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Drowning Incident Analysis

Author: Bob Clark

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Drowning Incident Analysis

  1. 1. Drowning Incident Analysis World Water Safety Conference Presenter: Robert Clark September 29, 2007
  2. 2. Agenda <ul><li>Analysis of the drowning of a four year old female during a supervised swim period at a public swimming pool operated by the City of Toronto </li></ul><ul><li>Accident </li></ul><ul><li>Contributing Factors </li></ul><ul><li>Lessons Learned </li></ul><ul><li>Prevention Strategies </li></ul>
  3. 3. The Accident <ul><li>Victim: Four-year old female </li></ul><ul><li>Supervised by Cousin (13 yrs) and Brother (7 yrs) </li></ul><ul><li>Afternoon Recreational Swim period </li></ul><ul><li>Strays from her guardian </li></ul><ul><li>Found on bottom of pool </li></ul><ul><li>Cause of death: Drowning </li></ul>
  4. 4. Contributing Factors ( determined by the Coroner’s Inquest) <ul><li>Entry Control Policy and Practice </li></ul><ul><li>Supervision by Guardian </li></ul><ul><li>Pool Clearing Procedures </li></ul><ul><li>Rowdy Behaviour of some Swimmers </li></ul><ul><li>Advertising of Entry Requirements to the Public </li></ul>
  5. 5. Lessons Learned <ul><li>1. Tragedy can occur when you least expect it </li></ul><ul><li>2. The public puts its unqualified trust in the lifeguard </li></ul><ul><li>3. Young children require direct supervision and their guardian must understand and fulfill this role </li></ul><ul><li>4. Rules must be Enforceable, Posted and Enforced </li></ul>
  6. 6. Lessons Learned <ul><li>5. Supervision of the pool must be uninterrupted because a victim can be very difficult to spot </li></ul><ul><li>6. The Media will influence the public’s view of the accident </li></ul><ul><li>7. Tragedy often follows a series of events, each not significant in itself but deadly when combined </li></ul>
  7. 7. Prevention Strategies <ul><li>1. Policies, Rules, Guidelines and Procedures—Our Responsibility </li></ul><ul><ul><li>For staff and swimmers </li></ul></ul><ul><ul><li>Well planned </li></ul></ul><ul><ul><li>Documented </li></ul></ul><ul><ul><li>Staff trained </li></ul></ul><ul><ul><li>Frequent practice </li></ul></ul><ul><ul><li>Enforcement </li></ul></ul><ul><ul><li>Swimming pools - supervised and unsupervised </li></ul></ul><ul><ul><li>Lakes, rivers and oceans - supervised areas </li></ul></ul>
  8. 8. Prevention Strategies <ul><li>2. Systems Audits—Are we in compliance? </li></ul><ul><li>Policies and Procedures </li></ul><ul><li>Facility </li></ul><ul><li>Supervision </li></ul><ul><ul><li>Audit by an external organization </li></ul></ul><ul><ul><li>Self Audit </li></ul></ul><ul><li>3. Public Education </li></ul><ul><ul><li>Parental Supervision </li></ul></ul><ul><ul><li>Pool Rules </li></ul></ul><ul><ul><li>Swimmer Behaviour </li></ul></ul>
  9. 9. Prevention Strategies <ul><li>4. Promote Learn to Swim </li></ul><ul><li>5. Swim to Survive </li></ul><ul><li>(Lifesaving Society, Ontario, Canada) </li></ul>
  10. 10. Prevention Strategies <ul><li>“Your ability to avoid or successfully manage a drowning incident is determined well before the incident ever occurs.” </li></ul>
  11. 11. Drowning Incident Analysis <ul><li>World Water Safety Conference </li></ul><ul><li>Presenter: Robert Clark </li></ul><ul><li>September 29, 2007 </li></ul>