Setting Your Course

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July 2004

By Susan J. Grosse, MS

How much will it cost? How long will it take? Where is it offered? Who is teaching? How long is the certification valid? Is it a national certification? What organization is sponsoring? What are the prerequisites?

All of these questions, and many more, are asked on a regular basis by aquatic rehabilitation professionals, and those wanting to become professionals in aquatic rehabilitation, as they seek training in safety and emergency response. In answer to a need for training, many different national organizations have developed courses and certifications designed to meet this need. But, which course is the right one for you?

It is actually impossible to answer that question. There is no best course. The right course for you is the course providing you with the knowledge and skills to meet every emergency that could possibly happen in your aquatic facility. But no two facilities are alike. Even identical pools serve different populations with diverse activities. The best course for one professional might be totally inappropriate for another. How do you decide?

MORE QUESTIONS
The questions above must, of course, eventually be answered. However, they are not the first questions to ask. Rather, consider the following: What is your legal duty to your clients? If you are receiving a fee for your services, you have a legal duty to your clients. What that duty is varies from state to state. At a minimum, you must meet the requirements of any and all local and state regulations and ordinances. Check your codes for operation of swimming pools. Many codes are written for size-specific pools. Some codes may not cover small pools used for therapeutic purposes. Other codes may not apply to hospital and/or rehab settings. If your facility is governed by the codes, you must adhere. If you are renting pool space, the pool owner must adhere.

What is the likelihood of an incident requiring emergency response? Many factors affect the answer to this question, including participant age, medical condition, degree of functional independence, mental competence, behavior patterns, and prior aquatic experience. Activity selection, scope, and parameters should also be considered. What will participants be doing? How much risk is involved in the activity? Participants with more severe medical conditions, behavior deviations, lessened mental competence, and/or lack of prior aquatic experience are probably more likely to be involved in situations that could require emergency response.

What types of emergency response incidents are foreseeable? Foreseeability is a major factor. If you can foresee an emergency situation, you must try to prevent it, as well as prepare to respond to it. While you may not be able to predict this for a new program and/or business, it is possible to consider what is known about similar types of programs. Applying the law of averages for similar types of facilities/programs will tell you a lot about what you can expect and should prepare for.

Table 1. General types of incidents that may occur, and procedures you should be prepared to apply if they do.

What is the industry standard of care for foreseeable incidents? Your care must, at the very least, equal the industry standard of care. If it does not, you are negligent in your duty to your clients. Industry standard of care is often reflected in safety and rescue courses sponsored by national level aquatic and/or emergency response organizations. When evaluating a sponsoring agency, look for a history of providing emergency response training, including a history of periodic updating of training protocols consistent with emergency cardiac care guidelines.

What is the worse case scenario of an incident at your facility? If you plan for the most severe incident, you will be prepared for minor situations.

What hazards exist in your facility? You must recognize, remove, and warn of all hazards that cannot be removed. From the parking area, entrances, hallways, stairs, and check-in areas to locker/ changing rooms, bathrooms, showers, and the actual pool area itself, hazards exist. Some may be permanent, such as wet floors. Others may be transient, such as a burned-out light bulb reducing visibility. Hazard recognition and removal must be a part of emergency response training.

How will you prevent foreseeable accidents? Prevention is the key in any operation. Not only must you know how to respond in an emergency, you must, to the best of your ability, be able to prevent that emergency from happening and prove you have taken any and all steps possible in that prevention.

What immediate emergency care are you prepared to give, should an incident occur? You, as the person working directly with the client and/or leading the group, are the immediate responder. What you do first may mean the difference between life and death of the individual. What you do first may make a major difference in quality of life for the incident survivor. You will be acting before your facility response team and/or EMS arrive on the scene. What you do first will play a major role in what EMS personnel are able to do when they arrive.

BEING READY FOR ANYTHING
Just because something has never happened does not mean it could not occur. Within the scope of foreseeability, if you can foresee something, it can happen to you. The burden to guard against harm rests with you. Table 1 more clearly defines general types of incidents that could occur and what you should be prepared to do if and when they do.

In addition, in providing CPR and/or first aid, you must be able to follow universal precautions. Any and all emergency care you provide should be done without endangering yourself and/or others.

Consider:

How big is your pool? Would you ever have to swim to reach someone in an emergency?
How deep is your water? Would you ever have to surface dive and retrieve a body?
How high are the sides of your pool? How would you remove an unconscious person from the water?
Is oxygen and/or an automatic external defibrillator (AED) on site? If so, are you expected to use it? (Note: oxygen and AEDs are becoming standard of care at aquatic facilities.)
How far away is your EMS response team?
How many staff at your facility are trained in emergency response? Who is required to respond?
What emergency equipment is available on-site? Who is trained in its use? Who is expected to use this equipment? You, as an immediate responder, should be trained to use all emergency response equipment available.

FINDING YOUR COURSE
Once you have answered all of these questions, then it is time to look at specific emergency response courses. Find a course to prepare yourself to meet the requirements of your job. You may not find one single course. Content is packaged in different ways by different organizations.

Beware of the following:

Courses resulting in certification with no expiration. Industry standard for CPR training is 1-year validity. Courses for medical providers and professional emergency care workers may have a 2-year validity. Longer or no validity period is not a state-of-the-art credential.
Courses not supported by a national organization with a history in emergency response training. Courses you might take for your own personal knowledge will not necessarily be recognized as comprehensive by a court of law in a situation where you have a duty to a client.
Courses not requiring practice and testing of skills. The only way to learn and practice rescue skills is to perform them. Mental practice and book study alone will not completely prepare you for skill application in an emergency.
Courses with no written test. It is just as important to test knowledge as it is to test skills.
Anything that looks too easy. There is no shortcut to mastery of emergency response skills.

In any emergency response course, whether it is lifeguarding, CPR, first aid, oxygen, AED, or general emergency preparedness, you will have to meet standards. Be prepared to do so.

Lastly, welcome recertification. Everyone needs memory refreshers. No emergency response certification should be good forever. Recertification is your chance to make sure you are prepared. Daily familiarity with circumstance dulls our recognition of hazard, fogs our response acuity, and diminishes our capabilities. Recertification keeps our preparedness on its sharpest edge. Isn’t that the level of training you would want if you were the victim?

Asking how much a course will cost, who will teach it, and where it is offered are all great questions. But ask the other questions discussed here first. They could well make the difference in being prepared to respond to emergencies in your facility. These are the questions that could save someone’s life.

Susan J. Grosse, MS, based in Milwaukee, is past president of the American Association for Active Lifestyles and Fitness and past chair of AAHPERD’s Aquatic Council. She can be reached at sjgrosse@execpc.com.

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July 2004