They were supposed to make headlines as heroes. Instead they ended up on front pages around the world as victims.
By all accounts, Bohdan Vitenko and Jonathan Proce, both 21, were
preparing for careers with elite military units. Vitenko hoped to
become a Navy SEAL and Proce, a lifeguard at another pool, was
heading to train for the Air Force’s Battlefield Airmen
commandos, similar to the Navy SEALs unit.
Both young men were strong and fit. Witnesses at Lyons Pool in
Tompkinsville, N.Y., on Staten Island, had seen them exercising in
the water regularly in pursuit of their dreams, according to the
New York Post.
That’s what got them into trouble on the morning of July 13,
when the two were pulled unconscious from the water. Despite rescue
attempts, they went into cardiac arrest. Vitenko was pronounced
dead that morning. Proce died about four days later. It appears
they had been using prolonged underwater breath-holding as part of
their training — and that was their fatal mistake.
Other athletes and swimmers continue to make the same mistake. And
the tragedy it causes may be on the rise, say some experts.
Holding your breath underwater is part of swimming, and under
normal circumstances, breathing as needed, there’s no danger.
That changes when you hold your breath repeatedly for extended
periods underwater, which is typically done for training or
endurance purposes. Preceded by hyperventilation (sometimes called
overbreathing) it can be fatal: death by what’s collectively
known as shallow water blackout.
While aquatics professionals know what shallow water blackout is
— more than 80 percent recognized the term in a recent online
poll of 566 Aquatics International readers — a much
smaller number seem to fully grasp how it’s caused or its
true risk. For example, nearly 90 percent surveyed labeled
prolonged breath-holding as dangerous. But 40 percent also said
they don’t have rules at their facilities forbidding the
Despite the known threat, some coaches still regularly use
breath-hold training. Lifeguards — the first defense against
drowning — are not being fully or consistently trained on how
to spot the risks, especially because the victims often are strong
swimmers, say experts interviewed for this story.
Within those disconnects, people are dying.
The Divers Alert Network has tracked drownings linked to
breath-holding for more than five years and reports at least 44
fatalities each year since 2004. In 2010, an analysis published in
the Southern Medical Journal identified eight
breath-holding related deaths in a survey of 180 pool drowning
incidents that occurred between 1998 and 2008.
But those numbers only scratch the surface. “My expectation
is, we’re clearly not seeing how many cases where
hyperventilation is a factor,” says Neal Pollock, Ph.D.,
research director at the nonprofit DAN.
That’s because when someone dies as a result of excessive
breath-holding, no forensic evidence is left behind to tell the
story, so such deaths often are not reported as drownings.
Swimmers are equally oblivious to the risks, which leads to still
“In many minds, it’s still a safe, fun and acceptable
practice,” says Tom Griffiths, founder of Aquatic Safety
Research Group in State College, Pa., referring to prolonged
breath-holding. “People out there just don’t know
it’s a problem.”
Some, such as Rhonda Milner, find out the most tragic way of all:
They lose a loved one to shallow water blackout. “I am
actually a physician myself, and the medical examiner on my
son’s case had never heard of this phenomenon. This is
shocking!” says Milner whose son, Whitner, drowned this
spring, apparently from shallow water blackout.
Milner and others are angry the industry hasn’t done more to
warn against the danger — and they’re determined to do
something about it. If aquatics refuses to police itself, they say,
they’ll get government to step in. To that end, Milner is
leading a grass-roots effort to outlaw breath-holding at public
“Pools are required to have signs for ‘No
running,’ ‘No glass,’ ‘No diving in shallow
water,’” Milner says. “But we are not educating
and warning against shallow water blackout, where swimmers are
persistently and regularly killing themselves.”
Understanding the risk
“Shallow water blackout” is a somewhat ambiguous term,
first used to explain blackouts among divers using closed-circuit
systems. These systems are similar to a standard scuba set, except
that the tanks contain a mix of oxygen and recycled exhaled gas,
which makes them lighter and smaller. The U.S. Navy formally
identified shallow water blackout after it lost several
Here’s how it happens: Hyperventilation (either voluntarily
or as a result of extreme exertion) causes the body to expel larger
than normal amounts of carbon dioxide. The CO2 acts as
the catalyst that triggers a person to breathe, so less of it means
a swimmer can remain underwater for longer than normal conditions.
But that process starves the brain of oxygen, which causes a
blackout, according to research published in the Journal of
Applied Physiology. No physical cue indicates when an
individual underwater is about to blackout, and when it happens,
the body’s natural reflex is to take a breath, forcing water
into the lungs.
If the person is not rescued and resuscitated immediately, a
drowning will occur. A shallow water blackout can become fatal in
less than 2½ minutes because the body is so depleted of
oxygen, Griffiths says. Under normal conditions, a drowning death
happens in somewhere around 5 minutes.
“The general public needs to be educated as to the dangers of
hyperventilation prior to becoming submerged in water, and
hyperventilation followed by breath-holding needs to be actively
discouraged,” says Jerome H. Modell, M.D., the author of that
analysis in the Southern Medical Journal.
Two practices coaches and individuals use that can include
- Static apnea. Practioners attempt to hold
their breath as long as possible, remaining underwater in a still
position. Sometimes it’s a game, but it also is used as
- Hypoxic training. A variety of hypoxic, or
low oxygen, training techniques exist. Some swimmers simply limit
breathing frequency. Others swim for distance underwater.
It is possible to use breath-holding in training safely, but under
very limited, controlled circumstances with careful monitoring.
Pollock suggests “limiting hyperventilation to two or three
ventilatory exchanges immediately prior to breath-hold,” as
indicated in a 2008 review article he published in the journal
Diving and Hyperbaric Medicine.
USA Swimming, the governing body of competitive swimming,
concurs and that guideline appears in the U.S. Navy Diving
Manual. It’s based on “a long history of what
seems to be a fairly safe degree of hyperventilation,”
Pollock says. However, he adds, “It does not provide a
guarantee, but a reasonable expectation of not depressing carbon
dioxide levels low enough to generate a high risk of hypoxic (low
oxygen content) loss of consciousness.”
Moreover, there’s no way to control that among average
swimmers, says aquatics expert Roy Fielding, senior lecturer in the
Department of Kinesiology at the University of North Carolina at Charlotte, and
a member of the American Red Cross Scientific Advisory Council and the
Aquatic Sub-Council. The average swimmer or diver who uses these
training methods is likely a strong and competitive individual who
might easily fall into the mind-set of “if a little is good,
more is better.” Many also may not recognize pre- breath-hold
activity as hyperventilation.
“The finding that more than half of recently reported fatal
breath-hold incidents were unwitnessed indicates a fundamental
problem in practice,” Pollock notes in his article.
Griffiths believes it’s very likely that breath-holding
activities may be a leading cause of drowning among strong
swimmers. He says hyperventilation can lead to other dangers.
“If it’s not shallow water blackout, it’s
probably a medical cause that precipitated the drowning, such as
Long QT Syndrome or a cardiac arrhythmia,” he notes.
Researchers suggest prolonged breath-holding can trigger those
scenarios as well.
Experts have known about shallow water blackout for years, but
Griffiths believes it hasn’t been recognized in the
mainstream media reporting on drownings until this year.
That’s probably because the only way to potentially identify
it is if an eye witness reports that the victim had engaged in
breath-holding preceded by hyperventilation.
“It’s still so unknown, it basically looks like a
drowning,” Milner adds. It was her drowned son’s
surviving younger brother who first brought up the possibility of
shallow water blackout. Milner says he discovered it only after
doing some research.
To make swimmers aware of the dangers, Milner, Griffiths and others
suggest starting with signage.
“Signs are essential,” Milner says. “They make it
clear that no breath-holding is allowed, and they bring awareness
since most people are not aware of the dangers of
But, ultimately, there will still be those who can’t resist
breaking the rules — and plenty of pools are still unguarded.
To truly prevent more drownings, it comes down to education and
“Warning signs are fine as a reminder, but the important
focus should be on comprehensive education to ensure that the risks
are understood by all — the would-be breath-hold diver, those
who could influence his or her behavior, and lifeguards responsible
to protect the public,” Pollock says. “Possessing true
understanding can offer much greater protection than simply knowing
a ‘rule.’ We will help more people both now and in the
future by educating rather than by issuing edicts.”
Major aquatics agencies do recognize the risks of breath-holding.
The American Red Cross issued advisories and includes information on the dangers
of hyperventilation in its lifeguard training materials and
learn-to-swim classes. YMCA of the USA sent memos to all aquatic stakeholders
about unsafe breath-holding practices, which includes information
in lifeguard training program and recommends that all local YMCAs
have a “breath-holding activities prohibited” policy.
USA Swimming states in its Safety/Loss Control Manual that
“hyperventilation (rapid deep breathing) before prolonged
underwater swimming is a dangerous practice that may result in
drowning.” But not all training providers give enough
information, Fielding says.
Among aquatics professionals, a majority know the term, but
drownings linked to breath-holding are still happening, so
it’s clear that not everyone fully understands the risks, he
adds. Fielding’s greatest concern is with pools that
don’t generally have someone dedicated to aquatic management,
such as hotel and apartment pools.
Additionally, some swim coaches may not have access to the latest
training and information, and are still engaging in dangerous
techniques. For instance, he says, imagine a volunteer coach whose
training was as a swimmer in high school 40 years ago. The only way
someone like that would know how to instruct today’s athletes
is by using the same methods learned decades ago.
Such scenarios worry other aquatics experts. “We need to be
proactive. We need to look at how many of those situations are
occurring,” says Robert Ogoreuc, aquatic director at Slippery
Rock University, and assistant professor in its Physical
When it comes to training the next generation of young lifeguards,
there’s a significant challenge in preparing them to be able
to communicate the risk to a strong adult swimmer.
Fielding recalls one incident in which a young lifeguard was
approached by an older “Navy SEAL in training,” who
stated that he would be practicing breath-holding in a corner of
the pool and did not want to be bothered. The guard did nothing,
and the man drowned.
Hoping to make sure something like that tragedy, or what happened
to her son, doesn’t happen again, Milner launched the
nonprofit Shallow Water Blackout Prevention earlier this
year, with Griffiths’ full support. Milner’s
mission is “shallow water blackout prevention through
awareness, education, and legislation.”
ShallowWaterBlackoutPrevention.org went live in June
and long-term goals of the organization include pushing for
“no prolonged breath-holding” (except by certified free
divers) policies at all pools, and warning labels on spear-fishing
equipment. To increase awareness, Milner connected with the
National Drowning Prevention Alliance and the Centers for Disease Control and Prevention.
Starting in her home state of Georgia, she’s also working
with lawmakers to develop legislation banning prolonged
breath-holding in public pools.
“This could lay the groundwork for federal
legislation,” Milner says. “I think that people just
don’t understand the physiology. You expect you’ll have
a warning that you need to breathe before you pass out, but
that’s not the case. … Shallow water blackout is
unintentional suicide and completely preventable.”