Biomechanics and Medicine in Swimming XI

STUDY 3
Participants: A combination of convenience and snowball sampling, located
participants who were water safety or aquatic professionals (e.g.,
lifeguards, lifesavers, scuba divers, and athletes of aquatic sports (N=34)
who could describe a drowning episode (Table 1).
Table 1.Demographic information of the participants in the interview
(n=34).
30 males (age 16–65 years, M = 28.4, SD =
11.3)
Gender
4 female (age 19–65 years, M = 37.5, SD =
19.5)
Greece (n = 25, 71.4%)
United Kingdom (n = 2, 5.7%)
Nationality
United States (n = 1, 2.8%)
Cyprus (n = 6, 17.1%)
Place of Reported
Drowning
Sea (above the water surface) (n = 23, 67.6%)
Sea (under the surface of the water surface) (n
= 5, 14.7%)
Lake (n = 2, 5.9%)
Swimming pool or water park (n = 4, 11.8%)
Apparatus and Procedures: The same procedure as in the previous study
(that examined observation of video recorded rescues) and past published
work was followed (Avramidis et al., 2007; 2009a; 2009b; 2009c;
2009d). Anonymity and confidentiality were maintained. The participants
received and read participant information sheet and, after having
any questions about their involvement answered to their satisfaction,
signed an informed consent form. The semi-structured interview schedule
included open-ended questions. The interview was transcribed and
inserted into the computer software NVIVO for content analysis.
results And dIscussIon
The aim of the present mixed methods research approach was to suggest
practical applications for drowning prevention and demonstrate the efficacy
of the proposed 4W model. A number of crucial findings therefore
need to be discussed.
Distance from Safety and the 3-Dimensions of Drowning and Rescue Intervention:
The video and interview analyses showed that the distance from
safety was a component of each drowning incident (Avramidis, 2009).
In particular, it was shown that the distance of drowning episodes from
safety ranged from 1-9 m up to many miles. Considering that distance
from safety is one of the components that affected the speed of rescue
and also that speed equals time, then there was a need to locate spatially
the activity prior to the incident and the location of drowning to understand
its antecedents. Consequently, depicting a drowning victim in
a geometric model at the centre of 3-dimensional space yielded crucial
findings. Drowning was the outcome not only of engagement in aquatic
activities (e.g. swimming, boating, scuba diving etc.) but also of activities
occurring in the air (e.g. parachute and bungee jumps, air and space
flights above the sea etc.) and on land (e.g. driving or walking in flooded
areas or frozen lakes). Therefore, in the examined sample in terms of
distance, the drowning problem as well as the consequent rescue intervention,
was not a 1-dimensional but rather a 3-dimensional problem
and task respectively (e.g. length, height or depth and width).
Drowning incidents in the video and interview studies occurred in
all 3-dimensions. The first dimension of length represented the distance
between the location of drowning and the shore or the poolside of such
activities as swimming, boating, sailing etc. The second dimension of
height or depth represented the distance between the location of drowning
from the water surface of such activities as air flight, space ship mission,
parachute and bungee jump, as well as scuba diving, spear fishing
and snorkelling respectively. The third dimension of width represented
chaPter6.medicineandwatersafety
the distance between the location of drowning in inland water from the
land in such activities as walking or driving in flooded areas and frozen
lakes etc. In other words, this showed that lifeguards, professional rescuers
and amateur lifesavers had to respond to drowning episodes whose
starting point was one of the previously described dimensions at various
distances from safety. Therefore, people became drowning victims
regardless of whether or not the distance of their undertaken activity
was far from the water.
A rescue intervention in the videos and interviews was a 3-dimensional
task. Rescues rarely occurred exactly in front of the eyes of the rescuer
on a perpendicular plane to allow a 1-dimensional intervention. For
example, the interviewee lifeguards from Greece who supervised 600
m and were positioned in the middle of a beach, had to run across the
beach a number of metres (e.g. dimension of width), attempt a swimming
approach from the shortest distance (e.g. dimension of length) and
possibly continue with an underwater search for the unconscious submerged
drowning victim (e.g. dimension of depth). Similarly, in other
rescues from the video analysis a rescuer had to run to the place where
the helicopter was parked (e.g. dimension of width), fly to the place
where the victim was drowning (e.g. dimension of length) and attempt
a rescue which required the rescue swimmer jumping into the water
and the eventual lift, together with the victim, into the helicopter (e.g.
dimension of height). This showed that lifeguards, professional rescuers
and amateur lifesavers had to respond to drowning episodes covering a
distance from safety to the place of the event in more than one dimension.
All these points suggested that perceiving drowning and the consequent
attempted rescue as a 3-dimensional problem and task respectively
had a number of implications. First, it revealed a number of ‘hidden’
drowning incidents that contemporary injury epidemiology would classify
under different codes, underestimating the burden of drowning and
therefore the magnitude of the problem, with negative consequences in
decision making to fund research and education in terms of prevention,
rescue and treatment (e.g. E830, accident to watercraft causing submersion;
E832, other accidental submersion or drowning in water transport
accident; E984, submersion [drowning] undetermined whether accidentally
or purposely inflicted). Second, it stressed the need, from an
educational point of view, for better public awareness regarding water
safety prevention in people who engage not only in aquatic activities but
also in non-aquatics in, on or around the water, for them to know how
to swim and be able to survive in an aquatic emergency.
Third, it showed that the 400 m swim for open water rescue and the
50 m swim for pool/water park rescue on their own were not adequate
teaching and test requirements to ensure a speedy approach because they
assessed speed in only one dimension. Instead, 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 in relation to distance.
Finally, the presence of each dimension and the number of metres
between the rescuer and the casualty of each of those dimensions posed
an additional number of obstacles that had to be overcome. For example,
a lifeguard who attempted a 1-dimensional rescue at a certain distance
from safety was concerned with fewer variables (e.g. distance from safety,
weather and environmental conditions etc.) than a rescuer who attempted
a 3-dimensional rescue who was concerned with all variables related
to width (e.g. run, likelihood of getting injured), length (e.g. swim, need
to fuel and operate a power boat or a helicopter etc.) and possibly height
(e.g. knowledge of handling a specialized rescue, concern about weather
conditions etc.) or depth (e.g. knowledge about marine life dangers, underwater
currents, water temperature etc.). Therefore, this stressed the
need for further education from the rescuer’s point of view.
Early Approach: A crucial finding of this research was that when approaching
the drowning victim, an early approach was required by
amateur and professional rescuers in the video and interview samples
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