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Saturday, January 21, 2012

It's easy to read the paper without realizing what needs to be fixed.

Tragically, a 64 y/o gentleman died in San Antonio yesterday. The cause of death has not been announced, but it's likely that it was either a sudden cardiac arrest, a ruptured aortic anurism, or asphyxia via drowning, with the most likely being a sudden cardiac arrest.

It is apparent from the article that there are a number of problems with the way public pools are staffed and managed that make it unlikely that someone could survive in the situation this gentleman encountered. Even more sadly, most of these factors are to some degree controllable by the management of the pool.

My mission is not to criticize anyone. My Mission is to point out that the odds of surviving were not good for several structural reasons and to rally public support for changing the environment.

THE DETAILS: published the news, and their story included the following.
  • "Annett told KSAT that she and her husband were swimming on Friday when she noticed him at the bottom of the pool.
  • "She called for help and three lifeguards pulled him out and administered CPR, but Earl did not survive."
  • There was no mention of an AED's having been used.
OK. Let's stop there and think about what we just read.
  • A quick check on the internet reveals that there are two pools at the Blossom Center in San Antonio: a 25 meter long pool, 7-13 feet deep and a 50 meter long pool, 3-12 feet deep.
  • These pools are in adjacent buildings.
  • The 'three lifeguard' reference suggests that two were assigned in the building that houses the larger pool, and one was assigned in the building that houses the smaller pool.
  • The story states that it was the three lifeguards that pulled the victim from the pool.
  • The story also clearly states that it was the wife who spotted the victim on the bottom and called for help.
The victim's chances of surviving the incident depends upon the cause of death and the timing of the steps taken subsequent to the victim's sinking to the bottom.

Let's first estimate how much time elapsed between the time of the incident and the time that CPR was initiated. I've included my estimate of the "shortest" (the minimum time possible) and "more likely" (the more likely value for that timing). These "more likely" values are by no means maximums. I am a swimmer and a paramedic and have had to respond in emergency situations.
  1. Discovery: the time between the event and the time the body was noticed on the bottom;
  2. LG's know: the time between the the body's being noticed and the cries for help were heard and understood by the lifeguards.
  3. Response to victim: the time between the cries for help were understood by the lifeguards and the time enough lifeguards were on the bottom at the victim's side to begin getting the victim out of the water.
  4. Extrication: the time between the start of the extrication and the time the victim was on his back out of the pool on a hard flat surface.
  5. To begin CPR: the time between the victim's being on his back on a hard, flat surface and the time CPR compressions were begun.
Item Shortest More Likely Comments
1.Discovery 2 sec 180 sec Which pool, how crowded
2. LG's know 3 sec 15 sec Try yelling something to a LG in an enclosed pool.
3. Response to victim 15 sec 50 sec Try it before you scoff. If you can swim 50 meters in 50 seconds, the local swimming coach wants to meet you. When you are in rescue mode you can run to a closer point, but on the average - if you are the only LG at a 25 meter pool or one of two LG's at a 50 meter pool, it's going to take you the better part of a minute to get into the water and get alongside the victim on the bottom, sometimes more, sometime's less.
4. Extrication 90 sec 120 sec If you haven't had to do this, please try it before you complain about my estimates.
5. To begin CPR 1 sec 15 sec Lifeguards are taught certificated CPR. That's necessary to make sure that management can be reasonably assured that the LG's actually attended class and passed.
Totals 1:51 6:20 If it took 6:20 to begin CPR, his odds of surviving with major brain functions intact had rapidly dwindled to about 1 in 20 by the time CPR began. (10% per minute)

  1. There need to be enough life guards on duty so that they have a high likelihood of being the first to notice the problem. One easy way of sizing up the life guard staffing, quality, and management is to walk up to a lifeguard, positioning yourself, if possible, to make sure he or she cannot see the pool, and ask how many people are in the pool. If the LG can't tell you instantly - and without looking at the pool - there is a problem. If there is only one on duty, there is a problem.
  2. There have to be enough life guards on duty to get any given swimmer from the bottom to the surrounding deck. After I saw the article this morning, I headed over to a local community pool, saw the lifeguard - a strong, fit person - intently watching the pool. I then took a look at the swimmers and made the assessment that about a quarter of the swimmers were people that the strong, fit LG on duty could not have single-handedly gotten out of the pool. (Yes, the LG answered without hesitation that there were nine people in the pool.)
  3. The LG has to have access to other help and an AED. If he or she are in a "one LG, one swimmer" situation, the LG needs a way of activating the emergency network (calling 911) and of getting an AED and a helper to his or her side quickly.
  4. There has to be an AED at the facility for the helper, when notified, can bring.
  5. The LG's have to drill. How many LG's regularly have had to get 200 pounds of limp victim off the bottom and onto the deck in a position ready for chest compressions?
None of these changes will happen without public pressure. Bob