The title alludes to a well-known Swedish crime novel and television series. Unfortunately, water-related incidents also result in fatalities in real life.
Photo: Sturlason
Summer is a season that draws many people to the water, but drowning fatalities are a tragic consequence of a time many look forward to. In Norway, an average of 85 people die from drowning every year (1) . Fewer than 5 % of these deaths involve commercial vessels, and drowning prevention efforts are therefore mainly aimed at recreational activities.
Drowning is classified as either fatal or non-fatal. People who survive drowning may recover with or without injury. The most common long-term complications affect the respiratory, neurological and/or cardiac systems, and are associated with hypoxaemia and hypothermia.
In hospitals, patients admitted following a drowning incident may be managed as major trauma cases and included in Norway's National Trauma Registry, but only if they have sustained additional trauma-related injuries (2) . In the Norwegian Patient Registry, reporting rates for general injuries have been as low as 40 %, and the figure for drowning injuries may be even lower (3) . Consequently, drowning incidents registered in Norway are predominantly fatal, and little is known about the number of non-fatal drownings.
The Norwegian Society for Sea Rescue's fatal drowning statistics are compiled using media monitoring, police and directorate records, and the organisation's own incident logs. By comparison, figures from the Norwegian Cause of Death Registry are consistently lower (1) . Consequently, the drowning statistics underestimate the risk of drowning in Norway, and some high-risk groups may be underrepresented. We also know very little about those who survive drowning or the severity of their injuries – information that is crucial for devising and evaluating preventive measures.
The drowning statistics underestimate the risk of drowning in Norway, and some high-risk groups may be underrepresented
Recent data from Denmark indicate that fatal and non-fatal drowning rates are roughly equal (5) . Data from Sweden show a similar breakdown; however, compared to those who died, survivors are more likely to be younger and female (6) . The extent to which these findings are generalisable to the Norwegian context remains unclear.
In Norway, the third sector and water safety organisations are calling for a national drowning registry (7) . However, the Government's action plan for the prevention of drowning, published last year, makes no mention of such a registry (3) . It is therefore unclear how it would be funded and managed. The 21 national members of Flyte, Norway's water safety umbrella group, are leading the campaign to establish a registry and achieve a 'Vision Zero' target for drowning fatalities. However, only the latter was endorsed in the action plan.
The 21 national members of Flyte, Norway's water safety umbrella group, are leading the campaign to establish a registry and achieve a 'Vision Zero' target for drowning fatalities. However, only the latter was endorsed in the action plan
In relation to improving drowning data, the Norwegian government intends instead to 'continue analysing and improving the accessibility of Norwegian Patient Registry records' (3) . They point to the Lighthouse Project, an initiative to improve reporting for road traffic injuries (8) . This project includes the introduction of data coordinators to oversee injury logging in hospitals and out-of-hours clinics, and a review of its findings is expected next year. Whether the more systematic data collection for road traffic accidents can be successfully applied to drowning cases remains to be seen.
The action plan has been criticised for being vague and non-committal. Under the plan, voluntary organisations are expected to 'continue to form part of the country's preparedness network' alongside search, rescue and emergency services. For instance, they are tasked with helping local councils provide swimming lessons for children and adults. The Norwegian government initially allocated NOK 78 million to a grant scheme for swimming lessons for kindergarten children, but evidence-based reasoning was derailed by political manoeuvring when the scheme was axed in the subsequent budget agreement with the Centre Party (Senterpartiet ), Red Party (Rødt ), Socialist Left Party (Sosialistisk Venstreparti ) and Green Party (Miljøpartiet De Grønne ) (9) .
Swimming lessons remain an effective way of preventing drowning. The Norwegian Institute of Public Health's 2024 evidence review identified swimming lessons and life jacket use on boats as the most critical preventive measures (10) . However, this is old news, on a par with the fact that alcohol consumption increases the risk of drowning. While it is currently legal in Norway to operate a recreational boat with a blood alcohol concentration of 0.08 %, the impact of lowering this limit for these vessels has never been examined. This knowledge gap is notable in itself. Another key insight from the review is that mandatory regulations are more effective than public awareness campaigns alone. However, this latter point may have limited relevance to Norway, given that several of the studies analysed focused on the safety of private swimming pools.
Globally, around 300,000 people die from drowning every year. People in lower socioeconomic groups are disproportionately affected. Nearly a quarter of all victims are children under five, and well over half are under the age of 30. In Norway, however, 80 % of drowning victims are aged 40 or older. Those who die in recreational boating accidents are almost exclusively male, and half are due to the consumption of alcohol or drugs and/or not wearing a life jacket (1) .
Globally, around 300,000 people die from drowning every year. Nearly a quarter of all victims are children under five, and well over half are under the age of 30. In Norway, 80 % of drowning victims are aged 40 or older
Administering first aid after an accident can save lives. If the child or adult is not breathing, start cardiopulmonary resuscitation (CPR) immediately with five rescue breaths, followed by cycles of 30 chest compressions and two rescue breaths. Continue until emergency services or other medically trained personnel with a defibrillator arrive.
The World Health Organization has put drowning prevention on the global agenda, designating 25 July as an annual awareness day. There is scope to improve preventive measures both in Norway and internationally. While awaiting further research into effective drowning prevention, remaining vigilant can help ensure a summer with fewer serious water-related incidents.