The purpose of this paper is to look at the area of risk management with reference to the sport of swimming. There is no doubt that the ability to prevent any types of injury to athletes is of the utmost importance. The safety of the athletes should therefore be the primary concern of both facility managers and coaches. By working together, one would hope, that all unnecessary injuries could be prevented. One of the most severe injuries that can occur is that of a spinal injury.
The area of prevention that addresses this issue is that of spinal injury management and it will be looked at more closely later in this paper. Even with all the extra emphasis in this day and age on safety issues, these kinds of injuries are still far too prevalent. In 1996, Michael Berger and Judith Middleton state that in the United Kingdom, there are around 40,000 children each year that suffer from head injuries. Some of these individuals will have received severe injuries, in that they will have been unconscious for at least 20 minutes and so will most likely have suffered brain damage.
The sport of swimming has the obvious danger of drowning. There are also potential risks of spinal injuries caused by collisions with the floor of the pool, the walls in the pool and other swimmers. Many other injuries can be the result of a slippery deck or training equipment not correctly stored away. There is also a risk of injury from the chemicals which are present at a pool such as chlorine. Aquatic injury prevention should be part of any facilities risk management program.
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Risk management involves identifying and reducing dangerous conditions that can cause injuries and financial loss. Thus, the aim of a risk management is in a way a kind of preventative medicine, to tackle the issue of a problem thus ensuring that those kinds of accidents will not occur. There are some that would contend that those individuals that suffer an injury are unfortunate victims of circumstance. Many injuries can be avoided through an understanding of the factors that can cause injuries to occur and then a knowledge of how to go about preventing such situations to occur.
Charles Bucher and March Krotee (1998) explain that there is an added risk in any physical education exercise as opposed to a regular class because the children are moving around and not sitting in a chair. The hiring of competent, qualified and certified employees in crucial not only for the planning but also for the conducting and supervising of activities. By making these simple efforts, the risk of injury can be minimized. Not only should the staff be up to par but also any equipment used as well as the facility being as safe as it could be. All coaches need to have fully up to date certificates and licenses.
All necessary measures need to be taken to prevent any injuries from occurring and the correct level of supervision is crucial. Bucher and Krotee explain that the coach is required to act promptly in performing first aid and CPR and nothing more. Coaches should always show all necessary levels of care in their professional activities. The American Red Cross (1995) suggest that by understanding how injuries are caused, this will help prevent them from occurring by increasing the staff"s awareness of risks and hazards, helping patrons to avoid risky behavior and developing an attitude of safety at your facility.
The Institute of Swimming Teachers and Coaches (April 1997) explain that by identifying not only what is a potential hazard but also assessing their risk level, and then evaluating whether or not all necessary precautions have been taken, this should help to prevent anyone getting injured. The ISTC, were not only referring to swimmers as potential victims but also to coaches, teachers, lifeguards, cleaning staff and receptionists. According to Bucher and Krotee, there is no doubt in today"s society that there are ever more increasing cases of teachers, coaches, schools and teams being sued in court.
It seems as though lawyers are readily available, also the public are becoming much more aware of their rights, as far as what they should be protected from a safety standpoint. It is suggested that the risk of legal action can be minimized by following some simple steps. Collecting all pertinent facts about the health of your athletes. Purchasing only the best equipment form the most reputable dealers and acquiring used equipment from companies renowned for high quality reconditioned merchandise.
Not laying the blame of an injury on anyone verbally but by carefully wording the exact nature of the injury and the preceding events on an accident report. Good supervision and instruction in very important. An emergency action plan should be drawn up, rehearsed and be ready to be activated at a moment"s notice. All necessary insurance precaution should be taken. Perhaps this is the most comforting defense for a coach. According to the United States Swimming, Inc. 1998 Insurance Summary, all swimmers registered with United States Swimming are covered by the USS Insurance policy as long as the injury suffered by the member was received during an approved activity under the policy. All USS swimmers are covered when they are participating in competitions, meets or events sponsored or sanctioned by USS, participating in organized, scheduled practice sessions and in organized, supervised travel to and from sponsored and sanctioned events or organized, supervised practice sessions.
Anthony McCaskey and Kenneth Biedzynski (1996) explain that coaches are those principally the defendants in law suits as it is generally agreed that coaches have the most control of those individuals in their respective sports. A coach may be found negligent if he does not follow his duty to conform to a standard conduct that protects others from unreasonable risk of harm. Participants are termed as either those directly or indirectly under the control of the coach.
Case law demonstrates that coaches responsibilities include: supervision, training and instruction, safe usage of all equipment, provided high quality assistants, warning of potential dangers, providing prompt and correct medical care, preventing injuries to competing athletes. The American Red Cross (1993) explain that lawsuits are becoming a concern for those giving care. Hence in the case of an emergency, the lifeguards and coaches are becoming increasingly apprehensive about giving care to victims of injuries.
The American Red Cross suggests that by being aware of some basic legal principles, individuals may lessen the chances that they may later be found to be negligent in some area or another. All lifeguards have a duty to care. That is, they are legally bound to provide care to a injured party if the giving of such care is laid out in their job description. The rescuer should follow a reasonable standard of care and failure to do so may result in a chance of being found negligent. The Good Samaritan Laws protect anyone giving care as long as they are not negligent and they act in good faith.
Consent should always be obtained from the individual. If the victim is an adult and they refuse care, one must not force care upon them. In the case of a child, the consent must be obtained form a parent or guardian. Any victim that is either unconscious or confused is assumed to give implied consent as it is assumed that if that person were fully aware of their predicament, they would accept the care that was offered. To obtain consent, the rescuer must identify themselves to the victim, give their level of training, explain what could be wrong and explain what care is planned.
Once care is begun, a rescuer cannot stop giving care until advanced medical professional arrive at the scene. Confidentiality must also be observed. Only the facility or team spokesperson may speak to attorneys or the media . A rescuer should only speak with law enforcement officers and the rescue squad when it arrives. Finally, record keeping is essential. The documentation is considered to be almost as important as the care itself. Bucher and Krotte (1998) state that coaches and instructors are expected to carry out their activities with all necessary levels of care.
If this is not the case, then they are leaving themselves open to a potential lawsuit filed against them for negligence. There is a requirement for the coach or instructor to take protective measures. Failure to do so will result in a lawsuit. In Roth versus New York (1942), all necessary measures were taken and a bather drowned after walking into deep water. There was nothing to stop this happening. The state was found to be liable. Bucher and Krotee explain that the failure to supervise correctly is the most commonly litigated situation.
By having alert lifeguards and coaches, a facility can seriously reduce to chances of injuries occurring. According to the American Red Cross (1995), effective surveillance has four elements. The ability to recognize the ways in which a drowning or distressed swimmer behave in the pool. An example of this would be that a swimmers would have rhythmic breathing, relatively coordinated movements, have a horizontal body position and be making recognizable forward progress in the water. In contrast a distressed swimmer would be breathing but also be calling for help, waving and be making very little forward progress in the water, if any at all.
A passive drowning victim would be considerably different to a swimmer. A Passive drowning victim would not be breathing, have no arm or leg movement, could be face down near the surface or in a submerged position and so obviously would be making no forward motion in the pool. Appropriate scanning techniques should also be employed to locate swimmers having problems in the pool. Lifeguards should be carefully and strategically placed throughout the facility. Each lifeguard should be fully aware of their responsibilities.
Coaches are responsible for teaching swimmers all necessary skills to compete, the correct procedures to reduce the risks of injury and making sure that their swimmers are physically fit enough to compete. The failure to provide adequate training or instruction to reduce the risk of injury has been a commonly cited reason in recent litigation. Supervision is absolutely critical when the consequences of depriving the body of oxygen are considered. Soon after breathing stops, then too will the heart. After six minutes or so, brain damage is possible.
Between six and ten minutes without breathing, brain damage is likely. If breathing is stopped for more than ten minutes, usually the brain damage is irreversible. Thus it is very important to be aware of the varying depths of water within the pool. In this way it is much easier to make sure that the children do not wander into water which is too deep for them. Also, this could help prevent spinal injuries from occurring by making patrons aware of when and where in the pool it is considered safe to dive. Without doubt, patron surveillance is one of the most important parts of a risk management strategy.
The Certified Pool Operator (Fall 1997) states that it is very important to regulate the use of pools, by watching children and though constant supervision of the pool. The Institute of Swimming Teachers and Coaches (April 1997) mentioned that in some pools there may be blind spots resulting from the positioning of features, glares and reflections. All of these factors can hinder surveillance and so through careful planning, these problems should be attempted to be eliminated by strategic placing of lifeguards. This comes directly under the realms of a good risk management program.
According to the Certified Pool Operator (Fall 1997), it is critical to identify areas of the pool that become slippery when wet. These range from the deck itself to corridors leading to and from the pool, locker rooms and snack areas. Communication can be used as a tool for helping to prevent injury and so is considered another 'gear in the engine" of risk management. Patrons need to be made aware of potentials for injury. They also need to be educated as to the risks from inappropriate behavior. All rules and regulations necessary for the prevention of injuries need to be forcibly enforced.
Signs are needed to warn pool users of danger areas. Since spinal injuries are more common in individuals visiting facilities for the first time and so are unaware of shallow areas. The side of the pool itself needs to be mark both on the deck it self and on the side of the wall facing the water to warn swimmers in the pool as to the changing depth of the water that they are in. In addition to signs depicting "No Diving" and the depth of the water, facility rules and regulations should also be clearly displayed. Running should never take place around the pool. As the side of the pool gets wet, it become treacherous.
Signs should be posted prohibiting to consumption of food and drinks in and around the pool. There is the obvious potential for injury from broken glass on the pool deck or in the pool from bottles that are accidental dropped on the pool side. Pool rules are not designed to prevent the patrons from having fun but more so to allow them to have fun in a hopefully relatively risk free environment. The pool rules should be displayed clearly on the wall of the pool. There are many great examples of pool rules, on would be that diving is only permitted in diving designated areas.
The deck needs to be checked daily for loose floor materials. There is also a risk for standing water on the deck itself. All such findings should be immediately reported to the facility manager. The deck should be kept clear of equipment and anything else that could be a potential hazard. The American Red Cross (1992) recommends that in areas where the water is less than five feet deep, there should be signs clearly stating 'Danger-Shallow Water- No Diving". It is suggested that these signs are close to the edge of the pool in contrasting colors to the pool deck.
If starting blocks are removable, they should be during recreational periods and should be stored in a safe location. If they are not easily removable, then they should be coned off or clearly marking as out of use to recreational swimmers. All kick boards and pull buoys should be stored away in their correct location and not left strewn about the pool deck. Any item left on the pool deck is a hazard. Any risk management program would include keeping the deck clear of obstructions. The American Red Cross (1988) states that all rescue and first aid equipment should inspected on a regular basis.
This equipment should also be easily accessible. Any piece of equipment that is found to be damaged in any way should be removed, repaired or replaced immediately. Following an emergency, all equipment that is used should be replaced promptly. Other areas should also be checked on a regular basis, such as the showers, locker rooms and restrooms which should be kept clean and hazard free. Coaches are also responsible for taking all necessary measures to ensure that all equipment used by their swimmers is of an adequate standard.
This issue is far more critical in a contact sport such as football where inadequate padding may lead to serious injury. Anyone working with chlorine should wear protective clothing such as gloves, goggles and clothing covering the rest of the body to minimize the risks of chlorine coming in contact with the naked flesh. Chlorine can enter the blood via absorption through the skin. Direct contact with the eyes can cause severe injuries. The American Red Cross (1995) terms chemical hazards as harmful or potentially harmful substances in and around the pool.
Storage areas of chemicals should be clearly marked hence warning both staff and patrons of possible dangers. The doors to such storage areas should be kept locked. Any suspicious odors in these regions should be reported immediately. The American Red Cross (1992) recommend storing all chemicals and chemical testing kits in child proof containers and out of children"s reach. Every year many individuals are injured from diving related injuries. These injuries are usually caused by collisions with the bottom and sides of the pool.
Thus it is of paramount importance that coaches and instructors take all precautions to prevent such injuries form occurring. Diving should not be taught unless all necessary safety equipment in readily available such as a back board and staff trained in spinal injury management are present. Coaches should make sure that all swimmers are educated in the obvious safety precautions. Never dive when someone else is in the water in front of you. All dives should be of a flat nature. All swimmers should enter the water fingers first and not head first, thus helping to cushioning the blow should the swimmer crash into the floor if the pool.
Never hold or position objects in the pool. A great example as to why it important to keep the diving area clear of obstructions is given by the American Red Cross (1992), which referred to the case Bill Brooks. One day, he dived into a pool and hit his head on an inner tube. He could remember laying face down in the water and being unable to move. Brooks, who once played college baseball, is now a C5 quadriplegic and will never walk again. The best protection against possible injuries is an informed, safety-conscious swimmer.
The Certified Pool Operator (Fall 1997) stated that in a typical year there are about 400 events that result in a quadriplegic injury in aquatic environments. According to the CPO, a quarter of these occurred in pools. The article went onto explain that 95% of the pool related injuries occurred in the shallow ends of pools. Through careful supervision and prudent coaching, swimmers can be educated as to safe methods of entry into shallow water. The Swimming Times (1997) suggests that the depth of the water should be taken into account in relation to the ability and height of the pupils.
Hence, none swimmers should not be taught in water that is ten feet deep and likewise, competitive swimmers should not be coached in shallow water. McCaskey and Biedzynski (1996) swimming incident rates come be totally eliminated if swimmers did not use racing dives into shallow water during practice or meets. According to McCaskey and Biedzynski, there has not been a direct injury in college swimming since a non-fatal one in 1982. The American Red Cross (1995) reveals that sports related injuries account for 13% of all spinal injuries.
These figures were derived from the National Spinal Cord Injuries Data Base. According to the American Red Cross, about 1000 people each year suffer spinal injuries from diving mishaps. The American Red Cross suggests the following ways to help prevent the occurrence of such injuries. The water depth should always be ascertained before entering. Only trained swimmers should be using the starting blocks. Coaches should be aware of these aspects and make sure they correctly supervise their swimmers during warm ups at competitions and at practice.
All these measures mentioned so far in the paper appear to be obvious, but unless they are adhered to tightly then mishaps can occur. It is not worth gambling with your swimmers" health. If a suspected spinal injury occurs, then the area must be stabilized and immobilized. There are certain situations when a spinal injury must always be assumed to have occurred. It is always better to be safe than sorry. If proper precautions are not taken when caring for injured victims, then that lack of risk management leaves the coach and facility open to legal action.
A spinal injury should be assumed for any injury involving a diving board, diving into shallow water, a fall from a height greater than that of the victim"s height. Also any visible bumps or depressions to the head, altered consciousness or complaints of back or neck pain from the victim. In some cases, the victim may be face down in the water. Although, the victim should be moved as little as possible following a suspected spinal injury, in this situation, the victim needs to be removed form the water.
If the victim is not removed, drowning will take place, the heart will stop and soon there after, brain damage will occur. The American Red Cross First Aid Manual (1993) explains that head injuries can rupture blood vessels in the brain causing pressure to build up leading to brain damage. The American Red Cross (1992) describes the typical recipient of a diving injury as a first time visitor to a location, not warned by a sign about the potential dangers, when lifeguards were not present and the water depth was less than four feet deep.
Any good risk management program could dramatically reduce the risk of this kind of injury. By having vigilant lifeguards, water depths clearly marked and no diving signs clearly posted on the deck, most of the risk can be reduced. These are all components of a well rounded risk management program. Since most spinal injuries occur when a person dives into water less than five feet deep, on arriving at a pool, a coach should check the poolside for all relevant safety warnings and make his swimmers aware of this risks. The facility staff should also be highly alert at all times.
All pools should have an emergency action plan. The EAP should explain exactly what procedure should be followed in the event of an aquatic emergency. The initiation of the EAP is the responsibility of the lifeguard. A typical signal to all pool patrons and staff is three long blows of a whistle. This would draw the attentions of the other pool patrons and then they would be more easily removed from the water for the protection of the victim. Also, other staff members throughout the building would be alerted of the EAP being activated.
The next stage is to begin whatever rescue or emergency action that needs to be taken. After determining the nature and extent of the emergency, another lifeguard or staff member will call the police, fire or rescue squad as necessary. The emergency number is usually 911 but may vary from area to area. If the pool a which you coach is in a new area, it is your responsibility to make sure that you are fully aware of the number to call in the event of an emergency. The required first aid should be continued be given to the victim until advanced medical care arrives.
Once care is commenced, it cannot be withdrawn, if it is, this constitutes abandonment which is a liable situation. Once advanced medical care arrives, all necessary accident reports are filled and the aid in crowd control. More often than not, only one person is designated as the spokesperson for a facility. This person and this person only is allowed to talk to anyone except for the police and the rescue squad. The Institute of Swimming Teachers and Coaches (April 1997) explains that whether or not a pool operator believes that his pool is a high or low risk facility, it is essential to have an emergency action plan.
According to the ISTC, an emergency is anything considered to of danger to a bather or employee. The following all come under that general description. Overcrowding is a situation where too many people are in a confined area. This could be fatal in a swimming pool. A good risk management program would outline maximum numbers for a pool. These levels would be set well below that of over crowding, hopefully eliminating this risk. Disorderly behavior is also a common cause of emergencies. With vigilant surveillance and firm enforcing of pool rules and regulations, this too could be eliminated as a risk.
Lack of water clarity will occur when the chemical levels in pool be out of balance. This too is a liability. If a child dives into water which he assumes to be deep but is in fact shallow, this could lead to a lawsuit. Especially because of the fact that the water clarity may have directly affected that child"s judgement. The ISTC explains that as a coach, it is your responsibility to know how to raise the alarm, how to get help form other staff members, how to initiate the appropriate rescue, who should summon the emergency services and so on.
Qualified lifeguards are trained to act as a team in the case of an emergency, thus it is crucial for a coach or instructor to be able to contribute positively to an emergency situation. The Institute of Swimming Teachers and Coaches (May 1997) states that teachers and coaches must be trained in what to do in the case of an emergency and in turn should make the pupils understand and be aware of the procedures involved in the EAP. The pupils needs to know where to congregate in case of an emergency and possibly if they will be required to stand near a particular doorway to attract the attention of the advanced medical care when it arrives.
The Institute of Swimming Teachers and Coaches (1996) stated that 93% of the schools in a survey had a formal emergency action plan. Two schools stated that they did not have one. Most of the schools in this survey had had swimming as part of their curriculum for more than six years. Coaches and other facility staff should go through regular in service days to rehearse emergency procedures. The emergency action plan should be rehearsed most importantly. For this procedure is what could make the difference between life and death for a victim.
In service training should cover the following points: review the potential hazards at the facility, review and update rules and regulations, practice the emergency action plan , practice rescue skills, carry out physical conditioning. Following an emergency, an accident report needs be filled out by the members of staff involved. The facility information such as address and phone number. Personal data of the injured party should also be included: name, age, sex, address. The location of the incident should be included as well as the a description of the incident.
It is very important to include what care was provided; was medical attention welcomed by the victim or refused? All of these issues are very important as law suits are far too prevalent in this day and age. Remember, consent must be obtained from the victim. To obtain this, the care provider must identify himself to the victim, give his level of training, explain what he thinks is wrong and then explain what he plans to do. If the victim refuses care, the care provider must try to convince the victim to receive care. According to the American Red Cross (1993), record keeping is nearly as important as the actual care given.
The record is a legal document and is vital if legal action is taken. Risk management is an important function of a sport program. A coach should be fully aware of all legal and ethical responsibilities that come with his position. Any form of negligence on his or her behalf resulting in increased risks of injury can lead to the increased chances of legal action. Risk management is not only concerned with limiting the chance of injuries being suffered but also reducing the chances of financial losses following such an incident.
Coaches" Quarterly (1998) states that effective in 1998, all United States Swimming coaches must have the following qualifications: Safety Training for Swim Coaches, First Aid and CPR. The Certified Pool Operator (1997) blames the individuals for their careless behavior. According to the article, pools are becoming safer. The main reasons for injuries today are victim"s carelessness. In a perfect world no one would need to know rescue techniques. Everyone would be careful, and safety would not be a problem. But ours is not a perfect world.
Because of dangerous situations, careless or carefree people, and changing water conditions, many dangers are in and around water. Risk management in a pool environment is basically concerned with aquatic injury prevention. A highly developed risk management program will substantially reduce the risks of injury. By understanding how injuries are caused, one can better prevent them. Effective communication with patrons is critical for helping to prevent injuries. Through this communication, the patrons can have fun in a safer environment.
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