Heads Above Water

Lessons, Programs & Technology Help Prevent Drownings

Many factors can increase a person's risk for drowning, with lack of swimming ability, no access to swim lesson programs and even parents not knowing how to swim being just a few.

"If a parent does not know how to swim, there is only a 19 percent chance a child from that household will ever learn to swim," said Tina Dessart, USA Swimming Foundation's Make a Splash program manager.

Not only that, "overconfidence in one's swimming ability, alcohol and drugs, not wearing a Coast Guard-approved life jacket in open water or boating situations, and lack of proper supervision" all are risk factors as well, she said.

With so many risk factors to consider, it is that much more important to know the different ways to prevent drowning—with one of the best being to learn how to swim early in life.

"Early childhood swim lessons reduce childhood drowning by 88 percent, according to the Centers for Disease Control & Prevention. This is the best way because it also opens the door to a lifetime of healthy activities," said Tom Lachocki, CEO of the National Swimming Pool Foundation (NSPF).

Drowning Prevention

William D. Ramos, Ph.D., a member of the American Red Cross Scientific Advisory Council and its aquatics subcommittee, agreed. He said that one of the messages he likes to put out front is that learning to swim is a major component of drowning prevention.

Besides that, he stressed that barriers or fences around aquatic facilities are important, as well as using pool covers and recognizing that and retention ponds or manmade features can be a safety hazard, too. It's important to "make sure we have an inclusive four-sided barrier around," Ramos said.

To boot, supervision is crucial around the water.

However, "the more people you have on hand supposedly watching, often the less supervising is occurring," said Tom Griffiths, Ed.D., president and founder of the Aquatic Safety Research Group, LLC, in State College, Pa. "Although we have been attempting to strengthen supervision around the water, research indicates that 90 percent of drowning victims had supervision," Griffiths said. "We need to supplement supervision with life jackets and drowning prevention technologies …"

Ramos, who also is an assistant professor at the Indiana University School of Public Health-Bloomington and director of the Indiana University Aquatics Institute, concurred. "Lifeguards are trained very well. But, they are not the panacea. They are not the cure-all. A lifeguard is part of the safety team," he said, adding that parents still need to supervise their children when they are in or around the water.

Noting that swimming in an unsafe or unknown area, swimming alone and not having proper floatation are other risk factors, Adam Katchmarchi, president of the National Drowning Prevention Alliance (NDPA), stressed that using multiple layers of protection is the best way to prevent drowning.

"One layer of protection or one method of reducing the risk isn't enough," he said.

For swimmers, some of those layers of protection include learning to swim, swimming when and where a lifeguard is on duty, having a "water watcher" (a designated person who will watch individuals in the water without distraction), wearing proper floatation devices, using drowning prevention technologies, and being trained in water rescue and CPR, among others.

Effective Products, Technology

Experts agree that one of the most effective products to protect swimmers is the life jacket.

"We have yet to find a single incident of a child drowning in a USCG-approved life jacket," Griffiths said. "Negative opinions concerning life jackets do not stand up to the data we have collected and are mostly based on personal opinions that are biased and antiquated."

"For kids and any inexperienced swimmer, wearing life jackets [is important]," Ramos said. "It's the No. 1 way to add that extra layer of protection, [and help them] stay afloat longer."

Life jackets not only should be U.S. Coast Guard approved, but should be of varying sizes and degrees.

"It's important [for them] to be designed to keep the child up and adult up based on weight and position," Ramos said.

On top of life jackets, drowning prevention technology has been added to the aquatic environment as an additional layer of protection.

"The goal of advanced drowning prevention technology is to 'have the lifeguard's back' and assist them in creating a safer aquatic facility," said Cynthia Stubbins, sales and marketing director for a Cypress, Texas-based company that specializes in drowning detection technology.

Drowning detection products available on the market today vary in terms of their technology and how they detect a possible drowning. "Starting with products that will let you know that someone is drowning if a person is wearing their device, to products that use above- or below-water cameras and hardware and software, to the latest more advanced technology that incorporates hardware and software along with artificial intelligence that monitors the entire pool area and can detect if a person is drowning," Stubbins said.

What's more, it is important to note that the Model Aquatic Health Code (MAHC) now suggests the use of technology as an additional layer of protection. The MAHC is a resource that was first released in August 2014 to give U.S. agencies that regulate aquatic facilities a way to standardize and improve existing pool codes. The code is clear to state that these water-monitoring technologies should not be considered as a replacement for lifeguarding staff, but as an additional layer of protection.

"As advancements have been made in technology and become more readily available, these advancements have been incorporated into drowning prevention and detection products," Stubbins said. "Fairly recent advancements in technology, such as tracking devices, ultra-high-definition cameras and artificial intelligence, are bringing drowning prevention products into the 21st century.

"In addition," she said, "as the price of these technologies decreases over time, these drowning prevention products are becoming more readily available and widespread in both commercial and residential environments."

Relatively broad selections of products and technology are available today in the area of drowning prevention products. Some are more directed toward residential applications, while others target commercial pools.

"Wearable technology, such as armbands, headbands and devices worn around the throat area can be used and monitored by sensing devices located around the pool. An alarm is sounded when a specific activity is sensed by the technology," explained Jerry Johnson, business unit manager for a company that specializes in drowning detection technology with U.S./Canadian headquarters in Norcross, Ga.

He noted that some technologies include the motionless detection systems, which are underwater cameras connected to a central unit with embedded motionless detection software.

"A motionless detection system is comparing images in order to trigger an alarm as soon as something new, motionless appears into a picture," Johnson said. "These types of systems are unable to differentiate between a real drowning case (someone lying motionless at the pool floor), a shadow projection or a strong light spot reflection into the pool or someone motionless head above the water surface into the shallow end."

Basically, these technologies that are applied to drowning detection will trigger substantial false alarms, he said.

"Most of the time these system alerts are delivered with 30 seconds (or more) detection delay in order to try to minimize the false-alarm rate. This is a very long period when time is of the essence in a drowning incident," he explained.

With classical video systems (CCTV), one or more additional staff needs to permanently stay behind a monitor (at the pool or somewhere else if the system is connected to a network).

"The staff will look at the pictures in order to check for a potential critical situation. Human-based, these systems do not bring any technological added value," Johnson said. "It has long been established that no one can be efficient looking at multiple images on one or more monitor(s) in order to detect within the requested time one or more critical event(s)."

Johnson's company's computer vision surveillance system recognizes texture, volume and movement within a pool.

"Comprised of an advanced overhead and/or underwater camera network that continually surveys the pool and a specialized software system that analyzes (in real time) the trajectories of swimmers," he explained, "the system can alert lifeguards in the first seconds of a potential drowning incident to the exact location of the swimmer in danger.

"Most of the advancements made in these type products are in the camera and computer technology being used," Johnson said.

While his company's system is covered by multiple U.S. patents from a design and software perspective, the processing capability of computers continues to increase exponentially, which allows the overall system to operate at a higher level.

Not only that, camera technology has expanded in the past few years, too, "…to a level where color and infrared cameras transmit extremely high quality images for analyzation by the software," Johnson noted. "The development of localization software allows the system to send pinpoint information to the lifeguards about an incident in the pool where they can go directly to the potential victim rather than have to search for them."

"Finally, there is Web-based software available to allow pool monitoring from remote locations or a smartphone," he said.

Stubbins noted, too, that limitations of the human eye and human brain make it virtually impossible for a lifeguard to monitor 100 percent of the pool 100 percent of the time.

"Obviously lifeguard equipment and training advancements are a positive change to make the lifeguards more effective. But, it is clearly not enough," she said. "The fact remains that drownings still happen at lifeguarded facilities, costing both lives and millions of dollars.

"It is imperative that we recognize that lifeguards need technology as an additional tool to their job," she said.

Lifeguarding Programs

A number of recognized lifeguarding programs exist in the United States, examples of which include the American Red Cross Lifeguarding, Starfish Aquatics Institute (SAI)—Star Guard, YMCA Lifeguarding, Ellis & Associates—(more waterpark-oriented), United States Lifesaving Association (USLA)—(more open-water-oriented) and Boy Scouts of America Lifeguarding.

"Generally speaking, lifeguarding is continuously progressing as a trade. New skills, cognitive knowledge and behavior training are being introduced each time a lifeguard training program is released/re-released," said Katchmarchi, who has been a lifeguard instructor/trainer for many years.

The challenge, he said, for any field (not just lifeguarding) is basing training and practice standards and guidelines on evidence-based research.

"While limited research on lifeguarding exists and more needs to be completed, some studies have shown promise. In my opinion, one of the weakest areas in lifeguard training is on surveillance and how we teach a lifeguard to watch the water," he said. "In recent editions, lifeguard training programs have incorporated more robust and comprehensive training on how to watch the water, recognize a potentially dangerous situation and better recognize a victim in need of rescue."

One way to check in on how lifeguards are performing involves audits, which take place when a lifeguard is on duty and takes part in a simulated rescue.

"While the victim and the auditor know it is just a drill, the lifeguard does not know if it is a real rescue or just a simulation. Research by Schwebel, Lindsay and Simpson (2012) has shown that lifeguard interventions (such as audits) can be effective in increasing lifeguard vigilance," Katchmarchi said.

"While there are a number of areas within lifeguard training that are in need of additional evidence-based research, lifeguard training programs have made significant advances in recent years and are continually being revised to increase the vigilance, response and care of lifeguards," he added.

Griffiths believes that all of the lifeguarding programs do a good job, but said it's difficult to teach lifeguards to detect drowning victims that they have never had the opportunity of seeing.

"Actual drowning videos caught on security cameras illustrate a much more diverse drowning display than what we originally thought," he said.

Sometimes lifeguards endure challenges on the job, one of which includes parents assuming that they can turn over control once a lifeguard is on duty.

"You have to convince [parents] to be part of the safety team," Ramos said.

You also need to fit your lifeguard staff to the context of your facility. "Environments can be tricky." Traditional pools, such as rectangular-shaped pools, are much easier to scan. So, "we are getting more creative with waterparks, [with] more staffing," Ramos said. "You think about a traditional lap pool, you can have one or two guards. And then you take a waterpark, and add two or three guards."

Water Safety Programs

Any opportunity to share water safety information with children and families outside of the water is a successful venture.

"The more we can discuss water safety, how to be safer in and around the water, and the importance of learning to swim with children and families, the more likely they are to act upon the messaging, and the safer they will be," Dessart said.

"There are a multitude of ways to educate children and their families (presentations, storybooks, hands-on activities, etc.)," she said, "and there are also a number of agencies who now have formal programs in place: Safer 3 Water Safety Foundation, the YMCA of the USA, the American Red Cross, Joshua Collingsworth Memorial Foundation, Swim Lessons University and the Boy Scouts of America, to name a few."

For example, the USA Swimming Foundation's Make a Splash initiative is a national child-focused water safety campaign, which aims to provide the opportunity for every child in America to learn to swim. Through Make a Splash, the USA Swimming Foundation partners with learn-to-swim providers and water safety advocates across the country to provide swimming lessons and educate children and their families on the importance of learning how to swim.

The Aquatic Safety Research Group's Note & Float program, aimed at preventing drowning at aquatic facilities throughout the country, not only prevents drowning, but also reduces water rescues, increases swim lesson enrollments, increases attendance and customer satisfaction, Griffiths said.

The program targets parents with children who cannot swim. And, the heart of the program involves identifying all non-swimmers who enter the facility, and then "floating" those swimmers with an appropriately sized life jacket.

In another example, the WHALE Tales program through the American Red Cross enables anyone to become an aquatic leader and teach community water safety courses. WHALE is an acronym that stands for Water Habits Are Learned Early. The program is designed to raise children's (K-6) awareness of safe behavior in, on and around the water. You don't need a pool to offer the program. The program is taught in many schools and summer camps, as well as during swim lessons.

"With the WHALE Tales program, the beauty is that it allows anyone to become an aquatic leader in their community; not a large certification is needed. It's more educational," Ramos said.

In fact, Katchmarchi said he has been using the WHALE Tales program for a long time to teach children water safety. He added that the Safer 3 Water Safety Foundation recently released a newly revised curricula and program materials that are "outstanding."

"Many of the foundations and organizations under the umbrella of Families United to Prevent Drowning have resources such as coloring books, story books, videos and informative guides on water safety available," he said. "Additionally, another great educational program has been the Pool Safely Campaign from the Consumer Product Safety Commission."

Ramos and his colleagues on the Red Cross Scientific Advisory Council have developed the Circle of Drowning Prevention and the Chain of Drowning Survival in order to raise awareness of the most important steps that people can take to reduce the number of preventable drownings.

Ramos also mentioned that the free American Red Cross Swim App has features specifically designed for children, including a variety of kid-friendly games, videos and quizzes. Water safety information for parents for a variety of aquatic environments (pools, waterparks and beaches) also is included.

Another program, the American Red Cross Junior Lifeguarding Program, is designed for youth ages 11 to 15 who are interested in strengthening their skills and preparing for a future lifeguarding course once they are old enough to enroll.

The Lifeguarding suite of programs is designed for those ages 15 and older who want to gain the knowledge and skills required to become a professional rescuer. The program includes training in water rescue skills, first aid and professional-level CPR/AED.

In addition, specialty modules are available for those who want to work at waterparks, waterfronts or facilities with aquatic attractions. The Waterpark Skills module covers preventing and responding to emergencies in aquatic facilities with waterpark features, and the Aquatic Attraction Lifeguarding course is designed for areas with water depths of 3 feet or less.