During the past few years, the aquatics industry has promoted professionalism and attention to detail in a number of areas, including lifesaving. Many valiant efforts have been made to further the cause. Unfortunately, there are flaws as well. Changes in our field can be good and bad, and depend heavily on a measured approach.

Historically, lifesaving knowledge and techniques were passed by field innovation and tradition. A good example of field innovation was the introduction of personal watercraft use for ocean rescue lifeguards. Many administrators in organizations employing surf lifeguards fought against personal watercraft use. Luckily for lifeguards and participants, common sense prevailed, and advanced equipment and techniques are common at well-managed ocean fronts.

Some would argue that an example of a tradition for lifesaving that is questionable (specifically, pool settings) would be the 500-yard swim test. While my personal opinion is that you want to train and hire the very best candidate for a lifeguarding position, why did we decide to use 500 yards? Why not 250 yards or a half-mile? 

Current activity in the industry has been to assign scientific findings to knowledge and skill sets. Scientific study has been undertaken in some areas, but not all lifesaving content has been analyzed by scientific methods. In the United States Lifeguard Standards report (USLS, January 2011), a vast pool of evidence-based knowledge was assembled. However, it concerns me that areas that were not acknowledged might be viewed by lifeguard training agencies and others as irrelevant or unimportant. An area in which I've had interest for some time (after I witnessed a breathing emergency) is emergency oxygen administration. The USLS report asked a single question about oxygen: “Is oxygen safe, effective and feasible in the drowning process resuscitation?”

During the review of evidence, the report states: “Health-care providers and emergency responders routinely administer supplemental oxygen to ill or injured patients. Although some first aid providers use supplemental oxygen, there are no research studies demonstrating benefit or absence of harm.”

To me, the report implies that health-care providers and emergency responders do not include lifeguards. The statement about “some first aid providers” leads me to believe that guards are being classified as having a closer relationship to first aid providers than health-care providers or first responders.

It should be noted that the 2007 American Association of Orthopaedic Surgeons' first responder text also identifies capable swimmers trained in lifesaving techniques to be the only ones who should enter the water for aquatic rescues. The 2001/2005 American Red Cross emergency response (first responder) text lists lifeguards as first responders. Additionally, the ARC text shows multiple depictions of lifeguards providing care in the content. In the 2008 National Safety Council's first responder text, lifeguards are listed as one of the other occupations that may hold first responder duties. This text also identifies in special rescue situations, such as deep water, that lifeguards have the specialized training and equipment to respond to victims.

The first responder texts currently hold the new title “emergency medical responder” (EMR). This is due to the term “first responder” being replaced by “EMR” in the EMS language. The 2011 AAOS EMR text directs the student only to attempt a water rescue if he/she is a capable swimmer trained in lifesaving techniques.

In the 2011 American Red Cross EMR text, lifeguards are listed as potentially providing the same minimum standards as the EMR. This text also has multiple depictions of lifeguards providing care as example demonstrations. The 2011 National Safety Council's emergency medical responder text lists lifeguards as one of the other occupations that may hold EMR duties. It also explains that guards receive specialized training on how to manage these victims.

This is so critically important to note because the following emergency medical conditions are listed by AAOS, ARC and NSC first responder texts (2007, 2001/2005 and 2008 respectively) as benefiting from emergency oxygen administration: heart attack, shock, stroke, poisoning, serious head injury, and complications during pregnancy. In the current EMR texts, all three agencies list emergency oxygen administration for heart attack, shock, poisoning, serious head injury, abdominal injuries, anaphylaxis/allergic reaction, serious back/spinal injury, respiratory arrest and distress, and seizure with difficulty breathing.

We know that lifeguards receive training for many of these medical emergencies and are the first medically trained staff on scene. In fact, they recognize the problems most of the time and initiate the response to care for the victim. Maybe my assessment of how the lifeguard training agencies will use these new lifeguard standards is completely wrong. I agree with the USLS report when it states: “The role of a lifeguard, regardless of where trained or employed, is to prevent death and injury. Using the best methods of training and standards of practice can therefore be expected to reduce the incidence of death and injury.”

In conclusion, the use of oxygen for medical emergencies (too numerous to list here) is well known. I hope the industry uses the historic common-sense approach to explain knowledge and skill sets when validated research for specific skills and knowledge is not available. Training agencies, practitioners, researchers, industry experts, educators and any parties in collateral fields need to come together to study our discipline.

As a friend recently put it, “Do not throw out the baby with the bath water.”

The individualistic or ownership driven approach weakens our field. The bickering about who is included or left out of the process is not a good situation and breeds distrust. All of the stakeholders need to come together to agree upon minimum training guidelines for lifeguards. We all have ownership for saving lives.