Swimming class

A Layered Approach to Preventing Drowning

It happens to people who think it could never happen to them.

by Perri Klass, M.D.

Published by the New York Times on July 22, 2019.

Levi Hughes was 3 years old, on vacation with his family and five other families, when he slipped off the couch one evening last summer while the group was waiting for it to get dark enough for their annual crab hunt.

The family was renting a vacation home in Alabama with a group of friends stretching back to Levi’s father’s residency in cardiothoracic anesthesia.

“Our son drowned when there were six physicians in the room, 12 adults, 17 kids,” said his mother, Nicole Hughes, a writing teacher and literacy coach in Bristol, Tenn., who now works extensively in drowning prevention, including with the American Academy of Pediatrics.

“Everything I read about drowning before Levi died, it was like background noise,” Ms. Hughes said. “We think it’s happening to neglectful parents” who don’t watch their children when they’re swimming. But as she learned after Levi’s death, for most toddlers who drown, it doesn’t happen in the context of time spent “swimming” — that is, time they’re known to be in the water. And drowning is the leading cause of preventable deaths in children from 1 to 4.

“We took water safety very seriously — if you’d given me a list of 1,000 reasons one of my kids would die, drowning would have been the 1,000th,” Ms. Hughes said.

“He was on the couch in khaki shorts and a yellow crab-hunting shirt,” that evening. “I wasn’t on my phone. I wasn’t drinking,” Ms. Hughes said. “Of course, I relived these seconds a thousand times — how did we not see him go out that door?”

And yet, somehow, he got out the door and down the stairs to the pool. She walked out onto the balcony, which overlooked two pools, and saw a bright spot of yellow in the deep end.

She ran screaming down the spiral staircase, she said, and jumped in the pool, and when she reached her son and grabbed his arm, someone else grabbed the other; one of her friends had jumped off the balcony. “We had the best possible immediate response — how can you get any better than five cardiothoracic anesthesiology physicians?” They got a pulse back, but Levi died.

Ms. Hughes now advocates for legislation to provide more barriers around pools. The pool where Levi drowned had a three-sided fence rather than the recommended four-sided kind and had no pool alarm, she said.

She wants children to take swimming courses with a water survival component; she is wary of puddle jumpers — popular life jackets that hold a child upright — which she believes can convince children they will float. Most of all, she says, she wants to see a cultural change around our attitude toward water safety, as has happened with the “Back to Sleep” education program and with car seat and seatbelt use.

“This can happen to anybody and it only takes a short period of time, and no one thinks this is going to happen to them,” said Dr. Sarah Denny, an associate clinical professor of pediatrics at Nationwide Children’s Hospital, who was the first author on the new American Academy of Pediatrics policy statement on drowning prevention. So there’s a good reason to bring this up every year, and review even what you think you already know.

[Read the full text of the Drowning Prevention statement. Review the A.A.P. Drowning Prevention Toolkit.]

“If you look at drowning deaths, there are two huge spikes,” said Dr. Benjamin Hoffman, who is the medical director of the Tom Sargent Safety Center at Doernbecher Children’s Hospital in Oregon, and was one of the authors of the statement. One is 1 to 4 years old, and the second is adolescents, especially boys, from 15 to 19. Many of them drown in open water, he said, sometimes “while boating, or jumping off a rock, or underestimating the power of mother nature.” Drowning is the second-leading preventable cause of death among 15- to 19-year-olds.

“We were lake people, we went to the lake every summer,” said Dana Gage, whose 15-year-old son, Connor, drowned in a Texas lake in 2012. “Connor was Coast Guard safety-certified,” she said. So when he got a last-minute invitation to a birthday party at the lake with friends, his parents agreed. It was the first time he had gone to the lake without them.

That evening, the boys at the party were playing follow the leader, and at 8:15 Connor jumped off the roof of the boathouse and did not resurface. At first, his friends thought he was joking, and then a frantic search began, and a dive team was called. “At 9 p.m. my son was pulled from the bottom of the lake, and of course, he could not be resuscitated,” Ms. Gage said.

An autopsy showed no other problems or injuries; he had not hit his head, Ms. Gage said.

“He was a heck of an athlete, an endurance runner, a swimmer. It’s inconceivable that he just jumped in the lake” and died.

With all the questions that people have asked her, the most important question, she says, is the one she never gets asked: “Where was his life vest?” If he had been killed in a car, not wearing a seatbelt, she says, there would have been outrage.

Every state has life jacket laws, she said, but most apply to boats, and only up to age 12. “As life jackets are coming off, the drowning rates are skyrocketing,” in adolescent boys, Ms. Gage said. “The only life vest laws we have in this land are connected to boating, but for every person who dies on a boat, there are six more swimming in natural water.”

Because most drowning prevention is focused on swimming pools and the risk to young children, she founded the LV Project in Connor’s memory to focus on open water and life jackets.

“When you move to natural water, there’s an immediate victim blaming: ‘Teenagers are not careful enough,’” she said. “Life vests on lakes should be like seatbelts in cars.” And parents should be

modeling safe behavior, she said, as they do with seatbelts.

“I would encourage parents to believe that their water safety job is not over when children learn to swim,” she said.

“We’ve decided as a society, we’re going to go to great lengths to ensure kids emerge from childhood into adulthood with the skills of driving a car; we have a systematic approach to driver’s ed,” Dr. Hoffman said. Water competence should be regarded the same way, he said.

“Swimming is really a life skill — your child doesn’t have to be on the swim team, but they should know how to swim,” Dr. Denny said. “How to keep yourself safe around water is just as important as other developmental milestones.”

Dr. Hoffman said: “There’s absolutely no way to drown-proof a child.”

Instead, “it’s all about layers of protection.” That means four-sided fences around swimming pools, alarms on doors that will signal if a child goes out, and, when children are around water, having a designated adult to watch them — in addition to a lifeguard if one is present. It means arms-length supervision for the young, and adults who know how to recognize drowning and are trained in C.P.R.

It means using Coast Guard-approved life jackets when people are out on open water. And it means making swimming lessons available to all; children growing up in poverty and minority children are at especially high risk, and are less likely to have access to swimming lessons.

“Drowning happens very quickly. It doesn’t play out as people expect,” with drama and calling for help, Dr. Hoffman said. “Kids just go down, it happens unbelievably quickly and silently.”

Blaming the Victims

Blaming the Victims

Photo: Well prepared kayakers in the River Thames. Photo is for illustrative purposes only and not involved or related to anyone within the article.

The following article by Moulton Avery was originally published in Paddler ezine, and is shared by permission.

Picture a mother struggling to bear an incomprehensible loss. Her husband and children are dead - victims of a kayaking accident that left her as the sole survivor. Who would be heartless enough to look her in the eye and tell her how stupid, how irresponsible, how reckless they were to go kayaking on that day, at that location, in those conditions.

Yet that’s precisely what many paddlers do on the internet in the aftermath of a tragedy, thoughtlessly hurling Darwin Awards in language that’s both insulting and gratuitously cruel. Is that the kind of culture we want to embrace in paddlesports – one that leaps to shaming and blaming fellow paddlers who are the victims of some unspeakable tragedy? Is that the kind of people we are? And if not, why do so many of us tolerate that sort of behaviour?

I’ve studied outdoor accidents for decades, and there’s a big difference between impartially analyzing an incident in search of lessons to be learned as opposed to personally attacking the victims for getting into unexpected trouble. Using terms like ‘reckless’, ‘irresponsible’, ‘negligent’, or worse does not contribute anything to either the paddling community or to future safety.


On October 7th, 2011, five experienced, safety-conscious paddlers went on a downwind surf-ski run on Lake Mille Lacs in Minnesota that ended in the tragic death of Todd Ellison.

The air temperature was 77F (25C) and the water temperature was 60F (15C). All the paddlers were dressed for immersion. Prior to launching, the group had discussed the possibility of splitting up and they did so midway through the downwind run, with three in one group and two in the other. John Ambrahms, one of the strongest paddlers, remained partnered with Ellison, while the others, who were moving faster, surfed ahead.

At that point a minor error occurred. Although the group as a whole had three VHF radios and four cell phones, the only communication device that Ellison and Ambrahms had was Ellison’s cell phone, which was in a storage compartment on his ski.

When Ellison capsized 2.5 miles (4 km) from shore in rough, shoal water, the Velcro portion of the ankle leash tethering him to his ski broke, and his boat blew away, taking their only means of communication with it. Towing Ellison proved useless and shortly thereafter, by mutual agreement, Ambrahms took off on a desperate 45-minute race to shore, in breaking beam seas, to get help. He was successful and the search commenced shortly thereafter.

It was too windy for a helicopter, so a fixed-wing aircraft was used to fly a search pattern augmented by multiple boats on the water. They searched in the general area of the capsize for five hours without finding Ellison.When the search resumed the following morning, he was found floating dead in the water about a mile from where he had capsized the previous afternoon.

Two years ago, I received a letter from Zach Handler, one of the paddlers in that group. It heightened my awareness of the lingering damage that thoughtless comments can have, long after the incident is forgotten by most paddlers. He wrote:

In the months after Todd’s death, there was a lot of commentary online, much of it quite negative of course. This came from two groups: one was lay people who thought we were crazy to be out there in the first place and got what we deserved. The other highly critical group were sea kayakers who disagree with surf-skiers’ minimalist approach to equipment. Some of the sea kayakers were clearly enjoying the fact that our tragedy gave them the opportunity to have an, ‘I told you so’ moment.

John Ambrahms, the paddler that had to abandon Todd in the water, never recovered. He always felt responsible. He kept Todd’s boat in his garage and looked at it every day. He shot himself on the edge of Lake Superior at his favourite paddling spot. That was a couple years ago. The rest of us are still best of friends. We paddle often. Most years we paddle across Mille Lacs on the anniversary of Todd’s death, both as a tribute to his life and as a way to make sure we are dealing with our own demons from that day.

Those two paragraphs should give anyone pause about making – or tolerating insensitive comments online. In the aftermath of tragedies such as this one, we need to remember our shared humanity as paddlers and be cautious, humble, and non-judgmental in our choice of words. Our aim should be to learn from the mistakes of others without adding to their misery.


Every week of the year, a steady stream of incidents roll across my desk and the most heartbreaking ones have dozens of associated news reports. Part of my job involves investigating paddlesports incidents and over the years, it’s given me a very keen sense of the tremendous pressure that reporters are under to get a story out – even though all the facts are not yet readily available.

As a result, many stories – and particularly the early ones – may contain inaccuracies about the weather, the conditions, the time of day, the type of boat involved and even the location of the incident itself. Ironically, many of the most unpleasant internet comments that I run across are based on this type of misinformation – which is seized upon by armchair critics.
Likewise, what does it mean to say that someone, “Should have known better,” when it’s clear that they didn’t know any better? Many hazards aren’t at all obvious and it’s worth remembering that we all began our sport at the bottom of the knowledge pyramid, knowing very little.


News reports frequently characterize novice paddlers as experienced. But ‘experience’ is contextual. One hundred uneventful outings on a familiar local lake confers familiarity and complacency, not depth of knowledge.

None of us are immune from making mistakes and errors in judgment and the safety hurdle faced by many paddlers is that they don’t have enough knowledge or experience to imagine the many things that can go wrong on even a modest outing. They aren’t helped in this regard by the many manufacturers, retailers and paddling publications that minimize hazards and sell the sport as a carefree activity that carries less risk than it does.

But paddling isn’t a risk-free activity, and the unsettling truth about decision making is that rational, clear, impartial, error-free, Mr. Spock-logical-type-thinking is the exception rather than the rule in life. We’re just not very good at it. In fact, we make mistakes and unwise decisions all the time.

We misplace car keys, TV remotes and cell phones, don’t remember to back up files and return calls, forget to buy things at the grocery store, underestimate how long something is going to take, overestimate our skills and physical abilities, commit errors while driving to the put-in and do all sorts of things that have the potential to come back, in one way or another, to bite us in the backside. We seldom take notice, because more often than not the stakes are so low that being wrong makes no appreciable difference to our daily lives.

We paddle to have fun, and often to experience a little excitement – or a lot – but none of us plans to wind up in a life or death situation. Tragedy always comes as a big, unpleasant surprise – to both victims and survivors.


In many sports, accident reviews are routine, and the whole community benefits when those involved have the courage to admit their mistakes so that lessons can be learned. Whether our mistakes are large or small, it’s never easy to own them, and if we tolerate a mean-spirited hosing down of those who step forward, we shouldn’t be surprised when the result is that eventually, nobody is willing to speak up.

Before his untimely death in 2012, Tsunami Rangers co-founder Eric Soares and I noticed this disturbing trend and came up with a plan. Whenever a paddler came forward, we would preface our comments by praising them for having the courage to do so, and thank them for sharing their story so that the rest of us could learn from their mistakes. We also resolved to condemn mean-spirited, unhelpful comments. It was a good idea and we could see it working as other paddlers picked up the torch and ran with it, but the internet is a bigger and more unruly place today and that commitment to civility needs a wider following. I hope you’ll join me in helping to promote it.

Note: We examine the Todd Ellison tragedy in greater detail on the National Center for Cold Water Safety website at http://www.coldwatersafety.org under Golden Rule No. 5, Case One.

Moulton Avery

Author bio:
Moulton Avery is the founder and director of the National Center for Cold Water Safety. He’s been sea kayaking in his Nordkapp HM since 1984, and has been a cold water safety advocate for over thirty years. His pioneering article Cold Shock was published in Sea Kayaker magazine in 1991, and he gave his first lecture on Accidental Hypothermia in 1974. His work has been featured in hundreds of newspaper articles, radio programs, and television shows, including The Washington Post, All Things Considered, and Oprah.

USCG Search

Unmanned Kayaks

For every unmanned kayak reported, the Coast Guard must assume that a person is missing and in distress, and that requires a full-scale search and rescue effort involving Coast Guard personnel, vessels and aircraft.

The Coast Guard estimates a team on the water costs $113,000 per hour.

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