Three separate breath-hold incidents at YMCA pools in a two-week period and another at Kenmore Pool in Saint Edward Park in Kenmore, Wash., have brought the issue to a head, and prompted industry action.

In the most serious incident, Marc William Dawson, a 17-year-old high school junior from Greenlawn, N.Y., died in February in the pool of a Long Island YMCA. Dawson was set to ship out with the United States Navy in September, and was practicing to train as a SEAL.

The most recent incident, in Washington, involved three girls at a Seattle synchronized swim team practice. Three girls, all between 12- and 15-years-old, passed out simultaneously swimming a 50-yard freestyle underwater without breathing and were subsequently rescued and hospitalized.

“The anecdotal data is beginning to support [the idea that breath holding] is a growing issue,” said Kevin Trapani, President and CEO of the Redwoods Group, which handles insurance for YMCA USA facilities.

“Hyper conditioning is a challenge at every level of sport. I don’t think there’s a major difference between [professional baseball players] using [performance enhancing drugs] and breath holding. Both are seen as a way to improve performance with very negative consequences. Facilities need to make it clear that [breath holding training is not allowed] and lifeguards need to be reinforced [with support from supervisors].”

Trapani notes that a number of organizations, including YMCA USA and Ellis, recommend against breath holding. David Markenson, MD, FAAP, EMT-P, Chair, American Red Cross Advisory Council on First Aid, Aquatics, Safety and Preparedness Panel says the Red Cross includes information on breath holding in its lifeguard and swim instructor training materials.

According to the agency, the “American Red Cross Lifeguarding manual, [says] hyperventilating is a dangerous technique some swimmers use to try to swim long distances underwater or hold their breath for an extended period while submerged in one place. They mistakenly think that by taking a series of deep breaths in rapid succession and forcefully exhaling that they can increase the amount of oxygen they breathe, allowing them to hold their breath longer underwater. This is not true. Instead, it lowers the carbon dioxide level in the body.”

Dr. Markenson adds that as of press time his panel is preparing a policy statement on the dangers associated with the activity, although he doesn’t expect this will change the information provided in aquatic training courses. “I always leave open the possibility of change, but scientific evidence supports our current messaging in the courses,” said Dr. Markenson.

Aquatics expert Tom Griffiths, director of the Aquatics and Safety Office for Athletics at Penn State University in State College, Pa., and founder of the Aquatics Safety Research Group, says in spite of the dangers, swim coaches and athletes continue to use hypoxic training, pushing to go deeper, farther, longer, and more needs to be done to raise the awareness of the dangers of the practice.

According to Griffiths, magician and endurance artist David Blaine popularized breath holding in May 2006 when he attempted to break the world record in Lincoln Center, New York City, on national TV. Blaine recently performed the stunt again on The Oprah Winfrey Show.

“Many breath holding cases go under reported because coroners are trained to put ‘drowning’ when there is a pool death,” said Griffiths. “A ban on breath-holding should be one of the ‘Big Three’ pool rules. Training organizations need to provide more and better information and every pool should ban all prolonged underwater swimming for time and distance, particularly when it is competitive, repetitive and includes hyperventilation.”