Potentially Dangerous When Wet

Aquatic risk management red flags

By Stacy St. Clair

When it comes to risk management, pool managers need to dive right in. Pools and waterparks, perhaps more than any type of recreation facility, are particularly susceptible to injuries and subsequent liability claims. The ongoing aquatic safety issues need to be addressed with both frequency and intensity.

But rather than talk about the same tired topics, we're putting a fresh face on five risk management areas.

We'll look at making your ladders as safe as the local playgrounds and the surprisingly few number of drinks it takes to impair diving. We'll also examine quelling the spread of recreational water illnesses and preventing drain entrapment.

And, perhaps most importantly, we'll offer tips at identifying potential sexual predators. Your pool and your patrons are more vulnerable to sexual abuse than you probably realize.

The biggest challenge, however, is addressing the safety issues while keeping the spotlight on aquatic recreation. Swimming, water fitness and other aquatic sports play a vital role in combating heart disease, diabetes and other obesity-related illnesses.

To lose that focus would be as detrimental to the public as ignoring the risk management issues outlined in this article.

"It's imperative to keep in mind that we don't want to scare people away from pools," says Tom Lachocki, director of the National Swimming Pool Foundation. "Pools are helping people exercise. Pools are saving lives."

PREVENTIVE PADDING

Imagine a new playground opens in your community.

It has a top-rate slide that the whole town seems to enjoy using. Once you get there, however, you see the playground has been built on hard ground without enough padding and safety surfacing. Falling from the apparatus could guarantee a cracked skull or worse.

You inspect the slide and notice there are no toe enclosures on the ladder. It's obvious a child's foot could slip right through the rungs.

The handrails are also too large for children to fully wrap their hands around. They won't have a secure grip as they climb the 10-foot ladder.

Would you let your child play on the slide? Probably not. It's not safe.

Yet the aquatics industry regularly installs diving boards with the same unsafe conditions. They're mounted on concrete slabs, without toe enclosures and handrails much too large for a child to completely grasp.

If they were playground slides, most diving boards would violate local and national standards. There would probably be a community uproar, as well.

"There's a disparity between what's permitted at playgrounds and what's permitted at pools," aquatic expert Jason Mart says. "The industry has to do something to change this."

There's more than just a moral obligation to keep patrons safe. There's also an important financial aspect to providing user-friendly pool ladders.

Injuries stemming from ladder falls have resulted in multimillion-dollar lawsuits. By providing safe climbs, aquatic managers reduce the risk of both injury and liability.

Until the industry makes ladders with smaller handrails and toe enclosures standard, proactive pools are installing padding under their diving boards to cushion falls. The pads, which cost between $1,000 and $5,000, increase in thickness depending on the ladder's height. The thickness also meets the Consumer Product Safety Commission's guidelines for falls.

The pads are slip-resistant to minimize injuries around the board, as well. They are waterproof, so aquatic managers don't have to worry about mold or mildew.

Safety-conscious pool managers also have begun installing padding around the entire deck area. The move protects patrons—especially overexcited children who forget the rules and run around the deck—from slipping and falling.

It may not be the industry's most important risk-management issue, but pool padding is gaining more interest. It's much-deserved attention, too, given the padding's ability to protect patrons and reduce liability issues.

"Drowning is always going to be the No. 1 risk management issue," Mart says. "But there are other areas that need to be considered, as well."


LIFEGUARD LOGIC

Everyone knows the best defense against drowning is good lifeguards. But we sometimes forget just how valuable these tanned pool watchers are.

Swimmers are less likely to drown in facilities that employ lifeguards. In 1998, for example, fewer than 100 people drowned in guarded pools and oceans. The number represents a mere 2.5 percent of the almost 4,000 fatal drownings that occur each year.

On guarded beaches, the United States Lifeguarding Association estimates the chance of drowning is one in 18 million. Horseplay and reckless swimming is also greatly diminished.

The Centers for Disease Control and Prevention has begun touting the importance of lifeguards as more communities and recreation managers have questioned whether guards are worth the cost and legal liability. The answer, according to the CDC and Red Cross, is an unequivocal yes.

"When weighing the cost and legal implications of intervention to prevent drowning," a recent CDC reports says, "decision makers should never lose sight of the enormous importance of protecting people from harm and preventing tragedy."


DON'T DRINK AND DIVE

Perhaps it's no surprise that drinking and diving don't mix.

A recent study, however, shows how dangerous it really is. Research done by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) shows a diver's ability to perform shallow-entry dives is impaired at a blood-alcohol concentration of only 0.04 percent.

That's half the legal limit in most states and the equivalent of a 160-pound man drinking two beers in an hour.

"It increases the risk to the point that the alcohol is a contributor to serious injury," says Dr. Bud Perrine, the scientist who led the study. "We now know what happens even with these fairly low amounts of alcohol."

As part of the study, 13 male subjects were asked to dive into a pool as if it held 3.5 feet of water. The performances were videotaped and rated on the relative risk of injury due to contact with the hypothetical pool bottom. None of the men realized his abilities deteriorated in lock step with his drinking, researchers found.

"As important as impaired performance, the divers show impaired perception of performances," says Enoch Gordis, NIAAA director.

The men were allowed to perform the maneuver sober, and all completed the task like a racing dive in which they hit the water and sprung to the surface. As they consumed alcohol, the dives became deeper, and in some cases, the subjects made little effort to stop their plunge. Roughly 11 percent of the 207 dives probably would have resulted in injury if the pool actually had been 3.5 feet deep.

The subjects also misbehaved on the pool deck, increasing the chances of a water-related injury in an uncontrolled environment.

"Their diving just really deteriorated—just as their behavior did," says Perrine, who also is the director of the Vermont Alcohol Research Center. "They started clowning around on the side of the pool and dancing. It wasn't very safe behavior."

The study is extremely important given the serious nature of diving-related injuries. Nearly 95 percent of diving accidents result in paralysis from the neck down, studies show.

"When we talk about shallow-entry injuries, we aren't talking about minor injuries," Perrine says. "We're talking about injuries that leave them quadriplegic, with no neurological function below the neck."

The data sends a critical risk management message for hotels, country clubs and other aquatic centers that have alcohol served in close proximity to the water.

Perrine has testified as an expert witness in several lawsuits between hotels and patrons who went swimming after drinking alcohol. In some cases, he says, the injuries resulted in upwards of $15 million judgments against the pool operators.

Many times, the hotel placed low priority on the pool after it closed. They wrongly believed the pool only required attention during hours of operation, Perrine says.

"That's a fallacious assumption," he says. "They have to secure the pool at night. Having a night watchman check every half-half hour is not enough. The control point has to be the pool itself."

Perrine recommends operators install motion censors that turn on lights and alert security personnel if the pool area is entered after hours. Other security measures such as higher fencing and constant security checks are additional ways of combating the problem.

"It cannot be a low priority," Perrine says.


DROWNING BY DEFINITION

Ever have a patron who nearly drowned? Turns out there's no such thing.

The CDC's National Center for Injury Prevention and Control is advocating that the term "near drowning" be stricken from our vocabulary.

The new definition of drowning, which will be published in Springer-Verlag's "Handbook on Drowning," describes drowning as "the process of experiencing respiratory impairment from submersion/immersion in liquid." It also has three classifications: death, morbidity and no morbidity.

However it's classified, drowning is—and always has been—the top safety concern for waterpark managers.

The latest CDC statistics show just how deadly it can be.

  • In 2001, 3,281 people drowned in the United States. The numbers, which do not include boating accidents, reflect an average of nine people per day.
  • For every child who drowns, three children receive emergency department care for nonfatal submersion injuries. Forty percent of these children require hospitalization.
  • Nonfatal incidents can cause brain damage ranging from memory loss and learning disabilities to a permanent vegetative state.
  • Males accounted for 78 percent of all drowning incidents in 2001.
  • Despite drowning rates, more women than men report a limited swimming ability.
  • In 2001, 859 children between the ages of 0 and 18 died from drowning. While drowning rates have declined in recent years, it is still the second-leading cause of injury-related death for children ages 1 to 14.
  • The drowning rate for all African-Americans is 1.4 times higher than for whites. The drowning rate for African-Americans between the ages of 5 and 19 is 2.6 times higher than white children.

  • ENTRAPMENT

    Pool entrapment is not new. The warnings have been around for years. Yet it remains a senseless—and wholly preventable—tragedy.

    An estimated 126 entrapment cases took place between January 1990 and October 2003, according to the latest figures from the Consumer Product Safety Commission (CPSC). Of those incidents, 25—roughly 20 percent of all entrapments—resulted in death.

    Aquatic centers and waterparks have a moral obligation to ensure their drains will not snare patrons. The precautions will not only save lives, they are part of any thorough risk-management plan.

    The protections, among other things, include making the right design decisions. Dual drains, if spaced and plumbed a sufficient distance from each other, minimize entrapments because bathers cannot block both drains.

    Some pools use so-called anti-entrapment covers that prevent arms and torsos from blocking the cover. Others eliminate direct suction outlets from pools and spas by installing a gutter system or surge tanks.

    Aquatic managers also can reduce risk with properly engineered and maintained atmospheric vents, which break the vacuum at the suction outlet once entrapment occurs. Release systems also may provide relief from certain kinds of entrapment.

    Once the mechanics are in place, pool operators still have major responsibilities. The National Swimming Pool Foundation (NSPF) advises paying close attention to spas and wading pools, where bathers are at greater risk because they're closer to the suction outlets in shallow water.

    Among the top priorities is ensuring the drains don't become clogged and drain covers are properly installed. No pool or spa should ever be opened if the drains are missing, damaged or secured incorrectly.

    Drain covers also should display markings for maximum flow rates, model number and proof of third-party testing, according to the NSPF. They also should be installed so that the maximum flow rating is not exceeded, making the drain more susceptible to entrapment and hair entanglement.

    Operators also should check frequently with the CPSC for any advances or new recommendations for preventing entrapment. Updates can be found at the CPSC Web site, www.CPSC.gov.


    AVOIDING ENTRAPMENT

    The National Swimming Pool Foundation recognizes five types of entrapment, all of them potentially life-threatening.

    Here are the five categories:

  • Hair entrapment: Occurs when long hair passes through the suction outlet and entangles itself beyond the cover. The suction pulls the head to the cover and locks it there. There were 40 hair entrapment incidents between 2001 and 2003, according the Consumer Product Safety Commission. Of those, 11 resulted in death.
  • Limb entrapment: Occurs when a drain cover is missing or broken. Suction pulls a limb—leg, arm, knuckle finger or toe—into the plumbing.
  • Body entrapment: Occurs when the body is held against the suction outlet and forms a seal. Fourteen deaths occurred from body or limb entrapment between January 2001 and October 2003.
  • Disembowelment: Occurs when buttocks seal a suction outlet, causing the rectum to burst and viscera to be pulled from the body.
  • Mechanical entrapment: Occurs when something attached to the bather—necklace, earring, bathing suit—becomes entangled with equipment below water.

  • WATER ILLNESSES

    No one goes to the pool to get sick.

    But that's exactly what's happening at aquatic facilities all over the country.

    Experts link about 10 diarrheal outbreaks to swimming pools each year. While the number may seem small to pool operators, it's probably grossly underestimated because most diarrheal illnesses do not get reported to health-care providers and health officials.

    One outbreak, however, can be devastating from both a financial and public-relations standpoint. Just ask the residents of Lawrence, Kan., where last year more than 600 people fell ill from the pool-related parasite cryptosporidium.

    "It's a major problem for aquatic facilities," says NSPF's Lachocki. "They're fighting open and invisible pathogens."

    Aquatic centers have begun combating the problem by educating the public. They're enforcing strict rules, insisting that patrons shower thoroughly before entering the water and prohibiting parents from changing diapers poolside.

    Pool operators have begun hanging posters and distributing pamphlets explaining why bathers should not swallow the water or swim when they have diarrhea. Some facilities also are instituting mandatory break times and encouraging parents to use that time to take their children to the bathroom.

    "From a prevention standpoint, it's one of the best things you can do," Lachocki says. "For example, you have to explain to parents why they can't change diapers near the pool or on lounge chair."


    BAD BUGS

    Cryptosporidium, a germ that causes diarrhea, continually threatens to hold pools and waterparks hostage. In order to combat the problem, pool operators and facility managers need their patrons' cooperation.

    The Centers for Disease Control and Prevention offers printable brochures and posters online at www.healthyswimming.org. Recreation managers are encouraged to print them out and hang or distribute them throughout their facilities.

    Here are six CDC-recommended "PLEAs" that facility managers can offer patrons to promote more sanitary pools. Post them throughout your aquatic center or waterpark to minimize the risk of recreational water illnesses.

    1. Please don't swim when you have diarrhea.

    2. Please don't swallow the pool water.

    3. Please practice good hygiene. Take a shower before swimming, and wash your hands after using the toilet or changing diapers.

    4. Please take your child on bathroom breaks frequently and perform regular diaper checks.

    5. Please change diapers in the bathroom and not at poolside or on deck chairs.

    6. Please wash your child thoroughly—especially in the rear end—with soap and water before entering the pool.


    The proper design also can help deter recreational water illnesses. The NSPF recommends using separate filtering systems for different areas of the pool. That way, only one section of pool has to be closed in the event of a diarrheal accident.

    Experts also recommend bathrooms be located close to the pool, making it easier for patrons to use the facilities. CDC studies show parents want clean, well-stocked bathrooms within a quick walk from the pool.

    The bathroom also should have adequate changing stations so moms and dads have a hygienic alternative to changing diapers near the water.

    "A lot of these issues can be addressed in the design," Lachocki says.

    The most important thing pools can do, however, is make sure their operators are well-trained. Having a pool operator who doesn't understand the job or the chemistry behind it is like hiring a lifeguard that doesn't know how to perform CPR or makes rescues.

    A recent NSPF study of six jurisdictions showed nearly one in every five operators had no formal training. Even worse, all six of the jurisdictions required it by law.

    Experts estimate nearly half of the pool operators are untrained in states that do not require it.

    "It's hard to believe," Lachocki says. "It's extremely important for operators to understand the chemistry behind it."

    The precautions will help prevent an outbreak of recreational water illnesses, thus keeping pools from having to close for health reasons. An unscheduled closing means lost revenue and extra expenses.

    But should a serious incident arise, Lachocki says operators should not be afraid to close the infected waters.

    "As little as people want to pull the cord," Lachocki says. "They don't want make their clients sick."


    CLEAN WATER

    You train your staff to prevent drowning. You've installed higher fences and security systems to prevent unwanted after-hours visitors.

    But how much have you done to prevent recreational water illnesses? Sanitary water means healthier, happier patrons and reduces liability. The Centers for Disease Control and Prevention, which has aggressively studied water illnesses, offers these dozen rules for cleaner pools.

    1. LEAD YOUR STAFF

    Make sure your staff understands the importance of preventing recreational water illnesses (RWIs). Discuss feasible steps for preventing an outbreak. Let your guards know it's OK to correct patrons who engage in unsafe behavior. For example, employees should be encouraged to stop patrons who change diapers near the water or on lounge chairs.

    2. PARTNER UP

    Work with the local health department and other pools to share information about outbreaks in your area. Ask local schools, day-care centers and camps to inform you of any diarrheal illnesses. Early warnings give you an opportunity to be more vigilant and step up sanitary measures.

    3. EDUCATE YOUR STAFF

    Would you put an uncertified lifeguard in the chair? Of course not.

    But how many of you let an untrained employee oversee the cleanliness of your water? Too many. Make sure your pool operators have taken a standardized training course taught by aquatics professionals.

    4. EDUCATE PATRONS

    Start by educating your season-pass holders, as they are likely to be your most frequent visitors. Consider brief safety programs for large groups before they enter the pool complex. This is especially important for large children's groups such as day-care centers and day camps.

    5. MAINTAIN EQUIPMENT

    Keep the chemical feed equipment and chemicals at optimal levels within state and local regulations. As you may know, poor pH control can compromise chlorine's effectiveness as a disinfectant. Make sure your staff knows that, too.

    6. CHECK YOUR DESIGN

    If you're building a new waterpark or aquatic center, consider a design that will best prevent the spread of water illness. Wading-pool filtration systems, for example, should not be on the same system as the rest of facility. This means only the kiddie pool will have to be closed in the event of a diarrheal incident.

    7. INSTITUTE DISINFECTANT GUIDELINES

    Have a written fecal accident policy in place and keep a record of all fecal accidents. This may help you respond more efficiently to any problems. Also make sure your staff is trained so they can respond properly and explain to patrons why, under some circumstances, it is critical to close the pool for a period of time. For detailed disinfectant guides, visit www.cdc.gov/healthyswimming/fecalacc.htm.

    8. EVALUATE YOUR HYGIENE FACILITIES

    CDC studies show parents contend they change diapers at poolside because changing rooms were unclean, poorly maintained and/or had inadequate diaper-changing facilities. Eliminate this excuse by providing clean, well-lit, well-stocked changing facilities close to the pool. Make sure the facility has warm running water and antibacterial soap.

    9. DEVELOP A BATHROOM-BREAK POLICY

    Reduce fecal outbreaks by scheduling hourly disinfectant breaks. Encourage parents to use the time to take their children to the bathroom. To prevent the spread of germs, make sure the bathrooms are stocked with toilet paper and ample soap for hand washing.

    10. CREATE SPECIAL POLICIES FOR LARGE GROUPS

    If large groups such as day-care centers frequent your facility, consider requiring the care providers to take RWI orientation. Make sure they realize your pool—just like their day-care center—does not allow children who are ill with diarrhea.

    11. POST AND DISTRIBUTE HEALTH INFORMATION

    The CDC offers posters and pamphlets to educate patrons on the dangers of recreational water illnesses. Post your pool's inspection reports, which let your patrons know you're taking sanitary water seriously.

    12. DEVELOP AN EMERGENCY RESPONSE

    Most pools have an emergency response plan for injuries and drowning, but few have a plan for managing a recreational water illnesses outbreak. Appoint a spokesperson to ensure that a consistent response is given to outside sources such as callers, the media, health department officials and others. Talk to colleagues who have experienced an outbreak. Ask them what parts of their response plans worked—and what did not.


    SEXUAL ABUSE

    Every pool seems to have one.

    A creepy loner that hangs out near the changing rooms. A childless man who sits near the kiddie pool. A goggle-wearer who constantly swims around children he doesn't know.

    Melissa Carrier hears these same stories at every aquatic facility she visits. She goes to the pools and waterparks to teach employees about identifying potential child abusers. Without fail, she listens to the lifeguards and gate monitors describe suspicious patrons and, occasionally, employees.

    "Inevitably, when we ask the questions, they all have stories," Carrier says. "One group says, 'We even have a name for him. We call him Chester the Molester because he comes by himself in the middle of the day and plays with children.'"

    Carrier works for Praesidium Inc., a Texas-based organization that helps recreation facilities and other kid-centered groups prevent abuse. The effort, which is supported by insurance companies, helps keep patrons safe. The training also serves to protect pools and waterparks from the lawsuits and liability claims that often accompany incidents of abuse.

    "Sometimes they don't know what they don't know," Carrier says.

    The first step toward preventing abuse at local aquatic centers is acknowledging it exists. In fact, pools and waterparks are havens for pedophiles because they are filled children in various stages of dress.

    "It's easy to gain access to kids and gain access without losing anonymity," Carrier says. "They can touch children in the pool and easily explain it away if someone challenges them on it."

    Aquatic centers also are susceptible because parents of proficient swimmers often pay little attention to their children. Moms and dads often chat with friends or sunbathe while their kids splash in the pool.

    "It shouldn't happen, but a lot of parents use the lifeguards as babysitters," Carrier says. "Children who want attention are more vulnerable. It's easier for [a pedophile] to engage them."

    Carrier encourages pool employees to look out for abnormal behavior. Some molesters like to go underwater near the slide, which allows them an unrestricted view of the children as they plunge into their pools and their bathing suits move. Others enjoy bumping and diving into kids at the wave pool.

    There are also reports of pedophiles using camera phones in dressing rooms and returning day after day to play with toddlers in the kiddie pool.

    Carrier also advises lifeguards to look for childless patrons who bring toys to attract young swimmers. She knows of one pool where a man brought dozens of inflatable toys and passed them out to children.

    "They [pool employees] need to recognize that these behaviors have to be addressed," Carrier says.

    Confronting suspicious patrons, however, is a delicate subject. Carrier advises facility employees to take a friendly, but pointed, stance. She suggests they approach questionable customers, introduce themselves and ask their names.

    "Just going up and introducing yourself is going to make a big difference," Carrier says. "You've taken away their anonymity. If they're there for the right reason, all you've done is made a personal connection without making any accusations."


    CD FOR SAFETY
       

    Despite the relative safety of pools and spas, injuries can be catastrophic. To continue improving the knowledge surrounding swimming pool and spa safety, the National Swimming Pool Foundation is offering its newly published Aquatic Safety Compendium CD.

    Designed to be an important tool that helps professionals clarify the merits of litigation based on scientific information, the CD contains comprehensive information on safety and legal issues that will assist attorneys, aquatic directors, property managers, pool builders, risk-prevention professionals and law-school faculty.

    For more information, call 719-540-9119 or visit www.nspf.org.




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