Biomechanics and Medicine in Swimming XI

BiomechanicsandmedicineinswimmingXi
Crucial Findings from the 4W Model of Drowning for
Practical and Teaching Applications
Avramidis, s. 1,2,3 McKenna, J., 1 long, J., Butterly, r., 1 llewellyn,
J.d. 4
1 Leeds Metropolitan University, UK
2 Hellenic Center for Disease Control and Prevention, Greece
3 Irish Lifesaving Foundation, Ireland
4 University of Cambridge, UK
This study aimed to suggest practical and teaching applications of the
4W model of drowning. A major literature review of quantitative research
was undertaken to identify potential risk factors of drowning
and qualitative content analysis was used to analyze publicly available
drowning incident videos (n = 41, M = 345.0, SD = 2.8), and 34 individuals
involved in drowning incidents were interviewed (30 males age
16–65 years, M = 28.4, SD = 11.3; 4 female age 19–65 years, M = 37.5,
SD = 19.5). Results confirmed that test criteria such as a 100 m run–50
m swim–100 m run for open water and a 50 m run–20 m swim–50 m
run for pool/water parks could be more useful for assessing speed combined
with an ‘early approach’ to the victim than any currently in operation.
The ‘early approach’ criterion would be established to test the ability
of the lifeguard to be able to remain alert, to have good vision, to recognize
the casualty’s instinctive drowning response, to initiate a rescue
ignoring the bystander’s lack of response and to reassure the drowning
victim. Drownings and their rescue interventions should be perceived as
3-dimensional problems.
Key words: lifesaving, lifeguarding, 4W model, drowning, water
safety, teaching.
IntroductIon
Drowning is a serious social and health problem worldwide but most
research focuses on epidemiologic and forensic aspects. Limited models
and teaching theories have been suggested and implemented in the
context of training, risk assessment, risk management and risk prevention
of drowning (e.g. Griffiths, 2000; Pia, 1984; Connolly, 2004; Ellis
& Associates, 1994). Because most of these theories and models were
not scientifically established their effectiveness has been questioned (see
Pia, 2007; DeRosa, 2008; Ellis and Associates & Poseidon Technologies,
2001).
Contrary to previous empirical published work, the 4W model on
drowning was a research-based proposed theoretical framework aiming
to offer an alternative way to understand the antecedents of drowning
and assist teaching in the field of water safety (Avramidis, 2009). More
precisely, this model suggested that when there is a human activity in,
on, around, near or above an aquatic environment then a drowning incident
may occur to whomever, wherever and under whatever circumstances
(Avramidis et al, 2007). Later, using novel practices, research
attempts were made to break the problem down into its basic building
blocks (e.g. each one of the 4 W’s) in an effort to better describe who
is more likely to be the rescuer (Avramidis et al., 2009a), who is more
likely to be the casualty (Avramidis et al., 2009b), where (Avramidis et
al., 2009c) and under what circumstances it is more likely a drowning
incident may occur (Avramidis et al., 2009d). Therefore, the purpose of
this study was to reassemble these basic building blocks into the 4W
model and to suggest practical applications for enhancing teaching of
drowning prevention and effective rescue.
Method
Consideration of debate about different paradigms (e.g. Morgan, 2007),
their strengths and limitations (see Hoshmand, 2003; Johnson & Onwuegbuzie,
2004), led to the decision to undertake a mixed methods
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approach ( Johnson & Onwuegbuzie, 2004) involving three studies. The
first study was a review of quantitative studies, aiming to support the
development of the theoretical framework of a 4W model. This model
would contain all the potential variables present during a drowning
incident (e.g. rescuer characteristics, casualty characteristics, place and
circumstances of occurrence of a drowning incident). The second study
based on observations of video recorded drowning rescues, aimed at assessing
whether or not the variables from the first study were present
and whether other variables emerged. The third study was based on interviews,
aiming to assess whether or not the variables found in the first
study were present, and finding possible emerging variables, but also to
give insights into questions that were left unanswered by the second
study. Finally, the variables that were present in all three specific sets of
data were synthesized to formulate a framework for drowning prevention.
This methodological procedure aimed to achieve multiple triangulation.
A more detailed explanation of the above will be given below.
STUDY 1
The first study was an extensive review of the literature on quantitative
studies. It was important that this type of research came first in the
current research design because the initial aim for the development of
the drowning prevention framework was to identify as many variables
related to drowning as possible. This could better be achieved by reviewing
a broad range of quantitative studies that had already examined the
drowning problem and located a number of related variables than by undertaking
a quantitative or qualitative study with a limited sample. The
terms ‘drown’, ‘aquatic emergency’, ‘risk factors’, ‘lifeguard’, ‘water safety’,
‘lifesaving’ and ‘rescue’ were used as key words in a search undertaken to
identify literature with variables that might be involved in a drowning
incident. The search used academic and professional aquatic safety textbooks
that are routinely available in libraries, electronic databases typically
available in academic libraries (e.g. Medline, Sport Discuss, Sport
Discuss with Full Text, PsychINFO and PubMed) and search engines
(e.g. Google and Yahoo) covering studies that assessed the epidemiology
and risk factors of drowning. The available literature was limited to those
available and published in Greek and English. Those qualitative data
that were generated (i.e. variables related to drowning) were clustered in
four pre-determined clusters namely ‘rescuer’, ‘casualty’, ‘place of drowning’
and ‘circumstances of drowning incident’. In an effort to identify
as many variables related to drowning as possible, this review study included
in the clusters not only variables that were well documented in
the literature but also variables that appeared to be related to drowning
in case studies. This ensured that possible contributing variables that
might have been neglected from the water safety related literature would
not be missed and would be given an equal chance of being included in
the theoretical framework of the study.
STUDY 2
Data Sources: The exact data sources and procedures have been reported
earlier (Avramidis, et al., 2007; 2009a; 2009b; 2009c; 2009d). A criterion-sampling
method obtained drowning-incident videos (N = 41) that
were freely available in the public domain. This method facilitated the
identification of variables and their relationships that otherwise might
not be available for fatal or non-fatal traumatic drownings. These visual
narratives ranged in length from 30 to 720 s (M = 345.0, SD = 2.8).
Apparatus and Procedures: The authors observed the videos on standard
equipment and software to perform appropriate qualitative analyses
(QSR, 2002). To deal with the various disadvantages and bias, the objective
and subjective audio and visual content of the video were observed
without unsupported assumptions and editorial comments. The audiovisual
content was transcribed twice within a period of three months.
This text was inserted into the computer software NVIVO (version
2002) for content analysis. A number of codes were identified within
the text. Finally, frequencies were measured.