Serve & Protect

Aquatic Safety & Staffing

By Richard Zowie

In any industry, safety is a vital issue. Today's tragic accidents often become tomorrow's guidelines. When accidents occur, facility managers work to ensure the accidents never happen again.

Facilities work to minimize accidents outside the pool area by using rubber mats and having strict rules barring running and horse play. Work is also being done to try to minimize the problems inside the pool to ensure the risks of recreational water illnesses are reduced, to make sure public pools abide by the Virginia Graeme-Baker Act, to use the latest technology to combat chloramines and to make sure lifeguards are up to date on the latest guidelines and techniques for water rescue.

Sometimes an accident can be localized and quickly corrected. Other times, accidents result in serious bodily injury or even death. Regulations are eventually issued. Aquatic facility directors are aware that practicing safety involves installing and maintaining the right equipment and making sure workers and patrons abide by rules to minimize (and, when possible, eliminate) dangers. Failure to do so can not only result in injury or death, but also in a potential lawsuit and patrons taking their business elsewhere.

Recreational Water Illlnesses

For some, swimming in a pool is a time to cool off and feel refreshed. With pools being chlorinated and treated with other chemicals designed to kill or subdue germs, they may even think of swimming pools as a pristine place—almost as good as taking a bath.

They couldn't be more wrong.

Pools (along with waterparks, hot tubs and decorative water fountains, as well as oceans, lakes and rivers) can be breeding grounds for recreational water illnesses. A swimmer can acquire RWIs by breathing, swallowing or having contact with contaminated water. The water can become contaminated when someone with an illness like diarrhea swims. According to the Centers for Disease Control, the average swimmer has about 0.14 grams of fecal matter on their bottoms. When swimming in a pool, the feces can get washed off. Even if trace amounts are inadvertently swallowed by another swimmer, the swimmer can become sick. RWIs can also cause gastrointestinal, skin, ear, respiratory, eye or neurological illnesses and even wound infections.

Some may think they're safe from illnesses if they're in a hot tub. After all, isn't the water in a hot tub warm enough to kill harmful germs?

Actually, no. One common skin infection that can be acquired from a hot tub is "hot tub rash." Chlorine and other agents that help to disinfect water tend to evaporate quicker in the higher temperatures of these tubs. Respiratory illnesses, the CDC reports, can also come from hot tub use if the tubs aren't properly maintained.

Chlorine can kill RWI germs, but it requires time. In a properly-disinfected pool, chlorine can kill most of these germs in less than an hour. But some germs like Cryptosporidium (or Crypto) can survive for longer—sometimes even days—even in a pool that's been maintained properly.

Who's at risk for contracting an RWI? According to the CDC, among those most vulnerable are children, pregnant women, those with compromised immune systems (such as those living with AIDS) along with recent organ transplant recipients or those who've received chemotherapy. Furthermore, the center reports that for people with weakened immune systems, pools contaminated with human or animal waste that contains Crypto can potentially be life-threatening. Those with compromised immune systems should consult their doctor before swimming.

Most RWIs are self-limiting, said Dr. Thomas Lachocki, CEO of the National Swimming Pool Foundation.

"This means that a person with a healthy immune system will fight off the disease," he said. "Rashes caused by bacteria in pools are often fought off by the body and the ill person does not receive medical attention."

Lachocki does feel that a person with Crypto should stay away from the water for two weeks after diarrhea symptoms pass since the person will remain contagious. He pointed out that whether or not a person with Crypto has a fecal accident in the pool, they can still inadvertently spread germs that can cause others to develop diarrhea.

"Recent studies evaluating swim diapers demonstrate they are not effective at containing Crypto," he added. "As a result, it is very important that people who have diarrhea stay out of the water. When an outbreak is spread in a region, it makes little difference if the ill bather swims in an indoor or an outdoor pool. The disease will spread."

When it comes to combating RWIs, Aquatic Safety Research Group founder Dr. Tom Griffiths said that while chlorine has been the number-one defense, ultraviolet light also appears to have much potential to help.

"[Ultraviolet light] is a very effective way of kicking it up a notch as far as disinfection is concerned," said Griffiths, who served as director of aquatics and safety officer for athletics at Penn State University for almost 25 years. "It looks like UV light is becoming more in use throughout the U.S. It also helps to keep down the chloramines and makes chlorine more effective."

What's the most effective way to help prevent RWIs? Griffiths has a direct approach that might not win many popularity contests.

"The most effective way is to keep sick people out of the water, but I don't think that's ever going to happen," he said. "The bottom line is to not allow your levels to get low. Keep high levels of chlorine in water. Backwash filters regularly. Use UV to supplement chlorine."

Lachocki added that all public pools should have trained and certified operators on staff or servicing the pool. Those operators should make sure that proper disinfection levels and pH levels are maintained at all times.

Even if aquatic facilities can't keep those under the weather from swimming, Griffiths suggests a common-sense approach that he feels could help a great deal: swimmers taking showers before getting into the pool.

"The whole swimming pool culture has to be changed if we're serious about reducing RWIs," he said. "People don't take a complete soapy shower before going into the water. If every person showered before going into the water, it would be cleaner and healthier…I think this would save an awful lot of work, effort, money and problems."

While RWIs present a problem that needs to be dealt with, Griffiths hopes that priorities will shift to what he feels are the major problems affecting aquatic facilities.

"Relatively speaking, RWIs, as far as causing fatalities, are not as big a problem as drowning or children not knowing how to swim," he said. "It's great we're cleaning up water quality, but I wish we spent more time and effort in drowning prevention. Compared to drowning, I don't think it's that big of a problem. We're not losing as many lives to RWIs as we do people not learning to swim or kids swimming unsupervised."

The Virginia Graeme Baker Pool and Spa Safety Act

Swimming can be a wildly popular activity for children, but caution has to be exercised. Parents might be quick to ensure their young children stay out of the deep ends of pools by confining them to wading pools or spas. Unfortunately, even in shallower pools children can still be at risk.

According to the CDC, every year nearly 300 children under the age of five drown in residential and public pools and spas. Thousands require emergency-room treatment or hospitalization, and those who don't die can experience brain damage or other permanent disabilities.

One problem is drain and suction entrapments. When drains have broken or when there are faulty or missing covers, items like hair, limbs, jewelry or clothing can become entrapped. The swimmer is then caught, unable to breathe, even in shallow water. Even evisceration is possible in some cases.

One tragic example is Virginia Graeme Baker.

In 2002, the 7-year-old girl was in a spa and became entrapped by the drain's powerful suction. It held Virginia under water as people struggled to free her. By the time they freed her, it was too late. Virginia died as she was rushed to the hospital.

To combat this, on Dec. 19, 2007 the Virginia Graeme Baker Pool and Spa Safety Act was signed into law. This law, which became effective in December 2008, has several purposes:

1. To enhance the safety of public and private pools and spas.
2. To encourage the use of layers of protection.
3. To reduce child drownings in pools and spas.
4. To reduce the number of suction entrapment incidents, injuries and deaths.
5. To educate the public on the importance of constant supervision of children in and around water.

Now that the bill is law, the current step is compliance and enforcement. The U.S. Consumer Product Safety Commission currently works to implement and enforce the act. The commission encourages the use of layers of protection like fencing around pools, continual supervision and requiring anti-entrapment drain covers along with other safety devices.

How have swimming pools been doing so far? According to U.S. CPSC public affairs specialist Kathleen Reilly's presentation to the commission at the October 2009 World Aquatic Health Conference, the CPSC has inspected 700 pools and has found 80 percent to be compliant.

"I think you could say that it's definitely happening," Reilly said, regarding the facilities' move toward compliance. "More and more people are coming on board. It took a while for inventory in the beginning to be available."

Reilly feels that media coverage has helped to get implementation of the Baker Act going, since those with public swimming pools see the public is informed and demanding the pools to be safe.

"Our priority is to have all pools compliant, but particularly the kiddie and shallower pools," she added. "It's been predominantly a problem for children, but we wanted to make sure all pools were compliant."

Griffiths said in the public swimming pool inspections he does, he's very surprised by the number of compliant pools he's encountered. However, he believes the Baker Act should've been done in chronological progression, focused on fixing shallow pools first and then moving onto medium depth and then deep-water pools. He also believes the suction entrapment problem is one that's primarily a small pool problem.

"It would've been more practical and affordable to do spas, wading pools and shallow pools first," he added.

Reilly sees the passage of the Baker Act as something that helps to address a wrong and do what's possible to ensure it doesn't happen anymore. Losing a child from a drowning or other fatal injury due to drain entrapment is a tragedy no parent should have to face.

"It's a horrible, horrible event and even more horrible if you don't survive," she said. "The idea that you won't get out of there is terrifying."

Of the pools that aren't compliant, Reilly said it comes down to two issues: money and a worry of further government intrusion into people's lives.

For those concerned with money, the problem stems from pools needing major restructuring or retrofitting.

"It's an expensive proposition and I can understand people's concerns," Reilly said. "Most of the time it doesn't cost that much money. Pools need to be maintained and kept in good operational order."

Others, she added, don't want the government interfering with their lives and wrongly perceive this law as doing that. They might argue that their pool's already safe, or that their drain's in the deep end where nobody can get near it. Sometimes, it takes a tragedy before people finally decide to do something.

Reilly said her organization soon plans to launch a national education program about entrapment and drowning prevention.

"Supervision is crucial, since little children can disappear easily," she said. "Once they go into the water, you may never hear them again. Once they go down it can be over. They're not like adults, who can come up and scream for help."

Lifeguards

One crucial part of aquatic safety is the staffing of lifeguards. Those who go to public swimming pools are no doubt familiar with the lifeguard who sits in the high chair scanning the water and watching for anyone who suddenly goes under water and struggles to resurface. The lifeguard then heads into the water to help.

Sometimes that's all that's needed and other times more action is required. If the person isn't breathing, the lifeguard then has to use mouth-to-mouth resuscitation and chest compressions. If all goes well, the person regains consciousness, begins breathing on their own and lives to swim another day (but hopefully without any more close calls). Others might require hospitalization.

Just like many other professions, lifeguarding evolves over time as the rules change, technology upgrades and new procedures fall into place. Currently, according to the American Lifeguard Association, there are two types of certification for lifeguards: one for both shallow and deep water and another for only shallow water. They must also be trained on cardiopulmonary resuscitation and automated external defibrillators, First Aid, oxygen supplement and blood pathogens. They also use the newest American Red Cross training aids that were released in January 2007.

Potential lifeguards also learn rescue skills, caring for head, neck or back injuries, and using a bag-valve mask resuscitator. Today's lifeguards also are trained on dealing with blood-borne pathogens, which is an OSHA requirement since it's almost inevitable that lifeguards will encounter body fluids when rescuing victims.

B.J. Fisher, director of health safety at the American Lifeguard Association, said they follow the American Red Cross guidelines when it comes to lifeguard certifications. Right now, the ALA is encouraging two things: people who can swim 50 yards continuously to become a certified lifeguard in a shallow pool (you must swim 300 yards continuously to become certified to be a deep-water lifeguard).

The ALA's also trying to recruit senior citizens back into the workforce as shallow-water lifeguards.

"We're encouraging the 'silver group' to come out of retirement as lifeguards," Fisher said. "With the shallow criteria, we can really approach this. Employers (looking for lifeguards) go for responsibility more than just physical capabilities. More pools being built now are shallow water pools only."

Fisher added that some are even renovating their pools, changing them from ones with deep ends to ones that are shallow water only. With these pools, while you won't have the drowning problems you would with deep ends, you'll still have small children that must be monitored.

When it comes to new guidelines for lifeguards, Fisher said things are slowly becoming more and more technologically advanced. They now have defibrillators available when performing CPR, something they started doing a few years ago before it became mandatory.

Gone are the days where lifeguards use mouth-to-mouth resuscitation to revive those who have quit breathing. Lifeguards now use airway masks, where they blow into a one-way valve to prevent the rescuer from receiving a transmittable disease from a victim. Fisher believes that lifeguards should take things a step further, since an airway mask doesn't prevent the rescuer from transmitting a potential illness to the victim. He sees a bag valve mask as the way to go. To use this, a rescuer squeezes the bag and administers air to the victim. The valve carries supplemental oxygen, which should be administered as soon as possible to aid in recovery.

"We're looking for codes to require the bag valve mask at pools," Fisher said. "The lifeguard is becoming more and more of a medical professional. They're being more trained to be like nurses and paramedics. They should have the tools and be able to administer advanced medical care, since they're first responder. If they don't take their job seriously, a life can be lost."

Fisher predicts that the bag valve will soon be required and the airway mask (and mouth-to-mouth, for that matter) will no longer be viable.

There have also been changes in the chest compressions to breaths ratio lifeguards must do. Fisher reports that they're looking at going from fewer breaths and more chest compressions.

"Studies are finding compressions are more necessary than breaths themselves," he said. "We may omit the breaths entirely. It's not accepted yet, but the industry is looking into that."

Other possible changes include getting away from centering the hand on the chest for compressions and now being able to use two hands instead of one on a child.

Dr. Alex Antonious, director of educational programs at NSPF, added that it's important to remember that lifeguarding also does not take a one-size-fits-all approach. Lifeguard training depends on whether the lifeguard will work at a waterpark, waterfront or with specific attractions like slides.

"How you deal with a spinal injury in a traditional swimming pool versus a water slide, for example, is very different," he explained. "Lifeguard programs must adapt to meet the needs of today as new facilities and new features at these facilities are introduced. Modern-day lifeguards are also trained in oxygen administration and in the use of automated external defibrillation. More and more facilities are beginning to make this equipment available in the pool areas."


Chlorinated Pools & Respiratory Health

Is it ever too early to let kids swim in chlorinated pools? Researchers from Belgium's Catholic University of Louvain's Department of Public Health looked into this. The team, which included medical doctor Antonia Sardella, doctors of philosophy Alfred Bernard and Marc Nickmilder and Catherine Voisin (who holds a master of science degree), did research to estimate the burden of allergic diseases associated with chlorinated pool exposure among adolescents.

Eight hundred forty-seven students ranging from 13 to 18 years of age were tested. They attended outdoor or indoor chlorinated pools at various rates. Of these, 114 attended mainly a copper-silver pool and served as the reference group. The team of researchers found that various respiratory disorders (such as hay fever, asthma and allergic rhinitis) were more likely among the adolescents who swam in the chlorinated pools. Specifically, those with atopy (a genetic tendency to develop allergies like hay fever, asthma and dermatitis) were at a greater risk of getting hay fever after more than 100 hours in a chlorinated pool and a greater risk of allergic rhinitis with more than 1,000 hours of swimming in these pools. These associations, the researchers noted, were not found among adolescents who don't have atopy or who swam in the copper-silver pools.

Their conclusion: chlorinated pool exposure "exerts an adjuvant effect on atopy that seems to contribute significantly to the burden of asthma and respiratory allergies among adolescents."

Their results were published September 2009 in Pediatrics, the official journal of the American Academy of Pediatrics.

Lachocki noted, though, that indoor pools have standards for temperature, humidity, air turnover and other requirements dictated by the American Society of Heating, Refrigerating and Air-Conditioning Engineers standards.

"Good water chemistry helps ensure good air quality," he explained. "Thus, proper disinfectant levels, pH and water balance remain important at all times."


Gas Phase Filtration and Indoor Pools

Many no doubt wonder what 2010 holds in store for aquatic safety. It's about looking at the problems pools have and search for ways to improve them.

One particular problem is how to improve indoor air quality. As people swim in a pool, jump into the water and splash around, the activity results in chloramines mixing into the air.

"The more splashing and more water features, the more atomization you have," said Mark Benard of a manufacturer that helps pools improve air quality. "Then, the more chloramines will be rapidly expelled into the air. Particularly in facilities like waterparks with tons of spray features and with kids running up to water and water slides. There's a lot of sweating. It's a real soup."

Chloramines develop when chlorine molecules become locked up with ammonia. Chloramine compounds are less effective at killing germs or viruses than regular chlorine compounds. Also, chloramines can emit a strong chlorine odor at pools.

Airborne chloramines, if they accumulate, can then burn the eyes and cause breathing problems. One recent example was the 2007 U.S. Swimming Championships in Indianapolis, where competition momentarily stopped due to swimmers being unable to breathe due to the poor HVAC processing of chloramines. This condition even has its own name—"Lifeguard Lung."

"In the 1970s, when indoor pools were first produced, there was no concern regarding energy," said Benard. "Then they started having energy concerns and noticed people started eventually getting sick from indoor pools. They'd cough and have irritation in their lungs and eyes. With a little research they found the sanitizing agent in pool—the chlorine—combined with ammonia and that along with sweat, natural body oils and diarrhea, this would result in chloramines. They found that it rests on the water's surface."

To combat this problem, Splash Universe is using a gas-phase air purification system—the first known use of such a system—in a waterpark along with dehumidification and proper air distribution.

When Splash Universe built 25,000-square-foot indoor waterparks in Dundee, Mich., and Shipshewana, Ind.,

it designed an HVAC system that would use the gas-phase air purification application to eliminate chloramines.

The gas-phase technology, first introduced in 2007, is actually a few decades old and has been used to eliminate gas contaminants when making paper or pulp, managing waste water and in other heavy industries.

Normally, chloramines as gaseous contaminants can easily pass through HVAC media filters. With the gas-phase filter technology, the chloramines are absorbed and eliminated from the air stream; the indoor pool air is then re-circulated through the HVAC system.

"With gas-phase filtration, they can capture chloramines since there's no other way to remove them," Benard explained. "You can't dilute them. The only way to capture them is chemically."

Splash Universe also supplements gas-phase filtration with ultraviolet radiation. This allows the facilities to consume less chlorine. Also, dehumidifiers remove excessive moisture, further helping gas-phase filtration do the job of preventing the build-up of chloramines.

While ultraviolet helps to reduce the amount of chloramines by sanitizing water, secondary sanitizers like chlorine are still needed.

"And if you're using chlorine you're still producing chloramines," Benard said. "The chemical media is very efficient. The real advantage of it is if you're not producing any chloramines for certain period of time, the media doesn't get consumed. It only starts to react when there's a demand for it. When you go through a period of time when nobody's swimming in the pool, media doesn't get consumed."

How often the filters get changed depends on how often they're used.

Proper ductwork is vital for sweeping all the chloramines off the pool water surface, and if the dehumidifiers don't have proper ductwork, there are pockets where chloramines can settle.

Instead of using metal ducts for air distribution in its facilities, Splash Universe uses fabric ducts. Unlike metal, fabric is cheaper to install, easier to hang across the ceiling above the pool and doesn't corrode.

Benard described the tube of fabric is one where holes are strategically punched in the side.

"Instead of a metal duct with a specific diffuser location, they can punch a multitude of holes to fine-tune where you want to distribute the air out of the fabric duct," he explained.

Splash Universe also uses heat-recovery dehumidifiers to provide free pool water heating and to control humidity. Instead of a 70 to 80 percent humidity range in normal indoor waterparks, humidity stays around 50 percent range.



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