INJURY
The role of evidence, standards and education in rock fishing safety in New South Wales, Australia Rebecca J. Mitchell,1 Lauren Ware, 1 Mike R. Bambach1
R
ock fishing is a popular aquatic activity in New South Wales (NSW), Australia. It is estimated that 150,000 to 200,000 individuals rock fish each year in NSW.1,2 Since 1992, more than 140 lives have been lost in NSW to rock fishing,3,4 six in 2011 alone.3 This is more than the fatalities attributed to hang-gliding, parachuting, scuba diving and snowboarding combined in the year 2002.5 While the dangers involved in these other sports are readily appreciated, attitudes towards rock fishing often remain lax, despite a survey of 2,776 fishing club members identifying rock fishing as one of the riskiest fishing activities.6 These anglers fish in sheltered bays and inlets, but also on coastal rock platforms where waves can break unpredictably and sweep anglers into the ocean. The unpredictability of the ocean on coastal rock platforms, combined with slippery rock surfaces, anglers who fish in isolation, and individuals who wear heavy clothing and do not use personal protective equipment (PPE) such as a life jacket or shoe cleats, can have adverse consequences for anglers. Various prevention strategies have been proposed and/or implemented in an attempt to reduce the number of injuries and deaths. These have largely focused on raising anglers’ awareness of the danger associated with this sport as well as risk-reduction strategies. These initiatives include: advisory campaigns or workshops;2 engineering initiatives, such as angel rings;7 enforcement initiatives;8 and other safety initiatives, such as identification of hazardous conditions on coastal rock platforms.9 However, few of these strategies have been evaluated for their effectiveness in improving rock fishing safety. This research aims to: 1) describe the characteristics of rock-
Abstract Objective: To examine rock fishing-related fatalities and hospitalisations, identify initiatives aimed at improving safety and survey key rock fishing stakeholders about the strengths and limitations of each initiative. Method: This research obtained information from mortality and hospitalisation statistics, the published literature and key stakeholders for opinions on the strengths, limitations and improvements for rock fishing safety initiatives. Results: Injury patterns involving rock fishers have largely remained unchanged over time. The literature revealed that many rock fishing safety initiatives focused on awareness raising and engineering initiatives, but ignored the development of guidelines and the use of enforcement strategies. There had been limited evaluations conducted of any of the initiatives reviewed. Conclusions: It is likely that a combination of evidence-based, standard-focused and education initiatives would be useful in improving rock fishing safety in NSW, provided that the impact of these initiatives were routinely evaluated. Implications: Information from this research will be used to inform preventive strategies aimed at improving rock fishing safety through better coordination of the role of evidence in informing standards and practices and the continued evaluation of these initiatives. Key words: rock fishing, water safety, standards, education, evidence fishing-related fatalities and hospitalisations in NSW; 2) identify education, engineering, and enforcement initiatives aimed at improving rock fishing safety and review their effectiveness; and 3) survey key rock fishing stakeholders regarding the strengths, limitations and potential improvement strategies for each safety initiative.
review on rock fishing safety and a survey of key stakeholders. Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee (No: 2009/06/165), the Department of Justice Ethics Committee (No: CF/09/7427) and the University of NSW Social and Health Human Research Ethics Advisory Panel (No: 9/1/024).
Data sources
Method A retrospective review of rock-fishing fatalities in NSW between 1 January 1992 and 31 December 2010 was based on information from the National Coronial Information System (NCIS), and hospital admissions in NSW between 1 July 2003 and 30 June 2011, which were recorded in the NSW Admitted Patient Data Collection (APDC). This was supplemented by a literature
The NCIS is a national internet-based data storage and retrieval system for Australian coronial cases. It contains information on every death reported to an Australian coroner since July 2000 (January 2001 for Queensland). Within the NCIS, detailed information regarding the circumstances of the death is available on ‘closed cases’ (i.e. coronial cases finalised by a coroner) and minimal information is available on ‘open
1. Transport and Road Safety (TARS) Research, University of New South Wales Correspondence to: Dr Rebecca Mitchell, Transport and Road Safety (TARS) Research, University of New South Wales, Old Main Building, Sydney, NSW 2052; e-mail:
[email protected] Submitted: November 2013; Revision requested: February 2014; Accepted: March 2014 The authors have stated they have no conflict of interest. Aust NZ J Public Health. 2014; 38:579-84; doi: 10.1111/1753-6405.12247
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cases’. Information is only available on ‘closed cases’ from Western Australia. Information was extracted from the NCIS for deaths that were indicated to be due to rock fishing. Data from the APDC include information on inpatient separations for individuals from NSW public and private hospitals, private day procedures and public psychiatric hospitals. Included are data on episodes of care in hospital, which end with the discharge, transfer or death of the patient, or when the service category for the admitted patient changes. Information collected includes patient demographics, source of referral, diagnoses, and clinical procedures. The hospitalisation data were coded using the International Classification of Disease, 10th Revision, Australian Modified (ICD-10-AM).10 Hospital admissions as a result of rock fishing and also other and unspecified types of fishing were identified using the following criteria: i) the hospitalisation was for a patient during 2003–04 to 2010–11; and ii) the activity conducted at the time the injury occurred was identified as ‘fishing’ or ‘rock fishing’ (i.e. ICD-10-AM: U54.10 rock fishing, and U54.19 fishing, unspecified). Hospitalisations following rock fishing and unspecified fishing were both examined, as it is possible that some rock fishers were classified as performing ‘unspecified fishing’.
that were involved in rock fishing safety. Ten documents were identified for detailed review. A Google search produced 47 documents not previously identified. All reference lists were scanned and a further 15 documents were identified. Where there was no information available regarding the effectiveness of an initiative for improving rock fishing safety, evaluation studies that examined the effectiveness of a safety initiative for other areas of water safety, such as life jacket use in boating, are reported due to the potential transfer of the success of these safety initiatives to rock fishing.
Key stakeholder survey A convenience sample of 79 key stakeholders from organisations and manufacturing industries with an interest in rock fishing safety were invited to complete an online survey between December 2011 and January 2012, about the effectiveness of different types of interventions aimed at improving rock fishing safety. A total of 45 respondents (57.0%) participated. The survey asked participants about their opinions on the strengths and limitations of each safety
initiative and any suggestions as to how each initiative could be improved.
Data management and analysis Analysis was performed using SAS version 9.1.11 Previous reports on rock fishing fatalities in NSW that analysed fatality data for the time periods: 1 January 1992 to 31 December 2000;8 and 1 July 2000 to 30 June 2007,4 were reviewed. A set of data variables describing the key characteristics of the individuals and the circumstances of the fatality common between these prior study periods were identified. Rock fishing fatalities in NSW between 1 July 2007 and 30 June 2010 were retrieved from the NCIS, and characteristics of rock fishing fatalities examined for the periods 1992–20008 and 2000–2010. There was a six-month period (i.e., 1 July 2000 to 31 December 2000) estimated to involve up to four rock fishing deaths that was included in both of the two periods examined. Hospitalisations relating to transfers or statistical discharges were excluded from the APDC data to partly eliminate ‘multiple counts’. These exclusions refer to transfers between hospitals or changes in the
Table 1: Characteristics of rock fishing fatalities in NSW, 1992-2010. 1992-2000a n = 74 (%)
2000-2010b n = 75 (%) Location Sydney Regional NSW Personal protective equipment (PPE)c PPE worn PPE not worn/unknown Mode of entering water Swept off rocks Fell off rocks Unknown Activity upon entering water Swimming/returning to rocks Rescue attempted Panicking Nothing Unknown Number of people fishing 1 2 3 4 5+ Unknown
1992-2000a n = 74 (%)
2000-2010b n = 75 (%)
64 36
47 53
9 91
23 77
55 13 32
59 5 36
16 12 3 1 68
46 7 3 10 34
23 27 16 8 9 17
24 36 18 11 11 0
The literature review identified evaluation studies that assessed the effectiveness of countermeasures that may have an impact on rock fishing safety. Relevant literature was identified by searching AusSport, Compendex, Embase, Health and Safety Science Abstracts, Medine, PsycINFO, Scopus, SportDiscuss and Web of Science using a variety of combinations of search terms, including ‘rock fishing’, ‘sport deaths’, ‘fishing’, ‘life jacket’, ‘rescue equipment’, ‘recreational anglers’, ‘beach signage’, ‘beach safety’, ‘beach injuries’, ‘beach safety for tourists’, ‘risk management’, ‘signage’, ‘safety ambassadors’, ‘safety champions’, ‘beach rescue equipment’, ‘coastal audit’, ‘coastal hazard rating systems’ and ‘ocean search and rescue’. This strategy identified 4,534 articles. The titles and abstracts of each were examined individually and irrelevant items discarded. Ten articles were accessed and seven were culled, leaving three in the final review.
Gender Male Female Age Minimum (years) Maximum (years) Mean (years) Tourist status Resident Tourist Unknown Country of origin Asia-Pacific Australia Europe Unknown Swimming ability Swimmer Not a swimmer Unknown Alcohol Alcohol involved Alcohol not involved Unknown
To access the grey literature, targeted searches were conducted of Australasian government, research organisation websites
a results from Jones.8 b results for 2000-2007 from Piliskic et al.4 and updated to 2010 from the NCIS analysis. c Personal Flotation Device (PFD) wearing rates were not reported for rock-fishers in Piliskic et al.;4 however, in Jones8 it was reported that no rock-fishers were recorded as wearing a PFD.
Identification of effective interventions
580
96 4
95 5
9 76 46
15 82 43
85 7 8
88 10 2
68 17 4 11
57 30 13 0
23 4 73
59 18 23
11 53 36
27 58 15
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Injury
Rock fishing safety
service category (e.g. a change from acute to rehabilitation) for a patient during one episode of care in a single facility.
Results Mortality Individuals who died while rock fishing in NSW between 1992 and 2010 were almost all males, with an average age in the mid-40s. The majority were Australian residents but, for individuals who were not born in Australia, the most common countries of origin were in the Asia-Pacific region. Where swimming ability was identified, most individuals were able to swim. The majority were either not wearing personal protective equipment such as life jackets, cleats, wetsuits or vests with flotation devices at the time of the incident, or their PPE use was unknown, and more than half the individuals were swept off the rocks by a wave. Most were rock fishing either alone or with one other person and alcohol was identified as being involved in 27% of cases during 2000–2010. Comparisons of fatalities between 1992–2000 and 2000–2010 indicate there were proportionally more regional fatalities in the 2000–2010 period. There were more individuals recorded as wearing PPE in 2000–2010; and more recorded where alcohol was involved in 2000–2010 (Table 1).
rock fishing safety initiatives and evidence of their effectiveness as identified from the literature, along with stakeholder opinions of the strengths, limitations and potential improvements for each initiative. There was scant evidence identified from the literature for the effectiveness of specific initiatives. The effectiveness of personal flotation devices (PFDs) in preventing drowning of individuals who fell into the ocean while boating is likely to show a similar benefit to rock fishers.12 Stakeholder opinions of initiatives varied, with most initiatives having areas identified for improvement.
Discussion Rock fishing, while popular among anglers, can be a dangerous form of recreational fishing due to the unpredictability of the ocean. This research used information from mortality and hospitalisation statistics, the published literature and key stakeholders to examine the characteristics and preventive evidence regarding rock fishing safety. In NSW, the number and circumstances of rock-fishing-related deaths have remained constant across almost a 20-year period. Hospital admission records of rock fishers
Literature and key stakeholder views There was little information identified that evaluated countermeasures that may improve rock fishing safety. Table 3 lists selected
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According to Jones,8 injured rock fishers often conform to one of three profiles: (i) those who are aware of the risks and choose to continue to fish under any conditions despite the danger; (ii) those who lack experience and awareness of the risks; and (iii) responsible rock fishers who know the danger and are prepared, yet are caught out by the volatility of the ocean. Safety is strongly dependent on the fisher’s behaviour. Primarily, the decision to fish at dangerous and turbulent locations, partnered with a lapse in attention to the ocean, can lead to anglers either falling on slippery rock surfaces or being swept out to sea, with survival then being strongly affected
Table 2: Characteristics of individuals who were hospitalised with rock fishing or unspecified fishing identified as the activity performed at the time of the incident in NSW, 2003-04 to 2010-11. Rock fishing n
Hospitalised morbidity There were 1,080 individuals hospitalised between 2003–04 and 2010–11 who were identified as fishing at the time of the incident. Of these, 304 (28.2%) were identified as rock fishing, 182 (16.9%) identified other specified fishing, including spear fishing, and for 594 (55.0%) the type of fishing was not specified. Almost all individuals who were hospitalised were male and the mean age of rock fishers was 47 years (range 6-82 years). Just less than one-third of individuals hospitalised had English identified as their preferred spoken language, with less than 3% with a preferred language other than English. For rock fishers, Australia was the most common country of birth (71.1%). Three-quarters of all hospitalisations for rock fishers were following a fall and exposure to inanimate mechanical forces, such as striking against objects or being hit by falling objects (Table 2).
show a similar pattern of demographic characteristics to rock fisher deaths, but a different picture in terms of the injury mechanism. The most common mechanism resulting in the need for hospitalisation was a fall. Only 5.6% of these hospitalisations were related to submersion. While mortality and hospitalisation records can provide information on the characteristics of injured rock fishers, there are still improvements to be made in terms of recording information on some of these characteristics, such as swimming ability, alcohol consumption and use of PPE.
Gender Male Female Age group