Swimming pool injury data: Improvements to lifeguard training

1. Introduction

At present, in the aquatic industry incidents are reported using one or more first aid and/or incident report forms that are facility specific. Some facilities use forms that gather a great deal of information, others have no minimum requirement of information. In addition, there is no evidence of this information being cross referenced between centres for comparison. As a result there is very little evidence to describe the extent of injuries/incidents that occur in commercial aquatic facilities.

The Guidelines for Safe Pool Operation (GSPO) developed in 1991 by Royal Life Saving Society Australia- Victoria branch is recognised as the Best Practice Manual for the aquatics industry across Australia. Evidence from the current study will help provide further directions for the GSPO. Any Guidelines that are updated as a result of the findings from the study will reach the aquatics industry and will thus help raise the standard expected of the aquatics industry.

Therefore, the current study aimed to describe the type of incidents (including first aid incidents and rescues) that occur at public swimming pools. Further aims were to describe the locations within the pools where incidents occur, the type of medical treatment required, and the rate of incidents.

2. Methods

Six months of data in relation to all incidents at 18 aquatic centres across Victoria was collected retrospectively. A cross-section of metropolitan and regional centres as well as seasonal and year round centres was selected.

Centre managers provided all major and minor incident report forms for the period of July 1 – December 31, 2004. For seasonal pools all data for the time they were open during that period was collected. Only information relating to the aquatic area of centres was included in the analysis, thus the pool itself, the walkways around the pool or pool concourse and the change rooms connected to the pool area. Any injuries occurring outside the aquatic area for example, fitness centre and that were not consistent with other centres were excluded from the analysis.

The data items on the report forms varied from centre to centre. Thus a common dataset was developed based on all data items, documenting and mapping the variations. A data collection form was developed using Microsoft Excel and data from the forms was then entered in a de-identified manner. The data was examined using descriptive statistics to identify trends and patterns in the data.

3. Results

In the six month period from July – December 2004, 1715 incidents were recorded in commercial aquatic facilities. This represents an incidence rate of 142.2 per 100,000 pool visitations. There was no significant difference found in number of incidents between males and females. The highest proportion of incidents was found in children aged between 5-14 years, accounting for 50% of all incidents.

Injuries were more frequent in the extremities, particularly the foot (29%), hands (10%), face (23%) and head (4%). The nature of injuries were typically minor cuts (45%), bruises (12%) and grazes (10%). Individuals were usually involved in water recreation (45%) or swimming lessons (26%) when the injury occurred, with injuries being caused by collisions, falls and cuts.

The most common first aid treatment was wound management (45%) that is, cleaning and dressing the wound, for cuts and grazes, followed by ICE (ice, compression, and elevation; 25%). Of the 149 cases where treatment time was noted (this only occurred a one facility) the median treatment time was 10 minutes (range: 5-110 minutes). Following initial treatment no referral for further medical attention was required in the majority of cases (59%).

4. Discussion

Further research is planned to extend this project further and capture standardised information from a greater number of centres in Victoria.

5. Conclusions

This study provides an indication of the typical incidents that occur in commercial aquatic facilities.

6. Take home messages

  1. The collection of swimming pool injury data provides a very useful tool for facilities to help improve the defined roles of lifeguards, their duties necessary for the prevention of injury, and provide information about hazardous areas in facilities.
  2. Pool injury data can provide many practical applications for lifeguard training. Historically lifeguard training programs have focused on core rescue and life support techniques which are still vital lifeguarding skills but this research has allowed training organisations to validate the common perception that the role most commonly preformed by lifeguards is one of basic first aid treatment. This has not necessarily changed the direct training content of lifeguard programs but now RLSSA has introduced a prerequisite of a First Aid qualification, this allows the lifeguard training program to continue to focus on the more advanced lifeguard skills, such as effective surveillance, spinal management, water rescue skills and alike while refining basic first aid and life support skills. The direct effect for lifeguards and employers of lifeguards is the continual need to ensure that lifeguards are up to date with correct treatment of first aid incidents, which has had a direct effect on in-service training programs.
  3. Injury data from swimming pools can also provide applications in regards to facility layout and processes, for example, the location of lifeguarding stations and first aid equipment. RLSSA via its publication, Guidelines for Safe Pool Operation has recommended that facilities provide appropriate areas on pool deck/concourse for lifeguards to treat these minor injuries without the need to be removed completely from the pool area. Also access to all key rescue and first aid equipment should be able to be achieved from pool deck.
  4. Further more long term applications for pool injury data includes facility design. These will take a longer time period to take effect in reducing the number of incidents. RLSSA via the working parties and risk management groups who develop the Guidelines for Safe Pool Operation manual will now incorporate this data into the design standards of facilities. Key factors that will be addressed will be finishing treatments for in pool and pool surround surfaces, along with issues such as traffic flow/management.
  5. The usability and application of injury data will be affected by the accuracy and consistency of data collection. The utility of the data would also benefit from the capture of exposure data to better determine injury rates.

7. Acknowledgments

We would like to acknowledge the support of the Royal Life Saving Society Australia in providing a grant for this project. We are also most grateful to the Management, and Operators of those centres that participated.