At the close of the World Congress on Drowning 2002, enthusiasm was high, with much information having been exchanged and many key decisions reached. The role of the International Life Saving Federation is to promote world water safety.© Thus, many of the recommendations and expectations at the end of the World Congress on Drowning focused on us. Rightly so. This paper is intended to hold us accountable by providing an update regarding specific actions the ILS has taken since the World Congress on Drowning. It is organized in accordance with published recommendations of the World Congress on Drowning. Thereafter, this paper notes some additional initiatives not specifically recommended by the World Congress on Drowning, but nevertheless essential to world water safety.

At the close of the World Congress on Drowning 2002, enthusiasm was high, with much information having been exchanged and many key decisions reached. The role of the International Life Saving Federation is to promote world water safety.© Thus, many of the recommendations and expectations at the end of the World Congress on Drowning focused on us. Rightly so. This paper is intended to hold us accountable by providing an update regarding specific actions the ILS has taken since the World Congress on Drowning. It is organized in accordance with published recommendations of the World Congress on Drowning. Thereafter, this paper notes some additional initiatives not specifically recommended by the World Congress on Drowning, but nevertheless essential to world water safety.

1. Specific Actions Regarding World Congress on Drowning Recommendations

WCD2002 Recommendation #1:

A new, more appropriate, world-wide uniform definition of drowning must be adopted. “Drowning is the process of experiencing respiratory impairment from submersion/immersion in liquid.”

The new definition has been embraced by the ILS and used in all publications since this decision was reached. This definition has also been endorsed and adopted by many leadership national and international organizations including the US Centre for Disease Control and the World Health Organization. The new definition has been published in the traditional medical literature. Drs Szpilman and Bierens from the ILS Medical Committee were authors for that work.

WCD2002 Recommendation #2:

There is a great need of adequate and reliable international registrations of drowning incidents.

In September 2004, the ILS Board of Directors approved the creation of the ILS Lifesaving Commission, which includes the ILS World Drowning Report Committee. The role of the World Drowning Report Committee is to assemble and publish a World Drowning Report, to promote it, and to ensure wide circulation. The inaugural report has now been produced. It was a mammoth task which involved extensive discussions with the World Health Organisation, the Centres for Disease Control and Prevention, and numerous other sources worldwide.

The World Drowning Report serves to highlight the importance of drowning as a world health problem by assembling available data and distributing it globally. Like other health problems, unless the impact of drowning is fully appreciated, the resources devoted to its prevention will be lacking.

One of the greatest problems the World Drowning Report Committee faced was lack of reliable data. In fact, few countries had such data available. It is hoped that by publishing the available data, thereby noting countries from which data is lacking, encouragement will be lent gather and report such data in each country of the world. The goal is that each succeeding version of the World Drowning Report will include an increase in the number of countries reporting reliable data.

WCD2002 Recommendation #3:

More data must be collected and knowledge gained about drowning in low-income countries and societies.

The ILS fully agrees with this statement. Unfortunately, data gathering for all causes of death and morbidity is generally less available from developing countries. This has forced the World Health Organisation, in its reports, to estimate and project numbers. The ILS is approaching this in two ways. First and foremost is an ongoing effort to create new lifesaving organisations in developing nations which can oversee and facilitate lifesaving efforts in these countries. Since WCD2002 16 new national lifesaving organisations from developing nations have joined the ILS. Many were created through the assistance of the ILS. Our Development Committee focuses its attention entirely on these efforts. Second, the continued publication of the World Drowning Report is intended, in part, to encourage better reporting on drowning from all countries of the world.

This conference will see examples of cohort sampling and extrapolation to larger national populations using a validated family sampling technique which allows a scientifically determined sampling. This data allows us to express the region or national drowning as a rate ” usually events/100,000. This is considerably cheaper and easier to achieve that collection of death or morbidity statistics for the entire population, when that infrastructure does not exist. This technique is something that can be undertaken in the high risk and least developed nations of the world. When we understand the size of the problem in such less adaptive populations, evidenced based strategic interventions become possible.

WCD2002 Recommendation #4:

Preventive strategies and collaboration are needed.

The very existence of the International Life Saving Federation is based on a premise that by collaborating, we improve efforts to prevent drowning. Most national lifesaving organisations are founded on a premise that prevention is the most effective strategy. The ILS, primarily through our Lifesaving Commission, is identifying best practice in drowning prevention throughout the world, publishing our findings, and recommending implementation of these practices. Examples include standardised signage, beach flags, medical procedures, and public education programmes.

WCD2002 Recommendation #5:

All individuals, and particularly police officers and fire fighters, must learn to swim.

In 2007, the ILS published a position statement on Swimming and Water Safety Education. Position statements of the ILS carry the full weight of our international body and our collaborating Member Federations. This statement, available on the ILS website, states in part as follows:

The vast majority of deaths by drowning can be prevented. Everyone, ideally commencing at a young age and regardless of ability and background, should have access to training in water safety, personal survival, and water rescue. Knowledge and understanding of water environments and their associated hazards should be taught to everyone at the earliest possible age. This awareness training should be accompanied by the provision of swimming teaching, in the safest manner possible and to at least a basic level of skill that provides the capacity for survival after unexpected and sudden immersion in water. Acquisition of more advanced water safety knowledge and swimming skills, to include water rescue and competitive swimming, should be encouraged as these enhance aquatic safety. Accessible and affordable training in water safety and swimming skills should, ideally, be made available for everyone, particularly children, in all countries, to a level consistent with the ILS International Water Safety and Swimming Education Guidelines.

As well as the foregoing, as noted therein, the ILS offers water safety and swimming education guidelines, which further advance these efforts and which are identified on our website. As well, the ILS promulgates recommended minimum standards for the training of people who will be involved in lifesaving efforts.

WCD2002 Recommendation #6:

Rescue techniques must be investigated, since most of the current rescue techniques have evolved by trial and error, with little scientific investigation.

The ILS is manifestly aware of this problem. Through the Lifesaving Commission, Rescue Committee, various rescue techniques are being re-evaluated for efficacy. Although the ILS lacks a budget to carry out the many research projects that might otherwise be considered ideal, ILS Member Federations are taking actions expected to evaluate techniques and practices.

In the United States, the Lifeguard Standards Coalition (www.lifeguardstandards.org) has been assembled by the three ILS Member Federations (American Red Cross, United States Lifesaving Association, and YMCA of the USA) to conduct an evidence-based review of lifesaving practices and techniques. This includes a review of existing research literature, identification of appropriate actions based on existing research, and identification of areas where further research is needed. Example issues being addressed are: How long should a lifeguard be assigned to continually watch the water before interruption of duty? What evidence is there to support the effectiveness of [specific] scanning techniques in identifying patrons in need of assistance? Are there unique aspects of establishing and maintaining upper airway management in the drowning process resuscitation? A more thorough discussion of this project will be presented by Dr. Peter Wernicki M.D. during World Water Safety 2007. As well, Dr. David Markenson M.D. will provide an overview of a similar process used by the American Red Cross to develop evidence-based first aid guidelines.

The Royal National Lifeboat Institute, also an ILS Member Federation, has commissioned several studies of lifesaving equipment and practices. One study, for example, addresses the need for specific swim training standards for lifesavers who will be assigned to surf locations. Another identifies effective public rescue devices.

WCD2002 Recommendation #7:

Basic resuscitation skills must be learned by all volunteer and professional rescuers as well as lay persons who frequent aquatic areas or supervise others in water environment.

In 2003, the ILS published a position statement on this subject, which can be found on the ILS website. It reads, in part: All lifesavers should be taught and maintain proficiency in CPR techniques in a course which is approved in their own country and consistent with the Guidelines 2000 [now the Guidelines 2005] for Cardiopulmonary Resuscitation and Emergency Vascular Care. All CPR courses for lifesavers should include the following elements: a. Lifesavers should be taught and maintain proficiency in both single rescuer and dual rescuer CPR techniques. b. Lifesavers should be taught and maintain proficiency in both head tilt-chin lift and jaw thrust methods of opening the airway. c. Lifesavers should be instructed that “compression-only” CPR is not appropriate in drowning cases.

WCD2002 Recommendation #8:

Uniform glossary of definitions and a uniform reporting of drowning resuscitation must be developed and used.

As noted in the response to Recommendation for #1, the ILS has actively promoted a uniform definition of drowning. Issuance of the World Drowning Report is intended, in part, to encourage increased drowning reporting of elevated quality and elevated uniformity from throughout the world. The ILS intends, through our network of national lifesaving organisations, to press for these outcomes and expects that projects already underway are having this effect presently.

WCD2002 Recommendation #9:

Hospital treatment of the severe drowning victim must be concentrated.

The ILS Lifesaving Commission, through our Medical Committee, are considering ways that this recommendation can be better promoted, possibly through issuance of a position statement.

WCD2002 Recommendation #10:

Treatment of the patient with brain injury resulting from cardiopulmonary arrest attributable to drowning must be based on scientific evidence.

The ILS Lifesaving Commission, through our Medical Committee, are considering ways that this recommendation can be better promoted, possibly through issuance of a position statement.

WCD2002 Recommendation #11:

Wearing of appropriate and insulating life jackets must be promoted.

The ILS, along with our Member Federations and associated international organisations actively promotes this, along with many other recommendations.

WCD2002 Recommendation #12:

The balance between safety and profitability of recreational diving must remain critically observed.

This recommendation was directed to the world-wide recreational diving industry and has not been addressed by the ILS.

WCD2002 Recommendation #13:

Safety of diving fishermen [predominately found in the poor countries around the world] needs more attention.

The ILS is addressing this recommendation as we are for all issues involving world water safety by aiding in the development of lifesaving organisations in all countries of the world, supporting those organisations through an exchange of best practice, and issuing guidelines aimed at water safety.

In addition to the recommendations above, the World Congress on Drowning 2002 outcome recommendations included the following:

• Global uniformity of beach signs and safety flags.

  A set of uniform beach safety flags has been published by the ILS. The ILS Lifesaving Commission, Rescue Committee is presently working with the International Standards Organisation on a project to further refine standardisation in this area and to develop standardised beach safety signs. Work in this area is ongoing.

• Risk assessment of beach hazards.

  The Lifesaving Commission, Rescue Committee, is presently developing global guidelines for risk assessment of beach hazards.

• Determination of optimal visual scanning techniques.

  This issue is currently being researched by the Lifeguard Standards Coalition (US). A report on the Coalition’s work will be reported separately, later at World Water Safety 2007.

• Construction of the most adequate rescue boats, including alternatives such as jet boats, hovercrafts, with minimum risk of injuries for the drivers.

  The ILS has primarily left this work to our Member Federations. Significant effort in this area is ongoing by the Royal National Lifeboat Institution (UK) and by other Member Federations.

Further Actions by the International Life Saving Federation

The International Life Saving Federation has been working on a wide variety of initiatives since 2002, in addition to those associated with recommendations from the World Congress on Drowning. In this section, you will find some examples.

• Comprehensive Drowning Prevention Plan: The Lifesaving Commission, Rescue Committee is finalising a comprehensive plan involving strategies to prevent drowning has been achieved, in collaboration with the Education Committee. Further discussions will take place at World Water Safety 2007 and input will be solicited.
• World Water Safety 2011:A bidding process has been developed and will soon be launched for hosting of World Water Safety 2011.
• World Championships: The ILS is recognised as the governing body for lifesaving sport by the International Olympic Committee. The ILS Sport Commission has overseen the organising of two international lifesaving competitions (Rescue 2002, Rescue 2004, and Rescue 2006) and anticipates Rescue 2008.
• Tool Kit for Developing Nations: The Lifesaving Commission, Development Committee is reviewing the WHO Guidelines for Safe Recreational Water Environments for distribution in developing nations. They are developing a “tool kit” for ILS representatives doing work in developing countries (health information, educational material, ILS history and expectations for volunteer workers, etc.)
• Standards Equivalency: The ILS has now approved a total of 51 training programmes of lifesaving organisations worldwide as meeting ILS certificate standards, thus promoting minimum international benchmarks for lifesaving tanning.
• Medical Position Statements: The Lifesaving Commission, Medical Committee has now published 13 Medical Position Statements, which are available on the ILS website. The most recent of these are entitled, “Human Experimentation and “Medical Priorities in Lifesaving.
• Fitness Standards: The Lifesaving Commission, Rescue Committee is in the process of developing a position statement on recommended minimum fitness standards for lifeguards/lifesavers.

2. Summary

The International Life Saving Federation has taken the lead role in identifying and addressing most recommendations from the World Congress on Drowning 2002 and continues to pursue every possible strategy to advance world water safety. The ILS Lifesaving Commission’s five committees (Rescue, Education, Development, Drowning Report, and Medical) have each identified specific solutions to myriad problems through a variety of strategies. Perhaps the most important of these to readers of this paper is the organising and convening of World Water Safety 2007, which will not doubt harness the lifesaving minds of the world to identify additional goals and strategies to further advance world water safety.