Biomechanics and Medicine in Swimming XI

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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 355
BiomechanicsandmedicineinswimmingXi (Avramidis , 2009). The review study revealed that many organizations across the world often linked the early approach to the drowning victim with the swimming speed that a lifeguard should have. However, many of the incidents in the two qualitative studies requiring lifeguard intervention were less than 10 m from safety but also in water depths little deeper than the victim’s height. This shows that early approach was needed for a rescue and, therefore, this element should have also been taught and tested in lifeguard certifications. To be able to approach a drowning victim quickly, it was more important to remain alert, have good vision, recognize the casualty’s instinctive drowning response, run up to the point on land that would allow the shortest swimming distance or wade approach and initiate a rescue ignoring the bystander’s lack of response. Therefore, the term ’early approach’ may be a valid and multidimensional teaching and test requirement; this is because it seems that it should be based not only on speed of swimming but on the speed that could be achieved in all the previously described elements that occurred, from the moment the casualty was spotted until the moment they were approached at distances up to 50 m. When the distance was greater than 50 m, a different rescue method may be used (e.g. rescue board, Jet Ski or power boat) rather than a swimming approach. conclusIons A number of conclusions arose from the synthesis of the present 3 studies. First, teaching prerequisites and test criteria like 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 park lifeguarding could be useful for assessing speed combined with an ‘early approach’ to the victim. Second, the ‘early approach’ teaching and assessment criteria establish importance of 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. Finally, drowning incidents and their rescue interventions should be perceived as 3-dimensional issues. reFerences Avramidis, S. (2009). The 4W Model of Drowning for Lifesaving of Non-Aquatic and Swimming Activities. PhD thesis. Leeds Metropolitan University. Avramidis, S., Butterly, R., & Llewellyn, D.J. (2007). The 4W Model of Drowning. International Journal of Aquatic Research and Education, 1(3), 221-230. Avramidis, S., Butterly, R., & Llewellyn, D.J. (2009a). Drowning Incident Rescuer Characteristics: Encoding the First Component of the 4W Model. International Journal of Aquatic Research and Education, 3(1), 66-82. Avramidis, S., Butterly, R., & Llewellyn, D.J. (2009b). Who Drowns? Encoding the Second Component of the 4W Model. International Journal of Aquatic Research and Education, 3(3), 224-235. Avramidis, S., Butterly, R., & Llewellyn, D.J. (2009c). Where do People Drown? Encoding the Third Component of the 4W Model. International Journal of Aquatic Research and Education, 3(3), 236-254. Avramidis, S., Butterly, R., & Llewellyn, D.J. (2009d). Under What Circumstances Do People Drown? Encoding the Fourth Component of the 4W Model. International Journal of Aquatic Research and Education, 3(4), 406-421. Connolly, J. (2004). C-Zones the Connolly Framework. In: S. Avramidis, E. Avramidou & J. Tritaki (Eds.) 1st International Lifeguard Congress (p. 12). Piraeus: European Lifeguard Academy. DeRosa, S.P. (2008). Demystifying the protection rule 10/20. In: S. Avramidis, (ed.) Handbook on safety and lifesaving (pp. 81-83). Greece: Stamoulis Publishing. Ellis and Associates & Poseidon Technologies (2001). First on-site study of vigilance shows lifeguards can’t possibly see everything all of the time. Bologne, France: Ellis and Associates & Poseidon Technologies. 356 Ellis, J., & White, J. (1994). National pool and waterpark lifeguard /CPR training. Massachusetts: Jones and Bartlett Publishers. Griffiths, T. (2000, March). Five-minute scan. Aquatics International, 12. Griffiths, T. (2001, March). Swim at your own risk. Aquatics International, 14. Hoshmand, L.T. (2003). Can lessons of history and logical analysis ensure progress in psychological science? Theory and Psychology, 13, 39–44. Johnson, R.B., & Onwuegbuzie, A.J. (2004). Mixed methods research: a research paradigm whose time has come. Educational Research, 33, 14–26. Morgan, D.L. (2007). Paradigms lost and pragmatism regained: methodological implications of combining qualitative and quantitative methods. Journal of Mixed Methods Research, 1, 48–76. Pia, F. (1984). The RID factor as a cause of drowning. Parks and Recreation, 19(6), 52-55; 67. Pia, F. (2007). What can science teach us about lifesaving and drowning prevention? In N. Farmer, and S. Beerman, (Eds.) World Water Safety Conference & Exhibition 2007 (p. 12), Oporto, Portugal: Associação de Nadadores Salvadores and International Life Saving Federation. Pia, F. (2008). Instinctive drowning response. In S. Avramidis (ed.). Handbook on safety and lifesaving (pp. 77-78). Greece: Stamoulis Publishing. QSR. (2002). NVIVO, Getting Started in NVIVO. Australia: QSR International Pty Ltd.
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average VO2 measured during resting
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Figure 2. Repeatability of the LTin
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