What a Fatal Drowning Study Tells Us About the Data We Collect: Lessons from Houston's multi-source research project and what they mean for aquatic operations

Every aquatic professional knows that drowning prevention extends well beyond what happens in the water. It involves everything surrounding a drowning event: who was present, where it happened, what protective factors were or were not in place, and what the chain of response looked like from the moment of the incident through to the medical examiner's report. A study published in Injury Epidemiology earlier this year brings that reality into scientific focus, and its findings have direct relevance for the aquatic operations community.

About the Research

Researchers from Texas Children's Hospital and Baylor College of Medicine set out to document the lessons learned during a probabilistic data linkage project on fatal drowning in metropolitan Houston, covering the years 2016 to 2022. Their goal was not simply to count drowning deaths, but to understand the full picture: where drownings occurred, who was at risk, what protective factors were present, and what the data could tell prevention practitioners at the local level.

The study reviewed twelve datasets and successfully linked eight, ultimately capturing 790 drowning fatalities across the region. The datasets were broad in scope: EMS reports, hospital and medical examiner records, boating and maritime accident data, weather events, police and media reports, hurricane data, beach rescue records, consumer product safety reports, swimming pool inspections, census data, and health equity information.

The scale of that effort alone makes a point that aquatic professionals already sense but rarely see quantified: drowning data is scattered, inconsistent, and too often incomplete.

Why Aquatic Operations Should Pay Attention

Drowning is one of the top three causes of unintentional injury death worldwide. In the United States, it is the leading cause of death in children aged 1 to 4, and fatality rates are also elevated in adults 65 and older.

Despite those numbers, the epidemiology of drowning at the regional level remains poorly understood. The reason is straightforward: no single data source provides complete information on people who drown. That is not just a research limitation. It is a prevention limitation. Without complete, accurate data, aquatic facilities, lifeguard agencies, park departments, and water safety organizations are making decisions without a full picture. The Houston study demonstrated that drawing data from across the care continuum produces an account that no single source can provide. Probabilistic linkage of multiple datasets allowed each source to complement missing information in others, reducing ascertainment bias and producing a unified database for analysis.

For aquatic operators, this reinforces something AOAP has long advocated: the data your facility generates matters. Incident reports, near-miss documentation, supervision records, and rescue logs all feed into the larger picture that researchers and public health authorities need to develop effective countermeasures.

The Aquatic Environment Is More Varied Than Any One Dataset Captures

One of the more instructive elements of this study is how it mapped the diversity of aquatic environments involved in fatal drowning. The Houston metropolitan region is not just swimming pools. It encompasses the Texas Gulf Coast, Galveston Bay, four large lakes, three river systems, numerous estuaries, bays, and inlets, as well as flood-control structures, including retention ponds, canals, and waterways.

Drowning deaths occurred across swimming pools (27%), natural water (27%), flood control structures (20%), bathtubs (19%), and during flooding events (6%).

That distribution is a prompt for aquatic professionals to think beyond the boundaries of their own facility. Community drowning risk is not confined to supervised venues. A substantial share of drowning deaths occurs in environments with little or no professional aquatic oversight, which makes water safety education, barrier implementation, life jacket compliance, and community outreach all the more consequential.

The Problem Is Not Just Missing Data.

It Is Inconsistent Data.

This is where the study becomes most instructive for practitioners.

The research team encountered significant obstacles in assembling a complete regional picture. Data were often unavailable, unstandardized, or missing key information, particularly in smaller counties that lacked financial resources and staffing.

Consider the challenge of identifying where a drowning occurred. That might seem like a straightforward task. In practice, it was not. Errors in location data included vague descriptions, inconsistent terminology such as mixing up Gulf of Mexico beaches with bay locations or confusing piers with jetties, no quantification of distance, and no descriptions of direction from a reference point.

When incident reports use non-standardized language, when one agency records a location as a "bayou" and another calls it a "creek," when a lifeguard report does not specify which section of a beach a rescue took place in, the data becomes difficult to aggregate and nearly impossible to analyze at scale. The consequence is that prevention resources cannot be reliably directed to the locations that need them most.

Risk and protective factor information presented similar problems. Not all data sources documented factors like swimming ability, life jacket use, supervision, and barrier integrity, and when they did, the information was often recorded in non-standardized form.

Hospital records showed a particular gap: information on supervision, resuscitation, and comorbidities was more frequently documented than swimming ability, life jacket use, the presence of barriers, or concurrent alcohol or drug use.

This reflects not a failure of individual professionals, but a systemic absence of agreed-upon standards for recording drowning-related information across agencies and settings.

A Case for Standardization

The study's conclusions on this point are direct. The drowning prevention field needs standardized data collection across the board.

The researchers call for widespread adoption of the Utstein classification template and the Child Death Review form across medical examiner offices, along with greater standardization of geographical information across agencies to improve the spatial accuracy of natural water drowning locations.

For aquatic operators, the parallel is clear. Every incident report your staff completes is a data point. Every near-miss, every rescue, every supervision log entry has the potential to contribute to a body of knowledge that informs prevention, but only if the information is recorded consistently, completely, and with enough detail to be useful to someone outside your facility.

In practice, that means documenting not just that a rescue occurred, but where in the facility, at what time, what the victim was doing, who was supervising, what barriers were or were not in place, and what the outcome was. It means using consistent terminology that aligns with national and international frameworks. It means treating every incident report as if a researcher might eventually need to connect it to a hospital record, a medical examiner report, and an EMS log, because that is exactly what this study shows researchers are trying to do.

Data and Advocacy

AOAP has consistently advocated for the use of evidence to shape aquatic policy and operations. This study is a useful example of what that evidence base requires in order to be credible and actionable.

The process of obtaining and analyzing data to describe the epidemiology of fatal drowning is complex, lengthy, and cumbersome. Documenting the process and lessons learned can support drowning research and inform regional drowning prevention strategies.

When aquatic professionals advocate for policy changes, whether around supervision ratios, barrier requirements, life jacket regulations, or swimmer safety programs, that advocacy is most grounded when it draws on data that is complete, standardized, and traceable. This study illustrates both how much can be learned when data is carefully assembled, and how much is lost when it is not.

The records aquatic operations professionals keep today are the foundation for the research that will shape prevention tomorrow. That is a reason to take documentation seriously, not as an administrative task, but as a professional responsibility with direct public health consequences.

Shenoi RP, Levine N, Camp EA, et al. "Lessons learned in a data linkage project on fatal drowning." Injury Epidemiology, Vol. 13, Article 17 (2026).

About the Author

As Founder & CEO of Swim Global Project, Nathalie Martin lives and breathes drowning prevention. Nathalie has a simple vision: "a global movement where drowning is preventable, competition gives way to cooperation, and everyone has a seat at the table". Through her work as the Research Liaison for AOAP, Nathalie is helping bring her work to our members in an actionable way. Reach out to Nathalie at nathalie@swimglobalproject.com.

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