Supervision and guardianship during drowning fatalities among Canadian youth: An 11-year review of a preventable paediatric public health crisis.

Drowning is a leading cause of injury-related deaths among youth worldwide, often linked to inadequate supervision and ineffective guardianship. While paediatric studies have examined demographics and risk factors, little is known about how these variables interact to influence rescue likelihood. This study addresses that gap using a multivariate binary logistic regression model to assess the odds of not receiving a rescue attempt, using fatality records (n = 638) from coroners and medical examiners across Canada (2006-2016). This approach captures all known accidental fatal drownings but findings cannot be generalized to include incidents in which the individual survived. The best model explained 45.1% of the variance in rescue outcomes (Nagelkerke Pseudo R² = .451) with 84.6% accuracy. Findings revealed that age, sex, alcohol use, perimortem activity, water body type and urban/rural location significantly impacted rescue attempts. However, chronic medical conditions and general bystander presence showed no significant relationship at the bivariate level. When demographics and situational factors were considered, bystander type (with adult, minors only or alone/not witnessed) became a key model contributor for predicting rescue attempt likelihood. Teenagers (15-18 years) accounted for 33.5% of drownings, followed by toddlers (2-4 years, 21.9%) and children (5-11 years, 20.5%). Compared to infants, older children and teens faced greater risks of not being rescued, and bystander presence does not equate to capable guardianship. Open water environments posed the highest risk, with ocean drownings 7.9 times more likely to result in no rescue attempt, compared to domestic settings.