Subject: Retraction Requested Re: NASCO (Golden State Lifeguards)

From: "Golden State Lifeguards" <info@goldenstatelifeguards.com>

Date: 9/21/2015 5:53 PM
To: <slangen@bgsu.edu>
CC: <docmarkenson@gmail.com>, <RFielding@uncc.edu>, <talees@nkc.org>,
<francescopia.phd@verizon.net>, <linda.quan@seattlechildrens.org>, <hsrb@bgsu.edu>,
<peter.heimlich@gmail.com>
September 21st , 2015
Stephen J. Langendorfer PhD
Editor, International Journal of Aquatic Research and Education (IJARE)
Professor/School Director, School of Human Movement, Sport, and Leisure Studies
Bowling Green State University (BGSU)
Bowling Green, OH 43403-0001
Dear Dr. Langendorfer:
This is to request that IJARE retract a research study published in the May 2010 issue, Development of In-Water
Intervention (IWI) in a Lifeguard Protocol With Analysis of Rescue History by John Hunsucker PhD and Scott
Davison of the National Aquatic Safety Company (NASCO), located near Houston, Texas.
This is also to request that you ask the authors to provide you with certain data used in the study and that you
provide me with the results.
Click here for a pdf file consisting of the study, the rebuttal, your editor's note, NASCO's reply to the rebuttal, and
a related letter to the editor from B. Chris Brewster, President of the United States Lifesaving Association.
From the study's abstract:
This paper discusses the development and effectiveness of a protocol for lifeguards in enclosed aquatic
facilities with special emphasis on scanning, rapid rescue, and applying a resuscitation procedure in the
water immediately after contacting a drowning victim. We call this set of procedures In-The-WaterIntervention (IWI). Testing showed abdominal thrusts (ATs) adapted for the protocol were the most
effective IWI procedure that could reliably be performed in deep water by 1618-year-old lifeguards.
Data analysis was done on a waterpark attendance of 63,800,000 with 56,000 rescues and 32
respiratory failures including four deaths.
From Analysis and Rebuttal of Development of an In-Water Intervention in a Lifeguard Protocol by Peter
Wernicki MD, Peter Chambers DO, Roy Fielding, Terri Lees, David Markenson MD, Francesco Pia PhD, and
Linda Quan MD, published in IJARE's 2011 issue:
The authors two-part goal was to describe a protocol they named in-water intervention (IWI) that uses
abdominal thrusts (ATs) and to report on its effectiveness at assisting drowning victims in waterparks.
We identify serious shortcomings in the papers methodology, interpretation and use of the literature,
and ethical principles. We conclude that their primary assertions were unsubstantiated by the evidence
they presented.
...The most disturbing aspect of this study is that Hunsucker and Davison ignored the ethical principles
governing the conduct of human subject research. The study failed to adhere to all three recognized
principles of human subject research - autonomy, beneficence, and justice as outlined in the Belmont
Report (National Commission 1979) and codified in all current regulations regarding human subject
research. It appears that experimentation was conducted on unknowing human subjects (failure to
adhere to autonomy). It involved the use of a disproved and potentially dangerous procedure that
ignored the international standard of care - CPR (failure to recognize beneficence). To make matters
even worse, the majority of the victims treated in the study were children (failure to adhere to justice).
Apparently, no institutional review board was involved, consent was not obtained, and procedures for the
conduct of human research in the absence of prospective informed consent were not followed. The
authors seemed to justify and conduct the experiment on their own without any oversight or outside
review. There was no informed consent given by the victims/patrons, but it is also unclear if the
lifeguards, instructors, facilities, or their insurers were aware that they were participants in an
unsanctioned study. By failing to employ appropriate methodology, statistical analysis, and conduct of
the study as previously described, the study cannot be of benefit and thus fails even the minimal
required test of human subject research - that a study has social value and scientific validity.

...Additionally, the authors egregiously fail to establish any process for checking for complications of ATs,
and seem to see no reason to do so, despite acknowledging that there have been ...very strong
concerns about the use of ATs for drowning. How many serious complications arose from the
unnecessary application of ATs resulting from protocols established by the authors?
...The use of ATs/Heimlich maneuver for drowned victims has been extensively reviewed, twice by the
Institute of Medicine (Rosen & Harley, 1995), multiple times by the Emergency Cardiovascular Care
Committee of the American Heart Association (Quan, 1993), by the International Liaison Committee on
Resuscitation and twice (in 2000 and 2006) by the Advisory Council on First Aid, Aquatics, Safety, and
Preparedness (ACFASP) committee of the American Red Cross (Pia, Fielding, Wernicki, & Markenson,
2010). At each review, each body recommended against its use for drowning resuscitation, noted that
ATs may be harmful, and limited its use only to airway obstruction caused by a solid foreign object. The
International Lifesaving Federation condemned its use in a published medical position statement
(International Life Saving Federation, 1996). No resuscitation guideline that we are aware of anywhere in
the world supports its use in drowning.
From your editorial, Protecting the Rights and Welfare of Research Participants, IJARE 2011, 5, 3-5:
The history of the rights and welfare of humans participating in research dates back to the 1947
Nuremberg Code and 1948 Universal Declaration of Human Rights. The need for the Code and
Declaration stemmed from the atrocities committed during World War II by National Socialists (Nazis)
who experimented on prisoners without their explicit permission or consent. Unfortunately, the abuse of
humans in research was not limited to Nazi wartime experiments, but extended to the now infamous
Tuskegee Syphilis Studies conducted on unsuspecting African-American men in the U.S. Following the
adoption of the human rights articles within the 1975 Helsinki Accords, all research in the U.S. was
expected to comply within standard operating protocols. All research institutions are required to establish
Institutional Review Boards (IRBs) responsible for reviewing and providing oversight on any and all
research conducted with humans.
One requirement of all research reported in APA journals (such as IJARE) is that authors indicate in the
Method section (note that Method is singular, not plural, by the way) that the study had been reviewed
and approved by an appropriate IRB and that the prescribed informed consent procedures have been
followed. It is the responsibility of reviewers and the Editor to make sure that all manuscripts are in
compliance with this ethical requirement.
1. This is to request that you apply the above standard to the Hunsucker/Davison study and to retract it.
2. Needless to say, authors of research studies published in peer-reviewed journals (including IJARE) are
obligated to maintain professional standards of transparency, including responding to reasonable requests
regarding their data. Otherwise how can readers evaluate the veracity of the published information? Further,
regarding the study in question, the waterparks which provided data to the authors may have participated in
violative human subjects research, likely a matter of concern to the scientific community and to the public.
In those regards, you'll recall I courtesy-copied you on an August 3, 2015 inquiry I e-mailed to Dr. Hunsucker and
Mr. Davison in which I wrote:
According to your article, Development of In-Water Intervention (IWI) in a Lifeguard Protocol with
Analysis of Rescue History, International Journal of Aquatic Research and Education, 2010, 4, 186-198:
Data analysis was done on a waterpark attendance of 63,800,000 with 56,000 rescues and 32
respiratory failures including four deaths.
Can you please provide me with the names and locations of the waterparks which provided the data,
and the years in which the data was collected by the waterparks.
I haven't received a reply so presumably the authors do not intend to provide me with the requested information.
Therefore, this is to request that you write Dr. Hunsucker and Mr. Davison and request that they provide you with
the information I requested as well as the dates and locations of the waterparks at which the 32 respiratory
failures including four deaths occurred, and that you provide me with the results.

I'm courtesy-copying Hillary Snyder PhD, BGSU's Research Compliance Officer, who may be a useful resource
regarding the human subjects protection issues.
If you're interested in learning more about the history of abdominal thrusts (the Heimlich maneuver) for drowning
rescue, you may wish to contact researcher/blogger Peter M. Heimlich who reportedly has conducted
considerable research into the subject and maintains a web page compiling media reports about NASCO's use
of the treatment.
Thank you for your attention and I look forward to your reply.
Sincerely,
Ed Castillo
Chief, Lifeguard/EMS Operations
GOLDEN STATE LIFEGUARDS
Pool Lifeguards, Ocean Lifeguards, Rescue Divers, Safety Divers, Trainers
Southern Californias Premier provider of private lifeguards since 2006!
Woodland Hills, CA
747-444-1035
www.goldenstatelifeguards.com
info@goldenstatelifeguards.com
Serving with Honor, Pride & Integrity

cc:
Peter Wernicki MD, Peter Chambers, Roy Fielding, Terri Lees, David Markenson MD, Francesco Pia PhD, Linda
Quan MD
Hillary Snyder, PhD, Research Compliance Officer, Bowling Green State University
Peter M. Heimlich, The Sidebar