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Fact or fiction?

Warm, sunny day. Patron in distress. Lifeguard grabs a rescue board. After launching the board, the lifeguard cries out in pain. Within moments, other lifeguards realize they must now rescue not only the patron, but the lifeguard as well.

Fact: Lifeguards have, indeed, avulsed body jewelry during the course of rescue operations. The pain and shock associated with traumatic avulsion (separation by force) has even required that the lifeguards themselves be rescued.

The general rule is, if you can pinch it, you can pierce it. According to a recent study done at Pace University in New York, 51 percent of undergraduate students have something pierced and, of those, 17 percent suffer medical problems via infection and tears. (The authors feel that their study, while limited to Pace students, offers “a diverse and representative sample” of U.S. collegiate students, while also recommending additional studies.)

Youth Studies Australia states that one-third of the population in Australia over 14 years of age has some kind of piercing. While not always noticeable in the business setting, body jewelry becomes apparent among lifeguards.

Risks associated with piercings vary according to the tissue pierced. Similarly, healing times vary. Factors that affect healing include lack of air flow, body fluid accumulation, presence of sebaceous glands and friction from close-fitting clothing.

Earlobes generally heal in as little as six weeks, while navel piercings can take from six to 12 months. During this time, piercings, like fresh tattoos, are considered open wounds. As with all open wounds, persons should be excluded from entering the water. Therefore, freshly pierced lifeguards should not be assigned patron surveillance duties, even though the risks of infection in a properly treated pool should be minimal.

EXTERNAL PIERCINGS
Body PartGeneral Healing TimeRisk of InfectionRisk of AvulsionHealth Risk or Concern
Ear Lobe6-8 weeksLowHighLittle pain. Heals quickly.
High Ear3-12 monthsModerateModerateCartilage, poor healer.
Nostril2-4 monthsVery HighModerateScarring, keloids, abscesses.
Nasal Septum4-8 monthsHighUnknown
Nasal Bridge8-10 weeksLowLow
Eyebrow6-9 weeksLowVariesBarbells snag less than rings. Often rejected.
Lip2-3 months<</span>ModerateHighLeaves a mark when jewelry removed.
Labret4-8 weeksModerateHighLeaves a mark when jewelry removed.
Nipple3-6 monthsModerateModerate to HighSome nipple rings twist with arousal. Must be pierced above center of nipple because of concern about penetrating lactating ducts.
Navel4-12 monthsHighHighDifficult to heal.
Scrotum8 weeksHighHighNot for bike riders. Must wear pad for healing.
Outer Labia6-8 weeksHighModerate
Ampallang2-3 monthsLow due to urinationUser dependentCannot heal under foreskin. Cannot remove for one year.
INTERNAL PIERCINGS
Tongue4-8 weeksHighLowSwells vascular.Potential airway obstruction.
Clitoris4-10 weeks High LowProfessionally controversial.
Source: New England Aquatics Network

A consistent policy

When developing policies that restrict body jewelry, it is important to relate the restriction to the essential job functions of a lifeguard. Examples include positions that exist to perform certain functions; those that a limited number of other employees are able to perform; and functions that are highly specialized or require special training or ability to perform.

For lifeguards, the ability to perform a rescue safely and effectively should be considered an essential job function. Restrictions designed to ensure that this function can be carried out would be considered reasonable.

Similarly, restrictions might be appropriate as safety precautions designed to minimize the likelihood of workplace injury. All policies should be developed prior to hire as opposed to in response to a specific individual’s piercing, and should be enforced without bias.

If current policies allow earring studs and plain wedding bands, employers must be careful to restrict other body adornments to those that likewise follow closely the contour of the body. A curved barbell in the eyebrow is less likely to snag than a ring, hoop or straight bar that protrudes from the body. Eyebrow rings pose a risk when removing rescue tube straps or when working with small children who may grab indiscriminately.

Employers can institute a policy similar to that of recent drug use and testing: “Given the public health implications, we will not hire anybody who has received a new tattoo or piercing in the past 60 days.” Typically, blood donation is prohibited for one year after body modifications.

Tongue piercings are never appropriate for lifeguards. Because jewelry ends can separate, tongue piercings present a choking hazard. The vascular nature of the tongue, which contains both the lingual artery and vein, means excessive bleeding even with a very small injury. Tongue piercings also never fully heal, and are likely to bleed upon irritation. The tongue swells rapidly following impact or allergic reaction, which can result in a tearing injury. Also, the American Dental Association has documented an increased incidence of dental fractures in patients with tongue piercings as a result of secondary impact injury. For these reasons, the ADA has taken a strong position against all intraoral piercings.

Recommendations

In developing restrictions on body jewelry, employers should understand that once healed, all jewelry could be safely removed. Concerns over holes closing are unfounded because people frequently remove jewelry or wear Lucite retainers, also known as invisible jewelry, when they wish to conceal the piercing. Invisible jewelry items are single captive ended and internally threaded. This means they are more likely to be pushed out or lost upon impact than to cause a traumatic amputation or avulsion.

Where else is body jewelry regulated? Hospitals regulate jewelry for staff and patients. Patients are commonly asked to remove all jewelry before procedures such as MRIs and surgery. The National Collegiate Athletic Association bans visible jewelry in all sports. If discovered during the course of the game, penalties are assessed. The U.S. Armed Forces regulates jewelry both in and out of uniform. In lifeguard training courses, instructors regularly ask students to remove all jewelry to reduce the risk of injury while practicing rescue skills.

Recommendations: Because of the increased risk of injury, all body jewelry, with the exception of medic alert tags, should be removed before the start of one’s shift. (Note: The NCAA requires athletes to tape medic alert tags to their body prior to entering play.)

When creating corporate policies, consider:

  • What is reasonable?
  • What is the likelihood of injury?
  • Could the specific article of jewelry interfere with job performance?