SENTINEL - A systematic approach to the early recognitions of drowning; The right response, to the right victim, at the right time

TitleSENTINEL - A systematic approach to the early recognitions of drowning; The right response, to the right victim, at the right time
Publication TypeConference Paper
Year of Publication2007
AuthorsDoyle, B, Dr Webber, DProf, J
Conference NameWorld Conference on Drowning Prevention
Date Published09/2007
PublisherInternational Life Saving Federation
Conference LocationPorto, Portugal
Other Numbers01-09

Context: Over two years from 2002-2004 our group conducted several studies on a large number of lifeguards into their ability to detect drowning behaviour at a variety of New Zealand beaches. The purpose of these studies has been to investigate lifeguard efficacy and to gain consensus on the most common behaviours displayed by distressed victims. Our results identified that the lifeguards we studied seldom detect the very early signs of distress and can fail to detect obvious autonomic behaviours (ie. the instinctive drowning response) well established by Pia. In multiple victim rescue situations our results identified that lifeguards generally have an inability to perform in-water triage. This resulted in some victims with a ‘low threat to life’ being rescued more readily than those with a ‘high threat to life’. In 2005, further research conducted identified the need for a new system to describe in more detail the subtle behavioural changes observed in some swimmers progressing through the ‘continuum of drowning’.

Method: The results from two independent observational studies and expert panel review of actual video footage of drownings provided the authors with a list of the most prevalent in-water behaviours displayed by persons requiring rescue in an open water surf environment. The authors divided these behaviours into five different classifications to create the SENTINEL model. We tested the application of the model on a category 9 (ABSAMP) rated beach. Each series of data (in water behaviour) was grouped and provided a status code from 1 to 5. These codes mirror existing triage and risk models such as the Australasian Triage Scale (ACEM). The status code is representative of the victims ‘threat to life’, and the response required to ensure the best outcome. For example; a submerged victim has an immediate threat to life, requires immediate removal from the water, in-water resuscitation as required and activation of emergency medical services before the victim is returned to shore. The status codes can be used for individual or multiple victim scenarios to prioritise who is rescued first, second and so forth. Because drowning is a complex public health problem we conducted a review of available literature to link environmental and host risk factors to each status code.

Results and Discussion: Early results are encouraging. SENTINEL is a new educational tool easily applied by lifeguards to classify a person’s risk of drowning by the behaviour they observe. These behaviours are likely to correlate to the SENTINEL status codes. The status codes provide the user with a plan based on observational data in which tactical and strategic decision making can be based. We believe SENTINEL will provide a framework for planners, educators, lifeguards, paramedics and emergency departments. This framework will provide a common language in terms of the severity of an incident. It will assist risk stratification of non-fatal drowning victims from the water to the beach; from the beach to the ambulance; from the ambulance to the hospital. Further research on the use of SENTINEL by lifeguards has commenced and early results will be presented at WWS.

Learning Outcomes
  1. Be able to identify a drowning victim at any stage of the ‘drowning continuum’, by viewing actual footage of drowning victims
  2. Describe the behaviours associated with each stage of the SENTINEL model
  3. Provided a simulation, be able to assign a status code using the SENTINEL system.
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