It was a pleasant summer day. The outdoor pool, a fairly large facility with 6-8 guard stations, was open. In the middle of open swim, a situation develops which causes lifeguards to jump from their stations into the water, submerge themselves on the bottom of the pool, stay on the bottom as long as possible, come up and check the situation, and then return to the bottom of the pool. What the lifeguards were responding to were gun shots. The standard procedure for gunshots heard is for lifeguards to jump, enter the water, submerge and stay there until they know the situation on the top of the water is safe -- theory being, a dead lifeguard is of no use to anyone. The safest place to be when you are out in the open in a swimming pool during gun[ire is on the bottom, not up on top or on deck. So, indeed, a young lifeguard submerged, stayed there, and came up when the shots had finished. The actual shooting occurred in a locker room area. Lifeguards had to clear the pool, deal with the shooter until police arrived, and do an evaluation after the event.
This is only one of many different life threatening situations lifeguards face. Probably the most familiar life threatening situations are patron generated -- water related incidents that are drownings or near drownings, as well as non-water related incidents such as a heart attach on deck or in the locker room. But lifeguards face other life threatening situations. A second type of life threatening situation is the non-water related life threatening situation; gun shots, assaults, and stabbings. A third category of life threatening situations which can happen to lifeguards are natural disasters, like tornadoes, which happen when the facility is open.
All of these life threatening situations have several common factors--
* They threaten the very life existence of someone
* They involve the presence of the lifeguard (or could)
* They are all psychologically distressing
* They are outside the range of usual human experiences (including bereavement, chronic illness, business loss, and marital conflict -- normal trauma in life)
* They all have the potential to result in post traumatic stress disorder (PTSD) for the persons involved.
Post traumatic stress disorder is development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member of other close associate. (APA, 1996).
PTSD gets it's definition from the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association -- more commonly known at DSM -- at this point in time, DSM IV.
Diagnosis in an individual is by characteristic symptoms which include --
* exposure to a traumatic event that is life or serious-injury threatening, during which the individual experiences a response of helplessness, extreme fear and/or horror
* re-experiencing a traumatic event through dreams, intrusive thoughts, reliving the experience, psychological distress upon exposure to event cues, and/or psychological distress upon exposure to symbols of the event
* persistent avoidance of stimuli associated with the trauma, or a numbing of general responsiveness that was not present before the trauma
* persistent feelings of increased arousal not present before the trauma, including sleep disturbances, irritability, difficulty concentrating, hypervigilance, and exaggerated startle response
* intensified symptoms when exposed to situations or activities that resemble or symbolize the original trauma
* a full symptom picture present for more than one month
* a disturbance causing clinically significant distress or impairment in social, occupational, or other important areas of functioning
PTSD can be--
* Acute -- duration of symptoms of less than 3 months
* Chronic -- when symptoms last 3 months or longer
* Delayed Onset -- at least 6 months have passed between the traumatic event and the onset of symptoms
Focus here is on PTSD, it's causes and occurrence specifically related to the job of the lifeguard and, more particularly, the job of seasonal lifeguard. This will include discussion of lifeguard related causes of PTSD, as well as recognition, treatment, and prevention of PTSD.
Lifeguard Related Causes of PTSD
We know what lifeguards do that contributes to stress build-up. They--
* sit or stand in the same place for long periods of time
* repeatedly visually scan the same area
* experience the potential for boredom while having to remain highly alert
* respond immediately through extremely physical tasks with little time for thought and analysis
* repeat and repeat their emergency response pattern
* endanger their own lives
* may have to watch or assist other rescue workers
* may observe death
* may have to apply emergency rescue techniques, including techniques which could result in contraction of fatal disease, and
* may have to invest an intense amount of physical and emotional energy in trying to save a life and be unsuccessful in that attempt.
Lifeguards have described (Nealy, 1993) the extreme impact of their experiences--
* Seeing a dead person -- pupils fixed, eyes rolled back, blue skin, flaccid skin, lack of muscle tone, no movement, wet, slippery -- are characteristics remembered by all. …