For years, aquatics professionals have been wrestling with questions about availability and use of life-support devices and techniques, including automatic electronic defibrillators, bag valve masks, suction devices, oxygen, artificial respiration and CPR.
But two very important questions are not being addressed. They involve our lifeguards, especially the 15- and 16-year-olds, who are often asked to work without adult support. The first question is whether someone that young has the maturity to be responsible for applying the last desperate measure to try to bring a drowning victim back to life. The second question is that of the long-term impact of a death on the psychological and emotional health of that lifeguard.
To begin with, drowning victims often will die even with life-support techniques because these work only a fraction of the time. The success rate for CPR is between 2.9 percent to 5.2 percent, according to studies at Albert Einstein College of Medicine in New York and Loeb Health Research Institute in Ottawa, Ontario, Canada. For AEDs, the success rate can be as much as 50 percent, but that’s only under the best of circumstances, according to a 2005 study by the American Heart Association.
As for artificial respiration (AR) or rescue breathing, research and our own experience has shown it can be effective, but only if it is applied properly and quickly.
To underscore this point, one insurance company that asked to remain anonymous has a long history of insuring numerous summer camps with aquatics facilities. Its records show that no drowning victim at any of its facilities who was under the water for more than one minute has been successfully resuscitated.
Under the protocols of most facilities, every guard, no matter how young or inexperienced, is required to apply all of the life-support techniques they have been taught. However, in examining National Aquatic Safety Co. (NASCO) files gathered while doing accident investigations for aquatics facilities, the authors found that in the last 12 fatalities investigated, only once did a lifeguard do the mouth-to-mask AR portion of the rescue protocol. In the other 11 cases, the AR was done by either a guest or management. The guards involved were trained by several different agencies, but all were trained in doing CPR.
Even health professionals are likely to refuse to do life support outside of a hospital setting. Fewer than half of the doctors and nurses surveyed said that they would do AR on a stranger, according to research published in the Western Journal of Medicine.
For most people, the experience of actually working on a victim is very traumatic. If a lifeguard brings in a drowning victim without respiration or a heartbeat, they are being confronted with what looks like a dead body: The skin may be waxy and pale or bluish; the pupils of the victim’s eyes may be “blown,” open and fixed; the body is flaccid dead weight; and often vomit, mucus and other body fluids and solids are present. In addition, reaction from the victim’s family or friends may range from rage to despair. Guards may be exposed to all of this and also feel shock and guilt that this incident occurred on their watch. The effect frequently lingers long after the initial incident.
We’ve been training lifeguards for more than 30 years and have seen the results of drownings on the victim and the rescuer many times. Here are three examples of how lifeguards were affected by deaths due to drowning:
Two female guards, ages 16 and 19, were on duty on the deck with their 40-year-old supervisor. A fatal drowning occurred. Five years later, when we talked to them, the women were still having nightmares about the drowning, and none of the people involved in the rescue had ever participated in aquatics again. This happened despite the fact that one of women had been a lifeguard for years and the other one was a competitive swimmer.
In a separate drowning incident, the lifeguard, a young man who was around 19 years old at the time, actually saw the victim climb out of the pool and collapse on deck, where she stopped breathing. He tried to revive her, but was unsuccessful. The lifeguard left aquatics and is still having difficulty coping with the incident.
A final example shows that not only the guard, but also the family of the guard, may be affected. The 17-year-old female lifeguard was involved in a drowning incident where a father and daughter slipped over the drop-off into deep water. The father was able to push the daughter back onto the 4-foot depth, but suffered a heart attack and drowned in the deep end. When the guard went home and told her father, he became physically abusive.
In fact, our experience shows that it is rare when a death due to drowning does not have a traumatic, long-term psychological effect on the guards involved.
What’s the alternative to having our youngest and most vulnerable lifeguards face life-and-death situations that would test the resources of even trained adult emergency personnel? We can only raise the questions and ask the industry to think about the impact shouldering such responsibility has on our youngest guards. Would you want your 15- or 16-year-old child to be face to face with death without the support of an adult? If you asked the parents of your youngest lifeguards that question, what would they say?