Alison Johns, aged 5 years, drowned in Lake Nagambie on 27 December 2022 while swimming with a borrowed inflatable ring in shallow water. A brief lapse in supervision occurred when her mother went swimming to a buoy; despite multiple adults present, none maintained continuous visual contact. The coroner emphasised that children under 5 require constant supervision within arm's reach, and that inflatable rings are not substitutes for active parental oversight. Key clinical lessons include the critical importance of designated water supervisors in group settings (adults often assume others are watching), and that drowning can occur silently in shallow water without obvious signs of distress. The death was preventable through continuous direct supervision and potentially through infrastructure improvements at inland waterways.
AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes.
Inadequate supervision - brief lapse in continuous visual contact
Use of non-approved flotation device (inflatable ring not attachable to wearer)
Limited swimming skills despite confidence around water
Absence of lifeguard patrol at inland waterway
No designated supervising adult in group setting
Murky water and dense reeds obscuring visibility
Assumption by multiple adults that another was supervising the child
Coroner's recommendations
Strathbogie Shire Council to consult with the Victorian Water Safety Coordination Forum, Life Saving Victoria and other appropriate bodies to ensure appropriate safety measures are in place at Blayney Reserve on Lake Nagambie, including appropriate signage, depth warnings, fencing or other identified safety measures to promote the safety of those engaging in recreational water activities such as swimming
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