Risky Business

Critical Safety Issues for Aquatic Facilities

By Joseph Ryan

In the past several years, aquatics have been gaining ground in the public mind as the new ticket to weight loss and a healthy life. Swimming is now routinely promoted by doctors and top university studies as one of the most effective and safest exercise activities to strengthen the heart and shed the pounds.

Meanwhile, the risks of swimming threaten to undermine all that aquatic proponents have strived to accomplish. Water-spread illnesses, drowning, diving injuries and suction entrapment cases continue to make headlines across the nation, permanently imprinting a negative view of aquatic facilities in the public mind.

"There is a lot that still needs to be done," said Tom Lachocki, CEO of the National Swimming Pool Foundation (NSPF).

Industry analysts readily admit that there are pools that are not as safe as they can be, and unintentional ignorance on the part of some facility managers is often the culprit.

"I look at the pool as a loaded gun," said Tom Ebro, founder of Aquatic Risk Management. "It has inherent dangers."

Yet there are many simple means to ensure that an aquatic facility is safe and an example of what is right in the industry. Sometimes, experts say, it just takes a little education.


Getting the most out of lifeguards

Simply hiring lifeguards to watch over an aquatic facility is not the best defense against drowning and other accidents. Having a properly managed, supervised and trained team of lifeguards is the single best defense.

To reach that goal, which many aquatic experts insist is a necessity, requires a never-ending cycle of quality management and, many argue, expert supervisors. This process begins by weeding through a stack of applications and picking the best candidate, and it doesn't stop, even once you ensure they are up-to-date on the latest in lifeguard techniques and practices.

"To manage people effectively, you have to be very familiar yourself with what you are asking them to do," said Mike Fijas, a former aquatic risk management specialist and current general manager of the soon-to-open Raging Waves waterpark in Yorkville, Ill.

Fijas is just one in a growing chorus of aquatic safety analysts calling for supervisors of lifeguards and even pool managers to be either trained as lifeguards themselves or become just as familiar with the practices through seminars and courses.

If the supervisor doesn't intimately know lifeguard standards, they argue, that person will not be able to adequately enforce them or even be aware when they broken.

"You have to have a well-informed and well-trained manager to ensure their lifeguards follow their training," said Connie Harvey, an American Red Cross health and safety expert. "We know that typically when there is a tragedy, it is more often the result of the lifeguard not following the training they had. The gap seems to be in management—that the lifeguard was not held to the standards they were trained to."

The Red Cross and other lifeguard-training organizations often provide special courses and seminars for facility managers who don't want to or have the time to get certified themselves.

Moreover, experts say it is important to remember that possessing a lifeguard certificate doesn't mean that the individual will know how best to rescue swimmers and monitor situations in a specific facility.

"It is up to the facility management to understand what kind of training is required for their own facility," Harvey said. "What does the facility contain? Is it a traditional rectangular swimming pool, or are there winding rivers or speed slides? What is the maximum depth?"

"All these things impact the training needed," she added. "And figuring out exactly what your needs are will drive you to the training."

Fijas suggests that supervisors develop their own tests and measurements for their particular facilities regardless of the certification a lifeguard possesses.

"A lot of facilities will just hire someone who is certified and just accept that certification at face value," he said. "But you don't know who gave them that certification. It could have been their cousin. So I would put them through your own test, just so you know."

Once a manager or supervisor is well versed in lifeguard policies and techniques, other common errors will often cease.

These usual mistakes include asking lifeguards to perform other duties, like cleaning up, when they are supposed to be watching the pool; failing to monitor the lifeguard's behavior and attitude toward guests; failing to rotate guard positions every 30 minutes; failing to provide in-service training at least once a month; and failing to have strict standards about slacking off on the job.

Properly supplying your lifeguards with the needed tools is equally important, experts argue. A full complement of required rescue materials, bandages and medicines for scrapes and illnesses need to be on hand and easily accessible.

Pool managers also should strongly consider purchasing heart defibrillator equipment and providing the necessary training, if that is not already required by local laws.

"It is now the standard of care," Harvey explained. Given the physical stress to patrons and the amount of people, "it makes a great deal of sense that defibrillators" be placed in all public aquatic facilities, she added.


Swim at your own risk?

Many aquatic facilities that aren't staffed with lifeguards, such as hotel swimming pools, often pin up big signs that read "Swim at Your Own Risk" or "No Lifeguard on Duty."

But is this the best way to protect patrons and the facility? Is there a better solution?

"It may satisfy the letter of the law, but not the spirit," said Randy Mendioroz, a principal with Aquatic Design Group. "Anytime you have a place opened to the public, ideally there is someone who should be supervising the pool."

Besides, those warning signs might not offer as much legal protection as facility owners think. Tom Ebro, an expert for plaintiffs in pool liability cases and founder of Aquatic Risk Management Consultants, said that regardless of the law, attorneys can argue that pool managers did not offer enough protection against a known danger. He said pool owners who don't hire lifeguards can be seen by juries as just "hiding behind the sign."

"(The signs) seem to put parents on notice," he said. "But average people cannot be counted on to detect a problem. Most drowning distress stages are not noticed."

If hotels and other aquatic facilities cannot afford the resources to hire lifeguards, experts suggest other measures that may increase safety at a moderate cost.

Mendioroz said that a differently worded sign, at least, may offer more protection.

He suggests signs that remind patrons to keep an eye on children and beware that there is no pool supervision.

Tom Griffiths, aquatics director for Penn State and founder of Aquatic Safety Research Group, recommends that an unsupervised pool's depth should be limited to no more than 5 feet.

"Children can still drown in 5 feet of water," he acknowledged. "But at least a non-swimming adult can still rescue a child in 5 feet of water."

Ebro recommends giving a staff member the duty of "rule enforcer" to keep an eye on the pool and make sure children are supervised and parents are aware of the rules. This should reduce the chance of drowning and injuries while at the same time increasing the chance an adult will notice a drowning victim in the first critical few minutes, he said.

"If you do that, it seems to me it would be a very hard case to prosecute," he said.

Bottom line, Ebro said, "Do a better job than just a little sign in the corner."



Trapped!

Of all the situations where individuals can get hurt or injured at public pool facilities, entrapment and suction drowning are perhaps the easiest to fix. Yet experts and industry leaders are still having trouble getting the word out—or at least getting pool owners to take action—on the mechanical remedies that can ensure swimmers don't get trapped by the pool's suction devices and drown.

To be sure, the danger is real. Between 1990 and 2004, at least 130 cases of body, hair and clothing entrapment have been documented by the Centers for Disease Control (CDC), with 27 resulting in the drowning deaths of the victims. At least 33 of the incidents occurred at public facilities, but the location of 45 other occurrences was not documented by the CDC.

Entrapment cases run the age range from infants to 89-year-olds, but a clear majority of victims are children and teenagers. Of 74 entrapment cases involving body parts like arms and legs, 77 percent were children under the age of 15. Many of those cases involved the kids playing with the drain.

When it comes to hair entrapment, cited in 43 incidents between 1999 and 2004, 92.5 percent of the victims were under the age of 15. Most of them were girls with long, fine hair who happened to be under water with their head near a suction point.

Generally, body entrapment occurs when the whole body or a limb gets stuck on a drain gate, preventing the person from escaping before they succumb to drowning. With hair entrapment, the CDC says, entangling of the hair in the drain causes drowning, not necessarily the powerful suction.

Solutions for these problems have been on the market for a quarter-century, but the deaths keep tallying up at the CDC.

Dome-shaped drain covers, on the market since 1982, can prevent the whole drain from being covered by the victim. A missing or broken drain cover makes entrapment much more likely.

"They are like ticking time bombs," said Ebro of Aquatic Risk Management.

Also since 1982, covers with smaller holes have been available. These limit suction rates, preventing hair from being sucked into a drain.

Suction devices are some of the most regulated aspects of pools across the country, but laws vary from state to state and city to city. However, there is an endless supply of safety recommendations.

For example, the National Electrical Code now requires an emergency shutoff switch near public hot tubs and spas. The CDC and the Association of Pool and Spa Professionals (APSP) recommend the special drain covers, dual drainage systems and devices that automatically shut off suction if pressure spikes, releasing the victim.

"The answer lies in layers of protection," Ebro noted.

Clearly the current problem with entrapment cases is coming from older pools and spas built before these standards became the norm. But that doesn't morally or sometimes even legally excuse the managers of those facilities from making the necessary and often simple upgrades.

Under new rules adopted in 2005, the CDC recommends that older pools with only one grate—the most dangerous kind—upgrade to at least two outlets per pump and install a suction release system, known as a safety vacuum release system, or SVRS.

If those remedies are not practical, the CDC recommends a minimum of safety drain covers, a power cutoff safety mechanism and limited suction through the drain of 1.5 feet per second.

Even if not mandated by local laws, multiple drains and shut-off systems are critical in wade pools, where it will be more common for children to sit and step on drain covers.

"Most owners don't want to do this," said Randy Mendioroz, a principal with Aquatic Design Group. "But I don't think they have a choice. It is that serious of an issue."


When you're away

In many cases the most dangerous time at a pool is when it is closed. You must be prepared to protect even malicious trespassers when you're not watching, experts say.

Sounds easy, doesn't it? Just put up a fence, lock the doors and hang up a sign that says "Closed." Right?

Actually, experts suggest that aquatic managers put as much thought into how to keep people out of the pool when it is closed as they may put into protecting swimmers during open hours.

For one, what type of fence should you get?

Wood and brick fences are relatively easy to climb over. Plus, they make it difficult for security personnel or police to see if anyone is inside.

The Consumer Product Safety Commission (CPSC) recommends that fences for personal pools be 4 feet high and made of vertical wrought-iron slats no more than 4 inches apart or chain link with holes no larger than 1 3/4 inches. On wrought-iron fences, the bottom vertical bar should be no more than 4 inches from the ground to ensure a child cannot squeeze under, the recommendations say. The commission also recommends safety latches and alarms on doors leading to the pool.

Public pools should have greater security, said Mendioroz of Aquatic Design Group.

While some states mandate a 6- or 8-foot-tall fence, he suggests 10 feet to the design firm's clients. This height ensures that teenagers and even adults can't scale the barrier easily. He said that the bottom horizontal bar should be no more than 2 inches from the ground.

"We always encourage clients to go the extra mile," he said.

Mendioroz's advice is based on his own terrifying experience. His 16-month-old son was once somehow able to get past the backyard wrought-iron self-latching fence and into the pool.

Mendioroz's wife spotted the boy and was able to pull him out of the pool and perform CPR. The doctors gave the child a 50/50 shot at surviving and only a 2 percent chance of living a normal life, but this year he is graduating college, Mendioroz said.

"I've been a real advocate for making sure that whatever you do, those barriers to the pool are really solid and in place," he said.

Many aquatic managers are discouraged from wrought-iron fencing because it can allow debris to blow onto the grounds and into the pool. However, Mendioroz recommends a solution to this problem: Put the fence on top of 2 feet of brick.

Additional measures to reduce risk while the pool is closed include adding security tarps on outdoor and indoor pools and a floating buoy detection system that will alert security personnel when something is making considerable waves in the pool. Such systems can sell for as little as $500.


A long, pool drink

Surprisingly, there have been few scientific studies on how much water swimmers swallow and whether that amount varies depending on age, gender and habits.

But the value of such data can be tremendous. It can help researchers determine who may be more at risk for a water-borne illness, and it can also help determine the amount of pool-cleaning chemicals that may constitute a health hazard.

Environmental Protection Agency (EPA) microbiologist Alfred Dufour has attempted to fill this void in crucial data, and his latest study may help pool managers understand why clean water is such a priority.

Dufour tested 553 swimmers by measuring the amount of ingested cyanurate, a pool-disinfectant chemical that is not absorbed by the body. The test results were released in his September presentation for the National Swimming Pool Foundation's World Aquatic Health Conference in Austin, Texas.

The test group involved recreational swimmers at both public and private pools, including 145 boys and 99 girls age 6 to 18; 80 men and 96 women age 19 to 40; and 54 men and 79 women age 41 or older. There was a total of 279 males and 274 females, and each participant was asked to swim exactly one hour for the test.

Dufour found that children swallowed nearly twice as much water as adults.

Children under the age of 16 swallowed an average of 1.6 ounces, compared to the adults' average of 0.8 ounces.

"This is the most important finding of this study," Dufour told seminar attendees. "It may tell us why children become ill at much higher frequencies than adults."

Dufour's test also found that among the adults, men swallowed considerably more water than women. The test found male adults accidentally drank an average of about 1 ounce and women swallowed an average of 0.6 ounces.

Dufour attributed this difference to an increase in vigorous swimming, such as laps, by the older males. He believes such pool activity causes people to swallow more water than relaxed swimming. However, Dufour didn't ask the test subjects to document their swimming styles, so a definitive relation between the swimming types and water ingested is not available.

Dufour was also surprised by the great variations in the amount of water subjects ingested. Some subjects ingested almost no water, while others drank as much as 10 ounces.

Requests for data from the new test have been pouring in from aquatic, chemical and risk management experts.

"Even before we were completing this study, we were getting requests," Dufour said.



What sign?

Let's say you have lifeguards and you train them well, you've protected against entrapment dangers and your facility is secure at night. What then is the next most important safety element in your pool?

Signs.

"If you sign with good warning colors and shapes in a logical sequence, you have a better chance of preventing those catastrophic issues," said Tom Griffiths, Penn State's aquatics director and athletic safety officer, and founder of Aquatic Safety Research Group.

But Griffiths has done some of his own studies that show that signs only have about 3 to 5 seconds to get their point across to readers. He suggests limiting the number of signs in a given area, but making sure you hit all the important points.

Meanwhile, Ebro argues the more signs, the better.

"You have to inform," he said. "It is not the lifeguard's function to inform."

Regardless, all signs should be sure to follow the universally accepted form: attention-grabbing colors and size, statement of a rule and then statement and depiction of a consequence for breaking the rule.

They also must be displayed in a prominent place. For example, general "No Diving" signs are written in red on the edges of a pool. They include the conveyance of a rule, and they depict a hurt head to explain the consequence of breaking the rule.

"If you know the thing you perceive as harmless is not, then you won't do it," Ebro reasoned.

Signs also need to be prioritized, with "No Smoking" signs getting less play than signs that warn against running.

Mike Fijas, Raging Waves general manager, said that some of the more basic rules should be spelled out in a "Code of Conduct" board that every patron sees before entering the pool area. Rules on the board would govern behaviors like swearing, smoking and drinking, among others.

"The facility has every right to expect certain things of a guest," Fijas said. "It should say, 'Enjoy yourself, but here are a few rules.'"


Who drowns?

In 2004, according to the latest available data from the U.S. Centers for Disease Control, 3,308 people drowned in the United States.

  • 78 percent of drowning incidents involve males.
  • 23 percent were children under the age of 14.
  • Nearly 500 children under the age of 4 drowned, with 300 being boys.
  • Alcohol use is involved in between 25 percent and 50 percent of adolescent and adult drowning deaths.

Note: These CDC results do not include boating-related incidents, but do include drowning incidents at private pools, in bathtubs and in natural bodies of water.



Getting ill at the pool

As managers focus on preventing drowning and other injuries and incidents at their aquatic facilities, sometimes the prospect of a massive illness outbreak can lose its priority. But Dr. Michael Beach, a CDC epidemiologist, said that this is dangerous thinking.

Preventing illness outbreaks can take as much continual supervision and prevention measures as stopping a child from diving into the shallow end of the pool.

Between 2003 and 2004, 62 water-borne illness outbreaks were reported in 26 states, infecting 2,698 people and causing 58 hospitalizations and one death, according to the latest CDC data. About half of the outbreaks were intestinal, 13 involved skin infections and seven were respiratory. Twelve others were either mixed illnesses or types of meningitis.

Intestinal illnesses were involved with 72 percent of the infected swimmers, and more than 90 percent of those infections either involved or were caused by Cryptosporidium, commonly called "crypto." Most of those infections occurred at treated pool facilities.

Crypto should be the number-one concern for pool facilities when it comes to a potential illness outbreak, Beach said, because even proper chlorination and common sand filtration can't stop it.

The bug is caused by microscopic parasites that live in the intestines and cause vomiting, fever and diarrhea.

Even though the illness is hard to kill, experts contend that there are measures on the market that have proven effective. Moreover, good pool maintenance and a quality patron and staff education program can significantly lessen the chances of an outbreak.

"We believe most outbreaks are prevented by good pool maintenance," Beach said. "But even the best-maintained pool can have an outbreak."

The parasite is passed on by patrons experiencing diarrhea. Therefore, kiddy pools and wade pools frequented by children are the most at risk.

Beach said that managers should institute a bathroom break policy at those pools every 30 minutes to help parents manage multiple children at once and decrease the chances of the pool becoming a toilet.

"The kids aren't being changed enough or using the bathroom," Beach said. "We would like to see all of that waste deposited in the bathroom, not the pool."

Brochures for guests and regular patrons as well as signs that warn about swimming while ill can also be helpful, Beach said.

"A lot of patrons just aren't knowledgeable about the issue," he said. "There is a resistance to talk about it, but there really shouldn't be."

Unfortunately, he also said many outbreaks appear to be caused by sick staff members, so reminders to lifeguards and pool employees also are critical.

"If (the staff) isn't feeling well, they will still get in the water," Beach said. "They don't want to lose that paycheck."

On the equipment front, Beach said that ozone or ultraviolet light disinfectors along with diatomaceous earth (DE) filters have proven very effective at eliminating crypto from the water.

Fijas of Raging Waves said UV filters have worked well in his experience. "From a standpoint of a pool, that is a great additional safety measure to kill all the bugs," he explained.

Overall, Beach said that as with all of the other safety issues at a pool facility, managers need to take the lead and assume responsibility for creating the safest environment possible for guests and staff.

"Swimming is a great physical activity. There are so many health benefits," he said. "But there are public health concerns too, and while we need to swim responsibly, managers need to realize they are the front line."



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