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Overseas Security Advisory Council
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Drowning Prevention and Water Safety Abroad

Introduction
According to the International Life Saving Federation (ILSF), 1.2 million people die by drowning every year – more than two drownings per minute. U.S. Department of State data indicates that 135 Americans drowned abroad in 2018; over the last two years, 18 percent of all non-natural U.S. citizen deaths abroad have been by drowning. The World Health Organization (WHO) warns that drowning is the third-leading cause of death by unintentional injury worldwide. Security managers should be aware of global drowning risks and water safety measures in order to equip traveling personnel, even if the purpose of travel has nothing to do with being in or near water.

What is drowning?
The World Congress on Drowning Prevention defines drowning as experiencing respiratory impairment from submersion/immersion in liquid. Though that definition is pretty straightforward, identifying instances of drowning is harder than one might expect. In his widely circulated article, Drowning Doesn’t Look like Drowning, retired U.S. Coast Guard helicopter rescue swimmer Mario Vittone details the Instinctive Drowning Response – the human reaction to avoid actual or perceived suffocation in the water. Surprisingly, it does not look as most people expect.

Dr. Francesco A. Pia, who coined the Instinctive Drowning Response terminology, made a number of
observations about this process. Most notably, he mentions that, except in rare circumstances, drowning people are physiologically unable to call or wave for help. He also notes that drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion. For this reason, travelers participating in water-based activities should be aware of the drowning signs to look for in other travelers, such as head tilted back, mouth at water level, and appearing to climb an invisible ladder.

Who is most susceptible to drowning?
Worldwide, most drownings occur to people in three age categories: 0 to 5 years old, 20 to 25 years old, and over 60 years old. More than half of the deaths recorded by the WHO are individuals under the age of 25. This category is particularly concerning for academic institutions, whose travelers largely fall into that demographic. Participation in watersports and recklessness are commonly cited contributing factors for the elevated drowning rate among 20 to 25 year olds. For those over 60 years of age, inability to swim and medical conditions that render swimmers unconscious (e.g. heart attack) are key safety concerns that contribute to drowning. Possessing the ability to swim is certainly crucial to drowning prevention. That said, as many as a quarter of all drowning victims are swimmers. Excessive alcohol intake is a key concern that leads to increased drownings in both age categories. According to the U.S. Centers for Disease Control and Prevention (CDC), alcohol use is involved in up to 70% of adolescent and adult deaths associated with water recreation.

Under what circumstances are drowning most likely to occur?
Globally, drownings tend to peak during the warmer summer months, when people flock to the water for relief and recreation. Mid to late afternoon is the most common time for drownings, likely due to factors such as heat, fatigue, and alcohol intake. According to the ILSF, one-third of water-related deaths occur after dark, including many fatal boating collisions. Not surprisingly, most drownings happen during activities without lifeguard supervision.

Drowning is a leading cause of death for U.S. travelers visiting countries where water-related activities are popular, such as Mexico and Costa Rica. These are also popular destinations for student travelers. According to data from the 2016-2017 academic year, Costa Rica was a top-ten destination for study abroad, with over 8,300 U.S. students studying there; Mexico attracted over 5,700 U.S. students. As noted in the OSAC Crime and Safety Report, Costa Rica experienced a record number of water-related deaths in 2017. Beaches with strong rip currents and no lifeguards were a key contributor to this trend. Rip currents – powerful, channeled current of water flowing away from shore – are one of the leading causes of drownings at beaches globally. According to the United States Lifesaving Association, rip currents account for over 80% of surf-beach lifeguard rescues. They are particularly dangerous for weak or non-swimmers.



Boating also
ranks high in the list of activities drowning victims were engaged in at the time of death. These deaths are generally the result of a collision with other boats or objects, capsizing, or falling overboard. According to the ILSF, in one quarter of boating-related deaths, there is no life jacket in the boat. Many of these deaths are related to recreational boating. However, many boating-related deaths are a result of carelessness and poor boating safety on behalf of a transportation or tour company. For example, in July 2018, 41 people died when a tour boat capsized in Thailand off the southern resort island of Phuket. Authorities charged the captain with negligence causing death. As noted in the OSAC Crime and Safety Report for Thailand, ferries and speedboats to/from Thai islands are often overcrowded and rarely carry sufficient safety equipment. This is the case for any number of other locations, where government oversight of safety may be lacking or nonexistent. Avoid travel on overcrowded boats, and ensure proper safety equipment is available prior to boarding.

What water safety measures should you observe to decrease the risk of drowning?

The CDC
recommends that travelers take the following precautions to prevent drowning abroad:

Learn about health and safety risks at your destination.

    • Research local water conditions, currents, and rules before you get in the water.
    • Ask about local sea animals, such as urchins, jellyfish, coral, and sea lice. 
    • Use experienced guides when boating, scuba diving, or participating in other water-related activities.

 
Be aware of your surroundings.

    • Pay attention to colored beach flags posted on the beach, which indicate if it is safe to swim. Make sure you understand and follow these local warnings.
    • Watch for signs of rip currents. If you are caught in a rip current, swim parallel to the shore until free from the rip current, then swim diagonally toward the shore.

 
Take steps to prevent injury.

    • Use proper safety equipment, such as life jackets.
    • Never swim alone or in unfamiliar waters.
    • Do NOT drink alcohol before or during swimming, diving, or boating.
    • Do NOT dive in shallow water. Always enter water feet first.
    • Be aware of hidden obstacles in the water that could cause injury.
    • Supervise children closely around water.

 
In addition to passing along water safety guidance to travelers, security managers should also set parameters around allowable water-based activities on business travel, including the use of water-based transportation. Though water-based activities often fall in the “bleisure” category (business leisure), employers may still have duty of care obligations. According to a recent regional study by International SOS and the Centre for Aviation (CAPA), one in four bleisure trips include an aspect of adventure or exploration, yet one in four organizations has not considered bleisure in their travel policy. Any considerations regarding support, requirements, or limitations for bleisure travelers should take into account the risks posed by water-based leisure activities.

In cases where travel is certain to involve water-based activities or travel, organizations may also consider training some travelers in cardiopulmonary resuscitation (CPR). This is common in academia, where institutions can mandate that trip leaders take the training rather than each individual traveler. Other water safety trainings, like those for boating, are less common.

Further Information
For additional information on drowning prevention and water safety abroad, please contact OSAC.

Additional Resources

OSAC – Repatriation of Human Remains
CDC – Water Safety Abroad
WHO – Global Report on Drowning
American Red Cross – CPR Training

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