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LJ 12 Increase Access to Lifesaving Equipment and Instructions at Key Water Sites

Key area

Life Jackets

Increase access to lifesaving equipment and usage instructions at key locations (life jacket loaner stations; public water access points for boating, swimming, and other types of water recreation).

Spectrum level: Changing Organizational Practices

Evidence level: Medium

Implementation levels: Community County National State

Rationale:

When rescue flotation is made readily available to bystanders, along with education on the use of rescue flotation devices, people may be more prepared to safely assist people during a water emergency. Anecdotally, bystanders enter the water when someone is drowning, so having rescue flotation devices available may reduce risk to bystanders and improve outcomes. Rescue flotation can also be used during weather disasters such as hurricanes, floods, and tsunamis. Additionally, in other areas, such as cardiopulmonary resuscitation (CPR), lay people have been effectively trained to perform specific tasks to save a lives.

Anticipated Impact:

After implementing this recommendation, you can expect to experience the following outcomes:

  • Providing bystanders greater access to rescue flotation, coupled with education on how and when to use this equipment, should lead to bystanders being more prepared to safely assist people experiencing a water emergency.
  • Having rescue flotation devices available to more bystanders should allow bystanders to face fewer risks and improve drowning incident outcomes.
  • Providing greater amounts of rescue flotation devices to communities can also lead to community safety during weather disasters such as hurricanes, floods, and tsunamis.

Evidence:

Water safety experts agree, life jackets should be promoted as a key safety device when in, on, or near water. There is evidence that life jackets reduce the risk of drowning fatalities in boats by 50%. A study found that among victims of boating-related drowning, none were correctly wearing a personal flotation device (PFD). A report found that both residents and tourists strongly agreed that PFDs should be carried on board. However, significantly less tourists agreed they should always be worn. Most in both groups agreed that advertising the importance of the use of life jackets would help, and they recommended safety information be provided in airports, hotels, public buildings, and tourist services.

Incident survivability rates during several different sea-faring aquatic activities have been shown to decrease as time to rescue increases, suggesting that increased life jacket wear among coastal and marine users may significantly reduce drowning-related deaths. However, there is additional research that shows that despite knowing that wearing life jackets can make fishing safer, many individuals (78%) reported never wearing one. Floatation devices were identified as a resource used during bystander rescues in Australia. The authors suggest that future safety intervention approaches should focus on the importance of flotation devices when performing a rescue.

Increased drowning rates in indigenous people may be due to the lack of water safety programs that account for differences in beliefs, attitudes, and behaviors about water-related activities. Life jacket education should therefore consider strategies to increase culturally relevant and effective messaging.

The Kids Don’t Float water safety program was an Alaskan initiative that provided evidence of the benefits of a family-centered life jacket education approach. The program included loaner boards and in-class and in-water lessons. Results showed increased participation in the Kids Don’t Float water safety programs from 2002 to 2019, along with decreases in drowning incidents, and increases in life jacket wear rates observed on power boats over a similar period. Additionally, water safety experts recommend that social media posts addressing life jacket use should be adapted for at-risk populations and that physicians and trainees should be trained in effective ways to counsel parents and caregivers in injury prevention, especially drowning prevention. It is recommended that pediatricians discuss using PFDs instead of air-filled swim aids, the benefits, and appropriate uses of different PFD types, and that no PFD is a substitute for appropriate supervision with families.
Finally, research shows that life jacket loaner programs can be an effective strategy to increase access, awareness, and use of life jackets. Additionally, eight best practices for a successful life jacket loaner program have been identified and include:

  • Signage and advertising
  • Educational information and messaging
  • Number and type of life jackets available
  • Sizes of life jackets
  • Construction of a stand
  • Location
  • Distribution process
  • Restock and inspection

Several organizations in low-resource areas are exploring the use of alternative materials instead of traditional life jackets. Their experience has shown that even small, commonly found objects, such as foam slippers (also known as flip-flops) and small plastic bottles can be used to keep a person afloat for a long time. Public rescue tube deployment in Hawaii has shown to be a protective factor among rescuer drownings.

Evidence Sources:

Centers for Disease Control. (2001). Drowning-Louisiana 1998. Morbidity and Mortality Weekly Report, 50(20), 413-414. www.cdc.gov/mmwr/preview/mmwrhtml/mm5020a5.htm

Van Dyke D., & Bennett E. (2018). Life jacket loan programs: Keys to success. Unpublished conference presentation.

Pitman S.J., Wright M., & Hocken R. (2019). An analysis of lifejacket wear, environmental factors, and casualty activity on marine accident fatality rates. Safety Science, 111, 234-242. https://doi.org/10.1016/j.ssci.2018.07.016

Jasper R., Stewart B.A., & Knight A. (2017). Behaviours and attitudes of recreational fishers toward safety at a 'blackspot' for fishing fatalities in Western Australia. Health Promotion Journal of Australia, 28(2), 156-159. https://doi.org/10.1071/HE16070

Strayer H.D., Lucas D.L., Hull-Jilly D.C., & Lincoln J.M. (2010). Drowning in Alaska: progress and persistent problems. International Journal of Circumpolar Health, 69(3), 253-264. https://doi.org/10.3402/ijch.v69i3.17627

World Health Organization. (2017). Preventing drowning: an implementation guide. https://www.who.int/publications/i/item/preventing-drowning-an-implementation-guide

McCallin T., Morgan M., Camp E.A., & Yusuf S. (2020). A pilot study on water safety education of providers and caregivers in outpatient pediatric clinical settings to increase drowning prevention knowledge. Clinical Pediatrics, 59(4-5), 490-495. https://doi.org/10.1177/0009922820903412

Stallman R.K., Moran K., Quan L., & Langendorfer S. (2017). From swimming skill to water competence: Towards a more inclusive drowning prevention future. International Journal of Aquatic Research and Education, 10(2) Article 3. https://doi.org/10.25035/ijare.10.02.03

Yuma P., Carroll J., & Morgan M. (2006). A guide to personal flotation devices and basic open water safety for pediatric health care practitioners. Journal Pediatric Health Care, 20(3), 214-2188. https://doi.org/10.1016/j.pedhc.2006.02.008

Moran K. & Ferner D. (2017). Water safety and aquatic recreation among international tourists in New Zealand. International Journal of Aquatic Research and Education, 10(1), Article 5. https://doi.org/10.25035/ijare.10.01.05E179

Golob M.I., Giles A.R., & Rich K.M. (2013). Enhancing the relevance and effectiveness of water safety education for ethnic and racial minorities. International Journal of Aquatic Research and Education, 7(1), Article 5. https://doi.org/10.25035/ijare.07.01.05

Cummings P, Mueller BA, Quan L. (2011). Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States Coast Guard data. Injury Prevention, 17, 56-159. http://dx.doi.org/10.1136/ip.2010.028688 World Health Organization. (2017).

Preventing drowning: an implementation guide. https://www.who.int/publications/i/item/preventing-drowning-an-implementation-guide

Bauer M.E., Giles A.R., Marianayagam J., & Toth K.M. (2020) Kids don’t float…and their parents don’t either: using a family-centered approach in Alaska’s kids don’t float program. International Journal of Aquatic Research and Education, 12 (4), Article 9, 1-5. https://doi.org/10.25035/ijare.12.04.09

Mecrow, T and Suvanprakorn Adisak. (2014). Water safety skills in the low-resource environment. In J. Bierens (Ed), Drowning (2nd ed. pp. 215-223). Springer Verlag. https://doi.org/10.1007/978-3-642-04253-9_32

Mecrow T.S., Rahman A., Linnan M., Scarr J., Rahman Mashreky S., Talab A., & Fazlur Rahman A.K.M. (2015). Children reporting rescuing other children drowning in rural Bangladesh: a descriptive study. Injury Prevention, 2, e51-e55. http://dx.doi.org/10.1136/injuryprev-2013-041015

Brander R.W., Warton N., Franklin R.C., Shaw W.S., Rijksen E.J.T., & Daw S. (2019). Characteristics of aquatic rescues undertaken by bystanders in Australia. PLoS One, 14(2), e0212349. https://doi.org/10.1371/journal.pone.0212349

Beale-Tawfeeq A.K. (2019). Triennial scientific review: Assisting drowning victims: Effective water rescue equipment for lay-responders. International Journal of Aquatic Research and Education, 10 (4), Article 8. https://doi.org/10.25035/ijare.10.04.08

Lawes J.C., Rijksen E., Brander R.W., Franklin R.C., & Daw S. (2020) Dying to help: Fatal bystander rescues in Australian coastal environments. PLOS One, 15(9). https://doi.org/10.1371/journal.pone.0238317

Velasco B., Galanis D. J., Bronstein A. C., & Downs M. (2022). Public rescue tube deployment in Hawaii: protective association with rescuer drownings. Injury Prevention, 28(4), 330-334. https://doi.org/10.1136/injuryprev-2021-044467

High Risk Populations Addressed:

Populations whose risk of drowning decreases the most with the implementation of this recommendation may have one or more of the following characteristics:

  • Children and adolescents
  • Parents and caregivers
  • Males 15-35 years old
  • Individuals who primarily speak a language other than English
  • Individuals with limited financial resources
  • Historically marginalized groups
  • Individuals with limited water competency
  • Individuals swimming in designated swim areas with no lifeguards
  • Individuals swimming outside of designated swim areas

Evaluation Metrics:

Indicators of long-term impact:

  • Reduction in the number of drownings where rescue flotation devices were previously not available
    • Reduction in drowning incidents due to misuse of a rescue device
    • Increase in life jacket loaner boards that have life-saving devices
    • Increase in the knowledge about the importance of life jacket use
    • Increase in the number of people trained in bystander rescue
    • Increase in the number of public water access points that have life jackets available for use (provided by the access point or an entity interested like hotel pools, water parks, schools, and city parks)

Indicators of intermediate impact:

  • Life jacket loaner stations and programs include rescue devices and education on proper use for bystanders
  • Rescue device use is tracked, monitored, and collected

Indicator of initial impact:

  • Increase in the number of life jacket loaner sites that also have rescue flotation by organizational ‘owner’
    • Increase in the number of free-standing rescue sites by organizational ‘owner’
    • Availability of rescue education and training in languages other than English
    • Passage of liability release for public water access points that set up and provide life jackets, and, or life-saving devices that includes liability release if the device is missing

Implementation:

Consider the following to ensure successful implementation:

  • Focus efforts towards on-shore or off-dock rescue.
  • Provide access to rescue flotation in conjunction with education and print materials that help educate bystanders on how and when to use these devices.
  • Provide education and materials designed to be accessible to a linguistically diverse population.
  • Implement cultural considerations into educational materials.
  • Consider finding national “role models” for life jacket use and rescue devices accessed by bystanders in an emergency.
  • Limit liability to public water access points for setting up and providing life jackets, and, or life-saving devices.
  • Limit liability if the device is missing. Create recommendations for including not a requirement.
  • Include groups that don’t typically access water such as people living in urban areas away from the water in education efforts.
  • Consider work currently being done by the Great Lakes Water Safety Consortium, the Great Lakes Surf Rescue Project, and efforts in Hawaii as examples.
  • Consider the International Drowning Research Alliance's (IDRA) recent research study that explores rescues using tubes as a reference for best practices.
  • Recommend wearing a life jacket along with using flotation for a rescue.
  • Include adult-size life jackets at loaner stations so that they can be worn to assist with a rescue.
  • Considered rescue floatation devices and their use during weather-related disasters such as floods, tsunamis, and hurricanes.
  • Consider that there are improvised materials used for water rescue such as a cooler, stick, or milk jug on a rope.

Challenges to Implementation:

When implementing this recommendation, you might encounter challenges related to the following factors:

  • Liability may be a concern
  • There may be a perception that life jacket use, or the need for rescue flotation, is only for poor swimmers.
  • Cultural differences around use and rescue may be difficult to navigate.
  • Determining where public water access locations are may be a challenge.
  • Coverage for “nonpublic water access” where folks may choose to recreate anyway may be a challenge.
  • The cost of additional equipment and ongoing maintenance may be hard to cover.
  • Tracking usage of equipment may be a challenge.
  • Perceptions among some members of the rescue community that rescue devices should only be used, and recuses only be attempted, by trained professionals may be difficult to navigate.

Potential Facilitators:

The following factors might facilitate the implementation of this recommendation:

  • Inclusion of bystander rescue education and training as a standard part of learn-to-swim and water safety programs
  • Inclusion of rescue equipment as part of life jacket loaner boards and programs.
  • Existing loaner programs with rescue equipment and free-standing rescue equipment that has been maintained could be used as a model/examples to follow.

Partnerships could include: - Schools - Public Health Agencies - Game and Fish - Parks at local, state, and national levels - State Department of Natural Resources (DNR) - Life jacket and rescue device manufacturers - Food vendors - Outdoor adventure groups - Service Clubs - Hotels - Physical fitness centers or sports complexes with pools or water access - Water parks - United States Lifeguarding Association (USLA) - Mayor and Governor association/groups - Sea Tow Foundation - BoatUS Foundation - Fire and EMS rescue - Coastal organizations

GAP Recommendation:

Little research on the effectiveness of bystander rescue using rescue devices.

Monitor and track rescue flotation so that data can be collected on use; indicating where, when and how it was utilized along with outcomes. Incorporate learnings from Access Gap Recommendation #2 evaluating the impact of publicly available rescue devices such as life rings, buoys, or tubes. Evaluate the impact of publicly available rescue devices such as life rings, buoys, throw ropes or tubes.

There is research to show that typically the first responder is going to be a lay person. There is also literature around altruism which supports the reality that people will likely go in the water to rescue someone. Participation in unsupervised environments is going to be ongoing so we need to understand how to help the lay person with rescue. Many organizations such as Safe Kids Worldwide and American Red Cross recommend knowing how to help someone who is having trouble in the water. Throwing a lifeline or rescue buoy may be one effective lifesaving skill capable of being taught to lay- responders/bystanders although no published studies support that opinion.

  • Results of a study in Australia document the dangers of bystander rescue and suggest that future safety intervention approaches should focus on the importance of flotation devices when enacting a rescue and further educating visitors about the rip current hazard. Future research should examine the psychology of bystander rescue situations and evaluate the effectiveness of different safety intervention approaches.
  • There is a need to evaluate what type of rescue equipment is most easily and effectively used by a lay person. There is also a need to evaluate how and if rescue equipment that is currently available at water access is used and maintained as well as whether there is loss/vandalism and liability that results from not having usable rescue equipment at a site in the event of an emergency. If we have it available, do people know how to use it correctly. This would include whether information at the site is referenced to help with correct use of the equipment. This evaluation is needed both for open water as well as for unsupervised pools in common use areas such as apartments and hotels.

References: Beale-Tawfeeq, Angela K. (2019) "Triennial Scientific Review: Assisting Drowning Victims: Effective Water Rescue Equipment for Lay-responders," International Journal of Aquatic Research and Education: Vol. 10 : No. 4 , Article 8. DOI: https://doi.org/10.25035/ijare.10.04.08 Available at: https://scholarworks.bgsu.edu/ijare/vol10/iss4/8

Lawes, JC et al. Dying to Help: Fatal Bystander Rescues in Australian coastal environments. PLOS One. 2020 Sep 16;15(9):e0238317. Doi: 10.1371/journal.pone.0238317

American Red Cross https://www.redcross.org/content/dam/redcross/atg/PDFs/TakeaClass/Reachorthrowdontgo.pdf

Safe Kids Worldwide https://www.safekids.org/research-report/hidden-hazards-exploration-open-water-drowning-and-risks-kids