Direct Body Contact Swimming Rescues
67
Robert Stallman, Arturo Abraldes, and Susana Soares
The basic philosophy of selecting the most appropriate rescue technique by using the over 100-year-old mnemonic, Reach – Throw – Row – Go – Tow remains the gold standard [1, 2]. The rescue categories are arranged by degree of risk and degree of difficulty [2]. The swimming rescue with no form of equipment (Tow), is both the most difficult and the most dangerous. Towing with direct physical contact must be the last resort [1, 2]. It should thus be a very rare occurrence. However, over 50 % of 482 trained lifeguards and water safety instructors had engaged in a body contact rescue. This is more than expected as all were trained not to use direct body contact towing, if at all possible. Even more alarming was the fact that for 32 % of these, this was their first ever swimming rescue [3]. The aim of this chapter is twofold: first, to support the growing best practice that it is not appropriate to include direct body contact (DBC) tows in the lifesaving education of the general public [3–5] and, second, to present and discuss the evidence-based data and best practice information on certain relevant techniques if a direct contact rescue is called for, or unavoidable. This information is also relevant for rescue towing with equipment. DBC towing is thus approached from the view of the highly trained pool or beach lifeguard, as it is not recommended for the lifeguard who is not assigned responsibility for the safety of others. R. Stallman (*) The Norwegian Lifesaving Society, Sandvollvn. 80, Ski 1400, Norway e-mail:
[email protected] A. Abraldes Department of Physical Activity and Sports, Faculty of Sports Sciences, University of Murcia, Calle Argentina s/n, Santiago de Ribera, Murcia, Spain e-mail:
[email protected] S. Soares Division of Continuing Education, Faculty of Sports, University of Porto, Rua do Rosmaninho 35, 1st Anda, Pedroucos, Maia 4435-438, Portugal e-mail:
[email protected] J. Bierens (ed.), Drowning, DOI 10.1007/978-3-642-04253-9_67, © Springer-Verlag Berlin Heidelberg 2014
423
424
R. Stallman et al.
It is recognized that there is not an international consensus on terminology. It has been necessary however to appreciate the studies which are referenced in this chapter, to mention different categories of persons. In this chapter, we refer to persons from the general public, trained by a lifesaving organization primarily to respond safely if perchance present in an emergency, as lifesavers. We refer to persons assigned the responsibility to both prevent and respond at a specific aquatic facility as lifeguards. We refer to persons engaged in the sport of lifesaving as competitive lifesavers. A rescuer is any person engaged in a rescue. In the other chapters of this book, the term lifesaver will be used in all these categories.
67.1
Comparison of Swimming Rescues Using No Equipment with Swimming Rescues Using Equipment
In 26 and 39 % of rescues in pools and in open water, respectively, the victim attempted to grasp the rescuer. In open water, the victims were older, larger, and further from safety. The threat was thus greater in open water where 33 % felt that their safety was threatened, and 25 % had to resort to an escape technique [3]. Active victims are more likely to panic, and all attempts at non-equipment-simulated rescue of a large, active, male subject failed [4, 6]. Therefore, rescue actions by bystanders must be performed without direct contact [5]. In an extensive study of the physiological demands of beach lifeguarding, it was found that in the 3.5 min calculated as the maximum time to reach a victim, rescuers could swim 200 m but paddle a rescue board 289 m. Oxygen consumption levels (VO2) of 2.97 l per minute for swimming and 3.2 l/min for towing were far more demanding than the 2.08 l/min for paddling and 2.1 l/min for paddling with the victim on the board. A rescue board is clearly less demanding, safer, and faster. It was recommend that both approach and towing should not exceed 70 % of maximum VO2, as the rescuer would experience accumulation of lactic acid and rapid onset of fatigue and perhaps be unable to complete the rescue or put themselves in danger [7, 8]. Using a rescue tube and not attempting to tow rapidly reduced the effort considerably compared to no equipment. The time to rescue however increased. The authors concluded that any disadvantage of using equipment was outweighed by the increased safety of towing with the equipment [4]. For more information on equipment and equipment rescues, see Chaps. 65, 66, 68, and 69.
67.2
The Use and Selection of Fins in Rescue Towing
There are many types of fins, often designed for a specific aquatic activity such as scuba diving and fin swimming. However, there is no specific type designed for rescue towing. Fin type, however, is specific to the characteristics of the user and the conditions under which they are used [9–11].
67 Direct Body Contact Swimming Rescues
425
The research literature on fins includes analyses of biomechanical aspects [10, 11], physiological aspects, assessment of efficiency [12, 13] and movement analysis of propulsion [14–16]. Towing with fins has been studied biomechanically, and various techniques have been investigated [9, 17]. Fins have been demonstrated to increase velocity, thus reducing time and potentially reducing effort, in approaching and towing the victim. All studies in this area unanimously conclude that swimming or towing with fins is more effective and faster than without fins, regardless of the type of fins used, the time used to put them on, or the conditions of the start [9–11, 15]. Even over a short approach and towing distance of 25 m, in a pool the time spent putting on fins is more than compensated for by the increased efficiency of both approaching and towing a victim [9–11]. The use of fins also makes the rescuer less dependent on the arms, freeing energy reserves better used in contacting, manipulating, and placing the victim in a position according to the needs imposed by the drowning conditions. This makes the use of fins, and training for their use, almost a moral obligation for the lifeguard. Moreover, the use of fins is easily adapted to, given the similarity of kicking without fins and with fins. Several studies have compared various types of fins in swimming and in mannequin towing [10, 11, 13]. The monofin has been found to be more effective than normal fins [12, 15]. No difference between small flexible fins and large stiff fins was found. The propulsion mechanics of the monofin which is not suitable in a rescue context has also been studied [17]. Differences were found between professional lifeguards and competitive lifesavers using four types of fins: flexible, short, stiff, and fiber. The competitive lifesavers obtained a higher velocity than the professional lifeguards, regardless of fin type, in both approaching and towing the victim. Stiff fins were most effective for the lifeguards, fiber fins for competitive lifesavers [11]. Stiff fins appear to be better for the noncompetitor in a towing situation in spite of the fact that fiber fins produced greater velocity [11]. Velocity decay and fatigue were greatest late in towing, indicating the rapid onset of fatigue [10].
67.3
Characteristics of Direct Body Contact Towing Techniques
There are only two alternatives in direct body contact (DBC) tows: using one arm or using both arms. More speed is generally possible with a one arm tow, using the other arm to swim. However, this usually offers less control. Best practice norms recommend that any tow, with or without equipment, must allow: • Constant visual and verbal contact with the victim • A view of the nearest haven of safety • The nose and mouth of both victim and rescuer continually above the surface • A body position which does not compromise the safety of the rescuer • A body position as horizontal as possible and which promotes effective leg or arm movements • Continual motion toward safety
426
R. Stallman et al.
It is obvious that various towing techniques are needed. In all cases, the safety of the rescuer comes first. Measuring force development, drag, and physiological characteristics of a body contact tow at a velocity of 1.2 m/s, passive drag was greater by 32 % (62–80 N) when encumbered by outer clothing, and the active drag while towing was another 45 % greater (112 N). Heart rate increased linearly to 170 beats per minute, fell significantly to 163 beats per minute when diving for the mannequin, and peaked at 173 beats per minute at the end of the towing phase. Both heart rate and blood lactate values compared well to competitive swimming values at the same distance [14]. Studies quantifying the time scale of rescues show that the return tow of the victim required at least twice the time of the approach swim [4, 16, 18], over only 25 or 50 m. When attempting to swim rapidly, both during approach and during towing, the peak of effort was attained during the last stages of towing [4, 14, 16, 19]. A similar time line was found when comparing different kinds of fins in a contact rescue. There was also a decay in velocity in the last half of the towing phase, indicating rapid onset of fatigue [10]. One study compared four towing techniques for energy cost, body angle of both rescuer and victim, efficiency, stroke length, and frequency. The cross chest carry scored most poorly, and the tired swimmer’s carry the best, on all parameters. The head and hair carry were between the other two. It should be noted that many consider the so-called tired swimmer’s carry not to be a carry at all but only an assist to a tired swimmer. Using it on a true victim puts the rescuer in an extremely vulnerable position. The biomechanical characteristics explaining the greater energy expenditure for the cross chest carry were greater trunk angle of both rescuer and victim which increase drag and shorten stroke length. Collectively, these factor causes a lower velocity [18]. In another study, skilled lifesavers were compared with less-skilled lifesavers. When performing the cross chest carry and the one-handed head-neck carry, the stroke length, body angle of the rescuer, depth of the feet of the victim, and towing velocity showed that the skilled lifesavers were significantly better on all parameters than the less skilled. For both groups, the cross chest carry performed more poorly than the head-neck carry [19]. A scale of behaviors of actual drowning victims was presented in 1974 [6]. This is still used today, especially in training lifesavers and lifeguards in the recognition of a person in difficulty. It also underpins the need to consider different towing techniques under differing conditions such as size and activity level of the victim, distance, wave and current conditions, and temperature [6]. Active victims demand more control and nonbreathing victim more speed. A conscious and cooperative victim may even be able to assist the rescuer. Here, the priority is safety not speed. For the nonbreathing victim, the very highly skilled lifesaver might consider inwater ventilation. The possible need for this underpins the importance of choosing an equipment tow, making in-water ventilation much easier. The less-skilled rescuer must get to safety as quickly as possible to start effective cardiopulmonary resuscitation (CPR).
67 Direct Body Contact Swimming Rescues
67.4
427
A Closing Caveat
Two sister research movements have existed side by side for several decades. Aquatic movement research was formalized when the first International Symposium for Biomechanics and Medicine in Swimming was held in Brussels in 1970. Drowning prevention research was formalized by Drowning 2002, in Amsterdam. Despite the great overlap of interests and goals, and the many ways in which each could benefit from the other, cross participation has been minimal. Both of these sister movements have an obligation to share responsibility for the improvement of water safety awareness and the prevention of drowning and to share methods, technologies, and results. All aquatic activities have the possibility and responsibility to contribute to reducing this major public health problem. The common goal should be a considerable increase in the number of researchers, educators, and providers who participate in both.
67.5
Directions for Further Research
Examining the risk of DBC rescues revealed that many victims attempt to grasp the rescuer, that 25 % of DBC rescues in open water involved the need for an escape technique, and that 33 % of these rescuers felt their safety threatened [3]. Others have demonstrated that the velocity attained in towing is less than half of that of the approach swim and that peak energy cost is in the last stages of towing [4, 14, 16, 18, 20]. A decay in velocity in the last half of a towing rescue of 25 meters suggest the rapid onset of fatigue [9–11]. The cross chest carry was the least efficient of the tows tested, and the tired swimmer’s carry was the most efficient, both physiologically and biomechanically [18–20]. Greater biomechanical efficiency was found when using fins in towing than towing without fins [9, 15]. Stiff fins proved most efficient for lifeguards and lifesavers, while fiber fins were most efficient for competitive lifesavers. Both flexible and short fins were less efficient in towing [11]. We conclude that DBC towing should be eliminated from lifesaving training for the general public. The focus should be on a broad spectrum of equipment tows. DBC tows should be reserved for the professional lifeguard although these persons may be even less in need of them. Towing with fins is clearly superior, but additional creative solutions are needed to integrate it into rescue routines. One area where DBC tows are recommended is in the controlled situation of the testing of lifeguards in assessment of their fitness for the demands of their profession [7, 8]. Several research needs can be proposed and include: • Investigation of the passive drag characteristics of victim and rescuer in various positions • Study of the active drag characteristics of the rescuer–victim system using various towing techniques and positions • Further study of the physiological and biomechanical characteristics of various towing techniques both with and without equipment
428
R. Stallman et al.
• Examination of the effect of various leg kicks and arm strokes on efficiency during towing • Continued study of the use of fins in towing, integrating, and putting on fins when starting a rescue sequence and removing them upon landing • Study of the use of fins with a variety of leg strokes • Further study of the effects of environmental factors on choice of towing technique, with and without equipment • Study of the effect of rescuer characteristics on choice of towing technique, with and without equipment
67.6
Recommendations of the Authors
• Efforts should be made to strengthen an international consensus on terminology. • Efforts should be made from both the biomechanics and medicine in swimming research community and the drowning prevention research community to share responsibility, methods, technologies, and results. • DBC towing rescue techniques should be eliminated from training of the general public. At the same time, the general public should be trained in the use of publicly available rescue equipment. • Professional lifeguards should use DBC towing only as a last resort and where risk is minimal and time is critical. • Discussion should be pursued regarding the observations that some competitive lifesaving events contradict principles of lifesaving as described in this chapter. The consequence of these discussions may be that for competitions some lifesaving techniques should also be eliminated. • DBC towing should remain as part of the controlled testing of lifesavers when assessing their fitness for the demands of their profession. • Creative methods need to be designed to integrate the use of fins by lifeguards, finding ways to compensate for the need to put fins on prior to a rescue effort or remove them upon landing.
References 1. Royal Life Saving Society Australia (1986) Swimming and life saving. McElroy K (ed). Swimming and lifesaving. RLSSA, Clayton 2. Royal Life Saving Society Canada (1971) Instructors manual. RLSS, Toronto 3. Dahl A, Miller I (1979) Body contact rescues – what are the risks? Am J Public Health 68:150–152 4. Michniewicz R, Walczuk T, Rostkowska E (2008) An assessment of various variants of water rescue. Kinesiology 40:96–106 5. Wiesner W (2011) Selected elements of lifeguarding education. In: Zukow W, Skaliy A, Napierala M (eds) The state, prospects and development of rescue, physical culture and sport. University of Economy, Bydgoszcz, pp 53–62 6. Pia F (1974) Observations on the drowning of non-swimmers. J Phys Educ 71:164–167
67 Direct Body Contact Swimming Rescues
429
7. Reilly T, Iggleden C, Gennser M et al (2006) Occupational fitness standards for beach lifeguards. Phase 2: the development of an easily administered fitness test. Occup Med (London) 56:12–17 8. Reilly T, Wooler A, Tipton M (2006) Occupational fitness standards for beach lifeguards. Phase 1: the physiological demands of beach lifeguarding. Occup Med (Lond) 56:6–11 9. Abraldes JA, Soares S, Lima AB et al (2007) The effect of fin use on the speed of lifesaving rescues. Int J Aquat Res Educ 1:329–340 10. Abraldes JA, Lima AB, Soares S et al (2010) Mannequin carry effort by lifesavers using different types of fins. Facta Univ Ser Phys Educ Sport 8:115–124 11. Abraldes JA, Soares S, Lima AB et al (2010) Comparison of manikin carry performance by lifeguards and lifesavers when using barefoot, flexible and fiber fins. In: Kjendlie PL, Stallman RK, Cabri J (eds) Proceedings: XIth international symposium for biomechanics and medicine in swimming. Norwegian School of Sport Science, Oslo, pp 42–44 12. Zamparo P, Pendergast DR, Termin A et al (2006) Economy and efficiency of swimming at the surface with fins of different size and stiffness. Eur J Appl Physiol 96:459–470 13. Zamparo P, Pendergast DR, Termin B et al (2002) How fins affect the economy and efficiency of human swimming. J Exp Biol 205:2665–2676 14. Daniel K, Klauck J (1992) Physiological and biomechanical load parameters in life saving. In: Maclaren D, Relly T, Lees A (eds) Proceedings: biomechanics and medicine in swimming, swimming science VI. E & FN Spon, Liverpool, pp 321–325 15. Rejman M, Wiesner W, Silakiewicz P (2007) Analysis of the usage of the dolphin-kick with fins while body contact swimming rescues. In: Abraldes JA, Rodríguez N (eds) Book of abstract international lifesaving congress 2007. Lifesaving Federation of Galicia, Corunna, pp 141–142 16. Silackiewicz P, Parnicki F, Rozanski P (2006) The efficiency of body contact swimming rescues performed with or without fins. In: Parnicka U (ed) Rocznik naukowy. ZWWF (in Polish), Biala Podlaska, pp 125–131 17. Rejman M, Staskiewicz A (2010) Identifying determinant movement sequences in monofin swimming technique. In: Kjendlie P, Stallman R, Cabri J (eds) Proceedings: XIth international symposium for biomechanics and medicine in swimming. Norwegian School of Sport Science, Oslo, pp, 160–162 18. Hay JG, McIntyre DR, Wilson NV (1975) An evaluation of selected carrying methods used in lifesaving. In: Lewillie L, Clarys JP (eds) Swimming II, proceedings: II international symposium on biomechanics and medicine in swimming. University Park Press, Brussels, pp 247–253 19. Juntunen P, Leskinen T, Louhevaara V et al (2006) Biomechanics of towing in skilled and lessskilled lifesavers. In: Vilas-Boas JP, Alves F, Marques A (eds) Proceedings: Xth international symposium biomechanics and medicine in swimming, Portuguese Journal of Sport Sciences. University of Porto, Porto, pp 48–50 20. Juntunen P, Louhevaara V, Keskinen K (2001) Physiological strain of a life saving test-a pilot study. In: Science TGSoS (ed) 6th annual congress of the European college of sport science – 15th congress of the German society of sport science, 24 a 28 de julio, The German Society of Sport Science, Cologne, p 1194
