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  • National CPR/AED Awareness Week

    National CPR/AED Awareness Week

    June 7th concludes National CPR/AED Awareness Week, and we at West Central District Health Department wanted to remind our communities about the importance of knowing CPR (cardiopulmonary resuscitation) and understanding how to use an automated external defibrillator (AED). When you think about it, these are remarkable discoveries. With a few simple steps, one human being can literally do the work of the heart and lungs for another human being, in essence, creating blood flow and a pulse to keep the brain and other vital organs supplied with life-giving oxygen until more advanced help arrives. A small electronic device, about the size of a toaster, can be used by simply looking at pictures and following voice prompts. This small device can deliver a shock of electricity that can return the heart to a normal, life-sustaining rhythm. When cardiac arrest occurs, the early initiation of CPR and the use of an AED gives the person in need a real chance at more time…more time for family, friends, celebrations, holidays, work, and purpose.

    CPR, taught in healthcare, taught in the workplace, taught in schools, and taught in the broader community is a powerful and empowering way to care for each other as members of a community. When sudden cardiac arrest occurs, and the heart is unable to supply oxygen, the quick action of a family member, a co-worker or even a stranger can mean the difference between life and death. The American Red Cross identifies 5 critical steps that need to occur to give someone in cardiac arrest the best possible chance of survival. These steps, known as the “Cardiac Chain of Survival” are the vital links everyone should know. The first link in the Cardiac Chain of Survival is early recognition and early activation of EMS. The signs of cardiac arrest include sudden collapse, loss of consciousness and respiratory arrest. The sooner 911 is called in a cardiac arrest, the more likely it is that a victim will survive. The second link is early CPR. Good effective chest compression started with haste can keep the flow of blood circulating until help arrives. Whether the responder is trained as a professional rescuer, is trained in a traditional workplace or community-based program, or even trained in the “Compression-Only” method of CPR, the effort to provide chest compressions doubles the chance of survival. The third link is early defibrillation by an AED. When serious illness or injury occurs, the electrical system in the heart can “short circuit” and circulation will stop or become too ineffective to sustain life. An AED is a portable electronic device, found in many public places, that can correct the abnormal heart rhythm and allow the heart to resume beating normally. According to the Red Cross, for every minute CPR and an AED are delayed, the victim’s chance of surviving goes down 10%. The fourth link in the chain is early advanced life support. When paramedics arrive on scene, they bring with them a set of skills that essentially make them an extension of the emergency room physician. Their training and expertise can go a long way in creating a good outcome. The final link is integrated post-cardiac care. The care received once the person arrives at the hospital is vital to his or her recovery and the recovery process is now seen as so important, the Red Cross has recently added it as a sixth link.

    According to the American Heart Association, in a single year, there are on average 475,00 deaths in the U.S. from cardiac arrest and when looking at out-of-hospital cardiac arrests, 70% occur in the home, with just under 19% occurring in public settings and just over 11% in nursing homes. The statistics tell an important story. When you take just a few hours to learn CPR, the person you save is most likely to be someone you know, someone you love, and someone you don’t want to be without. There is a universal need for everyone to know CPR. As we end National CPR/AED Awareness Week, please make a commitment to yourself, to your family and friends and to your community to learn to save a life.

  • Healthy Water, Healthy Swimming

    Healthy Water, Healthy Swimming

    What could be more inviting than crystal clear water on a hot summer’s day, a sparkling invitation to “come on in, the water’s fine!”? Is the water actually fine, and how do we know? Water is not only inviting to people, but also to a host of microorganisms and disease-causing germs. West Central District Health Department wants to empower you with information so that a water-borne illness doesn’t dampen your summer fun! Many folks are familiar with stale, stagnate water and its characteristic rancid smell. Dark and murky, this type of water would cause most people to steer clear. The challenge, particularly when it comes to public health, is identifying water that may not be healthy for swimming even though it looks clear and inviting. Water that people can enter, play in, swim in and enjoy is known as “recreational water.” Water in swimming pools, hot tubs, water playgrounds, lakes, rivers and even the ocean are all “recreational water.” Any of these bodies of water can be contaminated by any number of pathogens that can make you sick.

    Even when swimming pool operators do their best, they need your help to keep the water safe for everyone. Remember, you share the pool water with everyone and in large facilities, that could be hundreds of people every day. The most important safety tip you and every member of your family should know is to NEVER drink any recreational water. People are naturally more averse to drinking water from a natural body of water, but swimming pool water looks just like the water in our glass. Swimmers, particularly children, are more prone to swallow pool water than they might water that is less clear. Children will need to be reminded regularly about this very important water safety tip.

    The biggest concern when it comes to RWI’s is water contaminated with diarrhea. If someone with diarrhea contaminates the water, swallowing that water can make you sick. One person can contaminate an entire pool. Because it is not always apparent when someone has an accident in the pool, the best way to stay safe is to avoid getting water in your mouth and make that a practice during every swim, every time. Parents should not allow children to swim if they have diarrhea. Parents should also not change diapers on the pool deck, using designated changing areas only. Diaper changing on the deck can inadvertently contaminate the deck. If someone walks through the contaminated area, they can then spread those germs to the pool water. Children not reliably toilet trained must wear an appropriately sized swim diaper. This is a requirement in public swimming pools in the State of Nebraska. All swimmers, but especially children, should visit the restroom before entering the pool, even if they don’t feel any need. Parents should regularly check in with their children and remind them to use the restroom every hour or so.

    Before swimming and after every trip to the restroom, good hygiene goes a long way in keeping the pool water clean. Swimmers should take a cleansing shower prior to swimming and wash hand thoroughly after each trip to the restroom. Parents should also wash their hands after changing diapers. It may be surprising, but a common way for fecal matter to enter the pool isn’t from an accident in the pool but from incomplete or improper cleaning after going to the bathroom. If even that small amount enters the water, it can potentially make other people sick.

    While swallowing contaminated water is the biggest risk, you can also become sick through simple contact with the water, from breathing in the mists or aerosols from water contaminated with germs, as in hot tubs or spas, or even the chemicals created when chlorine interacts with the organic compounds found in urine, sweat, and feces. There is a common misperception that the strong, unpleasant chlorine odor found particularly at indoor pools is due to high levels of chlorine. The smell is actually the result of a buildup of what are known as chloramines, the compounds formed when chlorine is working overtime to disinfect substances like urine in the pool.

    The most common pathogens that cause RWI’s are microorganisms known as Cryptosporidium and E.coli O157:H7.1 Chlorine is an excellent disinfectant and it can take care of many pathogens quickly. Some, however, can live in pool water for some time, and “Crypto” can live in pool water for days. Crypto can be life threatening in people with compromised immunity. Children and pregnant women are also more at risk for severe illness. Crypto and E.coli cause acute gastrointestinal illness. Other pathogens of concern that cause acute gastrointestinal illness are norovirus, shigella, and giardia. These disease-causing germs can be found in natural water as well, even in that crystal clear mountain stream. Resist the urge on your hiking trip for a sip! You should never drink from a natural body of water. Pets can also be sicked by contaminated water. Germs like Legionella and Pseudomonas can cause acute respiratory illness and along with Pseudomonas, Avian schistosomes and algal toxins can affect the eyes, ears and skin.2

    The very best way to protect yourself and others is to stay out of the pool for two weeks following a diarrheal illness. Keep water out of your mouth and dry your ears after you swim. It is also helpful to understand what to expect when an accident does happen in the pool. The State of Nebraska’s regulations for swimming pool operators are designed to protect the public from RWI’s. If a solid stool is found in the pool, the pool will be cleared immediately. Pool staff will remove the stool and verify that the chlorine levels and pH of the pool meet the required levels. Bathers must remain out of the water for 30 minutes while the disinfection levels are assessed. While it is definitely an unpleasant thought, solid stool is considered “healthy stool.” If there is a diarrheal accident, however, it is considered to be a potentially infectious stool so the pool will be cleared and immediately closed. Staff will remove as much as possible and then pool operators will raise chlorine to very high levels. This level must be maintained for a specified number of hours. The pH, which is important in the effectiveness of the chlorine, must be lowered to levels incompatible with swimming as well. The pool filter must cycle through the entire volume of pool water a number of times and the entire filtration system must go through its own cleaning process. Even after these processes are complete, it can take days for the chemical levels to return to safe swimming levels. One “accidental fecal release” as it is known to pool operators, can close a swimming pool for days. In the summer heat or any time, that is the last thing a pool operator wants to do. Keeping recreational water safe takes a community approach. Education is the key! You can do a great deal to keep swimmers in the pool and disease-causing germs out of the pool!

    We hope you have found this 3-part series on water safety informative. Water safety is a body of knowledge designed to allow everyone to enjoy the many benefits of water! From the team at WCDHD, we wish you a safe and healthy summer of swimming!

    1,2,3 Centers for Disease Control and Prevention; Healthy Swimming

  • Healthy and Safe Swimming Week 2

    Healthy and Safe Swimming Week 2

    In this second installment of our “Healthy Communities” blog, we feature important and potentially lifesaving water safety information. In our first installment, we looked at drowning as a catastrophic event. We looked at the drowning process, the populations most a risk and the need for clarity and correct information about the behaviors and characteristics of a drowning victim. We highlighted common misconceptions about what happens in a water emergency and just how quickly someone, especially children, can lose their life in water.

    The good news is that drowning can be prevented. Aquatics professionals, healthcare professionals and leaders in public health like West Central District Health Department are a wealth of information about the ways families can mitigate risk and still enjoy summer’s favorite activity. Before heading to the pool, the lake, or the river, it is imperative that adult care givers prepare children of all ages for their time in the water and set clear expectations about the behaviors and actions needed to stay safe. Parents and caregivers should develop a plan that everyone must follow for a safe water visit and in a possible emergency situation. These water safety plans should be prepared even when a gathering is held near water, not just when the activity includes swimming. Remember, most people who drown did not enter the water intentionally.

    Take a water safety course if one is available in your area. A blog about water safety can only touch the surface of the things families need to know to stay safe around the wide variety of places people can enjoy the water. This type of education is not the same as swimming lessons. Water safety training is an educational curriculum that helps families develop a water plan that can prevent a tragedy and allow everyone to enjoy the wonders of being in the water safely. Swimming lessons should be thought of as an essential part of a child’s overall education. The philosopher Plato once remarked, “A man is not learned unless he can read, write and swim.” The earlier a child is introduced to the water the better. There are physical, cognitive, and emotional benefits beyond safety to young swimmers. Infants and toddlers demonstrate higher cognitive scores and better problem-solving skills than non-swimming youngsters.¹ Children who swim year-round are found to be more socially well-adapted. Water play also acts as resistance, building stronger muscles and better coordination. Swimming kids breathe better and get more oxygen.² Besides health and safety benefits, swimming is fun!

    One of the most concerning realities from a public health lens is the number of Americans who misjudge their ability or their child’s ability to swim. The ability to kick and paddle a few feet with the mouth barely clear of the water is often understood as “knowing how to swim.” The American Red Cross, the nation’s leading authority on water safety for over 100 years, surveyed Americans in 2014. The responses centered around a simple question, “Can you swim well enough to save your life?” Of Americans surveyed, 80% said they can swim…but less than half of Americans can perform all of the 5 basic skills that could save their life in water. Only 46% of Americans can perform all 5 of the basic water safety skills. These skills are: 1) Step or jump into water over your head 2) Return to the surface and float or tread water for at least one minute 3) Turn around in a full circle and find an exit while treading or floating 4) Swim 25 yards to the exit without stopping 5) Exit from the water with no assistance. These are the minimum skills required for anyone and they define what it means to be “safer” in the water.

    Beyond water safety education and learning to swim, parents and other caregivers should be very clear about their role in drowning prevention. Young children, non-swimmers and weak swimmers must be constantly supervised by a vigilant adult who remains within reaching distance of the child, even in the presence of lifeguards. Parents should not rely on floatation toys, “water wings” and other inflatables or even lifejackets to prevent drowning. While Coast Guard-approved lifejackets are important for non-swimmers and all boaters, parents cannot assume their child won’t remove a lifejacket when they are not looking and enter the water. Constant, vigilant supervision is necessary, with parents or caregivers in the water. Both parents and kids will also have more fun if everyone is in the pool!

    Make sure that there are barriers around any water and that those barriers are adequate and well-functioning. Home pools are a particular risk without common sense safety steps. Self-latching fencing and gates, locks, and alarms are all important, but nothing substitutes for constant supervision of young children. Remember that dangerous water for an infant and toddler can be as seemingly harmless as a bucket of water or a toilet. We talked last time about disproportionality in toddlers. Their heads are large and can make it impossible for them to get their face out of the water. Empty backyard kiddie pools each day. Infants under 1 year are more likely to drown at home, kids 1-4 are more likely to drown in a pool and kids 5-17 are more likely to drown in natural water.³ The bottom line is there is no substitute for adult supervision.

    When choosing where to swim, it is always better to swim in a lifeguarded facility. Lifeguards are trained to prevent and respond to emergencies and serve their communities as public safety personnel. Drowning rates are higher in un-lifeguarded areas. When enjoying a private pool, a lake front or riverbank, designate one person to be the “water watcher” and have rescue equipment available. Always keep a phone near the water and never let your phone become a distraction from the constant supervision of young children. Phones are your immediate connection to EMS in an emergency, but they can also interrupt that constant and vigilant supervision that is most needed. Caregivers should learn and practice CPR and First Aid for Severe Trauma.

    Teach your children to respect the authority of lifeguards and insist that they learn basic pool rules before being allowed to visit the pool without you. Rules are designed to protect everyone and one of a lifeguard’s primary duties is to enforce them. Remind swimmers to always walk. Have a targeted conversation about the dangers of headfirst entries into shallow water. Beyond drowning, spinal cord injuries are of real concern in any water setting. Those using open water where clarity is lacking should never use a head-first entry. Parents and caregivers can reinforce rules prohibiting pushing, shoving, dunking, and extended underwater breath-holding. Make sure your children visit the restroom before entering the water. In our final water safety blog, we will discuss recreational water-borne illnesses (RWI’s) and how you can help you and your child avoid these public health dangers.

    Keep an eye to the sky and avoid water environments during thunderstorms. Lightning is one of the most dangerous weather-related events and is of particular concern around any type of water. The American Lightning Foundation recommends leaving the water immediately upon seeing lightening or hearing thunder. Seek shelter and avoid tall structures, lone trees, and metal objects. Stay off landlines and out of showers. The recommended wait time to return to the water is 30 minutes following each lightning or thunder observation. If 30 minutes passes without lightning or thunder, you can return to the water, keeping a vigilant watch in case conditions change.

    When on vacation, make sure kids don’t head to the pool or hot tub until you are ready to go. If pool or spa water is murky or milky, rethink the decision to swim. Healthy pool water should be crystal clear. Check for broken and missing drain covers in both pools and spas. Congress passed the Virginia Graeme Baker Pool & Spa Safety Act to address the dangers of improper or broken pool drains after 7-year-old Virginia Graeme Baker drowned after she was trapped under water by the powerful suction of a hot tub drain.

    The most important component of any water safety plan, educational program or swim lesson is “respect.” Just as we teach our children to respect others, we must teach them to respect water. Water can be one’s best friend or worst enemy. The benefits to people of all ages of water are exceptional and swimming is truly one of life’s greatest enjoyments. Water, however, demands to be understood and respected. When we do that, we can go a long way in creating wonderful, lasting summertime memories of family, friends and the many joys of the water.

    1 http://www.braincourse.com/ambia.html
    2 http://healthbenefitsofwater.com/negative-ions/
    3 from Safe Kids Worldwide; Keeping Kids Safe In and Around Water

  • Healthy and Safe Swimming Week

    Healthy and Safe Swimming Week

    The final bell of the school year rings, and the eagerness of summer begins.  The heat of summer is relieved by the splashing, swirling, bubbling wonders of water in local pools, lakes, and rivers.  Many people are drawn to water for its cooling properties, the joy of movement unrestrained in the buoyant environment and the community of family and friends enjoying the signature activity of summer together.  May is National Water Safety Month and May 23-29 is Healthy and Safe Swimming Week, and West Central District Health Department is here to help you and your family enjoy the benefits of healthy swimming.  We are launching our blog with important information throughout this week about drowning, drowning prevention, and recreational water-borne illnesses.  You will also be able to see water safety tips for the whole family on our Facebook page.

    Most people delight in water and too often forget that there are inherent dangers that come from water-rich environments.  The ability to enjoy water safely means understanding the risks in a wide variety of aquatic settings, learning how to stay safe in each, and eliminating common misconceptions about the potential dangers of water.  We’d like to share some basic water safety information to help your family have the safest summer of swimming possible. 

    To understand water safety, it is important to have a basic understand drowning.  There is no such thing as being drown-proof.  There is also no such thing as “safe water,” only “safer water.”  The strongest, fasted, most gifted swimmers in all the world are lifeguarded whenever they are in the pool during the Olympics.  Anyone can drown. Water is one of the most powerful forces on earth and should never be taken lightly.  There should always be an emergency plan in place whenever your family is near the water.  Any illness or injury that can happen on land can also occur in water and the water makes dealing with the unexpected much more difficult.  Children are most at risk and extra care must be taken any time there is water around.  According to the Centers for Disease Control and Prevention, drowning kills nearly 4000 people each year in the United States and drowning continues to remain the number one leading cause of accidental death for children 1-4 years of age.  Between 2010 and 2019, there were 8,000 emergency department visits for non-fatal drownings.  Drowning injuries can result in brain damage, long-term disability, and a lifetime of crushing medical costs.  Another sobering statistic is that many people who drown, including children, never intended to get wet.

    While the risk to children may be more commonly understood, there are also other groups who are at higher risk of drowning.  Males make up nearly 80% of drowning deaths, and the CDC sites increased water exposure, risk-taking behaviors and alcohol use as potential factors.  There are long-standing inequities in access to swimming pools and swimming lessons across the country.  Drowning rates for Indigenous Americans or Alaska Native people ages 29 and younger are 2 times higher than the rates for White people, with the highest disparities among those 25-29 (rates 3.5 times higher) 1,2  Drowning death rates for Black people are 1.5 times higher than rates for White people.  Disparities are highest among Black children ages 5-9 (rates 2.6 times higher) and ages 10-14 (rates 3.6 times higher). 1  People with seizure disorders such as epilepsy are at higher risk for fatal and nonfatal drowning than the general population and other medical conditions such as autism and heart conditions are associated with a higher risk.3,4,5,6,7

    Water safety is a public health concern and our best weapon against drowning is information and education.  In his ground-breaking research on the nature of drowning titled “On Drowning,” Frank Pia, PhD, documented the potential consequences of the inability of people to recognize the signs of drowning.  His work captured images of parents enjoying the summer sun, watching their child play in the water.  What they were actually watching, however, was their own child drowning. 

    Drowning looks nothing like the way you may have seen it portrayed on television or in the movies.  The inability to self-support in water, for what ever reason, leads to something known as the “instinctive drowning response.”  Drowning is a continuum of events, that will ultimately be fatal without intervention.  Drowning behaviors are instinctual and those who are actively drowning cannot call out for help.  There are 3 types of victims according to the American Red Cross.  Distressed swimmers are those who may be good swimmers but who suffer an unexpected incident in the water such as a cramp, sudden illness or those who have overestimated their ability to swim.  Those in distress can, for a short time, self-support and may call out for help, but make little or no forward progress.  Without quick response, distressed swimmers can very quickly panic and become active drowning victims. 

    Active drowning victims are unable to self-support.  They may press down on the water in an effort to lift the airway above the surface of the water as they try to take a breath, but these efforts are short-lived and ineffective. They have no supportive kick, and the head may be tipped back with the eyes tightly closed or wide open.  The surface struggle can last as little as 30 seconds before the victim begins to sink below the surface.

    Passive drowning is a multifactor emergency.  Sudden illness, repeated breath-holding with or without hyperventilation, panic, spinal injury, hypothermia and drug and alcohol use are common causes.  The victim simply sinks below the surface with no sound or signs of a struggle.  Whether it be a distressed swimmer, an active drowning victim or a passive drowning victim, all those who love spending time in, on or around the water should be aware of the behaviors of people in trouble.

    Two commonly held misconceptions about drowning are that it takes many minutes and that there will always be some kind of sound or struggle involved.  These misconceptions are especially dangerous when children are involved.  Young children, even when in very shallow water, are often unable to lift their head above the surface because of their disproportionately large heads.  Additionally, they often have ample “baby fat” which causes the body to be more buoyant, making it more difficult for them to get to their feet.  Infants have nearly no ability to lift their heads.  Young children drown silently, in as little as 25-30 seconds with no surface struggle.  Those who do struggle at the surface often appear to be playing to the untrained eye.  Toddlers are quick and can enter the water during a single moment of inattentiveness by an adult.  There may be no splash, no noise, and no struggle.  Submersion is often quick and quiet and even a moment of inattention on the part of an adult can lead to a tragedy.

    The American Academy of Pediatrics advises that all children need close (within arm’s reach), constant and vigilant supervision.  The presence of lifeguards does not mean that parents don’t need to supervise their children.  It takes layers of protection to truly keep children and other non-swimmers safe in and around the water.  Parents or other attentive adults are the first and best defense against drowning.   Water safety is everyone’s responsibility and keeping everyone safe in, on and around the water takes everyone in the community doing their part.   Understanding the behaviors of drowning victims and the quick and quiet nature of most drownings will go a long way in helping you keep your loved ones safe while they are enjoying summer’s favorite activity.

    In our next blog post, we’ll offer important public health information about ways to reduce drowning risk throughout our communities.  Summer is here and swimming is one of the most positive, healthy and enjoyable activities families can share.  With an understanding of drowning, drowning prevention and recreational water-borne illness, we hope to help you and your family splish, splash, jump and dive into a happy, safe, and healthy summer swim season. 

    1. Clemens T, Moreland B, Lee R. Persistent Racial/Ethnic Disparities in Fatal Unintentional Drowning Rates Among Persons Aged ≤29 Years – United States, 1999-2019. MMWR 2021.
    2. Gilchrist J, Parker EM. Racial/ethnic disparities in fatal unintentional drowning among persons aged ≤29 years—United States, 1999–2010. MMWR 2014;63(19):421–426.
    3. Denny SA, Quan L, Gilchrist J, McCallin T, Shenoi R, Yusuf S, Hoffman B, Weiss J. American Academy of Pediatrics (AAP) – Council on Injury, Violence, and Poison Prevention. Policy Statement – Prevention of Drowning. Pediatrics 2019;143(5): e20190850
    4. Lhatoo SD, Sander JWAS. Cause-specific mortality in epilepsy. Epilepsia 2005;46(S11):36–39.
    5. Bell GS, Gaitatzis A, Bell CL, Johnson AL, Sander JW. Drowning in people with epilepsy – How great is the risk?. Neurology 2008;71(8):578–582.
    6. Guan J, Li G. Injury Mortality in Individuals with Autism. American Journal of Public Health 2017;107(5):791–793.
    7. Guan J, Li G. Characteristics of unintentional drowning deaths in children with autism spectrum disorder. Injury Epidemiology 2017;4(32):1–4.