Drowning Interventions

Boating Safety Training Programs

Background

According to the 1989 Red Cross survey 26 of boaters 16 and older, less than five percent of all boat operators (and less than four percent of all boaters) had taken a boating safety course in 1987. Only 31% of all boat operators (and 24% of all boaters) had ever taken a boating safety course in their lifetime. Exposure to a boating safety course does not necessarily translate to safe boating. Unfortunately, no studies have been done that examine the direct relationship between those persons having taken boating safety courses and those persons involved in boating accidents.

We found two studies relating to boating safety training, one for the general public and the other designed to reduce drowning among Alaskan fisherman. We have included the Alaskan occupational injury study for 2 reasons: it includes some teens and young adults, and it illustrates use of a cohort study design to evaluate boating safety training.


Review of boating safety training programs:

Author

Perkins, 1995

Study design and target population

Retrospective cohort study. 

Alaska commercial fishing vessels involved in a drowning or required rescue, 1991-1994.

Exposure: AMSEA safety course.

Intervention

18-24 hour course for commercial fisherman.

Course covers emergency preparedness, emergency response, and survival training.

Includes practicing emergency drills.

Outcomes

Drowning and hypothermia deaths. 

Victims & survivors identified from US Coast Guard database, NIOSH investigations, & newspaper accounts.

Results

159 vessel incidents reported by US Coast Guard; 114 documented deaths, 227 (66%) of survivors identified by name. 

8 of 86"at least one survivor vessels" and none of 64"at least one death vessels" had an AMSEA trained person on board (p=.021).

Study quality and conclusions

Boating safety course and accidents linked by person.

Number trained small (1,218 is 3% of registered fisherman); course is voluntary; no information on "prevented incidents".

Additional evaluation needed.



Author

Bernard et al., 1994

Study design and target population

Ecological study 

Registered recreational boaters in Louisiana, 1992-1993

Intervention

Education program (NASBLA-approved safety course) and enforcement of boating regulations

Outcomes

Reported boating accidents as a proxy for drownings and near-drownings. 

Citations used as a proxy for law enforcement presence.

Results

Mild inverse relationship between number of safety course graduates per parish and number of annual reported boating accidents in that parish. 

Law enforcement has a much weaker effect on preventing accidents than did safety course. Slightly positively correlated with accident site, suggesting correct disbursement of funds.

Study quality and conclusions

Accidents not linked to persons. Number of accidents probably underestimated. 

Parish (i.e., county) of accident not necessarily parish where boating safety course taken. Out-of-state boaters taken into account?

Summary of boating safety course studies

There is some evidence that a boating safety course sanctioned by the National Association of Boating Law Administrators (NASBLA) may prevent some boating accidents, but the evidence of a true association cannot be ascertained with the current study designs. The cohort study of Alaskan commercial fishing vessels is a stronger design which links individuals who completed the AMSEA course to boating incidents. Although the evaluation indicated the AMSEA training was effective, the number of commerical fisherman trained was too small to make conclusions about effectiveness.

Recommendations on effectiveness of boating safety training programs and enforcement of regulations

For the moment, there is no reason to suspect that a boating safety programs might increase the number of incidents and submersions except that more incidents may actually be reported. Time and cost commitments are probably the most important determinants in deciding to enroll in a boating safety course.

The AMSEA course is longer than the NASBLA course because it involves practicing emergency drills. This type of training could easily be adapted to recreational boating, small boats, and kayaks. At this time, we do not have sufficient data to recommend these courses.

Recommendations for future research

There exist no published studies of boating safety courses that go beyond simple descriptive epidemiology of boating courses and boating accidents. Much stronger causal inferences could be made if evaluations linked persons taking boat safety courses to persons involved in boating accidents as was done in the AMSEA evaluation. This would transform a strictly ecological study into a cohort design, with the exposure being the boating safety course and the outcome the boating accident. A case-control study design might also be used to examine the association between boating safety courses and drownings.

Given that boating incidents might serve as a useful proxy for drowning, the possible association of alcohol and boating accidents should also be examined, as well as the effectiveness of any regulations against alcohol and boating. One example of a good case-control study examined the effect of alcohol and drowning, showing that alcohol does indeed increase the risk of drowning.28