Introduction

Each year, about 4,000 people die from drowning in the United States (National Center for Health Statistics, 2000). Drowning was a leading cause of unintentional injury death among all ages in 1998, and the second leading cause of unintentional injury death among children ages 1-14 that same year (National Center for Health Statistics, 2000). Approximately 50-75% of drownings occur in open water such as oceans, lakes, rivers, and ponds (Dietz & Baker, 1974). About 60% of drowning deaths among children occur in swimming pools (Dietz & Baker, 1974).

Most drownings are preventable through such means as restricting swimming areas, posting warning signs, and fencing the perimeters of pools and waterways. Two important preventive strategies are providing lifeguards in public areas where swimmers frequent, and encouraging use of such protected areas. The United States Lifesaving Association (USLA) compiles statistics for drownings that occur at about 95% of ocean beaches and at some non-ocean sites patrolled by lifeguards.¹ For the years 1988-1997, USLA recorded fewer than 100 drownings at these sites with more than three-quarters occurring during hours when the beaches were unguarded (USLA, 2000). These data indicate that the vast majority of drownings each year occur at unguarded locations (Mael, Seck, & Russell, 1999); about 60%-70% of U.S. beaches are unguarded (Brewster & Richardson, 2001). USLA statistics estimate that the chance of drowning at a beach protected by lifeguards trained under USLA standards is less than one in 18 million per year (USLA, 2001).²

The Centers for Disease Control and Prevention (CDC), the American Red Cross and USLA routinely respond to inquiries regarding the efficacy of lifeguards in preventing drownings. Community and local government officials facing decisions about whether to begin, retain, or discontinue lifeguarding services typically want to know whether lifeguards are truly effective in preventing drowning and other aquatic mishaps, and whether the value of providing lifeguards outweighs the costs. Officials often use cost as the primary criterion in their decision-making.

This report is the result of a 1998 meeting CDC convened with a panel of experts to identify gaps in lifeguard effectiveness at recreational waters, and ways to remedy them. This meeting was intended as a discussion about the issues related to the provision of lifeguards. This working group discussed:

• the problem of retaining lifeguards and evaluating the efficacy of existing lifeguard services;

• drowning fatalities and other hazards resulting when lifeguards were removed from facilities;

• the best methods to communicate information about the efficacy of lifeguards to relevant constituents; and

• sources of information about the efficacy of lifeguards, additional data, resources, and case studies.

The report includes a brief history of lifeguarding services in the United States; data and findings related to the use of lifeguards in preventing drowning in open water and swimming pool facilities; the experience of an agency which does not provide lifeguards at its water recreation facilities; and economic and legal issues related to the provision of lifeguards. We also provide suggestions for decision makers and alternative solutions for preventing drowning.

Drowning prevention, much like other areas of injury prevention, is a young and emerging field. This report aims to stimulate new ideas and approaches. The authors of this report hope it is useful to local policy makers who must make vital decisions about the provision of lifeguards and other interventions to enhance water safety in their communities.

¹ Open water lifeguard agencies submit reports on annual beach attendance, rescues, preventive actions, drownings and other information to USLA, which reports lifesaving statistics from eight regions, with typically over 85 agencies and beaches reporting (USLA, 2001).

² This calculation is based on ten years of reports from USLA affiliated lifeguard agencies, comparing estimated beach attendance to the number of drownings in areas under lifeguard protection.