The Right Safeguards

Protecting Pool Patrons, Reducing Risk

By Wynn St. Clair

Aquatic centers are meant to be joyful recreation spaces. The waterslides, the lazy rivers and, yes, even the tween-commanded water cannons carry a promise of infinite fun to patrons.

Creating such an inviting atmosphere, however, is serious business because no swimming facility—regardless of its thrilling diversions and features—can survive without a meaningful safety plan. In addition to protecting lives, a safety-minded approach minimizes liability risks, reduces operation disruptions and encourages patronage.

Of course, it's impossible to inoculate a facility from every possible tragedy or minor mishap. But, with the proper programs, personnel, policies and procedures, aquatic managers can take tremendous strides toward making their waterpark or pool the healthiest, happiest and most hospitable facility possible.

The key, experts say, is to address these safety issues while keeping the spotlight on aquatic recreation. Swimming, water fitness classes and other aquatic sports can play an important role in combating diabetes, heart disease and obesity-related illnesses. In fact, swimmers have about half the risk of death compared with inactive people, according to the Centers for Disease Control and Prevention.

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

"You never want to make people afraid to swim," said aquatic expert Shawn Morris, who works with facilities across North America. "You want to address safety issues without making people terrified to go in the water."

Safety Personnel

As the public's recreation spending shrinks, aquatic centers may face smaller revenues. Some facilities—in particular, health clubs and hotels—have reduced expenses by cutting lifeguards. While managers may see it as a painful necessity, statistics show it may be detrimental to both patrons' and the facilities' overall health.

According to the CDC, U.S. lifeguards rescue more than 100,000 people from drowning annually. In addition, for every rescue, an effective lifeguard makes scores of preventive actions such as warning individuals away from dangerous areas and suggesting that poor swimmers stay in shallow waters.

Without question, professional lifeguards have had a major impact on drowning prevention in the United States. The number of Americans participating in water recreation has grown tremendously in the past century, but the annual incidence of drowning has declined nationally from about 6,300 people in 1981 to about 3,400 in 2007, according to the National Center for Injury Prevention and Control. Nevertheless, despite the advances in rescue techniques and the decline in drowning rates in the United States, drowning remains a leading cause of unintentional injury death, especially among children and youth.

"If the incidence of drowning is to be reduced further, greater attention to prevention, including the staffing and training of lifeguards, is essential," according to "Lifeguard Effectiveness: A Report of the Working Group," a publication of the National Center for Injury Prevention and the Centers for Disease Control and Prevention.

Reliance on Compliance

In many cases, pool safety is more than just a moral responsibility, it's a legal requirement. The Virginia Graeme Baker Pool and Spa Act required all public pools in the United States to meet a December 2008 deadline for outfitting drains with covers designed to prevent entrapment.

Named for former Secretary of State James Baker's granddaughter, who died at age 7 when suction from a hot tub drain held her underwater, the law aims to address a wholly preventable tragedy. The mandate, which received bipartisan support, requires commercial public pools and spas to take relatively simple measures to prevent drain entrapment from occurring.

An estimated 94 entrapment cases took place between 1999 and 2009, according to the most recent figures from the Consumer Product Safety Commission (CPSC). Of those incidents, 12 resulted in death. However, not all entrapment incidents get reported as such, so experts believe the number is much higher than statistics indicate.

"Kids have died in their parent's arms...kids have been stuck in a drain in the shallow part of the pool," said Paul Pennington, chairman of the Pool Safety Council, an advocacy group. "After an incident, the parents and public pool owners always say they didn't know anything about this issue."

About 42 percent of the reported incidents took place in public pools, reinforcing the fact that aquatic centers and waterparks have an 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. Under the law, all public pools and spas must have compliant drain covers and a second anti-entrapment system installed when there is a single main drain other than an unblockable drain.

Single drain public pools are not required to install multiple drains. Rather, federal law only requires that they install approved anti-entrapment drain covers and use one of the other secondary layers of protection. The law also does not require public pools to install new sumps.

"Nowhere (in the law) does it say to install two drains," Pennington said. "This can cost a lot of money because you have to empty a swimming pool and cut up the bottom of the pool to put in two drains. This can be especially cost-prohibitive for older pools that would then need to be re-plastered."

Dual drains, if spaced and plumbed at least 3 feet from each other, minimize entrapments because bathers cannot block both drains.

Dual drain pools only need to install approved safety drain covers to comply with the law, but the Pool Safety Council strongly recommends all pools and spas, even private residential pools and spas, install both approved drain covers and an additional layer of protection.

Pools do not need to be drained in order for drain covers to be installed. Initial requirements out of Los Angeles County that its 16,000 public pools be drained in order to replace covers would have led to nearly 1 billion gallons of wasted water, Pennington said.

The CPSC staff also recommends that to eliminate and not just mitigate the drain entrapment hazard in pools and spas, pool owners should disable old drains or build new pools without any drains and use gutters, overflows and/or skimmers to provide water to the pump.

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 that drain covers are properly installed. No pool or spa should ever be opened if the drains are missing, damaged or secured incorrectly.

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.poolsafely.gov.

Though pools were supposed to be shuttered until they met the law's requirements, recent media reports suggest this has not happened. For example, an investigation by the Daily Herald, a suburban Chicago newspaper, found that more than 1,000 facilities in Illinois weren't in compliance.

Most remained open anyway, the paper reported in August 2010. Pennington views their continued operation a federal crime.

"We want to make pools entrapment-proof," he said. "If a pool doesn't meet the standards, it shouldn't be opened."

Protective Padding

Progressive aquatic managers also are shunning outdated slides, diving boards and ladders for not being kid-friendly enough. Morris said operators should look at the equipment as if it were something to be installed at a local playground.

Is your slide built on hard ground and devoid of any padding and safety surfacing? Falling from the apparatus could guarantee a cracked skull or worse.

Do your ladders lack enclosures? Well, a child's foot could slip right through the rungs.

Are the handrails 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.

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

"I sometimes see things at pools that would never be allowed at playgrounds," Morris said. "It's an industry-wide problem that needs to be addressed."

It's more than just a moral imperative 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.

Proactive pools are installing padding under their diving boards to cushion falls. The pads 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.

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

"It may seem like a small thing, but it can prevent a lot of big headaches," Morris said. "There's nothing worse than gaining a reputation for being an aquatic center where people get injured."

What's in the Water?

Pools also don't want to earn a reputation as a place where people get sick. But that's a battle aquatic facilities all over the country are fighting on a daily basis.

Experts link about a dozen 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.

Between 2005 and 2006, for example, a total of 78 recreational water-associated outbreaks affecting 4,412 people were reported to the CDC. It's the largest number of outbreaks ever reported in a two-year period.

In addition to the public health incentives for keeping a disease-free pool, there are financial ones as well. These outbreaks resulted, in many cases, in pool closures, bad publicity and attendance drops.

Hospitalizations for three common waterborne diseases cost the health care system as much as $539 million annually, according to research presented this summer at the International Conference on Emerging Infectious Diseases. Using data from a large insurance claims database between 2004 and 2007, the study estimated the hospitalization cost of three common waterborne diseases in the United States: Legionnaires' disease, Cryptosporidiosis and Giardiasis. For each case of disease, they calculated the cost paid by the insurer, the out-of-pocket cost to the patient and the total amount paid.

Total estimated costs for hospitalization for the three diseases was $154 million to $539 million, including $44 million to $147 million in direct government payments for Medicare and Medicaid. Estimated annual costs for the individual diseases were: Giardiasis, $16 million to $63 million; Cryptosporidiosis, $37 million to $145 million; and Legionnaires' disease, $101 million to $321 million.

Inpatient hospitalization costs per case averaged more than $34,000 for Legionnaires' disease, approximately $9,000 for Giardiasis and more than $21,000 for Cryptosporidiosis.

"When people think about these diseases, they usually think of a simple case of diarrhea, which is a nuisance but quickly goes away. However, these infections can cause severe illness that often result in hospital stays of more than a week, which can quickly drive up health care costs," said Michael Beach of the Centers for Disease Control and Prevention, an author of the study.

Recreational water illnesses—which are often referred to as RWIs—are caused by germs spread by swallowing, breathing in mists or aerosols of, or having contact with contaminated water in swimming pools, hot tubs, waterparks, water play areas, interactive fountains, lakes, rivers or oceans. Splash parks, in particular, have become popular breeding grounds for waterborne illnesses because they are often unsupervised and users are less vigilant than pool patrons, according to CDC officials.

Diarrhea is the most common symptom, but other common complications include skin, ear, respiratory, eye, neurologic and wound infections. Children, pregnant women and people with weakened immune systems are most at risk for RWIs, which can sometimes be fatal.

Modest investments in preventing these diseases could lead to reduced disease and significant healthcare cost savings, Beach said. Some examples of possible, low-cost interventions include public education campaigns, suitable disinfection technology, appropriate hygiene facilities and regular inspection of pools and other recreational water facilities.


Drowning Prevention Matters

Who's at risk at your aquatic facility?

Though drownings continue to decline nationwide, more than 3,000 occur each year. Data from the Centers for Disease Control and Prevention paint an interesting picture of who is most at risk and perhaps why:

  • In 2007, the most recent year available, there were 3,443 fatal unintentional drownings in the United States, averaging 10 deaths per day.
  • More than one in five fatal drowning victims are children 14 and younger. For every child who dies from drowning, another four received emergency department care for nonfatal submersion injuries.
  • Nonfatal drownings can cause brain damage that may result in long-term disabilities including memory problems, learning disabilities and permanent loss of basic functioning.
  • In 2007, males were 3.7 times more likely than females to die from unintentional drownings in the United States.
  • Between 2000 and 2007, the fatal unintentional drowning rate for African-Americans across all ages was 1.2 times that of whites. For American Indians and Alaskan Natives, this rate was 1.7 times that of whites.
  • Alcohol use is involved in up to half of adolescent and adult deaths associated with water recreation and about one in five reported boating fatalities. Alcohol influences balance, coordination and judgment, and its effects are heightened by sun exposure and heat.

Teaching Safety

Another way to keep people safe in the water is to teach them how to be safe in the water.

Roughly 17 percent of American adults swim at least six times per year, studies show. But even more adults—a jaw-dropping 39 percent—described themselves as being afraid to put their heads under water, while 46 percent claim to be scared of deep water.

These numbers should serve as both an inspiration and a challenge to the aquatic industry. With an estimated 5,000 instructors in the United States today, that means each instructor has a pool of roughly 10,400 potential patrons he or she could be teaching.

"We need to teach adults to swim because more adults drown than kids in the United States," said swim instructor Melon Dash, founder of the Miracle Swimming Institute. "According to the CDC, more than 70 percent of the drownings in the U.S. are by adults. That's staggering."

Tapping adults who are too scared to swim should have a positive impact on other programs, as well. Dash said parents who are frightened by the water often keep their children out of learn-to-swim classes, as well.

Teach aquaphobes to love the water, Dash explained, and they will be more likely to enroll their children in aquatic programs. Ignore the problem, and the kids most likely will inherit their parents' reservations and pose safety risks for the aquatic facilities they visit.

Dash, who has taught more than 3,000 adults to overcome their aquatic fears, has witnessed this phenomenon with her own eyes. She estimates that 90 percent of her students had at least one parent who was afraid of water.

"Parents should learn to swim before their children. They need to know what the water is all about and they need to give correct messages to children as they're becoming learn-to-swim age and older," Dash said.

To address the issue, Dash founded a swimming school in 1983 specifically for adults who were afraid to swim. Her aim isn't to teach them to master freestyle by the course's end. Her initial concerns have nothing to do with whether they can tread water for long periods of time.

Oftentimes, the first step is just making the patron feel comfortable in the water, she said. Only when that occurs can additional progress and other lessons take place.

If a student doesn't like to let go of the pool wall, for example, Dash doesn't force him or her to try it right away. To the contrary, she encourages students to hang onto the side, if it makes them more comfortable. She tells them to feel the water, to think about how it feels and concentrate on how it moves against their bodies. It gives novices a chance to experience the water instead of allowing their reservations to consume them.

This philosophy contradicts old-school beliefs that a person only needs to learn how to swim or tread water to overcome aquaphobia. Her teaching experiences have taught her that adults cannot learn to swim until they conquer their fears.

"Here's the big problem when people are afraid: They cannot learn because they are not in control," Dash said. "They don't know if they're going to lose it or not. If they don't know, how are they going to concentrate on their breath? If they're worried about other things, then how can you get them to concentrate on the task at hand?"

Students move at their own pace and don't compete with one another. Classes typically meet eight times for three hours each, with one hour on land and two hours in a warm pool.

Dash suggests aquatic facilities advertise the classes with honest but reassuring messages. Potential patrons need to know that the course will cater to their specific needs.

She recommends posting a sign that reads something like this: There's a class in warm water on this day at this time, and you can sign up for it here. It's three hours long. It's free. It will feel too short. We guarantee it will change your mind about the water. Will you be there?

In the end, people who conquer their aquatic fears will become excited patrons and the parents of stronger swimmers, Dash said. And stronger swimmers means a safer aquatic experience for everyone involved.

"People drown because they lose it in the water and they don't know how the water works and swimming lessons don't teach it." Dash said. "You have to use a different paradigm. It's as simple as that."


Rules for Pools

Sanitary water means healthier (and therefore happier) patrons and reduces liability. The Centers for Disease Control and Prevention, which has aggressively studied water illnesses, offers these rules for cleaner pools:

1. Lead Your Staff

Of course, every facility has its own pressing priorities. And, of course, it's hard to juggle those demands.

However, all aquatic centers must make health a priority. The single greatest action you can take against water illness is to create an RWI protection plan. Be sure to back up your plan with resource investment and commitment. This will set the tone for the rest of the staff. Though an aggressive response after an outbreak is good, it's much more responsible (and cost-effective) to be proactive.

2. Develop Partnerships

Build a communication bridge between your facility and the local health department. This is an excellent way to get information on other outbreaks occurring in your area. If, for example, you begin to hear about outbreaks at other pools, day-care centers and schools your patrons attend, then take proactive measures and increase your vigilance to protect your facility. In the case of another local pool closing after an outbreak, work with health officials to educate the public—especially the swimmers who will be descending on your pool from the closed facility. Be sure to use the media, too, to help spread the message. Ask them to remind the public that no one should swim if they have diarrhea.

3. Educate Pool Staff

In the war against RWIs, there's no greater weapon than education. Make sure your pool operator, at a minimum, has attended a training course on waterborne illness. Your employees should be as well versed on good hygiene methods as they are on CPR techniques and lifesaving skills. Empower your staff to inform parents of proper poolside hygiene. They should be able to explain in an informative, yet inoffensive manner, why behavior such as using picnic tables to change diapers is unacceptable. This may dictate putting an older, more confident lifeguard in charge of the kiddie area.

4. Educate Swimmers & Parents

A proactive staff must educate the public on ways to prevent waterborne illness. First, ask bathers to not swim if they have diarrhea. Also instruct them to refrain from swallowing pool water. Other key elements include encouraging patrons to practice good hygiene (showering before swimming), make frequent diaper checks, take children on regular trips to the restroom, change diapers in the restroom, not poolside, and wash children's rear ends thoroughly with soap and water before swimming.

5. Evaluate Aquatic Facility Design

When building a new facility, consult industry colleagues and health workers about how to best design the facility to prevent outbreaks. The kiddie pool, for example, should not share the same filtration system as other parts of the aquatic center. Increasing the water turnover rates in kiddie pools also may reduce the chances of a waterborne illness. This decision, of course, must be made in conjunction with regulators to prevent suction problems.

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Rules for Pools

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6. Institute Disinfection Guidelines

It may not be required, but it's smart to have a written policy on how to respond to fecal accidents. Keep a written log of all fecal accidents, chlorine and pH level measurements and any major equipment repairs so you can respond better to any outbreaks or contamination. For detailed disinfection guidelines, go to: www.cdc.gov/healthyswimming/fecal_response.htm

7. Evaluate Hygiene Facilities

In a recent CDC survey, a majority of parents claimed to change their children's diapers at poolside because the restrooms were unclean, poorly maintained and did not have an adequate diaper-changing area.

Ask yourself a few questions. Does your aquatic center have adequate facilities? Are they close to the pool? Are they clean and well-stocked? Would you enter them barefoot? If you answered "no" to any of those questions, it's time to rethink your strategy. Better yet, ask your patrons the same questions. If they respond negatively to just one of the four, you've got some work to do. If your facility is large enough, consider hiring someone whose sole responsibility is maintaining the restrooms. You may want to consider spending the money to renovate your diaper-changing stations. You also may contemplate building diaper-changing cabanas with running water and soap near the kiddie pool. It's a terrific way to cut down on the number of diaper changes performed on lounge chairs and tables. These moves admittedly require some extra capital. However, they may prove to be good investments if they prevent an even more costly temporary closure after an outbreak.

8. Develop a Restroom Break Policy

Many aquatic facilities take a break every hour or so for chemical testing. This reassures patrons that the staff has the best intentions for their patrons' health and safety. You can take an even more proactive step toward reducing fecal accidents by referring to this period as the hourly "restroom break."

Have your staff inform parents that this is an optimal time to take their children to the restroom. If you implement this strategy, however, be sure that the facilities are clean and well-stocked with toilet paper and antibacterial soap to prevent the transmission of germs. Should parents inquire, tell them the restroom break not only cuts down on fecal accidents, it also reduces the amount of urine in the pool, which saves the disinfectant that should be killing germs.

9. Create a Special Policy for Large Groups of Young Children

If you allow large groups of small children—from a local day-care center, for example—to use your facility, have a special policy in place to reduce the chances of waterborne illness. First, require the caretakers to undergo RWI training. They should be briefed fully on many of the components listed above. Make sure they know that, just like many day-care centers, your facility does not admit children with diarrhea.

10. Post & Distribute Health Information

Don't be afraid to post signage in a conspicuous area before pool entry. The CDC recommends signs that state:

  • Don't swim when you have diarrhea.
  • Don't swallow the water.
  • Take your kids to the restroom frequently.

You also should encourage swimmers to shower with soap and water before entering the pool. This helps reduce the outbreaks by removing the invisible fecal matter from the swimmers' bottoms. A quick rinse over a swimsuit with cold water, however, is not going to do much good. Consider having hot showers available to encourage swimmers to give themselves—and their children—a more thorough cleaning before entering the pool.




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