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The American Red Cross identifies patron surveillance as the single most important component of protecting the health and safety of pool patrons.1 Pool patrons at aquatic facilities hosting athletic events, practices, training and conditioning, and rehabilitation will be a diverse population, including athletes, medical personnel, officials, coaches, and administrative officials. Athletic venues are notoriously chaotic environments. Aquatic facilities represent one of the most chaotic athletic venues because a larger number of patrons are brought together in a relatively small enclosed environment. The result is a very crowded and noisy pool deck. Medical personnel must be judicious in providing appropriate medical coverage during chaotic events as well as during more intimate practice, training, and rehabilitation settings where the less chaotic environment may invite complacency. Be it competition, practice, training, or rehabilitation activities, the American Red Cross highlights an appropriate surveillance plan as the cornerstone of protecting the health and safety of pool patrons at aquatic facilities hosting athletic endeavors. The responsibility for developing an appropriate surveillance plan falls on the team medical director, athletic trainer, and head lifeguard. The lifeguard profession is uniquely qualified and trained for water rescue and emergency care. It is often the case that non-lifeguard medical personnel are providing non-emergency injury care and management as athletes prepare for upcoming aquatic events during a meet. These medical personnel may not be consistently on the deck of the competition pool. Therefore, the medical team will plan such that the initial Critical Care TriangleTM responding to aquatic emergencies be comprised of the lifeguards with a communication system to alert the remaining members of the medical team.
All lifeguards will hold a valid lifeguard certification that includes completion of a lifeguard training program, first-aid training, and CPR with automated external defibrillator (AED) certifications. Lifeguards will also complete and maintain certifications in all required and appropriate watercraft operations.
Additional In-Service Training
The lifeguard corps will participate in a minimum of 4 hours of in-service training each month. The medical team director, head athletic trainer, and head lifeguard, in conjunction with an expert in a particular subject matter, such as a public health official, risk manager or human resources representative, may conduct in-service trainings. Training sessions will address issues, such as surveillance and recognition, water and land rescue skills, emergency response drills, decision-making protocols, facility rules, regulations, emergency action planning, customer service, records and reports, and physical conditioning. This training will include all appropriate members of the medical team and emergency medical services responding to the venue, and will be conducted in accordance with the Annual Training and Rehearsal section of the Comprehensive Document.
Appropriate Lifeguard Coverage
According to the American Red Cross, effective management of a suspected spinal cord injury in water requires a minimum of 2 lifeguards. Therefore, at least two lifeguards will be on duty at all times. Once the facility reaches 50 pool patrons, an additional lifeguard will be added for every additional 25 patrons.
When assigning proper lifeguard coverage, the medical team will provide enough lifeguards to ensure that appropriate lifeguard rotations can be performed to help minimize any fatigue and ensure that no one lifeguard spends longer than 60 minutes being responsible for surveillance, and no more than 90 total minutes providing surveillance and back-up.2
- Whistle Code Communication
The chaotic pool deck environment and aquatic facility acoustics make many traditional forms of communication challenging. Therefore, lifeguards traditionally use a whistle for communication. The medical team will use internationally accepted distress whistle codes as its main form alerting personnel to an emergency. Each whistle blast will last 3 seconds.3,4
- 3 whistle blasts: “Help Me / Alert”: Used when a lifeguard want to alert lifeguard corps to a potential emergency.
- 2 whistle blasts: “Come Here”: Used when a responding lifeguard wants to summon help from other lifeguard corps members.
- 1 whistle blast: “Where are you?”: Used to ask that a signal be repeated to help locate the origin of the distress call.
- Hand Signal Communication
The following hand signal communications will be used in concert with whistle codes:
- Arms Crossed On Chest: Medical Emergency, All Come
- Fist In Air: Non-Life-Threatening, Medical Assist
- Pat Top of Head: Waive off other lifeguards and assume responsibility
- Two-Way Radio Signal and Verbal Calls
The two-way radio alert signal will be used to broadcast three 3 second alert signals followed by a verbal call and the location of the emergency. The following verbal radio calls will be used in concert with whistle codes and hand signals:
- “All Come”: Medical Emergency
- “Medical Assist”: Non-Life-Threatening injury help required
Aquatic Facility and Emergency Response Readiness
All facility and equipment checks will be completed prior to an event. Checks will never be performed by staff currently responsible for surveillance. The Head Athletic Trainer or Head Lifeguard will verify that all equipment is in good working order, that there is a sufficient number, and equipment is in the proper location. Verify the following:
Standard Rescue Equipment
- Rescue tubes and/or buoys
- Rescue board
- Non-motorized craft
- Motorized craft
- Masks and fins
- Reaching pole
- Ring buoy
- Resuscitation masks
- Disposable gloves
First aid supplies
- Backboard(s) with head immobilizer and straps
- First aid kit
- Suctioning equipment
- Emergency oxygen delivery system
Other Safety Equipment
- Lifeguard stands/stations
- Communication devices
- Posted EAP and surveillance zones
- extra gloves
- face shield
- blood spill kit
Evidence Category C
- American Red Cross. Surveillance and recognition. In American Red Cross Lifeguarding Manual. American Red Cross.
- Royal Lifesaving Society UK. Managing health and safety in swimming pools. https://www.rlss.org.uk/hsg179. Accessed 8/15/19.
- International Distress Signaling. https://en.wikipedia.org/wiki/Distress_signal. Accessed 8/25/19.
- Outdoor Life International Whistle Codes. https://www.outdoorlife.com/blogs/survivalist/2013/06/survival-skills-signal-whistle-codes-%C2%A0/. Accessed 8/25/19.