Summary and Recommendations

This section summarises the current state of the art in drowning prevention using evidence that has become available since the first edition was published in 2006. Three levels or ‘tiers’ of evidence provide a basis for understanding the strength and applicability of evidence where cited:Tier-one evidence shows a cause and effect relationship based on cohort trials that demonstrated actual reductions in fatal drowning rates.Tier-two evidence shows an association with reductions in fatal drowning rates although without established causality. This evidence is usually from case-control or observational studies.Tier-three evidence is based on process changes not actually proven to reduce fatal drowning or to be associated with a reduction, but which are likely to result in a reduction, according to expert opinion.