open

The Implementation of Admission Standards in Ontario’s Class A Public Pools: An exploratory study

good afternoon everyone this is Eric

Devine for sci-fi Ontario branch here at

public health Ontario in Toronto I'd

like to thank Public Health Ontario for

co-hosting with us and providing us this

platform and welcome all of those folks

that are on the line today our presenter

today is affiliate attire she will be

presenting remotely there is no on-site

presence today and I did want to just

take care of a couple of housekeeping

items I did want to remind all those

inspectors that are interested or maybe

in the Toronto area tomorrow night that

Syfy Ontario branch and Ryerson

University of partnered together to

present pubs with phis

tomorrow night at 6 o'clock at Raymond

Wray VIP room at Ryerson University this

is an opportunity for students to engage

with professionals practicing in the

field and an opportunity for those

professionals to pass on their knowledge

and share their career paths with future

phis

and the last thing I would ask before we

kind of get rolling is that for those

people that are on the line if there are

multiple people in the room please

indicate the number of pH eyes of a

number of people that are in the room

with you just so that we can track the

numbers suppose the series so today

Fields attire is going to be presenting

on the implementation of admission

standards in Ontario's class a public

pools where she conducted an exploratory

study a philia is a recent graduate of

the fast track public health program at

school of occupational and public health

at Ryerson University in 2015 she was a

summer intern student with the Ministry

of Health and long-term care public

health division where she gained

experience in environmental health

policy and program work in the summer

fall of 2015 she held a practicum

position with Peel Region general

programs where she acquired a valuable

practical knowledge related to food and

water safety health hazards I pack and

communicable diseases she successfully

passed the board of certification exam

in October 2016 congratulations to you

and secured a contract position as a

public health inspector with Peel Region

in the advanced environmental health

general

programs so they'll further ado I will

pass it over to a philia and remind

everyone that we will be in lecture mode

for the duration of this presentation if

you do have any questions please

indicate them in the chat pod on the

bottom of the right-hand screen thank

you and welcome Ophelia hello thank you

I'm Ophelia Tatar and today I'll be

presenting the results of her research

study related to the implementation of

emission standards in Ontario's class a

public pool research made possible

through a collaboration between Ryerson

University and the Life Saving Society

the educational objectives of this

presentation are to provide an overview

of the public health issue of

recreational pool drowning in children

and the emission standards developed to

address it raised awareness of the

various anti drowning strategies and

public swimming pools the provision

standards use nationally and

internationally and present and discuss

details of emission standards

implementation at operator level in

Class A swimming public swimming pools

in Ontario we will start by establishing

the background related to the

development of admission standards by

exploring child supervision standards

and several the jurisdictions as well as

various anti drowning strategies and we

will continue with the actual study from

adjust objectives to conclusions and

recommendations in the Canadian context

of recreational water safety drowning

emerges of the primary cause of

accidental death in children aged one to

four and the second leading cause of

preventable death and children under ten

the burden of illness is much greater

though with six to ten times more

children experiencing near drowning the

requiring hospitalization and ronon for

sustaining permanent brain damage

research shows that the main

contributing factor in fatal water

incidents is the last battle

precision this sident is also revealed

by several ontario coroner's inquests

the accidental drowning deaths of

children and supported by data from the

Canadian Red Cross showing that all

children under 10 years old who drowned

recorders were not accompanied by an

adult and what surprising is that while

parents and Canada recognized adult

supervision of crucial to avoiding water

related injury and death all we have

admit that they constantly supervise

these children around water to mitigate

the threats can further reduce or

possibly eliminate preventable

recreational water related death

admission standards were developed by

the coroner's office they are primarily

intended for Class eight pools but can

also be used to guide safety policies

and cost equals the perfect child to

parent guardian of supervision ratios

are the main component but other

elements are also included such as the

facilities swim tests staff training

public communication financial tracking

standards

admission standards are not part of

legislation and their implementation is

voluntary in the 2010 drowning that

review Ontario's chief coroner's office

called for a concerted anti drowning

efforts from various stakeholders at

different levels of jurisdiction and

suggested appropriate courses of action

for each of them as depicted in this

slide all levels of government are

included for municipalities to various

provincial ministries and federal

agencies non-governmental organizations

such as The Life Saving Society or the

Canadian Red Cross are also called upon

the coroner's recommendations for the

Ministry of Health and long-term care

relate to admission and tracking

standards managed to increase direct

supervision of younger children in

particular non swimmers here you can see

the ministry supervision

that are based on the coroner's

recommendation as one can observe the

coroner's standards are more stringent

in terms of ages for children and

guardians as well as the use of personal

floatation devices when we did this

research we came to the conclusion that

the main issue with the admission

standards is that there are not part of

legislation and as of 2016 they're

voluntary and discretionary

implementation but public school

operators was not comprehensively

evaluated you know cheerio regulations

i-65 public pools that's all for the

safety requirement for public pools

including the present number

qualifications and duties of lifeguards

responsible for patron supervision

however the regulatory provisions of

lifeguard supervision are not intended

as a substitute for the parents

supervisory responsibilities toward

their child beginning in November 2015

the Ministry health consultations with

key stakeholders on the modernization of

safe food and water regulation and

consideration is given to charge the

provision standards under the current

regulatory review in stereo are the

ministry's request the provincial boards

of health through their public health

units promote the use of admission

standards to all inspected public pool

operators while underlined the

importance their importance in reducing

the risk of water related incidents the

ministry's recommendations represent

only a minimum standard several public

health units as well as public pool

operators have children to promote

analyzed stricter rules cannot Public

Health website revealed that a multitude

of promotional approaches related to

these emission standards

if you

routine pool inspections inclusion in

the operator's manual awareness

campaigns exploratory web pages etc the

provincial scan also brought to light

and you can see here a variety of

emission standards criteria such as a

child Guardian ratios and ages swim test

tracking standards the use of personal

flotation devices etc here are some

illustrations of different signs used by

public health units and pool operators

with some be more visually effective

than others a national jurisdictional

scan show that of the 13 Canadian

provinces and territories only Alberta

had out of the provision of children

incorporated in its legislation as of

2014 the full standards require the

development of a pool safety and

supervision plan based of the condom

life saving societies best practices to

consider the phasors age swimming

competency and adult oversight as well

as related they were related to patron

education and notification moving

forward recommendations for supervision

ratios are found in the guidelines group

of pool operations in British Columbia

and Ontario emission standards what we

found was that while the other provinces

and territories for those the

legislative reference to adult

supervision was what couldn't be found

other than by lifeguards many public

pools across from share across Canada

has voluntarily adopted various child

supervision rain shield an interesting

finding was that nova scotia operational

guidelines for aquatic facilities

recommending corporation of drowning

detection computerized technologies into

the aquatic safety plan

than eight for lifeguards examples of

international jurisdiction with a

variety of supervisory ratios include

Australia with the guidelines for

faithful operations the European Union

with the European basic guidance for

safety in swimming pools and a European

standard as well as the United Kingdom

with the guidance document and a

swimming pool child admission policy

this slide illustrates different child

supervision ratios applied in the United

Kingdom at various levels Life Saving

Society level and operator level to

determine the usage of supervisory

ratios and other measured measures aimed

at reducing water related incidents and

improving child safety 39 peer-reviewed

article were selected and studied each

addressing a number of anti drowning

interventions such as adult supervision

lifeguarding swimming skills and water

safety education environmental

modification technology and legislation

among those adults the provision of

children which is also at the core of

emission standards identified as a

mental and drowning prevention

furthermore it appears the direct

supervision or visual or within visual

auditory and arms reach is most

effective when tailored to the age and

developmental stage of the child

research equally confirms the critical

protective role of lifeguarding and this

is a highly demanding activity app

attention needs to be fully dedicated to

swimmer or safety while supervisor pools

are extremely safe recreational

environments I've got the loan cannot

ensure absolute safety leading

researcher to the significant conclusion

the supplementary measures of safety are

desirable

acquiring swimming skills and being

educated and water safety practices

early in life are also recognized as

important prevention elements

complementary measures in the form of

improved environmental school design

especially when legislated results and

controlled access that improves the

supervision anti drowning technologies

are intended as a complementary aid for

lifeguards and not as a substitute and

they vary from simple automated physical

barriers to complex detection and

signaling systems in regard to

legislation

research shows that drowning death rates

decrease post implementation of related

acts and regulations while emphasizing

that additional prevention strategies

are needed for long term results in the

form of continuous advocacy public

education campaign or compliance via

enforcement this slide illustrates two

newer anti drawing technologies on the

left are the programmable wristband and

underwater pool fenders from fan tag and

on the right are the computer aided

drowning detection structure from

Poseidon which integrate artificial

intelligence software with video camera

vision to process aquatic images now

that the context to tell supervision

standards was established we will

continue with the study was conducted

last year the primary objective of the

study was to explore emission standards

and fermentation you know Cheerios class

8 public schools as of February 2016 the

quantitative study it will survey with a

minor qualitative component open-ended

feedback was proposed to carry out the

research the certain was intended for

crossing public school owners operators

in Ontario on behalf of the research

team a recruitment email was sent by the

life savings

277 office class a public school

affiliates offices in Ontario using

Survey Monkey a 20 minute online the

novel questionnaire was designed to

explore groups of variables such as poor

characteristics with type location and

various operational details admission

standards which shall parent ratios

staff training efficacy etc or operator

feedback with implementation challenges

and successes or support for legislation

30 questions with varying a response

options were developed pre-tested and

adjusted based on feedback and ethics

approval was obtained from Ryerson

research Ethics Board these analysis was

performed using Microsoft Excel

respondents with significantly

incomplete answers were excluded and

mostly descriptive statistics were used

to report the results out of the 277

emails were sent 139 responses were

received out of which 114 were selected

for analysis yielding the response rate

of 41 percent those 114 surveys

accounted for 145 schools moving on to

the findings of the study most

respondents were found to hold a

supervisory and or managerial work

position in which they worked for five

or more years regarding tool parameters

results suggest that the pools are

evenly located in large urban medium and

small rural population centers

two-thirds are the indoor type and

nearly 90 percent that more lifeguards

on staff and required by law regarding a

mission

all respondents claimed to have adult

Anders integrator than their normal pool

operations

my responses are categorized by level of

provision ratios you can see on the Left

68 percent exceeded the ministry's

recommendation and similar similar

results can be observed for the age of

the Guardian on the right side with 60%

having a requirement of at least 16

years of age this bar graph depicts the

usage of various components of admission

standards other than ratio some of the

top components used by more than 50% of

schools are posting of signage at

reception of that area pre-screening

that entry sorting of children by

swimming ability using a visual

recognition system and postings on the

company's web site so East use

components were the body system and body

measurement this graph shows the

distribution of both by House staff

training related to admission standards

is delivered such as through stopped

books policies and procedures at the

beginning of employment or annually the

left side price chart depicts the

enforcement of admission standards

once the provision ratios are not met

indicated that when this occurs the

majority of pool 86% do not grant

admission to their patrons the right

side pie chart shows the distribution of

proof by the overall number of water

related safety incidents for instance

slips Falls near drowning or drowning

occurrences after the implementation of

admission standards as one can see no

pools reported on increased and 35%

reported that a group of the crease and

incidents when it comes to operate or

feedback the

most frequent implementation challenges

were increased processing time for 67%

of pools and negative public response

for 58% of pools less than 1/3 shows

increased cost and staffing as a

challenge other challenges Cups captured

under the open-ended response category

words and I quote how to educate staff

on the importance of enforcement how to

deal with disgruntled patrons

how to educate the public and another

one was the lack of standardization

across pools that leads to customer

complaints in terms of successes the

vast majority of respondents wanted to

improve safety and the fact that it's

easier to lifeguard is to provide a very

about a quarter also chose increased

reputation and good advertisement tool

as a success other success is captured

under the open-ended response category

where and I quote it has decreased the

number of young and/or non-swimmers

being dropped off at the pool and left

for us to babysit another one was people

understand that we take safety seriously

it is a great tool to educate parents on

the risk and another one was a greater

sense of responsibility placed on

phasors Guardians

despite encountering challenges in

implementation the majority of operators

have seen here 87%

describes the overall impact of

admission standards on their operations

as positive or very positive

approximately three-quarters of the

respondents indicated a lifeguard

feedback to admission standards with

positive or very positive and less than

a border indicated that the public's

feedback to admission standards which

was negative or very negative this slide

shows the distribution of pools with

operators would like admission standards

to be mandatory indicating

strong support for legislation and more

than three orders 78% of cases also a

few associative statistics were

attempted obscene in the next three

slides what we wanted to see is if there

is any statistically significant

association between admission standards

level and pool location shown in the

spot rate between admission standards

level and water safety incidents credit

pre and post-implementation and between

the emission standards level and waters

and water safety incidents or the other

one was like the level and type of

implementation challenges those results

will be discussed a little bit further

when we will interpret them as well to

summarize two-thirds of pools were the

indoor type pools were relatively evenly

distributed among large urban medium and

small rural population centers the fact

that 90% of pools had more lifeguards on

staff than required by law can indicate

that improved safety is of great

importance to operators as well as a

need to lessen the pressure on staff

related to the implementation of

emission standards hundred percent of

cases have had emission standard

integrated and pool operation and this

could reflect a true increase from 2011

when 96% of ossicles had some form of

emission standards or it could be due to

the fact that respondents were a

life-saving Society of Phileas 50

percent of operators claimed that they

were informed about the emission

standards by the local public health

unit and a 53% of cases the decision to

adopt those standards was not incident

by the local

calculate possibly due to the fact that

licensed society advocated admission

standards prior to public health units

and that respondents were licensed but

deflected in society's affiliate about

two-thirds of pools youth child parents

ratios and ages of guardians that

exceeded the ministry's recommendation

this is perhaps the reflection of these

recommendations being seen by operators

as insufficient this could also reveal a

heightened understanding of the crucial

role of adult supervision in the

prevention of recreational waters

incidents and children in addition to a

wide diversity of supervision ratios and

ages of Guardians other components are

used in different combinations of more

than 50% of pools

some examples are pre-screening at entry

serving of children by swimming ability

using a visual recognition system

posting of signage on premises etc this

assortment of requirements and their

combinations should light on the lack of

standardization across Ontario which was

identified by operators of the

contentious point in their relationship

with the public and might explain their

apparent strong support for a unified

legislative solution emission standards

were integrated in a multitude of

layered regular staff training

procedures or at more than 75% of food

and they were enforced in eighty-six

percent of school by denying entry when

required child Guardian ratios were not

met this indicates that operators are

clearly committed to building proper

scales with ourselves as well as to

thoroughly applying the standards

describe added procedural complexity and

the risk of losing

business in 50% of cases there was no

evaluation of the effectiveness of

emission standards highlighting the need

for an evaluation strategy no fools

reporters an increase in the overall

number of water related safety incidents

pre and post emission standards and

limitation and about a third reported a

decreased however it is unclear whether

there were actual decreases in water

related incident and a long-term study

is recommended to confirm this in terms

of operator feedback over 85% of

operators describe improved safety and

health for lifeguarding as top successes

suggesting that emission standards meet

their intended purpose and that they are

contributing to increase regarding

performance for 50% of respondents

increased processing time and negative

public response for top challenges

however it seems that these challenges

are manageable and I'll wait by

successes possibly explaining why the

majority of operator described the

overall impacts of emission standards on

their operations as positive or very

positive this finding was echoed by the

fact that almost three-quarters of life

rtfs was positive or very positive while

only 20% of public feedback was negative

insurance associations who located a

large urban and medium sized population

areas seem to be more likely to see the

ministry's recommendation so the

association group statistically

significant raising the issue of

resources availability and knowledge

translation and rural areas all the

stricter emission standards but not were

not more likely to encounter

implementation challenges and pools with

less restricted mission standards or the

association with

nonsignificant statistically but this

leads to the interesting idea that there

were no added operational birds there

was no added operational burden when

minimum requirements were surpassed when

comparing tools with different levels of

the mission standards there seemed to be

no statistically significant difference

in the number of water related incidents

pre and post-implementation although

this could be due to the small sample

size it turns off the studies critique

some of the biases identified or linked

to the selection process type of survey

and respondent but nevertheless the

study and its distribution were designed

to minimize those biases potential error

is related to questionnaire design and

interpretation as well as data analysis

were also identified and verification

processes were used to ensure accuracy

for limitation the most significant was

the constraint of time and human

resources which reduced the scope and

range of exploration the exclusion of

class B pool was the biggest one and

these craft be pooled although they

account for most drownings and public

pools they were not no not included in

our study primarily due to the limited

resources this can be addressed by

further research done by the exiting

Society in collaboration with Ryerson

University perhaps because these fools

are unsupervised admission standards

implementation and enforcement would be

difficult to assess raising questions

about the type and quality of data

collected and also just with food for

thought could this be an appropriate to

a place for anti drowning technologies

other limitations were the survey that

the survey did not account for

typical responses for one operator the

data was self-reported ie

not verifiable the primary focus was on

child parent ratio and that the

open-ended responses from operators were

not included in the analysis the current

study provides an initial insight into

the state of emission standards and

Clementi ation in Ontario's across a

public pool it describes the recreation

of water environment in which a coherent

safety intervention is voluntarily

adopted at a remarkably high rate with

challenges being balanced by successes

in many cases this implementation

precedes the ministry's initiative in

time as well as in complexity the

operator is approached to surpass the

minimum requirements suggest an elevated

awareness regarding the importance of

adults associations an important

conclusion is that owners and operators

would be amenable towards legislated

admission standard and this is

considered under the current regulatory

review done by the ministry this study's

findings could be used by public pool

operators prevention leaders and policy

makers with the goal of reducing

preventing the burden of illness and

injury related to recreational water use

and although admission standards appear

to be effective in their uptake is

positive more research is needed to be

conserved needed to be conducted for

conclusive results much future research

could improve the questionnaire and

expand adjust the study to Class B

public pools that include actual water

safety incidents data and examine and

trends what we found from the life that

inspires these

the data above the safety incidents is

most collected throughout the school

environment and there isn't a master

database where this information can be

found so pretty hard to come by also

evaluate and compare pools with emission

standards implemented versus pools

without explorer operator procedures for

evaluate for the evaluation of these

standards and include operators feedback

into a future legislative solution in

addition to admission standards a

variety of anti drowning initiatives

could be employed to ensure an effective

prevention strategy and when developing

these strategies in Ontario the reality

in particulars of an increasingly

diverse population would need to be

considered the interventionist execution

ought to be culturally mindful in order

to be effective to conclude I'd like to

thank Michael Shane and not only body

app of the Royal Life Saving Society of

Canada Ontario branch was listed with

the dissemination of the survey as well

as all the class a public pool operators

who completed the survey and provided

valuable feedback for additional

information and details related to this

project here's my contact information

and last couple slides are with the

references in case you wish to consult

them later on and with this our

presentation concludes thank you very

much for your time and attention

Thanks I hear that was a great

presentation I really appreciate it I'm

going to give a few months moments for

people to script questions that they may

have in the meantime I will remind all

those on the call that these slides will

be posted to the sci-fi Ontario website

promptly and we do also record these

sessions and we'll post the video and

commentary of this session to the sci-fi

Ontario YouTube channel which can also

be accessed through the Syfy Ontario

home page and also our my most people on

the line that the seminar series will be

in hiatus and April due to the Ontario

Public Health Conference if you haven't

got your tickets please attend now look

forward to seeing you there we will

return in May with another recreational

water seminar where fatty and and Maria

were are going to present on the

regulatory training program for pool and

spa operators don't tell nicely into a

filius presentation a few while we're

waiting for other questions to populate

I did have one about your your grounding

rates in your scan did you notice notice

any difference in the rates when they

were when you compare them to say the

province of Alberta which has mandated

adult supervision or in other

jurisdiction I recall Australia was one

of them did you notice any difference in

the drowning rates we didn't actually

compare those what we compared were the

child Guardian ratios so the study was

not geared towards the actual data about

the drowning incidents or water safety

related incidents was more about the

emission standards particularly those

child parent ratios in their

implementation but in terms of those I

can tell you that the ratios across

Canada vary slightly from from

our coroner recommended and from what

the ministry recommends and but what I

found internationally was that an

interesting idea popped up and those of

the risk assessment so in other words

they have some ratios that might be more

stringent than ours but the depending on

the situation so for instance if the

pool is just a regular pool there is a

certain ratio if that goes to a wave

pool then this ratio is decreased so

they are also doing a kind of real-time

risk assessment and then another

interesting issue was that in Europe

they seem to have defined the role and

the competencies of the Guardian or

parent much better so they're saying

that adult supervision means within

arm's reach and within visual and

auditory median see and also those

Guardians need to be proficient you know

be able to swim be able to provide help

if needed I don't know if that answered

your question

I appreciate it yes in terms of sorry to

interrupt in terms of them drawing data

and incident safety water safety

incidents data when Michael Shane told

us from the Life Saving Society that the

collection of this data is not done in a

in a systematic manner and there is no

master database where you could access

this

thank Sofia I just have a follow-up

there as well if you could please please

provide some details about how you

selected your pool for the survey and

how did you operationalize contacting

all of those people yes so as I

explained in some of the slides one

issue that came up when we were

designing the study was how to get the

survey out there and to the

collaboration with the Life Saving

Society that was the best way in the

fastest way we could get in touch with

operators so what we did we designed

this email and the licensing Society

distributed to their affiliates to do

177 of those affiliates swimming pools

phosphate swimming pools to secure email

we didn't have access to that so they

did it because they didn't want to give

us access to their to their affiliates

information so Life Saving Society

distributed those 277 emails and out of

those 277 certain number responded to us

so that was the way we selected our or

sample it turns out like initially we

thought that one email will go for each

pool location that's why we didn't

provide for in our survey for a question

that would clarify how many pools you're

responding for as an operator

so these 277 emails

might have accounted for I don't know

400 pools where what we know and in some

of the responses they did say oh I

managed six schools or I managed seven

pools and that's how we found out that

there was actually more cool than

responses

like sorry apologize for the Bell in the

background there's a fire alarm going

off here at BHO fire test thankfully I

appreciate your response and what it

reminds me of is another example of

where public health inspectors

collaborate with a wide range of

partners across the public health

spectrum we've seen in other

presentations where how inspectors will

contact our health inspectors other

jurisdictions we've partnered with with

business communities and then this is

just another great example of how pH is

reach out to try and help protect a home

of the public I don't see any other

questions here in the chat pod at this

time so with that and the buzzing in the

background I think that we will express

our thanks on behalf of sci-fi Ontario

branch and public health Ontario express

my thanks to athelia and all of her

collaborators in putting this

presentation together and we look

forward to seeing everyone in May

thanks very much everyone have a good

day thank you everyone bye-bye