Tag Archives: drowning

School Instructor-Lifeguards

I was looking for state laws regarding “Swim at Your Own Risk” signs for another blog when I ran across the following article: Lack of School Lifeguards Prompts Questions.

In particular, I was taken aback by a statement by San-Diego–based water safety consultant Alison Osinski when she said: “We’re asking them to do two jobs at once - teach and lifeguard - and that’s impossible,” With all due respect to Ms. Osinski and those who share this conventional wisdom, I strongly disagree.

While lifeguards in a lifeguard station scanning an area of responsibility certainly should perform no other duties, including, but not limited to, teaching lessons, the same is not true for swimming instructors and coaches. Instructors and coaches have a primary duty to supervise their group and account for their participants at all times. Although this is accomplished by course planning, assessment of participant ability, class organization and management, instructor positioning relative to the class, the use of safety equipment and accountability checks, etc., these tactics and others are as effective as scanning, if not more so when focused on the group appropriately and consistently. In the absence of lifeguard service, these methods can provide comprehensive and adequate supervision of the group. If lifeguards are also stationed, their supervision of the pool area is secondary to the supervision, control, and accountability provided by the instructor/coach.

If the group is too large to be supervised by one instructor/coach, money should be spent to provide additional instructors so the group can be divided to provide effective supervision before money is spent on a stationed lifeguard. While being beneficial, lifeguard services for instructional programs are secondary supervisors.

Every time aquatic experts point to the absence of a stationed lifeguard as the root-cause of a drowning during swimming instruction, they miss the main point that a swimming instructor or coach must be taught how to be an effective supervisor of their group at all times first and foremost.

 

Lifeguard Service in Instructional Settings

Recently, I read some very tragic news items involving school pool drownings. To read what I read, click the following:

Stories such as these cause us to reflect on the best way to keep our children safe and still provide needed swimming/water safety instruction. Often, the rote answer given by aquatic professionals, risk managers, attorneys, and others is what seems to be missing—a lifeguard on duty. To quote the American Red Cross, an authoritative source, from page 7 of its current Water Safety Instructor’s Manual:

An adequate number of lifeguards should be on-duty and conducting patron surveillance during all in-water sessions.

Despite all of this, a stationed lifeguard is not always the best solution. As aquatic professionals, we need to understand this so we do not miss the point when we train others, advise pool operators and school districts, talk to the media, or look for answers in the face of tragic events.

Supervision: Not Just from the Lifeguard Chair

During instructional activities, the swimming instructor or coach, not the lifeguard, is the primary supervisor of the class. The stationed lifeguard, if present, is a secondary layer of protection—a second set of eyes watching the pool. (If you doubt this, try an experiment: The next time you are teaching a group in the water, tell the lifeguard you are leaving your class in the water for 5 minutes while you go to make a phone call. See what happens!)

In contrast, even if the lifeguard isn’t present, primary supervision of the class is still there because of the instructor. In addition to being primary, instructor supervision is also more direct, specific, and proximal to the class. This means instructors can combine supervision and class management to ensure participant safety. To that end, instructors must:

  • Be prepared to make a rescue and to perform CPR/first aid
  • Account for every participant at all times
  • Use principles of class organization to keep participants safe, including:
    • Taking a position that enables you to watch the entire class at all times
    • Structure activities to minimize anticipated risks
    • Introduce and enforce pool/class rules that eliminate risky behaviors
    • Apply class and individual limits based on age, ability, water depth, class size, etc.
  • Integrate water safety into all swimming instruction

If an instructor cannot adequately supervise and control the class at all times, the class should not be in the water until it can be divided or until additional instructors can assist.

RECOMMENDATION #1: Correct any issues with primary supervision in instructional settings before calling for a lifeguard in a chair or other secondary solutions.

Single Lifeguards: “Fish Out of Water”

In addition to being a secondary supervisor, lifeguards hired alone (i.e., outside of a properly managed swimming pool) may lack the necessary infrastructure and support system to be effective. They are a bit like “fish out of water” because of the following:

  • Lifeguards should be screened and hired on the basis of meeting minimum standards required for the facility. Associations, schools districts, university recreation centers, private parties are more likely to hire individuals simply because they can produce certifications.
  • Lifeguards require training, including an orientation to the job and in-service training. Single lifeguards hired by uninitiated pool operators are likely to depend on the lifeguard’s initial Lifeguarding course to give the lifeguard all the training required.
  • Lifeguard training at the facility usually includes “shadowing” with an experienced lifeguard so the newbie learns how the pool area is supervised for consistency and facility-specific issues. In a single lifeguard environment, there is nobody to shadow.
  • The single lifeguard probably has to work without specific written procedures defining his/her role and authority, primary responsibilities, emergency response, etc.
  • Without direct supervision by a head lifeguard/aquatic supervisor, it is easy for a lifeguard to become complacent and undisciplined. They may stop suiting up, sitting in a designated place, continually scanning the pool area, etc.

Of course, these potential problems exist for the instructors as well. However, instructors have more to do in the pool area and should already be motivated to provide safe, effective instruction. It is much easier to expand their preparation to include safety, supervision in an aquatic environment, etc. than it would be to provide all the infrastructure required to manage one or more stationed lifeguards.

RECOMMENDATION #2: When hiring a single lifeguard to supplement supervision in instructional settings, make sure RECOMMENDATION #1 is in place and necessary lifeguard infrastructure is implemented and maintained.

Lifeguard Services Redefined

The issues I have addressed here (and probably budgetary concerns, etc.) have causes  some states to redefine lifeguard services to include supervision by swimming instructors with proper qualifications. For example, in California, Section 116028 of the California Health and Safety Code has the following:

…”Lifeguard services” includes the supervision of the safety of participants in water-contact activities by lifeguards who are providing swimming lessons, coaching or overseeing water-contact sports, or providing water safety instructions to participants when no other persons are using the facilities unless those persons are supervised by separate lifeguard services.

Michigan, a state where one of the referenced drownings took place, has a similar law as explained in Michigan Public Pool Safety Guidelines for Schools 2007:

…Public Act 368, R 325.2198, clearly specifies when a lifeguard must be on duty and the qualifications of that lifeguard. A lifeguard must be on duty:

  1. At swimming pools other than spas or wading pools.
  2. At pools owned and operated by governments, public corporations, or a school.
  3. If a pool has a water surface greater than 2,400 square feet.
  4. If a pool has a diving board(s).
  5. Whenever the pool is open for use.

 

There must be at least 1 lifeguard for every 75 swimmers…’.

This document goes on to describe the swimming instructor/lifeguard option:

…If a supervising instructor, teacher, or coach does not meet the requirements of Rule R 325.2198, listed above, then a separate lifeguard who meets the requirements must be present.

Questions often arise about the requirements of schools to provide lifeguards. Frequently there is only one staff person on duty during class/practice. This may lead some to think that lifeguards need not be present, but usually the coach or physical education teacher is not only a qualified instructor, but also a certified lifeguard.

There must be a lifeguard on duty whenever the pool is open for use, which includes physical education class, practice, and when the pool is being used by staff or by any group, regardless of the level of swimming competency.

Can the swim instructor or coach also act as the lifeguard if he/she meets the qualifications listed above?

The answer is yes, but it is important to reiterate that if a swim instructor or coach is acting as both the instructor and lifeguard, he/she must always keep in mind that he/she is a lifeguard first and foremost.

Why Swim Instructor Lifeguard Service Makes Sense

Since swimming instructors have an inherent obligation to provide supervision, it makes sense that laws defining lifeguard service would recognize this fact, especially in situations where hiring a stationed lifeguard is impractical, irrelevant, and/or out of budget (such as within a school district).

Lifeguard services provided by swimming instructors and coaches are different than that provided by stationed lifeguards, but it can be as effective if not more so.

RECOMMENDATION #3: Recommend/require swimming instructors and coaches to have training in lifeguarding, first aid, and CPR. Make sure their protocols include readiness, adequate supervision, effective class organization, etc.

What’s the Deal with CPR ABCs?

The “ABCs” of CPR have always referred to “airway, breathing, and circulation” or, to be more specific:

  • A: Open the airway and make sure it is clear
  • B: Check for breathing; if necessary, give 2 breaths
  • C: Check for signs of circulation (pulse); make sure there is no severe bleeding; give chest compressions in the absence of a pulse or other signs of life

In 2010, when CPR and first aid guidelines were last reviewed, these ABCs were in certain cases modified in an effort to increase the speed and effectiveness of CPR and related care. Understanding the new ABCs of CPR is key to understanding techniques like compression-only CPR and important priorities that make all the difference when seconds count.

CAB vs. ABC

The most significant change by far enacted by the Emergency Cardiac Care (ECC) Committee of the American Heart Association consists of rearranging the ABCs of CPR to CAB for patients of sudden cardiac arrest (SCA). CAB means (upon determining you have an unresponsive patient who suddenly collapsed):

  • C: Determine that there is no severe bleeding and begin 30 chest compressions immediately; if you are reluctant to give ventilations or do not have training in that skill, continue to give compressions to the patient until EMS personnel arrive
  • A: If you decide to give breaths, open the airway and make sure it is clear
  • B: Give 2 breaths followed by 30 more compressions

Why CAB Works

This change is designed to get compressions started as quickly as possible for victims that have oxygenated blood. Think about it. The patient was breathing until the moment of collapse. The heart stopped due to an electrical problem, not a lack of oxygen. Giving compressions immediately starts some oxygen-rich blood moving through the body, delivering oxygen to the brain and other vital organs. Taking time to give breaths delays the care this patient really needs.

According to the Sudden Cardiac Arrest Association, SCA is a leading cause of death in the United States, claiming more than 325,000 lives each year. During a sudden cardiac arrest, heart function ceases – abruptly and without warning. When this occurs, the heart is no longer able to pump blood to the rest of the body, and, in some 95 percent of victims, death occurs.

Why Compression-Only CPR Works

CAB is also explains why compression-only CPR works. Since the patient has oxygen in his/her system, performing compression immediately is a more critical care step. A recent study published in the New England Journal of Medicine showed no significant difference between the survival outcomes of patients given compression-only CPR and standard CPR. Compression-only CPR is easier to teach and to perform, especially by bystanders without protective devices learning CPR over the phone.

(For a hilarious American Heart Association public safety announcement starring Ken Jeong, go here.)

So, What About ABC?

Despite the ease and effectiveness of CAB and compression-only CPR for victims of SCA, the ABCs of CPR should still be followed for patients who are hypoxic (without oxygen). This includes the majority of infants and children and cases of respiratory problems that lead to cardiac arrest due to oxygen depletion.

Take a drowning victim for example. This begins as suffocation in water, but the heart usually keeps beating until the oxygen in the blood is used up. Then cardiac arrest occurs. This patient needs ventilations first and then compressions (standard ABC CPR). Giving compression first, or compressions only, to this patient may not be effective due to lack of oxygen in the bloodstream.

What About the “D”?

The “D” stands for defibrillation, administered using an automated external defibrillator (AED). Both patients may benefit from AED administration, which converts disorganized electrical activity in the heart to a normal rhythm. In other words, you can add a D to either ABC or CAB for a more comprehensive solution.

Come to think about it, “E” is for emergency medical services (EMS), which should already have been called (as soon as you know the patient is unconscious). So, now you have a complete chain of survival in both cases:

  • ABCDE for hypoxic patients and children
  • CABDE for adults who suddenly collapse (SCA) or children with known heart conditions