Child A - Non-inquest findings
Deceased
Child A
Demographics
8y, female
Date of death
2013-10-27
Finding date
2015-11-11
Cause of death
Anoxia due to fresh water drowning
AI-generated summary
Child A, aged 8 years, drowned at Lake Dyer recreational dam after receiving a blow to the face, likely from a boat at a busy boat ramp. Despite being a confident swimmer, the impact caused panic and fright reaction preventing successful escape. Supervision was adequate but momentarily obstructed by a boat. Key clinical lessons: prompt CPR initiation by bystanders and emergency services, early telehealth consultation with paediatric intensive care specialist, and appropriate resuscitation decisions after 30 minutes without response. Preventability focused on environmental factors (inadequate warning signage, undulating topography, lack of lifeguards) rather than clinical care. The minor facial injuries did not cause unconsciousness but precipitated panic in a stressful aquatic situation.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Error types
Clinical conditions
Contributing factors
- Blow to the face causing panic and fright reaction
- Loss of line of sight supervision due to boat obstruction
- Undulating topography of dam bottom leading to loss of footing
- Inadequate warning signage at Lake Dyer
- Busy boat ramp with multiple vessels
- Lack of designated swimming area
- Absence of lifeguards
Coroner's recommendations
- Seqwater should introduce signs specifically warning against swimming at Lake Dyer
- If Seqwater designates a swimming area at Lake Dyer or other dams, carefully examine the topography of chosen areas
- Consider cordoning off designated swimming areas
- Consider introducing signs encouraging the use of life jackets
- Consider feasibility of introducing lifeguards in popular swimming areas at dams in conjunction with local and State government and Surf Life Saving Australia
- Education for parents that swimming skill alone does not prevent drowning
- Supervision should increase with multiple children in water
- Education about dangers of shallow water blackout
- Life jackets should be worn in inland waterways with low visibility
- Dam operators should train staff and establish emergency procedures for missing persons or accidents at dams
- School swimming curriculum in Queensland should include education about shallow water blackout for students over 7 years
Full text
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