"July drowning at Water World stirs controversy over Heimlich" - INDenver Times, 9/11/09
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"July drowning at Water World stirs controversy over Heimlich" by
Steve Haigh, INDenver Times, September 11, 2009
One ecstatic lifeguard at Hyland Hills Water World will drive off
Saturday in a new Kia Rio as the top-prize winner of the theme park’s
annual employee-bonus program. Time to recognize the summer’s best
guard for attendance, leadership and customer service, but also a time
to reflect on a season unlike any other in the park’s history.
With more than 11 million visitors in its 30 years, Water World is
rightfully proud of its safety record. The popular Federal Heights
park had never lost a swimmer - until July 21.
A lifeguard scanning the Captain Jack’s pool, a 500,000-gallon
“gentle” wave pool, saw Mikhail Valov’s head above the water, but he
wasn’t moving. A lifeguard pulled Valov to the side, where he was
extricated. Resuscitation efforts by lifeguards and Federal Heights
Fire Department paramedics on duty at the park didn’t work.
The tragic death of the 48-year-old Arvada husband and father leaves
park officials troubled and puzzled. He “was in a small pool,” and
there was “no indicator he was in trouble,” said Joann Gomez, a
spokeswoman for Water World. Six lifeguards are always on duty near
Captain Jack’s pool, she said.
“It has been a very reflective summer,” Gomez said. “We’re heartbroken
for the family. It’s never going to be the same.”
Seven weeks later, Water World is still “gathering all the facts.” The
park’s internal investigation won’t be complete until the toxicology
results from the Adams County coroner’s office have been studied. On
Tuesday, Gomez didn’t know if park officials had seen the official
coroner’s report, including toxicology, which was released Aug. 17.
Coroner Jim Hibbard’s report says Valov’s accidental death was caused
by “asphyxia due to drowning,” and nothing in the toxicology results
sheds light on what might have happened in the pool.
HEIMLICH STIRS CONTROVERSY
Another aspect that’s troubling is the use of a rescue technique that
has been called at best inappropriate and at worst dangerous by
authorities on drowning and resuscitation. Before starting
cardiopulmonary resuscitation on Valov, a Water World lifeguard
performed the Heimlich maneuver.
The park hires about 300 guards every summer, and 125 are on duty at
any time. They’re trained by the National Aquatic Safety Co., based in
Houston.
“We did the Heimlich while we were in the water. When we pulled him
out, we began our CPR procedure,” operations manager Andy Maurek told
the Houston Press in July.
Maurek declined to be interviewed for this story, referring questions
to Gomez.
The Heimlich, which involves abdominal thrusts to force air out of the
lungs, is more commonly used to help dislodge trapped food in choking
victims.
“You’ve got the International Liaison Committee on Resuscitation, the
American Heart Association, the American Red Cross and the Institute
of Medicine all coming out to say the Heimlich has no role in
resuscitating drowning victims,” Dr. James Orlowski, the chief of
pediatrics at University Community Hospital in Tampa, Fla., and an
expert on drowning, told the Houston Press in August.
Orlowski and others point out that the Heimlich can lacerate or
rupture organs and cause vomiting and the harmful aspiration of vomit
into the lungs. They say it also wastes important time that risks
brain damage, which can occur in minutes.
“Every second counts in a situation where the individual is not
breathing,” Orlowski told the Houston paper, noting that the Heimlich
is no longer the first choice of the AHA and the Red Cross, which
favor back slaps.
In Valov’s case, the coroner’s report revealed “some aspiration of
gastric contents,” but they weren’t specifically connected to use of
the Heimlich.
Kathryn Emery, an attending doctor in the Emergency Room at the
Children’s Hospital in Aurora, said she has never heard of performing
the Heimlich as a first-response method for drowning victims. She said
CPR should be initiated as soon as possible and it shouldn’t be
delayed to perform the Heimlich, unless there seems to be an
obstruction to the victim’s breathing.
“The Heimlich has not been proven to remove fluids,” she said. The
human body’s reflex for keeping out water only lasts about 90 seconds,
Emery said, after which water begins to collect in a victim’s lungs.
When drowning victims reach the ER, doctors are most concerned with
getting oxygen to the victim’s body and ensuring that they can still
inhale properly, so having the victim quickly expel any water they’ve
inhaled is an important first step, Emery said.
As the very first responders, Emery realizes that lifeguards don’t
always have the same tools available to Emergency Medical Services
responders or doctors, so lifeguards are trained to do the best they
can. “It’s about what they have available to best help this person,”
Emery said.
NASCO follows the guidance of now 89-year-old Dr. Henry Heimlich, of
Cincinnati:
“Drowning victims die when their lungs fill with water. Air can’t get
into water-filled lungs. Heimlich maneuvers remove the water from the
lungs in 4-6 seconds. Pressing upward on the diaphragm jump-starts
breathing. Many drowning victims have been saved by rescuers
performing the Heimlich maneuver, even after CPR failed.”
DIFFERENT COMPANIES, DIFFERENT TRAINING
Lifeguards, from the neighborhood pool to the giant water park, are
schooled in rescue procedures, but not all receive the same training.
NASCO is the third-largest lifeguard-certification agency for water
parks in the country behind Jeff Ellis and Associates and the American
Red Cross. Its founder, John Hunsucker, a Ph.D. professor emeritus of
mathematics and engineering at the University of Houston, stands
behind his company’s lifeguard-training program, citing statistics
from the National Safety Council and the Centers for Disease Control
and Prevention.
“The drowning rate across the U.S. in pools is about 0.6 per hundred
thousand,” Hunsucker said Tuesday. “Assuming that Water World has
several hundred thousand guests per season (about 533,000 in 2008),
and this is the first drowning fatality in their history, this fact is
substantially borne out. ” In comparison, at pools staffed by NASCO-
trained guards, the drowning rate is 0.01 per hundred thousand,
Hunsucker said, over an “extended period of time.”
Hunsucker is no lightweight in the field of water safety. He has
helped create water-rescue techniques commonly used by many first
responders. He also has developed scanning procedures and ways to
identify drowning victims for lifeguards in water parks such as Water
World.
“He is like a drill instructor,” said Brian Passenti, pool manager
since 2008 at the Glenwood Springs Hot Springs Lodge & Pool. Passenti
took the NASCO training in 2003 when the Hot Springs Pool was
considering alternatives to the Red Cross certification program to cut
costs. Ironically, Passenti said one of his NASCO classmates in Texas
six years ago was Andy Maurek, the Water World operations manager.
Although the Glenwood Springs pool continues to employ Red Cross
procedures, Passenti was complimentary of the Houston company.
“In general, NASCO is trying to make a better water park from a safety
standpoint,” Passenti said. The company’s mission statement is “to
reduce the loss of life due to drowning.”
Hunsucker told the Austin Chronicle in January that only one life had
been lost during a rescue attempt by a NASCO-trained lifeguard since
the company was founded in 1974. But Hunsucker didn’t produce any
independent studies to verify that.
“I know of no independent audits of his success rates,” B. Chris
Brewster, president of the U.S. Lifesaving Association in California,
told the Houston Press in August.
Since mid-May, there have been two other drownings at NASCO-client
parks, besides Water World. A 14-year-old boy drowned in May at the
Wet N’ Wild Water World in El Paso, Texas. It was not known if the
Heimlich was used. According to media reports, the Heimlich was not
used Aug. 1 when a 3-year-old boy drowned in the kiddie pool at the
Kalahari Resort in Sandusky, Ohio.
Hunsucker first championed the Heimlich in a 1997 issue of the trade
magazine Splash, arguing that most lifeguards are teenagers too
immature to perform CPR — a technique he calls confusing and far less
effective than widely believed.
Hunsucker and NASCO staff have written academic papers about the long-
term effectiveness of CPR and the probability that the predominant
lifeguard age group in the water park industry – 16-18 – would refuse
to perform mouth-to-mouth. NASCO has another “blockbuster” paper due
out in late fall on the effectiveness of lifeguard protocols,
Hunsucker said.
“All of our experience with investigating lifeguard response to
drowning shows that approximately six out of seven trained guards
(with certifications across all agencies) refuse to do ‘mouth to
mouth’ on a victim,” NASCO wrote in a 2009 lifeguard training and risk
management proposal for the city of Dallas at its Bahama Beach
Waterpark. “We have never had a refusal to do the Heimlich,” which the
company calls a “proven first response” if restricted to no more than
five abdominal thrusts before attempting rescue breathing.
This is still in violation of all accepted practices, according to
drowning experts.
“It’s definitely delaying (CPR),” Orlowski said. “What we teach
lifeguards is that you start breathing victims as soon as we get to
them, even if that’s in the pool.”
Dallas hired NASCO to train its lifeguards but doesn’t use the
Heimlich.
CPR also puts the rescuer at risk of AIDS, hepatitis and tuberculosis,
as well as profound psychological scars, Hunsucker warned in the
Splash article. “Having performed mouth-to-mouth on a victim, I can
assure you that the mental involvement of the rescuer is quite large,”
he wrote. “The experience was quite traumatic to my mental health.”
Hunsucker went so far as to encourage lifeguards to choose for
themselves rather than “blindly follow” established medical protocols.
“God gave you a brain, or else you would not be a lifeguard,” he
wrote. “I am not a physician. But on the other hand, I’m not stupid,
either.”
Other than Water World, Hunsucker declined to identify NASCO’s clients
in Colorado. Most of the water parks in the Denver area, including the
Apex Center in Arvada, Elitch Gardens Island Kingdom Water Park in
Denver and Pirates Cove Family Aquatics Center in Englewood, are
affiliated with Ellis and Associates. So is Grand Junction Parks &
Recreation.
Among the many organizations that use Red Cross certification are the
South Suburban Parks and Recreation District, Splash Aquatics Center
in Golden and the Old Town Hot Springs pool in Steamboat Springs.
ELLIS DROPS THE HEIMLICH
From 1995-2000, Ellis, the nation’s largest trainer of water park
lifeguards, employed the Heimlich as its first step in resuscitation
training. This despite the views of the Red Cross, the heart
association and the International Lifesaving Federation that the
maneuver should be used only as a last-ditch effort and only when it
is apparent that the victim is suffering a blockage in the throat.
But in the spring of 2000, the Orlando, Fla.-based company dropped its
endorsement of the Heimlich for drowning cases.
One reason Ellis consultant Larry Newell gave to the Los Angeles Times
in 2000 was the refusal of the heart association, at an international
meeting held in January of that year, to change its negative
recommendation on the Heimlich maneuver.
In addition, by switching back to CPR, Newell said, Ellis would be
able to gather comparative data about which method as a first response
works better.
“We still don’t know whether it (Heimlich) is better than anything
else because we have no data to compare it to,” Newell said.
In 2009, Ellis has not reverted to employing the Heimlich.
CPR TRAINING SAVES LIVES
CPR doesn’t need defending, considering that 95 percent of lifeguards
in the U.S. receive the training, said Peggy Mercorella, a health and
safety education specialist at the American Red Cross in Denver. Using
the Heimlich “forces air up and out of the lungs,” Mercorella said,
and a drowning victim needs “as much air as they’ve got.”
“I can only speak to the fact that in the past year, in Denver and
Wheat Ridge, we’ve been able to recognize (Red Cross-trained)
lifeguards who have gotten people out of the water, done what they
were trained to do and saved lives,” she said. “Training is to be able
to act and know the consequences of not acting.”
The Red Cross recommends that after determining someone is not
breathing, call 911. Basic CPR begins by making sure the air passage
is clear. Start with two rescue breaths followed by 30 chest
compressions. Re-check for breathing, then repeat the two rescue
breaths and compressions until advanced medical help arrives. Rescue
breaths may be given using a breather mask. Having access to an
automated external defibrillator, or AED, also can make a life-saving
difference.
When considering how to train lifeguards, “What do you base your
guidelines on?” Mercorella asked, emphasizing that the Red Cross
follows the “standard practices” put forth by the Emergency Cardiac
Care Committee, the International Liaison Committee on Resuscitation
and the Consensus on Science and Treatment Recommendations.
Orlowski, the Tampa pediatrician, was far more critical of the
Heimlich training in the Houston Press. “For somebody to continue to
do this and to teach it is foolish and borders on the insane,” the
drowning expert said.
“Essentially what Hunsucker is doing is human experimentation on an
untested medical theory. It’s reckless and negligent, and just
unbelievably ¬unethical,” Brewster, president of the lifesaving
association, told the Houston Press in October 2007.
Hunsucker’s response this week to his critics, and the media in
general: “Show me one who’s ever made a rescue.” From the 2007 Houston
Press interview: “These so-called medical experts, “Screw ‘em. What do
you want me to do, walk in lockstep?”
LONG-TERM EFFECTS ON STAFF
At Water World, pools will be drained, and some will be covered for
winter, but there’s no way to know how the events of July 21 will
affect the young people sitting in the chairs and walking the decks,
eyes always on the pool. What can a pool manager do to keep a staff
focused after a drowning?
“You have to lessen the burden on the staff because people will carry
this with them the rest of their lives,” said Brian Anderson, a 24-
year veteran of pool management and currently aquatics director for
Pirates Cove. “Reassure the staff. Continue doing your in-service
training. If necessary, bring in outside people like therapists. Some
kids will just close up.
“The biggest thing you’d have to do would be an internal audit,
debrief the staff. Go over everything. Encourage your kids that you
did what you were trained to do to the best of your ability.”
Water World officials say they are scrutinizing lifeguard-training
procedures for 2010, and no decision has been made about using the
Heimlich or retaining NASCO, but their confidence is unshaken.
“The training has worked for us,” Gomez said. “We feel so blessed to
have 11 million visitors at the park (over 30 years). We’re very
confident with that training.”
While he won’t talk about his client relationship, Hunsucker has high
praise for the park.
“The Hyland Hills Water World lifeguards are among the best-trained,
conditioned and managed lifeguards in the nation,” he said in an e-
mail. “Denver has a lot to be proud of with this facility and with the
lifeguards and managers that work there.”
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Marcy Miranda, a Denver freelance writer, contributed to this report.
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