Staying Afloat: Safety Precautions in Aquatic Therapy

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Hello and welcome to the podcast. I'm Ryan, a certified occupational therapy assistant, and today I'd like to talk to you a little bit about safety first. Safety, obviously is very important in all of the therapies that we provide being that we tend to work in environments that are less controlled than a typical clinical setting. So either working outdoors in the forest or at the barn with the horses or in the pool. These places all have inherent risks to them, and so it's certainly something that we need to consider every time we go into a session. So I'm going to break this down today through a P E O lens because that kind of helps me to organize my own thoughts on the topic and how I like to think about it. P first we're gonna talk about the people, right? Person, environment and occupation. In this case, we're going to look at both the population of the clients that we're seeing as well as the therapists and the staff themselves. So first is the, Population and a big part of why the client's screening is so important and what should be factored into a client's screening should be some safety considerations such as who is the population that we're looking at helping? Is it mostly children or adults? Is it People with physical dysfunction or people are coming to us with other disorders. So identifying the clients, their conditions and how many you'd be looking at serving concurrently are all going to factor into what you need when it comes to the decision making process. As far as how many staff you're gonna need on hand and what types of tools and equipment you might need at the pool that you're going to be in. Next, I would say we would look at the staff. Again, the number of staff that you would need to maintain a safe environment, depending on how many clients that you're going to be seeing. The training of that staff. If you're at a community pool, we're gonna talk about we're gonna talk about this from the lens of an uncontrolled environment. So something like a community pool, something that's not in, in your own facility necessarily. Because it's a lot harder to control if you're in a community pool as far as setting up the environment. Are there lifeguards on staff? If not, do you have access to staff with lifeguard training? Does everybody have CPR certifications? Knowing where things such as the AED and other lifesaving equipment that could be needed would also be important. We'll talk about that a bit more when we get into looking at the environment. Another important factor that I, I would put under the P would be the emergency action plan. So this is a, "what would you do if." So, knowing first of all how to respond immediately in the event that someone needs to be rescued or pulled out of the water. What you would have to do as far as your primary assessment and and then reaching out for help as needed. And what level of help this could be even having, access to your cell phone close by and Just in case, it's not something that we like to think about, but it's something we have to think about. Having access to things such as a first aid kit and a CPR kit. And another thing that I like to have on my person is a whistle. And there's a few reasons for this. One of it is safety. If I needed to get somebody's help, and the environment made it difficult to yell across the pool deck. Having a whistle draws everybody's attention. Whistles also can be helpful for transitions. And another thing that I have on my body pretty much at all times is a wetsuit. Now the wetsuit is a safety measure for me because if I'm in the pool for three or four hours, depending on the water temperature, that can really take a toll on your body take a lot of energy and your core body temperature can drop down. But the other interesting thing about the wetsuit is it increases your own buoyancy. So in the event that you had to help somebody else in the pool, you already have a little bit of extra flotation to assist you with that. And also with that added buoyancy, it helps you to conserve your own energy if you're getting into deeper water where you might have to tread water or swim a little bit. So then moving on to the environment, we're looking at a site visit. So before you even really go into the, to the confirm that you're gonna have sessions at a location. You wanna do a site visit, you wanna make sure that it's appropriate for the population that you're going to be working with, and that they have the equipment there that can support the needs of that population. Considering the population, you wanna look at the needs. So the level of function. Is there gonna be a need for a Hoyer lift or a chair lift or something to get somebody in and out of the pool? Sensory needs. So this is one that, that we've seen that was interesting, because we work with a lot of kids with autism spectrum disorder .And I know from working in the forest that sometimes we'll be walking down a trail where the visual field is really restricted and then we'll come to an open area and the response from the client when the visual field opens up was something that the first time I saw it, I wasn't quite sure what was going on, but then when I thought back to the previous five minutes about what we'd just been doing, it was, ah-ha and being aware of that and being mindful that most community pools are very big, wide open spaces. And so they may be going from a small restricted hallway and then coming into this big wide open space that can sometimes have unanticipated effects on their sensory system that we should be prepared for or expect. I've seen kiddos climb the cement bleachers and go all the way up to the top and walk along the wall. I think maybe walking along the wall a little bit helps to limit their visual field, but then the elevation may also provide an increased sense of security. So just having an understanding that just being in that open environment can challenge certain clients' sense of security. And so maybe thinking of some ways to help mitigate that or at least decrease the time to transition into the session and having an understanding that it's important to limit the amount of time from when they enter the pool deck to transitioning into the session. So we want to consider, again, the physical and the sensory needs. Another thing we wanna look at is the entry and exit points. Not only for the external coming out of coming onto the pool deck, but also actually into the water itself. Again, ladders. The pool that, that we use actually has a drop in stairwell that is made out of pvc and that's been really helpful. Sometimes to help even help kids who can, who could use an a normal ladder, get in and out sometimes just to help those kids transition into the pool. Sometimes we'll do an activity just on the steps and every iteration of that activity, we'll do another step into the water and we can use that to, to help coax them into the water. But also knowing those entry and exit points, again, in case you have to make a rescue or in case you have to help somebody out of the pool. What's gonna be the the safest and quickest way to do. Another consideration is the water temperature. So I was talking about the wetsuit again. We tell all of our clients and the parents to consider purchasing a wetsuit. They're relatively cheap on Amazon and there's other places that you can get 'em. But this can make it the session go a bit smoother. And our water temperature's typically around 82 degrees. It's usually low eighties. If you're looking at physical dysfunction, I know typical aquatic therapy, when you're really working with physical dysfunction, you want the water much, much warmer than that, but where we're at, what we have access to, and the population that we're serving, that's not as much of a consideration. To compensate for that we bear that in mind to wear wetsuit when possible. And also maybe limit the length of the session depending on the individual kid. Hazards. You, you certainly wanna identify potential hazards, and when I say hazards, areas of the floor that are typically wet because it is a pool, it's a wet environment and it can be very slippery. We go over all of the rules with all of our clients. We have four rules and we even put 'em on a visual board for our kids who have a hard time following verbal directions to help them understand the rules to keep them safe. And the four four rules that we have are :no running entry and from the ladder only, if the whistle blows, then you have to get out and no, no jumping and no diving we say specifically, but for some of our kids we just say no jumping to simplify it. And so you also wanna look at off limit areas. So these are areas that if you have any kiddos who are, or clients who are elopers who you really have to watch. You want to identify what they could get into, that could potentially get them in trouble. And you wanna figure out ways to, to either block or mitigate the risk to that. For example, there is a spiral staircase that goes up into an observation deck for swim meets at the pool that we're at. And we had one kiddo who decided he was gonna go exploring up there and I had to I had to very quickly I saw where he was going, so I had to run over and physically block and I don't like to restrict kids as much as possible, but again, knowing that it's an environment that where there are inherent risks and he was going to do something that was going to be risky it was important to. We've since kind of made sure that there's equipment stacked in front of there that will at least slow 'em down a little bit so that we could prevent them from accessing that. Knowing you're off limit areas and knowing areas that maybe your clients could get into trouble it if if they wander over to it. And finally we're gonna look at occupation. So our occupation for this is going to be the treatment session itself. So I just covered this, but with the population in mind, anticipating hazards, some other hazards that, that we've seen or that are common if you have kids. So for me I have a few clients who have adhd. And with scheduling, sometimes there's toys left out from a previous session that I don't intend to use in the next session. And the clients with ADHD will right away identify those toys and beeline straight to them and, which is okay, we can use that, but at the same time, it's, it's not what I intend to happen in the session. And further, if those toys are left out in an area where they're at risk to either fall into the pool or or they see those toys and get excited and decide they're going to run for them before, before we even get into the session and have our little safety brief that could be a hazard. So I always try to clean up things and restore the area before in between sessions. Limiting time of the transition into the session. This is another one that if. Again if the kids are waiting in the area for an extended period of time, then there's more opportunity to get into trouble or get into those off limit areas. So really getting them transitioned in and. Getting into the session as quickly as possible, can help to mitigate any of the risks. Having flotation devices available. This can be swim bubbles for the very little. Clients who have are still having difficulty that are not strong swimmers just yet. Pool noodles, kickboards and our flow through mat. We love our flow through mat. It's like our, we refer to it as our swing in the pool. We can do all sorts of sensory input with it. A lot of good vestibular. We can even do some proprioceptive input with it. It's it's a much more versatile tool than I think we realized it first when we when we brought it in. But it's also, it's, it is a good way to assist in buoyancy as well. We also use kickboards and pool noodles. Now, those are not, red Cross certified flotation devices, but they can help for buoyancy. And if I, my clients, I really never keep them out of arm's reach again for safety reasons. But it's just another added layer of assistance if they needed it. With that in mind, you also want to ensure that you have enough help to be safe. Again. I talked about how many clients you intend to treat concurrently. So if you have multiple therapists in the pool we do that at times where we will have two of us treating separately in the same space. Having either students with you or an aid somebody that can help to stabilize a child if they're on a flow through mat and you're doing an activity on top of the flow through mat, having an extra set of hands is. Always a good thing and it always increases your level of safety while you're in the water. And again, if something were to ever happen or were to go wrong knowing what, knowing exactly what directions you would provide to help rescue that person who's in need of it and and get them the help that they need if they needed it. The last point that I will say is never force a session into a pool. Swimming is supposed to be fun. It's supposed to be an enjoyable experience. And we treat our therapy sessions the same way that it's not so much about being in the pool. We are occupational therapy practitioners. We're we're not swim instructors. The point isn't the pool, the point is the therapy. And the pool is a just another tool that we use. There's a lot of sensory elements to it that can be helpful. There's a lot of activities that we can do in there and a lot of kids are are very excited about getting into the water. And so that can increase client participation in the session. If it is something that they're excited about doing and they're motivated to do, however, if they don't want to get into the water for whatever reason that day, always have a plan B of something that you can work on. And if it is a motivation issue, then like I said, during the environment piece You can look for ways to incrementally help them transition into the pool. I always try to start off sessions as an invitation to go into the pool and never as a," time to go into the pool- and you're gonna go in whether you like it or not." It's I don't want kids to walk away from the experience with with a lost desire to to go swim. I love being in the water. It's always been something that I've enjoyed and it's been very important to me. And I like sharing that with others. But never force a kid to to have a therapeutic activity in the water. So that's gonna wrap it up for today. I hope you learned something. I hope it was helpful, and drop us a comment and we'd love to hear from you. Thanks.