Acute Stress Symptoms Among US Ocean Lifeguards

We designed a survey to study ocean lifeguard responses after a lifesaving rescue. Respondents were generally “healthy,” physically active Caucasian men, most being from California. During their career, 48% of respondents reported acute stress symptoms after performing such a rescue, especially those with a history of anxiety or a history of asthma. During the past century, ocean lifeguards have grown to play a critical role in protecting swimmers at many US beaches. They perform lifesaving ocean rescues and medical interventions. Approximately a quarter of American adults visit the beach annually. The health of lifeguards is potentially at risk as a result of long hours of daily seawater exposure through skin contact, water ingestion, or inhalation of marine aerosolized particles, and the psychological stress of rescues. A limited number of studies have considered sun exposure, red tides, drowning, rescues, fitness standards, visual acuity, and swimming performance. However, no studies, to our knowledge, have examined acute stress symptoms because of occupational rescues by ocean lifeguards. The goal of our study was to obtain data from lifeguards about their health and acute stress symptoms experienced associated with ocean rescues as a lifeguard. The objective of this study was to determine whether ocean rescues were associated with acute stress symptoms. English-speaking US ocean lifeguards at least 18 years old and employed a minimum of 20 hours per week were eligible to participate in the survey. Recruitment occurred through the United States Lifeguard Association online message board, social media ads, and by fliers. Study participants provided informed consent online and completed an online questionnaire using the software Survey Monkey (Survey Monkey, Inc, Palo Alto, CA). The survey was conducted from August through November 2010. Data analysis was conducted using Stata 11 statistical software package (StataCorp LP, College Station, TX). Univariate analysis and multivariate logistic regression were used to quantitatively describe the associations between risk factors and acute stress symptoms. The final multivariate logistic model included the independent variables of physician diagnosis of anxiety and asthma and self-reported adverse health symptoms after exposure to a red tide. The risk of illness was described as an adjusted risk ratio, with the associated 95% confidence interval (CI). The Institutional Review Board of the University of California, Berkeley approved the study protocol (2010-05-1557). One hundred sixty-eight ocean lifeguards responded to our survey. Table 1 reports lifeguard characteristics.Table 1Individual characteristics of ocean lifeguard participants (n = 168)CharacteristicnMedian, Range(%)Age (years)16824, 18–59Years lifeguarding1686, 1–30Rescues in the past week1642, 0–30Hours in ocean this past week1687, 0–60Lifeguards performing rescues in past week11367 With history of asthma2012 With history of anxiety149Ethnicity Caucasian (non-Latino)15592 Latino138Sex Men12172 Women4728Geographic location West coast10361 East coast4627 Gulf coast1610 Hawaii32 Open table in a new tab Nearly half the lifeguards reported at least 1 acute stress symptom after an ocean rescue (Table 2). Lifeguards experienced acute stress symptoms, but did not meet diagnostic criteria for acute stress disorder. In the adjusted multivariate logistic regression, lifeguards with a history of anxiety were 1.7 times more likely to experience acute stress symptoms after a rescue than lifeguards without a history of anxiety (95% CI, 1.3 to 2.2). Lifeguards who reported adverse health symptoms after red tide exposure were 1.4 times more likely to experience acute stress after a rescue than lifeguards without such a history (95% CI, 1.1 to 1.9). Lifeguards with a history of asthma were 1.7 times more likely to experience acute stress symptoms after a rescue as compared with lifeguards without a history of asthma (95% CI, 1.3 to 2.1).Table 2Acute stress symptoms experienced by lifeguards after ocean rescues (n = 167)aSymptoms not mutually exclusive.Symptomn(%)None8652Flashbacks of rescue4326Sleep difficulties3018Hypervigilance2616Recurrent dreams of rescue2616Recurrent recollections of rescue1811Avoid thoughts or talking about rescue1710Difficulty concentrating148Intrusive images148Exaggerated startle response117Irritability or outbursts of anger42a Symptoms not mutually exclusive. Open table in a new tab This is the first study to examine acute stress symptoms among ocean lifeguards. This was a relatively young, healthy, and active cohort. Nearly half reported acute stress symptoms after an ocean rescue. Our study found an association between lifeguard acute stress symptoms after an ocean rescue and anxiety, asthma, and adverse health symptoms after red tide exposure. Anxiety is one of the most prevalent mental health problems in the United States, estimated at 18% of the US adult population.1Kessler R.C. Demier O. Frank R.G. et al.Prevalence and treatment of mental disorders, 1990 to 2003.N Engl J Med. 2005; 352: 2515-2523Crossref PubMed Scopus (1372) Google Scholar “Acute stress disorder” is classified as an anxiety disorder in the Diagnostic and Statistical Manual of Mental Disorders.2American Psychiatric AssociationDiagnostic and Statistical Manual of Mental Disorders. 4th ed, text revision (DSM-IV-TR).. American Psychiatric Association, Washington, DC2000Crossref Google Scholar Given the potential life-threatening nature of lifeguard duties, ocean rescues for some lifeguards can be an occupational stressor leading to acute stress symptoms. Stress has been identified as a biological trigger for asthma in the general US population.3Quinn K. Kaufman J.S. Siddiqi A. Yeatts K.B. Stress and the city: housing stressors are associated with respiratory health among low socioeconomic status Chicago children.J Urban Health. 2010; 87: 688-702Crossref PubMed Scopus (33) Google Scholar Interventions to decrease asthma symptoms need to address individual reactions to acute stress. The self-report of adverse health symptoms after exposure to a red tide may be related to a stress response associated with potent neurotoxins of harmful algal blooms. Future studies are needed to identify acute stress symptoms and adverse health effects associated with specific harmful algal bloom toxins and concomitant pathogenic bacteria and viruses. Further research is needed to determine what effect, if any, rescue circumstances, environmental conditions, lifeguard training, and physical fitness have on acute stress symptoms. As with any pilot study, there are potential limitations. Self-reported data and self-selection bias are concerns of this study. The findings reported here may not be applicable to other lifeguard cohorts. Although our findings are limited to this rather modest interview population, they provide valuable baseline data on ocean lifeguards and generate hypotheses for future and larger studies. In conclusion, ocean rescues performed by lifeguards in this cohort were associated with acute stress symptoms. Additional research is warranted to investigate what effect, if any, rescue circumstances, environmental conditions, lifeguard training, and physical fitness have on acute stress symptoms.