Supervision, Timely Safe Rescue and Resuscitation

When individuals interact with water, it is important to have safety measures in place at the three main stages where morbidity and mortality from drowning can occur: behaviour in and around the water (supervision), removal from the water (rescue) and revival from inhaled water (CPR).  

Increasing awareness and teaching swimming and water safety skills are vital components of drowning prevention. Unfortunately, some drowning cases will still occur and while we can greatly reduce the incidence, communities must also be prepared to rescue and revive those who have been unintentionally submerged.  

These life-saving and rescue skills can be divided into three main components: good supervision of swimmers in and around the water, conducting a rescue that is quick and safe, and performing CPR. 

Supervision

Adequate supervision of high traffic recreational swimming areas is an effective way to prevent drowning. Supervision should be performed by a trained lifesaver, as well as the adult parents of children who are swimming. Children aged below 18 years should never be asked to supervise other children: they do not have the physical or cognitive capacity to supervise or respond appropriately.  

Supervision by lifesavers can be static (preferably on a raised platform with a view of the entire water body) or active (lifesavers complete regular circuits around a water body). Depending on the size of the water body, two or more lifesavers may be required. A standard ratio of 1 lifesaver to 25 swimmers is often suggested. Supervisors should be constantly scanning for warning signs or high risk behaviours indicating such as: a body not moving, unsupervised children and dangerous diving or jumping.  

Timely and safe rescue

This can be performed in a number of different ways depending on the conditions, the individual in distress, the bystander’s capabilities and availability of resources, such as the presence or absence of flotation devices. Those performing a rescue must always put their safety first as an event with one individual in distress can rapidly escalate into multiple drownings if the environment is unsafe. Some important water hazards to look for when planning a rescue include: debris, fast currents, cold water or adverse weather.  

The Royal Lifesaving Society recommends that potential rescuers always perform the following steps: 

• Awareness of situation: be able to identify an emergency situation and accept responsibility to offer assistance 
• Assessment: review the situation objectively and judge whether it is safe or not to perform a rescue. If it is unsafe to enter the water it may be appropriate to throw a floatation device to the individual and tow them to shore. 
• Action: Develop an action plan and share it with others if they are present. There may be multiple actions to take and you may need to delegate who does what.  
• Aftercare: provide first aid and CPR until professional medical help arrives/can be reached 

CPR

CPR is performed to maintain the supply of oxygen to the brain so that an unconscious individual does not suffer permanent brain damage. It is comprised of continuous cycles of 30 chest compressions followed by 2 ‘rescue breaths’. It can be performed on babies, children and adults, with modification to chest compression strength and breath volume for each. Chest compressions are the most important part of CPR and can be completed in isolation if mouth to mouth breaths are unable to be performed.  

Advantages

• Supervision, safe rescue and CPR are highly effective methods for initially preventing drowning, reducing the severity of drowning induced morbidity, and preventing drowning related mortality  
• Once taught, these skills do not cost anything to use and can be implemented in any area   
• Teaching safe rescue and CPR skills empowers the community and builds capacity  
• Secondary community based teachers can be trained to teach rescue and CPR which can reduce costs and can provide remote areas with the same skill set as urban ones
• Water users may incorrectly assume that because there are lifesavers present, they do not need to supervise their children 

Disadvantages

• Rescue and CPR skills are complex and will require a trained professional to teach community members 
• It may be costly or difficult to hire these professionals and to ensure they can access remote areas 
• CPR can only be conducted for a certain amount of time before professional medical intervention is required 
• Individuals may risk their own lives to save others  
• Rescue and CPR are complex skills and will require yearly refresher courses

Context

Supervision is most appropriately implemented in high traffic recreational swimming areas as these have the greatest need and may make a financial profit which can be used to employ trained and professional lifesavers. Examples include swimming pools and beaches.  

Providing rescue and CPR training to all children and adults who have regular contact with water is an appropriate drowning prevention measure, although it may not always be feasible. Therefore, if you cannot train everyone, consider employing other techniques such as fencing, signage and boating regulations.  

For areas that receive a high volume of swimmers, hiring and training professional lifesaver may be the safest option. If costs need to be kept low, invest in their training and attempt to recruit volunteer lifesavers.  

It may also be useful to include rescue, CPR and first aid training as a mandatory requirement for adults whose occupation is requires regular contact with water. Although, this may be difficult to implement for informal or self-employed workers as there may not be an official record nor any company to absorb the costs of training.