NUR 306 Module 2 Epidemiology Short Paper Example

No One Was Wearing a Life Jacket: The Descriptive Epidemiology of Fatal Falls Overboard in Commercial Fishing

[Student Name]

Southern New Hampshire University

NUR 306: Nursing in the Community

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

No One Was Wearing a Life Jacket: The Descriptive Epidemiology of Fatal Falls Overboard in Commercial Fishing

Descriptive epidemiology asks who is affected by a health problem, where it happens and when, before anyone asks why. For a community health nurse in a fishing town, the answers shape which crews to reach, in which season and with what message. This paper applies descriptive epidemiology to fatal falls overboard in U.S. commercial fishing, drawing mainly on the federal NIOSH analysis of deaths from 2000 through 2016 (Case et al., 2018), and then considers what the pattern means for a composite lobstering town, Pell Harbor, Maine. The data point to a problem that is concentrated in specific fisheries and working conditions, that is declining but still deadly, and whose outcome is decided almost entirely before the fall, because once a fisherman is in the water without flotation, rescue rarely succeeds.

Case Definition and Data Source

The analysis by Case et al. (2018) included unintentional fatal falls from commercial fishing vessels in U.S. waters, identified through the federal commercial fishing incident surveillance system. During 2000 to 2016, 204 fishermen died this way, accounting for 27.0% of all work-related deaths in commercial fishing during the period. For context, the industry's overall fatality rate in 2016 stood at 86.0 per 100,000 full-time equivalent workers, against 3.6 for the U.S. workforce as a whole. That comparison uses a rate, which divides deaths by the number of workers exposed; most of the fall data, however, are reported as counts and percentages of deaths, which describe the pattern among those who died but cannot on their own show which groups have the highest risk.

Person

The people who died were almost all men (202 of 204), with a median age of 43 years and a range of 16 to 77. Deckhands made up 58.8% of deaths and vessel operators 38.7%. The median length of fishing experience was 16 years, and only 4.4% had any documented formal marine safety training (Case et al., 2018). The profile is not one of inexperienced young workers. It is one of experienced adults, often working in familiar conditions, which suggests that familiarity itself may lower the sense of risk. Fulmer et al. (2016) reached a related conclusion from a different angle: in a survey of lobster captains in Maine and Massachusetts, acute injuries of all kinds occurred at 49.7 per 100 full-time equivalents, with 15.0 per 100 requiring treatment, far higher than rates found using Coast Guard reports alone.

Place

By region, the East Coast recorded 62 deaths (30.4%), the Gulf of Mexico 60 (29.4%), Alaska 51 (25.0%) and the West Coast 26 (12.8%), with 5 in Hawaiian waters. By fishery, Gulf of Mexico shrimp accounted for 34 deaths (16.7%), East Coast lobster for 18 (8.8%), Alaska salmon drift gillnet for 16 (7.8%) and East Coast scallop for 10 (4.9%) (Case et al., 2018). For Pell Harbor, the lobster figure matters most. Lobstering often involves small crews, frequently a single operator or a captain with one sternman, working with traps and moving lines on an open deck, which places the fishery squarely among the conditions associated with falls.

Time

Deaths from falls overboard declined over the study period by an average of 3.9% per year, from a high of 20 in 2003 to a low of 5 in 2016 (Case et al., 2018). The decline is encouraging, but the report cannot say whether it reflects safer practices, fewer workers or changes in how fisheries operate, because counts do not adjust for exposure. Seasonal patterns also matter locally. Fulmer et al. (2016) found that lobstering exposure, measured in full-time equivalents, was highest in summer and lowest in winter, so a nurse planning outreach in Pell Harbor should expect the most time on the water, and therefore the most opportunity for falls, in the summer and fall months, while spring rigging season offers the best chance to reach crews before the busiest months.

Circumstances and Outcomes

Half of the fatal falls (50.7%) happened while the fisherman was working with gear, most often setting it. The direct causes most often recorded were losing balance (32.2%), tripping or slipping (31.5%) and becoming entangled in gear (20.8%). Nearly half of the victims (48.5%) were working alone at the time, and alcohol or drug use was a contributing factor in 18.1% (Case et al., 2018).

The outcome data explain why the problem is so lethal. Most falls, 59.3%, were not witnessed, and 89.3% of those victims were never found. Among witnessed falls, rescue was attempted in 56 of 83 cases, and 22 people were recovered from the water but could not be resuscitated. None of the 204 victims was wearing a personal flotation device. Life rings were thrown in 19 incidents and led to recovery in 5, and a man-overboard alarm was used only once. Teske et al. (2022) note that personal flotation devices are not required to be worn on deck by U.S. commercial fishermen, which leaves wearing one to individual choice and vessel culture.

Implications for a Community Nurse

The descriptive pattern maps onto the levels of prevention. Primary prevention, keeping the fall from happening, belongs largely to vessel design and work practices, such as higher rails, managing lines on deck and tethers, which a nurse can support through the harbor committee but cannot deliver. Secondary prevention, surviving the fall, is where a nurse's skills in health teaching and social marketing fit best, because the single largest gap in the data is flotation, followed by alarms and recovery devices for crews that fish alone. Tertiary prevention, improving outcomes after recovery, includes cardiopulmonary resuscitation training for crews and rewarming procedures. For Pell Harbor, the data argue for a spring outreach effort on life jackets and man-overboard preparation aimed at small lobster crews and solo operators.

Limitations

The analysis has limits a nurse should acknowledge. Fall data are counts of deaths, so they cannot identify which fisheries have the highest rates without exposure figures for each. Surveillance systems may miss some deaths or misclassify circumstances, and alcohol and drug involvement depends on what was documented. Nonfatal falls overboard, which may be far more common, are not captured. Finally, national patterns may not match one harbor, so local data from the cooperative, the harbor master and the regional hospital would sharpen any plan.

References

Case, S. L., Lincoln, J. M., & Lucas, D. L. (2018). Fatal falls overboard in commercial fishing: United States, 2000-2016. Morbidity and Mortality Weekly Report, 67(16), 465-469. https://doi.org/10.15585/mmwr.mm6716a2

Fulmer, S., Buchholz, B., Jenkins, P., & Scribani, M. (2016). Work-time exposure and acute injuries in inshore lobstermen of the Northeast United States. Journal of Agromedicine, 21(2), 190-199. https://doi.org/10.1080/1059924X.2016.1143431

Teske, T. D., Case, S. L., Lucas, D. L., Forrester, C. L., & Lincoln, J. M. (2022). Have you met Angus? Development and evaluation of a social marketing intervention to improve personal flotation device use in commercial fishing. Journal of Safety Research, 83, 260-268. https://doi.org/10.1016/j.jsr.2022.08.022