NEHA Lifeguarding and the Model Aquatic Health Code Hello, everyone, and welcome to the presentation, "Lifeguarding and the Model Aquatic Health Code." To ask questions about this presentation, please join the presenter in the Networking Lounge at the designated time listed on the agenda I would now like to introduce Roy Fielding, a Senior Lecturer at the University of North Carolina at Charlotte Thank you, everyone, for attending I wanted to go through the lifeguarding and the Model Aquatic Health Code, and some of the information that was provided with this code in moving forward to the future of safer aquatics One of the things that the Model Aquatic Health Code – they had a vision A number of folks got together back in the early 2000s – Michael Beach from CDC being one of them and Doug Sackett from the New York Health Department at that time and some folks from the National Swimming Pool Foundation to look at things that were taking place across the country We had to remember that all the different states had different codes dealing with pools and that; and these folks had the vision and the thoughtfulness of looking at it and saying, "We should be better at this, and there should be consistent across the country in looking at the codes for swimming pools." So they developed the Model Aquatic Health Code to gather in this information One of the things with this vision was to take the mission on that was going to be collecting the information, assessing it, seeing if this was valid information, that it had science behind it or best practices, and then try and make our aquatic facilities as healthy and safe as possible looking at the Model Aquatic Health Code for guidance One of the things that we all know, and we need to remember as we go through is legislators, health departments and are not the true experts on swimming pools They basically have checklists that they go by, and they rely on others to help develop their codes as they move forward in that So this was one of the things that was kind of beneficial to the Model Aquatic Health Code in developing these different standards that different states could look at, possibly put into their health codes as they go through I know at this time that some states, my understanding is, that they're taking in all the Model Aquatic Health Code and developing their new basis for their regulations for swimming pools They're accepting it as whole Some of the states are looking at it for parts of it that are going to fit into their situation The mission continued, again, to provide assistance to the aquatic industry in helping them look at the science and how they were going to build pools and how they were going to operate pools and have kind of the best situation moving forward as they were going through it One of the things that people need to remember also, this Model Aquatic Health Code is a living document that is going to go on and on and on As science comes forward, as new techniques come forward that are, I guess, rational and something that we could look at and say this would be a better situation to go into a code issue moving forward, the Model Aquatic Health Code is trying to that research moving forward with that One of the things we looked at – again, I served as Vice Chair on two of the committees actually; one of them was on lifeguarding and bather supervision We needed to look at it from the standpoint of how can we make lifeguards better at the job that they're doing; but we also needed to understand that some of the pools don't have lifeguards, probably will not have lifeguards, and we had to kind of have a long debate on which pools were going to be required to have lifeguards as we went through One of the things that we were trying to is not upset the apple cart as far as the original and the existing situations in pools that are out there, but we're trying to give some guidance on this So this was trying to design it for new construction We were looking at pools that needed to have lifeguards were any pools deeper than five feet of depth; they allowed children under the age of 14 to be unsupervised; and one of the big things, and we're seeing a lot of this taking place that aquatic facilities have to be aware of, a lot of groups are using our pools now – whether it's daycare centers, whether it's sports groups They're NEHA Lifeguarding and the Model Aquatic Health Code using it as kind of a group-type activity with very few supervisors but a lot of kids This is where we're having a number of issues taking place with this, so that would have to be a lifeguarded pool Any pool that was wider than 30 feet – and the reason that this 30-foot was there is most people will have a ring buoy or some type of throwing device that has a rope on it that's either 50-feet long or one-and-ahalf times the width of the pool So it's fairly reasonable to expect somebody to be able to throw something at least 30 feet to get out there, so that was one of the configurations that we were looking at as well And then anything that has any type of wave-induced or any type of current going, any type of waterslide or landing area, and where the bathers enter from a height – like diving boards, drop slides, diving platforms and climbing walls Again, we're trying to look at it from the standpoint that these pools need to have lifeguards as they move forward; and, again, we're going from a new construction standpoint with that Looking at qualified lifeguards – we needed to define who is going to be qualified as a lifeguard that can be accepted under this new code with the Model Aquatic Health Code We had to look at training first One of the things that we looked at was they needed to have these different aspects So all lifeguard training needed to have hazard identification, emergency response, AED use, First Aid and CPR, and legal issues So this would be in the training of the lifeguards themselves that they'd have to have at least this information defined out and put in place as far as the curriculum for the lifeguard moving forward Another thing would be a qualified lifeguard would have to have current certification, or certifications, depending upon what organization they're going through So everything had to be current One of the key things, in my mind anyway, is meet all the preservice requirements The pool, UNC Charlotte, that I've been operating for a number of years is 13 feet in depth Well, I know in working with a number of agencies as far as the training is concerned, some of the lifeguard training might be done in only to 10 feet of water Well, we don't know if they can go to 13 feet of depth So one of the preservice requirements that we would have to have at our pool would be to make sure the lifeguard could go down to the deepest part of the pool, recover a victim or simulated victim on the bottom, bring him to the surface before we could allow them to be a lifeguard at that facility So one of the key things out there that all aquatic facility operators should pay attention to is make sure your preservice requirements for lifeguard hire includes everything that they might have to – any type of situation that they might have to get into Participating in continuing inservice training – again, this is one of the key things to make sure our lifeguards are going to be more current and are going to continue with the standards set forth by their training and their certifications The length of valid certification – one of the things that we debated back and forth because there have been different levels over the years as far as years that the certification was good for One of them was basically the lifeguarding itself In some people, it ranged from one year to three years; so we basically talked as a group and came to a consensus of two years as far as the lifeguarding part was concerned As far as the CPR, we looked at the research that out there; and there's really almost 40 studies that looked at CPR and the retention of the skill of CPR And no one basically can go two years and still have good retention; in other words, it basically said that there was inadequate skill retention after a two-year break from training But they also noted in some of the studies that were listed on this, they looked at doing some type of refresher within to 12 months of the original certification This showed that to be adequate as far as getting the retention in there So we chose the one year and, again, backed by science, to move forward with that as far as retention of CPR skills NEHA Lifeguarding and the Model Aquatic Health Code A qualified lifeguard should be assessed in the preservice as we talked about before Copies of certifications – we want to have these copies on hand at the aquatic facility in case there is any doubt Also, people can put into calendars now when certain guards are going to be coming up for a need for recertification; so these things should be kept in place One of the things that we've run into – and very tragically in some places – where the lifeguard has worked during the summer; their certification ran out in mid-July; and at the end of the season, they're still guarding; and the management did not realize that the person's certification was lacking at that time Documentation of inservice training – one of the things that all of us have learned over the many years of doing this is that if you have an inservice training, you've got to document it; otherwise, it didn't happen So documentation is one of the crucial things to make sure that the guards are going through the specific skills, you're documenting it what took place, who was there for the inservice, who was conducting the inservice, what were the actual skills presented in the inservice training and then have signatures, date, time, all that, placed into the documentation of the inservice One of the things I've encouraged in teaching pool operators in the past is encouraged them to get with their local EMS – whoever their EMS provider is – and have them visit the aquatic venue, have them sit down with the staff on what their responsibilities are going to be, and have that EMS provider basically be there to understand how to get into the facility as quickly as possible If they did have to some type of work with the gurney to haul a patient out, what would be the access that they would use? Get that done ahead of time, be prepared ahead of time for almost any situation that you might get in Other qualified skills, proficiencies – we want them to be able to demonstrate the knowledge and skill proficiencies that they had in their training course – as I talked about before, reaching the bottom of the maximum depth To me, this is one that is very, very crucial Tragically we've had some situations where lifeguards that were certified basically could not get to the victim in a pool that was deeper than what they had done in their training That's why we the pre-assessment We want to make sure that these guards can what they're supposed to in the maximum depths that are at that facility Be able to recognize a victim – in some facilities, we'll have some type of eye test, basically a vision test, going on to make sure that people can see There have been studies done on this that if a person even wearing corrective lenses or glasses, as a lifeguard they could see the victim Once they were in the water, they could basically make a successful rescue if that was possible even though their glasses were not with them or anything like that Be able to reach the furthest zone or patron surveillance within 20 seconds One of the things that is crucial when we start dealing with human lives is time Time is of the essence We want guards to get there as quickly as possible, to get to the victim Again, we've used this 20 seconds as far as getting to the farthest area of the zones Again, the committee that was dealing with this had a consensus that 20 seconds was a legitimate skill that they must have as they go through it Other qualifications and proficiencies that they would have beforehand in going through the inservice would be the water rescue skills, First Aid and CPR skills, execute emergency action plans This is one thing that should be developed for all pools for as many situations as they can possibly come up with that they have an emergency action plan for it and how it's going to be staffed, how it's going to be executed, and how they're going to be, as far as a lifeguard, working with a safety team to make sure that they can execute the emergency action plan when necessary Emergency closure issues – the lifeguard should know what are the issues that we need to close the facility, to get people out of the water to get them to safety, whether it's a weather situation or whether it's some type of violence taking place near or in the aquatic venue What are the closure issues that they need to get people out of the water to get them to safety as much as possible? NEHA Lifeguarding and the Model Aquatic Health Code One of the things that came out from CDC a couple of years ago was dealing with any type of contamination The lifeguards are probably going to be the frontline individuals that are going to be at the pool They're going to be able to see if something is happening, whether there's someone bleeding near the pool near the pool or in the pool If someone as vomited or there's a fecal accident in the pool, they need to know what's the protocol; what are we supposed to do? Is there a closure issue taking place? Do we need to get the people out of the water? What's taking place? So they need to be trained and understand that facilities – and usually this is for almost all of us in the United States, we're using CDC guidelines to follow their recommendations as far as this type of contamination protocol in moving forward Preservice requirements – certificates shall be maintained at the facility Policies and procedures, training specific to the venue – and this is one of the things, again We have these lifeguarding classes that are very generic in nature, and we need to make sure when the lifeguard gets to a facility and they're getting ready to be hired or they have been hired that any type of moving forward as far as their inservice training and that, it's very specific to the venue itself It shouldn't deviate really from their training; they should be using the same skills But because of the venue being set up differently than what they had in their training, they need to understand what they should as that first responder moving forward Demonstration of the safety team skills – again, we're talking about safety team now that can incorporate beyond the lifeguards It could be a cashier; it could be a locker room attendant; it could be a maintenance personnel All these people kind of play into the whole situation as far as being a safety team This goes back to the emergency action plans Who you have as far as your responders that should be part of this safety team for your aquatic venue, and how are they going to react together and work together as a safety team? Documentation of training – as we've talked about, whether it's inservice, preservice, there are documentations; there are certifications where they got certified I would always keep records of who their trainer was as far as their lifeguard instructor These are things that are crucial to make sure we've got very good staff at our aquatic venue Quality control – one of the things the Model Aquatic Health Code is look at the training agencies also We have very good training agencies out there, and then we have some training agencies that might be a little bit on the periphery, that is more profit oriented than skill oriented And we wanted to make sure that there was quality control built into both the instruction of the classes for the lifeguards that are taking this As you can see the first bullet, training agencies shall have a quality control system in place evaluating the lifeguard instructors, the ability to conduct courses So having this, whether it's evaluations being turned in, some type of feedback to the agencies to look at the lifeguard and instructors that are providing these courses to make sure that the folks are doing a quality job in producing these lifeguards I had a situation once where a lifeguard instructor near us in Charlotte, North Carolina, was training people; and they never got out of five feet of depth of water Well, this is totally against their training as far as the policies, as far as what they're supposed to be teaching in the first place So we had to go in and basically look at all these individuals, retrain them if they wanted to be retrained; but we had to pull a lot of the certifications off these folks because the lifeguard instructor did not train them properly in the first place We want to have quality individuals going out there as far as lifeguards So all the protocols, all the things that are required by the agency, should be a part of their course in the first place Again, agencies must have procedures allowing for correction and remediation that's what we did with those students – and, if necessary, revoking of credentials We had to it from the standpoint of the lifeguard and the students; the agency had to it from the standpoint of the instructors themselves in moving forward Again, have this quality control in place is crucial to make sure we have quality as far as lifeguard moving out into the different aquatic venues out there NEHA Lifeguarding and the Model Aquatic Health Code The safety plan and the safety team – again, each venue is going to be a little bit different So we need to identify any of the safety hazards that are at our pools Are these guards going to be working with chemicals? We have some facilities that guards not anything with chemicals; we have some facilities that guards are very much into the chemical handling and that Do we have their proper training? Have they been checked off on the safety precautions dealing with these different types of situations? So identifying/communicating health and safety hazards at that particular facility Mitigating health and safety hazards and closing the facility if needed, as we talked about before What are the hazards that could possibly take place at this pool that we need to evacuate people, get them out of the water, and get them to safety? This has to be preplanned Where are going to be the safe zones at our facility to get them to in different protocols, in different situations, as they move forward? Enforcing the aquatic facility rules and regulations – this is one of the things that we talked about for many, many years is making sure if a lifeguard is in the pool and they are the individual breaking the rule, they need to be called out as well as just a regular patron using the facility So if there are rules, they need to be enforced; they need to be regulated; and it's for everyone, not just the patrons using the pool It's for the staff as well as they go through it Responding to reported emergencies – what is the protocol? If a parent comes up and they've lost a child, what is the protocol to find this missing child in the pool, whether we search the pool first – which I think would be the logical thing Where were they last seen? We're trying to get as much facts as possible But if there's a possibility they went outside the venue, what steps we take there? So all this safety planning ahead of time is one of those crucial things to make sure that we are handling everything Supervising the safety team – we need to have individuals that are also trained from a supervision standpoint that are looking at the safety team,, running the drills with the safety team, making sure corrections are made, and making sure that it's done on a frequent basis Conducting preservice evaluations and conducting inservice training – this could be some type of supervisory, but these are things that need to be done along with the safety plan on the safety team, that all these things are being conducted as we're moving forward with it Elements of the safety plan – staffing, how many lifeguards are we going to have? Where they need to be positioned? We looked at it very carefully within the committee that we're looking at that 20-second rule from the standpoint that they can get to the furthest areas or the zone of patron surveillance within 20 seconds But we also talked about and went through that we needed to be very specific on where they're going to be located that they can see all area of their zone or patron surveillance We have different features; as you can see in this slide, there are diving boards A pool might have a slide They might have a pillar someplace that's going to block a certain position with the lifeguard Do we have that blind spot covered as we go through it? So positioning is very important as we move forward Emergency action plans – as we've talked about – written, rehearsed I know we're repeating some of this stuff, but it's being repeated for a reason because these are extremely important things to have done ahead of time Hopefully we never have to use them Hopefully that incident doesn't take place – but they will because we're dealing with people We're dealing with facilities that should be a wonderful, fun activity for parents and children to go to and all that But we've also got that inherent risk of water We've got objects that can hurt individuals and that So we've got to plan for the worst case scenarios NEHA Lifeguarding and the Model Aquatic Health Code Biohazard – whether it's, again, someone threw up, there's a fecal accident in the pool – have the appropriate plans Again, we're trying to develop those, especially in conjunction with CDC as we're going through it The preservice training plan needs to be developed; the inservice training plans needs to be developed All these are elements of the safety plan that's moving forward for the facility Zone of patron surveillance – this goes back to that staffing plan, as we were talking about, and also the viewing – that we can see all the areas from the bottom of the pool all the way to the surface and, if they have responsibilities on the deck of the pool, that that area is covered as well Again, one of the things that people got confused on because it's been in kind of our nomenclature for quite some time is the 10/20 rule The one thing that we took out of this – and this is the recognition that 10 seconds, which was part of the 10/20, was the recognition within 10 seconds Well, we took that out because that's something that's very nebulous How we determine that? The guard sees them and then we react So we can at least quantify how long it took them to get to a certain spot in the pool as we move forward Again, we took the recognition phase out of it; and that's why it's the 20 as we go through And just to reiterate, we need to make sure that they can see the entire zone as we move forward Rotation procedures – one of the key things, the horror stories of guards being left at a pool on a stand for four hours, two hours These types of things have been taking place for quite some time, and I'm pretty sure they're still taking place today because we read about these situations as we look at court cases and everything else Well, there's been a lot of research done that you cannot maintain vigilance for really – the studies have shown basically 30 minutes Now, we basically have allowed 60 minutes, as far as the max, as far as before they need to take a break But also the research has shown that if we can give them a break for to 10 minutes, it basically resets that vigilance that the lifeguard needs to have They have a reset taking place, and they can basically a good job as far as vigilance is concerned So we need to be very careful; we need to rotate them properly; we need to make sure the guards are alert These are the types of things that we need to make sure are taking place on a consistent basis We not want to be leaving those guards up there for long periods of time and them basically falling asleep And along with this rotation and kind of the vigilance that we're looking at, they can't have the iPads; they can't have the phones; they can't have anything that's going to be a distraction to them Their job is to watch people's lives, and so this is crucial that there's nothing else distracting them as they move forward So we need the reset; we need to have them rotated properly and moving through the rotation around the pool We talked about the breaks, rotations, procedures We tried to be as specific as possible that when they make a change, we're still providing that surveillance of the guards, that they have some type of formalized rotation procedures where a guard is coming up The guard in the stand is still watching The guard that's coming up to the replacement is notifying the guard that's on the stand that they're to replace them They will now the vigilance while the guard is climbing down No there, the guard that has climbed down is doing the vigilance The guard that is climbing up again, this is basically watching out for their safety to get on the stand right now And then you basically have the transition on No where you've got the guard in the stand that's doing the surveillance, and then you have the guard rotating off So there needs to be a plan that they it the same way every time as they're moving through so that we still have patron surveillance on the individuals that are in the water itself One of the things as far as number of lifeguards – this is going to be determined by doing that safety plan We're looking at how many zones there are going to be, how they're going to be staffed Again, one of the criteria is if we have all our guards in one place, can all the guards make the furthest point of that zone of patron surveillance within 20 seconds? NEHA Lifeguarding and the Model Aquatic Health Code We need to look at it from the standpoint, as we talked about before, looking at some type of blockage – whether it's some type of physical barrier, something's a temporary barrier that's blocking the view of the lifeguard Well, we need to cover that area Making sure the rotations are taking place, supervisors are present, and again, any type of personnel that's a member of the safety team to be able to respond to that We talked about there are going to be unguarded pools, as we talked about with the criteria before We're going to have unguarded pools Are there people trained that are at the facility that are going to be able to make any type of response – whether it's extrication, whether they've got reaching poles, they have ring buoys – all that type of safety equipment has to be in place They've got an emergency telephone that is hardwired in to be able to get to EMS as quickly as possible, even in guarded and unguarded facilities, as we move forward with the presentation Now, one of the things that I think is very crucial that people need to understand too is when we're dealing with qualified lifeguards This item number that was in the original Model Aquatic Health Code When qualified lifeguards are used, they shall be able to demonstrate proficiency in the skills as outlined in the MAHC in Section 62.1 – this is with their training – and have the ability to perform the following water rescue skills consecutively so as to demonstrate the ability to respond to a victim and complete the rescue Now, the key word here is "consecutively." They need to be able to these skills in the order that they're there, and them all Because if we don't all these – and I'll just go through them No 1, reach the furthest edge of the zone of bather surveillance within 20 seconds Recover a simulated victim, including an extrication, to a position of safety consistent with the Model Aquatic Health Code – and, again, the number that goes along with it Then be able to perform the resuscitation skills consistent with the Model Aquatic Health Code These are all things lifeguards have to If we fail on one of these, we not have a rescue; we basically have victim recovery So we want to be successful with that We want the guards to be successful with this They can all these skills if there was someone not able to help them And we want people to help We don't need to have a trained lifeguard as part of the safety team that's maybe helping with the extrication of the individual We want to get them extricated to safety, which would be on land or on the deck; and we still want to have the lifeguard, after performing these skills, be able to the resuscitation as they're moving forward I want to thank you for your time One thing that I wanted to share with you all is I've been collecting data since 2009 on making a rescue This is totally anonymous information, but we're trying to figure out and collect – and we've used this before – the data on making a report of a rescue, looking from the eyes of a lifeguard on how they saw the individual in trouble; what equipment they used to make the rescue; how far away they were from the victim on land; how far they were from the victim in the water; how far they had to travel, again what type of First Aid they had to use with them; approximate age of the individual We're trying to collect all this information to help us lead to better lifeguard training Again, having the research, having the data to show that lifeguards only have to travel certain distance (multiple voices) in the water to help us to build programs One of the things a lot of the agencies have been doing is equipment-based rescues Well, we're still getting data in from lifeguards that are doing swimming rescues without any type of equipment when they the rescue itself Well, this might be crucial to future development in the curriculum to add back in – because we had this at one time – doing swimming rescues without equipment NEHA Lifeguarding and the Model Aquatic Health Code I think it's much safer to it with equipment; but if people are doing it in the field, we want to make sure they're able to this and it safely Again, thank you so much for your time Thank you, Roy Thank you, everyone, for attending today's webinar, "Lifeguarding and the Model Aquatic Health Code." On behalf of the National Environmental Health Association and our presenters, thank you for joining us today and have a great rest of your day ... quality as far as lifeguard moving out into the different aquatic venues out there NEHA Lifeguarding and the Model Aquatic Health Code The safety plan and the safety team – again, each venue is going... "consecutively." They need to be able to these skills in the order that they're there, and them all Because if we don't all these – and I'll just go through them No 1, reach the furthest edge of the zone... watching The guard that's coming up to the replacement is notifying the guard that's on the stand that they're to replace them They will now the vigilance while the guard is climbing down No there, the