REPORT #5: THE END GAME
By Doug Forbes
Thousands of U.S. children land in hospitals or morgues year after year due to drowning. Numbers are on the rise, but resource allocation remains static.
Childhood drowning persists because adults do not:
Pay attention.
Follow proper safety protocols.
Pass water safety legislation.
Cull vital epidemiological data.
Widely support awareness initiatives.
But while adults are fallible, they are also under increasing pressure to sustain jobs, manage children, make ends meet and squeeze in essential downtime amidst one of the most profound health emergencies in modern history.
Even in the absence of a pandemic, ceaseless observation of very young children is a fool’s errand.
This is why caregivers deploy infant safety gates, baby monitors, toilet locks, shelf and cabinet anchors, fireplace grills, outlet covers, corner guards and the list goes on.
It’s also why certain states and municipalities mandate multiple layers of backyard pool protection, including fences and alarms.
Roughly 38% of children overall drown in pools and nine percent in bathtubs, according to Safe Kids Worldwide. Layers of protection can fill critical if not lifesaving gaps during inevitable lapses in care.
According to that same SKW report, backyard pools are only one slice of a far larger pie.
In fact, 43% of childhood drownings occur in ponds, rivers, oceans, canals, reservoirs and lakes, all of which are otherwise known as open water.
2020 was the deadliest year in Lake Michigan for drownings.
Jerail Lee, 12, was one such victim of open water drowning. He suddenly sank from Lake Michigan’s calm, chest-high waters into deeper waters on July, 9, 2020. Marine units found Lee’s body 90 minutes later.
Lifeguards were on duty but did not see Lee struggle.
The presence of open water lifeguards, however, does make a discernible difference overall.
For instance, the SKW report said that less than 4% of U.S. childhood drownings occur in ocean waters.
According to the United States Lifesaving Association, lifeguards made more than 71,000 beach rescues in 2019. Only 125 unguarded and 25 guarded drowning deaths occurred from a total estimated population of roughly 410 million.
The caveat: source data “is not a comprehensive list of all statistics generated by all beach lifeguard agencies.”
Alyssa DiMarino’s commitment to lifeguarding paid dividends in June of 2020.
She was off duty when she saved a 4-year-old boy — who evaded a guardian — from drowning at rocky Yorktown Beach, Virginia. DiMarino became a lifeguard after her own 6-year-old sister drowned years earlier.
Lifeguards cannot, however, monitor home pools or bathtubs or every waterfront location that fails to fall under a watchful government eye.
The issue is who can.
TRADITION
Swim lessons have long been the go-to solution to prevent drowning. The United States Swim School Association has more than 400 members alone. However, research around the efficacy of such lessons is sorely lacking.
In 2000, the American Academy of Pediatrics policy statement on swim lessons for infants and toddlers said, “Generally, children are not developmentally ready for swimming lessons until after their fourth birthday. Aquatic programs for infants and toddlers have not been shown to decrease the risk of drowning.”
In 2004, Dr. Ruth Brenner of the National Institute of Child Health and Human Development issued a white paper on the association between swim lessons and drowning risk reduction.
Brenner said, “It is imperative that more complete and more detailed data be gathered on swimming ability among drowning victims.”
Nearly five years later, Brenner spearheaded the release of a small research study with findings culled from 6 of 50 states. The study said swimming lessons were “associated” with an 88% reduction in the risk of drowning, “although our estimates were imprecise.” Brenner also said it was not possible to define the true extent of the protection.
No other similar U.S. swimming efficacy study is available.
In June of 2018, Emmy Miller, the 19-month-old daughter of Olympian Bode Miller and his wife Morgan, drowned at a neighbor’s pool. That same day, 3-year-old Levi Hughes drowned. Levi’s mother, Nicole, connected with the Millers. They urged the American Academy of Pediatrics to review its policies.
Despite a dearth of research, the AAP issued a revised policy statement 10 months later which cited the limited, decade-old Brenner study and said, “Evidence reveals that many children older than one year will benefit from swim lessons.”
Pediatrician and AAP injury prevention specialist, Dr. Ben Hoffman, said the one study was adequate enough to amend the organization’s position.
“AAP did not change its tune. The science changed, specifically with the Brenner study. That was a really well done piece of research, and while it does not help us understand what part of swimming lessons work, the cumulative conclusions show pretty definitively that 1-4-year-olds who have had swimming lessons drown much less often.”
Hoffman said that he and the AAP “did take advantage of the opportunity” to make a rapid policy change after the same-day drowning deaths of Emmy and Levi.
Although Hoffman said the AAP cannot dictate the practice of any physician, they created a new approach to family engagement that has been transformative to the way the AAP works.
Infant Swimming Resource is another transformative approach to drowning prevention.
The 50-year-old aquatics organization has recently received greater public attention now that the Millers and Hughes promote the model.
ISR focuses on equipping infants and toddlers with survival techniques that either enable them to self-rescue or sustain themselves until help arrives.
Training typically costs $150/week, roughly twice that of traditional swim lessons.
ISR has been widely scrutinized. In fact, some outright condemn its methodology.
Infant Swimming Resource CEO and President, JoAnn Barnett, said, “We don’t see ourselves in the swimming realm. We look at ourselves as a behavioral approach to drowning prevention. I very much understand why we are misunderstood. And I’m okay with that, because I know that the parents who find us don’t misunderstand.”
JoAnne Barnett teaches a baby survival skills.
Barnett said ISR is responsible for more than 9 million lessons “without an accident or incident” and thousands of prevented drownings documented through parent letters and emails.
None of that research is publicly available. Barnett said she has not had the time or resources to do so. Prevention advocate Nicole Hughes is working with Barnett and her son to afford studies in the near future.
Barnett said that it is befuddling why traditional swim schools are not scrutinized the same way ISR is, despite the persistence of childhood drownings.
Hoffman from the American Academy of Pediatrics said, “Our policy is and always will be based on the best available evidence. For infant survival classes in general, and ISR in specific, there is no peer reviewed data. Plain and simple. We can’t say they work, we can't say they don't.”
Dan Berzansky owns Premier Swim Academy, a swim school and lifeguard services business in greater Rancho Cucamonga, California.
Berzansky said in a website statement, “Aside from what we see as physical dangers associated with survival type classes, we recognize the emotional impact classes have on babies. The trauma of survival type classes often leads to a fear of the water and distrust of swim instructors, teachers, and even the parent that watches from the side of the pool.”
Hughes disagrees. “I do think that swim lessons that focus on survival – versus fun – make a difference. I have yet to meet a parent of a toddler who drowned who had completed survival swim lessons. Most parents wait until age four or later to teach their child to swim, so I don’t think it’s a coincidence that drowning is the number one cause of death in the 1-4-year-old age group.”
Nicole Hughes addresses infant survival lessons
In addition to swim lessons, CPR — cardiopulmonary resuscitation — has been widely considered as a critical tool in the drowning prevention arena.
According to ProCPR, The Society for the Recovery of Drowned Persons introduced the technique 280 years ago in London as “the first organized effort to deal with sudden and unexpected death.”
A 2002 study by Dr. Jane Wigginton for the World Congress on Drowning revealed that victims who received effective and relatively early bystander CPR intervention significantly benefited, while only 5% of those who required longer interventions survived.
According to a recent study in the Emergency Medicine Journal, the survival rate for cardiac arrests outside of hospital settings is only 12% and 24-40% inside. Regardless, more than 90% of research participants still wanted to receive CPR if needed.
Dr. Justin Sempsrott, co-founder of Lifeguards Without Borders, hosted a 7-part series titled Pre-Hospital Drowning Resuscitation which addressed a “chain of survival” in great detail.
Means to fortify that chain have come a long way over the past century.
Crew of England’s Fleetwood station wearing cork life jackets designed by Captain Ward (Photo courtesy Royal National Lifeboat Insitution, circa 1890)
INNOVATION
A relatively small group of innovators has attempted to compensate for human error by devising a range of water safety gear.
Life jackets, otherwise known as personal flotation devices (PFDs) are the most iconic and widely used safety aid. The Royal National Lifeboat Institution introduced its cork-based version in 1854 in order to better assist volunteers during rough-and-tumble sea rescues.
Today’s U.S. Coast Guard-approved models are vastly different from earlier models, with futuristic stylings, closed cell PVC marine foam, quick-release buckles and a variety of size and buoyancy options.
According to a USCG report, drowning represented 76 percent of boating accident deaths. Almost 85 percent of the victims were not wearing a personal flotation device.
Thanks to her life jacket, 9-year-old Ellie Alan survived a drowning in a stretch of unexpected rapids on Arizona’s Salt River.
Grandfather discusses how life jacket saved his granddaughter.
The CDC has warned against water-wings or noodles as lifesaving products because, unlike PFDs, they not only give children and caregivers a false sense of security but also fail to protect against drowning.
Like PFDs, pool fencing has also come a long way.
While states like California mandate two barriers of protection around backyard pools under the state’s Swimming Pool Safety Act, one of the most popular barriers is the self-latching mesh fence, like that made by Protect-A-Child.
A full-sized adult can literally lean all body weight on the fence without compromising its fiberglass structure or self-mending mesh.
According to a CDC report, a four-sided isolation fence (separating the pool area from the house and yard) reduces a child’s risk of drowning 83% compared to three-sided property-line fencing.
Introduced in 1996 and still on the market, the Safety Turtle Pool Alarm is one of the earliest technological drowning detection devices. Babies and toddlers wear a wrist bracelet that triggers an alarm monitor upon being submerged in water.
Non-wearable pool alarms have become the most popular prevention option and all but replaced pool covers. They can be mounted to the ground, fence, door and pool deck or they can float or submerge within the pool itself.
When infrared and sonar models detect breaches, they signal high decibel alarms around the pool and inside the home. Some options also afford smart controls via phone or desktop.
Coral Manta Detection System
Coral Detection Systems are for the less budget-conscious. The Coral Manta 3000, priced at $2,500, is the first computer vision-based artificial intelligence drowning detection system for residential application.
According to its website, Poseidon is the world’s leading computer vision drowning detection technology for public and commercial swimming pools. Designed to “complement the work of lifeguards,” Poseidon uses more than 1 million lines of analytical computer code to detect and signal submersions.
Development and installation fees for Poseidon begin at a cool $150,000 and reach upwards of $350,000.
From a high tech monitoring system to a low-tech life jacket, all devices have one thing in common. They must be installed, operated, monitored and maintained by people. And people are, of course, fallible.
URGENCY
Despite the availability of swimming lessons, CPR interventions, life jackets, fences, alarms, locks, monitors, elaborate computer detection systems, public and private initiatives and history as our guide, thousands of children continue to drown at a confounding clip.
The first four reports in this series and part of this one have served largely as a 30,000-foot view of the drowning prevention landscape, replete with innumerable trials disrupted by the rather rare, unequivocal triumph.
However, a deep bench of health and safety stakeholders is currently endeavoring to make an appreciable and enduring difference under the banner known as Water Safety USA with its flagship effort, the U.S. National Water Safety Action Plan.
According to its website, Water Safety USA is a roundtable of longstanding national nonprofit and governmental organizations with a strong record of providing drowning prevention and water safety programs, including public education.
The 10-year plan focuses on evidence-based drowning prevention strategies to be effectuated via a suite of models based on sociocultural, financial, topographical and other factors.
Morag MacKay is Director of Research for Safe Kids Worldwide and committee chair for the action plan. MacKay has worked in child injury prevention and control for more than 25 years with contributions to injury surveillance, research, education, policy, program planning and evaluation.
MacKay said, “While the six working groups are formed, we are still collecting contact information on stakeholders interested in supporting the working groups as they gather information to support the development of recommended models at the local, county state and national levels, which is the framework we’ve chosen for a US plan, as well as volunteers to review drafts as they begin to become available.”
In 2000, U.S. childhood drowning deaths for ages 1-17 totaled 1,209, according to CDC figures. In 2005, that total was 1,036. In 2010, 953. And in 2015, 811.
That equates to a 32 percent drop.
During that time, the Virginia Graeme Baker Pool and Spa Safety Act was passed, the CPSC launched its Pool Safely division while NGOs like the National Drowning Prevention Alliance and the American Academy of Pediatrics spearheaded spirited new prevention efforts.
In 2016, however, childhood drownings rose again to 905 and remained in the mid-800s during 2017 and 2018, the last two years data was available.
And for every one child drowning death, seven more children make their way into hospitals because of nonfatal submersions.
Marisa Clark’s 3-year-old daughter Blakely was one of those who was lucky. She accidentally fell into the neighborhood pool in Des Moines, Iowa. None of the 30 people nearby, including the babysitter and Clark’s husband, noticed Blakely fall in, let alone floating underwater.
Fortunately, Clark disregarded her husband who said Blakely did not require medical attention. Clark admitted Blakely to a local hospital where she battled serious lung inflammation and fevers before being discharged nearly a week later.
The Clarks could very well have disappeared into a haze of statistical confusion. Not every nonfatal drowning is registered, especially if a child never sets foot in an emergency room.
Data aggregation overall is far from sufficient.
The CPSC works with the CDC to report drowning statistics. CPSC spokesperson Patty Davis said there are gaps, but she also does not account for those victims who never enter the health system.
“The estimates of visits to hospital emergency departments are based on a random sample of hospitals nationally. To get a complete enumeration, we would need detailed reporting from every hospital which would be cost-prohibitive for our agency.”
Davis said the reported drowning fatalities are based on the sources of information available to CPSC but may not include every fatality. “We do not have an independent source for pool/spa fatalities.”
Perhaps this is simply the unavoidable status quo with restricted resources and data.
Perhaps there is not a remedy other than more of the same.
Perhaps taxpayers will continue to fork over $70+ million dollars every year in reactive care, according to Safe Kids Worldwide, and billions in lost productivity over time due to precious lives cut dramatically short.
Or perhaps it’s time that drowning prevention stakeholders take a look at behavior and habit-forming for some answers.
Charles Duhigg and The Habit Loop
BEHAVIOR
Some habits save lives. Others end them.
Many smokers conquer multiple packs per day and die young from lung cancer. Others quit with enough time to add decades to their lives.
Car seat laws require children to be tightly strapped into hard plastic cocoons.
When those children eventually become licensed drivers, seat belt laws require them to click it or get a ticket, all in an effort to avoid worse outcomes from crashes.
But for some reason, water is perceived as pure fun. Water is recreational. Water represents lifetime memories with family and friends. Water doesn’t carry warning labels like toys, pill bottles and cigarette packs.
People either forget or ignore the potentially deadly effects of water.
Changing such behavior seems tantamount to climbing a pile of Mt. Everests clad in nothing more than flip flops and bathing suit.
And because water represents billions and billions of dollars in requisite and recreational business — from utility companies and pool builders to swim schools, resorts and boat enthusiasts — water, water everywhere is not to be questioned as much as it is to be consumed or enjoyed.
Perhaps people merely look at water as a reward instead of a risk. It can be difficult to fathom catastrophic consequences resulting from ordinary habits or routines.
Harvard graduate, Charles Duhigg, is a Pultizer Prize-winning reporter and author of The Power of Habit.
Duhigg maintains that cues inform routines which, in turn, bear rewards that can be either good or bad. He calls this the habit loop.
Duhigg argues that people must properly diagnose habits by focusing on cues that forge the best routines.
With Duhigg’s model in mind, the reward from exposure to pools, rivers, lakes and oceans is not simply pleasure itself, but safe pleasure.
This could equate to a kind of pleasure one receives from excitedly flying on an airplane for five hours then landing at one’s vacation destination, thanks to a legacy of successful and requisite airline training and safety routines.
When invited to a backyard pool party for families, adults fasten seat belts, secure car seats and drive to that party by largely obeying the rules of the road.
When they arrive, many of those same rules are torn asunder. Adults chat with one another, bury drinks and occasionally eye their young splashing about the pool or running amok.
Sober and constantly vigilant adult “water-watchers” are ostensibly the exception and not the routine. They are inclined to believe this is play time, not rule time.
Although adults might form simple habits that prevent children from being left alone at a pool or other body of water, they do not necessarily form critical prevention routines during non-swim times.
For instance, during the evening of November 28, 2020, two-and-a-half-year-old twins in Indianapolis, Indiana, found their way into an indoor swimming pool. Both drowned but were revived and in stable condition. The whereabouts of the caregivers is yet unknown.
According to the Consumer Products Safety Commission, nearly 70% of 1-4 year-old children who drown do so during non-swim time.
These drownings reveal that the overriding catalyst is habituation which, unlike habit-forming, is the ability to switch off what may be perceived as unessential stimuli to focus on other matters, such as cleaning a kitchen after dinner, conversing with friends or even tuning into a TV show.
When in the presence of any body of water, whether a filled bathtub, a bay or a backyard pool, this behavior can induce serious risk instead of reward.
Although adults rightly contest that it’s impossible to put eyes on a child at all times, habituation breeds an incorrect assumption that mere proximity reduces risk.
Children explore. They evade. They do not understand boundaries. They are also more adept at unknowingly tempting risk than we realize.
These videos show children scaling pool fences.
ABC News ran an experiment in which people were invited to a pre-Fourth of July backyard party. Attendees were told they would learn about water safety at some point while they enjoyed the afternoon.
What the attendees did not know is that multiple aquatics professionals pretended to drown while the party rolled on. Not a single attendee noticed the simulated drownings as they tended to normal party behavior, routines, habits.
Replacing risky habituation with risk-reducing water safety habits is a layered exercise which requires recognition of certain cues.
For instance, when swim time concludes, adults with young children should be able to recognize that moment as a cue to exact a routine other than simply retreat from the body of water. They should, instead, remove pool toys, lock the pool gate or arm the pool alarm, all of which might take a minute or two.
Caregivers are thereby rewarded with the knowledge that they potentially saved their child every time they acted upon the cue.
B.J. Fogg agrees with Duhigg, He is the Director of the Stanford University Behavior Design Lab, author of Tiny Habits and popular speaker.
Fogg’s formula focuses on triggers, motivation and pragmatism.
For instance, owning a pool is not a trigger itself, primarily because perceptions of pools are largely high-reward, low-risk.
But if a city ordinance requires an impenetrable pool fence or the parent-caregiver has a personal affiliation with a drowning story or if a pediatrician consistently shares water safety reminders, each of those somewhat simple or small triggers is more likely to lead to sustainable, rewarding transformation.
In June of 2020, Phoenix pediatrician Dr. Gary Kirkilas said in an article, “Whether it’s your own pool or a neighbor’s pool or a community pool, first start with a mentality that any body of water is a real and constant drowning risk. We can’t drown-proof children, so we need layers of protection.”
That same summer, greater Phoenix suffered 90 water-related emergencies with 32 fatal drownings, 11 of which were children under age five.
Fogg said of motivation, when it’s high, people can do hard things, but once it drops, people only do what’s easy.
Nothing is easy about drowning prevention.
With 10 million residential and 310,000 public pools, almost 100,000 miles of shoreline and tens of millions of children who will, at some point, be proximate to water, the challenge is monumental.
But Fogg said in an interview that those who are committed to change should understand that it’s not all-or-nothing. Small victories go a long way.
In the drowning prevention world, advocates often have a difficult time when they don’t witness the progress they seek.
National Drowning Prevention Alliance Executive Director Adam Katchmarchi said he gets upset with relentlessly static or worsening monthly drowning statistics.
On the other hand, advocates like Katchmarchi might think that a presentation at a hospital or recreation center seems like a tiny gesture, but it’s one that could very well save a life.
As previously noted in this report, drowning figures dropped for roughly seven years after the launches of NDPA, the CDC’s Pool Safely division and the American Academy of Pediatrics’ Drowning Prevention Toolkit.
Dr. E. Scott Geller is Director, Center for Applied Behavior Systems at Virginia Tech and author, co-author or editor of 51 books.
Geller said in an article, “Safety isn’t primarily a technical problem or a behavioral problem. It’s a cultural problem. If the culture’s wrong, nothing works.”
He said behavior-based safety tactics largely address the symptoms instead of the causes of failures.
It is true that behavior in rural Ohio, where a 10-year-old drowned in the Ohio River in May of 2020, might be different than that of Dayton, where the city budgeted more than $100,000 for an aquatic sensor system at public pools.
The magnitude of America’s cultural diversity all but precludes drowning prevention advocates from influencing behavior change or habit-forming at every public or private waterfront.
Advocates must ask themselves what is good enough and how do they get there.
EXPERTS WEIGH IN
The following drowning prevention stakeholders offer thoughts on the future.
MICK AND SUE NELSON
Owners, Total Aquatic Programming, Colorado
(The couple also has a longtime employment arrangement with USA SWIMMING.)
If you consider the population growth in the past decade, we are actually making some minor headway. There are so many variables that affect drownings that sometimes it’s hard to identify a definite set of circumstances that can cause an increase. We would also agree that “supervision” plays a key role. We are all human and cannot be at 100% efficiency all of the time. There is power in numbers and sharing vital info. Even though we have been involved in aquatics our whole lives, we always learn new things from the National Drowning Prevention Alliance conferences. New things can lead to better ways to fight drownings. We hesitate to categorize this as “status quo,” but there is a morbid fact that drownings are like car accidents. They are bound to happen. That in no way means we accept the situation and stop trying to help. We personally feel that through the many organizations that are addressing the issue in some way, we are all making a difference. If messaging and education can make a difference, then 1000 hours each year spent developing and delivering the message is worth even one life saved.
ALISSA MAGRUM
Executive Director, Colin's Hope, Texas
Water safety and drowning prevention education of parents and caregivers prior to them having children or caring for children is ideal. If that is not feasible, then at the earliest possible moment and from multiple trusted sources, such as an OB/GYN or a pediatrician. Additionally, mainstream and social media campaigns would keep water safety in the front of people's minds. The other key piece is, in fact, behavior change in adults and behavior development in children, at the earliest ages. We must change cultural norms around water safety. Just as seatbelts were not the norm when I was a young child – I am 46 – they are absolutely the norm for my 15-year-old daughter. We must work on this behavior change piece intensely. Education, behavior change and cultural norm changes around water safety can move the needle in a big way and greatly reduce the number of fatal and non-fatal drownings. One drowning is one too many.
JUSTIN SEMPSROTT & ANDREW SCHMIDT
Co-Founders, Lifeguards Without Borders, Florida
SEMPSROTT: We have to have consistent messaging. Just because we have small successes with a campaign this year, we cannot rest on our laurels. Gun safety, car safety – they have consistent, cohesive messaging. With drowning, there are also different risk factors for different age groups which require different approaches. With motor vehicles or guns, those messages are the same. Drowning prevention is so multifaceted that it tends to overwhelm prevention agencies. The hope with the U.S. National Water Safety Action Plan is that it creates that guidebook that says here’s what your strategy should look like.
SCHMIDT: It is well within reach to cut the number of drownings in half in the U.S., but I don’t know if I can honestly say I believe that will ever happen. Developing a national plan for swim lessons and making basic water competency a childhood milestone would do wonders. If you look at countries like Australia, water competency is part of the culture, and their drowning rates represent that. Obviously, the sheer size and complexity of the U.S. often makes programs like these unachievable, but an effort should be made. In Florida, we have had legislation in the works to mandate state- provided lessons for elementary students. It takes a back seat to other legislative measures that have more lobbying power.
NICOLE HUGHES
Founder, Levi's Legacy, Texas
The missing factors in drowning prevention work are:
Drowning education must go beyond “watch your kids when they are swimming.”
Different age groups have very different risk factors and [require] focused education.
We need a cultural shift toward teaching infants that water is not meant to be a playground.
Drowning needs to be broken down by the very unique risk factors for each age group. The age group from 1-4 is very uniquely at risk of drowning during a non-swim time. For this group, the data is clear – these children are not drowning during a time when they are in or supposed to be around water. So, the emphasis on “watch your kids when swimming” is actually detrimental for this age group, because these children are not drowning during a swim-time. The stigma of neglect and the idea that drowning prevention is as simple as supervision... this is the greatest threat to drowning prevention. Parents who have not lost a child in this way to drowning think, “Well, you should have watched your kids.” And there is definitely an aura of smug judgment, as if this is a deserved punishment. And, I cannot blame those people – I used to think the same thing. Water is just primarily seen as fun and not as dangerous.
DR. LINDA QUAN
Pediatric Emergency Medicine Physician, Seattle Children's, Washington
We need to have pool barrier laws that are retroactive. We know they'll work. These laws around the country are only being applied to new pools. Well, how many is that? The Australians and New Zealanders have shown that it's not just about laws, but they could do better than the 50 percent improvement in drowning rates they have had if they had better enforcement. We have to have political will - that's what we're lacking. And that's where parents come in. Parents have a very strong voice and public health does not. And drowning prevention has not been organized enough to get its act together, the way it has in other countries. We're working on a national strategy, but it's going to be a tough one to try to get people to pony up and and say you really need a national law, or at least a law in every state, and make it retroactive. Also, we need better surveillance, better understanding of the problem. What was the level of superviosn? What was the fencing? We have a lot of epidemiologic questions, but we still don't know enough about the circumstances. I'm frustrated with human behavior. Changing human behavior with facts is not always successful. That's why I've been focusing more on laws.
Dr. Rachel Griffiths
Communication Director, Aquatic Safety Research Group, Pennsylvania
Unfortunately, we see too much of the same thing over and over. The aquatics industry and perceptions about water safety are very slow to change. There is an overreliance on supervision and an overestimation of its efficacy, yet a severe underutilization of other interventions, especially life jackets and technologies. Life jackets are underutilized and when it comes to swimming pools, parents and aquatics professionals inaccurately believe life jackets should not be worn because they would cause a false sense of security. Supervision, by far receives, the most emphasis, especially relying on supervision of lifeguards. While we believe supervision is imperative, it is imperfect. People drown with lifeguards on-duty, when people are around (sometimes especially when people are around), and with parent and other supervisors present. We discovered that lifeguards and other supervisors are subject to four main blindnesses – physical (they can’t see the victim with their eyes), cognitive (they are in denial and don’t believe what they don’t want to see; also experience freezing in a real drowning scenario), internal noise distractions (thoughts and emotions), and actual external distractions. Despite all the training lifeguards receive, even the best lifeguards can fail to see a drowning (physically or mentally) when a real incident occurs. Lifeguards and parents are also subject to the Bystander Effect, where the more people present, the less likely each is to respond to a drowning. Lanagan-Leitzel found that lifeguard training may be ineffective or counterproductive when comparing lay people to lifeguards expected to spot simulated drownings. The majority of lifeguard training is comprised of reactive rescue and resuscitation. There is very little dedication in water safety to proactive prevention. While rescue and resuscitation are important, we think there should be more of an emphasis on proactive prevention, to avoid needing the resuscitation. We stress it’s important to strengthen supervision and supplement supervision. Many parents and aquatics professionals alike are resistant to the supplementation part. They believe if there is good enough supervision, supervision will suffice. We believe the scale needs to be tipped the other direction for a better balance of proactive prevention in addition to reactive rescue and resuscitation. This includes practicing mindfulness to strengthen supervision, education of how quickly and quietly drowning can occur, and awareness that even the best supervisors are subject to lapses in supervision and additional layers of protection are needed. We strongly believe life jackets are needed for all bodies of water including swimming pools for children who cannot swim. Lastly, water safety suffers from a lack of consistent messaging. While there are more organizations working together today to develop common drowning prevention practices, messaging to the public can be inconsistent, confusing, and often just wrong. Water safety practices need to be based more on data and what actually happens, rather than continuing to do things the way they’ve always been done.
JENNY MCCUISTON
Co-Founder, Goldfish Swim School, Michigan
There is so much more to be done to provide education on water safety – it takes a village. We need great champions across industries to come together to combat these avoidable tragedies. By working together and creating strategic alliances, we can change the way our culture perceives water, spread awareness on the truths about drowning and save our future children… it is time for radical change. Parents and guardians turn to pediatricians to provide them with the information they need to keep their children safe. Car seats, home safety, proper nutrition and medication are all part of important conversations for families with young children. Now it is time to add water safety to the list. We launched a program called Goldfish RX. The program aims to build relationships with pediatricians across the country by providing educational material needed to promote doctor-patient conversations around drowning prevention, the importance of water safety, and the value of swim lessons at a young age - while also providing a prescription tear pad to prescribe every child an introductory, complimentary swim lesson.
MEGAN FERRARO
Executive Director, The ZAC Foundation, Connecticut
There are so many layers to this challenge. It felt very fragmented when I first started. Messaging was inconsistent. There wasn’t a lot of sharing of best practices. But Families United to Prevent Drowning helped make inroads. We are now talking at a high level. The tide is finally starting to turn. We should continue what we are doing, but it’s our job to think creatively about unique solutions, such as partner companies interested in injury prevention. I have been delighted to work with the American Red Cross and Connie Harvey, the Director of its Centennial Campaign. We promote swim classes, CPR training , instruction for lifeguard instructors and more. I also advocate that we look at successful strategies and borrow where we can. The National Water Safety Action Plan originates from an urgent recommendation by the World Health Organization for all countries to adopt an integrated approach. In fact, we have already run pilot Drowning Prevention Action Plans in Illinois, Texas, Missouri and Connecticut. We pulled together members of public health, first reponders, communitiy leaders and media to be part of the process. We found that people wanted to make this a priority. We’re also finding pain points. Foundations need to be armed with tools to lobby state governments and adjust priorities as we witness new trends. ZAC Camps are held all across the country. Our staff and partners spend time both in the pool and out. Curriculum and engagements with parents are customized depending upon location and environments. We teach the ABC&Ds of drowning prevention — adults, barriers, classes and CPR and drains and devices. Attention of the AAP on this issue is another important tactic — talking to parents at an early age about what drowning prevention means. Although it is frustrating, because pediatricans have said to us “How can we tell parents to enroll in swimming lessons that they cannot afford? We cannot make them feel guilty. We need to talk to them about gross motor skills and eating and milestones.” I tell everyone I can that we need to discuss this topic the same way we discuss with children about touching the stove or crossing the street. And finally, we must improve the speed at which drowning data can be accessed and its quality, analysis and dissemination.
JOANN BARNETT
CEO and President, Infant Swim Resource, Washington, D.C.
There is no vaccine for drowning. When I see kids in puddle jumpers, I know what that means. They’re learning to be vertical in the water, and they are learning that the water is fun. So, a child that is vertical with a head disproportionately weighing as much as it does, it’s not at all surprising when they drown. Children first need to gain a respect for the water. We teach children, as soon as they can crawl, to roll over and float so they can rest and breathe – self-rescue. Once they can walk, then that is evidence that they are also developmentally ready to swim. From six months to a year, when kids are not walking, the ability to roll over then float is self-rescue and survival. But, it’s important to quickly build upon those skills, as the child grows developmentally, so they ultimately swim for fun and enjoyment.
