Guide to managing your aquatic risks

Drowning and spinal injuries at swimming pools and aquaticare are some of the most traumatic and costly events any program can face. The trauma is not restricted to the child who is injured or dies, but encompasses the family, lifeguards, facility staff, and community. A death or injury claim involving drowning can result in multi million dollar awards and significant, undesirable media attention.

In June 2002, the World Conference on Drowning Prevention adopted a more appropriate, uniform definition of drowning: “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.” Under this definition, drowning is a process that can be interrupted, by rescue for example. This new definition excised the use of the term near-drowning.

The National Safe Kids Campaign estimates 5,000 children ages 14 and under are hospitalized annually as a result of drowning incidents; 15% die in the hospital, and as many as 20% suffer severe, permanent neurological disability. Two factors make a youth program drowning very difficult to defend in court: it’s reasonable to expect the facility to be maintained safely, and it’s reasonable to expect appropriately trained supervisory personnel on the job during swimming activities.

This safety guide discusses the major areas that aquatic managers must address:

• Principal causes of drowning
• Staff certification and training
• Rescue equipment and emergency procedures
• Communications equipment
• Facility design
• Managing visiting groups

In a controlled environment, after you eliminate the alcohol factor, there are three primary causes of drowning and spinal injuries: unsafe conditions, unsafe acts, and errors in judgment.

Ultimately, responsibility for the health and safety of program participants, visitors, and staff falls on the facility director. The responsibility (liability) of an aquatic program extends beyond the water to the deck or beach area (electrical appliances, glass hazards, inappropriate patron behavior) and into locker rooms and showers (slip hazards and areas for potential sexual molestation). Pool facilities must also provide a safe environment for contractors who come to your site. Falls into unguarded pits in pump rooms, inhalation of powder or gas chlorine, and injuries from slip-and-fall accidents could result in claims against your organization.

Staffing qualified lifeguards, and training them to follow your organization’s specific procedures, is the first step toward a successful aquatic program. Aquatic administrators should address two separate areas of training:

• Lifeguard certification by an outside organization (i.e. American Red Cross, Jeff Ellis, USLA, YMCA)
• In-service, facility-specific training designed to verify and improve lifeguards’ skills and teamwork

Every aquatic facility should have emergency and operational procedures that address the hazards, activities, and patrons specific to their organization. Due to the variety in quality and content of lifeguard certification programs, aquatic directors should not rely on them as the sole means of staff training. It is advisable to work with an aquatics professional to design an in-service and skills testing program to address your site-specific needs.

Lifeguard certification
Over the past few years, there have been a number of significant course revisions within the American Red Cross and YMCA aquatic programs. Training priorities have changed and some courses have been eliminated or revised. For example, the American Red Cross Head Lifeguard course has been replaced by Lifeguard Management. The American Camp Association provides a comprehensive listing of certifications that meet specific ACA standards. The below chart describes courses offered by major lifeguard training organizations:

Lifeguard management courses
The American Red Cross, Ellis and Associates, and YMCA have provided Lifeguard Management courses for several years. The courses are designed for people who supervise lifeguards, and cover topics such as selecting and training lifeguards, inspecting facilities, and managing an aquatics program.

The training is recommended not only for those who have direct supervisory responsibilities for lifeguards, but also for people who have overall responsibilities for lifeguards. The American Red Cross Lifeguard Management course is class-room only (no in-water elements) and has no precourse skills requirements. Any currently certified Lifeguard Instructor can teach the course.

Markel recommends that at least one facility member becomes certified in Lifeguard Management or has documented training to the equivalent level. Documentation should be from a third party (i.e. a college transcript or letter from a professor indicating they worked at the pool on campus). That person should also be at least 21 years old, and have a minimum of six weeks of experience in a management/supervisory position in a similar aquatics program.

See Appendix B for additional courses available to lifeguards.

In-service training
If your lifeguards received training from several different organizations, your in-service training becomes even more critical for consistent responses and teamwork.

The following lists the skills that you can incorporate into your in-service training program, depending on your organization’s activities, equipment, and conditions:

• Bag-valve mask and oxygen therapy.
• Aquatics programs should work with local EMS to determine the best course of action for spinal with a lifejacket.  For open water programs it may not be in the best interest of the victim to first get them to shore and then board.
• Submerged victim search patterns for zones of coverage to take place in under three minutes (longer than that and lifeguards are doing body recoveries, not rescues).
• Rescue breathing in deep- and shallow-water conditions.
• Stabilizing a fractured leg in deep water from a water skiing injury.
• Retrieval of a weight representative of a 180-pound person in 12 feet of water.
• Submerged victim search with the use of fins and face mask.
• Victim retrieval practice with a rescue board or other rescue device.
• Multiple victim retrieval practice (simulated lightning strike).
• Unruly patron intervention.
• Retrieving multiple boats blown by the wind.
• Seizure victim stabilization.
• Allergic reaction simulation.
• Hostile visitor simulation.
• Whole rescue simulations, not just the rescue itself.
• Emergency and reporting procedures.
• Scanning and zone coverage skills.
• Victim recognition.
• Decision making and problem solving scenarios.
• Guarding individuals with disabilities.
• Communicating in common terms in language commonly used.

Scenarios should include rescue through resuscitation. Often times aquatic facilities will perform the specific rescue but not think about pulse-non-breather.

The YMCA recommends at least two hours of in-service training per month during high season, and at least one hour at other times of the year. Additional time would be needed for facilities that have play elements or open water, as these require special procedures. Ellis and Associates mandates in-service training four hours per month for full-time employees,and one hour per month or four hours per quarter for part-time employees. USLA requires providing lifeguard time for daily workouts to maintain physical fitness and stamina, recommends monthly drills involving mock rescues and other emergencies for all employees, and requires a minimum 16 hours per year in rescue skills refresher training.

It is highly recommended that lifeguards actually get in the water to workout, swim laps and practice swimming skills. In camps with big bodies of water, this is especially important not only due to the wind and wave action, but also distance as well as temperature of the water. An 82 degree pool is very different than the 75 degree lake in the morning.

Pre-employment screenings
To ensure your facility hires properly trained lifeguards who are physically able to provide rescue services, conduct the following pre-employment screenings:

Check certification records. During the application process, it’s essential to check with the certifying agency to verify that your facility’s lifeguards have completed formal training.

Conduct a physical screening. Conducting a physical screening of lifeguards provides your organization with necessary information on whether a lifeguard will be able to perform all the essential functions of the job. Most importantly, it helps you determine any physical limitations that might impact the lifeguard’s performance of lifesaving duties.

Conduct a vision screening. If lifeguards cannot see clearly without corrective eye wear, they must have that eye wear with them to perform their jobs. Some programs have accommodated lifeguards who wear contact lenses by providing eye goggles. Other programs, such as those operating in open-surf conditions, have determined that contact lenses are a job disqualification because they are likely to be dislodged in turbulent surf conditions, even with the use of goggles. Job disqualification for the use of corrective eye wear is a site and condition specific consideration that needs careful study and even legal advice. The bottom line is that if lifeguards can’t see the victim, they can’t perform their jobs properly, and the chance of a successful rescue diminishes.

Offer the Hepatitis B vaccination. Aquatic directors should be aware that the Occupational Safety and Health Administration (OSHA) requires your organization to offer lifeguards, in writing, the Hepatitis B vaccination series. Although lifeguards may initially refuse the vaccination, they may change their minds (while still in your employ) or request it following a blood-borne pathogen exposure.

Faster response time saves lives
Rapid response time is critical if a youth is to make a full recovery after a drowning incident. Most CPR classes state that brain damage does not begin until a youth has been without oxygen (underwater) for about four to six minutes.

Make sure your lifeguard training focuses on quick response times and searching large areas quickly. In cloudy water lakes, provide swim fins and face masks to facilitate search efforts, and train lifeguards in their use.

Opening and clearing airways
It’s impossible to overstate the importance of opening, and if possible, clearing the airway of drowning victims. Simply opening the airway when the victim’s mouth is above water often results in spontaneous respirations.

There are some fundamental differences between the American Red Cross, YMCA, Jeff Ellis, and USLA airway clearing training. American Red Cross lifeguards are taught to bring the victim out of the water onto a backboard or side of the pool before beginning rescue breathing and CPR. USLA, Jeff Ellis, and YMCA lifeguards are taught to try to establish an airway as soon as possible, even in the water. It’s important that aquatic directors understand the airway-clearing protocols their lifeguards were taught, especially when lifeguards received training through several different organizations, and match lifeguard training to their organization’s facilities and activities.

If your aquatics program operates at a lake with a large swim area, speak with your lifeguard training agency about which airway-clearing protocols to use in your specific situation.

Keeping lifeguards alert
Many factors can contribute to lifeguard fatigue, including noise, amount of time spent in the sun, high temperatures, amount of water consumed, sleep deprivation, alcohol consumption, monotony, and medications prescribed. Studies have shown that fatigue can reduce peripheral vision by as much as 30%. Combine that with a lack of vigilance and you have a deadly combination for almost any activity.To keep lifeguards alert, Markel advises 20- to 30-minute rotation schedules and a body position change (stand, sit, or kneel on one knee) every 5 to 10 minutes. Lifeguards must also be positioned so that they can clearly see 100% of their zone of coverage. Chairs set back from the edge of the pool create blind spots in front of the lifeguard. Provide lifeguards with shade and clothing that reduces the effects of sun exposure. Sunglasses are essential to reduce eye fatigue and protect eyes. Polarized sunglasses are highly recommended, as they greatly reduce the effects of glare.

Automated External Defibrillators (AEDs) are portable units used to electrically stimulate the heart during sudden cardiac arrest. Cardiac arrest has been reported in youth programs for a variety of reasons, such as a congenital heart defect, electrical shock, a blow to the chest during a fight, or being hit with a baseball.

Anyone attending your aquatic facilities could have a sudden cardiac arrest unrelated to drowning. Therefore an AED may be critical.

Drowning results in suffocation, which eventually results in failure of the heart muscle to continue beating. Establishing an airway and rescue breathing is critical in these situations.

Although AEDs may be expensive, talk to your regional American Heart Association or American Red Cross to see if they know of a funding source in your region. Also, make sure you add your AED to your insurance policy in case of theft or vandalism.

Some aquatic administrators may think they don’t need AEDs because of their facility’s close proximity to a rescue station. The American Heart Association says that when a person suffers a sudden cardiac arrest, their chances of survival decrease by up to 10% for every minute that passes without defibrillation. At most facilities, the absolute minimum time between the occurrence of a cardiac arrest and the arrival of an ambulance is at least five to ten minutes.

You should obtain advice from legal counsel and research your state and local regulations that might affect your program, including training requirements, medical control, notification of AED use, location, and immunity provisions.

Oxygen delivery
Increasing oxygen delivery in rescue breathing can reduce brain and cardiac damage, so it is important to provide the electrical stimulus from the AED in conjunction with oxygen.

The International Life Saving Federation (ILSF) takes the following position on oxygen delivery: “The physiological benefit of providing oxygen to spontaneously breathing drowning victims or during CPR in drowning victims in respiratory arrest is clear and advocates that oxygen should be used in all drowning victims.”

The ILSF recommends using reliable oxygen equipment that is simple to assemble and operate. They recommend a non-rebreathing mask with a fixed flow of 15 liters of oxygen per minute for spontaneously breathing victims, and a bag-valve mask with oxygen inlet for patients in ventilatory arrest. Make sure the oxygen container is large enough to allow oxygen delivery until professional medical personnel arrive on the scene. Protect your staff and satisfy OSHA requirements by adding non-latex gloves and a blood-borne pathogen kit to your AED.

Proper use of a bag-valve mask and portable oxygen requires practice. This would be a good in-service skill to practice with your staff, including interaction with EMS. Handling and storing oxygen safely requires special care. Although oxygen does not burn, it will fuel fires and cause them to burn hotter and faster. Keep the area surrounding the oxygen cylinder clear of electrical devices, flammable items, or hazards that might cause sparks, damage, or deterioration. If a fire occurs, alert fire fighters to the presence of the cylinders.

Refill oxygen bottles before they reach a residual pressure of less than 200 p.s.i. If the response time for your rescue squad is more than five minutes, you may wish to increase your residual pressure requirements. Use the following formula to calculate the remaining useful oxygen to determine if your aquatic facility has enough oxygen to maintain until EMS arrives:

(Gauge Pressure minus Safe Residual Pressure) times Cylinder Factor divided by Flow Rate
The following are factors for some of the common cylinder types:

Answer: 6.4 minutes

Solution: (800 minus 200) times 0.16) divided by 15 = 6.4

Many states mandate the presence of telephones at swimming pools. Most states have not specified whether cell phones are adequate, and concrete walls of indoor pool buildings may compromise cellular reception. At larger aquatic facilities and at many lake operations, walkie-talkies have proven to be very effective at communication within the facility, but they can’t directly communicate with EMS.

Horns and whistles: These devices are often the communications equipment of choice for lifeguards and aquatic staff. Most aquatic programs develop their own communications signals. Make sure to explain these signals to all participants during your swimmer orientation program. Reliable communication methods are critical to keeping lifeguards and patrons aware of potentially unsafe circumstances and dispatching lifeguards to emergencies. As the size of your facility increases, the need for reliable communication methods becomes ever greater, because lifeguards may be too far from each other to speak clearly or even see each other. While some boats have horns (i.e. ski boats) it is always recommended that a backup be carried, in the event the horn doesn’t work; especially if they are across the lake.

Canoes and kayaks: These craft have their own communication system with paddle or arm positions. The American Canoe Association offers courses and publications on this form of communication.

Lightning-warning systems: Some aquatic programs, particularly those in coastal areas or locations known for sudden lightning storms, have added lightning-warning systems connected to a horn. Lightning can be very dangerous to indoor pools as well. Lightning can travel through windows or an open door, and the electrical current could pass through the ground to piping or cables that go into your pool or locker rooms. All programs should have specific plans for quickly evacuating the waterfront or pool in the event of lightning.

Weather boards: Many programs post a weather board at the entrance to their aquatic areas that is updated daily with the expected weather conditions. This is a great method to communicate to staff and participants about potential inclement weather, as well as to indicate when additional sunscreen should be applied.

Should you allow a visiting group to swim in your pool or lake, or use your boats without your qualified lifeguard present? Absolutely not. Pools are viewed as attractive nuisances,and the host program (camp, school, club, conference center) can easily be held responsible for any injuries or deaths. An outdoor pool is potentially dangerous in ways that many directors never consider. For instance, many youth roller blade or skateboard and would like access to an empty pool.

What if the visiting group wants to bring its own lifeguard? Legally, this is a complicated issue because the answer will vary according to the laws, statutes, and legal precedents set in each state. The legal concept is referred to as negligence per se, which means that if a program violates a statute/law/regulation, the program is negligent. Some states specifically prohibit the use of a pool without a lifeguard provided by the owner. Asking a visiting group to sign waivers or release forms is of little value in these states. The host program cannot transfer the responsibility for the safety of the group at a pool (and probably a lake) facility. Here are two options for a visiting group wishing to swim at your facility:

• Any lifeguards with the visiting group would serve as extra spotters, not lifeguards. The host program takes full responsibility for the visiting group.
• The visiting group respects the host program’s liability concerns and does not swim at the host facility.

Groups that have access to canoes and other boats must also have access to the life jackets. If you don’t want groups to have access to the equipment, lock it up. This includes ALL equipment and not just the paddles and PFD’s.

Swimming at other facilities
If your organization takes groups to the local YMCA or community pool, you still have some liability. Depending on how frequently your organization uses the community pool, you might ask the pool director to add your facility and staff as additional insureds to their insurance policy. Also, ask your attorney about other methods that might protect your organization. Ask parents to sign informed consent forms, which include a release of liability.