Chapter 7_ Scanning and Surveillance (Lifeguards).pdf

Chapter 7: Scanning and Surveillance (Lifeguards) Section 1 - Drowning Statistics There are an estimated 320,000 annual drowning deaths worldwide. Drowning is the 3rd leading cause of unintentional injury death worldwide, accounting for 7 percent of all injury-related deaths. In the US, an average o...

Chapter 7: Scanning and Surveillance (Lifeguards) Section 1 - Drowning Statistics There are an estimated 320,000 annual drowning deaths worldwide. Drowning is the 3rd leading cause of unintentional injury death worldwide, accounting for 7 percent of all injury-related deaths. In the US, an average of 3,500 to 4,000 people drown per year. That is an average of 10 fatal drownings per day. Nearly 80% of people who die from drowning are male, as of 2022. Many factors might contribute to higher rates of drowning among males, including increased exposure to water, risk-taking behaviors, and alcohol use. 1.1 Children As of 2024, drowning is the #1 leading cause of death for children ages 1-4. Drowning rates are highest in children ages 1-4, followed by children 5-7 1.2 Drowning Risks Vary by Race and Household Income Drowning death rates for Black people are 1.5 times higher than the rates for White people. Disparities are highest among Black children ages 5-9 (rates 2.6 times higher) and ages 10-14 (rates 3.6 times higher). Sixty-four percent of African-American, 45 percent of Hispanic/Latino, and 40 percent of Caucasian children have few to no swimming skills. When parents have no/low swimming skills (or competence) ability, their children are unlikely to have proficient swimming skills. This affects: 78 percent of African-American children 62 percent of Hispanic/Latino children 67 percent of Caucasian children African-American children ages 5 to 19 drown in swimming pools at rates 5.5 times higher than Caucasian children in the same age range. Seventy-nine percent of children in households with incomes less than $50,000 have few-to-no swimming skills. 1.3 Drowning Factors Not knowing how to swim: Many adults and children report that they can’t swim or that they are weak swimmers. Participation in formal swimming lessons can reduce the risk of drowning among children and young adults. Lack of close supervision: drowning can happen quickly and quietly anywhere there is water, especially to unsupervised children. It happens in lakes and oceans, pools, bathtubs, and even buckets of water. Location: The highest risk locations for drowning vary by age. Among infants under 1 year old, two thirds of all drownings occur in bathtubs. Most drownings happen in home swimming pools among children ages 1–4. About 40% of drownings among children 5-14 occur in natural water, and about 30% occur in swimming pools. More than half of fatal and nonfatal drownings among people 15 years and older occur in natural waters like lakes, rivers, or oceans. Not wearing life jackets: Life jackets can prevent drowning during water activities, especially boating and swimming. The U.S. Coast Guard reported 658 boating-related  deaths in 2021—81% died by drowning, and 83% of these people were not wearing life jackets. Drinking Alcohol: Alcohol impairs balance, coordination, and judgment, and it increases risk-taking behavior. Among adolescents and adults, alcohol use is involved in: ○ up to 70% of deaths associated with water recreation, like boating or swimming ○ nearly 1 in 4 emergency department visits for drowning ○ about 1 in 5 reported boating deaths. Using drugs and prescription medication: Certain medications can increase the risk of drowning, especially psychotropic medications commonly prescribed for depression, anxiety, bipolar disorder, schizophrenia, and other conditions. Side effects from these medications can be similar to the effects of alcohol, such as a difficulty thinking clearly and decreased motor skills. Other drugs and prescription medications might also increase drowning risk. Section 2 - Proper Surveillance As a lifeguard, the only way to avoid someone drowning during your shift is being physically and mentally prepared while surveying your area flawlessly. 2.1 Scanning Scanning is the systematic visual observation of the facility, its patrons, and their activities. Effective scanning must be considered the foundation of the lifeguard surveillance system. Scanning requirements and techniques are affected by numerous factors, including: 2.1a The number of patrons and their activities Guards should be aware of all patrons and what they are doing while noting the number of swimming patrons. Patrons should be mentally grouped by physical location and what they are doing in the water. 2.1b The number of lifeguards and their locations When the number of swimmers in the swimming area reaches the given maximum capacity for the primary guard it is his/her responsibility for requesting additional guards. Depending on where the majority of the patrons in the water are located, this additional guard may be placed in a number of different locations. The guards will scan different areas of the swimming area, being sure to overlap their scanning. The primary guard should continue to scan the entire area. 2.1c The Facility design and layout While this typically affects pool guarding more than open water guarding, guards should be aware of not just the swimming area but its surrounding areas as well. 2.1d Weather conditions Weather conditions will affect your scanning. While guarding you should watch for storms and growing waves that can be dangerous to swimmers. Fog can also be of danger as it can restrict the guard's ability to see the entire swimming area. If this happens, notify your manager and the Beach Office immediately, who will then decide further action, most likely closing the swim area. 2.2 Areas of Responsibility While scanning, the lifeguard is responsible for more than the swimming area. Lifeguards must consider all areas of the water, the beach, and related facilities as part of their responsibility and potentially an area where they must respond. 2.2a Primary Zone The swimming area is the lifeguards’ top priority. The Primary Zone for each lifeguard is the water area for which they are responsible. This zone automatically increases when lifeguards in adjacent towers are on a response or the tower is closed. In the case of the Evanston Beaches, this is the swimming area outlined by the swimming buoys. 2.2b Secondary Zone Usually this area includes adjacent water, including the Primary Zone of other lifeguards, the beach, immediately adjacent park areas, the sky, and the water surrounding the swimming area. Less frequent scanning of this zone is required, but the lifeguard should check this zone regularly. 2.2c Tertiary Zone Generally, the Tertiary Zone includes all other areas within sight of the lifeguard. It could include adjacent streets and parking lots for example. These areas should also be quickly scanned, but far less frequently than the Primary and Secondary Zones. Guards may not necessarily respond to these areas themselves, but may observe an incident that requires a response by a supervisory unit, a rescue boat, or other department such as police and/or fire personnel, and must notify them as necessary. 2.2d Overlapping Responsibility Beaches with multiple towers or stands need to keep them close enough together to allow overlapping of vision to avoid creation of blind spots or areas without coverage between guards. In this situation, there is no clear boundary between the stations. Guards must overlap their visual scanning effort and eliminate the potential for one guard thinking that a potential victim is in someone else’s water. 2.2e Cross Checking Coverage Because glare and other natural conditions may obscure portions of an area, guards must cross check with each other to ensure that all areas are completely covered. Communication is a valuable tool for lifeguards in these situations. Radios or telephones are the best methods to properly communicate in these circumstances. 2.3 Principles of Scanning Open water scanning is significantly different from scanning a pool, but the basic principles are the same. Effective scanning assumes that lifeguards can see the entire area, that they know what they are looking for, and that they will recognize it when they see it. 2.3a Positioning Lifeguards must be positioned with clear, unobstructed sight lines. Lifeguards must move to counteract visual interference; this will come into play when roving. When up in the  chair, however, guards should be sure that they have a clear running path to the waterfront free of patrons, beach towels, holes, or other objects that may slow their response time. 2.3b Sight Lifeguards must take steps to minimize the effect of reflection or glare (e.g. change position, use polarized lenses). Lifeguards’ scanning strategy must compensate for an inability to see below the surface (e.g., waterfront environments), and for the distance from patron activity (e.g., use of binoculars). 2.3c Recognition Lifeguards must practice and improve perception skills in order to understand the signs of potential trouble and the characteristic behaviors of those in need of help. Studies indicate that drowning can occur in seconds. Some victims may struggle, while some slip quietly below the surface. Despite the lifeguard’s best efforts, he or she may not see the event. The less time it takes to effectively scan the entire zone, the better, but scan too fast and you could scan over a potential problem. Lifeguards who have worked in a facility for a time come to know the sights, sounds, patterns, and rhythms of an area and the activities which are normal for that facility. 2.4 How to Scan Scanning is not just looking. While scanning, a lifeguard is actively watching for specific signs and actions that may represent a potential victim or danger. 2.4a What to do Sweep your eyes over your zone, moving your head to see things to the right and left. Take note of patrons and activity right in front of you. Lifeguards in the chair should periodically look below them. Include adjacent lifeguards on each sweep to receive any visual communications they might be sending and to check the area behind them. Scan below the surface and the bottom regularly. Attend to the “hotspots” in your Primary Zone more often (drop-offs, sandbars, the shoreline, rocks, deep area, and jetties). Ensure that anyone who submerges re-appears. Note that an activity hotspot can move with the people who create it. 2.4b What to watch for: Focus on people and what they are doing. Make eye contact whenever possible, watch the face. Look and listen for the unusual. Avoid staring fixedly at the same thing. Give your eyes a break by focusing momentarily on some distant object or horizon. Use your peripheral vision to detect movement. Never stop scanning when speaking to a patron. In outdoor facilities, monitor changes in environmental conditions (weather and water) for impact on patron behavior and safety. 2.5 MOB 8 Proper surveillance of the swimming area requires more than just simply paying close attention to the swimmers. To maintain alertness and awareness of everything happening in your area of supervision, you will follow a specific set of surveillance techniques including defined scanning patterns, targeted focus, and periodic mental rehearsal of rescue procedures. The MOB 8 is a scanning technique that will help you do just this. 2.5a MOB 8 Patterns All guards will follow the same scanning patterns while engaged in patron surveillance. The four patterns your head and eyes will follow while scanning across the swimming area are an M, a Bulls Eye or swirl (the O), a B, and an 8. You will use each pattern in the above order for about seven minutes to total approximately one thirty-minute shift. The M and B patterns will begin and end in the lower left of the swimming area. The O and 8 patterns will begin and end in the top center of the swimming area. Each sweep will take about ten seconds. 2.5b Further MOB 8 Instruction You will scan by moving both your head and eyes. This helps you to maintain focus on the center of your field of vision while still making use of your peripheral vision. Visual perception studies show that we see detail best in about the middle 15% of our field of vision (central focus) and we can detect motion and changes in movement patterns best in our peripheral vision. 2.5c Instructions for different scans As you begin a scanning pattern, the first sweep should give you a general overview of the area and allow you to divide the swimmers into groups. With each subsequent sweep, you will focus briefly on one individual in each group (targeted focus). Focus on a different individual in each group with each successive sweep. Be aware of motion occurring in your peripheral vision throughout each sweep. 2.5d Staying ready and alert After following a scanning pattern for about five minutes, focus briefly on a possible high-risk swimmer, and then mentally rehearse making a rescue following all proper procedures. Continue scanning while rehearsing the rescue then begin the next scanning sequence. 2.6 Strategic Scanning Lifeguards use a variety of strategies to organize and sort through sensory input, which can be overwhelming on crowded days. 2.6a Head Counting Try to count the number of people in your area on each scan. When the number changes, find out why. This technique is of great importance to the open waterfront lifeguard, due to the limited visibility of the water. Since the water is typically turbid  enough so that visibility is limited, waterfront lifeguards cannot afford to let any person disappear for more than a moment. 2.6b Grouping Sort patrons into groups by sex, age, risk potential, activity, and combinations of the above. Monitor changes in the groups. 2.6c Mental Filing On successive sweeps, build patron profiles, which take note of swimming ability, skill, activity, or other relevant factors. Track changes in patron behavior or activity on each scan. 2.6d Profile Matching On each scan, measure what you see against the characteristic profiles of potential trouble or victim types. 2.6e Tracking Track the progress of individuals who submerge, and those who fit a high-risk profile (e.g., the lone child at the water's edge). 2.7 Scanning and the Senses Studies indicate that many situations have been avoided by methods that the lifeguard didn’t intend to use. Experienced lifeguards have been known to be able to “predict events” by “unusual means". In all reality, this is because the experienced guard has honed his senses to identify specific triggers. 2.7a Vision Track the general ebb and flow of patrons. Follow the progress of patrons who are at elevated risk of injury or accident. Watch for changing weather conditions. Monitor the positions and activities of other lifeguards. Visual scanning requires the guard to sweep their area of responsibility continually, looking from side to side, checking each person or group of persons briefly to ascertain any of the previously defined indications for difficulty of distress. 2.7b Hearing Listen for unusual sounds such as people arguing, many people talking at once, equipment breaking, etc. Listen for signals from other lifeguards or patrons (e.g., whistles, shouts for help). Listen for sounds that come from beyond your field of vision when you can hear people but can’t see them. Listen for sounds of potential environmental hazards such as thunder. 2.7c Smell Smells can betray the use of liquor or illegal substances, chemicals (which might indicate a leak or spill), or smoke from a source of fire.  2.7d Touch Feel the sun's heat, the roughness or slipperiness of surfaces underfoot, drops of rain, or a breeze developing into stronger winds. Section 3 - Recognition and Assessment In order to effectively prevent injuries and successfully intervene before a drowning occurs, one of the primary skills a lifeguard must learn is the recognition and assessment of potential victims, often before the victims themselves are aware they are in danger. Experienced lifeguards can frequently predict which persons will need assistance long before an emergency arises and sometimes even before they enter the beach. This is possible by observing visual clues. While some of the information may appear to contain bias, the information is based on statistical evidence based upon years of evaluating rescue records and accounts of seasoned lifeguards. 3.1 Dry Land Observations The observation of patrons as they arrive and “set-up” at the beach front will many times provide specific clues as to the possible aquatic abilities or beach sense of various individuals. 3.1a Age Very old or very young individuals should be watched carefully. They may lack the physical ability or strength to fight an unexpected current or to quickly move away from a dangerous situation. These individuals usually incur injuries very near the shoreline requiring quick recognition and immediate response. 3.1b Physical Condition Persons who are overweight or extremely underweight have their own specific problems in an aquatic environment. Individuals who appear to be out of shape or not capable of swimming for extended periods of time should be watched over carefully. Overweight persons may become easily exhausted and are hampered in their ability to move quickly to avoid danger. Overweight and underweight patrons can be adversely affected by even moderately cold water. 3.1c Intoxication Alcohol and water don’t mix. Most beach facilities (including Evanston) do not allow alcoholic beverages, and for good reason. Statistics indicate a high degree of drowning incidents in the United States related to alcohol consumption. Individuals are impacted by the impairment of their normal physical abilities and the impairment of their ability to act responsibly. If a patron on the beach or in the park is observed acting erratically or showing signs of intoxication, severe intoxication, or suspected drug induced actions or activities, Evanston Dispatch should be notified immediately and EPD/EFD response requested. If you are concerned for your safety or well being, do not approach the patron in question There are medical emergencies that can mimic intoxication, do not delay in contacting EFD/EPD  3.1d Improper Equipment & Flotation Devices Some individuals who have limited swimming skills often rely on flotation devices to bolster their ability to access deeper water. While we do not allow them in our swimming areas, patrons who bring them should be carefully watched once they are in the water because they may have planned on the device helping them to swim. We do not allow flotation devices other than USCG certified lifejackets because they cannot be relied on to safely keep a swimmer above water. Lifejackets that are not USCG certified may become separated from the swimmer by wave action, or the apparatus can deflate because of a leak, leaving the swimmer to their own basic ability. 3.1e Improper Attire Persons entering the water wearing clothes other than those meant for swimming are also at risk. The weight and the restrictive nature of wet clothing can cause a person to tire more quickly. Persons who are swimming unprepared should be watched as this shows their inexperience in the water. Similarly, not using wetsuits when they should be used or using them when they are not needed are also clues. 3.1f Disabilities While persons with physical impairments generally know their limitations and often use swimming as a means of exercise, the addition of currents, waves, variable water temperatures, and other environmentally driven factors, may cause them great difficulty. They should be watched carefully and warned of these types of hazards. 3.2 Drowning Presentations The following are classic, obvious signs that a person has gone beyond being in distress to the imminent danger. 3.2a Double Arm Grasping Resembles an ineffective butterfly stroke when the individual slaps the water with both arms simultaneously. 3.2b Climbing the Ladder Simply stated, the victim looks as though they are climbing an imaginary ladder in the water. They look as though they are attempting to crawl up and out of the water. 3.2c Drowning Stages In the open water environment, the drowning process involves three distinct stages which can be interrupted through timely intervention: Distress (distressed swimmer) Panic (active victim) Submersion (passive victim) This process is usually progressive, but not always. Either of the two initial stages may be skipped completely depending upon a variety of factors. 3.3 In Water Observations Once the above visitors enter the water, additional clues will aid the guard in evaluating their condition. The pre-entry clues simply allow the guard to key in on individuals who MAY be a problem. When they hit the water, either the suspicions are confirmed or negated. A number of signs and symptoms in the water are the essential clues the guard must watch for. 3.3a Facing towards shore Swimmers generally face toward shore when they are concerned about how to get there. Body surfers and body-boarders usually face the waves to prevent them from being pummeled and to catch waves. The less experienced individuals are looking toward shore as their haven of safety. 3.3b Head low in the water Competent swimmers remaining in a stationary position usually hold their head high. They tread water, breaststroke, or swim on their back but generally they keep their chins well out of the water. 3.3c Low or erratic stroke This usually accompanies the subject's head being low in the water. The swimmer may display erratic stroke with the elbows dragging. 3.3d Lack of kick Under normal circumstances the weaker swimmer displays little or no kick. Stronger swimmers are able to propel themselves solely with their legs. 3.3e Waves breaking over the head Most people who are competent swimmers will dive under or jump over waves to prevent them from being pummeled. 3.3f Hair in the eyes The natural instinct for most people in control of themselves in the water is to sweep the hair out of their eyes. 3.3g Glassy, empty, or anxious eyes It is said that the eyes are a window to our emotions. Depending on the distance and the quality of optical equipment, the lifeguard can read fear, anxiety and fatigue in the eyes of a distressed swimmer. 3.3h Heads together Swimmers who suddenly converge and remain together may be attempting to assist one another. Persons who congregate together in the water for no other apparent reason may be attempting to assist another person who is in difficulty. 3.3i Hand waving This should be self-explanatory. The guard must be alert to it as an indicator of someone in need of assistance. 3.3j Being swept along by or fighting the current The first sign of distress for a swimmer caught in a current is that they are being swept laterally or being pulled offshore by the current. 3.3k Erratic or unusual behavior Watch for hyper-active motions, such as flailing or for total immobility in the water. 3.3l Clinging to fixed objects Individuals hanging onto buoys or other solid structures may need help.  3.4 Characteristics of Distressed Swimmers and Drowning Victims Behavior Swimmer Distressed Active Passive Can continue Struggles to Not breathing Rhythmic Breathing breathing and call breathe; can’t call breathing for help for help Relatively Floating, sculling, Arms to sides, Arm and Leg coordinated or treading water; pressing down; no None Action movement can wave for help supporting kick Horizontal, vertical Face-down, or diagonal, Body Position Horizontal Vertical submerged or depending on near surface means of support None; has only Recognizable Little or no 20-60 seconds Locomotion forward progress, None progress before less and less able submerging to support self Section 4 – Maintaining Vigilance Water surveillance is a tedious and sedentary job. It’s both monotonous and stressful. A lifeguard may scan for hours, days, or weeks without observing anything requiring a critical response. If the lifeguard is not alert, a life-threatening emergency may be missed and a life lost. Maintaining vigilance is therefore a vital issue for lifeguards. The Lifeguard Standards Coalition reviewed all available research on vigilance. The information in this section relies primarily on the coalition’s findings. Sleep Deprivation – It is important for lifeguards to have a full night’s sleep. Otherwise the ability to spot victims in distress may be compromised. Recreational Drug Use – The use of recreational drugs affects vigilance, even when the user is not under the influence. Caffeine – The consumption of caffeinated, non-sugary drinks has been demonstrated to benefit vigilance, but there is no evidence that sugared drinks are beneficial. Caffeine, however, is also a diuretic, which dehydrates you, which can impact vigilance. Make sure to stay properly hydrated. Sleep Apnea – It has been shown that people with untreated sleep apnea may have issues paying attention. Heat - Heat has been shown to negatively impact vigilance, so reasonable steps should be taken to protect lifeguards from high temperatures.  Hydration - Ensuring that lifeguards stay well hydrated can be expected to reduce drops in vigilance associated with heat. Screening - Because sleep apnea and drug use negatively impact vigilance, screening for them and taking other steps to reduce or eliminate the impacts can be expected to improve overall vigilance of a lifeguard agency. Time on Task - Vigilance has been repeatedly shown to decline over time. The USLA encourages limiting continuous assignment of lifeguards to surveillance duties to one hour, followed by a break of at least 15 minutes. Exercise - Aerobic exercise can positively impact a subsequent vigilance task, so lifeguard management should encourage it and lifeguards should avail themselves of the opportunity when possible. Ideally, this involves training in lifeguard skills such as running, swimming, and use of rescue boards, for example. Background Noise - Noise has been demonstrated to negatively impact vigilance. The impact of listening to music or a radio broadcast while involved in water surveillance should be carefully considered. During times of very low beach and water activity, this may have a beneficial effect of relieving boredom. Distractions – No cell phones allowed in the chair or while participating in surveillance. Section 5 - The Pathophysiology of Drowning During drowning, breathing typically occurs in fitful gasps on the surface, when possible, and there may be coughing and sputtering as water is inadvertently drawn in with a breath. The inhalation of water into the lungs is known as water aspiration, while the swallowing of water into the stomach is water ingestion. Both of these usually occur. Victims may attempt to hold their breath to avoid water aspiration. If water gets into their mouth, which is usually unavoidable, they typically swallow it. A significant quantity of water is often ingested and may be vomited later, particularly during resuscitation efforts. Once the victim’s airway is underwater, the victim may inhale water, but the larynx will sometimes close reflexively, preventing all but a small amount of water from being aspirated. As is the case on the surface, the victim may swallow significant amounts of water instead. In about 10% of fatal drownings the larynx closes upon initial contact with water and never relaxes, thus preventing water from ever entering the lungs. As the victim loses consciousness due to lack of oxygen in the tissues of the body (hypoxia), the larynx may relax, allowing more water to enter the lungs. Vomiting may occur, secondary to cerebral (brain) hypoxia or gastric distension. Without freshly oxygenated blood, the heart will stop beating and pumping blood. Brain death usually begins in five to six minutes after adequately oxygenated blood stops circulating, although in some very unusual cold-water drownings this may be greatly delayed. In these cold-water cases, significant hypothermia occurs which decreases the cerebral requirement for oxygen. Unlike sudden cardiac arrest (a heart attack), where the heart stops beating first, death from drowning starts with suffocation. The heart itself is healthy and functioning, but over time there is inadequate oxygen in the blood to support life. Eventually, the healthy heart stops beating. Drowning is not simply a case of suffocation. In most cases the lungs are traumatized by aspiration of water. Even if the victim is rescued and revived, this trauma will make it difficult for the lungs to transfer oxygen to the bloodstream and tissues. In addition, the drowning process produces a frothy liquid (pulmonary edema) in the airways. When a submerged drowning victim is recovered, the person is typically experiencing severe hypoxia. Immediate resuscitation efforts, beginning with ventilations are therefore needed, ideally with administration of oxygen and, if possible, positive pressure ventilation The effects of freshwater and seawater drowning differ somewhat. In freshwater drowning, water quickly enters the bloodstream through the lungs. In seawater drowning, the aspirated seawater can draw fluid from the bloodstream into the lungs. On the part of the lifeguard, treatment is the same for both cases. Studies have demonstrated that the actions of lifeguards in rescue and resuscitation of drowning victims are the most important link in the chain of survival. In fact, the outcome of drowning patients is usually more dependent upon the timeliness and effectiveness of the initial rescue and resuscitation efforts than on the quality of hospital care. Automatic external defibrillators (AED) have become a common tool of lifeguards. They are primarily intended to correct problems associated with sudden cardiac arrest. AEDs can sometimes stop ventricular fibrillation, an uncoordinated beating of the heart. Ventricular fibrillation is rare in submersion victims. Most drowning victims have healthy hearts that simply cease to function due to hypoxia. The best approach in treating drowning victims is to prioritize immediate CPR measures, ideally with high flow oxygen. If available, an AED should be used, in accordance with the manufacturer’s instructions, in the relatively unlikely case the victim is experiencing an arrhythmia that can respond to defibrillation. Regardless of the drowning process, treatment of a recovered drowning victim by the lifeguard is the same, whether water has been aspirated or not. Successful rescue ventilation occurs even with aspirated water in the lungs. Abdominal thrusts (such as the Heimlich maneuver) should not be used in resuscitation of drowning victims, except in cases that repeated repositioning of the airway suggests a foreign body obstruction (other than water). This maneuver will not remove significant amounts of water from the lungs. It may cause regurgitation and aspiration of stomach contents and other serious complications to resuscitation and recovery of the victim Section 6 - Sudden Submersion Syndrome In some cases, people in water are rendered unconscious, disabled, or dead due to situations that may include heart attacks, cardiovascular accidents (strokes), epileptic seizures, head or neck injury, severe trauma, alcohol or drug overdose, cold shock, and other conditions. A victim on the surface suddenly submerges, usually without a struggle. We define this as sudden submersion syndrome. Sudden submersion syndrome is particularly difficult to prevent because it typically happens so quickly. The victim may have shown no prior indication of problems and be in a water area with no obvious hazards. The tremendous difficulty involved in spotting a victim of sudden submersion syndrome, particularly with a large beach crowd under observation, makes the importance of effective surveillance critical. Even with the most effective surveillance by trained and experienced lifeguards, sudden submersion syndrome may still occur. Section 7 - Hypoxic Blackout When people submerge and hold their breath, they can proceed to unconsciousness. This is often preceded by the individual hyperventilating prior to submersion. The loss of consciousness can have several causes. It’s usually related to hypoxia with low levels of carbon dioxide (CO2). When an individual breath-holds, oxygen level decreases (hypoxia) and CO2 level increases. The rising CO2 level is what triggers the urge to breath and this usually occurs long before the hypoxia is so advanced that the individual becomes unconscious; however, after hyperventilation, CO2 is abnormally low and one can lose consciousness before ever getting the cue to breath. The person could either be moving in a vertical plane in the water column (swimming forward underwater) or they could be static with little movement. The depth of the water has no significance to the outcome of unconsciousness. Lifeguards who observe individuals who are practicing hyperventilation and extended breath-holding should discourage it and educate people about the dangers involved. The term shallow water blackout has been misapplied to this malady; however, it is a term related to a specific scuba diving problem, not breath-holding. Section 8 - Delayed Effects of a Drowning Part of the drowning process involves water aspiration. People who are rescued from drowning (or who rescue themselves) may initially appear to be healthy, but if they have aspirated water or vomitus, they may later suffer serious complications. This is typically due to damage to the lungs and their oxygen exchange capabilities. One possibility is acute respiratory distress syndrome. ARDS can have a rapid onset and cause death hours or days after the drowning event. Victims who have been rescued from drowning are often in a state of denial or embarrassed and simply want to walk away. It is very important to carefully evaluate those who appear to have aspirated water for signs and symptoms of water aspiration. Specific guidelines for treatment of drowning victims and for determining whether they should be sent to the hospital for further care can be found in the chapter Medical Care in the Aquatic Environment. Section 9 - Release of Drowning Victims from Care Following a rescue or incident, if a victim has inhaled water in a drowning incident, but is conscious, the manager or supervisor will still activate a response from EFD. Once EFD has assumed care of the victim/patient, release from care becomes the responsibility of the EFD. Section 10 – Vessels in Distress Proper surveillance of the secondary areas requires that the lifeguard is able to recognize boats in distress. If at any time you see a vessel or other larger floating object (tube, raft, etc.) without anyone on it, you must contact the beach office or EFD. If it is in close proximity to the beach and conditions are safe enough, attempt to reach the object either by swimming or by rescue board. 10.1 Kayaks/Canoes Raising their paddles in the air (City of Evanston Aquatic Camp and Sailing Staff instruct paddlers to use this signal when in trouble) The boat is making no progress especially if they are attempting to paddle against the wind or waves The kayak is going sidewise with the wind, current, or waves People are outside of the boat The boat is low in the water, listing to one side, or submerged Waves continually crash over the side and into the boat 10.2 Sailboats/sailboards/windsurfers The sail is down The sail is luffing (flapping in the wind) for a long period of time The vessel has flipped and either no one is trying to right it or they can't right the boat The vessel is blowing sideways with the wind The vessel is low in the water or submerged 10.3 Motorized vessel The boat is drifting and/or not anchored You can see that someone has removed the boat’s engine cover You see smoke The boat is low in the water, listing to one side, or submerged The boat is going sidewise with the wind, current, or wave