Gerald Dworkin "Standard of Care"- NDPA Symposium 2012

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Gerald'M.'Dworkin'Consultant,'

Aquatics'Safety'&'Water'Rescue'

Lifesaving'Resources,'LLC'www.lifesaving.com'

'Developed(for(

National'Drowning'Prevention'Symposium'(2012)'

''

!!

THE!POWER!OF!WATER!!THE!POWER!OF!WATER!SHOULD!NEVER!BE!UNDERESTIMATED+2!ITS!BEAUTY,!STRENGTH+OR!FORCE.!

!LIFE!CANNOT!EXIST!WITHOUT!WATER.!IT!EMPOWERS+US!AND!COMMANDS!RESPECT.!!!

BE!READY+FOR!IT!!!!

www.lifesaving.com!

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26'

Gerald'M.'Dworkin'Consultant,'

Aquatics'Safety'&'Water'Rescue'

Lifesaving'Resources,'LLC'www.lifesaving.com'

'Developed(for(

National'Drowning'Prevention'Symposium'(2012)'

''

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PRINCIPLES$!  Rule'of'Numbers'!  PRM'Factors'!  RID'Factors'!  Threat'Assessment'&'HRD'Factors'!  Suction'Entrapment'&'VGB'Act'!  Legal'Responsibility'&'Liability'

Factors'!  Rules,'Regulations'&'EEC'Factors'!  Layers'of'Protection'(LOP)'!  Surveillance'Protocols'!  Standard'Operating'Procedures'

(SOPs)'!  FacilityUUse'Guidelines'(FUG)'

!  Emergency'Action'Plans'(EAPs)'!  Emergency'Response'Plans'(ERPs)'!  Incident'Command'(IC)'&'Incident'

Action'Plans'(IAPs)'!  Spinal'Injury'Management'&'

Mechanism'of'Injury'(MOI)'!  Body'Substance'Isolation'(BSI)'

Protocols'!  Rescue'Priorities'!  Management'of'Hypoxia'(MOH)'!  Positive'Pressure'Ventilation'(PPV)'

Protocols'!  CPR'Protocols'!  AED'Protocols'

28'

MURPHY’S$LAWS$

1.  Anything'that'can'happen'–'will'happen.'

2.  When'it'does,'it'will'happen'at'the'least'opportune'time.'

3.  Mother'Nature'is'a'Bitch!'

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1.''Anything'that'can'happen'–'will'happen.'

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2.  When'it'does,'it'will'happen'at'the'least'opportune'time.'

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3.''Mother'Nature'is'a'Bitch!'

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EMERGENCY$RESPONSE$PLAN$

THUNDER$&$LIGHTNING$STORMS$

!  Recognize(the'Danger'

!  Evacuate(all'Patrons'&'Staff'

!  Return(Procedures'

Policy'Development'

33'

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RULE$OF$NUMBERS$'

Frequency!:'Probability!'

The'more'patrons'who'use'your'facility'increases'the'probability'of'a'significant'incident.'

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Each'day'you'operate'without'a'significant'incident'brings'you'one'day'closer'to'when'the'incident'will'occur.'

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DROWNING$101$

!  7th'leading'cause'of'unintentional'injury'deaths.'

!  2nd'leading'cause'of'unintentional'injury'deaths'for'children(1(–(14(years(of(age.'

!  3rd(leading(cause(of(death(for(children(0(–(4(years(of(age.(

!  6'–'10'times'more'people'suffer'brain'damage'than'death'from'submersion'incidents.'

!  Minorities'drown'at'a'rate'2x'greater'than'''''''''''''''''''''''''''whites.'

!  Males'drown'at'a'rate'4x'greater'than'females.'

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!  6,000'–'7,000'drownings'annually.'

!  3,500'during'recreational'swimming'activities.'

!  90%'in'open'water.'

!  50%'U'67%'are'alcohol'or'drugUrelated.'

!  100+'in'“guarded”'facilities.'

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PEDIATRIC$SUBMERSIONS$

!  Second'leading'cause'of'unintentional'death'nationwide.'

!  Leading'contributing'factor:'Lack(or'lapse(in'adult(supervision(

'!  Young'children'are'attracted(to'water'and'have' '''little'concept'of'the'dangers(associated'with'water.'' ''''The'action'of'children'around'water'is''''''''''''unpredictable.'

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!  BIG'HEAD'/'LITTLE'BODY'SYNDROME.'

!  Nearly'half'of'the'victims'were'out'of'sight' ' '''''less'than'5'minutes'prior'to'the'incident.'

!  Drowning'is'a'silent(death.'

!  64%'of'the'victims'were'not'expected'to'be' ' ''''''''in'or'near'the'swimming'pool'prior'to'the' ''''''''incident.'

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WATER$CRISES$Distress'Swimmer' Drowning'Victim'

!  Can'support(self'in'water'by'swimming'or'floating.'

!  Can'keep'head'out'of'water'to'breathe.'

!  Can'call(out'for'help.'

!  Can'wave(for'help.'

!  Cannot'support(self'in'water'by'swimming'or'floating.'

!  Cannot'keep'head'out'of'water'to'breathe.'

!  Cannot'call(out'for'help.'

!  Cannot'wave(for'help.'

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INSTINCTIVE$DROWNING$RESPONSE$

!  Head(is'tilted(back(in'attempt'to'breathe.'

!  Vertical(position'in'the'water.'

!  Arms(are'extended'laterally.'

!  Victims'don’t(call(out'for'help.'

!  Victims'don’t(wave(for'help.'

!  Appear(to(be(playing(in(the(water.(

!  Struggle'for'20'–'60'seconds.'

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THE$DROWNING$PROCESS$

!  Struggle((20'–'60'seconds)'

!  Ingest'&'aspirate'water'into'stomach'&'airway'

!  Laryngospasm(

!  Hypoxia(

!  Unconsciousness'

!  (Aspirate'water'into'lungs)'

!  Respiratory(arrest(

!  Cardiac(arrest(

47'

TYPES$OF$DROWNING$

!  Wet'drowning'

!  Dry'drowning'

!  Laryngeal(drowning(

!  Mammalian'diving'reflex'

!  Shallow'water'blackout'(hyperventilation)'

!  Silent'(passive)'drowning'

!  Long'QT'Syndrome'

!  Torso'Reflex'

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SECONDARY$DROWNING$INCIDENT$

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CHERRY$HILLS$WATERPARK$INCIDENT$

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P$R$M$FACTORS$

' 'Prevention('' ' 'Recognition(

'' ' ' 'Management(

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PREVENTION$

!  Establish'&'enforce'rules(&'regulations(

!  Strategic'positioning'of'lifeguard(stations(

!  Remove'or'warn'of'hazards(

!  Prohibit'or'safeguard'risks(

!  Vigilant'surveillance(&'supervision(

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RECOGNITION$

!  Incidents(

!  Potential(for'Incidents'!  Hazards'!  Risks'

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MANAGEMENT$

!  Potential(for'incidents'!  Hazards'!  Risks'

!  Incidents(!  Rescue'!  Emergency'patient'care'

!  Rescue'equipment'

!  Personal'protective'equipment'(PPE)'

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LOUISIANA$SUBMERSION$INCIDENT$

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R$I$D$FACTORS$

'Recognition('' ' 'Intrusion(

'' ' ' 'Distraction(

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A$SERIES$OF$EVENTS$

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THREAT$ASSESSMENT$&$HRD$FACTORS$

Hazard''+''Risk''=''Danger''

Hazards'!  Remove'!  Warn'

Risks'!  Prohibit'!  Safeguard'

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VIRGINIA$GRAHAM$BAKER$(VGB)$ACT$

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http://www.lifesaving.com'

LEGAL$RESPONSIBILITY$&$LIABILITY$

!  Duty(to(Act(

!  Good'Samaritan'Laws'

!  Consent(

!  Abandonment'

!  Records(&(Reports(

!  Negligence'

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NEGLIGENCE$

1.  Duty(to'Plaintiff'

2.  Breach(Duty'

3.  Injury(or'Loss(

4.  Direct'Correlation(of'Breach'to'Injury/Loss(

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COEUR$D’ALENE$INCIDENT$

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www.yonigottesman.com'

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RULES,$REGULATIONS$&$EEC$FACTORS$''Establish(

'' ' 'Enforce(

'' ' ' 'Consequences(

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LAYERS$OF$PROTECTION$

!  Supervision(!  Isolation(fencing(!  SelfSclosing,(selfSlatching(&(selfSlocking(gates(!  Gates'open'outward,'away'from'the'pool'!  Pool'cover'!  Pool'alarm'!  Passive'monitoring'!  Lifeline(!  Depth(line(!  Depth'markers'!  Telephone(

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GOFF$V.$HAMLET$APARTMENTS$INCIDENT$

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'http://www.lifesaving.com/poolUsafelyUdigitalUassets'

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PERSONAL$FLOTATION$DEVICES$(PFDS)$

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WEAR$IT!$

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PFD$TYPES$

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SURVEILLANCE$PROTOCOLS$

!  30Ssecond(Rule(

!  10/20(Rule(

!  10'x'10'Reaction'Rule'

!  Rotation(

!  Zone(of(Responsibility((ZOR)(

!  Sunglasses'

80'

SUNGLASSES$

!  Protection(from'ultraviolet(rays(during'sunlight.'

!  Protection(from'powerful(light(because'when'eyes'receive'extra'light,'it'closes'the'iris'causing'the'lifeguard'to'squint.'

!  Protection(from'glare(because'water'can'reflect'a'great'deal'of'light'and'conceal'objects.'

!  Eradicate'light'frequencies'that'can'blur( ((((((((((((((vision'or'reduce(contrast.'

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POLARIZED$SUNGLASSES$

!  From'the'moment'of'reflection,'light'becomes'polarized'and'forms'visual'noise'–'blinding(glare(that'interferes'with'the'real'image.'

!  Polarized'lenses'enhance(visual(acuity,(color,(contrast(and(comfort.'

!  Tinted(lenses(only'reduce'light'transmittance'–' ''''they'do(not(block(blinding(glare.'

82'

USLA$POSITION$ON$

PATRON$SURVEILLANCE$'Lifeguards'assigned'to'supervise'an'aquatic'area'shall(not(be(subject(to(duties'that'would'distract(or'intrude(their'attention'from'proper'observation'of'persons'in'the'waterfront'area,'or'that'prevent(immediate(assistance(to'persons'in'the'water.'

'Specifically,'lifeguards(assigned'to'water' ' ''surveillance'shall(not(be(assigned(to(any( ((((((((((((((duties(other(than(public(safety!'

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OPERATIONAL$PROTOCOLS$

!  Standard'Operating'Procedures'(SOPs)'

!  Emergency'Action'Plans'(EAPs)'

!  Emergency'Response'Plans'(ERPs)'

!  Incident'Command'(IC)'&'Incident'Action'Plans'(IAPs)'

! Missing'Person'vs.'Missing'Bather'

!  Credible'Witness'

85'

LIFEGUARD$QUALIFICATIONS$'

Certification'vs.(Qualification''

!  Screening'!  PreUService'Training'!  Standard'Operating'Procedures'(SOPs)'!  Surveillance'Protocols,'Victim'Recognition'&'Zones'of'Responsibility'!  Emergency'Action'Plans'(EAPs)'!  Emergency'Response'Plans'(ERPs)'&' ' '''''' ''''''''

Emergency'Drills'!  Incident'Command'(IC)'&'Incident'Action' ' ''''''''''''''''''

Plans'(IAPs)'!  Rescue'&'PPE'Equipment'

RESPONSIBILITY$OF$

AUTHORITY$HAVING$JURISDICTION$(AHJ)$

!  Conduct'Threat'Assessment'

!  Determine'Level'of'Operational'Capability'Required'

!  Plan(for'the'Incident'

!  Train(for'the'Incident'

!  Acquire'the'Resources(Required'to' ' '''''''''''''Safety'&'Effectively'Manage(the'Incident'

87'

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JAMIE$KENNEDY$EXPERIMENT$

88'

A$B$C$RESCUE$'(Primary(Response'

'( (CoverSup(Response'

'( ( (Secondary(Response'

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FACILITYNUSE$GUIDELINES$

!  Accountability'

!  Supervision'

! Within'Arm’s'Reach'

!  Lifejackets'

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COMPETITION$DIVING$INCIDENT$

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WATER$ENTRIES$

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SPINAL$IMMOBILIZATION$PROTOCOLS$

The'lack'of'neurological'deficit'does'not'rule'out'injury.''It'just'means'the'injury'is'not'yet'apparent.'

'If'the'Mechanism'of'Injury'(MOI)'is'sufficient'to'have'caused'a'spinal'injury,'then'assume'the'injury'exists.'

'Emergency'Care'Protocols'

!  Standing'takeUdown'!  Shallow'water'!  Deep'water'!  Land'

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DIVING$INCIDENT$

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PATIENT$ASSESSMENT$'

A'''''='''''Airway''

B'''''='''''Breathing''

C'''''='''''Circulation''

D'''''='''''Disability''

E'''''='''''Examination''

M'''''='''''Mechanism'of'Injury'

97'

BSI$PROTOCOLS$

!  Universal'Precautions'

!  Personal'Protective'Equipment'(PPE)'

!  Vaccine'Preventable'Hepatitis'!  Hepatitis'B'Vaccine'!  Hepatitis'A'Vaccine'!  Hapatitis'A/B'Vaccine'

98'

MANAGEMENT$OF$HYPOXIA$

Positive'Pressure'Ventilation'(PPV)'!  Personal'resuscitation'mask'(PRM)'!  Personal'resuscitation'shield'(PRS)'!  BagUValveUMask'(BVM)'resuscitator'

Oxygen'Administration''Airway'Management'

!  Suction'

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MASSACHUSETTS$INCIDENT$

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BASIC$LIFE$SUPPORT$

Chain'of'Survival'!  Access'!  CPR'!  AED'!  Advanced'Life'Support'(ALS)'

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CPR:'Life'Saving'or'Life'Sustaining?'!  30:2'ratio'

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AED'Protocols'

101'

AED$PROTOCOLS$'

Automated'External'Defibrillator''

!  High'&'Dry'

!  Verbal'Commands'!  I’m'Clear!'!  You’re'Clear!'!  Everyone’s'Clear!'

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HUNTINGTON$BEACH$AED$RESCUE$

103'

PRINCIPLES$!  Rule'of'Numbers'!  PRM'Factors'!  RID'Factors'!  Threat'Assessment'&'HRD'Factors'!  Suction'Entrapment'&'VGB'Act'!  Legal'Responsibility'&'Liability'

Factors'!  Rules,'Regulations'&'EEC'Factors'!  Layers'of'Protection'(LOP)'!  Surveillance'Protocols'!  Standard'Operating'Procedures'

(SOPs)'!  FacilityUUse'Guidelines'(FUG)'

!  Emergency'Action'Plans'(EAPs)'!  Emergency'Response'Plans'(ERPs)'!  Incident'Command'(IC)'&'Incident'

Action'Plans'(IAPs)'!  Spinal'Injury'Management'&'

Mechanism'of'Injury'(MOI)'!  Body'Substance'Isolation'(BSI)'

Protocols'!  Rescue'Priorities'!  Management'of'Hypoxia'(MOH)'!  Positive'Pressure'Ventilation'(PPV)'

Protocols'!  CPR'Protocols'!  AED'Protocols'

104'

SAN$JOSE$NEARNDROWNING$INCIDENT$

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TOMORROW’S$LIFEGUARD$

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Lifesaving!Resources,!LLC!www.lifesaving.com!

Gerald!M.!Dworkin!gerald@lifesaving.com'