EARLY DETECTION OF A PERSON AT RISK OF DROWNING. IMPLICATIONS ON TRAINING AND PERFORMANCE OF PROFESSIONAL LIFEGUARDS

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Around four hundred observations of adult swimmers during ten summer seasons were analyzed and then sorted according to their skills and behaviour. Underwater observation proved essential to …

Around four hundred observations of adult swimmers during ten summer seasons were analyzed and then sorted according to their skills and behaviour. Underwater observation proved essential to understand how bathers manage to remain afloat and how they react to potential water incidents.

Results: Our analysis showed that bathers could be classified according to the following criteria:
- Aquatic abilities, motor skills and performance.
- Body and head positions in water.
- Swimming movement tracks.
- Response to “incidents”.
- Signs indicating failure to control buoyancy.
- Signs indicating a drowning process.

Thus, we described and defined five categories of swimmers’ ability levels including risks factors involved, as well as surveillance criteria focused on detecting when a swimmer starts to lose control. A six-hour teaching module was specifically developed and incorporated into our lifesaving courses including strategies to improve drowning prevention and surveillance: guides to advise bathers on safe behaviours, swimming movement patterns and early drowning recognition tips. Additionally, psychological training on social skills was included in order to improve the relationship between professional Lifeguards and pool users. This module has been implemented in ESS lifesaving training courses since 2003, reaching over 345 lifeguards in our new or refresher courses. Follow-up questionnaires completed around a year after the above-mentioned training activities resulted in over 90% effectiveness of professional performance regarding swimmers’ surveillance and early drowning detection.

Discussion: Our results show a direct relationship between aquatic expertise and the possibility that bathers’ reaction is not being effective enough to overcome a drowning episode and also suggest a clear relationship between real or perceived performance and the actual behaviours of swimmers at a pool.
Certain factors have a considerable bearing on the development of potential drowning situations:
- Not knowing how to move and control the face, the eyes or the head underwater.
- Not knowing how to do the apnoea technique or hold breath underwater.
- Beginner or very basic swimming skills or lack of self-confidence.
- Increase of water treading movements to keep afloat.
- Not being able to react to incidents properly.

Our classification has proved highly useful to improve lifeguards’ professional response to potential drowning situations as it significantly reduces the necessary time to detect, assist, or perform the rescue of swimmers in trouble. It is easily understandable with an appropriate but simple audiovisual support and adaptable to all kinds of bathers and pool conditions. Moreover, our study clearly shows that most people at risk do not wave their arms or shout for help; on the contrary, they move their arms underwater trying to remain afloat, gasp for breath or present reflex apnoea.

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  • 1. Luis M. Pascual-Gomez Primary School Teacher, Certified Swimming and advanced Life Saving Instructor Instructing Team Director of Escuela Segoviana de Socorrismo. Segovia (Spain) www.sossegovia.com Early Detection of a person at risk of Drowning Implications on training and performance of professional Lifeguards.
  • 2. Escuela Segoviana de Socorrismo Segovia Lifesaving School Luis M. Pascual-Gomez Primary school teacher. Certified swimming and Lifesaving Instructor. Instructing Team Director of Escuela Segoviana de Socorrismo (Segovia Lifesaving School), Segovia (Spain)
  • 3. About us
    • ESS is a non-profit organization, a group of Lifeguards and LS Instructors founded in 1996 with the aim to improve LS performance and teaching.
    • ESS is based at Segovia an historical city 100 km from Madrid, and organizes courses of: LS and LS Teachers First Aid, BLS, AED, Psychological First Aid, and refreshing courses for LS and LS Teachers.
  • 4. About us
    • Organized 6 International Congresses from 1997 to 2004 whose papers are available at our web page:
    • www.sossegovia.com
    • Our blog is one of the most visited LS blogs in Spain.
    • http://sossegovia.blogspot.com
    • Profiles at SN: Facebook, Tuenti
    • Twitter: @Sossegovia
  • 5. About us
    • ESS generated over 20 innovative works in the field of LS training and Drowning prevention.
    • Works locally (Segovia county) and regularly collaborates with and belongs to other Spanish organizations who work nationwide.
  • 6. About us
    • ESS Technical Team has nationwide prestige in Spain as they have produced innovative but strong evidence-based work in the field of aquatic Lifesaver training.
    • ESS 2010 annual income was 10.500 €, but the remaining money for activities was only 2.100 €.
  • 7. About us
    • ESS Technical Team members do activities and research for free and are paid only for their classes on LS courses.
    • ESS has performed several yearly campaigns on water safety and drowning prevention: child safety; safety pools; safety reservoirs; education about LS tasks and performance, etc.
  • 8. Luis M. Pascual-Gomez Primary School Teacher, Certified Swimming and advanced Life Saving Instructor Instructing Team Director of Escuela Segoviana de Socorrismo. Segovia (Spain) www.sossegovia.com Early Detection of a person at risk of Drowning Implications on training and performance of professional Lifeguards.
  • 9. Background - I
    • The Aquatic Professional Lifeguard takes up 95 % of its working time on prevention and surveillance tasks to detect drowning victims.
    • Lifeguard training-specific on drowning prevention:
      • Bathers aquatic environment behaviour.
      • Incidents and accidents.
      • Epidemiology; Aetiology, Development; Phy sio-Pathology, etc..
  • 10. Background - II
    • The time a drowned victim remains in anoxia determines its chances of survival .
    • Shortening the time to detect and intervene is esential in a water incident.
  • 11. The Hot Spots Research Area Ap plication Area
  • 12. Aims / Objectives / LOs
    • Analyze over 400 bathers’ behaviour , performance and swimming skil ls’ in water (pool) through direct observation and video recording, to propose categorizing them into 5 levels .
    • Correlate our observations with literature statements to propose effective measures to improve Lifesaver’s strategies on Risks Prevention, Surveillance and Early Drowning Detection .
    • LO: At the conclusion, participants should better appreciate our proposal as a powerful prevention, surveillance and drowning observational assessment and teaching instrument .
  • 13. Bathers’ Observation
  • 14. Aquatic “Incidents”
    • An event that causes distress and momentary loss of breathing, floating or movement control.
    • Contacts or disturbs between swimmers
      • Disorientation or control loss
    • Splashing and swell.
      • Discomfort, apnea reflex .
    • Accidental water swallowing
      • apnea reflex, choking cough.
    • To be out or deep o do not reach the edge.
      • Control loss due to fear and distress.
    • Accidental falls, tiredness, discomfort, illness, stroke or seizure , etc.
  • 15. Swimmers’ Categories
    • Swimmers had been classified regarding:
    • Aquatic abilities and motor skills and performance.
    • Body and head positions in water.
    • Behaviours and displacements paths on water surface.
    • Self-confidence on aquatic performance.
    • Response to incidents.
  • 16. Swimmers’ Categories 5. Response to incidents.
    • Detection of swimming failure features.
    • Signs that indicate a drowning process start-up .
  • 17. Movement tracks
    • Displacement p aths gives information related with self-confidence and self-perception of performance in water.
    Shallow waters Deep Waters Pool width Near edge Erratic, free space Standing Pool laps Floating on their back
  • 18. Classification: 0 to 4 levels
    • Brief description
    Good to Very Good Medium to Good Poor/Medium (Occasionally Good) Poor Very bad Self-Confidence Dive headfirst and swim underwater Able to jump on foot standing from the edge Achieve static apnea, float on their back Occasionally may float on their back No Other Aquatic Skills Avoid interactions actively. Stop floating and recover movement Are aware of others’ activities. Avoid interactions, stopping o changing direction Foresee incidents, reacts keeping in motion, protective apnea Twist head, increase supporting movements, can’t move body Turn head and body moving away, arms protect face Incidents Pool laps Pool laps. Stops on the edge to turn. Central deep pool area: erratic looking for free space or in pool width Shallow waters: erratic. Deep waters: near edge Standing, shallow water Movement Tracks Coordinated and adapted to the movement Coordinated. Can do static and dynamic apnea Adapted to the movement but not totally coordinated Uncoordinated Uncoordinated Breathing Arms and legs, crawl, breaststroke, backstroke Arms and legs, crawl, breaststroke Arms and legs, mainly breaststroke Supporting arms, legs barely move, breaststroke No, or only waving arms Propulsion Horizontal Horizontal Nearly horizontal Tilted (>45º) Vertical (90º) Feet on the ground Body Submerged Submerged Tilted. Submerged face, but not head Up Up Face/Head 4 3 2 1 0
  • 19. Why do the swimmers fail?
    • Just a few factors have a considerable bearing on the development of a risk-drowning situation:
    • Swimmers that don’t know how to put the face, eyes or head under the water , and don’t use goggles.
    • Swimmers that don’t know to achieve apnea or hold their breathe underwater.
    • Swimmers whose basis skills are weak or lack self-confidence (floating, propulsion and breathing mechanics).
    • Swimmers that react increasing the supporting swimming movements to stay afloat , (instead of stopping, holding their breath and recovering their normal movements)..
  • 20. Why do the swimmers fail? - I
    • Swimmers that don’t know how to put their face, eyes or head under the water , and/or don’t use goggles,
    • Swimmers that don’t know how to achieve apnea or hold their breathe underwater.
    • Are highly affected for “wet face” reflex , losing breathing control.
    • Refl ex apnea may cause that they can’t react properly and became distressed or panic.
  • 21. Why do the swimmers fail? - I I
    • 3. Swimmers whose basis skills are weak or lack self-confidence (floating, propulsion and breathing mechanics):
    • Would be frightened because they fe el that their abilities are too weak to keep them safe.
    • Altered breathing mechanics, and protective apnea may appear.
    • Became distressed disordering the swimming movements , while legs remain motionless..
  • 22. Why do the swimmers fail? - III
    • 4. Swimmers that react increasing the supporting swimming movements to stay afloat, (instead of stopping, holding their breath and recovering their normal movements).
    • Arms increase supporting movements, while l egs are motionless .
    • Breathing control is highly affected and protective apnea appears when face becomes submerged.
    • Disorder their movements as much as would became su bmerged due its inefficacy.
  • 23. On the “Borderline”
    • Those features are on the borderline between safety and a distress or drowning episode and could be easily observed and detected daily when a trained Lifeguard is aware of how they are produced.
    • Disorder or chaotic swimming movements .
    • Change to a vertical body position.
    • Arms increase supporting movements .
    • Motionless legs .
    • Altered breathing mechanics .
  • 24. Discussion-I
    • Improving Lifesavers’ daily routine
    • Classification rationalizes and eases observation and surveillance tasks, r educ ing observational stress and tiredness.
    • Easily recognizable behaviour and motor patterns which are daily observable .
    • Significantly reduces the time to detect , assist and perform a rescue of a swimmer in trouble.
    • Movement paths help on the early detection of silent or passive drowned bathers.
  • 25. Discussion-II
    • Imp roving Lifesavers’ training
    • There is enough evidence to justify those finding and the suggested training method would be included into the compulsory syllabus of Lifeguards’ instruct ion .
    • Easily understandable with simple audiovisual support .
    • Highly useful and locally adaptable for Lifeguards’ prevention strategies .
  • 26. Discussion-III
    • Imp roving b athers’ safety
    • The relationship between: in-water self-confidence; self-perception of the performance and a risky behaviour is three-way and we can either act overall or on each one.
    Performance Self-Perception In water Self-Confidence Behaviour and Risk-Taking
  • 27. Discussion-IV
    • Improving swimmer s’ training and prevention
    • Swimmers’ training should focus o n improv ing aquatic abilities and reacting properly to incidents.
    • The general strategies for drowning prevention anywhere would find valuable a guide to detect a person showing slightest signs of a drowning process , rather than actually drowning.
  • 28. Limitations
    • Most pools have no drowning events over several seasons.
    • Drowning process were not observed but minor incidents or distressed swimmers during the research.
    • Should consider contrasting observations in open water .
  • 29. Thank you. I would be very happy to expand on this concepts later on. www.sossegovia.com