Conclusion: Indications for effectiveness
In their reports Branche et al. (2001) and Weiss et al. (2010) report that they found no formal scientific studies investigating the effectiveness of lifeguards in preventing drowning. They did find anecdotal reports indicating drowning rates are lower when lifeguards are present. For example, Weiss et al. describe the US Lifesaving Association reporting that only 20 of the 109 beach drowning deaths occurred on guarded beaches in 2007. Branche et al. describe four local case studies that support the positive impact of lifeguards at beaches where multiple drownings had occurred when unguarded. An observational study of Schwebel et al. (2007) found that a brief periodic 'booster' intervention targeting lifeguard behavior, was able to improve safety at a public swimming pool in the United States. Postintervention; lifeguards displayed better attention and scanning, and additionaly patrons displayed less risky behavior.
Based on these reports and on expert opinion (WHO Guidelines for safe recreational water environments, 2003) we conclude that lifeguards, when adequately staffed, qualified, repeatedly trained and equipped, appear to be an effective strategy to prevent drowning.
Recommendations (for research & practice)
Practice and Policy
Lifeguards should have appropriate training and hold a suitable current qualification. Re-qualification should be undertaken at regular intervals, and practical rescue and resuscitation skills should be practiced frequently. It has been noted that initial introduction of lifeguard certification may impact availability of qualified lifeguards. Lifeguard observation points must have a clear and unobstructed view of the area of supervision including both the water and surrounding area. Lifeguards on duty should be easily identifiable at a distance and in a manner that sets them apart from others at the beach or water recreational facility. Lifeguard organisations should develop written “standard operating procedures” that include supervision requirements (WHO Guidelines for safe recreational water environments, 2003).
Pediatricians should support efforts to ensure that community pools and other pools accessible to the public (such as pools at apartments, hotels, and motels) have certified lifeguards with current CPR certification (AAP, 2010).
When selecting an open body of water in which their children will swim, parents should select sites with lifeguards. Even for the strongest of swimmers, it is important to consider weather, tides, waves, and water currents (AAP, 2010; Weiss et al. 2010). In many domains of pediatric safety, adult supervision has emerged as one of the most effective means to prevent unintentional injury. The same holds true for swimming environments (Schwebel et al., 2007).
Creating and maintaining national surveillance databases of drownings are essential in order to evaluate the effectiveness of lifeguards. These databases should include near-drownings and regulations.
As suggested by Schwebel et al. (2007), theoretically driven brief interventions targeting lifeguard attention and surveillance could be tested more extensively to see whether they are effective in reducing risk of drowning in public swimming pools.
Review Date: 21/04/2011
Articles (reviews) and reports were included that were published between 1991 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.
Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Irrelevant studies were excluded, i.e. the article does not comprise  the evaluation or effectiveness,  the prevention of child injuries,  the specific preventive measure studied. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).
The outcomes of the study were reviewed by an expert in the field of child safety in the spring of 2010.
Guidelines for safe recreational water environments : volume 1. coastal and fresh-waters (version 1.0)
Technical report : prevention of drowning (version 1.0)
Jeffrey Weiss (2010)
Lifeguard effectiveness : a report of the Working Group (version 1.0)
Christine M. Branche, Steven Stewart (2001)
Brief report : a brief intervention to improve lifeguard surveillance at a public swimming pool (version 1.0)
David C. Schwebel, Sydneia Lindsay, Jennifer Simpson (2007)
Policy statement - prevention of drowning (version 1.1)
Committee on injury, violence, and poison prevention (2010)