (n=444)


Worn properly (n=20)

Worn improperly 2%

(n=7)

Present and not worn (n=50)

Not present (n=170)

Not worn and unknown if

present (n=100)

Unknown (n=97)

38% 23%

22% 11%

5%

PAGE | 32


ENVIRONMENT FACTORS BODY OF WATER

Recreational boating deaths mainly involved lakes and rivers, daily life lakes, oceans and rivers, and occupational oceans and lakes (Figure 26). CURRENT

Current was unknown or irrelevant for 41% of boating deaths in rivers. DEPTH OF WATER

Water depth was unknown for 61% of deaths. For the remainder, 14% occurred in water 2.5 metres or less deep, with 4% in less than 1 metre. DISTANCE FROM SHORE

Distance from shore was unknown for 58% of boating immersion deaths. Of the remainder, 38% occurred within 50 metres of shore, including 8% at 2 metres or less, 12% at 2.1-15 metres, and 17% at 16-50 metres.

Figure 26 BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY BODY OF WATER,

CANADA 1991-2010 (n=444)*


Ocean (n=14)

Lake (n=12)

River (n=6)

Occupational (n=32)

44%

19%

38%

Ocean (n=53)

Lake (n=83)

River (n=35)

Unknown 1% (n=1)

Daily life (n=172)

48%

20% 31%

Ocean (n=13)

Lake (n=134)

River (n=77)

Unknown <1% (n=1)


60%

34%

6%

PAGE | 33


TRENDS

TRENDS BY PURPOSE OF ACTIVITY

Between 1991-1995 and 2006-2010 the proportion of recreational boating immersion deaths increased from 50% to 59% and daily living fell from 40% to 29%. There was no change for occupational (Figure 27).


PURPOSE OF ACTIVITY AND 5-YEAR PERIOD, CANADA (n=444)


50%

45%

54%

59%

51%

40%

45%

37%

29%

39%

6%

9%

9%

6%

7%

4%

2%

1%

7%

3%

0% 20% 40% 60% 80% 100%

1991-1995(n=189)

1996-2000(n=103)

2001-2005(n=82)

2006-2010(n=70)

1991-2010(n=444)


Recreational Daily living Occupational Other/Rescue/Unknown

PAGE | 34


TRENDS IN AGE-SPECIFIC RATES

A large improvement in the rate of immersion boating deaths was observed for males 20 years of age and older between 1991-1995 and 2006-2010 (Figure 28). For females, there were relatively few boating deaths in each age group; therefore, small changes in rates were observed but the number of deaths in each age group remained about the same. Due to small numbers, rates for females are not shown.

Figure 28 AGE-SPECIFIC RATE AND NUMBER OF BOATING IMMERSION DEATHS OF

ABORIGINAL MALES BY 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=412)*


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ 1991-1995 3 3 5 1 15 47 36 33 19 13 1996-2000 0 2 2 3 4 23 27 13 14 3 2001-2005 0 0 1 0 12 18 16 21 7 2 2006-2010 0 0 1 1 8 12 12 15 14 3

* This figure excludes 3 victims for whom age was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

1.91

0.41

8.69

16.30

14.10

20.04

15.03

23.73

0.78 1.26

2.00

6.81

8.28

5.55

7.66

4.11

0.20 0.00

4.45 4.70 4.33

6.33

2.47 1.95

0.20 0.31

2.45 2.93 3.13

3.79

3.98

2.45

0

5

10

15

20

25

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years

1991-1995 (n=175) 1996-2000 (n=93)

2001-2005 (n=78) 2006-2010 (n=66)

PAGE | 35



The rate of boating immersion deaths declined between 1991-1995 and 2006-2010 for males (Figure 29). The rate for females remained low and fairly constant during 1991-2010.

Figure 29 RATE AND NUMBER OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

SEX AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=444; 412 MALES, 32

FEMALES)


1991-1995 1996-2000 2001-2005 2006-2010 Males 175 93 78 66 Females 14 10 4 4



There was little improvement in the proportion of boating immersion deaths involving alcohol between 1991-1995 and 2006-2010 (Figure 30). However, there was an improvement in the proportion of incidents where alcohol involvement was unknown.

TRENDS IN USE OF A PERSONAL FLOTATION DEVICE The proportion of victims reported to be wearing a flotation device remained at about 5% during the 20-year period (Figure 31). In about 40% of deaths there was no flotation device reported present, which is a requirement for all provinces. Unknowns decreased from 29% during 1991-1995 to 13% during 2006-2010.

9.30

4.42

3.07 2.35

0.71 0.46 0.15 0.14

0

2

4

6

8

10

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

5-year time period


PAGE | 36


Figure 30 PROPORTION OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY BLOOD

ALCOHOL LEVELS* AND 5-YEAR PERIOD, CANADA 1991-2010 (VICTIMS ≥ 15 YEARS

OF AGE; n=414)§

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 40 victims (9 in 1991-1995, 11 in 1996-2000, 12 in 2001-2005, and 8 in 2006-2010); decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 31 PROPORTION OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY USE OF

A PERSONAL FLOTATION DEVICE AND 5-YEAR PERIOD, CANADA 1991-2010 (n=444)


20%

37%

32%

42%

29%

10%

9%

14%

8%

10%

5%

1% 4%

5%

4%

42%

39%

41%

41%

41%

23%

15%

9%

3%

15%

0% 20% 40% 60% 80% 100%

1991-1995(n=164)

1996-2000(n=82)

2001-2005(n=69)

2006-2010(n=59)

1991-2010(n=374)



3%

6%

6%

4%

5%

1%

2%

1%

4%

2%

10%

17%

5%

14%

11%

41%

39%

33%

37%

38%

17%

20%

34%

27%

23%

29%

16%

21%

13%

22%

0% 20% 40% 60% 80% 100%

1991-1995(n=189)

1996-2000(n=103)

2001-2005(n=82)

2006-2010(n= 70)

1991-2010(n=444)

Worn properly Worn improperly Present and not worn

Not present Not worn and unknown if present Unknown


PAGE | 37


TRENDS BY REGION There has been a steady decline in Aboriginal boating immersion deaths in all regions of Canada, with the exception of the Northern Territories where there was a decline after 1995 but no further improvement (Figure 32). A significant improvement between the first and second five-year time period was observed for Ontario; however, this is likely due in part to undercounting of deaths as Aboriginal by coroners in Ontario.

Figure 32 RATE AND NUMBER OF BOATING IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

5-YEAR PERIOD, CANADA 1991-2010 (n=444)


2.30

5.11

6.56

3.13

3.67

18.94

4.91

1.88

2.55

2.83

1.86

2.28

6.19

2.41

1.69

2.66

0.67

1.57

0.91

5.58

1.57

0.57

0.91

1.28

1.16

0.31

6.04

1.21

0 5 10 15 20

Immersion deaths/ 100,000 population/ year

Region 1991-1995 1996-2000 2001-2005 2006-2010

Atlantic (n=4)

(n=4)

(n=5) (n=2)

Quebec (n=19)

(n=9) (n=12) (n=5)

Ontario (n=49) (n=23) (n=7) (n=15)

Prairies (n=53)

(n=36) (n=36) (n=29)

B.C. (n=24)

(n=17) (n=8) (n=3)

Territories (n=40)

(n=14) (n=14) (n=16)

Canada (n=189)

(n=103) (n=82) (n=70)

PAGE | 38

A Q U A T I C A C T I V I T Y I M M E R S I O N S

During 1991-2010, there were 208 immersion deaths of Aboriginal peoples during aquatic activities. These incidents involved victims who intended to be in the water.

PURPOSE OF ACTIVITY

Of all aquatic deaths, 88% involved recreational activities, 2% daily living, and less than 1% involved occupational activities. 7% of victims had been attempting a rescue, and 3% were engaged in unknown or other activities (Figure 33). TYPE OF ACTIVITY

The most frequent recreational activities were swimming followed by playing in water or wading (Figure 34).

Figure 33 PROPORTION OF AQUATIC IMMERSION DEATHS* OF ABORIGINAL PEOPLES BY


* 204 (98%) all aquatic immersion deaths (including recreational, daily living, occupational, rescue and other/unknown) were due to drowning, 1 (0.5%) was due to drowning complicated by hypothermia, and 3 (1%) were due to hypothermia Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013


Daily life 2% (n=4)

Occupational <1% (n=1)

Rescue (n=14) Other/Unknown

(n=6)

88%

7% 3%

PAGE | 39


Figure 34 PROPORTION OF RECREATIONAL AQUATIC IMMERSION DEATHS* OF ABORIGINAL

PEOPLES BY TYPE OF ACTIVITY, CANADA 1991-2010 (n=183)


PERSONAL FACTORS AGE AND SEX

The main risk group by age was 15-49 years, with most deaths between 15 and 49 years of age (Figure 35). Females were at low risk as all ages. Males accounted for 87% of aquatic immersion deaths.

ALCOHOL

Overall, alcohol was above the legal limit or suspected in about 70% of deaths and below the limit in about 10% (Figure 36). Of those victims who were found to have a blood alcohol above 80 milligram percent, about 60% had a blood alcohol of at least three times the legal limit for operating a motor vehicle.

SWIMMING ABILITY

Swimming ability was unknown for 37% of aquatic immersion deaths. For the remainder, 13% were non-swimmers, 15% were weak swimmers, 10% were intermediate swimmers, 6% were strong swimmers, and 55% were swimmers not further defined.

Playing in water/wading (n=40)

Swimming (n=128)

Diving/jumping (n=7)

Hunting 1% (n=1)

Fishing in water 1% (n=1) Partying 1% (n=2)

Other 2% (n=4)

70%

22%

4%

PAGE | 40


Figure 35 AGE-SPECIFIC RATE AND NUMBER OF AQUATIC IMMERSION DEATHS OF



<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Males 0 6 13 12 25 56 38 19 10 1 Females 0 7 5 3 3 5 2 2 1 0


Figure 36 PROPORTION OF AQUATIC IMMERSION DEATHS OF ABORIGINAL PEOPLES BY BLOOD



0.91 1.09

2.58

3.95

2.85

1.69

1.06

0.28

0.57 0.30 0.34 0.32 0.14 0.15 0.10

0.00 0

1

2

3

4

5

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years


3%

4%

10%

19%

24%

35% >300 mg% (n=35)


101-150 mg% (n=4)

151-200 mg% (n=10)

201-250 mg% (n=19)

251-300 mg% (n=24)

81-100 mg% 4% (n=4)

Above limit (n=99) Below limit

(n=9)

Alcohol suspected

(n=14)

No alcohol (n=25)

Unknown (n=11)

63%

16%

7%

9%

6%

PAGE | 41


ENVIRONMENT FACTORS

BODY OF WATER

Lakes and rivers were the most frequent bodies of water for aquatic immersion deaths (Figure 37). Rivers followed by lakes were the most frequent for non-recreational deaths. CURRENT

Current was associated with at least 34% of aquatic immersion deaths, possibly more as water current/flow was unknown for 40%. SUPERVISION

Overall, 12% of victims were alone at the time of the incident, 14% were with minors only, and 59% were with at least one adult. For children 0-9 years of age, 10% were alone and 58% were with minors only. Among 10-14 years, 13% were alone and 47% were with minors only.

Figure 37 PROPORTION OF AQUATIC IMMERSION DEATHS OF ABORIGINAL PEOPLES BY TYPE

OF BODY OF WATER*, CANADA 199-2010 (n=208)

* Pool includes 1 private pool, 1 public pool, and 2 public waterpark/waterslide incidents, lake includes pond and reservoir Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Ocean (n=1)

Lake (n=9)

River (n=14)

Other (n=1)

Non-recreational (n=25)

56% 36%

4% 4%

Ocean (n=7)

Lake (n=82)

River (n=82)

Other/ Unknown

(n=8)

Pool 2% (n=4)

45% 45%

4% 4%


PAGE | 42


TRENDS


Males 20-29 years had the highest rate of immersion death during 1991-1995 (Figure 38). There appears to have been a decrease for this age group between 1991-1995 and 2001-2005, but no change thereafter. For females, there were few deaths in each age group; therefore, rates for females are not shown.

Figure 38 AGE-SPECIFIC RATE AND NUMBER OF AQUATIC IMMERSION DEATHS OF

ABORIGINAL MALES BY 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=180)


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ 1991-1995 0 3 4 1 9 24 12 6 2 0 1996-2000 0 1 2 3 9 12 7 5 3 1 2001-2005 0 1 3 3 3 10 11 6 1 0 2006-2010 0 1 4 5 4 10 8 2 4 0


TRENDS BY SEX

There appears to have been a decline in the rate for males between 1991-1995 and 2001-2005, but no change between 2001-2005 and 2006-2010. Females were at low risk during all four five-year time periods (Figure 39). TRENDS IN ALCOHOL INVOLVEMENT

The proportion of aquatic immersion deaths involving alcohol was unchanged between 1991-1995 and 2006-2010 (Figure 40).

1.21

0.41

5.22

8.32

4.70

3.64

1.58

0.00

0.58

1.26

4.49 3.55

2.15 2.14 1.64

1.37 0.78 1.02

1.11

2.61

2.97

1.81

0.35 0.00

1.00

1.55 1.22

2.44 2.09

0.50

1.14

0.00 0

2

4

6

8

10

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years

1991-1995 (n=61) 1996-2000 (n=43)

2001-2005 (n=38) 2006-2010 (n=38)

PAGE | 43


Figure 39 RATE AND NUMBER OF AQUATIC IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

SEX AND 5-YEAR TIME PERIOD, CANADA, 1991-2010 (n=208)


1991-1995 1996-2000 2001-2005 2006-2010 Males 61 43 38 38 Females 8 12 4 4


Figure 40 PROPORTION OF AQUATIC IMMERSION DEATHS OF ABORIGINAL PEOPLES BY BLOOD


* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 4 victims (1 in 1991-1995 and 3 in 1996-2000); decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

3.24

2.04

1.49 1.35

0.41 0.55

0.15 0.14

0

1

2

3

4

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

0 p

opu

lati

on/

yea

r

5-year time period


15%

20%

12%

16%

16%

9%

5%

12%

10%

9%

8%

3%

9%

3%

6%

62%

68%

59%

61%

63%

6%

5%

9%

10%

7%

0% 20% 40% 60% 80% 100%

1991-1995(n=53)

1996-2000(n=40)

2001-2005(n=34)

2006-2010(n=31)

1991-2010(n=158)



PAGE | 44


TRENDS BY BODY OF WATER

The rate of aquatic immersion deaths in rivers showed little change between 1991-1995 and 1996-2000, but rates did decline between 1996-2000 and 2006-2010 (Figure 41). There was a decline for lakes between the first and second five-year timer period but no further improvements in the last 15 years. The numbers for other bodies of waters including oceans, pools and other/unknown were small during 1991-2010.

Figure 41 RATE AND NUMBER OF AQUATIC IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

BODY OF WATER* AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=208)

* Lake includes pond and reservoir; pool includes 1 private pool, 1 public pool, and 2 public waterpark/waterslide incidents


0.78

0.78

0.13

0.00

0.10

0.77

0.42

0.00

0.05

0.05

0.38

0.37

0.04

0.02

0.00

0.23

0.42

0.02

0.02

0.05

0.0 0.2 0.4 0.6 0.8 1.0


Body of water

1991-1995 (n=69) 1996-2000 (n=55) 2001-2005 (n=42) 2006-2010 (n=42)

River (n=30) (n=33) (n=20) (n=13) Lake (n=30) (n=18) (n=19) (n=24) Ocean (n=5) (n=0) (n=2) (n=1) Pool (n=0) (n=2) (n=1) (n=1) Other/unknown(n=4) (n=2) (n=0) (n=3)

PAGE | 45

N O N - A Q U A T I C A C T I V I T Y I M M E R S I O N S

A non-aquatic immersion death involves a victim who had not intended to be in water. This mainly involves individuals who unintentionally fell into water. Non-aquatic immersions accounted for 21% of immersion deaths of Aboriginal peoples during 1991-2010. PURPOSE OF ACTIVITY AND TYPE OF ACTIVITY

62% of non-aquatic immersion deaths occurred during recreational activities, 26% daily living, 1% occupational, 2% rescue of another person or animal, 1% other and 8% during unknown activity. Most recreational deaths occurred while walking or playing near water or on ice, and most daily life deaths during travel on foot (Figure 42). Recreational and subsistence fishing from land were next in frequency. Some of the adult deaths with unknown purpose of activity could have represented unrecognized suicides or where evidence was unclear.

Figure 42 NUMBER OF NON-AQUATIC IMMERSION DEATHS* OF ABORIGINAL PEOPLES BY

PURPOSE OF ACTIVITY§ AND TYPE OF ACTIVITY, CANADA 1991-2010 (n=255)

* Non-aquatic deaths included 224 (88%) deaths due to drowning, 23 (9%) deaths due to drowning complicated by hypothermia, and 8 (3%) deaths due to hypothermia without autopsy evidence of drowning § Occupational includes 1 commercial fishing and 2 ‘other’ occupational activities Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

93

42

8

1

7

6

52

8

6

3

5

3

21

0 10 20 30 40 50 60 70 80 90 100

Playing near water or on ice

Walking near water or on ice

Fishing from land

Ice fishing

Patying

Other

Travel on foot/walking

Fishing

Other

Number of deaths

Activity

Recreational Daily living

Occupational

Rescue

Other

Unknown

PAGE | 46


PERSONAL FACTORS

AGE AND SEX

The main risk groups for falls into water were children aged 0-9 years, and adults 15-65+ years of age (Figure 43). Except for children 0-9 years where both boys and girls were at risk, most deaths involved males.

Figure 43 AGE-SPECIFIC RATE AND NUMBER OF NON-AQUATIC IMMERSION DEATHS OF



<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ Males 0 48 17 5 19 29 20 33 20 12 Females 2 28 2 3 1 4 2 6 2 2


ALCOHOL

Alcohol was present or suspected in about 80% of deaths for victims 15 years of age and older (Figure 44). If deaths classified with alcohol unknown are excluded, alcohol would be present or suspected for 83% of deaths. About 40% of victims with a blood alcohol above 80 milligram percent had a blood alcohol three times above the legal limit for operating a motor vehicle.

3.10

0.46

1.96 2.04

1.50

2.93

2.12

3.40

1.52

0.30 0.11 0.26

0.14

0.46 0.20 0.45

0

1

2

3

4

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years


PAGE | 47


Figure 44 PROPORTION OF NON-AQUATIC IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

BLOOD ALCOHOL LEVELS*, CANADA 1992-2010 (VICTIMS ≥ 15 YEARS OF AGE;

n=150)§


SWIMMING ABILITY

Swimming ability was unknown for 84% of immersion deaths involving falls into water. For the remainder, 32% were non-swimmers, 4% were weak swimmers, 7% were intermediate, 21% were unknown level. Swimming ability was reported as irrelevant for the remaining 36%.

ENVIRONMENT FACTORS

BODY OF WATER

Rivers were the most frequent body of water for non-aquatic deaths, followed by lakes (Figure 45).

BODY OF WATER BY AGE

Infants, toddlers and children up to the age of 14 most commonly fell into lakes followed by rivers (Figure 46). For young adults 15-24 years, rivers were the most common followed by lakes and oceans. Oceans were the second most common after rivers for individuals 45-64 years.

BODY OF WATER BY PURPOSE OF ACTIVITY

For recreational activities, rivers and lakes were most frequent (Figure 47). For daily living activities, rivers were most frequent, followed by lakes and oceans.

4% 7%

14%

38%

11%

26% >300 mg% (n=22)

Unspecified (n=3)

101-150 mg% (n=6)

151-200 mg% (n=12)

201-250 mg% (n=32)

251-300 mg% (n=9)

81-100 mg% (n=1)

Above limit (n=85)

Below limit (n=10)

Alcohol suspected

(n=15)

No alcohol (n=22)

Unknown (n=8)

61%

16%

11%

7%

6%

PAGE | 48



BODY OF WATER*, CANADA 1991-2010 (n=255)

* Lake includes pond and reservoir Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013


AGE AND TYPE OF BODY OF WATER*, CANADA 1991-2010 (n=255)

* Lake includes pond and reservoir Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

River (n=111)

Lake (n=83)

Ocean (n=20)

Pool 2% (n=4)

Ditch (n=11)

Sewage lagoon 2% (n=4)

Other (n=19) Unknown 1% (n=3)

44%

33%

8%

7%

4%

26%

41%

48%

54%

63%

43%

47%

44%

33%

21%

11%

29%

1%

13%

10%

17%

14%

6%

1%

5%

10%

3%

7%

5% 14%

7%

3%

5%

6%

7%

7%

0% 20% 40% 60% 80% 100%

0-4(n=78)

5-14(n=27)

15-24(n=40)

25-44(n=61)

45-64(n=35)

65+(n=14)


Age group

River Lake Ocean Pool Ditch Sewage lagoon Other Unknown

PAGE | 49


Figure 47 PROPORTION OF IMMERSION DEATHS FROM FALLS INTO WATER DURING NON-

AQUATIC ACTIVITIES BY ABORIGINAL PEOPLES BY PURPOSE OF ACTIVITY AND BODY

OF WATER*, CANADA 1991-2010 (n=255)


CURRENT

Moving water, such as strong current, rapids or whitewater, hydraulic current, dam spillways, waterfalls, ocean tide or undertow, was associated with at least 27% of non-aquatic immersion deaths. This value is likely conservative as water current or flow was unknown for 42% of deaths.

ICE AND WATER TEMPERATURE

Ice was present for at least 15% of non-aquatic immersion deaths, possibly more as ice conditions were unknown for another 15% of deaths. Water temperature was unknown for 58% of deaths. For the remainder water temperature was reported to be very cold (<10°C) for 59%, cold or cool (10-20°C) for 34%, and irrelevant for 7% due to indoor incidents.

LIGHT CONDITIONS

Light conditions were unknown for 23% of deaths. For the remainder, 39% occurred during reduced visibility (29% in the dark, 10% in twilight), and 58% occurred in daylight. Another 3% occurred where light conditions were irrelevant.

SUPERVISION

Overall, 47% of children 0-14 years-old were alone at the time of the incident, 44% were with minors below the age of 18 years, and only 7%were with at least one adult. Among 0-9 year-old victims, 45% were alone, 44% were with minors only and 7% were with at least one adult. Among 10-14 year-olds, 63% were alone and the other 37% were with minors only.

0% 10% 20% 30% 40% 50%

River (n=111)

Lake (n=83)

Ocean (n=20)

Ditch (n=11)

Pool (n=4)

Other/Unknown(n=26)


Body of water

Recreational Daily living Occupational Rescue Other/unknown

PAGE | 50


TRENDS


The rate of non-aquatic immersion deaths declined for 0-9 year-old males between 1991-1995 and 2006-2010 (Figure 48). There were few deaths for females in each age group and therefore rates have not been shown.

Figure 48 AGE-SPECIFIC RATE AND NUMBER OF NON-AQUATIC IMMERSION DEATHS OF

ABORIGINAL MALES BY 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=203)


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ 1991-1995 0 27 6 1 8 11 5 8 5 5 1996-2000 0 12 4 2 3 9 5 7 3 4 2001-2005 0 2 2 1 5 2 6 7 5 3 2006-2010 0 7 5 1 3 7 4 11 7 0


5.73

0.41

4.64

3.81

1.96

4.86

3.96

9.13

3.12

0.84 1.50

2.66

1.53

2.99

1.64

5.48

0.78

0.34

1.85

0.52

1.62 2.11

1.76

2.92

2.40

0.31

0.92 1.71

1.04

2.78 1.99

0.00 0

2

4

6

8

10

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/yea

r

Age group in years

1991-1995 (n=76) 1996-2000 (n=49)

2001-2005 (n=33) 2006-2010 (n=45)

PAGE | 51


TRENDS BY SEX

The rate of non-aquatic immersions deaths for males of reported Aboriginal ethnicity declined during 1991-2005, but no decline was seen from 2006-2010 (Figure 49). Females were at low risk for the entire four five-year time periods.

Figure 49 RATE AND NUMBER OF NON-AQUATIC IMMERSION DEATHS OF ABORIGINAL

PEOPLES BY SEX AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=255)

Number of deaths by 5-year period

1991-1995 1996-2000 2001-2005 2006-2010 Males 76 49 33 45 Females 20 14 9 9


4.04

2.33

1.30 1.60

1.02

0.64 0.34 0.30

0

1

2

3

4

5

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

5-year time period


PAGE | 52



There was no improvement in the proportion of immersion deaths involving alcohol between 1991-1995 and 2006-2010 (Figure 50).


BLOOD ALCOHOL LEVELS*, CANADA 1992-2010 (VICTIMS ≥ 15 YEARS OF AGE;

n=150)§

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 10 victims (1 in 1991-1995, 6 in 1996-2000, 2 in 2001-2005 and 1 in 2006-2010); decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

15%

10%

22%

16%

16%

7%

27%

11%

3%

11%

7%

7%

7%

8%

7%

61%

50%

59%

70%

61%

11%

7%

3%

6%

0% 20% 40% 60% 80% 100%

1991-1995(n=46)

1996-2000(n=30)

2001-2005(n=27)

2006-2010(n=37)

1991-2010(n=140)



PAGE | 53

L A N D , I C E A N D A I R T R A N S P O R T I M M E R S I O N S

Land, ice and air transport immersion deaths accounted for 17% of immersion deaths of Aboriginal peoples during 1991-2010. TYPE OF INCIDENT

More than half of the land, ice and air transport immersion deaths involved driving on ice with snowmobiles, ATVs and on-road vehicles, another 25% driving on roads and bridges and losing control into water or through ice (Figure 51).

PURPOSE OF ACTIVITY

64% of deaths occurred during activities of daily life, 28% were recreational, 6% were occupational, and 2% were other or unknown (Figure 52).

Figure 51 PROPORTION OF LAND, ICE AND AIR TRANSPORT IMMERSION DEATHS* OF

ABORIGINAL PEOPLES BY CIRCUMSTANCE OF TRANSPORTATION, CANADA 1991-

2010 (n=203)

* 141 (69%) immersion deaths were due to drowning, 51 (25%) were drowning complicated by hypothermia, and 11 (5%) were hypothermia without autopsy evidence of drowning Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Went through ice while driving on ice

(n=113)

Drove off bridge into water 2% (n=4)

Drove off road into water (n=47)

Air crash into water 1% (n=3)

Other (n=7)

Unknown (n=29)

56% 23%

14%

3%

PAGE | 54

L A N D , I C E , A N D A I R T R A N S P O R T I M M E R S I O N S

Figure 52 PROPORTION OF LAND, ICE AND AIR TRANSPORT IMMERSION DEATHS* OF

ABORIGINAL PEOPLES BY CIRCUMSTANCE OF TRANSPORTATION, CANADA 1991-

2010 (n=203)


PERSONAL FACTORS AGE AND SEX

The age and sex profile for immersion deaths while driving on-road, mainly including crashes into water from roads, differed from driving on ice (Figure 53). Most on-road crashes mainly involved persons age 15-49. Immersion deaths during activities on ice involved mainly males 20-64 years of age.


Recreational (n=56)

Occupational (n=12)

Rescue <1% (n=1)

Other 1% (n=3) Unknown <1%

(n=1)

64%

28%

6%

PAGE | 55


Figure 53 AGE-SPECIFIC RATE AND NUMBER OF LAND, ICE AND AIR TRANSPORT IMMERSION

DEATHS OF ABORIGINAL PEOPLES BY CIRCUMSTANCE OF TRANSPORTATION* AND

SEX, CANADA 1991-2010 (n=164; 51 ON-ROAD*, 113 ON-ICE)†


<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ Males on-road 0 1 0 0 5 11 3 6 1 2 Females on-road 0 2 0 1 5 5 6 0 2 1 Males on-ice 0 2 1 3 5 35 23 15 13 5 Females on-ice 0 1 0 0 0 5 1 2 0 1

* On-road includes crashes off roads and bridges into water † This figure excludes 1male victim who died during on- ice travel for whom age was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

0.05 0.00

0.52

0.78

0.22

0.53

0.11

0.57

0.10 0.10

0.56

0.32

0.41

0.00

0.20

0.23

0.0

0.2

0.4

0.6

0.8

1.0

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

Age group in years

Males on-road (n=29) Females on-road (n=22)

0.14 0.27

0.52

2.47

1.72

1.33 1.38 1.42

0.05 0.00 0.00

0.32

0.07 0.15

0.00

0.23

0

1

1

2

2

3

3

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

Age group in years

Males on-ice (n=103) Females on-ice (n=10)

PAGE | 56


ALCOHOL

Alcohol was above the limit or suspected for about 60% of deaths for victims 15 years of age and older (Figure 54). If deaths classified as alcohol involvement unknown are excluded, alcohol would be present or suspected for 70%, and so the true proportion of incidents where alcohol was present may be as high as 70%. Most victims above the legal limit greatly exceeded it.

Figure 54 PROPORTION OF LAND, ICE AND AIR TRANSPORT IMMERSION DEATHS OF

ABORIGINAL PEOPLES BY BLOOD ALCOHOL LEVLS*, CANADA 1991-2010 (VICTIMS ≥

15 YEARS OF AGE; n=191)§


16%

33%

25%

18%

6% >300 mg% (n=5)

101-150 mg% (n=14)

151-200 mg% (n=28)

201-250 mg% (n=21)

251-300 mg% (n=15)

81-100 mg% (n=2)

Above limit (n=85)

Below limit (n=15)

Alcohol suspected

(n=9)

No alcohol (n=45)

Unknown (n=33)

45%

18%

24%

5% 8%

PAGE | 57


EQUIPMENT FACTORS

TYPE OF VEHICLE

For on-ice travel, snowmobiles were the most frequent type of vehicle, followed by cars and ATVs (Figure 55). For on-road travel, cars were the most frequent, followed by trucks and commercial trucks.


ABORIGINAL PEOPLES BY CIRCUMSTANCE OF TRANSPORTATION AND TYPE OF

VEHICLE, CANADA 1991-2010 (n=203)*

* This figure excludes 3 air crashes, 7 ‘other’ transport incidents, and 29 incidents where the circumstances of transportation were unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Snowmobile (n=95)

Car (n=6)

ATV (n=6)

Other 1% (n=1)

Unknown (n=5)

84%

5%

5% 4%

On-ice (n=113)

Car (n=18)

Truck (n=8) Commercial truck (n=8)

Snowmobile 2% (n=1)

ATV 2% (n=1)

Other 2% (n=1)

Unknown (n=14)

On-road (n=51)

35%

16% 16%

27%

PAGE | 58


ENVIRONMENT FACTORS

REGION

The type of motor vehicle most frequently involved in land, ice and air transportation immersion deaths differed by region of Canada (Table 4). For the Atlantic Provinces, snowmobiles accounted for all land, ice and air transport immersion deaths, and in Quebec 90% were due to snowmobiles. In the Prairies there were many immersion deaths from both snowmobiles and on-road vehicles. In British Columbia, nearly all deaths involved on-road vehicles. In the Northern Territories, immersion deaths mainly involved snowmobiles.

Table 4 REGION VERSUS TYPE OF VEHICLE FOR LAND AND ICE TRANSPORT* IMMERSION

DEATHS OF ABORIGINAL PEOPLES, CANADA 1991-2010 (n=200)

Type of vehicle

Snowmobile ATV On-road vehicles

Other Unknown Total

n % n % n % n % n % n Region Atlantic 9 100 0 0 0 0 0 0 0 0 9 Quebec 9 90 0 0 0 0 0 0 1 10 10 Ontario 27 69 4 10 3 8 0 0 2 5 36 Prairies 37 46 3 4 29 36 2 3 9 11 80 B.C. 1 4 0 0 8 35 0 0 14 61 23 Territories 32 80 2 5 4 10 0 0 2 5 40 Unknown 2 100 0 0 0 0 0 0 0 0 2 Total 117 58 9 4 44 22 2 1 28 14 200 * This figure excludes 3 deaths involving air transportation Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

PAGE | 59


TRENDS TRENDS BY SEX FOR ON-ROAD AND ON-ICE INCIDENTS

There was some decrease in death rates for males on ice during 1991-2000, but no change during 2001-2010 (Figure 56). Numbers are too small to interpret other possible trends by sex or for on-road travel. There was little change in the number of deaths for males on ice during the entire period.

Figure 56 RATE AND NUMBER OF LAND, ICE AND AIR TRANSPORT IMMERSION DEATHS OF

ABORIGINAL PEOPLES BY CIRCUMSTANCE OF TRANSPORTATION, SEX AND 5-YEAR

TIME PERIOD, CANADA 1991-2010 (n=164; 51 ON-ROAD*, 113 ON-ICE)


1991-1995 1996-2000 2001-2005 2006-2010 Males on-road 5 9 6 9

Females on-road 4 4 7 7 Males on-ice 29 28 21 25 Females on-ice 3 5 1 1

* On-road includes crashes off roads and bridges into water Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

0.27

0.43

0.24 0.32

0.20 0.18

0.26 0.24

1.54

1.33

0.83 0.89

0.15 0.23

0.04 0.03 0

1

2

1991-1995 1996-2000 2001-2005 2006-2010

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

5-year time period

Males on-road (n=29) Females on-road (n=22)

Males on-ice (n=103) Females on-ice (n=10)

PAGE | 60



There was no improvement in the proportion of land, ice and air transport immersion deaths involving alcohol between 1991-1995 and 2006-2010 (Figure 57).


ABORIGINAL PEOPLES BY BLOOD ALCOHOL LEVELS*, CANADA 1991-2010 (VICTIMS

≥ 15 YEARS OF AGE; n=198)§

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 4 victims (1 in 1996-2000 and 3 in 2006-2010); decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

19%

27%

29%

25%

24%

9%

2%

5%

5%

6%

15%

11%

3%

8%

46%

49%

34%

53%

45%

21%

7%

21%

20%

18%

0% 20% 40% 60% 80% 100%

1991-1995(n=68)

1996-2000(n=41)

2001-2005(n=38)

2006-2010(n=40)

1991-2010(n=187)



PAGE | 61

S N O W M O B I L E I M M E R S I O N S

Snowmobiling is an important means of travel on snow and ice for Aboriginal peoples, but on-ice travel can carry considerable risk. During 1991-2010, there were 117 immersion deaths due to snowmobiling, representing 58% of all land, ice and air transport immersion deaths and 10% of all immersion deaths of Aboriginal peoples. TYPE OF ACTIVITY AND PURPOSE OF ACTIVITY

Snowmobiles were most frequently used for activities of daily life, followed by recreation (Figure 58). Of the daily living snowmobile immersion deaths, 97% involved travel. For recreational, 95% involved snowmobiling for recreation and 5% involved hunting. 43% of occupational incidents involved commercial fishing.

Figure 58 NUMBER OF SNOWMOBILE IMMERSION DEATHS OF ABORIGINAL PEOPLES BY



PERSONAL FACTORS

AGE AND SEX

Most snowmobile immersion victims were males between the ages of 20 and 65 (Figure 59). Males 20-29 years of age had the highest rates. There were only 9 snowmobile immersion deaths of females during the entire 20 years.

ALCOHOL

Alcohol was present or suspected in over half of snowmobile immersion deaths (Figure 60). For those individuals with a blood alcohol above 80 milligram percent, approximately one third had a blood alcohol three times the legal limit for operating a motor vehicle.

Daily living (n=64)

Recreational (n=44)

Occupational (n=7)

Rescue 1% (n=1)

Unknown 1% (n=1)

55% 38%

6%

PAGE | 62


Figure 59 AGE-SPECIFIC RATE AND NUMBER OF SNOWMOBILE IMMERSION DEATHS OF

ABORIGINAL PEOPLES BY SEX, CANADA 1991-2010 (n=117; 108 MALES, 9 FEMALES)*

Number of deaths by age group

<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+ Males 0 1 2 2 8 35 24 15 13 7 Females 0 0 0 0 1 3 1 1 0 3

* This figure excludes 1 male victim; age was not reported Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 60 PROPORTION OF SNOWMOBILE IMMERSION DEATHS OF ABORIGINAL PEOPLES BY

BLOOD ALCOHOL LEVELS* AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (VICTIMS


* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 3victims; decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

16%

33%

25%

18%

6% >300 mg% (n=5)

101-150 mg% (n=14)

151-200 mg% (n=28)

201-250 mg% (n=21)

251-300 mg% (n=15)

81-100 mg% (n=2)

0.14 0.18

0.83

2.47

1.80

1.33 1.38

1.98

0.00 0.00

0.11 0.19

0.07 0.08

0.00

0.68

0

1

2

3

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

Age group in years


Above limit (n=38)

Below limit (n=10) Alcohol

suspected (n=9)

No alcohol (n=29)

Unknown (n=23)

35%

27%

8% 9%

21%

PAGE | 63


EQUIPMENT FACTORS

FLOTATION

During 1991-2010, there were only two snowmobile immersion deaths where a personal flotation device (PFD) was used and worn properly. PFD use was unknown for 26% of deaths. For the remainder, a PFD was not worn in 49% of deaths and was recorded as irrelevant for 48%.

ENVIRONMENT FACTORS ICE CONDITIONS AND BODY OF WATER

Because of the presence of moving water beneath the ice, no river or outflow/inflow of lakes can ever be considered fully safe for ice travel. During 1991-2010, 81% of snowmobile immersion deaths involved the snowmobile going through ice into water while driving on ice, while 1% involved going off a bridge and 1% involved going off a road into water or through ice. For the remaining 17%, this was unknown. Open holes in ice and intact but thin ice were the most commonly reported ice conditions (Figure 61). Overall, lakes were most frequently involved in snowmobile immersion deaths, followed by rivers and oceans.


BODY OF WATER* AND PRESENCE OF ICE, CANADA 1991-2010 (n=117)

* Lake includes pond Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Ocean (n=17)

Lake (n=63)

River (n=36)

Other 1% (n=1)

54%

31%

15%

Body of water

No ice 2% (n=2)

Ice intact but thin (n=46)

Open hole in ice (n=50)

Floe or pack ice 2% (n=2)

Cracked 3% (n=3)

Other (n=7)

Unknown (n=7)

39%

43%

6%

54%

6%

Ice conditions

PAGE | 64


COLD AND HYPOTHERMIA

Since snowmobile travel involves snow and ice, and the time of year, participants are at risk of both drowning and hypothermia. While hypothermia was reported by coroners as a contributing factor in 2% to 17% of immersion deaths in other major categories of activity excluding land, ice and air transport, it was reported in 44% of snowmobile immersion deaths (Figure 62). However, it is probably a factor in all snowmobile deaths even if not reported.

VISIBILITY: LIGHT CONDITIONS AND WEATHER

Light conditions were unknown for 26% of snowmobile deaths. For the remaining, 67% occurred in reduced visibility (61% in the dark, 6% in twilight), and 31% occurred in daylight. Weather conditions were reported for only 15% of snowmobile deaths; among these, snowing was reported for 33% and fog for 11%.

Figure 62 PROPORTION OF SNOWMOBILE IMMERSION DEATHS OF ABORIGINAL PEOPLES WITH

REPORTED HYPOTHERMIA, CANADA 1991-2010 (n=117)


Drowning without hypothermia (n=66)

Drowning with hypothermia (n=41)

Hypothermia without drowning (n=10)

56% 35%

9%

PAGE | 65


REGION

The Northern Territories had the highest rate of snowmobile immersion death, much higher than the rest of Canada (Figure 63). British Columbia had the lowest rate.

Figure 63 RATE AND NUMBER OF SNOWMOBILE IMMERSION DEATHS OF ABORIGINAL PEOPLES

BY REGION, CANADA 1991-2010 (n=117)*

* This figure excludes 2 snowmobile immersion deaths from the breakdown by region for which the province of incidence was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

0.87

0.52

0.72

0.44

0.03

3.36

0.61

0 1 2 3 4

Atlantic (n=9)

Quebec (n=9)

Ontario (n=27)

Prairies (n=37)

B.C. (n=1)

Territories(n=32)

Canada (n=117)


Region

PAGE | 66


TRENDS


The proportion of victims with no alcohol in the blood increased steadily during all four five-year time periods (Figure 64). The proportion of snowmobile immersion deaths where alcohol was present or suspected decreased between 1991-1995 and 2006-2010.


BLOOD ALCOHOL LEVELS* AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (VICTIMS


* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 3victims (1 in 1996-2000 and 2 in 2006-2010); decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

18%

27%

32%

40%

27%

14%

4%

11%

8%

7%

19%

11%

9%

41%

38%

21%

30%

35%

20%

12%

26%

30%

21%

0% 20% 40% 60% 80% 100%

1991-1995(n=44)

1996-2000(n=26)

2001-2005(n=19)

2006-2010(n=20)

1991-2010(n=109)



PAGE | 67


REGION

Overall for Canada, there appears to have been a decrease in snowmobile immersion deaths of persons of Aboriginal ethnicity during the first ten years, and none during the last ten years (Figure 65). Although based on small numbers, the Northern Territories had much higher rates than the other regions of Canada, and rates have remained high there throughout all four five-year time periods. Rates appear to have improved substantially for Aboriginal peoples in Ontario and the Prairies and unchanged elsewhere.

Figure 65 RATE AND NUMBER OF SNOWMOBILE IMMERSION DEATHS OF ABORIGINAL PEOPLES

BY REGION AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=117)*

* This figure excludes 2 snowmobile immersion death from the breakdown by regions in 1996-2000 for which the province of incidence was unknown Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

1.15

0.81

2.14

0.77

0.15

5.21

1.19

0.94

0.57

0.99

0.62

0.00

1.77

0.70

0.68

0.00

0.19

0.35

0.00

2.79

0.36

0.86

0.73

0.09

0.16

0.00

3.77

0.38

0 1 2 3 4 5 6


Region 1991-1995 1996-2000 2001-2005 2006-2010

Atlantic (n=2)

(n=2)

(n=2) (n=3)

Quebec (n=3)

(n=2) (n=0) (n=4)

Ontario (n=16) (n=8) (n=2) (n=1)

Prairies (n=13)

(n=12) (n=8) (n=4)

B.C. (n=1)

(n=0) (n=0) (n=0)

Territories(n=11)

(n=4) (n=7) (n=10)

Canada (n=46)

(n=30) (n=19) (n=22)

PAGE | 68

B A T H I N G I M M E R S I O N S

Immersion death from bathing accounted for a small proportion of immersion deaths among victims described by coroners as Aboriginals. It is quite possible that urban or other off-reserve incidents were seldom reported as Aboriginal deaths. During 1991-2010 there were 34 drownings from bathing in bathtubs, accounting for 3% of immersion deaths. All incidents were classified as activities of daily life.

The main ages at risk for bathing drownings were children below 10 years of age and persons 15 to 64 years. Alcohol was involved in about 35% of deaths for persons 15 years of age and older. Epilepsy/seizures were a factor in 30% of bathtub deaths. No significant trends in bathing immersion deaths were apparent. Figures relating to bathing drownings can be found in Appendix A.

PAGE | 69

W A T E R - R E L A T E D T R A U M A D E A T H S

Trauma deaths, including all injury fatalities other than immersions, represented 2% of water-related deaths (27/1240) of Aboriginal persons during 1991-2010. These deaths included head injuries, spinal injuries, severe lacerations and air embolisms. 14 (52%) of traumas were recreational, 7 (26%) were associated with activities of daily life, 5 (19%) were occupational, and 1 (4%) was unknown. Aquatic activities were the most frequent, followed by land, air and ice transportation and boating.

In terms of risk factors for water-related trauma deaths, males accounted for 85% of victims. Most trauma victims were between the ages of 15 and 49. Alcohol was present or suspected for 50% of trauma deaths. If the deaths where alcohol was unknown are excluded, alcohol would be present or suspected for 60% of deaths. For figures relating to water-related trauma deaths, refer to Appendix B.

PAGE | 70

D I S C U S S I O N & R E C O M M E N D A T I O N S

OVERVIEW OF MAIN SURVEILLANCE AND RESEARCH FINDINGS

The Aboriginal population is ageing, like other Canadians, although perhaps more slowly. During the 20 years of Red Cross water-related injury surveillance, the proportion of the population as young children fewer than 10 years has gone done by one-third while the proportion as persons 40 and over has doubled. Furthermore, a large proportion of Aboriginal populations are now urban. This changes the risk for injuries, especially those associated with the natural environment. Furthermore, many of the risk factors for immersion are becoming more similar, although some may differ in degree from other Canadians. Hence, rural residence may now be a greater factor than specific cultural factors. While local cultural factors deserve careful consideration, interventions that have worked for other Canadians may well often also be appropriate for Aboriginal peoples. While Red Cross data are not yet available for all Canadians for the entire 20-year period, for 1996-2000, immersion deaths for Aboriginal peoples were still about five times greater than for all Canadians, but appear to have shown considerable improvement especially for boating. Rates for both Aboriginal and non-Aboriginal peoples living in rural areas would be expected to be higher than for urban areas.

The main activities associated with Aboriginal water-related injury deaths include boating, aquatic activities, non-aquatic activities, land and air transport, and bathing. Overall, recreational deaths accounted for about 55%, daily life/subsistence for about 35%, and occupational 5% of all immersion deaths. There was no significant overall trend in the purpose of activity, but there was a shift towards recreational for boating.

Adult and youth males at all ages are the main group at risk of water-related deaths, followed by small children of both sexes. Alcohol, often at high levels, has been associated with at least 60% of water-related injury deaths. The proportion of victims using illegal drugs increased from 7% to 20%. Even though drugs are generally detectable longer than alcohol as body decomposition occurs, unknowns for alcohol remained at about 10% for victims 15 years of age and older, while there was no drug testing for 30%.

While swimming ability was unreported for 70%, among the remainder 40% were weak (can support self at surface for a brief period) or non-swimmers. For children under 10 years old, about 75% had no adult supervision, including only 40% accompanied by other minor children.

There has been a steady decline in boating deaths during the past 20 years. For other activities there was improvement in the first 10 years, but none during the past 10.

By numbers of deaths, the Prairies, the Northern Territories, Ontario and BC should be the focus for prevention going forward. The Northern Territories consistently had the highest death rates during the last 15 years of the surveillance period, while the Prairies had the highest numbers of deaths.

For certain categories of injury death, mainly immersions and on and off road injury, rural residents including Aboriginal peoples are generally at much higher risk than urban. However, when urban residents travel to rural areas, they are also at risk. In the Red Cross surveillance database, rural incidents are defined as those where the nearest town or city has fewer than 1000 residents. For rural Aboriginal residents, 794 immersion deaths occurred in rural locations and 26 in urban. For urban residents, 218 deaths occurred in urban locations and 125 in rural.

PAGE | 71

D I S C U S S I O N A N D R E C O M M E N D A T I O N S

In order to interpret trends, the reader should be aware that not all provinces make a consistent effort to identify and record Aboriginal ethnicity, and indeed there can be a policy not to record it. A special effort was made in Ontario with the chief coroner and legislative approval during 1991-1995 to review the Aboriginal ethnicity of all water-related injury deaths, but that did not continue to the same extent after that period. In the Prairie Provinces there has been specific interest to identify Aboriginal injury deaths and develop prevention. In B.C. during the last five-year period, information systems and reporting changed and it has been difficult for Red Cross data collectors to identify Aboriginal ethnicity. Hence while this report identifies main risk factors as proportions of deaths reported as Aboriginal, incidence rates should be interpreted cautiously.

Risk factors, trends, and outstanding issues for prevention will be briefly reviewed by activity. Since many of the activities and possible solutions have been reviewed in considerable detail in previous Red Cross surveillance reports for all Canadians including Aboriginals, some in collaboration with other organisations and many on the website, the interested reader is referred to the reference list including Red Cross reports at the end of this document. BOATING IMMERSIONS

Boating accounted for 37% of immersion deaths and was the leading activity that resulted in a fatality. Fortunately, there has been a steady decline in Aboriginal boating immersion deaths in all regions of Canada during the 20 year surveillance period, with the sole exception of the Northern Territories, where there was a dramatic decline during 1991-1995, but then no further improvement. The decline in boating fatalities has also been observed among other Canadians. While some of the change may be attributable to less complete reporting of Aboriginal ethnicity by coroners resulting in undercounting of deaths as Aboriginal, other factors such as research and surveillance based boating safety programmes across the country are probably also important. The decline may also be due in part to changes in residence of many Aboriginal families to urban areas with decreased exposure to boating. There is less subsistence boating and more recreational such that recreational boating accounted for 60% of Aboriginal deaths during the first five-year period, compared with 50% in the last. As with other Canadians, wearing of flotation devices remains low among victims, for Aboriginal peoples reported at only about 5%, although it is higher among non-Aboriginal survivors and probably also Aboriginals. Alcohol use remains high among victims at 55%.

For the past 20 years nearly all boating victims have been adult males. Other risk factors with Aboriginal boating deaths frequently include adverse weather conditions with wind and waves, overloading and standing in boats, and cold water. Such factors lead to capsizing, swamping and falling overboard, and all the adverse effects of sudden cold water immersion. Most of the boats involved are small open powerboats, followed by canoes. Many small open powerboats marketed in Canada do not have sufficient freeboard or flotation or reentry access for safe use in high winds and waves. On the other hand, among 40% of boating deaths where distance from shore was known, about 40% of those occurred only 50 metres or less from shore and for some of those the water was shallow. AQUATIC IMMERSIONS

Aquatic activities accounted for 17% of immersion deaths. Nearly all occurred during recreation, including swimming, wading, and playing in water. Victims included mainly males 15-49 years, followed by children under 10 years of age. Alcohol was involved in about 80% of aquatic immersions for victims 15 and older; in many deaths, blood levels were extremely high. 80% is a high proportion compared with all Canadians. Swimming ability was unknown for 40% of aquatic

PAGE | 72


immersions. Of the remainder, 30% were weak or non-swimmers. Lakes and rivers each accounted for 45% of deaths, the ocean 4% and swimming pools only 2%. Over time the greatest reduction has occurred with deaths in rivers. About 65% of child victims 0-14-year-of age were without adult supervision. Trends suggest a decline during the first 10 year period, and little change during the second. NON-AQUATIC IMMERSIONS

Non-aquatic activities accounted for 21% of immersion deaths. These incidents mainly involved a victim who fell into water while playing or walking on water or ice during recreations, followed by travel on foot as part of daily life. Victims were mainly males 15 to 65 years, and boys and girls under 10. Alcohol was involved in about 80% of deaths, frequently at very high levels of blood alcohol. Swimming ability was not reported for 85% of victims, while for the remainder 35% were reported as weak or non-swimmers.

As for supervision of children, 90% of victims under 10 years of age and 100% of 10-14 year olds were unsupervised by an adult and either alone or with other children. Recreational incidents occurred equally in lakes and rivers, while for daily or subsistence life, rivers were more frequent. For toddlers 1-4, immersions mainly occurred in lakes followed by rivers and other locations, while for children 5-14 years, lakes and rivers were about equally involved. For persons 15 to 65+ years, drowning in rivers predominated. Moving water, often powerful rapids, is a frequent factor for deaths in rivers. About 40% of deaths occurred during reduced visibility at night or twilight. LAND, ICE AND AIR TRANSPORT IMMERSIONS

These incidents occurred during off-road travel on ice, about 55%, and loss of control driving-on road into water 25%. Ice incidents mainly involved 20 to 65+ year old males, on-road 15-49 year old males and females. About 85% of on-ice incidents involved snowmobiles, the remainder ATVs and cars. For on-road incidents, 35% involved cars and 32% trucks and commercial trucks. Most snowmobile deaths occurred in the Prairies, the Northern Territories, and Ontario, and virtually none in BC. On-road vehicle into water deaths mainly occurred in the prairies and BC. During the first 10 years of surveillance, there was some decline in on-ice deaths, but none during the second decade. Frequency of on-road vehicle deaths did not change.

For snowmobile fatalities, 55% occurred during daily life/subsistence activities and about 40% during recreation. Alcohol was involved in 50%. The proportion of deaths with zero blood alcohol rose steadily from 18% to 40% during 1991-2010; however, deaths with unknown alcohol did also rise from 20 to 30%. As for flotation, PFDs were only known to have been used properly twice in 117 deaths.

Ice conditions included open holes 43% and thin or cracked ice 42%. 55% involved lakes, 30% rivers, and 15% oceans. Previous Red Cross reports found that many snowmobilers went into open holes after dark and/or in blowing snow. This is probably due to the very high speeds of many modern snowmobiles.

The greatest numbers of deaths occurred in the Prairies, followed by the Northern Territories and Ontario, while the rate per hundred thousand people per year was five times higher in the Northern Territories than for Canada. For Canada, immersion deaths for snowmobiles declined during the first 10-year period, and remained unchanged during the second. There was a steady decline throughout 1991-2010 in Ontario and the Prairies, but no change in the Northern Territories.

PAGE | 73


BATHING

While 34 bathing deaths of reported Aboriginals accounted for 3% of Aboriginal immersions, the true total would probably have been higher if Aboriginal ethnicity had been recorded completely for urban residents. More information about completeness of reporting for on- and off-reserve residents would be helpful. The main risk categories were children below 10 years of age, and persons 15-64. Alcohol was involved in about 30% of deaths of persons 15 and older. Epilepsy/seizures were a factor in 30% bathtub deaths. TRAUMA

Water-related traumatic injury deaths accounted for 27 deaths. This was only 2% of all water-related injury deaths during 1991-2010, about three times less proportionally than among all Canadians. Aquatic injuries during diving, boating collisions, road crashes into water, and falls into water accounted for most incidents, resulting in death mainly by head and/or spinal injury.

SURVEILLANCE AND RESEARCH BASED PRIORITIES FOR PREVENTION

Most immersion deaths among Aboriginal people involved adult males, and boating was the most frequent activity. Based on the national surveillance data and other research sponsored by the Red Cross since 1991, and even before that, boating safety education has been directed for more than 20 years to address youth and adult males. Indeed the first major national boating research report of the Red Cross was entitled Boating Drowning in Canada: A Problem of Adult Males. Earlier Red Cross research in B.C. had found that boating safety education directed towards primary school children was ineffective. Immersion death rates are now much higher among adult males than for children. On the basis of national surveillance data, there has been much greater understanding among Red Cross, the Canadian Coast Guard, and the Office of Boating Safety of Transport Canada that boating deaths are mainly an injury prevention issue for adult males, with few child victims, and all three organisations have collaborated on national boating safety reports. The Ontario Provincial Police marine safety division in Northern Ontario also made extensive use of the first Red Cross adult boating safety report for adult males, and declines in Aboriginal boating immersion deaths in Ontario have been impressive during the 20 year-surveillance period.

This appears to have had positive results for all Canadians including Aboriginal peoples, and there has been a steady decline in Aboriginal boating fatalities during all five-year periods from 1991-2010. Other factors such as migration to cities with lesser exposure to boating, a decrease in subsistence activities associated with boating, and the ageing population with less risk taking have probably all been factors.

Interventions that would be expected to have a great impact on Aboriginal boating deaths and for all Canadians include mandatory legislation and enforcement regarding wearing of flotation devices and where indicated flotation/hypothermia gear. In a 1990’s Aboriginal boating survey with the Red Cross in northern Saskatchewan, boat operators expressed a wish for legislation so that they could insist on their passengers wearing PFDs. Swimming ability could also be pertinent to survival, as at least 20% of boaters perished within 50 metres of shore. Various automatic passive prevention measures could include improved safety design of small open aluminum boats to take account of performance in wind and waves, such as greater freeboard, flotation and built in steps for re-entry. Improved communication technology such as satellite phones and personal locator beacons and simple weather radios to monitor wind and wave conditions would also be helpful in conjunction with the gear to prolong survival in cold and rough waters.

PAGE | 74


All of these interventions would benefit from culturally sensitive public safety education targeted to youth and adult males, and possibly wives, mothers, and elders. In some communities there have been prevalent beliefs that it is preferable to die quickly in cold water, justifying non-wearing of flotation devices. With the introduction of technology to improve survival, such beliefs could be expected to change, as they have for off-shore commercial fishermen.

Other areas that should benefit from education and enforcement would be non-consumption of alcohol and drugs before and during water-related activity. Much more complete testing of all immersion and trauma victims for other drugs as well as alcohol could have major benefits.

It could also be helpful to assess boating and water safety programmes in the Northern Territories to assess whether certain elements of those contributed to the remarkable drop in boating deaths during 1991-1995, and why the improvement stalled for the following 15 years. AQUATIC INCIDENTS

For aquatic incidents, main issues include adult supervision of children in and around the water. Swimming instruction has now been found effective in reducing the risk of immersion death of young children (American Academy of Pediatrics, 2010, Brenner et al, 2009, Yang L et al, 2007). Informal education was not helpful. Hence more evaluation of the most appropriate curriculum for swimming training and water safety instruction would be of value for Aboriginal and other rural children. Use of alcohol among victims 15 and older is extremely high and education of youth and adult males on this point is needed. Education about the hazards of current is still also needed. Mothers would benefit from education on supervision including being within touch of their children, and all youth and parents about risk of alcohol and water, and current (Yang et al, 2007). In selected situations, barriers around play areas and windows where families could observe young children at play could help. NON-AQUATIC INCIDENTS

For non-aquatic activity incidents where people fall unexpectedly into water, many of the preventive factors would be similar to those for aquatic. Supervision is key for children, and staying away from water during and after alcohol consumption. Swimming ability and water safety training can help teach how to work with and not against current, for self-rescue in rivers. Avoiding use of alcohol near the water is a key issue for youth and adult males. ICE AND ROAD TRANSPORT

For ice and road transport, since ice travel on modern snowmobiles typically occurs at very high speeds, making it difficult to see ahead and stop quickly on ice, travel at night or during snowstorms is especially hazardous, and frequently leads to immersion in open holes, often where current is present. All of these factors in combination with alcohol impairment raises risk to very high levels. Furthermore, flotation/hypothermia suits are rarely used. Interventions that have proven successful in the Prairies and Ontario should be assessed for use in the Northern Territories. For on-road travel, factors such as lack of genuine ice or studded tires could be a factor. BATHING

Because of the risk of seizures, persons with epilepsy should shower and avoid being alone in or close to bodies of water including bathtubs. While prevention of bathtub drownings among infants and toddlers should focus on constant adult supervision and use of child bathtubs, prevention

PAGE | 75


among adults should include safe bathing practices for people with epilepsy and other seizure disorders, as well as avoiding using a bathtub in conjunction with alcohol and/or other drug use. Preventive education for persons with epilepsy/seizure disorders and their families could be provided by community nurses and physicians. CONCLUSION

In conclusion, a balanced and comprehensive approach to injury prevention is generally most effective, such as use of Haddon’s injury matrix, with attention to personal, equipment and environment factors for the pre-event, event and post-event phases of incidents during the main aquatic activities (Barss et al 1998, Haddon 1980). No one method, such as education or legislation alone, provides optimal protection. Safe boating and communications equipment, legislation regarding operation of boats when impaired and wearing of flotation devices together with improved designs would do much to protect adult males during boating. Elimination of man-made open bodies of water near homes, and/or automatic gates and barriers, together with enclosure of play areas near homes would protect young children. Training of caregivers and babysitters in appropriate methods of supervision, provided by Red Cross and other responsible groups, could be helpful. More training about the potential power and hazards of current is needed or people living near and using rivers. Since the highest levels of alcohol impairment were observed for aquatic and non-aquatic incidents, water safety training should include information about alcohol and other drugs, and coroners should ensure wherever possible to document drugs in fatal immersions.

Since swimming training has proven helpful in reducing risk of drowning, schools could provide and evaluate formal swimming training at the entry age for school or even before, as was done for a period of time with a mobile pool in the Northern Territories. It would also be beneficial for the Red Cross to provide a research/surveillance educational programme for high schools in rural and Aboriginal communities, and to evaluate the results in terms of knowledge attitudes and practices. It would be advantageous to provide this for male and female youth since while males are generally at greater risk, a well informed mother should be protective for both children and father. Methods of peer-based interactive learning and teaching to improve not just knowledge but also attitudes, as developed by the World Health Organisation for HIV (Barss et al, 2009). Aboriginal police could perhaps also provide assistance for teaching and patrolling to promote water safety, and provide positive role models by using the appropriate flotation, hypothermia protection, boats, and communications equipment.

Culture specific issues could focus on traditional beliefs that promote safety, and others that might raise risk. Interest elders might be interested in involvement in educational programmes, first to draw on traditional knowledge and beliefs, raise their awareness of new safety equipment, and then collaborate with them to change attitudes towards safety measures. A key consideration is to provide sound information about the hazards of water-related activities in challenging rural environments together with both modern and traditional methods and equipment for minimising such risks. Rather than describing people who live in rural locations as high risk groups, the focus should be on the various activities and main risk factors for each, together with the most appropriate safety equipment, knowledge, attitudes, and practice.

For greater details about cold water immersion and ice, powerboat and unpowered boating immersions, and fishing deaths, 10-year reports can be found at the Canadian Red Cross website under drowning research or by using the hyperlinks in the citations.

PAGE | 76

P A R T 1 A P P E N D I C E S A N D R E F E R E N C E S

PAGE | 77

A P P E N D I X A - B A T H I N G

Figure 1 AGE-SPECIFIC RATE AND NUMBER OF DROWNINGS INVOLVING BATHING FOR

ABORIGINAL PEOPLES BY SEX, CANADA 1991-2010 (n=34) Number of drownings in age group

<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Males 3 4 0 0 2 2 5 1 1 0 Females 4 3 0 0 1 1 3 3 1 0


Figure 2 RATE AND NUMBER OF BATHTUB DROWNINGS FOR ABORIGINAL PEOPLES BY SEX

AND 5-YEAR TIME PERIOD, CANADA 1991-2010 (n=34)

Number of bathing immersion deaths by sex

1991-1995 1996-2000 2001-2005 2006-2010 Males 3 7 5 3

Females 4 3 6 3 Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

0.16

0.33

0.20

0.11

0.20

0.14

0.23

0.10

0.0

0.1

0.2

0.3

0.4

1991-1995 1996-2000 2001-2005 2006-2010

Ba

thin

g f

ata

liti

es /

10

0,0

00

p

opu

lati

on

/ ye

ar

5-year time period

Males Females

0.33

0.00

0.21

0.14

0.37

0.09 0.11

0.00

0.33

0.00

0.11

0.06

0.21

0.23

0.10

0.00 0.0

0.1

0.2

0.3

0.4

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

pop

ula

tion

/ ye

ar

Age group in years

Males Females

PAGE | 78

A P P E N D I X A - B A T H I N G

Figure 3 PROPORTION OF BATHING DROWNINGS OF ABORIGINAL PEOPLES BY BLOOD

ALCOHOL LEVELS*, CANADA 1991-2010 (VICTIMS ≥ 15 YEARS OF AGE; n=20)

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 4 NUMBER OF BATHING DROWNINGS OF ABORIGINAL PEOPLES BY VARIOUS

CHRONIC HEALTH CONDITIONS, CANADA 1991-2010 (n=34)

* Includes depression 1, schizophrenia 2 † Includes drug abuse 1, cancer 1, migraine headaches 1, chronic pain 1 Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

8

3

3

3

2

2

1

1

4

0 2 4 6 8 10

Epilepsy

Other seizure disorder

Alcoholism

Mental illness*

Mental disability

Cardiac illness

Diabetes

Physical disability

Other †

Number of deaths

Health condition

20%

20%

40%

20% >300 mg% (n=1)

101-150 mg% (n=1)

151-200 mg% (n=1)

201-250 mg% (n=2)

Below limit (n=2)

Above limit (n=5)

No alcohol (n=13)

65%

10%

25%

PAGE | 79

A P P E N D I X B - T R A U M A

Figure 1 PROPORTION OF WATER-RELATED TRAUMA DEATHS* OF ABORIGINAL PEOPLES BY

ACTIVITY, CANADA 1991-2010 (n=27)

* Drowning was considered a secondary cause of death for 16 (59%) of water-related trauma deaths Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

Figure 2 AGE-SPECIFIC RATE AND NUMBER OF WATER-RELATED TRAUMA DEATHS OF



<1 1-4 5-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Males 0 1 0 0 3 8 6 4 1 0 Females 0 0 0 0 1 3 0 0 0 0


Boating (n=6)

Aquatic (n=10)

Non-aquatic (n=4)

Land, ice, or air transportation

(n=7)

37%

22% 26%

15%

0.05

0.00

0.31

0.56

0.45

0.35

0.11

0.00 0.00 0.00

0.11

0.19

0.00 0.00 0.00 0.00

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0-9 10-14 15-19 20-29 30-39 40-49 50-64 65+

Dea

ths/

10

0,0

00

po

pu

lati

on/y

ear

Age group in years


PAGE | 80

A P P E N D I X B – T R A U M A

Figure 3 PROPORTION OF WATER-RELATED TRAUMA DEATHS OF ABORIGINAL PEOPLES BY

BLOOD ALCOHOL LEVELS*, CANADA 1991-2010 (VICTIMS ≥ 15 YEARS OF GE; n=26)§

* ‘Limit’ refers to federal legal limit of 80mg%; some provinces have lower limits § This figure excludes 1 victim; decomposition rendered blood alcohol unreliable Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

17%

17%

8%

42%

17% >300 mg% (n=2)

Unspecified (n=2)

201-250 mg% (n=1)

251-300 mg% (n=5)

151-200 mg% (n=2)

Above limit (n=12)

Alcohol suspected (n=1)

No alcohol (n=9)

Unknown (n=3)

46%

35%

15%

4%

PAGE | 81

A P P E N D I X B – T R A U M A

Table 3 WATER-RELATED TRAUMA* DEATHS OF ABORIGINAL PEOPLES BY TYPE OF ACTIVITY,

INCIDENT, NATURE OF INJURY, DEMOGRAPHICS AND ALCOHOL INVOLVEMENT,

CANADA 1991-2010 (n=27)

Activity/incident n % Nature of

injury n

Sex Alcohol Other risk factors

n M F mg% n

Boating

Boating collision 5 19 Head injury Spinal injury Decapitation

3 2 1

5 1 0 >80 Unk.

2 1 2

Ocean tide Cold water Non-swimmer Suspected illegal drugs No PFD

2 3 1 1 1

Fell/thrown overboard

1 4 Head injury 1 1 0 254 1

Aquatic activities

Diving into water 6 22 Head injury Spinal injury

4 2

6 0 0 >80 180 275 297 Unk.

1 1 1 1 1 1

Strong current Cold water Illegal drugs

2 2 3

Falls while in water

2 7 Head injury 2 2 0 0 2 Cold water 1

Air embolism 2 7 Air embolism

2 2 0 0 2 Cold water Ocean tide Illegal drugs

2 1 1

Non-aquatic activities

Falls into water 4 15 Head injury Laceration

2 1

4 0 265 337 380 Unk.

1 1 1 1


2 1 1

Land, ice and air transport

On-road motor vehicle

4 15 Head injury 3 2 2 >80 160 Unk.

1 1 2


2 2 2

All-terrain vehicle 1 4 Head injury 1 0 1 >80 1 Illegal drugs 1

Air crash 2 7 Head injury 1 2 0 0 2

Total 27 100 * Primary cause of death was injury other than drowning, although drowning may have complicated another injury Source: The Canadian Red Cross Society & the Canadian Surveillance System for Water-Related Fatalities, 2013

PAGE | 82

A P P E N D I X C – A B O R I G I N A L P O P U L A T I O N E S T I M A T E S

Table 1 POPULATION OF ABORIGINAL PEOPLES BY AGE AND SEX ACCORDING TO THE

CENSUS/ABORIGINAL PEOPLES SURVEY, CANADA

1991 1996 2001 2006*

AGE

BOTH SEXES

0-9 256,200 195,912 205,509 207,243

10-14 106,933 82,980 99,862 123,925

15-19 63,372 74,016 84,220 121,726

20-29 113,587 136,584 147,357 169,535

30-39 93,523 125,892 145,232 160,433

40-49 54,990 83,700 115,744 171,035

50-64 43,463 61,740 88,963 143,930

65+ 19,676 27,396 37,019 56,612

TOTAL 751,744 788,220 923,906 1,154,439

MALES

0-9 129,300 101,196 103,965 100,021

10-14 54,533 42,588 52,714 64,413

15-19 31,551 37,476 42,628 65,314

20-29 51,400 63,972 71,134 82,017

30-39 42,924 59,184 71,218 76,716

40-49 25,768 40,104 53,570 79,216

50-64 20,427 30,132 42,950 70,415

65+ 9,276 12,636 16,562 24,505

TOTAL 365,179 387,288 454,741 562,617

FEMALES

0-9 126,900 94,716 101,544 107,222

10-14 52,400 40,392 47,148 59,512

15-19 31,821 36,540 41,592 56,412

20-29 62,187 72,612 76,223 87,518

30-39 50,599 66,708 74,014 83,717

40-49 29,222 43,596 62,174 91,819

50-64 23,036 31,608 46,013 73,515

65+ 10,400 14,760 20,457 32,107

TOTAL 386,565 400,932 469,165 591,822 * Total number of Aboriginal peoples in 2006 differs between Table 1 and Table 2 as 5400 people with unknown age were excluded from the population by age in Table 1

PAGE | 83

A P P E N D I X C – A B O R I G I N A L P O P U L A T I O N E S T I M A T E S

Table 2 POPULATION OF ABORIGINAL PEOPLES BY REGION ACCORDING TO THE

CENSUS/ABORIGINAL PEOPLES SURVEY, CANADA

1991 1996 2001 2006*

REGION

BOTH SEXES

Atlantic 33,413 36,288 48,740 69,614

Quebec 78,403 70,200 71,093 109,623

Ontario 156,894 141,948 182,811 234,148

Prairies 316,708 359,820 413,066 501,803

British Columbia 124,892 136,908 160,850 191,640

Territories 41,433 43,056 47,348 53,011

TOTAL 751,743 788,220 923,906 1,159,839 * Total number of Aboriginal peoples in 2006 differs between Table 1 and Table 2 as 5400 people with unknown age were excluded from the population by age in Table 1

PAGE | 84

P A R T 1 R E F E R E N C E S

American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. Policy Statement Prevention of Drowning. Pediatrics 2010;126;178-185 (doi: 10.1542/peds.2010-1264). Barss P. Section 3 The Prevention of Drowning, Section 3.9.1 National Surveillance-Based Prevention of Water-Related Injuries in Canada. In: Bierens J. (Ed). Handbook on Drowning. Heidelberg: Springer-Verlag, 2006 pp117-118. Barss P Drownings, near drownings, and other water-related injuries: Circumstances and Opportunities for Action. Book Chapter in: For the Safety of Canadian Children and Youth: From Injury Data to Preventive Measures. Ottawa, ON: Health Canada, 1997, 184-196. Barss P, Grivna M, Ganczak M, Bernsen R, Al-Maskari F, Agab HE, Al-Awadhi F, Badawy AM, Al-Baloushi H, Al-Dhaheri S, Al-Dhahri J, Al-Jaberi A, Al-Kaabi S, Karaji MA, Khouri A, Al-Kitbi H, Al-Mansoori D, Al-Muhairy S, Al-Neaimi W, Shamsi EA, Al-Zahmi A, Yammahi AA. Effects of a Rapid Peer-based HIV/AIDS Educational Intervention on Knowledge and Attitudes of High-School Students in a High-Income Arab Country. J Acquir Immune Defic Syndr 2009;52(1):86-98. Barss P, Smith GS, Baker SP, Mohan D. Injury Prevention: An International Perspective. Epidemiology, Surveillance, & Policy. New York: Oxford University Press, 1998, 1-378. Brenner RA, Taneja GS, Haynie DL, Trumble AC, Qian C, Klinger RM, Klebanoff MA. Association between swimming lessons and drowning in childhood: a case-control study. Arch Pediatr Adolesc Med. 2009 Mar;163(3):203-10. doi: 10.1001/archpediatrics.2008.563. Canadian Red Cross Boating Immersion and Trauma Deaths in Canada – 18 years of research. Ottawa, ON: Transport Canada Office of Boating Safety and Canadian Red Cross (also in French), 2011, pp. 1-. Available at URL: http://www.tc.gc.ca/eng/marinesafety/debs-obs-resources-publications-redcrossreport-3320.htm Canadian Red Cross Boating Immersion and Trauma Deaths in Canada – 16 years of research. Ottawa, ON: Transport Canada Office of Boating Safety and Canadian Red Cross (also in French), 2010, pp. 1-68. Available at URL: http://www.tc.gc.ca/eng/marinesafety/debs-obs-resources-publications-redcrossreport-3320.htm Canadian Red Cross Immersion and Other Injury Fatalities during Powered Boating in Canada: 10 Years of Research. Special Research Report. Ottawa, ON: Canadian Red Cross (also in French), 2009. Available at URL: http://www.redcross.ca/cmslib/general/m3e_boating.pdf Canadian Red Cross Immersion and Other Injury Fatalities during Fishing in Canada: 10 Years of Research. Special Research Report. Ottawa, ON: Canadian Red Cross (also published in French), 2009. Available at URL: http://www.croixrouge.ca/cmslib/general/m5e_fishing.pdf Canadian Red Cross. Immersion and Other Injury Fatalities during Unpowered Boating in Canada:10 Years of Research. Special Research Report. Ottawa, ON: Canadian Red Cross (also in French), 2009; pp. 1-58. Available at URL: http://www.redcross.ca/cmslib/general/m4e_upboating.pdf

http://www.ncbi.nlm.nih.gov/pubmed?term=Brenner%20RA%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Taneja%20GS%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Haynie%20DL%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Trumble%20AC%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Qian%20C%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Klinger%20RM%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Klebanoff%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed/19255386


PAGE | 85


Canadian Red Cross Ice and Cold Immersion Fatalities in Canada: 10 Year of Research. Special Research Report. Ottawa, ON: Canadian Red Cross (also published in French), 2006, 1-66. At Canadian Red Cross’s website, URL: http://www.redcross.ca/cmslib/general/ws_final_m2_english2006_04_19.pdf Canadian Red Cross Drowning and Other Water-Related Injury Fatalities in Canada: An Analysis of the Circumstances and Trends of Water-Related Fatalities in Canada in 1991-2000. Ottawa, ON: Canadian Red Cross (also published in French), 2006, 1-42. Available at: Canadian Red Cross What We Have Learned About Drownings and Other Water Related Deaths in Canada 1991-2000. Canadian Red Cross. 2003, 1-24. (Also published in French). Available at Canadian Red Cross's website, URL: www.redcross.ca/cmslib/general/10drwn_english.pdf Les faits saillants sur les noyades et autres décès liés à l’eau au Québec. Also published as: Pertinent facts about drownings and other water-related deaths in Quebec. Gouvernement du Québec: Secrétariat aux loisirs et aux sports, Direction de la sécurité. 2002, 1-12. Canadian Red Cross Drowning and Other Water-Related Injury Fatalities in Canada Concise Visual Surveillance Report: An Analysis of the Circumstances of Water-Related Fatalities in Canada in 1999. Ottawa, ON: Canadian Red Cross Society, The Canadian Coast Guard – Fisheries and Oceans, McGill University, 2001, 1-124. ISBN 1-55104-269-X (also published in French). Canadian Red Cross Drowning and Other Water-Related Injury Fatalities in Canada: Concise Visual Surveillance Report: An Analysis of the Circumstances of Water-Related Fatalities in Canada in 1998. Ottawa, ON: Canadian Red Cross Society, Canadian Coast Guard – Fisheries and Oceans, McGill University, 2000, 1-114. ISBN 1-55104-250-9 (also published in French) Canadian Red Cross Drowning and Other Water-Related Injury Fatalities in Canada: Concise Visual Surveillance Report: An Analysis of the Circumstances of Water-Related Fatalities in Canada in 1997. Ottawa, ON: The Canadian Red Cross Society, The Canadian Coast Guard – Fisheries and Oceans, McGill University, 1999 (also published in French). Canadian Red Cross Drowning and Other Water-Related Injury Fatalities in Canada: Concise Visual Surveillance Report: An Analysis of the Circumstances of Water-Related Fatalities in Canada in 1996. Ottawa, ON: The Canadian Red Cross Society, The Canadian Coast Guard – Fisheries and Oceans, McGill University, 1998, 1-100. ISBN 1-55104-217-7 (also published in French). Canadian Red Cross Drowning and Other Injury Fatalities During Boating in Canada - National Report: An Analysis of the Circumstances of Drowning and Other Injury Fatalities During Boating in Canada in 1995. Ottawa, ON: The Canadian Coast Guard, in collaboration with The Canadian Red Cross Society and the Régie régionale de la santé de des services sociaux de Montréal-Centre, Direction de la santé publique 1997:1-62 (also published in French). Canadian Red Cross Drowning and Other Water-Related Injury Fatalities in Canada: Concise Visual Surveillance Report: An Analysis of the Circumstances of Water-Related Fatalities in Canada for 1994 and 1995. Ottawa, ON: The Canadian Red Cross Society, 1997, 1-136 (also in French).

PAGE | 86


Canadian Red Cross. Drownings Among Swimmers in Canada: Circumstances and Prevention [An analysis of the circumstances of water-related fatalities for swimming, wading, and diving into water during 1991-94]. Ottawa, ON: The Canadian Red Cross Society in collaboration with the Régie régionale de la santé et des services sociaux de Montréal-Centre and the Canadian Surveillance System for Water-Related Fatalities, Special Research Report, 1996, 1-72, (Published in French as: Noyades chez les baigneurs au Canada: Circonstances and prévention [Une analyse des circonstances des décès liés à l'eau pendant la baignade, le barbotage et le plongeon, au Canada de 1991 à 1994). Canadian Red Cross National Drowning Report: An Analysis of the Circumstances of Drownings and Other Water-Related Injury Fatalities in Canada for 1993 [Comprehensive Surveillance Report]. Ottawa, ON: The Canadian Red Cross Society in collaboration with the Régie régionale de la santé et des services sociaux de Montréal-Centre and the Canadian Surveillance System for Water-Related Fatalities, 1996a, 1-176 (Published in French as: Rapport national sur les noyades: Une analyse des circonstances des noyades et autres décès par traumatisme liés à l'eau survenus au Canada en 1993). Canadian Red Cross Drownings Among 1 to 4 Year Old Children in Canada: A High Risk Group for Water-Related Fatalities. Ottawa, ON: The Canadian Red Cross Society. Special Research Report, 1994a, 1-31 (Published in French as: Noyades chez les enfants de 1 à 4 ans au Canada) Canadian Red Cross Author and senior analyst. Drownings Among Recreational Boaters in Canada: A Problem of Male Adults in Small Powerboats and Canoes. Ottawa, ON: The Canadian Red Cross Society. Special Research Report, 1994b, 1-60 (Published in French as: Noyades chez les plaisanciers au Canada) Canadian Red Cross (2001). An Analysis of Drowning and Other Water-Related Injury Fatalities in Canada for 1999. Ottawa: The Canadian Red Cross Society (also published in French). Available online at: http://www.redcross.ca/cmslib/general/99_00_drowningreport-2001e.pdf Damestoy N. Injury Mortality Among the Cree of Northern Québec 1982-91 [MSc thesis]. Montréal, Québec: McGill University, Department of Epidemiology and Biostatistics, 1994. Haddon W Jr. Advances in the epidemiology of injuries as a basis for public policy. Public Health Rep 1980;95(5):411-21. Public Health Agency of Canada (2010). Injury Surveillance On-Line. Leading causes of injury deaths in Canada, by injury and age-group, 2005. Available online at: http://dsol-smed.phac-aspc.gc.ca/dsol-smed/is-sb/c_ind_matrix-eng.php#matrix SmartRisk (2009). The Economic Burden of Injury in Canada. Toronto: SmartRisk. Available online at: http://www.smartrisk.ca/downloads /burden/Canada2009/EBI-Eng-Final.pdf Statistics Canada (2009). 2006 Census: Aboriginal Peoples in Canada in 2006: Inuit, Metis and First Nations, 2006 Census. World Health Organisation (2012). Fact sheets on drowning. WHO website. Available online at: http://www.who.int/mediacentre/factsheets/fs347/en/index.html Yang L, Nong QQ, Li CL, Feng QM, Lo SK. Risk factors for childhood drowning in rural regions of a

developing country: a case-control study. Inj Prev 2007;13(3):178-82.


http://www.ncbi.nlm.nih.gov/pubmed?term=Yang%20L%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Nong%20QQ%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Li%20CL%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Feng%20QM%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Lo%20SK%5BAuthor%5D&cauthor=true&cauthor_uid=17567973


PAGE | 87

P A R T 2

PAGE | 88

P R O M I S I N G P R A C T I C E S F O R P R E V E N T I O N

SITUATING THE PROBLEM: INTERNATIONAL AND NATIONAL CONTEXTS

Globally, several factors can be identified as contributing to individuals’ vulnerability to water-related death: being male; being an ethnic or racial minority; experiencing material deprivation; low levels of education attainment; and residing in rural areas (WHO, 2012). Available international data show that ethnic and racial minority group members have higher drowning rates in comparison to a nation’s population as a whole (Golob et al, 2012). People with low socioeconomic status and from less affluent areas tend to die by injury to a greater extent than others, and “Among mortality studies, the empirical evidence at hand often shows strong associations with individual- and area-based deprivation.” (Laflamme et al, 2009)

Aboriginal peoples in rural locations in Canada experience high rates of fatal immersions. Males are over-represented (Canadian Red Cross, 2006). A report for the Canadian Centre for Policy Alternatives noted that Aboriginal peoples’ median income was 30% lower than other Canadians, and hence suffer higher rates of material deprivation and lag in educational attainment (Wilson & McDonald, 2010).

While Aboriginal peoples are particularly vulnerable to death by immersion, with cold as a frequent factor, research findings from Part 1 highlight the need to focus injury prevention interventions on those who are most vulnerable. These include Aboriginal males 15 years and older who participate in recreational and daily living boating and aquatic activities in natural environments. Regionally, rural areas from Ontario west and into the Northern Territories merit focus. As with other Canadians, but often to a greater degree, alcohol is a factor for many victims. While there have been notable improvements in immersion death rates during the past two decades, especially for boating among adult males, current water safety messages may not be reaching all of the most vulnerable in Aboriginal and other rural populations at high risk, or, some messages may have low uptake for a variety of reasons.

PROMISING PRACTICES AND INITIATIVES

Drowning prevention in Aboriginal and other rural peoples is a complex undertaking due to the variety of factors that coalesce to make such peoples more vulnerable, including for some, remote locations, reduced access to health care, low socio-economic status, societal marginalisation, cultural and gender differences in risk perception and communication, and the diversity among and within Aboriginal peoples and communities. As such, no single intervention is likely to be successful in all communities. Rather, a variety of approaches as prioritised by communities are more likely to be effective.

Here, an overview is provided of promising practices/initiatives that may help reduce immersion deaths among Aboriginal peoples and, more specifically, the most vulnerable subgroups. This is based on a Dr Giles team’s research and familiarity with reports, research, initiatives, and programmes. Illustrative examples are provided, including examples from Canada and other countries. Examples selected are the most relevant available to illustrate the approach, intervention, and/or outcome.

FOCUSED DROWNING PREVENTION STRATEGIES FOR MALE YOUTH AND ADULTS

Risk perception is influenced by risk communication, which in turn influences risk taking. To decrease drowning risk, it is important to ensure that risk communication strategies meant to decrease risk of drowning are congruent with how individuals perceive risk. A U.S. study found that men drowned more often than women because they had a higher exposure to aquatic environments

PAGE | 89


and less to swimming lessons. Despite the latter, men more often self-reported high levels of swimming skill (Howland et al, 1996). Men were more likely to have swum in natural bodies of water, alone and at night. They more often consumed alcohol and in greater amounts in aquatic environments than women. This study did not consider ethnicity.

Gender differences have been observed in risk perception and risk taking. Lower perception of risk is associated with increased risk-taking behaviours. In a meta-analysis of 150 studies that examined risk-taking of males and females, it was found that males were more likely to take risks than females (Byrnes et al 1999, p.377, 378). Gender differences in risk taking varied by age and context and the study reported that male risk taking “does not seem to manifest itself in a simple or constant way across ages or contexts”. Men and boys reportedly “took more risks even when it was clear that it was a bad idea to take a risk”. The opposite was the case for women and girls.

Despite such differences in risk perception and risk taking and much higher rates of drowning amongst men ages 15-65+, some drowning prevention programmes continue to focus on children. More targeted messaging focused on men should be developed, using different messages and forms of media to appeal to different age groups, such as social media for younger men. The Red Cross has produced posters depicting Aboriginal men pulling fishing nets from the water while wearing lifejackets. The focus on Aboriginal men engaged in a risky behaviour such as boating/fishing while wearing lifejackets was very appropriate. Such an approach is known as a “peripheral strategy” for health interventions, one that presents risk messages in ways likely to appeal to the target population (Kreuter et al, 2003). A strong initiative could be collaborating with Aboriginal communities to design and evaluate similar posters to those described above, as well as social media campaigns that feature and appeal to different age groups of Aboriginal men.

CULTURE AS AN INTEGRAL PART OF DROWNING PREVENTION INITIATIVES

Often, culture is ignored in efforts to create “one size fits all” programmes. Yet, evidence clearly shows that successful health interventions, particularly for injury prevention, engage with the target group’s culture in meaningful ways. This is a challenge given the diversity amongst Aboriginal peoples, as well as between urban and rural. It is problematic to assume that an approach that is successful in a Cree community will work for Inuit or Dene. Overlooking cultural differences can result in campaigns that are culturally irrelevant.

A socio-cultural strategy refers to health interventions that incorporate an in-depth understanding of culturally normative practices and beliefs, shared by most members of the targeted group (Kreuter et al, 2003). Socio-cultural interventions for drowning prevention are based on the idea that water safety messages must be culturally meaningful and reflect a group’s beliefs, values, and behaviours, if they are to result in desired behavioural changes.

Ensuring that messages are congruent with the target group’s cultural and behavioural norms is of great importance. For example, a current water safety message is that one should keep one’s child “within an arm’s reach” in aquatic settings. There is a potential cultural bias in this message that needs to be addressed. Aboriginal norms of child supervision can differ from Euro-Canadian norms. It has been stated that “Aboriginal parenting is often characterized by shared parenting” (Red Horse et al, 1987 p. 70). Others noted that within some Aboriginal communities, members share responsibility of caring for (McShane & Hastings, 2004) and watching children (Lame et al, 1994). It was reported that Aboriginal children are free to explore their environments to a greater extent than in non-Aboriginal communities (McPherson & Rabb, 2001). As a result, the message of ensuring that your child is always within an arm’s reach within an aquatic environment may be

PAGE | 90


problematic, particularly in communities that are located on a natural body of water. While the literature strongly supports the need for very close supervision around water, the ways in which this message is communicated must be considered so that it does not come across as being culturally insensitive. Drowning prevention programmes must be viewed as being culturally acceptable if they are to be successful.

A study in Tuktoyaktuk, Northwest Territories, Canada, demonstrated the importance of culture (Giles et al, 2010). The researchers collaborated with community members to assess use of lifejackets. Local residents did not believe that wearing a lifejacket was an effective method of preventing drowning. The findings emphasized the importance of identifying and understanding culturally-based attitudes and beliefs in creating effective drowning prevention programmes that are socially and culturally relevant for ethnic and racial minorities. Hence, prior to attempting change it is advantageous to focus on understanding an attitude and behaviour, particularly cultural dimensions.

In order to make drowning prevention culturally acceptable, there is a need to include traditional knowledge in water safety interventions. Aboriginal peoples have travelled on waterways since time immemorial; as such, many persons have considerable knowledge concerning ways in which Aboriginal and other rural peoples can remain safe. Uptake of water safety programmes could be enhanced by including hunters, trappers, fishers, and Elders, together with their culturally normative practices and beliefs, in swimming lessons. This could be achieved as guest instructors and/or by receiving training as instructors (Giles et al, 2010).

The Alaska Eskimo Whaling Commission, the United States Coast Guard, and the Alaska Native Tribal Health Consortium worked with Mustang Survival, a flotation device manufacturer, to develop a white float coat. Such coats are a full jacket fabricated with buoyant materials providing thermal protection. The target population was Native Alaskan whalers. This is a strong example of a promising practice for culturally relevant drowning prevention (Giles et al, in press). The whalers had expressed a desire for white flotation devices because they believed that coloured devices frightened away the animals they hunt. The white float coat met the target population’s cultural needs and proved popular (Barber, 2010), demonstrating the importance of ensuring that messages are respectful and understanding of community members’ beliefs, attitudes, and cultural practices.

COMMUNITY PARTICIPATION IN PROGRAM DESIGN

Health Canada (2008) stated that injury prevention campaigns for Aboriginal peoples should engage communities during conception, development, and implementation and be culturally meaningful for community members. Providing a substantive role for community members in planning and decision making in program development can result in culturally relevant and effective message strategies. Known as constituent-involving health interventions, such approaches incorporate the target group’s meaningful involvement in program and material development (Kreuter et al, 2003).

A constituent-involving approach to water safety that reduced drownings among Alaska natives included culturally appropriate messages created by Tribal Elders, prominent and trusted community members (Zaloshnja et al, 2003). Promotion of flotation jackets was framed in collectivist values: ‘‘Wear a float jacket so that if you drown, people will not have to drag the river for your body’’. Emphasis was shifted from the value of the individuals’ life to the importance of community members’ time, as they had to each year drag the rivers for loved ones’ bodies. Following the campaign, drowning on the river delta decreased by 53%, with annual cost savings of

PAGE | 91


U.S. $1.2 million for recovery operations. Now virtually all community members wear float coats on the river. This powerful study is one of the few that outlines both the life-saving and cost saving measures of water safety interventions involving constituents.

The Canadian Red Cross’s worked with several Aboriginal communities, in Alberta. Programmes included the Youth Leadership and Resiliency Pilot Program 2009-2013 with members of the Blood Reserve, and the Tipi of Courage Circle of Wisdom Seniors Project. These and other programmes stressed the importance of building meaningful relationships with members of Aboriginal communities. Messages do not need to be entirely negative. As with other cultures, Aboriginal peoples often use humour to convey important messages.

A challenge with delivering such customized approaches is that a new intervention may need to be crafted for each community. By using a train-the-trainer format, organisations could create a “toolbox” to empower Aboriginal communities and internal sub-populations to develop their own culture, gender, and age appropriate messages in their own languages. Messages could be shared via local means, such as community radio, regional newspapers, and social media, to ensure distribution to the target audience. Given high rates of immersion deaths in western and northern Canada, interventions should be urgently developed with Aboriginal peoples in these regions, such as the First Nations Health Authority in British Columbia. IMPLICATIONS OF SOCIO-ECONOMIC STATUS FOR PROGRAM DESIGN AND ACCESS TO

SAFETY EQUIPMENT

Socio-economic status (SES) is a “composite measure that typically incorporates economic, social, and work status. Economic status is measured by income. Social status is measured by education, and work status is measured by occupation. Each status is considered an indicator. These three indicators are related but do not overlap” (US Centers for Disease Control and Prevention, 2012). Such factors have a large impact on injury and mortality rates, including drowning. For example, a Manitoba study found that regardless of rural or urban residence, children from lower SES families tended to experience more severe injuries, and more often fatal. Children in the lowest income group were 1.5 times more likely to drown (Brownell et al, 2002). Injury prevention programmes had less impact on childhood injury hospitalisations in lower SES groups than in high (Brownell et al, 2010). Lower individual or area SES is associated with higher risk of unintentional injury (Cubbin & Smith, 2002). Thus, a program’s result may differ based on the target group’s SES. Since some Aboriginal peoples experience higher prevalence of low SES than others, developing risk communications without first considering risks associated with low SES conditions could limit success. Programmes that reduce inequities by providing free or low-cost access to safety equipment such as lifejackets should be identified as promising practices, even though they are sometimes limited and short-term in nature. Examples include provision of PFDs in Alaska’s Kids don’t Float, PFD loans in the NWT, and GPS and other safety equipment loans by the Hunters and Trappers Organisation in Nunavut.

PROGRAM FOCUS ON RURAL AREAS AND NATURAL SETTINGS

As Red Cross surveillance data in Part 1 show, Aboriginal peoples in Canada who live in rural areas mainly drown there, while Aboriginal peoples living in urban settings drown in both urban and rural locations. At present, Aboriginal peoples including adults and children mainly drown in natural bodies of water, to a greater extent than other Canadians. For aboriginal children 1-4-years-old, swimming pools are less frequently involved. Proven practices that do protect small children from unsupervised access to swimming pools include automatic protection by self-closing and self-

PAGE | 92


latching gates, in conjunction with vertically barred fencing. Natural environments do pose more of a challenge, especially when communities live in immediate proximity to a natural body of water. Nonetheless it is feasible to enclose backyard play areas for the most vulnerable children 1-4 years old with simple automatic gates and fencing. These can be fabricated at home at low cost. Similar gates are useful both for enclosing play areas and for preventing falls on stairs. Plywood, spring hinges, and self-latching devices are available at most hardware stores. Furthermore, homes should be designed so that parents working in the kitchen can easily observe their children at play in an enclosed yard.

Water safety skills need to be identified and/or developed that are effective and practical for rural and natural settings. For boating this could include safety practices for unexpected immersions, including cold water survival decisions such as whether to swim to shore or stay with the boat. Documents such as the Canadian Red Cross’s (2010) Water Safety Injury Prevention Resource for First Nations Communities and Northern and Remote Water Safety Community Resource (2004) may be effective in addressing such needs.

Recent studies from the U.S. and China indicated that formal swimming instruction was protective against drowning among 1-4 year old children (Brenner et al, 2009; Yang et al, 2007; American Academy of Pediatrics, 2010). Canadian Red Cross data suggest that swimming ability may be a protective factor, with few Aboriginal drowning victims identified as strong swimmers, compared with weak or non-swimmers. However, more complete recording of swimming ability for drowning victims by police and coroners would be helpful in improving data to verify this. Implementing programmes such as Red Cross Swim may serve as a risk reduction strategy. This program was designed to incorporate a balanced and comprehensive approach to injury prevention using Haddon’s injury matrix, with attention to personal, equipment and environment factors for the pre-event, event and post-event phases of incidents, during the main aquatic activities

PROGRAM FOCUS ON DROWNING DURING BOATING AND NON-AQUATIC ACTIVITIES

Circumstances of water-related fatalities suggest that water safety practices should be more broadly addressed. Part 1 surveillance data show that many people became immersed when they had no intention of entering the water. During such incidents, one can find oneself in unfamiliar circumstances, which could differ from environments in which swimming training, if any, was received. An immersed person could be fully dressed, in a vehicle, disoriented after falling from a boat or river bank, intoxicated, and/or in darkness. Some such conditions may be feasible to replicate for training purposes; however, due to the potential risks it may not be possible to simulate all scenarios.

While such a recommendation for swimming and water safety training seems intuitive, usual training in optimal environments, such as swimming pools with warm water, may need to ensure competencies not usually associated with swimming activities. Such competencies could include immersion and exiting the water in clothing to sense the rapidity of onset of cold and the need to carry a change of clothing in a dry bag, how to remain at the surface while fully clothed after an unexpected immersion, and how to navigate moving water safely.

Boating-related fatalities are of special concern. Everyone who operates a power-driven boat for recreational purpose requires passing an exam to obtain a Pleasure Craft Operator Card, except in the NWT and Nunavut where risk is the greatest. According to Transport Canada (2013), the Pleasure Craft Operator Card indicates that a “boater has a basic level of boating safety knowledge required for safe recreational boating. These requirements were introduced in 1999 in response to

PAGE | 93


high levels of boating deaths and injuries, with the goal of improving safety on Canadian waterways by education and training.” Prior to this requirement, rates of recreational boating-related fatalities among Aboriginal peoples had steeply declined and continues to do so. Nonetheless, Aboriginal peoples do still have considerably higher boating death rates than the average for all Canadians. What could be helpful are safety training programmes or initiatives targeting Aboriginal and other rural peoples in their usual boating activities and environments. Such programmes would best be co-created with Aboriginal and rural peoples.

Since training for all specific conditions in which people drown in rural locations may not always be feasible, an evidential strategy to promote behaviour change could be another option. Evidential strategies involve presenting evidence, often in the form of epidemiologic data, to demonstrate that a specific problem affects members of a given group (Kreuter et al, 2003). An evidential approach for Aboriginal peoples would involve providing information on activities that present the greatest risk for drowning, locations where drownings tend to occur such as rural areas and in specific bodies of water, and on drowning risk-reduction practices such as wearing a flotation device and not consuming alcohol. Ensuring that messages are culturally relevant by participatory development of messaging and targeting of the most vulnerable, such as men 15-65+ years, would effectively combine several best practices. TRAINING AND RECOGNITION OF ABORIGINAL PEOPLES AS WATER SAFETY INSTRUCTORS

Rural and remote environments require specialized safety knowledge. It is important to train and employ trusted Aboriginal members of communities as Water Safety Instructors and/or lifeguards, particularly persons with expert knowledge of local bodies of water used for recreation and daily life (Rousell & Giles, 2012; Giles et al, 2007; Giles et al, 2010; Rich & Giles, in press). Such individuals should possess or be willing to learn both traditional and current knowledge, equipment and practices, and display culturally safe communication and leadership skills when involved in training of other local peoples. Non-Aboriginal and non-local water safety instructors can recognize Aboriginal peoples’ knowledge and skills, by inviting their participation in water safety training. Such endorsement of local leadership and skill could be a strong contributor to ensuring broader dissemination of water safety messages and information to aboriginal communities. MULTI-LEVEL INTERVENTION

Disparities in social determinants of health are a recognised contributor to health inequities. A multilevel approach for reducing drowning in Aboriginal communities could ensure alignment of government policy (PHAC, 2005) with social determinants of Aboriginal peoples’ health. This would contribute to a positive policy environment, facilitating change in individual and public health by promoting positive choices for adoption of effective safety behaviours.

CONCLUSIONS ANDRECOMMENDATIONS

Considerable surveillance data are available in Part 1 of this report on risk factors for immersion deaths among Aboriginal peoples. Various approaches to prevention of water-related fatalities in challenging rural and remote environments require piloting and evaluation. It is feasible to develop evidence-based interventions to reduce water-related fatalities among the most vulnerable. These include Aboriginal males 15-65+ years of age who participate in recreational and daily living boating, aquatic, non-aquatic and ice transport activities in natural environments in rural areas, especially in the Prairies and Northern Territories.

PAGE | 94


The promising and best practices outlined above, and others, alone or combined will require development, piloting, evaluation and implementation in a representative sample of communities and individuals, in order to assess feasible and optimal practices for the main target activities and peoples. Since all communities, individuals, customs, and environments change over time, successful interventions will require revisiting and updating to meet changing needs. Ongoing research and evaluation will be essential to ensure programmes are designed, implemented and delivered for the most vulnerable, and for everyone who could benefit.

PAGE | 95


American Academy of Pediatrics, Committee on Injury, Violence, and Poison Prevention. Policy Statement Prevention of Drowning. Pediatrics 2010;126;178-185 (doi: 10.1542/peds.2010-1264). Brenner RA, Taneja GS, Haynie DL, Trumble AC, Qian C, Klinger RM, Klebanoff MA. Association between swimming lessons and drowning in childhood: a case-control study. Arch Pediatr Adolesc Med. 2009 Mar;163(3):203-10. doi: 10.1001/archpediatrics.2008.563. Brownell, M., Friesen, D., & Mayer, T. (2002). Childhood injury rates in Manitoba: Socioeconomic influences. Canadian Journal of Public Health, 93(S2), S50-6. Byrnes, Miller, and Schafer (1999). Byrnes, J. P., Miller, D. C., & Schafer, W. D. (1999). Gender differences in risk taking: A meta-analysis. Psychological Bulletin, 125, 367-383. Canadian Red Cross (2004). Northern and remote water safety community resource. Winnipeg, MB: Author. Canadian Red Cross. (2006). Drownings and other water-related injuries in Canada: 10 years of research. Ottawa, ON: Author. Canadian Red Cross (2010).Water safety injury prevention resource for First Nations Communities. Ottawa, ON: Author. Centers for Disease Control and Prevention (2013, Jan 24). Social determinants of health. Retrieved from http://www.cdc.gov/socialdeterminants/Definitions.html Cubbin, C., & Smith, G. S. (2002). Socioeconomic inequalities in injury: Critical issues in design and analysis. Annual Review of Public Health, 23, 349-375. Flynn, J., Slovic, P., & Mertz, C. K. (1994). Gender, race, and perception of environmental health risks. Risk Analysis, 14(6), 1101-1108. Giles, A. R., Baker, A. C., Rousell, D. D. (2007). Diving beneath the surface: The NWT Aquatics Program and implications for Aboriginal health. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 5(1), 25-49. Giles, A. R. &, Castleden, H. & Baker, A. C. (2010). “We listen to our Elders. You live longer that way”: Examining aquatic risk communication and water safety practices in Canada’s North. Health and Place, 16, 1-9. Giles, A. R., Strachan, S., Stadig, G., & Baker, A. C. (2010). Don’t be scared, you don’t have to wear your lifejacket’: using the theory of planned behaviour to understand lifejacket usage in Tuktoyaktut, Northwest Territories, Canada. Polar Record, 46(4), 1-8. Golob, M. I., Giles, A. R., Rich, K. (2012). Identifying promising practices for enhancing the relevance and effectiveness of water safety education for ethnic and cultural minorities. International Journal of Aquatic Research and Education, 6, 39-55. Gustafson, P.E. (1998) Gender differences in risk perception: Theoretical and methodological perspectives. Risk Analysis, 18(6) 805-811.

http://www.ncbi.nlm.nih.gov/pubmed?term=Brenner%20RA%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Taneja%20GS%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Haynie%20DL%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Trumble%20AC%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Qian%20C%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Klinger%20RM%5BAuthor%5D&cauthor=true&cauthor_uid=19255386

http://www.ncbi.nlm.nih.gov/pubmed?term=Klebanoff%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=19255386



PAGE | 96


Health Canada. (2008). A journey to the teachings : A community approach to injury prevention facilitator manual. Ottawa, ON: Ministry of Health Howland, J., Hingson, R., Mangione, T. W., Bell, N., & Bak, S. (1996). Why are most drowning victims men? Sex differences in aquatic skills and behaviors. American Journal of Public Health 86(1), 93-96. Kreuter, M., Lukwago, S., Bucholtz, D., Clark, E., & Sanders-Thompson, V. (2003). Achieving cultural appropriateness in health promotion programs: targeted and tailored approaches. Health Education Behaviour, 30(2), 133–146. Laflamme, L., Burrows, S., & Hasselberg, M. (2009). Socioeconomic difference in injury risks: A review of findings and a discussion of potential countermeasures. Copenhagen, Denmark: World Health Organisation Europe. Lame Deer, J. F., & Erdoes, R. (1994). Lame Deer: Seeker of visions. New York NY: Washington Square Press. McPherson, D., H., & Rabb, J. D. (2001). Indigeneity in Canada: Spirituality, the sacred and survival. International Journal of Canadian Studies, 23(Spring), 57-79. McShane, K. E., & Hastings, P. D. (2004). Culturally sensitive approaches to research on child development and family practices in first peoples communities. First Peoples Child and Family Review, 1(1), 38-44. Red Horse, J. G., Lewis, R., Feit, M., & Decker, J. (1978). Family behaviour of urban American Indians. Social Casework, 59(2), 67-72. Rich, K., & Giles, A. R. (in press). Contextually appropriate aquatic programming in Canada’s North: The Shallow Water Pool Lifeguard Certification. Canadian Journal of Native Studies. Romanow R. (2002). Building on values: The future of healthcare in Canada. Commission on the Future of Health Care in Canada. Available: http://www.cbc.ca/healthcare/final_report.pdf . Rousell, D., & Giles, A. R. (2012). Leadership, power and racism: Lifeguards’ influences on Aboriginal people’s experiences at a Northern Canadian aquatic facility. Leisure Studies, 4(31), 409-428. Rupnik, C., Thompson-James, M., & Bollman, R. D. (2001). Measuring economic well-being of rural Canadians using income indicators. Ottawa, ON: Statistics Canada. Smith, G. S. (1995). Drowning prevention in children: The need for new strategies. Injury Prevention, 1(4), 216-217. Taylor-Clark, K., Koh, H., & Viswanath, K. (2007). Perceptions of environmental health risks and communication barriers among low-SEP and racial/ethnic minority communities. Journal of Health Care for the Poor and Underserved, 18(4), 165-183. Transport Canada (2013). National Pleasure Craft Operator Competency Program. Retrieved: http://www.tc.gc.ca/eng/marinesafety/debs-obs-paperwork-paperwork_operator-360.htm

PAGE | 97


World Health Organisation (2012). Facts about injuries: Drowning. Retrieved from http://www.ripcurrents.noaa.gov/resources/DrowningFactSheetWHO2.pdf Wilson, D., & Macdonald (2010). The income gap between Aboriginal peoples and the rest of Canada. Ottawa, ON: Canadian Centre for Policy Alternatives. Yang L, Nong QQ, Li CL, Feng QM, Lo SK. Risk factors for childhood drowning in rural regions of a

developing country: a case-control study. Inj Prev 2007;13(3):178-82.

Zaloshnja, E., Miller, T., Galbraith, M., Lawrence, B., DeBruyn, L., Bill, N., Hicks, K., Keiffer, M., & Perkins, R. (2003). Reducing injuries among Native Americans: Five cost-outcome analyses. Accident Analysis & Prevention, 35(5), 631–639.

http://www.ncbi.nlm.nih.gov/pubmed?term=Yang%20L%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Nong%20QQ%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Li%20CL%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Feng%20QM%5BAuthor%5D&cauthor=true&cauthor_uid=17567973

http://www.ncbi.nlm.nih.gov/pubmed?term=Lo%20SK%5BAuthor%5D&cauthor=true&cauthor_uid=17567973
