AEDs… From My Perspective
Volume 4 Issue 4 (2001)
Roy Fielding, University of North Carolina - Charlotte

Editor’s Note: This letter is included in this issue of From the Stand for two reasons: it raises some very good questions regarding liability and our responsibility to our lifeguards and to highlight the author’s research and the results of his research. This letter is a response to a letter to the editors of Aquatics International (the March 2000 issue) written by Gerald Dworkin. The letter was never printed in the magazine.

I want to thank Gerald Dworkin for answering some of my questions on AEDs. I completely agree with him that aquatic facilities are safer when it has qualified and well-trained lifeguards on-duty with the correct supervision. The supervision of lifeguards needs to be done by individuals who have been properly trained in managing all aspects of an aquatic facility (including training). Regarding the safety of AED use, Dworkin states we need to “be sure that rescue personnel and the victim are not lying, kneeling or standing in a pool of water before the AED is turned on.” His statement implies to me that there could be a chance of injury to the rescue personnel. However, we are at an aquatic facility and there is water everywhere! I am no rocket scientist but doesn’t ELECTRICAL CURRENT + WATER = CONDUCTIVITY = PROBLEM?

Dworkin also states that “the AED must be used within the first four minutes of the cardiac arrest.” This statement really bothers me. Has Dworkin actually tried to do what he has now set as a standard AED protocol? I did, and I will share with you my findings (albeit shocking).

I had lifeguards participate in time trials at the University of Northern Iowa and the University of North Carolina at Charlotte to see if the four minutes Dworkin suggested is possible. Unlike a real-life scenario, our’s was a controlled environment. The lifeguards knew ahead of time that an AED was needed and that there was nothing else to be concerned with, as in a spinal injury or other problems. The victim was on the surface 60 feet away from the lifeguard and 15 feet from the side of the pool in a passive state. The clock was started and the lifeguard responded 10 seconds into the time trial. A second lifeguard immediately cleared the pool and moved to assist the rescuing lifeguard. This was done in both deep and shallow water with an AED, a designated dry area, dry towel, and backboard all located within 15 feet of the removal point for this victim. We tried to make this as controlled of a rescue as possible using the following parameters suggested by Dworkin:

• 1. Remove victim from the water.
• 2. Place victim on a backboard.
• 3. Quickly towel-dry the victim’s chest before placing electrodes on the victim.
• 4. Be sure the rescuer personnel and victim are not lying, kneeling or standing in a pool of water before the AED is turned on.

There was ONLY one person out of TWENTY-ONE, who performed the rescue in four minutes—he is a professional triathlete. He achieved the time by not continuing CPR once it was determined the victim was not breathing, had no pulse, and he took less than two seconds to simulate hooking up the electrodes and towel off the victim. Lifeguards that were members of the university swim team averaged four and a half minutes while lifeguards that were not swim team members averaged five and a half minutes.

I feel Dworkin’s statement sets a standard that every lawyer will now use as the “standard” for all lifeguards as stated by an “expert”. The data shows that even under ideal and controlled conditions that it cannot be done consistently under four minutes as he suggests!

There are numerous real-world problems lifeguards can encounter, such as removing the top of a bathing suit on a female to place electrodes, other lifeguards unable to help until the pool is cleared, determining that a AED is needed, transporting the AED to the rescue scene, and so on.

Here is some other interesting data regarding how often AED may be needed. This information is a preliminary report from a national lifeguard training agency (Jeff Ellis & Associates) that accurately tracks aquatic facility statistics (this information was presented at the 2000 Texas Public Pool Conference). In 1999, the facilities Ellis tracked had 60,000,000 people go through them. There were only three cardiac arrests in all of 1999, and all three were not in the water at the time of their arrest. One person in 20,000,000 patrons had cardiac arrests at these facilities. Statistically speaking, if a pool had 1,000 patrons a day and is open 90 days a year, that facility can expect to have an heart attack once every 222 years. The same pool open 300 days a year can expect to have an event once every 66 years.

The other problem I have is with Dworkin’s statement comparing the ease of updating an AED to that of “any computer.” I truly would like to hear a CEO of a company that manufacturers AEDs make that statement. More than likely, the CEO would be fired by the shareholders for being such an idiot! I have upgraded, as in purchased new, my computer on average of every three years to keep up with technology, and my first IBM PS-2 is now a very expensive paperweight. Maybe comparing it to a toaster would be better, a very expensive toaster.

I really would like to have aquatic facility operators say that we will and should be responsible for problems, incidents, and accidents that we can PREVENT. Yes, people can dive into the shallow end of a pool and have a spinal injury. We cannot stop them, but we did warn them the best we could. Did we try to prevent the accident? The only way we can prevent all accidents is to prevent people from using the facility. A cardiac arrest is something that can happen anytime or anywhere, but my pool did not cause a person to have a cardiac arrest. I would love for the aquatic facility operators to say we have lifeguards that enforce rules, prevent accidents, assist patrons, provide basic first aid, and make rescues, and are able to notify the proper professional caregivers that are needed.

We already have a lifeguard shortage and I do not think it will help to add more and more duties, certifications, and LIABILITY to our lifeguards. LIABILITY is the trump card when someone wants to slam the door shut to reality. Reality is the minute you take the job you become LIABLE everyday you are on the job. In fact, I lost an excellent lifeguard when a conversation with her parents turned into a discussion concerning LIABILITY. The lifeguard told her parents that she would be responsible for any mistake made during an incident and her parents told her that she had to quit her job as a lifeguard immediately. We can be held responsible for anything that we do or do not do, but no one seems to understand this until there is an accident and litigation is involved. We are going to start hearing more and more from parents saying to their child, “You are doing what, for how much money, and you are responsible for that, and you screw up and you’re liable.” I do not think so!
I am not against AEDs, but I just want lifeguards to be able to do what they do best—help prevent injuries and provide first aid when needed. Soon lifeguards will need to go to medical school before qualifying for a guarding position. I also am very tired of people writing articles that are basically self-promoting to be an “expert witness”. Lifeguards have a truly difficult job, and they do a great job. Can they do better? Yes, all of us aquatic professionals can do better. It unfortunately comes down to who has the best lawyer.