Identifying Gaps in Shallow Water Blackout Prevention
Though it is a popular training technique and even seen as a feat of strength, prolonged breath holding can be extremely dangerous. Shallow Water Blackout (SWB) has become a leading cause of drowning in YMCA pools across the US—resulting in a similar number of fatalities as non-swimmer drownings since 2008. The Redwoods Group has advised partner organizations, including YMCAs, to prohibit prolonged breath holding for all swimmers to prevent SWB injuries and deaths. During the summer of 2016, a team of Consulting Fellows from The Redwoods Group designed and implemented an aquatic safety audit and performed the audit at 110 pools across 73 YMCA associations throughout the eastern half of the United States. The audit procedures included a survey of the pool environment, lifeguard characteristics and readiness, a simulation of even dangerous behaviors (including hyperventilation and static breath holding), and interviews to determine knowledge of SWB-related rules.
Over the course of the summer, the Redwoods Consulting Fellows team traveled to pools in 17 states and the District of Columbia. Only 40 of the 110 pool visits (36.4%) resulted in at least one correct implementation of SWB-related rules and only 18% of the visits resulted in enforcement of rules regarding static breath holding, in particular. In addition, the vast majority of lifeguard and non-pool staff did not show awareness of rules around prolonged breath holding or Shallow Water Blackout (when asked if the swimmer would be allowed to swim full laps underwater). The team analyzed the simulation results, as well as data from the pool environment and area demographics and found that most variables considered in this study were not meaningful in predicting the results of the SWB simulation. However, a couple of variables--higher ratios of patrons to lifeguard/staff and the poverty level of the zip code where the pool is located—showed some relationship with the results of the simulation.
The Redwoods Consulting Fellows team concluded that there are two main issues regarding the lack of rule enforcement—an “Awareness Gap” and an “Action Gap.” The Awareness Gap describes YMCA pools that did not show an understanding of SWB dangers or their related rules. Only about 31% of the lifeguards interviewed in this study showed an awareness of SWB-related rules. The Action Gap describes YMCA pools that may know SWB-related rules, but, for a variety of reasons, are not enforcing them. In fact, only 7.5% of the lifeguards interviewed showed awareness of SWB rules and enforced them in the simulation.
In response to these apparent gaps, the Redwoods Consulting Team recommended the following: promoting the use of effective pool signage and policies, strengthening communication tools to/from Aquatics Directors, providing tools to help lifeguards recognize and enforce the rules (including specific definitions of the rule and scripted responses), and including SWB intervention practice in lifeguard in-service or online trainings.
The Redwoods Consulting Fellows team was made up of Graham Sharpe (Business Analyst at The Redwoods Group in Morrisville, NC), Miranda Jacobs (Claims Analyst at The Redwoods Group), and Patrick Minor (Senior at North Carolina Central University).
The Redwoods Group is a social enterprise that works to reinvent insurance to keep people safe and build more just, equitable communities. Since 1997, Redwoods has used the data it collects through insuring youth-serving nonprofits to fight child sexual abuse, drownings and other preventable risks. We identify practical, systemic and cost-effective solutions that address the root causes of harm and help to heal communities. Yet we can’t disseminate these solutions alone. That’s why we work closely with our customers to implement proven safety practices within their organization that will build a culture of safety. And it’s also why our Foundation works to build community-wide movements to prevent child sexual abuse, eradicate drowning deaths and promote social entrepreneurship.