Managing aquatics can be one of the most challenging jobs at camp. Creating and maintaining a fun environment is only part of the challenge. The real challenge is how to provide that fun safely. While campers and most staff consider water a friendly and exciting place, we should never forget that water can be a "hostile environment."
In June 2002, the World Congress on Drowning 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 fourteen and under are hospitalized annually as a result of drowning incidents; 15 percent die in the hospital, and as many as 20 percent suffer severe, permanent neurological disability. The typical medical costs for a drowning victim who survives the event can range from $75,000 for the initial emergency room treatment to $180,000 a year for long-term care. Costs for caring for a drowning victim who suffers brain damage can be more than $4.5 million. These figures do not include legal fees, court-awarded judgments, damage to the camp's reputation (which could impact donations), or bystander claims from a relative.
Two factors make a camp drowning very difficult to defend in court: it's reasonable to expect the aquatic facility to be maintained safely, and it's reasonable to expect appropriately trained supervisory personnel on the job during swimming activities to respond appropriately in a timely manner. In general, the only potentially defensible causes of a drowning at camp are pre-existing medical conditions (seizure or heart attack), and those defenses would be contingent on the circumstances of the entire situation (what was the camp told on the medical forms, what did the lifeguards know, etc.). The defense attorney would have to show that the youth would have died from the medical condition even if the camper had been on land.
There are three key elements for camp directors and aquatic risk managers to address: facility design, prevention and response. Each of these elements poses challenges that will be unique to your camp as well as elements that will fall under industry standards, certification curriculum, and governmental regulations.
Facility Design
While the majority of drowning incidents at summer camps are directly related to lack of supervision, the design and maintenance of the aquatic areas can certainly contribute to a drowning or cervical spine injury. The following are risk management considerations for the design of your aquatic areas:
- Lifeguard Chairs: The shape of a pool and the positioning of lifeguard chairs can create blind spots for the lifeguards. Chairs set on the deck away from the water create a blind spot immediately in front of the lifeguard. A good rule-of-thumb is to position lifeguards in an elevated position (usually 5 feet but check your state regulations) at the edge of the deck with a coverage zone of 45 degrees on each side. Lifeguard chairs should be equipped with an umbrella to reduce sun exposure.
- Signage: Most states require you to post "No Diving" signs and water depths on the deck of the pool or lake pier. Some states require you to post the water depths on the side of the pool above the water line. It's a good risk management practice to do both. Make sure you indicate the unit of measure (feet) for the water depth. A pictogram for the "No Diving" sign is also a good idea for those who can't read or don't read English.
All aquatic areas should have signage posted detailing the rules of use. Many states have specific regulations about not only the wording of various rules, but also the specific font size, contrasting colors, and language. - Float Ropes: All pool and lake swimming areas should have a safety-float rope separating the deep end from the shallow area. State regulations vary on the water depth, but most regulations fall around 4 feet 6 inches.
- Size of Zones of Coverage: Many aquatic areas, particularly open water, are simply too large for one lifeguard to cover. Remember, the lifeguards zone of coverage is three-dimensional, not just the surface. The size of the zone a lifeguard can cover depends on the clarity and depth of the water, swimming ability of the guard, additional rescue equipment (swim fins for example) that might normally be used, swimming abilities of campers, and other factors. A general rule-of-thumb is that a lifeguard should be able to get to anywhere in their coverage zone within twenty seconds.
Prevention
The best drowning is the one that did not happen. Prevention is (or should be) 98 percent of the lifeguard's role. The role of prevention is probably the most overlooked element in terms of staff screening, training, skills verification, and equipping. Consider the following prevention risk management recommendations:
- Swimmer Behaviors: Little is done in the way of initial certification training to assess the swimmers and their behaviors. The lifeguard's role is not just to enforce the posted rules, but to identify potential problems and intercede. For instance, the nine-year-old nonswimmer who is holding onto the side of the pool and edging his way into deeper water should be instructed to go back before he slips off the side. Few people drown while in a horizontal position; people usually drown in a vertical position. A key behavior lifeguards should target is a swimmer's ability to make forward progress in the water.
- Staff Screening and Preparedness: Many camp directors think that a "certification" equates to "qualification" for a lifeguard. This is a very dangerous and inaccurate assumption. Numerous camp directors have found forged lifeguard certifications. These cards were sold on college campuses, and the forgery came to light only when the lifeguard's swimming and rescue skills were observed to be lacking. A call to the issuing American Red Cross chapter showed they had no training records for the lifeguard.
Many factors can influence a lifeguard's ability to physically perform the job. Some physical factors can be dealt with, some cannot. If a lifeguard can't dive to the bottom of your swimming pool and retrieve a person using their rescue tube, then that lifeguard should not be guarding the deep end. That doesn't mean that they can't guard the shallower waters, or perhaps if the lifeguard is provided swim fins, they can perform the rescue in deep water successfully. Another physical factor that camps should address is the use of corrective eyewear and sunglasses. If a lifeguard can't see the victim, they can't perform their job properly, and the chance of a successful rescue diminishes. Polarized sunglasses are highly recommended, as they reduce the effects of glare. The US Lifesaving Association has determined that lifeguards wearing contacts and operating in open-surf conditions is a job disqualification due to the likelihood that the contacts can be dislodged in turbulent surf, even with the use of goggles. Job disqualification for use of corrective eyewear or physical limitation needs careful study and even legal advice.
Lifeguard preparedness is a mental exercise as much as it is physical. If a lifeguard is "zoning" in the chair on a hot day, they can be the greatest rescuer in the world and it won't matter. 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 prescribed medications. Fatigue can also significantly impact peripheral vision. Combine reduced peripheral vision with a lack of vigilance, and you have a deadly combination for almost any activity. Two steps camp directors can do to help address lifeguard vigilance include:
Step 1: Rotate lifeguard positions every twenty to thirty minutes. Simply getting up and moving around often helps as does a change of view.
Step 2: Inform lifeguards that part of their summer evaluation will include the question: "How well did the lifeguard maintain their health and demonstrate healthy behaviors to the campers during the summer?" That question covers everything from wearing sunscreen and washing hands, to getting enough sleep and being prepared to work following time off.
No single source lifeguard training certification is going to teach lifeguards 100 percent of what we wish they should know. Such a course would be time and expense prohibitive, which means that aquatic directors have to institute in-service training. The YMCA recommends at least two hours of in-service training per month during the high season and at least one hour a month at other times of the year. Additional time would be needed for facilities that have play elements or open water, as these have special procedures. Jeff Ellis and Associates mandates four hours per month for full-time employees and one hour per month (or four hours per quarter) for part-time employees. USLA requires a minimum of sixteen hours per year in rescue skills and refresher training, with additional time for monthly drills and daily workouts to maintain physical fitness and stamina. American Red Cross also recommends in-service training. The camp director's emphasis on making in-service training occur on a regular basis is an indicator of the safety culture of that camp. A word to the wise: document your in-service training. In court, if you didn't write it down, it didn't happen.
- Visiting Groups: Should a visiting group be allowed to swim in your pool or lake, or use your boats without a 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. Even in the winter, an outside pool is potentially dangerous in ways that many directors never considered. For instance, many youths roller blade or skateboard and would like access to a pool. Add accumulated rain water in the deep end of the pool and an unlocked fence, and your facility could soon be under new ownership.
What if the visiting group wants to bring their own lifeguard? Legally, this is a complicated and technical question, because the answer will vary according to the laws, statutes, and legal precedents set in each state. The legal concept here is referred to as "negligence per se," which basically means that if a program violates a statute/law/regulation then 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:
Option 1: Any lifeguards with the visiting group would serve as extra spotters, not lifeguards. The responsibility for the group stays with the host program.
Option 2: The visiting group respects the host program's liability concerns and uses a swimming facility away from the host program.
The use of signage and posted rules around aquatic areas is very important for all aquatic facilities. It should come as no surprise that the wording, size of the letters, and possibly even the language (English, Spanish, etc.) could be dictated by state or local ordinances, which vary tremendously.
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.
Response
A rapid response time is critical if a youth is to make a full recovery following a drowning incident. Most CPR classes state that brain damage does not begin until the person has been without oxygen (underwater) for about four to six minutes. However, a study of drowning claims at Markel indicates that the time frame for full recovery is much shorter. In fact, nearly all youths died when they were underwater for more than an estimated 90 to 120 seconds. Although there have been exceptions to this time frame, youths who recover often have severe cardiac, respiratory, or brain damage.
It is 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 the water often results in spontaneous respirations.
There are some fundamental differences between the American Red Cross, YMCA, Jeff Ellis and US Lifesaving Association (USLA) airway-clearing training. American Red Cross lifeguards are taught to bring the victim out of the water (on a backboard if a spinal injury is suspected) onto the 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 different organizations. 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.
- Portable 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 major training programs (American Red Cross, YMCA, Jeff Ellis) all have courses in oxygen therapy. Most lifeguards take advantage of this training. Given the position statement of the ILSF, the fact that most lifeguards have the training, portable oxygen is relatively inexpensive, and the clear medical benefits, why would a camp not have oxygen at the waterfront?
- Automatic External Defibrillators (AEDs): There is an article in the Fall 2004 The CampLine on AEDs in the camp environment that covers this equipment. Suffice it to say that if you don't have one, it would be a good risk management practice to start budgeting for one.
Summing It All Up
One philosophy that should guide your aquatic management decisions is "we will do everything we can to minimize the amount of time it takes to deliver that first breath." From lifeguard training, close proximity positioning, equipping the guards with the proper rescue equipment, to mock drills and facility inspections, we will do what we can to make our waterfront a model for others.
One YMCA director recently told me about their lifeguard competition. In three years, they have gone from ninety-seven participants to nearly four hundred. They have corporate sponsors giving prizes, and the competition has resulted in lifeguards all over the area practicing and preparing all year round. A lifeguard competition at a camp could be turned into an event day for the campers to reinforce the importance of the lifeguard's role and to recognize each individual.
Originally published in the 2005 Winter issue of The CampLine.
