Boating-related sports and recreational injury, Victoria ... · prevention initiatives in Victoria. We report on injury associated with surf sports separately, and an update report

VICTORIAN INJURY SURVEILLANCE & APPLIED RESEARCH SYSTEM HAZARD 56 page 1

Hazard(Edition No. 56)Summer 2004Victorian Injury Surveillance& Applied Research System (VISAR)

www.general.monash.edu.au/muarc/visar

Monash UniversityAccident Research Centre

In this edition of Hazard we analyse recent boating-related recreational injury data to provide a context for marine injuryprevention initiatives in Victoria. We report on injury associated with surf sports separately, and an update report on marineanimals injuries is posted on the VISAR website.

Boating-related sports and recreationalinjury, Victoria July 2000 to June 2002Karen Ashby & Erin Cassell

SummaryThis edition of Hazard provides anoverview of unintentional fatal and non-fatal injuries associated with boating-related sport and recreational activities.

There were 18 fatalities, 205 hospitaladmissions and 517 EmergencyDepartment (ED) presentations (non-admissions) for boating-related injuriesover the 2-year period July 2000 to June2002.

All fatalities resulted from drowning. Theactivities being engaged in at the time ofdrowning were fishing from a boat (44%),boating (28%), kayaking/ canoeing(17%), riding a personal watercraft(PWC)/jetski (5%) and sailing (5%). Bycontrast, approximately half of the non-fatal injuries were related to water skiingand PWC/jetski riding.

Two-thirds of fatalities occurred oninland waters and a third in coastal waters.

Males predominate at all levels ofseverity, representing over three-quartersof injured persons and over 90% offatalities. ED presentations were moreheavily weighted towards the 15-29 agegroup (48%), whereas persons aged 45years and older were more represented indeaths and hospital admissions (39% and33% of cases respectively).

The lower extremity (mostly knee, hip/thigh and foot) was the most commonlyinjured body site for both hospitaladmissions and ED presentations,accounting for approximately one-thirdof cases. Forty-three percent ofadmissions were fractures, most

commonly to the spine/back (17% offractures) and the lower leg (12%).

Recommendations for boating-relateddrowning prevention include mandatorywearing of personal floatation devices(PFDs) for operators and passengers ofrecreational vessels, and education andother initiatives to reduce consumptionof alcohol during boating activities.

Further research is needed to identifypromising and proven measures to reduceinjury in water skiing (and relatedactivities), PWC riding, boating(including fishing from boats), sailing,canoeing and kayaking. Data qualityimprovements and the collection ofexposure (time-at-risk) data are alsorecommended.


Selected sports and active recreation Table 1participation rates, Victoria: 2001-02

*Note: These figures are close to, but not below, the cut-off point for reliabilitySource: Sport and Recreation Victoria & Victorian Health Promotion Foundation, Victoriansparticipation in exercise, recreation and sport (2001-2002)

IntroductionThe great coastal stretches and inlandwaterways of Victoria provide a perfectsetting for a wide variety of recreationalboating activities. The Exercise,Recreation and Sport Survey (ERASS)conducted in Victoria in 2001/2 estimatedthat 114,000 Victorians participated inboating-related sport and recreationalactivities over the previous 12 months,the most popular being water skiing/powerboating and sailing (SRV, 2003).Fishing had 59,900 participants butfishing from boats could not be separatedfrom other fishing activities (eg. pier orrock fishing).

This edition of Hazard provides anoverview of unintentional fatal and non-fatal injuries associated with boating-related sport and recreational activitiesutilising data from the Marine IncidentDatabase (MID) and the NationalCoroners Information System (NCIS) (asreported in Bugeja ‘Recreational VesselFatalities in Victoria’, 2003) and theVictorian hospital-based injurysurveillance databases (the VictorianAdmitted Episodes Dataset and theVictorian Emergency Minimum Dataset).Activities covered by this report includerecreational boating, water skiing,personal watercraft (PWC or jetski)riding, rowing, canoeing, kayaking,sailing, rafting and kitesurfing. Scubadiving and snorkelling (n=14) wereincluded as it is not known whether boatswere involved in the activity.

Injury cases related to non-boat aquaticsport and recreation activities such asswimming, surfing and windsurfing wereexcluded, as were cases associated withboat maintenance. A separate report onsurf sport injury including board, windand body surfing can be found on page16. Fishing-related injury was excluded,except when the case record specificallyidentified that the injured person wasfishing from a boat. Injuries that occurredduring paid work were also excluded.

Hospital emergency department (ED)presentations data underestimate the sizeof the boating-related recreational injuryproblem. Several hospitals that arescheduled to join the VEMD in 2004 -Sale, Bairnsdale, Wodonga, Swan Hill,Warrigal, Hamilton and Sandringham - aresituated in areas where boating-relatedwatersports are popular. The data forhospital admissions, however, are notaffected as the admissions database(VAED) provides complete coverage ofhospitals across the state.

MethodsFatality data were extracted from therecent report ‘Recreational VesselFatalities in Victoria’ (Bugeja, 2003), ajoint initiative of the State Coroner’sOffice, the Department of HumanServices and Marine Safety Victoria. Thereport covers fatal drowning of occupantsof recreational vessels between July 1999and June 2002. We extracted a subset ofdata from this report covering fatalitiesin the period July 2000-June 2002. Theauthor supplied supplementary data onfatalities that occurred over this period.

Non-fatal injury data were extracted fromtwo hospital databases held or accessedby VISAR:

• Victorian Admitted Episodes Dataset(VAED) – Victorian public and private

hospital admissions (July 2000 to June2002); and

• Victorian Emergency MinimumDataset (VEMD) – Victorian publichospital emergency department (ED)presentations (July 2000 to June 2002)

The method for extracting data isdescribed in Box 1 (page 15).

Results

DeathsFatality data for the financial years2000/01 and 2001/2 were extracted fromthe recent report “Recreation VesselFatalities in Victoria” compiled byBugeja (2003), with additional informa-tion on the cases of interest supplied bythe author. The Victorian report onlycovered fatalities due to drowning.Australian Bureau of Statistics (ABS)Fatality File recorded only one non-drowning recreational boating-relatedinjury death in 2000/2, related to PersonalWatercraft (PWC/jetski) riding.

There were 15 recreational boating-related incidents resulting in 18 drowningfatalities in Victoria over the 2-yearperiod of interest, seven in 2000/2001and eleven in 2001/2002. Co-morbidity,in the form of heart disease andabnormalities were identified in four


cases at autopsy. The sport and recreationactivities being undertaken at the time ofdrowning were fishing from a boat (44%),boating (28%), kayaking/ canoeing(17%), riding a PWC/jetski (5%) andsailing (5%). Most fatalities (61%)occurred when the vessel was underway.

Over half the drowning deaths occurredafter a boat capsize (56%). Otherdrowning incidents occurred when thedeceased tried to swim to shore from adisabled boat (17%), the craft collidedwith another object (11%), the boatsuddenly sank (5%), the deceased wasthrown overboard (5%), and when theboat became disabled and the deceasedentered the water to bring it to shore(5%).

All eighteen drowning victims, exceptone, were male. Eighty percent wereaged 25-54 years. Half the deceasedwere classified as ‘experienced’ in theuse of the craft, 17% were inexperiencedand the remainder had either limitedexperience or the amount of theirexperience was unknown.

Drowning more commonly occurred ininland waters (67%, mostly inlets, lakesand rivers) as opposed to coastal waters(33%, mostly bays). Half the fatalincidents occurred in clear weatherconditions, a further 28% occurred incloudy conditions, 6% in rain and theother case reports did not specify theweather conditions. One-third of victimswere reported as not having checked theweather conditions before taking out thevessel. Whether or not the other two-thirds checked conditions was unknown.Visibility was reported as ‘good’ at thetime of most incidents (56%). Only threefatalities occurred in strong windconditions. The state of the sea includingwind generated swell and ocean swellappeared to be a significant factor in atleast half of the cases. In several cases,small vessels were being operated inconditions, both water and weather, thatwere inappropriate for their size.

Coronial findings indicate that 15 victims(83%) had a personal flotation device(PFD) available for use, however only

five (28%) were wearing a PFD whenretrieved from the water. A smallproportion of victims (11%) carried aradio and only 6% carried a mobile phone.Forty-four percent of victims had noavailable means of communication.Alcohol was involved in 28% (n=5) ofcases; equipment (electrical failure) ormaterial factors played a role in 28%(n=5) of cases.

Over the same 2-year period, July 2000to June 2002, there were 75 recreationalboating-related fatalities in Australiaincluding those that occurred in Victoria.Twenty-eight fatalities (37%) wererelated to fishing from boats, thirteenvictims (17%) were PWC/jetski riding atthe time of the fatal event, seven (9%)were canoeing/kayaking, five (7%) weresailing, two were water skiing and onewas using a non-powered inflatable craft.

Hospital-treated injuryThere were 205 hospital admissions and517 ED presentations (non-admissions)for boating-related sport and recreationalinjuries over the 2-year period July 2000to June 2002.

Crude mean annual rate per 100,000 population of Figure 1boating-related sport and recreational hospitaladmissions: Victoria, July 2000 to June 2002 (n=205)

Source: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002

Table 2 compares the pattern of injuryfor deaths, admissions and ED pre-sentations (non-admissions):

• Males appear to be over-representedat all levels of severity, representingbetween 76% and 94% of injuredpersons.

• Presentations were more heavilyweighted towards the 15-29 age group(48%), whereas deaths and admissionswere more heavily weighted towardsthose aged 45 years and older (39%and 33% of cases respectively).

• Fatalities mostly occurred in fishingand motorboat activity whereasapproximately half of non-fatalinjuries were related to water skiingand PWC (jetski) riding.

• The lower limb was the mostcommonly injured body site for bothhospital admissions and presentationsaccounting for approximately one-third of cases.

• Forty-three percent of admissions werefractures; most commonly to the spine/back (17% of fractures) and the lowerleg (12%).


Pattern of boating-related injury, July 2000 to June 2002 Table 2

Source: Deaths: Bugeja (2003) Recreational Vessel Fatalities in Victoria 1999-2002 (selected data covering period July 2000 to June 2002)Hospital admissions: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002Hospital emergency department presentations (non-admissions): Victorian Emergency Minimum Dataset (VEMD) July 2000 to June 2002


Hospital admissions for boating-related sport and Table 3recreation injuries by craft/activity type and lengthof hospital stay: Victoria, July 2000 to June 2002

Source: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002

Frequency of boating-related sport and recreation Figure 2injury ED presentations (non-admissions): Victoria,July 2000 to June 2002 (n= 517)

Source: Victorian Emergency Minimum Dataset (VEMD) July 2000 to June 2002

Hospital admissions (n = 205)Figure 1 shows the age breakdown for allboating-related sport and recreationinjury hospital admissions from July 2000to June 2002. Injury rates were higherfor males in all but the 0-4 and 75-79 agegroups (but case counts in these agegroups were small). The highest rates ofboating-related injury for males were seenin age groups 25-29 and 40-44 years(both 4.9 per 100,000 population). Wecannot conclude that males are at higherabsolute risk of serious injury in boating-related recreational activities than femalesbecause available data indicate that theirparticipation in these activities is alsomuch higher (SRV, 2003).

The major causes (mechanisms), body sitesinjured and the nature of injury are shownin Table 2. As VAED data are capturedusing the ‘water transport’ codes no furtherdetail of the mechanism of injury arerecorded. Admitted ED cases extractedfrom the VEMD were analysed to provideadditional information on hospitalisedinjury cases by specific activity and areincluded later in this report.

Forty-three percent of hospital admittedinjuries were fractures, most frequently tothe spine/back and lower leg (17% and12% of fractures respectively).

Length of stayApproximately half (49%) of cases wereadmitted to hospital for less than 2 days,37% stayed 2-7 days, 13% stayed 8-30days and 1% (2 cases) stayed more than 31days.

Both cases that stayed more than onemonth suffered from head injuries.Nineteen percent of the stays between 8and 30 days were spine/back injuries.Table 3 indicates that the shortest stayswere for injuries sustained during sailingand non-powered inflatable riding (63%and 71% respectively stayed <2 days).At the other end of the scale, 28% ofthose injured when fishing from a boathad a length of stay of 8-30 days. Thelongest stay was an injured PWC riderwho stayed 73 days.

Comparison of length of stay withall sports injuriesBoating-related hospital stays tend to belonger than stays for injuries related toother sport and recreation activities. Forexample, 72% of all sports-relatedadmissions recorded on the VEMD overthe same time period —July 2000 to June2002— had a length of hospital stay ofless than 2 days, 26% stayed 2-7 daysand 3% stayed 8-30 days. The

comparative proportions for boating-related sport and recreation were 49%,37% and 13% respectively hospitalised(Table 3).

Emergency Departmentpresentations, non-admissions(n = 517)Admitted cases are not included inpresentation data to avoid doublecounting. Accurate rate data are not


ED presentations (non-admissions and admissions) Table 4for boating-related injuries by craft/activity type:Victoria, July 2000 to June 2002 (n=604)

Source: Victorian Emergency Minimum Dataset (VEMD) July 2000 to June 2002* The discrepancy between the numbers of hospital admissions for the VEMD and the VAEDis likely to be due to incomplete coverage of all hospitals in the VEMD and failure of someVEMD hospitals to identify activity a the time of injury in case narrative data.

The six boating-related sport and recreation activities Table 5most associated with injury

Source: Deaths: Bugeja (2003) Recreational Vessel Fatalities in Victoria 1999-2002 (selecteddata covering period July 2000 to June 2002)Hospital admissions: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002Hospital emergency department presentations (non-admissions): Victorian EmergencyMinimum Dataset (VEMD) July 2000 to June 2002

knees and ankles (5% and 4%respectively).

Severity by sportThe VEMD also records the number ofcases subsequently admitted to hospitalafter ED treatment, thus giving a proxymeasure of severity (Table 4). The overallproportion of ED presentations requiringhospital admission was 15%. The highestadmission rates were for boating (23%)and kite surfing (20%).

The six highest rankedboating-related sport andrecreational activities forinjuryThis section provides an overview of theavailable data for the six boating-relatedrecreational activities that were mostcommonly involved in fatalities andhospital-treated injury (Table 5). Theanalysis utilises fatality data from theState Coroner’s Office and VAEDadmissions and VEMD presentations(non-admissions) data for the period July2000 to June 2002. Ranking is based onfrequency data.

1. WATER SKIING ANDRELATED ACTIVITIES

There were 309 hospital-treated injuriesrelated to water skiing and relatedactivities (50 admissions and 259presentations). The related activitiesinclude wake or knee boarding and tubing.In tubing a person is towed on aninflatable tube or ‘ski biscuit’ behind theski boat. These related activities areidentifiable in the VEMD, but not in theVAED.

Males accounted for 82% of admissionsand 75% of presentations. Bothadmissions and presentations peakedamong persons aged 25-29 years (27%and 22% of water skiing and relatedactivity cases, respectively). A further22% of admissions and 18% ofpresentations were in the age group 20-24 years.

available because of the incompletecoverage of the Victorian population bythe VEMD. Figure 2 shows the age andgender breakdown for boating-relatedsport and recreation presentations (basedon frequency data). Results of analysesare summarised in Table 2. Males wereover-represented in injuries among all

age groups. Falls (41%) and collisionswith objects and persons (32%) were themajor mechanisms of injury. The mostcommon specific injuries were openwounds to the face and head (14% of allrecreational boating-related injury EDpresentations), and sprains and strains of


Water skiing injury, level of severity by age group Figure 3Victoria, July 2000 to June 2002 (n=309)

Sources: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002Victorian Emergency Minimum Dataset (VEMD) July 2000 to June 2002

Water skiing injury by body site and severity Figure 4

Sources: admissions - VAED July 2000 to June 2002 (n=50);presentations - VEMD July 2000 to June 2002 (n=259)

Hospital admissions (n = 50,annual average frequency 25)Water skiing accounted for almost one-quarter of all admissions for boating-relatedsport and recreational injuries. Other waterskiing related activities such as tubing are notcoded on the VAED, hence admissions dataonly report water skiing injury cases. Thirty-three admissions were recorded in 2000/01and 17 in 2001/02. The decrease may beassociated with drought conditions that havereduced participation in watersports on inlandwaterways, although ED presentations werestable over the same period.

Among admissions, the head/face/neckwas the most frequently injured bodyregion (30%), followed by the lowerextremity (26%) and trunk (20%).Fractures accounted for 42% of waterskiing admissions and dislocations afurther 12%. One admission was a neardrowning. The most common specificinjuries were skull fractures (8%),vertebral fractures (8%) and shoulderdislocations (8%).

Fifty-six percent of water skiing injurycases were admitted to hospital for lessthan 2 days, 34% stayed 2-7 days and 5%stayed 8-30 days. The five cases that hadthe longest stays were for injuries to thebrachial artery (upper extremity, 2 cases),lumbar vertebral fracture (1 case),fractured neck of femur (1 case), and legtrauma that included a hip dislocation,blood vessel and nerve trauma (1 case).

VAED coding does not provide any detailof the circumstances of the injury.However, analysis of case narrative datafor admissions recorded on the VEMD(n=28) provides some additionalinformation. One quarter of the VEMD-recorded admissions were caused byhitting a tree when skiing, 14% occurredwhen a body part was caught in the skirope and 11% when a boat hit the skier.

Hospital ED presentations (non-admissions) (n = 259, annualaverage frequency 129)Fifty percent of all boating-related EDinjury presentations were for water skiingand related activities. Most cases (78%,

n=203) were associated with water skiing.A further 17% (n=44) were associatedwith towed boards (wake, knee or ski),and 5% (n=12) with ski biscuits or tubing.One hundred and twenty-two presenta-tions (non-admissions) were recorded in2000/01 and 137 in 2001/02.

The lower extremity was the mostfrequently injured body region (34%),mostly the knee (13% of all water skiingpresentations), ankle (9%) and feet (7%).Other commonly injured body sites werethe head (14%) and the shoulder (9%)(Figure 4). Sprains and strains were the

most frequently occurring type of injuryaccounting for 26% of presentations.Open wounds (18%), fractures (15%),and injuries to the muscles and tendons(10%) were also common. The mostfrequently occurring specific injurieswere open wounds to the head (9% ofwater skiing and related activitypresentations), sprains or strains of theknee (7%), shoulder dislocations (5%)and ankle sprain or strains (5%).

The major mechanism of water skiinginjury was a fall while skiing (49%).Other mechanisms included being struck

Head/face/neck 30%, 21%

Shoulder /upper arm 10%, 12%

Forearm /hand /fingers4%, 16%

Trunk 20%, 6%Hip /thigh 12%, 5%

Knee 4%, 13%Ankle 2%, 9%

Feet /toes2%, 7%

Other 16%, 11%


Motor boating injury by body site (ED presentations only) Figure 5

Source: presentations - VEMD July 2000 to June 2002 (n=151)

Fishing from boats injury by body site (admissions only) Figure 6

Source: admissions - VAED July 2000 to June 2002 (n=18)

by an object (12%, including skis andrope handle), being caught in the towline(9%) and ear problems from contact withthe water (3%).

Towed board injuries most commonlyresulted from falls from the board (43%)and being struck by the board (32%). Allbut one of the twelve ski biscuit andtubing injuries occurred when the injuredperson fell from the biscuit/tube when itwas being towed by a boat in the water.

2. MOTOR BOATING, BOATINGNOT SPECIFIED

There were 5 deaths and 151 EDpresentations for sport and recreationinjuries related to motor and other boats.The lack of specificity in text narrativesof “boating” cases made it impossible toidentify the type of boat involved in EDpresentations.

Deaths (n = 5)The five drowning fatalities occurred infive separate incidents:

• All of the deceased were male

• Three of deceased were aged 25-39,the other two were aged 50-54

• Two of the deceased were noted to beexperienced boaters, one wasinexperienced and the experience ofthe other two was not specified

• Two fatalities occurred when thevessel capsized, one when the vesselsank, one when the deceased attemptedto swim to shore from a disabledvessel, and the remaining case whenthe deceased entered the water to bringthe disabled vessel to shore

• Alcohol played a role in two fatalincidents

• One victim was wearing a PFD butremoved it when nearing the shoreafter swimming from the vessel.

Hospital ED presentations(non-admissions)(n=151 annual average frequency 76)Most presentations were male (80%) andone-quarter were aged 25-34. Themechanism for more than a third (36%)of injuries was a fall. Other commonmechanisms of injury were being struckby, or colliding with, an object (28%)and cutting and piercing (11%). Fivepercent were contact with the boatpropeller.

Open wounds (29%), sprain/strain (17%)and fractures (14%) were the mostcommon injuries. Lower extremityinjuries accounted for 35% of all injuries.Head/face and neck injuries were alsocommon (17%) (Figure 5).

3. FISHING FROM BOATSThere were 8 deaths and 18 admissionsfor recreational fishing from boats. Thebroad coding categories of the VEMDand lack of specificity in text narrativesmade it difficult to distinguish betweencases that involved fishing from boatsand other fishing localities such as rocks.Only those cases which specified that theperson was fishing from a boat at thetime of injury were included.

Deaths (n = 8)Five separate incidents resulted in 8drowning fatalities.

• Seven of the deceased were male

Head/ face /neck 17%

Lower extremity 35%

Trunk 9%Upper extremity excl. fingers 12%

Hand /fingers 12%

Other 15%

Head /face /neck 33%

Lower extremity 33%

Trunk 6% Upper extremity 17%

Other 11%


PWC injury, level of severity by age group, Victoria, Figure 7July 2000 to June 2002 (n=87)

Sources: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002;Victorian Emergency Minimum Dataset (VEMD) July 2000 to June 2002

• 38% were aged 40-49. A further 25%were aged 20-29 years, 25% were aged60-64 years and 12% were aged 50-59years.

• Half the deceased were noted to beexperienced boaters

• Four incidents and 6 fatalities occurredwhen a vessel capsized

• Two fatalities occurred when thedeceased tried to swim to shore from adisabled vessel (in one incident)

• Alcohol played a role in at least onefatal incident that claimed 2 lives

• Two drowning victims were wearingPFDs

Hospital Admissions (n = 18)Most admissions were male (n=15) andone-third were aged 60 years or older.Injuries to the head/face/neck and lowerlimb were most common (Figure 6). Themost frequently occurring injury wasfractures (n=10 cases), most commonlyof the face and hip.

4. PERSONAL WATERCRAFT(PWC)/JETSKI RIDING

There was one death and 87 hospitaltreated injuries (48 admissions and 39ED presentations) related to PWC riding.ED presentations are obviously under-reported on the VEMD as all admissionsenter through the ED.

Males accounted for 85% of admissionsand 87% of presentations. Forty percentof admissions were in the age group 35-49 years and a further 19% in the agegroup 10-14 years, whereas half thepresentations were aged 20-29 years(Figure 7).

Deaths (n = 1)One fatality occurred when a PWC drivenby an inexperienced operator collidedwith a ski boat. The deceased suffered ahead injury and was unconscious whenthrown into the water and drowned,despite wearing a PFD. Inexperienceand speed were identified as contributoryfactors (Bugeja, 2003).

Hospital admissions (n = 48,annual average frequency 24)Twenty-three percent of all hospitaladmissions for boating-related recrea-tional activities were associated withPWC riding. Twenty-six admissionswere recorded in 2000/01 and 22 in2001/02.

The lower extremity was the mostfrequently injured body site (40%),followed by the head/face (23%) andtrunk (21%) (Figure 8). Half the admittedcases were fractures. Open woundsaccounted for a further 13% of cases andintracranial injury 10%. One admissionwas a near drowning. The most commonspecific injuries were intracranial injury(10%) and tibial fractures (8%).

Forty-four percent of PWC injury caseswere admitted to hospital for less than 2days, 40% stayed 2-7 days, 15% stayed8-30 days and 2% (one case) stayed morethan 31 days. The cases that stayed 8-30days were admitted with fractures oflumbar vertebra (2 cases), burns (1 case),fractured femur (1 case), head injuryincluding skull fracture (1 case) and legtrauma (1 case). One case stayed in

hospital in excess of 10 weeks sufferingfrom multiple injuries including headinjuries, fractures of the femur, forearmand patella and numerous open woundsassociated with the fractures.

VAED coding does not provide detailsof the circumstances of the injury. Onlysix of the admissions were recorded onthe VEMD database so further informa-tion from that source is limited. Three ofthe VEMD-recorded admissions involvedfalls from the PWC, in 2 cases the injuredperson fell onto the PWC and in theremaining case a person was struck by aPWC.

Hospital ED presentations(non admissions)(n=39, annual average frequency 19)Eight percent of all ED presentations forboating-related sport and recreationalinjuries were PWC riding cases. Twenty-one presentations were recorded in2000/01 and 18 in 2001/02.

The lower extremity was the most frequentlyinjured body region (31%), mostly the foot(13% of all PWC injury presentations),and knee (10%). Other common body sites


Personal watercraft injury by body site and severity Figure 8

Sources: admissions - VAED July 2000 to June 2002 (n=48);presentations - VEMD July 2000 to June 2002 (n=39)

6. CANOEING/KAYAKINGThere were three deaths, six hospitaladmissions and 10 ED presentationsrelated to canoeing and kayaking.

Deaths (n = 3)The three fatalities occurred in threeseparate incidents:

• All of the deceased were male

• Two of the deceased were aged 25-39and the other was aged 50-54

Case 1: The deceased was paddling ahome-made canoe with two other adults.The condition of the canoe had deterior-ated with use and was consideredunsuitable for the sea conditions at thetime of the incident. Neither safetyequipment nor PFDs were carried andweather conditions were unsettled. Thecanoe capsized in changed weatherconditions and the deceased drowned.

Case 2: The deceased was an inexper-ienced kayaker who went kayaking witha friend. The kayak capsized, one personswam to shore, and the other drowned.Neither the deceased nor the friend waswearing a PFD and both had consumedalcohol.

Case 3: The deceased was an experiencedkayaker who was paddling a Level 4rapid (on a scale of 1 – 6) on a Victorianriver. Witnesses reported that thedeceased was paddling within hiscapabilities. The deceased becametrapped under a large rock whilenegotiating a rapid. The strong currentand turbulent rapids made it impossiblefor him to free himself and he drowned.The deceased was wearing a helmet anda PFD.

Hospital admissions (n = 6)All admissions, but one, were males.Cases were aged between 25 and 54 years.Dislocations were the most commoninjury type (33%). Half the injuries wereto the shoulder (50%). Five of the sixadmissions had a length of hospital stayof 2 days, the other was hospitalised forfive days.

injured were the thorax (23%) and the face(21%) (Figure 8). Sprains and strains andopen wounds each accounted for 23% ofpresentations. Fractures (18%) and injuriesto the muscles and tendons (8%) were alsocommon. The most common specificinjuries were open wounds to the face (18%of total PWC injury presentations) andfractures of the thorax (10%).

The major mechanism of injury was afall from the PWC (44%). A further 10%of cases were injured when struck by aPWC and 5% sustained knee injuriesafter kneeling to ride the PWC.

5. SAILINGThere was one death, 16 hospitaladmissions and 29 ED presentations forsailing-related injury.

Deaths (n=1)The deceased was an experiencedcrewman on a 12-metre yacht competingin a race. The yacht had trouble with oneof the sails at the front of the boat. Thevessel was then hit by a strong windsquall and the wind gust caused the boatto shift violently, the deceased was sweptoverboard and drowned. The deceasedwas not wearing a PFD.

Hospital admissions (n = 16)All admissions were male and all but onewere aged 40 years or older (up to age76). Nine admissions (56%) were forinjury incidents occurring on board thecraft without an accident involving thecraft. Fractures were the most commoninjury (44%). Most injuries were to thetrunk (38%) or the head/face (31%).Length of stay in hospital was shorterthan for other boating-related sport andrecreation injury cases with most cases(63%) staying less than 2 days. Thelongest stay was 16 days.

Hospital ED presentations (n = 29)Most presentations were male (69%).Presentations peaked in age groups 35-39 years (21%, n=6) and 50-54 years(17%, n=5). The most common mech-anisms of injury were falls (28%, n=8)and being struck by the boom (24%,n=7).

Sprain/strain (24%), open wounds (21%)and superficial injuries (21%) were themost frequently occurring type of injury.Upper extremity injuries accounted for38% of all injuries. Head/face and neckinjuries were also common (24%).

Head /face /neck 23%, 28%

Upper extremity 15%, 2% Trunk 21%, 28%

Lower extremity 40%, 31%

Other 1%, 11%


Hospital ED presentations (n = 10)Most presentations were male (60%).The most common mechanisms of injurywere falling from the canoe/kayak (40%,n=4) and colliding with a fixed objectwhilst paddling (30%, n=3).

Injuries were sprain/strains, superficialinjuries, fractures, dislocations, an openwound and a foreign body. Lower backand shoulder injuries each accounted for20% of canoe-kayaking injuries.

DiscussionRecreational boat operator license feeswere introduced in Victoria in February2002 for all PWC operators and alloperators of other powered boats agedunder 21 years, and from 1 February2003 for all other powered boatoperators. The Victorian governmentset aside a proportion of funding fromthe fees to expand boating safetyinitiatives implemented by Marine SafetyVictoria (MSV). The newly created MSVBoating Safety Funding Program aims toreduce the potential for injuries andfatalities related to the operation ofrecreational boats.

MSV has recorded boating-relatedincidents reported by the Victorian WaterPolice onto the Marine Incident Database(MID) since its establishment in 1988.In 2002, MSV contracted MUARC toconduct the first-ever detailed analysesof incidents recorded on the MID (MSV,2002). The availability of hospital-basedinjury surveillance data through VISARallowed a more comprehensive pictureof the size and nature of the boating-related sport and recreation injuryproblem to be drawn. The project report,Marine Safety in Victoria (2002),revealed that MID data underestimatedthe size of the injury problem.Approximately 10 times as many serious(hospitalised) boating-related injuriesoccurred in Victoria each year than wererecorded on the MID. The size of thewater skiing injury problem wasparticularly revealing as these injuryincidents are rarely reported to the Water

Police and hence few were recorded onthe MID. Our study reports fatality andinjury data for the latest available two-year period 2000/01 and 2001/2 andexpands on the information provided inthe MUARC report published in 2002.

Reducing recreational boating-related fatalitiesEighteen Victorians drowned inrecreational boating-related incidents inthe two-year period July 2000 to June2002. Over the same period there was anannual average of 37 recreational boating-related fatalities nationally. In Victoriaand nationally fishing from boats was themost common activity associated withrecreational boating-related drowning.

The drowning incidents reported hereare a subset of those included in thecomprehensive study of recreationalvessel drowning fatalities compiled byBugeja from MID and Coroners’ data(2003). The major findings andrecommendations of that report hold forthe subset included in this study. Bugeja(2003) found that, in most instances,drowning resulted from a combination ofthree factors: hazardous environmentalconditions; vessel occupants suddenlyand unexpectedly entering the water; andthe absence of Personal Flotation Device(PFD) use. PFDs are required by law tobe available for each passenger in arecreational vessel. Non-wearing of aPFD was reported as the most significantfactor contributing to the drowningdeaths. Alcohol was also mentioned as acontributory factor but data on alcoholinvolvement in drowning cases wereincomplete.

The major recommendation from thereport was that the National Marine SafetyCommittee should review and strengthenthe Australian Standard for PFD Type 1(AS1512) and that, subsequently, MSVshould prepare a case for the governmentto regulate that the wearing of PFDs ismandatory in vessels measuring up toand including six metres in length. Thereport also recommended that MSVenhance education relating to recreationalvessel passenger safety; and that MSV

and other water safety organisationseducate participants in recreationalboating activities of the dangers of alcoholconsumption in and around aquaticenvironments.

Personal Flotation Devices (PFDs)There are three recognised types of PFDs,Types 1, 2 and 3. Only Type 1 isrecognised as a life jacket, as it providesthe highest level of buoyancy (87newtons) and is designed to keep thewearer’s head above water and body in asafe floating position. Victorian lawrequires that a PFD Type 1 is carried forevery person on board a boat includingpersons being towed, and that the PFDmust fit the person for whom it is intended.

PFD Types 2 and 3 are buoyancygarments which are only designed to keepthe wearer’s head above water. Canoeistsand off-the-beach sailors often use type 2PFDs, whereas water skiers and PWCriders favour Type 3.

There are currently no regulatoryrequirements that mandate the wearingof PFDs, except by children under theage of 10 years. A child is required towear an approved PFD type 1, 2 or 3 atall times while the vessel is underway,unless the child is in a deckhouse, cabin,half cabin or secured enclosed space.

In November 2002, MSV commissionedQuantum Market Research to undertakea pre and post evaluation of MSV’s LifeJacket and Licensing campaign. Therewere 351 phone interviews conductedwith registered boat owners over a 5-dayperiod in November 2002. Respondentswere typically male, owners of a fishingboat or dinghy (70%) or ski boat (17%),who used their boat seasonally (51%)compared to all year around (26%), oninland lakes or rivers (59%) or on PortPhillip Bay (36%). With respect tocarrying and wearing PFDs the studyfound that: most owners carried a PFDType 1, either fitted (33%) or foam blocks(26%); most owners never wore a PFDwhen boating (57%) or do so only onsome occasions (26%); and many ownerscould not name the conditions under


which PFDs should be worn (Bugeja,2003).

Since 1988 a number of Coroners’investigations of recreational vesselfatalities (mostly drownings) haverecommended the compulsory wearingof PFDs by vessel operators andpassengers (Bugeja, 2003). Acting on arecent Victorian Coroner’s investigationand recommendation (Coroner Byrne2003), MSV conducted a stakeholderworkshop in November 2003 to discussthe issue. MSV is now considering therange of options arising from thediscussions at the meeting, from the statusquo to legislation to mandate PFDwearing (modelled on Tasmanianlegislation passed in 2000). MSV hasnot yet released its response to theCoroner’s recommendation, which willtake key stakeholders’ views intoconsideration.

At the same time PFD designs continueto improve. Devices currently availableon the market act as clothing garmentsunder normal circumstances but inflateas a PFD on contact with the water. Thisinnovative design feature addresses someof the inconvenience factors associatedwith wearing a PFD at all times.

Alcohol and injury in watersportsThe Bugeja report (2003) indicated thatseven (18%) of the 40 recreational vesseldrowning cases that occurred in Victoriafrom 1999 to 2002 were found to havealcohol present post mortem. Bugeja(2003) noted that the determination ofalcohol contribution to drowning deathsis complicated by a number of factorssuch as the time between the incidentoccurring and body recovery,putrefaction (decomposition) of the bodyand the extent of toxicological testing.

She noted that peak alcohol concentrationoccurs between half an hour and twohours after consumption. However, thetime between incident and body recoveryfor the seven fatalities that had alcoholpresent post mortem was between 7 hoursand 21 days (Bugeja, 2003). For bodiesnot quickly recovered, decomposition has

commenced and this process leads to theformation of alcohol in the body tissueand fluids, making alcohol consumptionmore difficult to determine.

Driscoll, Harrison and Steenkamp (2003)recently reviewed alcohol use and watersafety to assist the development of theAustralian National Alcohol Strategy.Part of the project involved a review ofthe literature on the role of alcohol inserious and fatal injuries resulting fromrecreational aquatic activity (includingswimming and diving). The authorsfound that there was very little Australianinformation. However, more compre-hensive North American data indicatethat alcohol is widely used by participantsin recreational aquatic activity.

US studies also indicate that alcohol isdetected in the blood of about 30-50% offatally injured persons involved inrecreational aquatic activity. The studiesthat were reviewed indicated that therelative risk of death associated withrecreational boating was approximately11:1 for persons with a BAC of 0.10g/100ml compared with persons who hadnot been drinking. The review teamconcluded that even small amounts ofalcohol increase the fatality risk (Driscollet al, 2003). Water sports/safetyorganisations and the water police needto be more active in educating watersportsparticipants on the dangers of alcoholconsumption and any form of aquaticactivity.

A controlled epidemiological study isrequired to more precisely identify therole of alcohol as a risk factor for boating-related drowning.

Reducing injury in PersonalWatercraft (PWC) ridingPersonal watercraft (PWC), also knownas jetskis and wave runners, are smallpowerboats. The first modern PWC wasintroduced in 1974 by Kawasaki as the“jet ski”. It was designed to accommodateone rider in a kneeling or standingposition, had a 32 horsepower engineand could reach speeds of 30mph (White& Cheatham, 1999). By contrast, current

model PWC can accommodate up to 3passengers, are operated by the driversitting, standing or kneeling, are able totow skiers, have engines up to 215 horsepower and are speed limited at 65mph(Jones, 2000; PWC Australia, personalcommunication 2004). There is a trendtowards the purchase of three seatermodels for use by families (David Heyes,PWC Distributors Australia, personalcommunication, 2004). Current modelPWC cost between $11,000 and $22,000brand new and approximately $7,000second hand (PWC Australia and PeterCorcoran, MSV, personal communica-tion, 2004). PWC are fast, manoeuvrableand easily launched and recovered. Allthese features account for their growingpopularity.

Although they have some safety features,such as an automatic ‘kill’ switch thatshuts off the engine in the event theoperator falls off and no exposedpropellers, the speed, power and growingpopularity of PWC have led to an increasein injuries. Few other vessels are capableof the speeds reached by PWC. Mostpowered vessels operate at the 20-35knot range, not up to the PWC range of60 knots or more (Peter Corcoran, MSV,personal communication 2004)

VISAR data indicate that each year inVictoria PWC are associated with anaverage of 1 death and at least 45 hospitaltreated injuries. Victims are typicallymale aged between 20 and 49 years. InVictoria deaths are fortunately infrequent.However, a preliminary review of theresearch literature reveals an increasingnumber of case series reports of PWCrelated injuries and deaths from severalcountries.

Latest Victorian figures show that therewere 4,255 PWC registered in 2001/02an increase of 615 on the previous year(Peter Corcoran, MSV, personalcommunication 2004). The estimatedVictorian injury rate is 9.4 per 1,000registered PWC in 2001/02. If under-reporting is taken into consideration thenthe Victorian rate is similar to the UnitedStates (U.S.) rates reported by Brancheet al (1997). They ranged from 8.4-11.4


injuries per 1,000 PWC in operation inthe U.S. in all but the final year of theseries where the estimated rate was ahigh 16.2 injuries per 1,000 PWC.

Branche et al (1997) also reported a 4-fold increase in PWC-related injury inthe U.S. between 1990 and 1995 and arate of ED treated injury that is 8.5 timeshigher for PWC than for motorboats.The number of fatalities reported in theU.S. has grown at an alarming rate, from5 in 1987 to 57 in 1996 (White &Cheatham, 1999).

Although Victorian hospital-treatedinjury data indicate that the mechanismof most PWC injuries is falls, the fatalitydata reported here and international caseseries indicate that most fatalities andserious PWC injuries occur when thePWC collides with other vessels or fixedobjects. Victorian data show that thelower limbs are the most common bodyregion injured. Victorian admissions datashow fewer head (17%) and spine/back(6%) injuries compared to the cases seriesdata reported in the literature (13%-54%for head injuries and 20%-38% for spinalinjuries) (Haan et al, 2002; Bierle et al,2002; Jones, 2000; White and Cheatham,1999; Shatz et al, 1998; Branche et al,1997).

Behavioural factors contributing to injurynoted in the literature includeinexperience, operator inattention, excessspeed and reckless operation. Bull et al.(2000) note that the operating charac-teristics of the PWC may contribute toinjury. PWC are manoeuvrable onlywhen the throttle is open and, contrary toexperience in all other motor vehicles, anobstruction is not avoided by slowingand turning but by maintaining orincreasing speed and turning to avoid thehazard (Bull et al, 2000). Also, no brakingis available. Stopping is achieved bycutting the throttle and coasting. Whenthe PWC is coasting no steering ispossible.

Chalmers et al (2003) reviewed theliterature on PWC injuries and found nopublished evaluations of interventions.

The authors compiled several recomm-endations for prevention from theirreading including: training of operators;developing ‘right of way’ guidelines andgeneral safety guidelines for the use ofPFDs; helmet use; regulation of PWCuse; and improvements to PWC design.Other recommendations in the literatureinclude promotion of adult supervisionof child riders and setting a minimum agerequirements for riders (Bull et al, 2000).Right of way guidelines are law inVictoria as are use of PFD and licensingof riders which includes restrictinglicensing age and speeds for those withrestricted licences aged 12-16 years.

Reducing injury in waterskiing (wake or knee boarding,sea biscuit riding and tubing)There are up to 40,000 water skiers inVictoria (SRV, 2003) and an estimated30 million recreational and competitivewater skiers world-wide (Waltrip andGrace, 2001).

An average of 129 Victorians present tohospital each year for injuries associatedwith water skiing and related activities.Males aged 25-29 are most frequentlyinjured and injuries are typically to thehead face and neck (admissions) andlower limbs (admissions and EDpresentations). Our study indicated thatfalls were by far the most commonmechanism of injury, followed bycollision with objects and being caughtin the towline.

Chalmers and Morrison (2003) reviewedthe research literature on injury associatedwith water skiing and reported a similarset of mechanisms. However, somecommon mechanisms reported from otherstudies, such as collisions with otherskiers and boat propeller injuries, wereuncommon in our study. We found onlyone injury case that was the result of acollision with another skier, and no casesof propeller injury to water skiers.However, there are substantial missingdata on the mechanisms of injury in theVictorian hospital datasets and narrativedata in the VEMD is of varying quality.

An in-depth follow-up study of injuredwater skiers is required to betterunderstand the mechanisms of waterskiing injury, obtain more detail of thecircumstances in which the injuries occurand identify the potential risk factors inorder to formulate prevention strategies.

Waltrip and Grace (2001) observed thatthe types of injuries sustained differedaccording to the level of participation ofthe water skier. Competitive skierssustain knee, back and shoulder injury,whereas recreational skiers are morelikely to sustain boat and propeller injury,vaginal and rectal injury and tympanicmembrane (ear) injury from falling intowater (Waltrip and Grace, 2001).

There are several other activities relatedto water skiing such as wake or kneeboarding and tubing, in which a person istowed on an inflatable tube or ‘ski biscuit’behind the ski boat. Ten percent ofVictorian ED presentations for boating-related injury were associated with theseactivities. Chalmers and Morrison (2003)report on a Canadian study of child injuryhospitalisations related to water tubing.The Canadian authors speculate that therisk of injury for ‘tubing’ is higher thanfor water skiing, as those being towed inthe tube have little control of the tube andare unable to determine the direction offorward momentum. Our Victorian dataindicate that although case counts aresmall (n=18) the proportion of child casesrequiring admission is high (33%).

Neither analytic studies nor evaluationsof interventions are reported in theliterature on water skiing injuries so theevidence for risk factors and preventionstrategies is limited. Chalmers andMorrison (2003) suggest that risk factorscould include gender and experience, andinterventions could include the impositionof speed limits on boats towing skiers,especially around docks and buoys;avoidance of shallow water; regulationof tow rope lengths; wearing of PFDs;increased responsibility by boatoperators; and increased vigilance byobservers in boats.


RecommendationsInjury surveillance• Analyse marine incident and boating-

related sport and recreation injury dataannually as new data becomes avail-able for research, prevention andevaluation purposes.

• Review data sources for coverage,comprehensiveness and quality, andimplement data improvementinitiatives.

• VISAR to report back to hospitals ondata quality shortcomings and seeksupport from relevant governmentdepartments to encourage hospitals toimprove case narrative reports in theVictorian Emergency MinimumDataset (VEMD).

• Consider the collection of exposuredata (participation and/or time-at-risk)for specific boating-related sport andrecreational activities to allow theestimation of injury risk per participant/per time unit in these recreationalactivities, and comparison of injuryrisk between these and other sport andactive recreation activities

• Liaise with Sports and RecreationVictoria (SRV) to separate water sportand boating relevant categories infuture ERASS participation surveysto make their data more useful forinjury prevention purposes

Research• Conduct comprehensive reviews of

published and unpublished literaturein the major boating-related sport andrecreation activities to better under-stand the pattern of injury, andcontributory factors and to identify,from evaluation reports, the provenand promising strategies and counter-measures to injury.

• Undertake a follow-up study ofpatients presenting to hospitalemergency departments with injuryrelated to participation in boating-related sport and recreation activities

to investigate in more detail the patternof injury, putative risk/contributoryand protective factors to injury andpotential solutions and to documentthe first aid and emergency responsein the immediate post-injury period,treatment and rehabilitation and anyadverse outcomes.

• Conduct studies to investigate thecontribution of alcohol to fatal andserious injury in boating related sportand recreational activities

• Conduct an observation study todetermine pre-intervention wearingrates of PFDs prior to the introductionof any mandatory wearing regulations.

Injury prevention and controlinitiatives• The wearing of the most appropriate

Personal Flotation Device should bemandatory for the operator and allpassengers in recreational vessels thatmeasure six metres or less in length.Prior to legislating for mandatorywearing of PFDs, the AustralianStandard (AS 1512) for Type 1 PFDsshould be strengthened to at leastmatch the performance and safetyrequirements of InternationalStandards.

• Information from surveillance data,literature reviews and key stakeholders(safety and sports associations) shouldbe used to design, implement andevaluate interventions to reduce injuryin boating and boating-related sportand recreation activities particularlyfishing from a boat, personalwatercraft (PWC) riding, water skiing/sea biscuit/tubing and canoeing/kayaking.

• Water sports/safety organisations andthe water police should be supportedto more actively educate watersportsparticipants of the dangers of mixingalcohol use and aquatic activities.Other measures to change the cultureof alcohol consumption in water sportsshould be investigated.

Useful websites that provide safety andprevention information for boating-related recreation activities include:

http://www.marinesafety.vic.gov.au - thewebsite of the MSV. It provides safetyinformation for recreational boaters,advice on PFD use, and information forenthusiasts of specific activities such askite surfing

h t t p : / / o z p w c . c o m / o z p w c / h o m e /safety.asp - the website of PWC Australia.It provides key messages for PWC safety,and education

http://www.biavic.com.au - the websiteof the Boating Industry Association ofVictoria. It provides a safety equipmentguide for vessels of varying sizes

http://www.mast.tas.gov.au - the websiteof Marine and Safety Tasmania. Itprovides both general safety informationand specific information for recreationalboaters

http://www.nmsc.gov.au - the website ofthe National Marine Safety Committee

http://www.safeboating.org.au - thewebsite of the Australian and NewZealand Safe Boating Education Group,hosted by the Australian Maritime SafetyAuthority

http://www.amsa.gov.au - the website ofthe Australian Maritime Safety Authority

ReferencesBierle EA, Chen MK, Langham MR, KaysDW and Talbert JL. 2002. Small watercraftInjuries in children. The American Surgeon.68 (6): 535-538.Branche CM, Conn JM, Annest, JL. 1997.Personal watercraft-related injuries. JAMA.278(8):663-665.Bugeja L. 2003. Recreational vesselfatalities in Victoria: 1999-2002. A jointinitiative of the State Coroners Office, theDepartment of Human Services and MarineSafety Victoria. Published by the VictorianState Coroners Office.


Bull M, Agran P, Laraque D, Pollack SH etal. 2000. Personal watercraft use by childrenand adolescents. Pediatrics. 105(2): 452-453.Chalmers DJ and Morrison L. 2003.Epidemiology of non-submersion injuries inaquatic sporting and recreational activities.Sports Med. 33 (10):745-770.Driscoll T, Harrison J and Steenkamp M.2003. The role of alcohol in fatal injuriesarising from recreational aquatic activity.Proceedings from the 1st Asia-Pacific InjuryPrevention Conference & 6th NationalConference on Injury Prevention andControl. 16-18 March 2003, BurswoodInternational Convention Centre Perth,Western Australia.Haan JM, Kramer ME and Scalea TM.2002. Pattern of injury from personalwatercraft. The American Surgeon. 68(7):624-627.Jones C. 2000. Epidemiology of personalwatercraft-related injury on Arkansaswaterways, 1994-1997: identifying prioritiesfor prevention. Accident Analysis andPrevention. 32:373-376.Marine Safety Victoria. 2002. Marine safetyin Victoria. A report prepared by MonashUniversity Accident Research CentreShatz DV, Kirton OC, McKenney MG,Ginzburg E, Byers PM, Augenstein JS,Sleeman D and Aguila Z. 1998. Personalwatercraft crash injuries: an emergingproblem. The Journal of Trauma.44(1):198-201.Sport and Recreation Victoria and VictorianHealth Promotion Foundation. 2003.Victorians’ participation in exercise,recreation and sport (2001-02).Waltrip RL and Grace N. 2001. WaterSkiing. In: Fu FH and Stone DA (editors).Sports injuries: mechanisms, prevention,treatment. Philadelphia (PA): LippincottWilliams & Wilkins. 804-817.White MW, Cheatham, ML. 1999. Theunderestimated impact of personal watercraftinjuries. The American Surgeon. 65(9):865-869.

AcknowledgementsThe authors gratefully acknowledge thecontributions of Lyndal Bugeja (StateCoroner's Office); PWC Australia; DavidHeyer (PWC Distributors Australia) andPeter Corcoran (Marine Safety Victoria).

Box 1. Methods of extracting boating related sport andrecreational injury from hospital injury datasetsData were extracted from the Victorian Admitted Episodes Dataset (VAED) and theVictorian Emergency Minimum Dataset (VEMD) using different methods due todatabase-specific coding issues.

The VAED records hospital admissions for all Victorian hospitals, both public andprivate. VAED data are coded using the World Health Organization InternationalClassification of Diseases (ICD) coding system. Data for the period July 2000 toJune 2002 are coded to ICD version 10. Boating-related sport and recreation injurywas identified using the following ICD10 codes: ‘V90-94’ covering “water transport”,but excluding cases associated with body surfing. As the focus of this report isrecreational injury, cases with an activity code associated with ‘paid’ or ‘other work’were excluded (n=18), as were intentional cases and cases where the intent was notspecified.

The VEMD records public hospital presentations to 28 EDs, representingapproximately 80% of statewide ED presentations. Narrative data were utilised toidentify specific boating-related recreational injury cases, as there are no specificcodes to identify cases. Keywords used in the search included: boat, canoe,catamaran, dinghy, jetski, kayak, kneeboard, parasail, PWC, sail, raft, rowing,scuba, snorkel, surf, tinny, wakeboard, waterski, windsurf and yacht (and spellingvariations of these). As this report focuses on unintentional recreational injury,cases with an activity code denoting injuries in ‘paid’ or ‘other work’ were excluded,as were intentional cases or cases where intent was not specified. There were severalcategories of injury identified using this narrative search strategy that were out ofscope of this review. They included injury cases that occurred in boat sheds; whena person was working/repairing a boat or boat building (model and otherwise); andnon-specific skiing injury cases that occurred during the official snow skiing season(June to September).

Supplementary analyses of narrative data from VEMD-recorded hospital admissionsfor boating-related sport and recreation were performed to provide additionalinformation on the circumstances of injury of hospitalised cases as the VAEDrecords no narrative data.

7th Australian InjuryPrevention Conference2nd Pacific Rim Safe

Communities Conference15-17 September 2004Mackay, Queensland

Information on websitewww.nisu.flinders.edu.au/aipn/conference2004


Surf sport injury presentations by age group and Figure 1level of severity: Victoria, July 2000 to June 2002 (n=148)

Sources: Victorian Admitted Episodes Dataset (VAED) July 2000 to June 2002;Victorian Emergency Minimum Dataset (VEMD) July 2000 to June 2002

The Exercise, Recreation and SportSurvey (ERASS) conducted in Victoriain 2001/2 found that an estimated 58,000Victorians participated in surf sports overthe previous 12 months (SRV, 2003).Surf sports include board surfing,windsurfing and body surfing.

Hospitalised surf sport-related injurieswere identified on the Victorian AdmittedEpisodes Dataset (VAED) using theICD10 code ‘V90-94’ covering “watertransport” and the fourth charactersubdivision .8 ‘Other unpoweredwatercraft (surfboard and windsurfer)’.The VAED could not identify injuryassociated with body surfing. EmergencyDepartment (ED) presentations wereselected from the Victorian EmergencyMinimum Dataset (VEMD) if the 250-character text narrative ‘Description ofInjury Event’ included the term “surf”,which identified board surfing,windsurfing and body surfing cases.

There were 148 hospital-treated injuriesrelated to surf sports identified in the 2-year period July 2000 to June 2002 (28admissions and 120 ED presentations),though this may be an under-estimatedue to non-specified data. Malesaccounted for 86% of both admissionsand presentations. Persons aged 15-29years were over-represented in bothadmissions and presentations (57% and50% of cases, respectively). A further13% of admissions and 11% ofpresentations were aged 10-14 years.

Hospital admissions (n = 28,annual average frequency 14)Twelve admissions for surf sports (notincluding body surfing) were recorded in2000/01 and 16 in 2001/02. The head/face/neck was the most frequently injuredbody region (36%), followed by the lowerextremity (25%) and trunk (25%). The

1 Damian Morgan is a PhD student at the Monash University Accident Research Centre investigatingsurf beach drowning. http://www.general.monash.edu.au/MUARC/hons/students.htm

major types of injuries were fractures(29%), open wounds (18%), and nerve/spinal injury (14%).

Fifty-seven percent of surf sport injurycases were admitted to hospital for lessthan 2 days, 29% stayed 2-7 days and14% stayed 8-30 days. The four casesthat had the longest stays were treated formultiple fractured vertebrae (2 cases),concussion and oedema of spinal cord (1case) , and hip dislocation (1 case).

VAED coding does not provide any detailof the circumstances of the injury, nordoes it categorise surf sports separately.However, analysis of case narrative datafor admissions recorded on the VEMD(n = 14) provides more details of theevents surrounding these injuries. Mostinjuries (79%) were to surf board riders,and 21% were to windsurfers. The mostcommonly reported mechanism of injurywas being “dumped” by a wave (21%).

Hospital ED presentations(non-admissions) (n = 120,annual average frequency 60)Forty-seven presentations (non-admissions) were recorded in 2000/01and 73 in 2001/02. Most surf sportinjuries occurred in surf board riding(88%), followed by windsurfing (8%)and bodysurfing (4%).

The most commonly injured body regionswere the lower extremity [28%, mostlyfoot and toe (12%) and knee injuries(6%)], head/face/neck (28%) andshoulder (13%). Sprains and strains weremost frequently occurring types of injuryaccounting for 28% of presentations.Open wounds (27%), dislocation (10%)and fractures (9%) were also common.The most frequently occurring specificinjuries were open wounds to the face(13% of surf sport presentations), andshoulder dislocations (8%).

Injury in surf sportsKaren Ashby and Damian Morgan1


The most common mechanism of injuryreported was being struck by an object(44%), mostly a surfboard (22% of allsurf sport injuries). Other mechanismsincluded falls (26%), being dumped by awave (4%), colliding with another person(4%) and cutting/piercing (4%).

DiscussionThe 1230km Victorian coastline includes588 surf beaches and abundant surf breaksover sand bars, rocks, and reefs (Short,1996). These surf spots, many within aday trip of Melbourne, provide a rangeof opportunities to learn and practicesurf sports under varying water and waveconditions. Injury hazards manifest insurf sports stem from a combination offactors pertaining to environmentalconditions (e.g., wave action), equipmentused in performing the activity (e.g., surfboards), the activity itself (e.g., paddling),human interaction (e.g., crowding), andocean-based hazards (e.g., stingingjellyfish) (Chalmers & Morrison, 2003;Nathan et al., 2002; Navarro, 2001).

The patterns of injury type, body locationand mechanism found in this study isbroadly similar to studies of surf sportinjury in Victoria and elsewhere(Lowdon, 1983; Hartung, 1990;Nathanson et al. 2002). In this study,30% of surf sports injuries requiringhospital treatment were to the head/face/neck body region; this finding accordswith two previous studies that attributed37% of surf sport injuries to this bodyregion (Lowdon, 1983; Nathanson et al.2002). The proportion of injuries to thelower extremities reported in this study(28%) fell between the figures reportedby Lowdon et al. (21%) and Nathansonet al. (37%). Open wounds, sprains,strains and fractures were found to becommon injuries requiring hospitaltreatment in our study. Similarly inNathanson et al’s. study, based on selfreport (rather than hospital treated cases)from 1237 (mostly US) surfers, foundthat lacerations comprised 42% of acuteinjuries, followed by contusions (13%),sprains (12%) and fractures (8%).

Many injury mechanisms, and resultantinjury types, are common to the threesurf sports discussed here (surfing,windsurfing, and body surfing), althoughthe frequency of occurrence is likely tovary between activities. For board surfers,being hit by their own or another surfer’sboard is the major mechanism of acuteinjury (Nathanson et al. 2002). Othermechanisms identified in Nathanson etal.’s study include: contact with the oceanfloor; hydraulic wave energy; excessivebody motion; and marine animal stingsor bites. As for board riders, thecommonest reported injury mechanismfor windsurfers is contact with the board(Chalmers & Morrison, 2003). Injuriesrelated to equipment involve the boom,footstrap and fins (Chalmers & Morrison,2003). Wave dumping of inexperiencedbody surfers places them at risk of spinalinjury or drowning (Hartung, 1990).Studies of specific surf sports injuries,mechanisms and treatments have alsoreported abdominal trauma and ocularinjuries (Kim et al. 1998; Choo et al,2002).

Precise data on exposure (time at risk)together with accurate injury data arerequired to determine the true injury ratefor surf sports. These data are also neededto assess the extent to which theoverrepresentation of injuries to malesaged 15-29 years is a reflection of thissubgroup’s exposure to surf sportactivities.

A number of authors have discussedequipment modifications as an injuryprevention strategy in surf sport activities(Kim et al. 1998; Choo et al, 2002;Nathanson et al. 2002; Navarro, 2001).The rounding of sharp edges on surfboardnoses and fins is an obvious measure butwill lack acceptance among users ifequipment performance is reduced. Fullbody wetsuits also offer some protection.Based on the author’s observations (DM),specially designed protective equipmentsuch as helmets, booties, eye gogglesand gloves are not in common use amongVictorian surf sport participants. Furtherresearch is required to determine the mosteffective strategies for promoting the

acceptance of protective clothing andequipment and other potential injuryprevention measures (such as surf beacheducation) among surf sport participants.

ReferencesChalmers, D. J. and L. Morrison (2003).Epidemiology of non-submersion injuries inaquatic sporting and recreational activities.Sports Medicine 33(10): 745-770.Choo, K. L., J. B. Hansen, et al. (2002).Beware the boogie board: Blunt abdominaltrauma from bodyboarding. Medical Journalof Australia 176: 326-327.Hartung, G. H., D. A. Goebert, et al. (1990).Epidemiology of ocean sports-related injuriesin Hawaii: ‘Akahele O Ke Kai’. HawaiiMedical Journal 49(2): 52, 54-6.Kim, J. W., H. R. McDonald, et al. (1998).Surfing-related ocular injuries. Retina 19:424-429.Lowdon, B. J., N. A. Pateman, et al. (1983).Surfboard-riding injuries. Medical Journal ofAustralia 2: 613-616.Nathanson, A., P. Haynes, et al. (2002).Surfing injuries. American Journal ofEmergency Medicine 20(3): 155-160.Navarro, R. A. (2001). Surfing. SportsInjuries: Mechanisms, prevention, treatment.F. H. Fu and D. A. Stone, LippincottWilliams & Williams: 725-732.Short, A. D. (1996). Beaches of the VictorianCoast and Port Phillip Bay: A Guide to theirNature, Characteristics, surf and safety.Sydney, Coastal Studies Unit of theUniversity of Sydney.Sport and Recreation Victoria and VictorianHealth Promotion Foundation. 2003.Victorians’ participation in exercise,recreation and sport (2001-02).

The next VSCN network meetingwill be held on

Wed 7 April at 9.30 a.m.at VicRoads, 60 Denmark St., KewTheme: Road Safety to celebrateWorld Health Day 2004 - Road Safetyemail for program: [email protected]


- INDEX -Subject Edition PagesBabywalkers, update ......................................................................................................................... 16,20,25,34 ................... 1-4,12-13,7-8,7-8Baseball ............................................................................................................................................................. 30 ...................................... 10-12Boating-related recreational injury ................................................................................................................... 56 ........................................ 1-16Bunkbeds ........................................................................................................................................................... 11 ............................................ 12Bicycles - Bicycle related .................................................................................................................... 6,34,44 ....................... 1-8,8-12,10-11

- BMX bikes ............................................................................................................................. 31,44 .................................. 9-11,7-8- Cyclist head injury study ................................................................................................... 2,7,8,10 .................................. 2,8,13,9

Burns - Scalds ........................................................................................................................................3,25 .................................... 1-4,4-6- Burns prevention.......................................................................................................................... 12 ........................................ 1-11

Child care settings ............................................................................................................................................. 16 ........................................ 5-11Client survey results .......................................................................................................................................... 28 ............................................ 13Data base use, interpretation & example of form .............................................................................................. 2 .......................................... 2-5Deaths from injury (Victoria) ..................................................................................................................... 11,38 ................................ 1-11,1-13Dishwasher machine detergents - Update ....................................................................................................... 18 ............................................ 11DIY maintenance injuries ................................................................................................................................. 41 ........................................ 1-12Dog bites, dog related injuries ....................................................................................................... 3,12,25,26,34 ................. 5-6,12,13,7-13,2-5Domestic architectural glass .................................................................................................................... 7,22,25 ............................. 9-10,1-5,12Domestic Violence ...................................................................................................................................... 21,30 .................................... 1-9,3-4Drowning/near drowning, including updates .................................................................................... 2,5,7,30,34 ....................... 3,1-4,7,6-9,5-7Elastic luggage straps ........................................................................................................................................ 43 .......................................... 2-6Escalator ............................................................................................................................................................ 24 ........................................ 9-13Exercise bicycles, update ................................................................................................................................. 5,9 ................................... 6,13-14Falls - Child, Older Persons .................................................................................................................. 44,45,48 ....................... 1-17,1-15,1-12Farm ............................................................................................................................................................. 30,33 ..................................... 4,1-13Finger jam ......................................................................................................................................... 10,14,16,25 ...................... 5,5-6,9-10,9-10Fireworks ........................................................................................................................................................... 47 .......................................... 2-7Geographic regions of injury ............................................................................................................................ 46 ........................................ 1-17Home ........................................................................................................................................................... 14,32 ............................... 1-16, 1-13Horse related ..................................................................................................................................................7,23 .................................. 1-6,1-13ICD-10 AM coding developments ................................................................................................................... 43 ........................................ 8-13Infants - injuries in the first year of life ............................................................................................................. 8 ........................................ 7-12Injury surveillance developments ..................................................................................................................... 30 .......................................... 1-5Intentional ......................................................................................................................................................... 13 ........................................ 6-11Latrobe Valley - First 3 months, Injury surveillance & prevention in L-V .............. 9, March 1992, Feb 1994 ....................... 9-13, 1-8, 1-14Lawn mowers .................................................................................................................................................... 22 .......................................... 5-9Marine animals .................................................................................................................................................. 56 ...................................... 18-20Martial arts ........................................................................................................................................................ 11 ............................................ 12Motor vehicle related injuries, non-traffic ....................................................................................................... 20 .......................................... 1-9Needlestick injuries ................................................................................................................................ 11,17,25 .............................. 12,8,10-11Nursery furniture ......................................................................................................................................... 37,44 .............................. 1-13,11-13Older people ...................................................................................................................................................... 19 ........................................ 1-13Off-street parking areas .................................................................................................................................... 20 ...................................... 10-11Playground equipment ......................................................................................................... 3,10,14,16,25,29,44 ..... 7-9,4,8,8-9,13,1-12,13-14Poisons - Domestic chemical and plant poisoning ..................................................................................... 28 .......................................... 1-7

- Drug safety and poisons control .................................................................................................... 4 .......................................... 1-9- Dishwasher detergent, update ..................................................................................................10,6 ..................................... 9-10,9- Early Childhood, Child Resistant Closures ....................................................................... 27,2,47 ........................... 1-14,3,11-15- Adult overview ............................................................................................................................ 39 ........................................ 1-17

Power saws, Chainsaws .............................................................................................................................. 22,28 .............................. 13-17,8-13Roller Blades, Skateboards .............................................................................................................. 2,5,25,31,44 ............ 1-2,11-13,12,12 3-7,8School ................................................................................................................................................................ 10 .......................................... 1-8Shopping trolleys ................................................................................................................................... 22,25,42 ........................... 10-12,8-9,12Smoking-related ................................................................................................................................ 21,25,29,44 ............................. 10-12,6-7,8Socio-economic status and injury ..................................................................................................................... 49 ........................................ 1-17Sports - Child sports, Adult sports ....................................................................................................... 8,9,44,15 ................. 1-6,1-8,15-16,1-10Surf sports ......................................................................................................................................................... 56 ...................................... 16-18Suicide - motor vehicle exhaust gas ................................................................................................. 11,20,25,41 ........................ 5-6,2-4,3-4,13Tractor ......................................................................................................................................................... 24,47 .................................. 1-8,8-10Trail bikes .......................................................................................................................................................... 31 .......................................... 7-9Trampolines ................................................................................................................................................. 13,42 .................................. 1-5,1-11Trends in road traffic fatality and injury in Victoria ....................................................................................... 36 ........................................ 1-13Vapouriser units ................................................................................................................................................ 43 .......................................... 7-8Venomous bites and stings ............................................................................................................................... 35 ........................................ 1-13VISS: How it works, progress ...............................................................................................................1,26 .................................... 1-8,1-5

A decade of Victorian injury surveillance ..................................................................................... 40 ........................................ 1-17VISAR: Celebration of VISAR's achievements ............................................................................................... 50 ........................................ 1-25Work-related ............................................................................................................................................... 17,18 ................................ 1-13,1-10


VISAR Executive /Editorial BoardProf Joan Ozanne-Smith, Monash University Accident Research Centre (Chair)Prof Ian Johnston, Monash University Accident Research CentreAssoc. Prof James Harrison, Research Centre for Injury Studies (SA)Assoc. Prof David Taylor, Royal Melbourne HospitalMs Erin Cassell, Monash University Accident Research CentreGuest Editors: Mr Peter Corcoran, Manager Recreational Boating, Marine

Safety VictoriaMs Lyndal Bugeja, Research Officer, State Coroners Office

VISAR StaffDirector: Ms Erin CassellCo-ordinator: Ms Karen AshbyResearch Assistant: Ms Angela ClappertonMedico/Clerical Support Officer: Ms Christine Chesterman

General AcknowledgementsParticipating hospitals

How to accessVISAR data:VISAR collects and analyses informationon injury problems to underpin thedevelopment of prevention strategies andtheir implementation. VISAR analysesare publicly available for teaching,research and prevention purposes.Requests for information should bedirected to the VISAR Co-ordinator orthe Director by contacting them at theVISAR office.

Contact VISAR at:MUARC - Accident Research CentreBuilding 70Monash UniversityVictoria, 3800

Phone:Enquiries (03) 9905 1805Co-ordinator (03) 9905 1805Director (03) 9905 1857Fax (03) 9905 1809

Email:[email protected]

Coronial ServicesAccess to coronial data and links with the development of the Coronial's Servicesstatistical database are valued by VISAR.

National Injury Surveillance UnitThe advice and technical back-up provided by NISU is of fundamental importance to VISAR.

From October 1995Austin & Repatriation Medical CentreBallarat Base HospitalThe Bendigo Hospital CampusBox Hill HospitalEchuca Base HospitalThe Geelong HospitalGoulburn Valley Base HospitalMaroondah HospitalMildura Base HospitalThe Northern HospitalRoyal Children's HospitalSt Vincents Public HospitalWangaratta Base HospitalWarrnambool & District Base HospitalWestern Hospital - FootscrayWestern Hospital - SunshineWilliamstown HospitalWimmera Base Hospital

From November 1995Dandenong Hospital

From December 1995Royal Victorian Eye & Ear HospitalFrankston Hospital

From January 1996Latrobe Regional Hospital

From July 1996Alfred HospitalMonash Medical Centre

From September 1996Angliss Hospital

From January 1997Royal Melbourne Hospital

From January 1999Werribee Mercy Hospital

From December 2000Rosebud Hospital

All issues of Hazard and otherinformation and publications of theMonash University Accident ResearchCentre can be found on our internethome page:

http://www.general.monash.edu.au/muarc/visar


VISAR is a project of the Monash University Accident Research Centre.

Hazard was produced by the Victorian Injury Surveillance and Applied Research System (VISAR)with the layout assistance of Christine Chesterman & Glenda Cairns, Monash University

Accident Research Centre.Illustrations by Jocelyn Bell* and Debbie Mourtzios

ISSN-1320-0593

Printed by Work & Turner Pty Ltd, Tullamarine

*Copyright clause: Copyright for all creative property as commissioned including sketches, remains under theexclusive ownership of Jocelyn Bell.

Project funded byVictorian Health Promotion Foundation

Documents

Boating-related sports and recreational injury, Victoria ... · prevention initiatives in Victoria. We report on injury associated with surf sports separately, and an update report