Task Force on Rescue – Organisational Aspects:
Rescue Planning,
Training and Preparation
Task Force on Rescue
Section editors: Rob Brons and Chris Brewster 4.1
Overview 135
Chris Brewster and Rob Brons 4.2
Recommendations 138
Chris Brewster and Rob Brons 4.3
Rescue Organisations: Paid or Volunteers? 142 Mike Espino and Chris Brewster
4.4
Lifeguard Effectiveness 145 Ralph Goto
4.5
Quality Assessment and Risk Monitoring of Lifesaving 147 Rob Brons
4.6
Beach Hazards and Risk Assessment of Beaches 151 Andrew Short
4.7
Training Standards for In-Water Rescue Techniques 156 Rick Wright
4.8
Training and Equipping Rescue Personnel for Flood Rescue 159 Slim Ray
4.9
Learning from Computer Simulations 162
Wiebe de Vries
Ann Williamson and Julie Gilchrist 4.11
Risk Management in Training of Rescue Techniques 172 Richard Ming Kirk Tan
4.12
Lifesaving as an Academic Career: International Perspectives 176 Veronique Colman, Stathis Avramidis,
Luis-Miguel Pascual-Gómez,
Harald Vervaecke and Ulrik Persyn 4.13
Fund-Raising for Lifesaving 183 Klaus Wilkens
4.14
Lifesaving in Developing Countries 185
Margie Peden and John Long
Task Force Chairs
▬ Chris Brewster
▬ Rob Brons
Task Force Members
▬ Tom Griffiths
▬ Jim Howe
▬ Gabriel Kinney
▬ Andrew Short
▬ Peter Wernicki
▬ Klaus Wilkens
▬ Mike Woodroffe
▬ Rick Wright
Other Contributors
▬ Stathis Avramidis
▬ Veronique Colman
▬ Mike Espino
▬ Julie Gilchrist
▬ Ralph Goto
▬ John Long
▬ Jerome Modell
▬ Luis-Miguel Pascual-Gómez
▬ Margie Peden
▬ Ulrik Persyn
▬ Richard Ming Kirk Tan
▬ Slim Ray
▬ Harald Vervaecke
▬ Wiebe de Vries
▬ Ann Williamson
4.1 Overview
Chris Brewster and Rob Brons
The World Congress on Drowning 2002 focused on three specific areas involv- ing drowning: prevention, rescue and treatment. It was widely agreed that the most effective way to prevent death or injury from drowning is by prevention.
Through public education, water safety training, proper design of aquatic areas,
and other similar means, a large number of people can be protected in a rela-
tively inexpensive and efficient manner. On the other hand, the least effective way to prevent death or injury from drowning is through treatment of drowning victims, because this necessarily takes place after an event that has already done some damage to the victim – damage that is sometimes irreversible regardless of the quality of treatment.
The effectiveness of rescue, as a method of preventing death or injury falls in the middle of prevention and treatment. A properly skilled and equipped res- cuer, who recognises the distress of a person in the water or who is dispatched to the area in time, can successfully interrupt the drowning process. Tens of thou- sands of rescues occur each year throughout the world. In Southern California alone, for example, lifeguards report over 40,000 rescues from drowning in a typical year.
Most rescues stop the drowning process before the victim sustains injury.
Some rescues even take place before victims are aware of the peril facing them.
Victims in such cases are typically able to walk away without any medical treat- ment. In other cases, some degree of injury may be sustained, which can either be treated onshore with basic first aid procedures or which necessitates a trip to an advanced medical facility.
Rescuers, such as lifesavers, are not only responsible for rescue itself. Most rescue organisations provide preventive services, both off-site and on-site.
Lifesavers may, for example, lecture schoolchildren, organise junior programs, or distribute brochures at special events. When people arrive at an aquatic area, they may find signs, flags, or other devices to encourage them to pursue recrea- tional activities in the safest possible manner. While swimming, lifesavers may move swimmers away from hazardous areas into safer areas, for example. This is often called proactive lifesaving or, more typically, preventive lifesaving.
Lifesavers are not the only aquatic rescuers who practice prevention. So do coast guards, harbour patrols, marine patrols, and other groups responsible for promoting boating safety. Since drowning is the primary source of death from boating accidents, preventing these accidents from happening and promoting use of safety devices, like lifejackets, is critical. It provides the victims a longer survival time and gives rescuers a greater opportunity to respond to reports of distress before serious injury occurs.
In many cases, those who respond to the call for a water rescue are not spe- cialists in this discipline. They may be firefighters, police officers, or park rang- ers for example. In areas under their purview, where they know aquatic acci- dents are likely, these people should also promote prevention. For example, in areas where ice related accidents happen with regularity, local law enforcement and firefighters may instruct the populace in how to avoid falling through the ice into the water.
Preparing organisations and the individuals of which they are composed to effectively provide aquatic rescue services is a critical task for any society.
Drowning is one of the leading causes of accidental death and injury worldwide,
eclipsing death from fire in many countries. Thus, response preparations should
be seen as no less important than crime or fire prevention. Likely locations and
circumstance that might cause drowning should be identified, organisations de-
veloped, personnel trained and equipped, and plans put in place to effectively
and efficiently address likely circumstances. In short, communities should pre- pare themselves effectively to prevent, respond to, and treat drowning.
Rescue is the subject of two sections of this handbook. This expanded treat- ment addresses the many types of circumstances that require rescue, the myriad techniques involved, the wide array of equipment used, and the different organi- sational approaches. The World Congress on Drowning 2002 brought together experts in water rescue from a very broad array of disciplines. These sections reflect their contributions. Utilising the information in these sections, effective lifesaving organisations can become even better at what they do, and those begin- ning to provide lifesaving services will have a roadmap at their disposal, drawn by some of the most respected experts in the field of aquatic rescue worldwide.
In this section, we focus on organisational issues that can help prevent accidents and improve outcomes when accidents occur. In the next section, we will focus on specific tools and knowledge disciplines for effective drowning prevention.
Rescue organisations can be made up of volunteers, paid personnel, or a combination of the two. Chapter 4.3 provides an overview of these approaches, based on discussion at a highly attended expert session at the World Congress.
Whether volunteer or paid, funding lifesaving services requires justifying the need, as well as the cost, to those in positions of authority. An extraordinary document on this topic was produced by the Centers for Disease Control and Prevention (Atlanta – USA). It discusses the effectiveness of lifeguards at pre- venting drowning and is intended for use by decision-makers who are consider- ing beginning, enhancing, or even terminating lifeguard programs. An overview can be found in the Chapter 4.4
Part of the effective organisation of lifesaving work includes occasional re- views of the work that is conducted; Chapter 4.5 provides some recommenda- tions in this regard.
Perhaps the first step in developing an effective approach to rescue is evalu- ating the need. Chapter 4.6 details a method for identifying beach (and water) hazards and assessing risk that can be used to determine when, where, and in what magnitude resources should be devoted to drowning prevention. This pro- gram has been effectively applied in several areas of the world.
To prepare for aquatic rescue, personnel must of course be properly trained.
Several of our chapters address training. The development of appropriate, gen- eral standards for training is covered in Chapter 4.7 . There are a variety of spe- cialised circumstances in which lifesaving organisations are needed. Flood res- cue is addressed in Chapter 4.8 . An approach to training that involves the latest technology is described in Chapter 4.9 .
Considering the importance of measuring and demonstrating the work done by lifesavers, collecting data is essential. A review of Chapter 4.10 will yield some valuable recommendations for lifesaving organisations around the world.
Training is one area that can involve special types of risk. Chapter 4.11 is devoted to this subject. In addition to training, lifesaving work also has inher- ent risks. Managing those risks and limiting liability are important elements of lifesaving. An excellent overview can be found in Chapter 4.12 .
Can lifesaving training be considered an academic pursuit? In some areas of
the world, this is clearly the case, as described in Chapter 4.13 .
Whether the rescue organisation is made up of paid personnel or volun- teers, adequate funding is critical. Chapter 4.14 provides some new ideas and insight into a particularly effective fund-raising campaign used by the German Lifesaving Federation (DLRG).
Some 97% of drowning deaths occur in less developed nations. Clearly, pre- vention and other lifesaving services are needed in developing countries, just as they are in developed countries. However, the tremendous challenges faced by developing countries may make it much more difficult to organise lifesaving services there. A discussion of this topic, including some staggering statistics, can be found in Chapter 4.15 .
In summary, this section provides a wealth of information on organisational aspects related to lifesaving. The careful reader will gain tremendous insight into ways to develop and improve aquatic rescue services. The opportunity is yours.
4.2
Recommendations:
Rescue Planning, Training and Preparation
Chris Brewster and Rob Brons
In some areas of the world, there are few, if any people trained, equipped, or pre- pared to provide timely rescue to people in distress in the water. In other areas, highly advanced rescue services exist. Even these advanced services however, can improve. Therefore, a comprehensive strategy to reduce drowning world- wide must include methods of providing rescue services where they do not exist, and improving the quality of existing rescue services.
Prior to the World Congress on Drowning, the Rescue Task Force was assem- bled. This group of nine experts was asked to focus attention on eight rescue- related topics and to make specific recommendations. These were reviewed and accepted by the Rescue Task Force and the Steering Group of the World Congress on Drowning. During the Congress, these topics were discussed in further detail and the recommendations were published, in abbreviated form, in the appendi- ces of the Final Recommendations of the World Congress on Drowning. In this chapter, you will find brief synopses, compiled by the Rescue Task Force leaders, of each of the topics addressed by the Rescue Task Force involving planning, training, and preparation. Specific recommendations are also included. For a more thorough explanation of each topic, please read the chapters in this section authored by the named experts.
During the World Congress on Drowning, additional topics with regard to
swimming training and scientific investigation of rescue techniques resulted in
additional recommendations as a product of discussion among the experts in
attendance. These are listed as recommendations 5 and 6 in this chapter. The
remaining recommendations 7–10 are covered in Chapter 5.2 .
4.2.1
Recommendation 1 – Risk Assessment of Beaches
Task Force Expert: Andrew Short
One of the greatest challenges to drowning prevention faced by governments and private businesses which oversee aquatic areas used for recreation, is de- termining the level of drowning prevention efforts justified by hazards present.
Inevitably, this determination will be partially based on factors such as the so- cietal valuation placed on human life. For example, an underdeveloped country battling serious disease or malnutrition will likely see the value of drowning prevention as a much lower priority than a developed country.
These factors aside, creating a meaningful drowning prevention strategy necessarily entails gauging the varying levels of hazard presented at aquatic are- as. Specifically, for example, are signs an adequate deterrent? Should the aquatic area be staffed with lifesavers? If so, at what levels, with what equipment avail- able, during what times of day or season?
It is particularly difficult to quantify the need for these services considering the widely varying beach conditions that may exist, as well as attendance levels, the skill level of water users, and so forth. Pioneering work in this area has been conducted for Surf Life Saving Australia (SLSA) by Andrew Short.
According to Short, “The Australian Beach Safety and Management Program ... compiled a database containing the location, physical characteristics, access, facilities, and hazards at everyone of Australia‘s 10,685 beach systems ... SLSA has also used the above system to develop a Beach Management Plan and more recently incorporated it into a Coastal Safety Auditing Program. The former pro- vides a flow chart for the lifesaver to determine both the modal and prevailing beach hazard rating, thereby providing a standard and quantifiable measure of hazard on each and every patrolled beach. The chart goes on to suggest the level of water safety resources (personnel and equipment) required to mitigate the level of risk. The latter is a national auditing process that uses the beach safety rating in combinations with other factors to develop a holistic approach to the development and maintenance of a safe coastal environment.” ( Chapter 4.6 )
Rescue recommendation 1:
It is recommended that the work of Andrew Short be considered as a basis for
developing a worldwide standard for the evaluation of hazard presented at
beaches and for developing appropriate drowning prevention strategies.
4.2.2
Recommendation 2 – Training Personnel for Flood Rescue
Task Force Expert: Slim Ray
Inland flooding, whether from river floods or flash floods, is the top weather- related killer worldwide. Floods inflict thousands of casualties, in many years more than wars, terrorism and revolutions. Surprisingly though, as Rescue Task Force member Slim Ray points out, “... while many countries have large and lav- ishly-equipped anti-terrorism units, specialised flood rescue units are rare. In fact, few local and national emergency services worldwide possess even the most elementary training and equipment for flood rescue. Unfortunately it is com- mon to see firefighters, police, and military personnel out in flood waters in their service uniforms and fire fighting protective gear, bravely trying to impro- vise rescues on the spot with inadequate and inappropriate equipment. Often rescuers pay for their unpreparedness with their own lives.” For example, in a recent case in the US, in which 52 people died, 10% of the flood fatalities were rescue workers. ( Chapter 4.8 ) This topic is also mentioned in Section 11 .
Rescue recommendation 2:
Communities throughout the world, which can expect to face flooding, must prepare themselves, and the emergency workers they designate, to effectively respond to flood rescue. This includes planning, along with proper equipment and training. Training must be realistic and conducted on moving water. Rescue units must have an effective incident command structure. Plans should call for them to be deployed early enough in the event to make rescues rather than body recoveries. They should be supported by other emergency responders trained locally.
4.2.3
Recommendation 3 – Training Standards for In-Water Rescue
Task Force Expert: Rick Wright
Throughout the world, the many organisations which train persons to rescue
others in the water have developed training standards which they consider ap-
propriate to the expectations placed upon the lifesavers. Typically, these are
based on anecdotal evidence of appropriate minimum training standards, or
historical experience. These standards, while in some cases roughly comparable,
are as diverse as the number of organisations in existence. However few, if any,
scientific studies have been made to objectively determine the minimum levels
of training required to adequately prepare one human being to save the life of
another in the water. ( Chapter 4.7 )
Rescue Recommendation 3A:
Scientific study should be undertaken to form a basis for determining the skills required to rescue another human in an aquatic emergency. Such a study should ascertain whether there is a link between the actual biomechanical and physi- ological performance of in-water rescue and the training and assessment mecha- nisms that qualified the human to perform such a rescue. Furthermore, the study should seek to determine whether the resulting condition of the patient would be different as a result of the skills or knowledge of the rescuer.
Rescue Recommendation 3B:
Based on the results of the study, the International Life Saving Federation should evaluate its current recommended minimum competencies for lifesavers, making any appropriate modifications.
4.2.4
Recommendation 4 –
Fund-Raising for Aquatic Lifesaving Organisations
Task Force Expert: Klaus Wilkens
Lifesaving organisations of the world must continually seek funds to ensure ad- equate working capital to provide necessary levels of resources to carry out their mission of drowning prevention. While some are government funded, others rely exclusively on donations and similar sources of income. Both non-govern- ment and government rescue organisations can benefit by effective fund-raising programs. Unfortunately, despite the fact that the services they provide have tremendous appeal, lifesavers are not always effective fundraisers. Some aquatic rescue organisations have developed highly advanced fund raising mechanisms.
Others suffer greatly for lack of resources. ( Chapter 4.13 )
Rescue Recommendation 4:
An international study of fund-raising activities by aquatic lifesaving organisa-
tions should be commenced to identify the most effective methods. The results
of this study should be shared worldwide, with the ultimate benefit of helping
these organisations generate necessary working funds to help them reduce the
incidence of drowning worldwide.
4.2.5
Recommendation 5 – Swimming Training
Knowing how to swim is a critical skill to prevent drowning for individuals at risk.
Rescue recommendation 5A:
International organisations such as the World Health Organisation (WHO), International Red Cross and Red Crescent (IRCRC) and the International Life Saving Federation (ILS) and their national branches must emphasise the impor- tance of swimming lessons and drowning survival skills at all levels for as many persons as possible.
Rescue recommendation 5B:
The relationships between swimming lessons, swimming ability and drowning in children needs to be studied.
Rescue recommendation 5C:
Certain public officials such as police officers and fire fighters, who frequently come in close contact with persons at risk for drowning must be able to swim for their own safety and for the safety of the public.
4.2.6
Recommendation 6 – Rescue Techniques
Most of the current rescue techniques have evolved by trial and error, with little scientific investigation.
Rescue Recommendation 6:
Rescue organisations such as the International Life Saving Federation (ILS), the
International Lifeboat Federation (ILF), the International Red Cross and Red
Crescent (IRCRC) but also the International Maritime Organisation (IMO) must
be encouraged to evaluate the self-rescue and rescue techniques in their training
programs in accordance with current scientific data on effectiveness and effi-
ciency. Based on the data, the best rescue techniques must be selected for educa-
tion and training programs.
4.3
Rescue Organisations: Paid or Volunteers?
Mike Espino and Chris Brewster
At the World Congress on Drowning 2002, a full expert session was devoted to the topic: Rescue Organizations: Is There a Difference Between Volunteers and Professionals? The session was well attended by representatives of volunteer and professional rescue organisations and many comments were received. It was agreed at the beginning that volunteers can actually be considered professional with respect to the manner in which they carry on their work. Therefore, the subject of the discussion was refined to the differences between rescue organi- sations composed of paid (compensated as workers) and volunteer (providing services with no salary involved) lifesavers. This chapter is an effort to reflect comments and sentiments expressed during the session. As used in this book, the term ‘lifesaver’ applies to a person who assumes a responsibility to protect, rescue, and resuscitate others in an aquatic setting, whether formally titled life- saver, lifeguard, or by some other term.
Aquatic protection and rescue services have evolved differently in different countries. In some countries, such as Australia and Germany, there is strong emphasis and reliance upon volunteer lifesavers, with a smaller number of paid lifesavers. In others, such as the US, there is strong emphasis on paid lifesavers, with very few volunteers. As one participant pointed out, the drowning victim does not care whether the rescuer is paid or volunteer. Nevertheless, there are significant differences between the systems.
The public is not always aware of whether the lifesaver is paid or volunteer, but when this is known, public perceptions of the two systems can differ. Paid lifesavers may be viewed positively by the public they serve as being highly pro- fessional in their training and conduct. It is often presumed that if someone has been hired and trained to do the job, and if they do it for a primary source of income, they are likely to be very good at it. On the other hand, some peo- ple, whether fairly or unfairly, view public employees with a degree of disdain.
Volunteer lifesavers may also be viewed very positively because they are donat- ing their time for the good of the community. Some though, may view them as hobbyists, rather than professionals.
Funding sources for paid and volunteer systems are typically different. Paid
lifesavers are usually compensated, whether directly or indirectly, by govern-
ments or corporations. People are perhaps less inclined to donate money to these
organisations. They expect the services rendered to be funded through public
sources, such as taxes and fees. Special fund-raising events may be conducted
to augment primary sources of income and some paid organisations do so quite
effectively. Volunteer organisations are usually funded by donations, corporate
sponsorships, memberships, and fund-raising events. The altruistic nature of
their work leaves people more inclined to offer funds to support them. In addi-
tion, these groups may be more likely to be allowed to engage in unusual types of
fund-raising not normally permitted. For example, some Australian lifesaving
clubs are legally permitted to allow forms of gambling and serving of alcohol in
their clubs as a means of raising funds. Some volunteer organisations contract their services to public or private organisations, receiving compensation to sup- port the costs of conducting lifesaving work.
Retaining volunteer lifesavers in adequate numbers requires an environ- ment which encourages continued participation and service. Some will remain involved regardless, due to strong ties to the organisation. Others will require incentives, like special events, funding of competitions and travel, and special recognition. These costs must be borne by the organisation. The most effective volunteer systems have strong national structures, which help attract and re- tain members, and work through local club systems supported by the national organisations. For paid lifesavers, simply maintaining an adequate salary level and employee benefits is typically enough to ensure longevity of service. Even so, a seasonal, paid lifesaver may work only a few years until finding full time employment elsewhere, whereas a volunteer may continue to contribute leisure time to lifesaving for decades.
Paid lifesavers can generally be expected to be more reliable than volunteers with respect to issues like arriving to their assigned work location on time and working designated hours. This is primarily due to the fact that the income of paid lifesavers is dependent upon retaining employment by following work rules.
In volunteer organisations, this may be encouraged through minimum require- ments expected of all volunteers. However, enforcement is difficult since there is no economic incentive. The ultimate penalty for the paid lifesaver is loss of a job, whereas the penalty to the volunteer is loss of an opportunity to participate and contribute as a lifesaver.
Minimum standards and duty of care for paid and volunteer lifesavers should be the same when they are assigned the same duties. Generally, the training levels of paid lifesavers, whether it be minimum or advanced, are higher than those of volunteers. This stems, in part, from the fact that volunteers have only so much time available and may only be willing to train to a certain degree. Paid lifesavers can be required to undergo extensive training, so long as the employer can afford to provide it or can require it as a condition of continued employment.
While higher aggregate training levels in a volunteer organisation come with little cost, typically limited to training supplies and perhaps paid trainers, they are more difficult to achieve. Some volunteer lifesaving organisations attempt to overcome this by staffing higher numbers of volunteers and depending upon a team approach to emergency responses.
More volunteer lifesavers are needed to provide the same staffing level as provided by paid lifesavers. Volunteers can only devote a limited amount of their free time to lifesaving, while paid lifesavers have full or part time employment.
Volunteer programs therefore require that far more people be trained. A smaller corps of paid lifesavers, who work more frequently, can be expected to be more familiar with current practices and procedures. They may also know one an- other better since a limited number of lifesavers work more hours. This may help them work as a team more effectively.
Depending on longevity of employment, paid lifesavers may have either more
or less aggregate experience than volunteers. In an organisation where paid life-
savers stay with the profession for a short period of time, but volunteers continue
for many years, the volunteers may be more experienced. They may also be older and more mature. On the other hand, in organisations where paid lifesavers con- tinue their employment for many years, the aggregate experience they gain may far exceed that of volunteers.
The number of paid lifesavers is limited to available budgets, and paid life- saving organisations are more likely to be affected by changing budgetary prior- ities and circumstances of governments. Volunteer lifesaving organisations are not usually impacted as significantly by variations in local government budgets, since without labour costs, the costs of conducting their lifesaving work is mini- mal. Even in poor economic times, it may be possible for volunteer lifesaving organisations to maintain consistent levels of service.
In countries and in organisations with a combination of volunteer and paid workers, there can be tension between the two for a variety of reasons. These include different training levels and different work standards, among other rea- sons. This creates a management challenge. In an organisation where a core paid staff is augmented by volunteers, the responsibility is on management to ensure that volunteers are valued and respected. Conversely, in organisations where volunteers are regarded as the predominant providers of lifesaving, manage- ment may need to take steps to ensure that paid staff are also valued.
Regardless of the relative merits of paid versus volunteer lifesaving, some countries simply cannot afford to pay lifesavers, or at least not all lifesavers. In Australia, where a large proportion of lifesaving services are provided by volun- teers, a sweeping change to a paid system might be too expensive. Nevertheless, Australia has steadily increased its percentage of paid lifesavers (who are known as lifeguards in Australia). This change is occurring over time. As the respon- sibilities and expectations of lifesavers grow, the percentage of paid staff can be expected to increase in comparison to volunteers.
In developing nations, it may be difficult to maintain volunteer lifesaving organisations. This is because leisure time, the period during which volunteer lifesaving is usually practised, is extremely limited, if not completely unavail- able. Therefore, while developing nations may have the greatest difficulty al- locating funds for paid lifesaving services, paid services may be the only viable alternative.
4.3.1
Summary and Conclusions
Based on the discussion in our forum, it would appear that if budget is not a sig-
nificant obstacle, the paid approach to providing lifesaving services has several
advantages. Paid lifesavers can be held to higher standards, be better trained,
be more reliable, be more accountable, and be better prepared to act independ-
ently. Because of lack of leisure time to volunteer, the paid approach may be the
only feasible one in some developing nations. Few areas of the world, however,
have the level of resources required to pay the number of lifesavers desired for
optimum levels of safety. Thus, where an adequate number of volunteers can
be relied upon to meet acceptable minimum standards and to make themselves
available when needed, volunteer systems have proven viable. In volunteer sys- tems, it appears that having a core paid staff to work with and help coordinate activities of the volunteers is ideal.
4.4
Lifeguard Effectiveness
Ralph Goto
The Centers for Disease Control and Prevention (CDC), the American Red Cross, and the United States Lifesaving Association (USLA) routinely respond to inquiries regarding the efficacy of lifesaving services in preventing drown- ing. Some of these inquiries are from communities and local government of- ficials facing decisions about whether to begin, retain, or discontinue lifesaving services. In response to these inquiries, in 1998, the Centers for Disease Control and Prevention (CDC) Division of Unintentional Injury Prevention conducted a meeting of a panel of experts to discuss the effectiveness of lifesavers in pre- venting death and injury. This effort was lead by Christine Branche, Director of the Division of Unintentional Injury Prevention. A report, entitled Lifeguard Effectiveness: A Report of the Working Group, was issued by the CDC in 2001 and is available at: http://www.cdc.gov/ncipc/lifeguard/lifeguard.htm. The report discusses methods of evaluating the efficacy of lifesaver services, communicat- ing information about the efficacy of lifesavers, and the sources of information about the efficacy of lifesavers, including data, resources, and case studies.
The lifesaver effectiveness report is the result of the efforts to assemble a panel of experts in the US to discuss these issues and to review data on the ef- ficacy of life guarding services. The purpose of the report is to describe the ef- ficacy of lifesaver services for the prevention of drowning. It was also the intent of the group to have the report serve as a tool for local government officials in making decisions about the provision of lifesaver services in their areas. The ob- jective of the report was to provide a balanced overview of the costs and benefits of providing lifesaver services to prevent drowning and water recreation-related injuries. The document was well received in the US by organisations such as the American Red Cross and the USLA.
In June of 2002, an expert meeting at the World Congress on Drowning in
Amsterdam was convened to introduce the report to the international commu-
nity. The Experts Meeting at the World Congress on Drowning provided a forum
for the report to be presented to the international lifesaving community. The
focus of the report was on effectiveness rather than efficacy. The report should
be used as a “model to bridge the gap between lifesaving and science,” and it
could be used as a reference in the ongoing debate on whether it is best to pro-
vide paid professional lifesavers versus volunteer lifesavers, which is addressed
elsewhere in this section (see Chapter 4.3 ). Comments from participants at the
World Congress on Drowning were generally favourable towards the report, as
most agreed that the document will be of tremendous value when justifying the
provision of lifesaving services. Discussion included relevance of the report on
an international level, considering the differences in each country‘s lifesaving system, but the consensus of the group was that the report had global implica- tions and value.
The following is the executive summary contained in the report:
“Each year, about 4,000 people die from drowning in the United States.
Drowning was a leading cause of unintentional injury death among all ages in 1998, and the second leading cause of unintentional injury death among chil- dren ages 1–14 that same year. Approximately 50%–75% of drownings occur in open water such as oceans, lakes, rivers, and ponds. About 60% of drowning deaths among children occur in swimming pools.
Many organisations, including the Centers for Disease Control and Prevention (CDC), routinely respond to inquiries regarding the efficacy of lifesavers in pre- venting drownings. Community and local government officials facing decisions about whether to begin, retain, or discontinue life guarding services typically want to know whether lifesavers are truly effective in preventing drowning and other aquatic mishaps, and whether the value of providing lifesaver protection outweighs the costs. Most drownings are preventable through a variety of strate- gies, one of which is to provide lifesavers in public areas where people are known to swim and to encourage people to swim in those protected areas. Some esti- mates indicate that the chance of drowning on a beach protected by lifesavers can be less that one in 18 million. There is no doubt that trained, professional lifesav- ers have had a positive effect on drowning prevention in the United States.
The significance of the patron surveillance and supervision that lifesavers provide is emphasised by understanding how people drown. Many people as- sume that drowning persons are easy to identify because they exhibit obvious signs of distress. Instead, people tend to drown quietly and quickly. Children and adults are rarely able to call out or wave their arms when they are in distress in the water, and can submerge in 20–60 seconds. For these reasons managers should never assign lifesavers duties that distract them from keeping an eye on the water, such as selling admission tickets or refreshments. In addition, the presence of lifesavers may deter behaviours that could put swimmers at risk for drowning, such as horseplay or venturing into rough or deep water, much like increased police presence can deter crime.
When making decisions about using lifesavers and other means of increas- ing public safety in aquatic settings, policy makers should use available local evidence. This evidence includes:
▬ The effects that lifesavers have had on patrons‘ safety and attitudes
▬ The number of people using the facility or beach area during the past years
▬ The incidence of water-related injuries and drownings at the facility or beach area during those time periods
▬ Data on the number of water-related injuries and drownings at pools and beaches in the local area or state with and without lifesavers, for comparison,
▬ The level of lifesavers provides (number of lifesavers per number of persons and
using the facility)
In addition to these factors, policy makers should consider public attitudes about lifesavers and legal issues related to using lifesavers.
4.4.1 Website
▬ http://www.cdc.gov/ncipc/lifeguard/lifeguard.htm
4.5
Quality Assessment and Risk Monitoring of Lifesaving
Rob Brons
In 1993 the Dutch government introduced the concept of the safety chain to es- tablish national policy on safety and security. This concept is now used by all police and fire services in the Netherlands. Some local and regional services have adopted this concept as a guiding template to organise their fire service.
The fire service of the Hague has implemented the safety chain not only for the fire service but also for lifesaving activities on the beaches of Scheveningen (the Hague, the Netherlands). This chapter introduces how the concept of the safety chain can be implemented for lifesaving services.
4.5.1
The Safety Chain for Firefighters
The safety chain is composed of links which are aimed at the monitoring of safe- ty and security in the community. Once the elements of each link in the safety chain have been identified, it is important to make each link as strong as pos- sible. The five links of the safety chain are:
▬ Pro-action
▬ Prevention
▬ Preparedness
▬ Response
▬ Recovery
Within the safety chain the target care system is used. For firefighters, the target care system means the most adequate response time to arrive at the potential incident sites, according to the state of prevention and the activities that take place at the site. Level of training and size of the teams and their equipment are determined accordingly. For example, depending on these aspects, the response time of the first fire truck has to be within 5, 8, 10 or 15 min. The target care sys- tem applies equally to buildings, industrial plants and non-urban areas.
The safety chain interrelates with the target care system. When there is a
large number of persons located at the potential incident site, there is greater
need for prevention because response and recovery may become problematic.
Prevention is also emphasised when the people in the area are mentally disabled people, children, prisoners or other groups who run extra risks. When preven- tion measures are well developed (a strong prevention link in the chain), the re- sponse time may be longer than when prevention measures are poor or absent.
The target care system also allows checks and balances by other public au- thorities and government bodies or politicians. The system provides informa- tion about which level of safety has been selected for potential incident sites and allows government bodies or politicians to consider whether this level is accept- able or not. In case a higher level is requested by the public authorities, the safety link concept and the target care system make it possible to formulate how the fire service has to be organised to reach this higher level and to calculate the expected costs.
4.5.2
The Safety Chain for Lifesavers
There are many similarities between the skills of firefighters and lifesavers and between the responsibilities of the two organisations ( ⊡ Table 4.1 ). Using the safe- ty chain for lifesaving activities is therefore also a useful tool to plan, execute and check the quality and monitor the risks of lifesaving organisations.
During the planning and implementation of the safety chain concept for life- saving, additional natural and human factors need to be considered. Examples of natural factors include wind (speed, direction), tide (low, high), waves and temperature changes. Human factors include physical capacities (young age)
⊡ Table 4.1. Similarities between lifesaving services and fire services
Chains Lifesaving service Fire service
Proaction Infrastructure Building and infrastructure
Planning of locations Reachability of emergency services
Prevention Patrol by foot, boat, car Fire prevention advice
Signs and flags Building planning advice
Preparation Planning of personnel/equipment Planning of personnel/equiment Education, training Education, training
Response criteria Risk assessment
Response Emergency response Emergency response
Recovery Personnel and drowned persons Personnel and victims
Evaluation Evaluation
and psychological aspects (fear, courage and handling of dangerous situations).
The same five steps in the safety chain can also be identified for the organisation of lifesavers..
Pro-action means ‘to step back’ and look to the aims and responsibilities of the organisation. How can lifesaving tasks be implemented or improved? Pro- action is the opportunity to think about infrastructure. Examples of pro-action are the manipulation of natural factors, the design a lifesaving station, the iden- tification of areas of high risk and safe swimming and the indication of these areas by signs and flags.
Many questions need to be solved for an appropriate pro-active link. Such questions include: How can natural factors be influenced? Can the natural or man-made environment be changed to reduce hazards? Is it possible to make a risk assessment for beaches? Can unsafe beaches be closed down? How and when can drowning victims reach the nearest hospital? These, and other, questions are very relevant when planning a lifesaving service at a beach.
Prevention helps to avoid rescue, injury or death by drowning. Good and sufficient manpower and mitigation of risks are possibilities for prevention.
Examples of prevention are patrol schedules in areas where problems might oc- cur, as well as informing the public about potential dangers.
An adequate lifesaver patrol can provide safe beaches by warnings and an- ticipating dangers. An understandable warning system can support prevention.
The use of positive information is better than the use of negative information.
Shields that indicate dangers will challenge certain persons to act in an unsafe way. Pointing out safe areas is therefore better than pointing out unsafe areas.
The research and development of warning systems with uniform pictograms are useful for lifesaving activities.
Recognition of certain indicators help lifesavers to focus on times and places where problems are likely to happen. Local statistics for beaches in the Hague revealed that these indicators are days with a light wind, some sunshine, few swimmers, as well as days when the tide turns to flood. When large numbers of people are pursuing recreational activities, social control provides a higher level of safety. These data help to identify the moments that higher levels of risk should be anticipated.
Preparedness can be divided into two parts: subject and object prepared- ness. Subject preparedness determines the way lifesavers are able to do their job.
Education and training are essential elements of subject preparedness. Object preparedness is achieved by preparation of lifesaving material. Examples are the purchase of the most reliable material and procedures to check and double check material.
Preparedness for objects and subjects will reduce unsafe bathing and swim- ming.
The geographic planning of the locations of lifesaving stations is also part of
the preparedness link because the location is essential for good supervision of
the beach. This is shown in the following example: The location of the lifesaving
stations of the Hague (total beach length 12 kilometres, or 7 miles) was histori-
cally based on the rowing distance between each station. According to the tar-
get care system, the new aim is that lifesavers arrive at the incident site within
3 min. Since, however, the sun shines from the south in the afternoon and cre- ates a glare that shines in the eyes of the lifesavers looking in that direction, the stations are located at locations from where rescues can occur within 3 min and where one third of the patrol area is to the south and two thirds to the north.
Object preparedness also improves when each station is installed with the same equipment and rescue material and when this material is located at the same point in each station.
The preparedness of lifesavers can also be influenced by good standards of recruitment. In the Hague, every member has to pass tests before he or she may serve as a lifesaver. These tests are based on the daily skills of lifesavers: the requirements include being able to swim 100 meters in 1.55 min, swimming for 15 min, 50 meters transportation swimming and 25 meters under water swim- ming, as well as running 800 meters within 4.15 min. Practical skills in first aid and basic life support also have to be demonstrated. Because all lifesavers have to pass these tests each year, every lifesaver on duty is confident about his own safety skills, but also about the safety skills of his or her colleagues. Periodic and realistic training is planned and this is essential to keep lifesavers in good physi- cal condition. Quality of equipment and the number of personnel also improve the quality of the lifesaving activities.
Response is the way a lifesaver reacts after an emergency call. It is also closely related to the way a lifesaver sees, feels and believes in lifesaving and for that reason response is the most appealing aspect for lifesavers. The response by lifesavers is also the most eye-catching link of the safety chain for visitors of beaches. Nevertheless this aspect is only one aspect of the safety chain. Adequate response needs a delicate mix of personnel, equipment and organisation. It also needs awareness of potential dangers, alertness and the right amount of adrena- lin. In addition to this, the best equipment, good education, frequent training and tight organisation are needed for the best response.
As this book points out, most drowning victims die within 5 min under wa- ter. Enabling lifesavers to rescue a victim within this time frame is a very de- manding target for the organisation of a lifesaving operation. Not only is the first response essential, but also the link to professional medical help. When a lifesaving organisation is able to save someone from the water and provide basic life support within 5 min, but is unable to get medical treatment or transporta- tion to a medical facility, the preparation link needs improvement.
The last link is recovery. Examples of recovery include not only medical care for drowning victims, but also care for the lifesavers themselves, for example in the case of post-traumatic stress syndrome. ( Chapter 5.20 )
It is also important for lifesaving organisations to have facilities within the
organisation to deal with post-traumatic stress.
4.5.3 Conclusion
Certainly in some communities, the lifesaver is a local hero due to his response actions. But within the concept of the safety chain, the rescue activity is only one link out of five. All links have to be considered to guard the beach in a profes- sional and reassuring way.
Quality assessment and risk monitoring with the use of the safety chain con- cept enables lifesaving activities to be improved in a scientific and systematic approach. To develop this concept, data, knowledge and experience needs to be sought and gathered. The application of the safety chain, which has proven ef- fective for police and firefighting organisations, will result in similar benefits for lifesaving organisations.
4.6
Beach Hazards and Risk Assessment of Beaches
Andrew Short
The types of beaches that exist around the world and their associated physical characteristics and dynamics are reasonably predictable using current scientific knowledge of beach systems [4]. With this information it is possible to assess and quantify the associated beach hazards. What is less predictable is the level of beach usage and awareness of people using the beach. It is only with a combi- nation of hazard assessment and a prediction of human knowledge and prepar- edness, that public risk on beaches can be assessed. This chapter examines the present status in achieving risk assessment of beaches.
4.6.1
Beach Systems
Beaches are wave and tide deposited accumulations of sediment (sand through cobbles and boulders) deposited between modal wave base and the upper swash limit. Beaches are the major route for public access to the sea and oceans. As such beaches are a major site of recreation as well as water access for small craft and boats. The type of beach is a function of the sediment size, the wave height, wave period, tide range and relative tide range (RTR). The latter is the ratio be- tween the spring tide range and average wave height: RTR = TR/H (TR = spring tide range; H = average breaker wave height).
The RTR can be used to divide beaches into three systems: wave-dominated, tide-modified and tide-dominated.
▬ Wave-dominated beaches occur when the RTR is less than 3
▬ Tide-modified when the RTR is between 3 and 7
▬ Tide-dominated when the RTR is between 7 and 15, grading into tidal sand
flats when RTR exceeds 15
Within each system there can be considerable variation in sediment size, wave height and period. This variation is accommodated in the dimensionless term fall velocity ( Ω), which is a function of the wave height, wave period and sedi- ment size, measured by its fall velocity in water. Based on the variation of the fall velocity, the three systems can be divided in nine beach types. Each of the nine beach types is the product of the interaction of shoaling and breaking waves and swash acting over the mobile beach sediment, coupled with tidal movement of the shoreline ( ⊡ Table 4.2 ).
Across each type, a predictable range and sequence of hydrodynamics (shoaling and breaking waves) occurs, together with a predictable combinations of surf zone processes (breaking waves, long shore currents, rip currents, wave set up and down), which in turn may imprint their dynamics on the underlying beach and surf zone (such as bars, channels, troughs, rip channels, rhythmic
⊡ Table 4.2. Beach systems, types and controls
Relative tide range (RTR)
Ω = Hb/WsT Beach type Beach hazard
rating in Australia
aWave-dominated
<3 <1 Reflective 1–2
<3 2–5 Intermediate
b3–7
<3 >6 Dissipative 8–10
Tide-modified
3–15 <2 Reflective and low tide bar 2–4
3–15 >2 Low tide bar and rips 2–4
3–15 >6 Ultradissipative 2–3
Tide-dominated
7–15 <1 Beach and sand ridges 1
7–15 <1 Beach and sand flats 1
>>15 <<1 Tidal sand flats 1–2
Hb: breaker wave height (m); T: wave period (s); Ws: sediment fall velocity (ms
–1); Ω: fall velocity (dimensionless).
a
Ratings vary in different wave environments between 1 (=low risk) to 10 (=high risk).
b
