An Open Letter To Our Clients, The Public and The Press
The mission of The National Aquatic Safety Company is to reduce the loss of life due to drowning. Please note that this mission statement does not say: to reduce the loss of life due to drowning for only clients of NASCO; our mission is much broader than that. To that end, we feel we have an obligation to share our experience by publishing our data.
We are, and have always been, on the cutting edge of lifeguarding technology. We publish our work and are open about what we do. Because of this, we will be and have been attacked by others whose technology and protocols lag significantly behind ours and by some of the press whose desire is to create controversy where none should exist.
In truth, most of the criticism centers on the use of abdominal thrusts in our rescue protocol. The reasons that abdominal thrusts are embedded in our rescue protocol can be simply stated as:
- It works and works well.
- It does no additional harm to the victim.
- It delays the initiation of on deck CPR only a very small amount of time, and
- It initiates a respiration step early in the rescue sequence.
The following items are listed with the intention of presenting what we do and how well it has worked.
What We Do.
1. The abdominal thrusts are only a very small, but important part of a fairly sophisticated protocol involving victim recognition, scanning, and on-deck management.
2. When the victim is on the deck, we follow the American Heart Association guidelines for CPR. The treatment of a victim on the deck falls within the purview of the AHA, and we follow their protocols.
3. While there has been little significant research on drowning since the 1970s and 80s (Laurence M. Katz, et al. “Drowning: a cry for help.” Anesthesiology 110.6 (2009) 1211-1213), and even some confusion about the definition of drowning, most experts agree that the longer it takes to initiate attempts to restore respiration the poorer the chance that spontaneous respiration will be restored.
4. The time between when a victim is in the water and non-breathing and when they are placed on the deck and conventional CPR is initiated is typically between two and four minutes. The step of this sequence that often takes the longest is the extrication from the water.
5. During the rescue process, we do five and only five abdominal thrusts while the victim is still in the water. These thrusts delay extrication between four to six seconds. The intent of these thrusts is to begin to initiate respiration. This step normally occurs within 15 to 30 seconds of victim identification. We use the technical term, In the Water Intervention, or IWI to refer to this process.
6. While there are other alternatives for IWI than abdominal thrusts, our tests showed that the leading candidate, In the Water Mouth to Mask, (IWMM) was not effective for several reasons. One was the time delay that ensues when performing IWMM. Also, the procedure has an extremely high refusal rate, i.e., lifeguards are very reluctant to do it. In addition, it is difficult to get a good seal when attempting to perform this procedure in the water.
How Well Has It Worked.
1. We require our clients to furnish us with in-depth rescue statistics at the end of each season. These statistics are then compiled and analyzed to determine how effective our protocols might be. Then, the information is published. One of our recent research papers, for example, reported the trending from 56,000 rescues.
2. The method of proof about the effectiveness of a protocol that carries the most weight is simply the collection of data. To this end, we publish our data. In one of our recent research papers, NASCO published results of the company protocol that showed a fatality rate of 0.00635 per 100,000 guests in our facilities over the time period studied.
3. The question then becomes one of whether this is a good or bad rate. Unfortunately, there is a dearth of information regarding the effectiveness of other drowning rescue protocols. Stated simply, we weren’t able to locate information about the effectiveness or lack thereof of any other drowning rescue protocols. There are only two other fatality rates that we have been able to determine. One is the CDC estimate of 0.6 fatalities per 100,000 population for all pool drowning. Another is 0.7 per 100,000 attendance obtained from an un-published report NASCO did for the Six Flags Corporation in the 80s. Compared to these, the NASCO protocol is roughly 100 times more effective.
4. Our research and data showed that in 43.75% of the cases, IWI alone was all that was required to restore spontaneous respiration. In none of these cases was an injury reported due to the application of abdominal thrusts.
A Few Further Comments
1. We neither support nor do not support the application of abdominal thrusts as a method of treatment for drowning by the general public. We are neutral on this issue. While we feel that we have experience and data to support what we do with our protocol, the general application of abdominal thrusts is outside our purview. We have a controlled environment with significant training in our program.
2. A fact which is often reported in the press, and seems to have little bearing on the issues at hand, but perhaps should be addressed is this: John Hunsucker, NASCO’s president, has four college degrees and none of them are in medicine. Hunsucker’s degrees are in math, physics and engineering. However, Hunsucker has over 50 refereed publications in numerous journals on a myriad of subjects. In addition, Hunsucker has been the major professor for numerous graduate students at the masters and Ph.D. levels. Hunsucker is experienced with research and for example, has been involved in research on the Shuttle Program and the Space Station Program for NASA.
3. As a general rule, NASCO has taken the position we will only talk to the press when doing so will help to fulfill our mission to reduce the loss of life due to drowning. Drowning rescue protocol should be decided by the careful collection of data and the open discussion of alternatives that have proven to be successful.
4. With careful consideration and analysis, we continue to seek improvements to our protocol. We particularly look forward to open discourse with other agencies which collect data on the effectiveness of different protocols.