Aquatic Safety Strategies Help Prevent Drowning
By Dave Ramont
There are many good reasons for people to get into the water: entertainment, exercise, relaxation, therapy, rehabilitation, or just cooling off. But of course, water can also prove to be dangerous; the Centers for Disease Control and Prevention (CDC) tells us that drowning ranks fifth among the leading causes of unintentional injury death in the United States, with about 10 people dying every day. On average, two of those victims are children aged 14 and under. The CDC also reports that early childhood swim lessons can reduce childhood drowning risk by 88 percent, but that many people don't possess basic swimming skills. Fortunately, there are organizations dedicated to helping others learn to swim, and making aquatic facilities safer in general.
Start With the Basics
The American Red Cross created the first national water safety program in the United States, helping to reduce accidental drownings by nearly 90 percent nationwide in the past century. But they're not about to become complacent. "1914 was the year we added drowning prevention to our mission, so when we hit that 100-year point, we really wanted to do something that was very impactful," said Connie Harvey, director of Aquatics Centennial Initiatives for the Red Cross. So they created the Aquatics Centennial Campaign, a multi-year action that aims to teach 50,000 more people to swim, in addition to the 2 million people they already train annually.
Harvey explained how they zeroed in on selected cities where drowning rates were higher than the national average, hoping that by providing more resources they could lower those numbers, and "ensure that families have access to swim lessons that are affordable and available when it makes sense to them. With our swim classes we're always getting them toward water competency."
She said their programs include parent and child, aquatic preschool, learn to swim, and adult lessons. "We think it's important for parents and caregivers to know how to swim if they're going to be supervising their children around water."
Harvey added that the Red Cross want to help create a pathway, especially for those who may not have had the opportunity when they were younger to learn how to swim, to gain the skills and knowledge to become future lifeguards and swim instructors. "The one main concept is about the learn-to-swim lessons; the other part is about building that capacity so that they can create more swim lessons by building more swim instructors and lifeguards, and it's also about water safety for parents and caregivers to include learning CPR. So those are the main pillars of the Centennial Campaign."
Through the campaign, the Red Cross also provides resources to their partners to help them offer their programs at reduced rates.
The National Swimming Pool Foundation (NSPF) is a nonprofit working to create more swimmers and make pools safer. Their mission is "Encouraging healthy living by increasing aquatic activity through education and research." And in 2012, they launched their Step Into Swim Campaign.
Tom Lachocki, chief executive officer at NSPF, said that in the past four years, 35,000 families have gained a more proficient swimmer as a result of the campaign. "Every Step Into Swim donation NSPF receives, plus some we add, we give away to programs that create swimmers. Our goal is to create 1 million swimmers in 10 years."
Lachocki explained that the NSPF works with sponsor and partner, Master Pools Guild, along with other industry leaders, to create grassroots giving. They're also working with Jewish Community Centers and the Angels of America's Fallen, through their Lessons From Lylah program, to ensure the children of fallen military and first responders learn to swim.
"When a child learns to swim, the child is more likely to be proficient in the water," said Lachocki, adding that families with proficient swimmers are twice as likely to buy a pool or join an aquatic facility. "When we create swimmers, we reduce drowning, help more people live happier and healthier lives, and build demand for the pool, spa and aquatics industry."
An Ounce of Prevention
The Aquatic Safety Research Group (ASRG), founded by Dr. Tom Griffiths, is "Dedicated to reducing disability and drowning at aquatic facilities while enhancing the swimming experience, through research and education."
ASRG Communication Director Rachel Griffiths feels that drowning is a public health issue that is largely preventable. "It's important to keep educating and training facilities, staff and the public about water safety, because we can make an impact and save lives through empowering lifeguards and the public, environmental changes, and the use of lifesaving devices and technologies," she said.
ASRG teaches Aquatic Risk Management seminars, and Griffiths said the focus is to supplement and strengthen the training and knowledge base of facility staff through materials that are largely not offered in other courses. "Applying research from other fields, such as aviation and traffic safety research can help broaden our perspectives, gain clarity and spark innovation within the aquatic safety field."
Griffiths said there are some simple steps for making venues safer, such as educating parents to watch their children closely, and added that they recommend additional lifelines in shallow water, thereby creating separate sections for shallow, intermediate, and deep water. "Too many children drown before they can even reach the lifeline, which is currently required at the five-foot break point in the pool."
Good signage in warning shapes, colors and symbols is also helpful, according to Griffiths, as it can help increase awareness of the most significant hazards at aquatic facilities. "It also informs the public of their responsibilities to practice safety and keep children safe with what we believe are the four most important messages: non-swimmers should wear life jackets; no diving in shallow water; no long breath-holding; and parents watch your children."
Griffiths added that good signage can also help open communication lines with the public. "For example, they may ask why breath-holding is not permitted or request a life jacket," she said.
In fact, life jackets are becoming more accepted at pools. "At one point in time it was only for boats," Harvey said, "and now it's becoming much more commonplace that they are not only allowed but also more available in pools."
ASRG promotes their Note & Float Campaign, developed by Dr. Tom Griffiths in 2008. The free program helps children become more comfortable in the water while jump-starting the learn-to-swim process. Rachel Griffiths explained how non-swimmers are "noted" with wristbands and required to be "floated" in properly fitting U.S. Coast Guard-approved life jackets. She added that some facilities wanted the program but didn't have the funds to acquire the life jackets, so they started the nonprofit Note & Float Life Jacket Fund. In just three summers, the program has donated 700 life jackets to 11 pools across nine states. Following implementation of the program, most facilities that received life jackets from the fund have reduced rescues by at least 50 percent and have doubled swim lesson enrollment, according to Griffiths.
Jim Clark, an NSPF Instructor and recreation coordinator for Parks and Recreation in Willoughby, Ohio, explained that Note & Float is an important program as it addresses drowning head-on. "Like bike helmets, seat belts and air bags, life jackets are a great way to address a danger with reliable technology," he said.
When Clark first suggested providing loaner life jackets, he explained, he was told that they give a false sense of security, and so parents might not watch their kids. But he pointed out that they were already rescuing people suffering from a false sense of security. "Do we have some parents zone out and not actively supervise their child while they're in a life jacket? Sure. But I'll take giving an assist to a kid floating in a life jacket any day over having to rescue one who is drowning."
Clark said that the jackets are available at both of their facilities, with staff helping members select a properly-sized jacket that is returned when they're finished. He added that the life jackets, which are utilized by both children and adults, also promote inclusion rather than exclusion.
The city of Bryan, Texas, has also implemented the Note & Float program, and Parks and Recreation Aquatics Supervisor Marty Mulgrew said it's been a tremendous success, and well-received by the community. He likes the program because it does something more tangible than just preaching water safety. "Note & Float takes it a step further and makes non-swimmers easily identifiable at our facility and puts them in a life jacket to keep them safe, along with providing information about why swimming is important," he said.
In Bryan, every child under the age of 12 is tested to identify non-swimmers and swimmers, Mulgrew said. Test results are tracked and provided to each parks and recreation facility. Program information is provided to families in both English and Spanish, and all are encouraged to enroll their non-swimmers in swim lessons. The city received 68 life jackets through the campaign, which spurred an opportunity to purchase additional jackets for all four of their facilities. "We've seen a 60 percent drop in the number of times our lifeguards have to enter the water for a guest for water-related emergencies," Mulgrew added.
The Right Stuff
What about other products related to water safety—lifeguard chairs, rescue poles and hooks, tow lines and throw ropes, first-aid kits and first responder bags? How critical are these items when facility managers are shopping for products? "There are things that are important and can make a difference, but mostly it's the staff that matters," said Sandy Kellogg, aquatic director for the Mount Vernon Recreation Center in Fairfax County, Va. She's also an instructor of lifeguards, water safety, and Aquatic Facility Operators (AFO), and has spoken at conferences for both national aquatics and parks associations.
Kellogg feels that products are only as effective as the people using them, and agrees that signage is important to inform people, but most effective when staff utilizes the signs to explain rules. And she points out that the best first aid equipment won't help a patron, and can even cause harm, when used incorrectly.
"The most important equipment needed in my opinion is correct training equipment," she said. "When lifeguards train, practice does not make perfect, practice makes permanent."
Kellogg explained that training on a faulty AED (automated external defibrillator), or one that's different from what the facility uses, doesn't train staff to act in an actual emergency using the real equipment. "Decent mannequins that mimic the force necessary for compressions on an actual person will train proper depth and rate far better than cheaper models," she added. Mannequins come in infant, adolescent and adult versions.
In-service is the best safety tool, according to Kellogg—constant re-training and skill checks of staff. "Several certifying agencies, like NASCO and Ellis & Associates, mandate regular, documented in-service. The Red Cross recommends it, and the Model Aquatic Health Code (MAHC) does as well," she said.
She believes in constantly reinforcing what the lifeguard's role is, so that they believe that every minute they're on duty they're responsible for lives in the water, and pool operators remember that, while it may be tempting to take shortcuts with chemistry, the health and safety of everyone around is at stake. "Staff that has not had regular in-service is also not prepared for an emergency, and any incident will have a profound effect if they're not well-trained," she added.
When it comes to training, Kellogg sees a couple different approaches, with larger entities often running their own classes or offering community classes that they can pull from. Her agency runs about 12 classes per year to certify Ellis & Associates lifeguards, which are not open to the public, but are filled with their own new hires. "Smaller agencies rely on community classes, and typically I see them using more Red Cross programs. The larger training programs mandate in-service, smaller organizations may have more difficulty accepting the financial obligation of staff training."
The American Red Cross provides lessons and training through parks and rec facilities, colleges and universities, YMCAs, Jewish Community Centers, etc. "They go through our certification system to be able to offer these courses themselves, so they become Red Cross partners," Harvey said. "The classes overwhelmingly are taught by them, but using the Red Cross curriculum, so they are teaching our program."
Instructors are trained by Red Cross instructor trainers, and they're authorized to continue education within their organization and also offer that to the public. "The same thing happens with our lifeguarding courses and water safety instructor courses," Harvey said. "We do have a very clear system of incoming instructors and instructor trainers and instructor trainer educators so that there's a consistent and standardized approach to all of the Red Cross programs that happen across the country and military installations overseas."
The Red Cross has other offerings for facilities as well, including a lifeguard management course, which Harvey feels is a strong way to educate those coming up the career ladder, for instance going from a lifeguard to a manager. The online course offers guidance and instruction about hiring, facility safety, risk management, having in-service training plans, etc.
There's also a Red Cross Aquatic Examiner service, which allows for a third-party objective review of a facility's lifeguarding operations. "We'll do a walk-through with the management team to help provide a second check, to ensure they've got everything they need," Harvey said. This includes equipment and emergency action plans. There are also unannounced visits to observe lifeguards in action, and certain lifeguards might be designated to perform skill tests right then and there.
Like Kellogg, Harvey strongly believes a facility should have a robust in-service training program, which includes the practice of emergency action plans. This would include all staff expected to respond in an emergency, from calling 911 to meeting EMS and knowing which gates to use, to crowd control, etc.
ASRG also conducts safety and lifeguard audits. Griffiths explained that they gather as much information as possible to learn about a venue's policies, practices and patron base, because while management knows their facility better than anyone, it sometimes takes an outsider to identify areas in which improvements can be made. "Sometimes management already knows an issue that needs to be improved, and outside experts can corroborate whether attention is needed in that area," Griffiths added.
Audits should be innovative to be as unexpected as possible to help train lifeguards more realistically, according to Griffiths, who added that in addition to rescue and resuscitation training, surveillance training addressing physical and mental barriers is also important. "Improved belief in efficacy to perform a rescue, strategies to take quick action, and practice spotting the unexpected can help reduce the chance of the need for resuscitation."
Looking for red flags should be enlisted in training, such as children behaving hesitantly around water. "We strongly suggest the 5/30 Model of Aquatic Accountability, where lifeguards do the Five Minute Scanning strategy and someone in management walks the pool deck every 30 minutes. The more the lifeguards see their supervisors, the more alert they tend to be," Griffiths said.
Other Water Safety Trends
The NSPF and American Red Cross are members of Water Safety USA, a consortium of organizations, each with a strong record for providing drowning prevention and water safety programs. Some of the other 14 members include the USA Swimming Foundation, Boy Scouts of America, National Park Service, U.S. Consumer Product Safety Commission and the YMCA.
"The organizations agree together annually on a unified water safety message campaign," Lachocki said. "To maximize effectiveness, each of the member organizations disseminates the designated message to their constituency and reports back to the group on reach and impact."
In 2016 the joint message was "Water Safety: It's Learning to Swim and So Much More." The 2017 message was "Designate a Water Watcher: Supervision Could Save a Life."
The science-based and free Model Aquatic Health Code (MAHC) was created to ensure the safety of aquatic venues, and Lachocki believes that facilities should strive to comply with the code. "The MAHC has gained such support that many health departments will even accept variances to local requirements that comply with the MAHC."
Kellogg agrees that important work is being done with codes and requirements. "The MAHC was born out of a desperate need for an industry best practice standard, and while it doesn't mandate anything, it's becoming a go-to reference for agencies and states looking to strengthen their codes."
As far as current trends, Lachocki explained that the industry is collectively gaining momentum to treat the source of that noxious smell often found at indoor pools, which is typically the byproduct created from the reaction of chlorine with contaminants in urine like urea and uric acid. "350 and growing organizations are committed to the Prevent Pee in the Pool campaign," he said, with special signage with tips on how to prevent this problem available to help facilities communicate this critical message to staff and patrons.
Kellogg said that a lot of attention is being placed on water chemistry and air quality, trying to ensure a physically healthy environment. "Secondary sanitation, ozone, regenerative filters, alternative disinfection—lots of different research to make sure our water stays clean and safe," she said.
Tom Griffiths mentioned a device they observed at the World Conference on Drowning Prevention, a lightweight handheld sonar unit for the open water which should make search and recovery significantly safer. Rachel Griffiths added that there are also more promising technologies being developed to supplement supervision, and there appears to be more awareness and education about non-fatal drownings. "We also have to give praise to the many agencies that recently increased their education and warnings about Shallow Water Blackout," she added.
Harvey brought up a term that is being embraced by the drowning prevention and water safety communities: water competency—the concept that there are minimum skills that everybody should have. She pointed out that this knowledge shifts based on where you are, that water competency in a pool is different from the same in an ocean environment, and the public needs to be educated that those skills aren't necessarily transferrable. "So I think you'll start hearing a lot more about water competency and how it applies to different environments, whether we're talking about swimming or boating or whatever," she said.
Kellogg feels that water safety is improving, but there are still an unacceptable number of drowning deaths every year. Many of these are children, with minority children often being statistically overrepresented. She'd like to see swimming become a mandatory part of physical education curriculums at every elementary school, partnering with local facilities or agencies to get kids to aquatic safety classes. "We did an excellent job teaching people to use seatbelts and car seats; life jackets and swim classes should be equally important. Parks and recreation agencies need to be an advocate for aquatic safety, even if they don't have the facilities to offer it."
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