Water Safety/Drowning/Lifesaving

World Art on Swimming

by Stathis Avramidis

Avramidis, S. (2011) World Art on Swimming. International Journal of Aquatic Research and Education¸ 3(5), pp. 325-360.

This article aims to identify swimming-related artwork from Paleolithic times up to the present day and to assess... more This article aims to identify swimming-related artwork from Paleolithic times up to the present day and to assess whether possible use of art could act as an aid to teaching. An art search obtained 50 paintings and sculptures. Results confirmed that artists have bestowed a wealth of related artwork on the world of aquatics. Depictions of people swimming competitively or recreationally, diving, bathing, working and fighting were found in Egypt, Greece, Persia, Italy, Spain, the USA, Japan and China. Depending on the particular society, the ability to swim indicated either a high or low socio-economic status. In some depictions, knowledge of swimming was accompanied by the ability to dive from high cliffs or into deep water, to hold one’s breath underwater, and to show physical endurance. A variety of swimming strokes were depicted throughout history in art. Various types of swimwear, or nude swimming, were evident in different societies.

The 4W model of Drowning

by Stathis Avramidis

Avramidis, S., Butterly, R., & Llewellyn, D. (2007) The 4W Model of Drowning. International Journal of Aquatic Research and Education¸ 1(3), pp. 221-230.

The aim of the present study was to develop a conceptual model of drowning incidents. Qualitative content analysis... more The aim of the present study was to develop a conceptual model of drowning incidents. Qualitative content analysis (QSR, 2002) of drowning incident videos (n = 41), and semi-structured interviews of those involved in drowning incidents (n = 34) followed by the measurement of frequencies and Boolean search with matrix intersection was conducted. Results confirmed that when there is human activity in, above, or around an aquatic environment, a drowning incident may occur to whomever, wherever, and under whatever circumstances may exist. Factors that determined drowning outcome were, in order of importance, rescuer characteristics (Who1), casualty characteristics (Who2), location (Wherever), and general circumstances (Whatever). The interaction of the rescuer with the casualty largely determines the outcome of drowning. The 4W model is a promising tool in lifesaving and lifeguarding.

Hollywood Stars’ Involvement in Aquatics and Water Safety

by Stathis Avramidis

4.3. Avramidis, S. (2010) Hollywood Stars’ Involvement in Aquatics and Water Safety. International Journal of Aquatic Research and Education¸ 4(2), pp. 208-222.

The aim of this educational review article was to identify cases of Hollywood stars who have been involved in... more The aim of this educational review article was to identify cases of Hollywood stars who have been involved in aquatics. A literature search was conducted using the terms ‘drowning’, ‘Hollywood’, ‘actor’, rescue’, ‘aquatics’, ‘swimming’ and ‘lifeguard’. It was found that several Hollywood film stars (n=33; males=20, females=13) have worked as lifeguards (n=12), performed lifeguard rescues (n=2), or lifesaving rescues (n=4), were aquatics athletes (n=6), or suffered drowning-related incidents (n=9). A brief overview of those actors and their involvement in aquatics is presented.

Under What Circumstances Do People Drown? Encoding the Fourth Component of the 4W Model

by Stathis Avramidis

Avramidis, S., Butterly, R. & Llewellyn, D. (2009) Under What Circumstances Do People Drown? Encoding the Fourth Component of the 4W Model. International Journal of Aquatic Research and Education¸ 3(4), pp. 406-421.

The aim of the present study was to identify under what circumstances people drown. Qualitative content analysis was... more The aim of the present study was to identify under what circumstances people drown. Qualitative content analysis was utilized to analyze drowning incident videos (n = 41), and semi-structured interviews of those involved in drowning incidents (n = 34). Results confirm that drowning incidents might occur at any time and during any season although mainly during the daytime. Drowning can occur after engaging in just about any form of human activity, on, near, above or under the surface of a liquid (mainly water), and often as the result of a lack in quality or absence of rescue and personal protective equipment. Also, any risky activity that doesn’t comply with appropriate safety procedures might lead to drowning and various types of rescue might be used.

Where do People Drown? Encoding the Third Component of the 4W Model

by Stathis Avramidis

Avramidis, S., Butterly, R. & Llewellyn, D. (2009) Where do People Drown? En-coding the Third Component of the 4W Model. International Journal of Aquatic Re-search and Education¸ 3(3), pp. 236-254.

When there is human activity in, above, or around an aquatic environment, a drowning incident may occur due to rescuer... more When there is human activity in, above, or around an aquatic environment, a drowning incident may occur due to rescuer characteristics, casualty characteristics, location, and general circumstances (Avramidis, Butterly & Llewellyn, 2007). The aim of the present study was to identify where people drown. Qualitative content analysis was utilized to analyze drowning incident videos (n = 41), and semi-structured interviews of those involved in drowning incidents (n = 34). Drowning incidents may occur in any aquatic environment with a water depth that allows immersion or submersion; in a variety of environmental conditions; where the ground in sloping; at any distance from safety; where anxiety is caused; in the absence or safety regulations or when the law is breached.

Who Drowns? Encoding the Second Component of the 4W Model

by Stathis Avramidis

Avramidis, S., Butterly, R. & Llewellyn, D. (2009) Who Drowns? Encoding the Second Component of the 4W Model. International Journal of Aquatic Research and Education¸ 3(3), pp. 224-235.

The aim of the present study was to identify the casualty characteristics that contribute to drowning according to the... more The aim of the present study was to identify the casualty characteristics that contribute to drowning according to the 4W model (Avramidis, Butterly & Llewellyn, 2007; 2009). Qualitative content analysis was used to analyze drowning incident videos (n = 41), and semi-structured interviews of those involved in drowning incidents (n = 34). Results confirm that human activity in, on, around an aquatic environment can lead to drowning regardless of the casualty’s type, gender, age, ethnicity, and area of residence. Males far outnumbered females as drowning victims. Younger persons were more likely to drown than adults. Due to socio-economic differences black people in our sample were likely to drown more often while whites who drowned were engaged in aquatic activities that lower socioeconomic individuals likely cannot afford or gain access to. Non swimmers, casualties who have lost consciousness and non-residents to specific aquatic environments also were the ones in the highest danger.

Crucial Findings from the 4W Model of Drowning for Practical and Teaching Applications

by Stathis Avramidis

Avramidis, S., McKenna, J., Long, J., Butterly, R. & Llewellyn, D. (2010) Crucial Findings from the 4W Model of Drowning for Practical and Teaching Applications. In Kjendlie, P-L., Stallman, R.K., & Cabri, J eds., 40th International Symposium for Biomechanics and Medicine in Swimming 2010, Oslo: Norwegian School of Sport Sciences, pp. 00-00.

This study aimed to suggest practical and teaching applications of the 4W model of drowning. A major literature review... more This study aimed to suggest practical and teaching applications of the 4W model of drowning. A major literature review of quantitative research was undertaken to identify potential risk factors of drowning, qualitative content analysis was used to analyze pub-licly available drowning incident videos (n = 41, M = 345.0, SD = 2.8), and 34 individu-als involved in drowning incidents were interviewed (30 males age 16–65 years, M = 28.4, SD = 11.3; 4 female age 19–65 years, M = 37.5, SD = 19.5). Results confirmed that test criteria such as a 100 m run–50 m swim–100 m run for open water and a 50 m run–20 m swim–50 m run for pool/water parks could be more useful for assessing speed com-bined with an ‘early approach’ to the victim than any currently in operation. The ‘early approach’ criterion would be established to test the ability of the lifeguard to be able to remain alert, to have good vision, to recognize the casualty’s instinctive drowning re-sponse, to initiate a rescue ignoring the bystander’s lack of response and to reassure the drowning victim. Drownings and their rescue interventions should be perceived as 3-dimensional problems.

Risk Taking Behaviour as a Cause of Drowning after Engagement in Swimming & Non-Aquatic Activities

by Stathis Avramidis

Avramidis, S., Butterly R., & Llewellyn, D. (2007) Risk Taking Behaviour as a Cause of Drowning after Engagement in Non-Aquatic and Swimming Activities. In: Farmer, N., & Beerman, S. eds. World Water Safety Conference & Exhibition 2007, Oporto (Portugal), AsNaNa and International Life Saving Federation, Matosinhos 27-29/09/07, p. 21.

Context: According to the 4W model one of the key factors of drowning is the casualty characteristics (Avramidis,... more Context: According to the 4W model one of the key factors of drowning is the casualty characteristics (Avramidis, Butterly, Llewellyn, 2007). The aim of the study was to identify if risk taking behaviour can lead to drowning after engagement in swimming and non-aquatic activities. Methods: Qualitative content analysis (QSR, 2002) of drowning incident videos (n = 41), and semi-structured interviews of those involved in drowning incidents (n = 34) followed by the measurement of frequencies and Boolean search with matrix intersection was conducted. Results/Discussion: Risk-taking behaviour was the cause of drowning in relatively few aquatic accidents (11, 15%). Sensation seekers were willing to take risks that involved psychological anxiety (7, 9%) for satisfying their need (e.g. illegal bungee jump and parachute jump from high bridges etc.) (Franken et al., 1992). Learning Outcomes: 1. People behave riskily while engaged in activities perceived as controllable by themselves and recognized as risky by others. 2. High sensation seekers are unrealistically optimistic, take risks voluntarily for satisfying their needs, view the world as less threatening and fearful, expect that the outcome would be less negative, and are likely to report a lifetime history of antisocial behaviour. 3. Risk taking behaviour can lead to drowning.

Drowning & Deaths due to Great Flood & Tsunamis Disasters

by Stathis Avramidis

Avramidis, S. (2004)  In: Barrosso, B.B., Gomez, L.M.P., Marinas, M.A.G., and Velaso, P.S. eds. VI Jornadas 2004, VI ESS Congress of Lifesaving. Book of Abstracts, Spain: Escuela Segovia de Socorisimo, pp. 225-226.

Abstract: Drowning is well established as leading cause of death in many age groups. It has also been said that... more Abstract: Drowning is well established as leading cause of death in many age groups. It has also been said that during great disasters loss of life is a great tragedy. Helpers or rescuers are always the hidden victims of a disaster. Therefore the problem is two-fold. Objectives: The purpose of this study was to evaluate the value of reported great disasters (tsunamis and floods). Method: Tsunamis and floods that are refereed in the book ‘Great Disasters’ of Albert et al., (1989) were evaluated. Results-Conclusion: (1) The examined disasters (n= 22) were floods (17, 77%), and tsunamis (5, 23%). (2) In 22 disasters during the period 1896-1988, totally 675.759 people were killed or drowned. (3) The results of such disasters are drowning or generally death, and lost of properties. (4) An international collaboration in coping great disasters between different countries, is vital as in those critical moments, it is very difficult to cope such wide emergencies relying on your own strengths. This is also possible because great disasters related to flood or tsunamis some times last days or even weeks and therefore, there is enough time for emergency services from other, neighbour countries, to come and assist.

Lifeguards at the Olympic Games?

by Stathis Avramidis

Avramidis, S. (2008) Lifeguards at the Olympic Games? Technical Rescue Newsletter, 53 p. 8.

Do we need Lifeguards in Olympic Games? This article presents an unusual case of lifeguard intervention during the... more Do we need Lifeguards in Olympic Games? This article presents an unusual case of lifeguard intervention during the Athens 2004 Olympic Games.

Miracle or Coincidence in Aquatic Rescue: A Case Report

by Stathis Avramidis

Avramidis, S. (2007)  In: Abraldes Valeiras, J.A. & Rodriguez, N. eds. Abstract Book of the International Lifesaving Congress, Spain: Lifesaving Federation of Galicia, p. 54.

Aim: To report the case of a fisherman who was speared and successfully rescued by lifeguards and neurosurgeons.... more Aim: To report the case of a fisherman who was speared and successfully rescued by lifeguards and neurosurgeons. Method: The case of a 20-year old fisherman is reported, who was speared in head entering at his jaw and protruding from the top of his scull; he was rescued, admitted to the intensive care unit for operation, stayed in comma for few days and had full recovery. About 10 days before the rescue, he had visited a monk who had told him that he ‘should not be afraid of anything’ rubbing the top of his scull and the jaw exactly at the points where the 40 inches spear passed. After the incident the monk predicted also the day that he will recover from comma. The author concludes that although there is not scientific evidence to support an ‘act of God’ similar to those reported in historical, mythological and Biblical references (Avramidis, 2007; Avramidis, Giannakidis, Petenioti & Avramidou, 2007), this case raises the likelihood of the existence of a miracle as contributing variable to survival. Future research on the basis of ‘is the rescuer or the casualty likely to be assisted by spiritual powers?’ remains in order.

Treating a Drowning Casualty with a Near-Death Experience

by Stathis Avramidis

Avramidis, S., Miner Holden, J.M., & Clark Sharp, K. (2007) In: Abraldes Valeiras, J.A. & Rodriguez, N. eds. Abstract Book of the International Lifesaving Congress, Spain: Lifesaving Federation of Galicia, p. 63.

Aim: Drowning casualties have sometimes reported near-death experiences (NDEs). Method: In this article, we review and... more Aim: Drowning casualties have sometimes reported near-death experiences (NDEs). Method: In this article, we review and suggest coping strategies that enable professional rescuers and lifeguards to provide more quality services to these individuals. We provide recommendations for the way that resuscitation should be performed, assuming that the casualty might be having an NDE, and for providing effective aftercare to an unconscious drowning casualty, a conscious casualty that cannot verbalize, and the recovered drowning casualty who had an NDE. Results-Discussion: Drowning is a leading cause of mortality and morbidity worldwide, and it is likely that about 10-30% of successfully resuscitated drowning casualties have had NDEs (Greyson, 2000). Thus, it is logical to assume that water safety professionals may have overlooked the occurrence of NDEs in previous resuscitants and that they are best equipped to provide the highest quality care to future resuscitants if they are armed with NDE-related knowledge and skills. Information about NDEs can be helpful not only to resuscitants but also to water safety professionals themselves. Equipped with the above knowledge and skills, they can feel prepared for the occurrence of NDEs among their successful resuscitants and confident that they will be able to respond in a way that is most facilitative of the drowning casualty’s future psychological well-being. In addition, the great majority of reported NDEs suggest a profoundly pleasurable existence beyond physical death, one to which nearly all NDErs look forward to returning when their life’s work has been completed. Thus, lifeguards and lifesavers can rest in the knowledge that drowning casualties who remained conscious beyond the first few moments of the drowning process probably moved beyond an experience of terror into one of profound peace and pleasure. Perhaps most importantly, when water safety professionals inevitably encountered victims who could not be saved, they might very well be comforted to know that any ongoing conscious experience on the part of the victim was most likely of a profoundly pleasurable nature (Holden, in press).

Influence of biomechanical parameters on the straddle entry used in lifesaving and lifeguarding (Abstract)

by Stathis Avramidis

Avramidis, S. (2002) Exercise & Society Journal of Sport Science, 31, pp. 188-189.

Introduction: The straddle entry has been recommended by many lifesaving organizations around the world a safe tool... more Introduction: The straddle entry has been recommended by many lifesaving organizations around the world a safe tool for demonstrating an effective and  safe entry into the water, in order to achieve a successful rescue. Nevertheless, none has yet investigated scientifically the variables that constitute the quality of the required biomechanical characteristics for both sexes. Purpose: The purpose of the study was to see if a difference in technique of straddle entry (SE) is reflected in corresponding differences in a head length which will be maintained above the water at the end of the entry. Method: Two qualified lifeguards from the RLSS UK, served as participants. The female lifeguard (FL), was ex-national champion sprint breaststroke swimmer (age 23 years, height 1.50 m, mass 63.1kg) and the male lifeguard (ML), was ex-national champion water polo player (age 27 years, height 1,86 m, mass 84.3kg). They performed 40 trials of the SE in different conditions using the technique of the flexed and apart legs. Anthropometric variables were measured. The lifeguards were filmed in the saggital plane, with a 24Hz digital video camera above and a waterproof video camera under the water. A 2-D kinematic model was employed to obtain the join angles. Biomechanical parameters were examined and statistical differences were checked. Findings- Results: The variable that determines the maintenance of the head above the water (HAW) after the submersion for the FL was the angle among femurs (AAFs) and also the combination of AAFs with the forward trunk inclination. The FL was also dependent on variables such as the toe-to-toe distance (T-t-TD) and the knee-to-knee distance (K-t-KD). The ML showed that it depended only on the K-t-KD and the T-t-TD.  The ML was found to easily maintain his HAW when using any entry. The male's entries did not have significant differences between each other. The FL had significant differences between the conditions which required smaller and bigger AAFs, small AAFs and the complete SE, and finally the mid-point AAFs and the complete SE. The ML demonstrated a superiority in maintaining the HAW overally. The FL performed a better complete SE. Conclusion: The above findings are the first in the area of lifesaving. They are applicable by the ML and FL in indoor swimming pools and in a calm open water. Althought only two subjects were used, it may soon be possible to achieve integration of research findings in to the field of SE. Therefore, further research is required.

Competitive Anxiety in Lifesavers and Swimmers

by Stathis Avramidis

Avramidou, E., Avramidis, S., Pollman, R. (2007)  Competitive Anxiety in Lifesavers and Swimmers. International Joumal of Aquatic Research and Education, 1(2), pp.  108-117.

This study examined state and trait anxiety in competitive lifesavers and swimmers. The participants completed the SAS... more This study examined state and trait anxiety in competitive lifesavers and swimmers. The participants completed the SAS and the CSAI-2d before a training session and the CSAI-2d again before a competition. The competitive lifesavers were found to have lower levels of cognitive and somatic anxiety than competitive swimmers. Both groups were found to have lower levels of self-confidence but higher levels of somatic anxiety before a competition than before regular training sessions. Lifesavers found their levels of somatic anxiety to be more facilitative than the swimmers did. Both groups perceived that higher levels of self-confidence were more facilitative before competition than before training. Differences in the relationship between state and trait anxiety for swimmers and lifesavers were observed. The generally lower levels of cognitive and somatic state anxiety in lifesavers and their interpretation of somatic anxiety during competition would benefit their performance and decision making.

Lifeguard Operations: Summary of Practices at the Athens 2004 Olympics

by Stathis Avramidis

Avramidis, S. (2008) Lifeguard Operations: Summary of Practices at the Athens 2004 Olympics. International Journal of Aquatic Research and Education¸ 2(1), pp. 47-56.

The article discusses the impact of an accident on each host country for the Olympic Games, in which an athlete cut... more The article discusses the impact of an accident on each host country for the Olympic Games, in which an athlete cut his head after diving from a 3-meter springboard in September 1988 in Seoul, Korea. The lessons learned from the incident were applied by each host country to organize better facilities and safer games. Sports facilities, particularly the aquatic facilities and the lifeguards who had to supervise the swimming pools, also must be ready.

Drowning Survival in Icy Water: A Review

by Stathis Avramidis

Avramidis, S., Butterly, R. (2008) International Journal of Aquatic Research and Education, 2(4), pp. 355-362.

We conducted an extensive literature review using the search terms of “drowning” and “hypothermia” to discover the... more We conducted an extensive literature review using the search terms of “drowning” and “hypothermia” to discover the major factors related to differences in survival rate especially associated with hypothermic effects. Studies indicated that some differences in drowning survival could be identified associated with age, sex, length of submersion, reduced core body temperature, and quality of cardiopulmonary respiratory care. The variability of results associated with the large number of studies prevented us from making any recommendations about whether hypothermia can improve survival among either children or adults.

Letter to the Editor

by Stathis Avramidis

Avramidis, S. (2008) International Journal of Aquatic Research and Education¸ 2(2), pp. 103-105.

Animal Rescuers: A review

by Stathis Avramidis

Avramidis, S., Avramidou, E. (2008) Animal Rescuer: A Review. International Journal of Aquatic Research and Education¸ 2(4), pp. 346-354.

What do pigeons, dolphins, horses and dogs have in common with a rescuer? They have all been used as partners in... more What do pigeons, dolphins, horses and dogs have in common with a rescuer? They have all been used as partners in rescuing drowning casualties. The present review article summarizes how they contribute to a rescue, as well as describes some historical incidents in which animals saved human lives. Animals rescue humans either as a result of training that they have received, or they are driven by pure instinct ((Abstract of the authors)

Lifeguard Leadership

by Stathis Avramidis

Avramidis, S. (2009). Lifeguard Leadership. International Journal of Aquatic Research and Education, 3(1), pp. 89-100.

Drowning is a universal and leading cause of accidental death worldwide (Avramidis, 2003a; Bierens, Knape, &... more Drowning is a universal and leading cause of accidental death worldwide (Avramidis, 2003a; Bierens, Knape, & Gelissen, 2002). Some people believe that the solution to preventing drowning is to have lifeguards assigned to all areas where people can swim or enter the water. Several decades ago, some people believed that a key to improved water safety was at hand, merely through the hiring of lifeguards. Eventually, most aquatic agencies realized that another key to improved water safety is the careful training and supervision of these lifeguards (Griffiths, 2000). In fact, this author argues that we also need a “head” or “lead”lifeguard, who will “guard,” or supervise, the lifeguards.

Drowning in Greek History and Mythology

by Stathis Avramidis

Avramidis, S. (2009). Drowning in Greek History and Mythology. International Journal of Aquatic Research and Education, 3, pp.422-431

The purpose of this article was to describe the prevalence of drowning as a cause of death in the mythology of ancient... more The purpose of this article was to describe the prevalence of drowning as a cause of death in the mythology of ancient Greek history and under what circumstances it occurred. From all the names and references (n= 40,000) recorded in a database of the ancient and mythological Greek literature (Devouros, 2007), the number of drowning incidents was identified (n=37, 17 males (45.94%), 6 females (16.22%), and 14 reports of multiple casualties (37.84%). The review of the database confirmed that drowning was attributed to ‘acts of demigod’ but was more often due to human accidental submersion or to ‘acts of God’ such as disasters like heavy rain, flooding, or tsunamis. Based on this review, the causes and rates of drowning (down from 57.5 to 2.69 per 100,000 population) may have changed through the centuries, but death by drowning remains a major health problem in Greece.