SWBA Coronial Considerations

Brief Report

By Steve Glassey PhD FInSTR, Public Safety Institute

Keywords: flood, scuba, diving, swiftwater, rescue, safety, drowning, carcinogens.

Abstract: Drowning is a leading cause of accidental death worldwide, with traditional drowning prevention strategies focused on buoyancy aids and protective equipment proving insufficient in mitigating the immediate risks of cold water shock and drowning. Swiftwater Breathing Apparatus (SWBA) has emerged as a potential game-changer, offering respiratory protection at the water’s surface and a means of interrupting the drowning process. This report examines how SWBA can disrupt the drowning process, the benefits of using SWBA compared to existing protective equipment, the issue of water rescuer fatalities and carcinogenic risks, and the potential implications for insurers and coronial inquests.


Drowning is a major public health concern, with an estimated 295,000 deaths occurring worldwide each year (Franklin et al., 2020). Traditional drowning prevention strategies have focused on buoyancy aids like personal flotation devices (PFDs) and protective equipment such as helmets. However, these measures do little to mitigate the immediate risks of cold water shock and the drowning process itself (Glassey, 2023). Swiftwater Breathing Apparatus (SWBA) has emerged as a potential solution, offering respiratory protection at the water’s surface and a means of interrupting the drowning process.

Disrupting the Drowning Process

The drowning process involves a sequence of events, including struggle to keep the airway clear of water, initial submersion and breath-holding, aspiration of water, unconsciousness, and cardio-respiratory arrest (Tipton & Montgomery, 2022). SWBA can interrupt this process at critical points:

1. Maintaining a clear airway: SWBA provides a means to maintain a clear airway even if submerged or engulfed by water, preventing the initial struggle to keep the airway clear (Glassey, 2023).

2. Mitigating the gasp reflex: The gasp reflex, triggered by sudden skin cooling on immersion, can result in involuntary aspiration of water (Tipton & Montgomery, 2022). With SWBA, the operator can quickly access the mouthpiece to provide breathable air, preventing aspiration during the initial cold shock response.

3. Preventing water aspiration: Aspiration of water leads to worsening hypoxia, unconsciousness, and eventually cardio-respiratory arrest (Tipton & Montgomery, 2022). By preventing water aspiration, SWBA can delay the onset of these later stages of the drowning process.

Benefits of SWBA Compared to Existing Protective Equipment

While PFDs and helmets provide important protection, they do not address the immediate risks of cold water shock and the drowning process (Glassey, 2023). SWBA offers several key benefits:

1. Respiratory protection: SWBA provides a means to breathe while submerged, reducing the risk of water aspiration (Glassey, 2023).

2. Increased rescue time: SWBA provides additional time for self-rescue or assisted rescue, increasing the chances of survival (Glassey, 2023).

3. Compatibility with existing equipment: SWBA can be used in conjunction with PFDs and helmets, enhancing overall safety (Glassey, 2023).

Water Rescuer Fatalities and SWBA

Bystanders who attempt to rescue drowning victims often become victims themselves, a phenomenon known as aquatic victim-instead-of-rescuer (AVIR) syndrome (Turgut & Turgut, 2012). Studies have shown that a significant proportion of drowning incidents involve would-be rescuers (Turgut & Turgut, 2012; Zhu et al., 2015).

SWBA could potentially reduce the risk of rescuer fatalities by providing respiratory protection and increasing the chances of successful rescue. As awareness of SWBA grows, it is possible that future coronial inquests into rescuer fatalities may start to question why rescuers were not supplied with SWBA.

Implications for Coroners and Medical Examiners

Swiftwater Breathing Apparatus (SWBA) has emerged as a potentially game-changing technology in water-related activities, addressing a critical gap in existing safety equipment. Unlike traditional Personal Flotation Devices (PFDs) which focus primarily on buoyancy, SWBA provides respiratory protection, preventing water aspiration which can occur even with small amounts of water and lead to drowning (Glassey, 2023). This makes SWBA particularly relevant in activities such as kayaking, rafting, swiftwater rescue, surface water rescue, and ship boarding, where individuals may face sudden submersion. For coroners and medical examiners, understanding the potential impact of SWBA is crucial when investigating water-related deaths, as its presence or absence could be a significant factor in the outcome of an incident.

The relevance of SWBA in water-related deaths extends beyond recreational activities to professional rescue operations and emergency situations. It can provide critical extra minutes for self-rescue or being rescued alive in swift water environments, minimize the risk of ingesting contaminated flood water, and help rescuers focus on their tasks by providing a sense of security. In the context of drowning prevention, SWBA addresses the limitations of traditional safety equipment, potentially revolutionizing water rescue operations and improving survival rates in various water-related incidents.

Implications for Insurers

As the benefits of SWBA become more widely recognized, insurers, particularly in the US market, may start to exclude cover for incidents where SWBA was not used. This follows a pattern seen in other industries, where insurers have mandated the use of specific safety equipment or risk management practices as a condition of coverage (Viscusi, 1993).

Carcinogenic risks to floodfighters

Besides drowning, there are other risks to flood rescuers including a significant risk of carcinogens being present in flood water, which can pose serious health hazards to rescue personnel and others exposed. Floodwaters often contain a wide array of toxic substances, including known and potential carcinogens like benzene, vinyl chloride, arsenic, asbestos, heavy metals (lead, mercury, cadmium), pesticides, and polycyclic aromatic hydrocarbons (PAHs) (CDC, 2022.; Euripidou & Murray, 2004). These carcinogenic contaminants can come from submerged hazardous waste sites, industrial runoff, damaged chemical storage facilities, and sewage. Exposure to these carcinogens in floodwater, even at low levels, can increase long-term cancer risk, especially with repeated or prolonged contact (Phung et al., 2014).

For rescue workers operating in flooded areas, protection against inhalation and ingestion of these hazardous substances is critical. Carcinogens and other toxins in floodwater can enter the body through ingestion of contaminated water, inhalation of vapors or contaminated dust, and absorption through the skin, especially if there are cuts or abrasions (Anderson & Meade, 2014). With the proper precautions, training, and protective gear, rescue workers can reduce their cancer risks while providing vital emergency services in flooded areas. However, the potential long-term health impacts should not be underestimated. The potential for SWBA to reduce the risk of ingesting flood water stands to reason, however further research is needed to validate this hypothesis.


SWBA represents a significant advancement in swiftwater rescue, offering a means to interrupt the drowning process and potentially reduce the risk of rescuer fatalities. As awareness of SWBA grows, it is likely that its use will become more widespread. For coroners and medical examiners, considering the role of SWBA in water-related deaths can contribute to more accurate death certifications and provide valuable insights for improving water safety standards and practices.

Further information on SWBA can be found at www.swba.tech


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The original article was published in Preprints (12 June 2024).