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Drowning:
by A child drowned about a hundred yards from my home last year. It happened in the pool at the condominium complex where I used to live, on the day we traditionally think of as the start of summer, Memorial Day. Everywhere there was a pool people gathered to try to get out of the heat. One of those people, a ten-year-old girl, was visiting a pool where relatives lived. She was one of seventy or eighty people who crowded into a small pool protected by a single lifeguard. There was no clear explanation of how it happened. In fact, there were conflicting stories from many different sources. I am sure judges and lawyers and insurance people will eventually sort out all the facts, at least to satisfy their own needs, but one thing is clear: a child drowned in a guarded pool. Think about that for a moment. When I did, I got angry. How could this be, I thought. In a small pool, filled with adults, watched by a trained lifeguard, how could a little girl die? I could imagine someone climbing over a fence at night and drowning while no one was there to help. I could imagine a toddler wandering into a backyard and falling into an unprotected pool. I could imagine someone having a heart attack, someone diving in and sustaining a spine injury. Yet I could not fathom a way for a child to drown in such a place. My anger led me to start asking questions and start looking for answers. What is drowning? In medical terms, drowning is death by suffocation from submersion. In the aquatics profession we look to the national training agencies for a definition. The YMCA of the United States defines drowning as "asphyxiation due to blockage of the trachea, usually by water, causing respiratory arrest." The central idea is that drowning is a respiratory emergency caused by a fluid that blocks the breathing passage in one of two ways, wet drownings and dry drownings. In wet drownings, there is water in the victim's lungs that limit the body's ability to exchange gases and provide oxygen to the blood. It is also possible that water can be drawn into the bloodstream through the lung's alveoli, the tiny sacs that exchange gases in the small blood vessels of the lungs. This dilution can cause an electrolyte imbalance in the body which can bring on fibrillation in the heart, according to the YMCA. Fluids also play a part in the second kind of drowning, dry drowning. In these cases, there is often little water found in the victim's lungs, because there is reflex spasm of the larynx when fluid first hits it. Most people have experienced this sensation when something "goes down the wrong pipe." The tightening of the throat that we experience is actually a less serious form of laryngeal spasm. Dry drownings are rare, accounting for at most 20 percent of all cases. One of the medical examiners I spoke with said that he had never encountered one. For a lifeguard there is little difference in the water rescue skills required for either case, but there may be some differences in the resuscitation of the victim. While this clinical information is important, it does not answer the more frightening question: what is it like? Aquatic professionals are often called upon to simulate drowning victims for training lifeguards. Yet, as strong swimmers, we may not really understand what is going through the mind of a weak or non-swimmer in distress in the water. Imagine being suspended in space. There is nothing solid to hold on to (swimming instructors often hear children complain of a fear of falling because they don't feel anything holding them up). There is little or no air to breathe, so you feel pressure in your chest and throat. Your body is telling you to breathe, but it won't let you breathe in water. Your eyes are clouded and your hearing
is one of the most frightening and painful experiences imaginable. One myth about drowning that survives to this day is that it is a painless, almost pleasant way to die. Survivors testify otherwise: "...When the cramp hit me, I sank to the bottom of the lake 12 feet down, in a doubled-up position. Compounding the wracking pain in my trunk was a mounting choking sensation. (Try holding your mouth and nose after taking a deep breath. Hold your breath until it becomes unbearable; then try holding it a few seconds past the unbearable point. It's a horrible sensation and would give you a dim idea of just one aspect of how it feels to drown.) The pressure of the water caused a stabbing pain in my eyes and ears... try to keep your head when water begins to seep into your already tortured lungs and your body is a mass of pain and you know you are dying... I remember that I screamed down there against a solid wall of water—I remember that I threshed and bobbed, but only succeeded in burrowing my head into the slime of the lake floor...." The more I considered drowning from the victim's point of view, the more it angered me, because most drowning victims are young people. The National Safety Council indicated that 53 percent of drowning victims are under twenty-five. Drowning is second only to automobile accidents as a cause of death for those ages 5 to 19. The research I conducted on swimming pool drownings in the Chicago area indicated that 60 percent of the cases identified were victims under age nineteen.
When the victims are children, especially toddlers, drownings can happen anywhere. A study of drownings in Los Angeles identified cases of drownings in rivers, lakes, and pools but also in buckets, bathtubs and toilets. However, private pools are identified as the most frequent site. This trend varies with location. In Minnesota, for example, 95 percent of drownings between 1980 and 1985 occurred in lakes and waterways. In a North Carolina study, only 8.2 percent of drownings occurred in swimming pools. In the controlled environment of a swimming pool it seems that there should be fewer drownings and previous research bears this out. However, when a drowning does occur in a swimming pool, particularly in a pool with lifeguards on duty, the results seem more catastrophic. The mindset of aquatics professionals and, to some extent, the public at large, seems to be that we ought to be able to prevent these tragedies. But can we? The drowning that occurred near my home was what Dr. John Hunsucker would call a "mystery drowning." It was a drowning for which there was no explanation. There was no evidence of head or neck trauma. She did not have any known medical problem, such as epilepsy, which might cause unconsciousness. No one witnessed her exhibit any of the classic distress signs that we associate with an active victim. In fact, it was such a small pool and there were so many people there that it is unlikely she could have thrashed around as we know active victims will, without being noticed. She just drowned. In the 1992 National Pool and Waterpark Lifeguard Training Manual, Hunsucker proposes a possible explanation for mystery drownings. Imagine the girl starting in the shallow end of the pool, swimming underwater and jumping up into the air to catch a breath before ducking back under again. She repeats this several times, but doesn't notice that the water is getting deeper each time she jumps. Then, she jumps and finds that she doesn't get a mouthful of air, but rather a mouthful of water. The result could be a laryngeal spasm leading to a dry drowning. Although witnesses said there was a tremendous amount of water expelled from the girl's mouth when she was brought out onto the deck, it may be that, as she became unconscious, her larynx relaxed, and water came freely into her airway. It may also be that, upon her first mouthful of water, she was frozen with fright. Hunsucker likens this reaction to that of an animal caught in the headlights of a car, unable to move due to overwhelming fear. The frustrating thing about this case and others like it is that we will probably never know what really happened. Luckily, swimming pool drownings are extremely rare and swimming pool drownings where lifeguards are present are even more so. To get an idea of how often they occur, I contacted the coroner's offices in three counties in northern Illinois. Through their records, I was able to identify fifty-three swimming pool drowning fatalities in the last ten years. There may have been other cases that were not reported to coroners but that is unlikely so these cases represent most if not all the swimming pool drownings during that period. Examination of these cases presents some interesting facts:
These findings are consistent with other studies of drowning deaths, showing that pools are relatively safe places. Fifty-three deaths in ten years is a very small percentage of the millions of people who swam in everything from backyard pools to large public facilities in that time. Further, they show that drownings are far more likely to occur in private pools rather than public pools. This is encouraging for aquatics professionals who spend so much time preventing and preparing for these catastrophies in their facilities. Yet the scarcity of swimming pool drownings also works
against us. In the aquatics profession we spend considerable time and effort preparing for something that almost never happens. Swimming pool lifeguards faced with a drowning are like firemen who go for years without ever seeing a fire and then are faced with a blaze that consumes a whole city block. Pool guards can easily develop an " it can never happen here" attitude that lulls them into passivity. In this regard, waterparks have a distinct advantage over "flatwater" pools. With their larger crowds and moving water, waterparks experience many more near-drownings. Consequently, their lifeguards are much more aware of the potential for disaster. The rarity of swimming pool drownings also gives us few opportunities to learn. When an incident does occur, it is important to take the time to analyze it and attempt to determine the circumstances that led to it. The cases I reviewed gave me a chance to do that. One case showed just how quickly a drowning can occur. The incident happened during police training at a high school swimming pool. Police candidates were being screened for their swimming skill and one of the candidates started to struggle. He turned to swim back to the side and just fell face down in the water. He was pulled out almost immediately and given CPR but was not revived. According to the report the drowning occurred in full view of trained instructors. The autopsy showed that, in addition to pool water, he had asphyxiated stomach contents. Only seconds passed between the time when he was swimming and the time when he was motionless. Another case points out that swimming pool design may be a factor in a drowning. A young boy drowned at a public pool, yet was not found for several minutes. It is possible that, since the boy was black and the lane markers on the bottom of the pool were painted black, his body was not observable. A new design of lane markers, one that uses two narrow lines instead of one wide line, might eliminate this phenomena. The significant number of trespasser drownings makes me think there should be more emphasis placed upon alarm systems for pools. Many public buildings have burglar alarms that tie them directly to the police dispatcher. Why has the principle of motion detectors not been applied to swimming pools? One of the drowning cases that stuck in my mind happened at an urban public pool where an eight-year-old boy drowned while the pool was closed. The significant thing about the case is that there were as many as fifty people in the pool with him at the time. Even though they are rare, drownings in public pools when lifeguards are on duty are double tragedies. The lifeguard is actually the other victim. One of the first things that went through my head when I heard about the drowning near my home was, did I know the guard? I remember looking at the young people on my staff that next week as they went about their jobs. They took their responsibilities seriously enough but they were typical teenagers, fully enjoying the summer without much thought beyond what they would do after they got off work. If the drowning had occurred in our pool instead of a private one across town, how much different would their lives be? Jeff Ellis, of the aquatic risk management firm Ellis and Associates, has been an investigator and expert witness in 109 drownings, some of which are still in litigation. "Lifeguards get
the raw end of the deal emotionally," he says. "Everyone focuses on the victim and no one takes care of them." Jeff and his senior associates tell horror stories about lifeguards whose young lives were all but destroyed by a drowning in their facility. Many drop out of school. Rarely do they continue lifeguarding. Carol Pick, an Ellis and Associates' senior partner, told me that she knows of one lifeguard who is still in counseling five years after the incident. Looking at my lifeguards, all full of youth and spirit, this possibility makes my blood chill. What, then, can the aquatics profession do to prevent these tragedies that we are not already doing? I don't have all the answers, but I do have some suggestions. First, we can review the way we train our lifeguards. Dr. Hunsucker points out that in most lifeguard courses we spend considerable time training guards how to react to a drowning, but little or no time teaching them what to look for to prevent one. Are there changes in pool design, lifeguard training, or pool operational procedures which would improve the ability of a lifeguard to see a motionless person on the bottom of a pool? These are questions we need to ask. We can also commit ourselves to water safety education, not just teaching people to swim. Of course there are already many tools available to teach people water safety. The American Red Cross "Whales Tales" program is a good example. The question is, how do we get them more before the public eye? We need to extend our reach beyond our pool decks. We can also take steps to make private pools safer. As aquatics professionals, we should try to influence local and state lawmakers to consider licensing backyard pools, perhaps even requiring the inspections similar to those public pools get. Maybe we can't require motels and apartment complexes to have lifeguards, but we could force them to make their pools more secure to prevent them from becoming statistics. Finally, we could establish a national database on swimming pool incidents. One of the great frustrations in the research I did for this paper was that there is no good source for this information. One county coroner's office I spoke with did not even have the ability to tell me how many people died from drowning, much less how many died in pools. Ellis and Associates has an excellent start in this direction, requiring a report to be filed anytime there is a lifeguard action. As large as it is, however, their database covers only their own clients. A more universal database would allow us to track the situations that lead to drownings and take steps to eliminate those circumstances. I wish I could say that I learned something new about drowning after the incident at the pool near my home, something that would make a difference. Realistically though, I only confirmed many of the things I already knew about swimming pool drownings. I can say, however, that the process renewed my commitment to the aquatics profession. As I looked through those coroner's files I was struck by the fact that each folder of notes represented a life that had ended, most of them children who would never grow up. Hemingway said, "the death of even one man diminishes us all." In the same manner, even one drowning in a guarded pool is a stain on our whole profession. There is no way a drowning should occur in a guarded pool. Perhaps we can't control people who fill their bodies with drugs or alcohol and come to our pools and get hurt. Perhaps we can't make all people who own backyard pools keep them locked and secure. Perhaps we can't stop people who are determined to climb our fences at night. However, we can and we must put an end to drownings where they are preventable.
About the Author Ron Shaw is Facility Supervisor for Buffalo Grove Park District. He has worked as an aquatic director for several YMCAs and park districts since 1983. He currently manages the operations and programs of two busy public swimming pools. Ron holds a BS in physical education and an MA in communications from the University of Illinois, Chicago.
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