Safe in the Water

Programs, Audits Are Key to Enhancing Aquatic Safety

Drowning remains the No. 1 aquatic safety issue, with lack of swimming ability, the absence of close supervision while swimming and the failure to wear life jackets being just a few of the risk factors.

"While we do a relatively good job of keeping our eyes on children of tender years, we often forget the older lap swimmers. Statistics show that the only increase in water-related deaths comes in that older age category between 49 years and 81," said Tom Griffiths, president and founder, Aquatic Safety Research Group.

"I can't begin to count the number of drownings involving lap swimmers. Many of these pool deaths are medically related, but if water enters the lungs in these victims, aquatic facilities are going to have a tough road ahead defending themselves," he said.

Time and again, an assumption is made that someone is watching the water when no one really is.

"Too often, unnecessary drownings and near drownings occur because a parent or adult assumes kids can swim or that someone (lifeguard, other adults nearby or other kids) is watching the water," said Dan Berzansky, owner and president of Premier Aquatic Services, an Aliso Viejo, Calif.-based aquatics service company that specializes in aquatics programming, lifeguarding, and CPR/AED and first aid training. "Most of the time, it's a bad assumption. Once there is an emergency, oftentimes no one around knows how to respond. The delayed response time leads to irreversible damage or even death of the victim."

The issue of supervision, meaning active supervision by people who bring kids to pools, makes up one of two big components of aquatic safety today, noted Connie Harvey, director, Centennial Initiative for the American Red Cross.

"Many adults do not pay close enough attention to the children in the pool," she said. "They rely completely on the lifeguard, but forget that the lifeguards are there watching everybody. It is also the responsibility of the adult to keep an eye on those they brought. Put down your phone, put down your magazine.

"And for the littlest kids and non-swimmers," she added, "the adult needs to be practicing 'reach supervision,' which means staying within arms' reach of the swimmer, especially when he/she is in the pool."

Secondly, not enough people know how to swim well.

"At minimum, people need to be able to complete the sequence of water competency," Harvey explained. "We also need people to become stronger swimmers so that they can become water safety instructors or lifeguards and become the next generation of people protecting lives in and around the water."

Water Safety Programs

That being said, swimming lessons early and often will help to reduce the number of drowning deaths, Griffiths said.

"Selecting Mommy and Me type of programs that do not force water instruction on the young child and educate the parents are best. Safe water play and entertainment in the water at those early ages is preferable to stroke instruction—that can come later," he said.

One of the biggest programs available today to teach water safety comes from the Red Cross, the Learn-to-Swim program.

"Every Learn-to-Swim lesson not only teaches swimming skills, but it has a safety topic integrated into it," said Nichole Steffens, product manager, aquatics, American Red Cross. "So, every time a participant comes for a swim lesson, they're also getting a water safety lesson. And it's not just safety skills such as wearing a life jacket. It's also about learning safe behavior around the water."

The Red Cross also offers Longfellow WHALE Tales, which is a K-6 classroom-based program designed to raise children's awareness of safe behavior in, on and around the water.

"WHALE Tales is a free course that can be taught by any aquatic leader, Red Cross instructor or school teacher. WHALE Tales can be taught without a pool and is a great rainy-day activity for schools, summer camps and during swimming lessons. It is also part of the Red Cross Swim App," Steffens said.

"Finally, I'd encourage parents to download the Red Cross Swim App, which contains tons of water safety content for adults as well as children," she added. "This app was created as a companion to the Learn-to-Swim program (including Preschool Aquatics). It helps keep new swimmers motivated while providing parents the latest in water safety guidance to help ensure families stay safe in, on and around the water. It is not meant to be used at the pool instead of watching your swimmer."

Adam B. Katchmarchi, M.S., EMT-B, vice president of the National Drowning Prevention Alliance (NDPA) and an instructor at Indiana University of Pennsylvania (IUP), noted that parks and recreation centers are doing "great aquatic safety programs."

"I talk at different conferences, and I usually ask my audience what has worked," Katchmarchi said. He has discovered that the more attendees reveal and share what their programs are like, the more that other people can learn from that.

He added, too, that water safety programs not only get the kids involved, but the parents as well. The idea is getting parents together and having a lifeguard or aquatics director highlight the points about water safety, provide education for the parents and stress that you still have to watch your kids in the water.

"[Parents] are the first line of defense against drowning. Lifeguards are human. They can make errors. Nothing is better than keeping an eye on your own kid," he stressed.

Programs are available to help understand the risks involved with water activities, such as Safer3, a program that teaches a three-pronged approach and covers the main safety mechanism: recognizing risks associated with water-related activities; implementing strategies to reduce and manage those risks; and responsibly maintaining those strategies.

"The program is designed to teach kids and adults what the risks are, how to reduce/eliminate the risks and how to respond in the case of an emergency," Berzansky said. "There are other organizations out there, but I believe Safer3 is making amazing strides into being a great voice for water safety."

Safety Equipment

In case of an emergency, having a rescue tube on hand as a lifesaver for the victim and the rescuer, as well as a ring buoy, are essential. In fact, Griffiths said he would like to see the ring buoy made better use of.

"That device is over 100 years old and was invented to be thrown off ships to rescue a person overboard; that's why the line attached is so long. But that line attached to the ring buoy is problematic," he said. "It always gets tangled and people can't throw the ring buoy with accuracy or consistency. I would like us to take the line off large ring buoys and have rescuers swim it out to the victim."

Griffiths also said that children who cannot swim should be in a properly fitting life jacket until they can be competent and confident in the water.

"Kids in life jackets just won't drown, plus our data suggests when a Note & Float policy is adopted by a swimming facility, swimmers, parents and lifeguards are all happier and appreciative," he said.

For resuscitation efforts, it was unanimous among aquatics experts that an AED (automated external defibrillator) should be on hand, along with oxygen. "An AED may not help with all drowning victims, but not having an AED is really going to hurt the facility when defending a lawsuit," Griffiths said.

Berzansky said an AED is a necessity and added that his company offers the community free AED classes. "The AED will come with a CPR mask and gloves, which is the last piece of equipment needed," he said, adding that clear signage with the address of the facility is of the utmost importance, too. "This will help the rescuer or bystanders communicate their location to EMS quickly and correctly," he said.

Similarly, Katchmarchi suggested that a well-stocked first aid kit and an AED and having supplemental oxygen are crucial. "Drowning is a respiratory event. And that's something that is lagging behind, having emergency oxygen available," he added. "Most facilities don't have that ready to go."

Not only is drowning an issue, but so is the risk of concussions. USA Swimming and the American Red Cross both have acknowledged the danger of swimmer concussion from the impact at the wall.

As a result, a new pool safety device brought to market earlier this year from a Camarillo, Calif.-based company features a wall-bumper design and has been tested to decrease the impact of wall collisions by more than 300 percent. The semi-submersible system hooks onto lane lines to reduce injury from wall impact and does not interfere with turns or stroke.

"Believe it or not, concussion and injury from wall collisions is actually a big safety hazard for swimmers," said Keith McKnett, a veteran swimmer and swim coach who founded the company in 2013. "Every swimmer has had a run-in with the wall at some point, whether missing the backstroke flags or just misjudging the distance to the wall during a regular flip turn," he said. "It's not as widely reported as injuries from other big school sports, like football or basketball, but it is a real issue that I've seen and heard throughout my years of coaching."

McKnett, who also is a 20-year swim coach at Rio Mesa High School, added that with swimming being an excellent form of exercise, it's important to make it accessible and safe for everyone, regardless of their skill level.

"Wall collision is a very real source of injury that affects all swimmers, but especially those who are sight-impaired, have special needs and are inexperienced swimmers," McKnett said. "I've seen parents trying to protect their children from wall collisions at swim meets by waving kick boards to warn them of the proximity of the wall. It's an imperfect system. We need to improve it."

Meanwhile, Katchmarchi, who conducts training at different aquatic facilities throughout the country, added that all lifeguards should have their pocket CPR resuscitator masks on hand, too.

"Other things aquatic facilities should have is a good quality backboard," he said, adding that it is a necessity to ensure that the backboard is in good working order at all times.

"I recommend having a backboard and having some equipment for practice; having some equipment that isn't used all the time," he said.

Finally, technology is a huge benefit, too.

"Computers are vigilant and humans are not," Griffiths said, noting that technologies continue to save victims in swimming pools that lifeguards miss.

One particular technology, a computer-assisted video system that was developed by a Norcross, Ga.-based company, detects drowning victims on the bottom. Griffiths believes it has more than 30 documented drowning victim saves that lifeguards on duty missed.

"It is a very effective, but expensive, system," he said.

Safety Audits

Aquatic safety audits, which are designed to help increase safety by recognizing the steps that can be taken to reduce the risk of drowning or serious injury, should really be done more often.

"But change it up whenever you can," Griffiths said. "We have moved from active victims on the surface to dummy drops on the bottom, but when the City of Phoenix courageously spent an awful lot of time and effort getting their 'victims' to perform dead man floats while breathing through hidden straws on the surface, their well-trained lifeguards failed miserably.

"So, however many audits facilities have done in the past, they should either try to do more, or better yet, do them differently," he added.

He also explained that now that lifeguard audits are close to being the norm, lifeguards begin to test for the test. In other words, if a facility only does "dummy drops" with victims on the bodies, the lifeguards will quickly learn when these unannounced drops will be coming.

"The City of Phoenix introduced human floaters on the surface breathing through straws, and the lifeguards were not very good at detecting them," Griffiths said. "So, to be effective, lifeguard audits should include various scenarios—victims on the bottom, victims on the surface and whatever else may happen in particular pools.

"Also, lifeguards just need to get wet more often, particularly in boring rectangular pools. Lifeguards who just sit all day watching the water without getting into it much expend a lot of energy overcoming resting inertia to check on a swimmer in the water," he said.

Finally, Griffiths added that too much time is spent practicing backboarding skills that may never be used and that may not make a real difference.

"I honestly believe too many lifeguards spend too much time boarding non-breathing children that do not have neck injuries only because they spent most of their time learning backboarding procedures," he said. "Lifeguard training and auditing needs more work on the proactive prevention side; we do pretty well on the reactive rescue and resuscitation side of the training continuum."

Matt Haynes, aquatics product manager for lifeguarding and assessment services for the American Red Cross, explained that there are two kinds of safety audits—internal audits and external audits.

"Internal [you should do] at least monthly. And, external audits at [your] discretion. It depends on how long their season is," he said.

It is wise to have one audit earlier in the season and one later in the season to see if improvements have been made. For example, maybe a facility's staff wasn't fully trained early on. And then when you go back for a second audit, you will see some progression.

"Early on during an audit, you might get brand new staff or the lifeguards themselves. It might be their first real job. The professionalism might not be there yet. Trying to figure out what is acceptable and what's not," he said. "Administrators in aquatic facilities will be seasonal and first time running a facility. So sometimes there are growing pains and learning curves."

Safety audits can be very educational, with suggestions being made and simple ways to implement them.

Speaking from personal experience, Berzansky said he requires his staff to do a safety audit every day, and sometimes multiple times a day.

"We have created a facility checklist that lists every nook and cranny of the facility that we inspect," he said.

For example, the audit schedule includes the following:

• Checklist 1 - Detailed report done two times per week: every single handle, showerhead, hose bib, light, chair, diving block, chemical controller, chemical lines, pool vacuum, etc.
• Checklist 2 - Daily Report: checklist of "to dos" discovered in the detailed report as well as big items like doors, chemical controllers and mainly cleanliness issues.
• Checklist 3 - Hourly reports: pool counts, chemical readings and cleanliness.

Lifeguard Training/Certification

Some of the latest praise in lifeguard training and certification involves junior lifeguard programs across the country.

"These not only get younger people involved and away from their computers and handheld devices, but they become skilled at water safety and rescue and the program becomes a feeder system for lifeguards at the facility," Griffiths said. "I also think head lifeguard programs will grow in the future, particularly with the MAHC coming into effect."

Haynes said the latest trends he sees involve blended learning, a combination of in-person training and online training for homework and assignments. "The use of the Internet is becoming very prevalent," he said.

He also referenced a safety program released by the American Red Cross in 2014. The program involves the designation of a new professional lifeguard certification for extreme shallow water and the launch of two new programs that are designed to increase safety at facilities employing lifeguards.

The new Red Cross Aquatic Attraction Lifeguarding course trains lifeguards specifically guarding attractions in extreme shallow water, defined as three feet or less. This includes winding rivers, catch pools, slide runouts, water play areas and slide dispatch.

Berzansky added that "the biggest change we have made over the past two years is training.

"Every staff member is running in-service training during every shift. This could be anything from swimming to stay in shape, rescuing fellow staff or secret victims who act out a scenario without the staff being aware," he said.

"Our checklist of skills is roughly 80 to 90 skills or scenarios, and every staff member will be faced with a scenario every shift," he added. "This keeps the staff engaged, motivated, and most importantly, ready to respond in an emergency."

The MAHC

Back in August 2014, the first edition of a special guidance document, called the Model Aquatic Health Code (MAHC), was released to give U.S. recreation facilities and spas a resource to improve their existing pool codes.

In recent months, there have been 159 change requests submitted for the MAHC, with 15 percent being editorial, 52 percent non-controversial and 33 percent categorized as major change or impact, said Doug Sackett, executive director of the Council for the Model Aquatic Health Code (CMAHC).

For example, one of those change requests, under the major change/impact category, Sackett noted, proposes to change the design section (Section 4.8.2.2.4) requirement for diving board stands and platforms 2 meters or higher, to require stairs (vs. ladders) for diving board stands/platforms 1 meter or higher. The rationale addresses injury data from falls from diving boards and ladders.

Sackett added that he does not know what the results of the member voting will be because there are differences of member opinion on each.

Currently, all pool codes are written and enforced by state and local agencies independently. Jurisdictions can use the MAHC to update or implement codes, rules, regulations, guidance, laws or standards governing swimming pools, spas, hot tubs and other public, treated, recreational water venues to reduce infectious disease outbreaks, drowning and chemical injuries.

So far, Sackett said that states must review head-to-head and fit into regulatory or legislative process and timeframe so adoption can take one to two years.

"Twenty-three state and local jurisdictions are comparing the MAHC to their existing code or moving ahead on potential adoption (e.g., New Mexico, Indiana)," he said, adding that the CDC has conducted four head-to-head comparisons of the MAHC to state code.

What more needs to be done?

"We must overcome the tendency to only react or continually tweak the MAHC without a long-range goal to improve the overall system," Sackett said. "We should be planning where the entire system should be moving and incrementally submit change requests and research data to get us there (e.g., filtration and recirculation, air handling, advanced water treatment)."

He also said that CMAHC needs to have a proactive strategy in order to advance the MAHC vs. just finessing the wording. "The CMAHC needs to continue efforts to promote awareness of the MAHC throughout the aquatics industry," he said, such as working with the National Swimming Pool Foundation (NSPF), World Waterpark Association (WWA), National Environmental Health Association (NEHA), National Association of County & City Health Officials (NACCHO), National Recreation and Parks Association (NRPA) and others.

The idea behind this is to discuss how the MAHC, through its science-based, data-driven, risk management approach, helps make pools healthier and safer.

Secondly, through adoption of the MAHC, a uniform model code, inconsistencies across jurisdictions around the country can be reduced, making it easier to do business. Third, the financial and resource burden on state and local health departments to develop or update their codes can be greatly reduced, Sackett explained.

Griffiths believes the MAHC will continue to have a positive effect on the industry. The fact that the code is so comprehensive, involved so many professionals, and updates and renews every two years is "huge." "Aquatics people need to read the MAHC and research the MAHC. It is a wonderful and exciting resource for us all. It's an encyclopedia of swimming pool standards that actually educates the reader," he said. "Even if a state or region does not adopt the MAHC, or portions of it, those working at pools need to know what is in there. I can tell you attorneys are quickly going to learn about the MAHC."