fletemeyer perspectives in drowning recognition...related to the emotional state of the lifeguard....

New Perspectives in Drowning Recognition John R. Fletemeyer, Ph.D.

Dr. John Fletemeyer is a research professor at the Laboratory for Coastal Research at Florida International University. He has conducted extensive field research in Africa that focused on the aquatic behavior of primates. He is the author of two books on drowning and aquatic safety and has published over 100 articles and reports. He is the recipient of the Paragon award as well as many numbers of other awards. He has served in numerous elected positions and been a consultant for over 50 government agencies and private organizations. He has appeared on numerous TV programs including 60 Minutes as a drowning expert.

Abstract Aquatic warning signs serve two vital functions; they warn the public about a hazard(s) that is not previously known to exist and they serve as a reminder about a dangerous condition(s) that is already known to exist. Despite the proliferation and industry reliance on aquatic warning signs, there are a number of obvious and a few not so obvious factors that are responsible for influencing their effectiveness. The objective of this paper is to identify some of the not so obvious factors that up to now have not been considered. This paper relies on information provided by this investigator in a recent episode of 60 Minutes and on some original research conducted over the last ten years. Recommendations will be made that will increase the effectiveness of aquatic warning signs.

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Re-evaluating Drowning Statistics and More Effective Lifeguarding Practices

By

Dr. John R. Fletemeyer Research Professor, Laboratory of Coastal Science Florida International University

This paper has two objectives:

1. To explain why drowning statistics are unreliable and under reported. 2. To identify methods, strategies, and practices for improving lifeguard effectiveness.

I. Drowning Statistics:

The Centers for Disease Control and Prevention reports that about 4,200 people drown in America every year and states that the drowning rate is decreasing. Some attribute the decrease in drownings to better water safety education targeting specific ethnic and racial groups with high drowning rates, increasing participation in learn to swim programs, the Virginia Graeme Baker Pool and Spa Safety Act reducing the number of entrapment drownings, and the construction of barrier fences around backyard pools. Regarding barrier fences, it has been estimated that home drownings have been reduced by 50 to 90 percent. In addition there are a number of specific cases which have shown a remarkable reduction in drownings. For example, on some beaches where the consumption of alcohol has been outlawed, the number of drowning and near drownings have decreased significantly. At the All American Canal in Southern California where over 500 Mexican migrants drowned, the implementation of an intervention program involving a bilingual education program and a system of float lines stretched across the canal has been successful. Since the implementation of this program, there has been only one drowning along this water body. Despite the compelling evidence for fewer drownings, the drowning statistics reported by the CDC are

suspect for several reasons.

1. The boating industry reports that approximately 3,000 people die in boating accidents every year. When someone falls from a boat and drowns, it is often regarded as a boating fatality, not

a drowning.

2. A significant number of drowning fatalities are never reported, i.e. All American canal drownings Haitian drownings and rafting across the Florida Straits


3. Drownings vs. secondary drownings. In many states, people who drown but remain alive for more than 72 hours are classified as a secondary drowning and consequently, they are not

represented as a drowning statistic.

4. Medical Examiners, especially those from inland states with no or little experience in drowning, sometimes list cardiac arrest, drug over dose, etc. as the primary cause of death on the death

certificate.

5. Drownings are sometimes coded differently, i.e. as suicide and a car accident involving water.

For the reasons stated above, it would not be surprising that the number of drowning deaths in the U.S.

is double than what is being reported. This under reporting may have important social and economic

consequences. For example, more federal and state funding might be devoted to drowning if legislators

became aware that there are significantly more drowning fatalities. It is important to acknowledge that

many more dollars are being spent for fire safety and education programs than for drowning prevention

programs.

II. Lifeguard Effectiveness

In 2001 the Centers for Disease Control and Prevention published a milestone report entitled,

LIFEGAURD EFFECTIVNESS: A REPORT OF THE WORKING GROUP. This report provides empirical data

about the effectiveness of lifeguards. In addition, this report provides evidence that lifeguards are

responsible for making aquatic environments safer, primarily by practicing preventative strategies. It is

important to note that this represents a significant paradigm shift from aggressive intervention focusing

on victim recue commonly practiced before the 1980’s and often glamorized in the movies.

Although lifeguards are instrumental in preventing drowning, still a significant number of drownings occur in guarded areas. Nineteen percent of child drowning fatalities take place in public pools with certified lifeguards on duty. The remainder of this paper is devoted to discussing some methods for improving lifeguard effectiveness and hopefully will lay the groundwork for future discussion.

1. Age and Experience

Research conducted by Fletemeyer and others suggest that there is a correlation between lifeguard’s

age, experience and effectiveness. Everything else being equal, there is a greater probability of a

drowning occurring in an aquatic environment with a less experienced lifeguard.

The common practice within the lifeguard industry is to assign newly certified lifeguards with lifeguard

responsibilities without the benefit of additional in-service training or mentoring. Consequently,

lifeguards are sometimes not prepared to assume the responsibility of a lifeguard.

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Unpublished qualitative research by Fletemeyer determined that many new trained lifeguards were not

able to accurately describe the behavior of an active drowning victim and were not able to differentiate

between and active and passive drowning.

In another unpublished study, newly hired lifeguards were not able to identify rip currents. Both types

of identification are critical to effective lifeguarding and involve skill sets usually gained through

experience, not by book training.

There are cases when a lifeguard with relatively little work experience failed to respond to a drowning victim because he or she believed that the victim was engaged in play behavior.

In a study conducted by Leatherman and Fletemeyer, it was determined that rip currents, accounting for at least 80 percent of beach drawings, were often not detected by lifeguards.

Only the most experienced lifeguards were able to reliably detect rip currents.

Providing lifeguards with the additional, supervised experience is problematic primarily because of the

need for an inexperienced lifeguard to associate with an experienced lifeguard for an extended period of

time. Many lifeguard agencies do not have the resources to permit this practice. However, to improve

lifeguard effectiveness, a mentoring program should be established not only on beaches but at

swimming pools and water parks.

2. Certification Standards

There are five certification programs recognized in the U.S. The training and the qualification performance standards for these programs are not the same. In some cases, certifications are wrongly accepted. For example, along the many ocean beaches in Massachusetts, the American Red Cross Waterfront Lifeguarding module and the lifeguard training program is accepted as the certification and training standard for ocean lifeguards. According to the American Red Cross, this training was never designed for ocean lifeguarding. Similarly, many beaches located on the Great Lakes have conditions resembling ocean beaches, i.e. in one year, 25 swimmers drowned in rip currents in Lake Michigan. Consequently, lifeguard training and certification should reflect ocean conditions not flat or calm water beaches.

3. Observational Methods/Profiling

Various observation methods have been recommended, even required, for life guards. Perhaps, the

best known of these is the 10/20 method requiring a lifeguard to systematically scan his or her area

every ten seconds. There are other scanning methods, but these are less rigid than the 10/20 method.

For example, the American Red Cross requires that a lifeguard scans “thoroughly and repeatedly” but

does not place time requirements for scanning.

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It has been correctly pointed out that the routine associated with systematic scanning is sometimes

responsible for causing eye fatigue and boredom. This sometimes causes a lifeguard to look but not to

see!

In addition, rigid scanning strategies, such as the 10/20 do not work in bathing environments with heavy

bathing loads. Consequently, a more effective strategy involving profiling is needed. Profiling is often

negatively associated with law enforcement and racial profiling. In lifeguarding, profiling involves

applying knowledge about drowning behavior to identify individuals most likely to be involved in a

drowning incident. Factors that should be considered when developing a swimmer drowning profile

includes

Sex—significantly more males drown than females. Age—depending on the aquatic environment— in pools children are the most likely to

drown, while at the beach, in addition to children, young risk taking teenage and young

adult males are more likely to drown. In hot tubs and spas, the elderly are at the greatest

drowning risk.

Race—the drowning rate is significantly higher for blacks than Caucasians. Physical nuances—dress, obesity, skin tone, muscularity, wearing glasses in water Behavioral nuances—swimming stroke mechanics, response to approaching waves, entering

the water, breath holding games.

Drinking alcohol or signs of inebriation. Other—medical tags, use of inhalers, snorkeling gear.

4. Distracters

The American Red Cross discusses the “RID factor” and considers it to be a major cause of drowning. RID is an acronym for Recognition, Intrusion and Distraction. A distracter for the purpose of this paper represents any disturbance capable of impacting a lifeguard’s

ability to watch the water and to identify signs of a victim in distress. While most distracters are

physical, a few are not. Some are more significant than others (Fletemeyer, unpublished) and are

related to the emotional state of the lifeguard. The following represents 19 distracters, most of which

can be eliminated by the implementation of policies and practices by management. These should be

addressed in a facility’s SOP manual.

Glare—Locate lifeguards to minimize the impact of glare especially during mid-morning and late afternoon. Provide polarizing sun glasses. -4-


Lighting—the combination of artificial and ambient light should be consistently maintained to allow observation of the pool bottom. This should be a minimum of 10 lumens. Sodium lighting should not be used.

Noise—sources should be eliminated and decibels should be reduced to a tolerable level.

Cell phones and texting—Cell phones should not be allowed on the pool deck or in the lifeguard tower.

Radios—No personal radios or headphones.

Hunger and thirst—Encourage lifeguards to bring lunch and snacks and allow time for eating. Make sure lifeguards remain hydrated.

Sleep—Establish polices and/or encourage lifeguards to always get a minimum of eight hours sleep before reporting to work. If lifeguards are hung over or appear to be sleep deprived, send them home or assign a non-lifeguarding tasks.

Bathroom breaks—Develop rotating scheme allowing lifeguards to take bathroom breaks.

Members of the opposite sex—Supervise lifeguards making sure they are not being distracted by members of the opposite sex.

Clocks—Remove clocks from walls and from the lifeguard’s field of vision.

Non lifeguard work—Establish policies to prevent multi-tasking and minimize secondary responsibilities, including filling out paper work while on duty.

Temperature—Try to maximize lifeguard’s confront level, i.e. warm weather clothing on cold days. Provide umbrellas on hot, summer days.

Wind/Inclement Weather—Create an environment allowing lifeguards to keep out of the wind, i.e. enclosed lifeguard towers or provide wind screens.

Reading—No books, magazines, newspapers on pool deck or in lifeguard tower. Also no lifeguard manuals.

Breaks—Allow lifeguards the opportunity to take regular rest breaks.

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Horseplay and related activities—Establish rules limiting horseplay and any activity that impact’s a lifeguard ability to observe the water.

Socializing—Limit socializing with members of the public and with other lifeguards.

Work duration—Maximum of eight hours, overtime should not be allowed.

Alcohol and drugs—Establish a drug policy and implement pre-employment drug screening.

III. Summary and Conclusion

For several reasons identified in this paper, the number of drownings may be seriously under estimated. If this is supported by future research, aquatic professionals must use this as justification to expand existing water safety programs and to develop new ones. New programs must target specific drowning environments and must rely on scientifically valid and reliable research. When developing new programs, it might not be necessary to reinvent the wheel. There already may be effective programs worth imitating.

As bathers continue to drown in the presence of lifeguards, this paper suggests the need for better and

improved practices. It cannot be denied that effective lifeguarding is part art and part science. The art

part cannot be learned in books. It involves a learning curve and is achieved primarily through on the job

experience and learning how to profile bathers while using any of the scanning methods being taught by

the various training organizations. The science part relies on management’s ability to provide

continuous recurrent training opportunities, establishing a mentoring program and by eliminating many

of the distracters that are responsible for impacting lifeguard effectiveness.


LtoR: Dr. John Fletemeyer, Dr. Steve Leatherman


Re‐ evaluating Drowning Statistics and more effective Lifeguard

Practices

ByDr. John Fletemeyer

Research Professor, Laboratory of Coastal ResearchFlorida International University


1. To explain why drowning statistics are unreliable and under reported

2. To identify methods, strategies and practices for improving lifeguard effectiveness

Drowning Statistics

CDC reports that 4,200 individuals drowning every year


Better safety & education programs targeting certain ethnic and racial groups

Increased participation in learn to swim programs

The Virgin Graeme Baker Pool and Safety Act


The Construction of barrier fences around backyard pools

Outlaw alcohol on beaches

All American Canal Drownings


CDC Statistics may NOTbe accurate

3,000 boating deaths that are listed as boating fatalities

and NOT drownings


Many drowning fatalities are never reported

Drowning resulting in death more than 72 hours are called Secondary Drownings

Medical Examiners sometimes misrepresent drowning


Drownings are sometimes incorrectly coded, i.e.

suicides & car accidents involving water

LIFEGUARD EFFECTIVENESS

Lifeguard effectiveness: A report of the working group


Age and experience:

Certification Standards


Observation Methods/ Profiling

The 10/20 Scanning method is not effective with

heavy bathing loads


Profiling helps lifeguards toidentify potential drowning victims

SexAgeRacePhysical nuancesBehavioral nuancesDrinking other

Profiling Criteria

Distracters


RID

RecognitionIntrusion and Distraction

Glare

Lighting


Noise

Cell phones and texting

Radios


Hunger and thirst

Sleep

Bathroom breaks


Members of the opposite sex

Non-Lifeguarding work

Temperature


Wind/ Incle-ment weather

Reading

Horseplaying


Socializing

Work Duration

Alcohol and drugs


THANK YOU!

QUESTIONS&

COMMENTS


Lunch Roundtable: Psychological Impact of Drownings on Young Lifeguards

Post-traumatic Stress among Teenage Lifeguards

Dr. John Fletemeyer, Laboratory for Coastal Research, Florida International University

Ms. Connie Harvey, Manager of Aquatics Programs, America Red Cross

Dr. Lori Zoellner, Department of Psychology, University of Washington

Post-traumatic stress disorder (PTSD) first appeared in the nomenclature with the advent of DSM-III (1980) and received considerable attention in the military and after the Vietnam War. However, it is well recognized that PTSD may also occur in other professions exposed to serious injury and death, and among traumatized children experiencing a school shooting or having their home destroyed by a hurricane or tornado. Lifeguarding is unique because it is the only profession that regularly employs teenagers and requires making split second decisions that have life and death consequences. About ten years ago, Fletemeyer began interviewing teenage lifeguards involved in a drowning event using qualitative survey methods. A total of 11 lifeguards have been interviewed thus far. Some of the lifeguards involved in this initial survey report having bad dreams, feeling stressful, having recurring daytime thoughts about the incident and feeling guilty. One 17 year old male lifeguard involved in a near drowning incident stated that he now reads the bible more frequently and that he would never again work as a lifeguard. As the lifeguard industry grows, it will continue to rely heavily on teenage lifeguards to fill its employment needs. It is important to consider if post-traumatic stress (PTS) or PTSD represent a serious problem. If future studies reveal that it does, then it may be necessary to put in place psychotherapeutic interventions. Currently when a lifeguard is traumatized by a drowning event, it is problematic in regards to getting professional cancelling. It may be necessary for the American Red cross, the YMCA and other organizational stakeholders to take an active, leadership role to ensure that proper responses are taken by individuals at the supervisory and management level. Considering the above, the objective of this World Aquatic Health Conference session is to establish a venue that will begin an open and objective dialogue where professionals from different fields and with different perspectives can provide input about the impact of PTSD on young lifeguard so that future recommendations can be articulated and adopted.


fletemeyer perspectives in drowning recognition...related to the emotional state of the lifeguard....

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