Special thanks to Dr. Tom Griffiths for carving out time for this interview!
You can learn more about Dr. Griffiths and the Aquatics Safety Research Group here.
Transcription
Britt Jackson
Hello, my name is Britt Jackson and I'm the executive director of Shallow Water Blackout Prevention. We are a nonprofit organization that exists to raise awareness about the dangers of prolonged underwater breath holding, and to educate the general public on how to prevent incidences and fatalities due to shallow water blackout. I am delighted to be joined today by an expert in the aquatics industry, Dr. Tom Griffiths. Dr. Griffiths is one of the leading experts in the field of aquatic safety. He's the founder of the Aquatic Safety Research Group. He's been teaching and in charge of swimming programs on college campuses for 38 years, 23 years at Penn State University and a dear friend of our organization. He's been part of our board of directors since its conception. His team of experts, they have set a high standard for aquatic safety. So we're so pleased to engage in this conversation today about the need for awareness and what is surrounding the shallow water blackouts at this point and how we can prevent them from happening.
Tom, it's so good to have you here. Tell me, you have talked a lot about shallow water blackouts. You wrote about them back in the '80s, but tell me how you first came to understand what they were and your background.
Tom Griffiths
Sure. First of all, thanks for having me on Britt, really appreciate it. I'm glad for the opportunity to save lives. Shallow water blackout goes way back in time. I learned about shallow water blackout in the 1970s, early 1970s, 1971, 1972, when I was studying to be a scuba diving instructor. The number one resource for me and many scuba instructors was the United States Navy scuba diving manual, which was very technical. That was really our bible to learn how to teach scuba diving safely. One of the big areas in the Navy diving manuals was the danger of shallow water blackout, but it was addressed from a free diving perspective. So I learned about all the physiology of that through the United States Navy diving manual, and then taught that while I was teaching scuba diving classes, because a big part of scuba diving is snorkeling and freediving in a recreational setting and then you move on to scuba diving.
In 1983, I wrote my first book and that was a scuba diving book, Sport Scuba Diving in Depth. In there also, I wrote about the dangers of shallow water blackout. But again, it was primarily targeted and focused for snorkelers, mask, fins and snorkels, without the tank. It wasn't until 10 years later, 1983, I'd published Sport Scuba Diving and Death. And then about 1991-92, I finally figured out that these really good swimmers who were drowning in pools were succumbing to shallow water blackout or, medical maladies that were underlying that were triggered by shallow water blackout. We haven't discussed that yet, but that's true too. That's kind of the metamorphosis of shallow water blackout as far as my career is concerned.
Britt
You started writing about it in the early '80s. Then in the early '90s, you realized it was happening in swimming pools among regular competitive swimmers.
Tom
That's correct. Well, competitive swimmers, Navy SEALs, triathletes, synchronized swimmers. It finally dawned on me as we started collecting data that, wow, this was the same, not identical , as a freediving, shallow water blackout, but very, very similar. I might add that, a person who I really studied and admired was A.B. Craig, A.B. Craig, Dr. Craig was an exercise physiologist at Princeton University, and he did the first real research on shallow water blackout and shallow water blackout victims back in the '60s.
A.B. Craig was a swimmer at Princeton University. The reason why he got into it, because his teammate, who was also a co-captain, Dr. Craig was a co-captain of his college team, Princeton University, and his buddy was too. His buddy said, "I'm going to swim three lengths underwater. And on his third length, he passed out and ultimately drowned and died. Because this was not only his teammate, but his co-captain, his research in exercise physiology focused on the dangers of breath holding underwater, swimming underwater. He published his articles in the journal of the American medical association back in 1962. So this problem is not new. We've just done a horrible job educating the public. So we're trying to make up for lost time.
Britt
Okay. Explain to me what the issue is with the prolonged underwater breath holding. What is causing these blackouts?
Tom
Yeah, it's mostly a lack of oxygen, particularly for people who are swimming lengths over and over, or going down and holding their breath for as long as they can. The major problem is, they use up so much oxygen that there's not enough oxygen to support consciousness and they black out, hence, shallow water blackout. When we start talking about CO2 involvement, which carbon dioxide is involved, sometimes our message gets lost. But, it's as we're exercising, and as we continue to do this, we're overbreathing and we're exhaling too much. We're blowing off too much carbon dioxide, which is the trigger mechanism to breathe. So when we overbreathe, we lower our CO2 level, which is the trigger mechanism, and we use up too much oxygen and we black out. Both are true, but I prefer to keep our eyes on the lowered oxygen, our consuming of oxygen by holding our breath too long, so as not to confuse people out there. It's basically, we use up too much oxygen, we can't support life anymore and we black out.
Britt
We're going to talk about who is prone to experience a shallow water blackout. But, when you talk about this, it reminds me of how many of the cases that have been reported to us where we hear the blackout happened at the end of a workout or at the end of a practice, a person stayed longer to continue to practice more. They were drained of oxygen and energy and everything and that's when typically you're at the highest risk, I would say.
Tom
I concur. I agree completely. It's usually the end of a workout or an end of a set where people have been doing underwater drills. They've lowered their carbon dioxide level, but significantly lowered their oxygen level, so they black out. Now, many of these shallow water blackout cases are simply drownings. But many of them are also what we call genetic drowning triggers. I don't want to get into all of them, but there are a myriad of medical maladies like, long QT syndrome, RYR2, which is a genetic drowning gene. Those are triggered, those are precipitated by breath holding. So even if you don't succumb to drowning by shallow water blackout, voluntary breath holding can trigger these underlying medical maladies that you may not know about. So that's another reason why we don't want people to be holding their breaths underwater.
Britt
Wow, that's incredible. Well, tell me who is prone to experience the shallow water blackout? What kind of sports or are there any specifics here?
Tom
Well, anyone can get shallow water blackout, but typically you need to be a good breath holder. You need to be a good swimmer. So, Navy SEALs, triathletes, I mentioned these before. Just extreme athletes. Also, there's a horrible push amongst Olympic type athletes, whether it's track and field or wrestling or whatever. Like, "Well, if you really want to reach your peak, in addition to all the training that you're doing in the gym or out on the road or on your bike, go underwater and try to hold your breath for how long." Which is crazy. You get these extreme athletes. You get a lot of Type A individuals. If you're talking about a college student, they're usually a double major, they have great grades, because they push themselves beyond their limits. You have to be a good enough athlete to deplete your oxygen stores by staying down for real long time. So they're very good candidates for that.
But on the other extreme, young kids who are jumping up and down on the pool deck and playing Marco Polo and picking up pennies off the bottom, they can be huffing and puffing out of excitement and continually holding their breath and using up their oxygen stores, and at the same time blowing off carbon dioxide, which tells them when to breathe. So, kids playing underwater games and doing that, and for both groups, it's competitive and repetitive. If breath holding is competitive, in other words, for time or for distance, and it's repetitive, you're doing it over and over, whether you're a little kid playing a game or a world class athlete, those two ingredients are a recipe for disaster. Competitive, either against yourself or someone else, or repetitive, that will get you.
Britt `
Even from the biggest guy Navy SEAL training, down to junior, my little seven-year-old boy, they're all at risk for it?
Tom
They're all at risk. Yeah. But the people who subject themselves more to holding their breath longer and more often are more likely to suffer shallow water blackout than someone who was just holding their breath one time for 30 seconds or a minute. It's got to be competitive. It's got to be repetitive. If I can go back to A.B. Craig without taking too much time, he had two great mantras which was, one breath, one time. That's it, and then you rest. One length, one time, and then you rest. For those people who feel that they must do some underwater training. Those two mantras, I think, are pretty safe ideas. One breath, one time only. One length one time, only. And that's it.
Britt Jackson
Yes. You have said, in spite of all the education and warning about shallow water blackout, we've been talking about it for decades. The problems seem to be getting worse lately. I can confirm that from the reports we've received, even just in the last six months, the problem is getting worse. Why is that?
Tom
It's the internet exploding with techniques to find Nirvana and reach that total relaxation by holding your breath underwater. Freediving really, really deep for really, really long. Freedivers get a lot of press, get a lot of endorsements, but they also have a lot of fatalities. I think likes on Facebook and so forth where people are taking videos, taking pictures of, "Boy, I can't believe he's been down there for three minutes already." Many years ago, David Blaine was the famous stunt man who was holding his breath on the Oprah Winfrey show. I think it's those type of daring, adventuresome skill sets that people like to read about and watch videos on.
The other thing, I've had two cases, no, three cases of double drownings with shallow water blackout, where the individuals say, "I'll bet you I can stay down longer. Okay. On the count of three, let's go," and they both go down together, and they both drown. That happened to two Navy SEALs. It happened more recently to two Navy SEAL wannabes, high school seniors who were trying to become Navy SEALs, and so they find these exercises online. In Staten Island, New York, they found a pool that would let them do their exercises and they both died simultaneously on the bottom of the pool. So, yeah, it's bad.
Britt
Let's talk about hypoxic training for a minute because. First of all, I think many athletes don't even realize that they are actually getting themselves to a hypoxic state, or actually practicing hypoxic training. But you have some opinions about this. So I want to hear what you have to say about hypoxic training. Is it okay? How is it safe? How is it not? What should athletes be aware of?
Tom
Yeah. I've spoken to a lot of exercise physiologists about this, who study the training process. Most of them say there's actually no proof that hypoxic training actually improves performance. We think it does. We use it because we hope that it does. But there's no proof that it actually does. And again, when you do the hypoxic work at the end of the workout, you're more likely to have a blackout. There was one exercise physiologist, and I believe he worked with U.S.A Swimming, he said, the only safe hypoxic training is on dry land. Because again, if you do blackout, and anyone can have a hypoxic blackout if they're working hard enough, if you have a hypoxic blackout on land, we can get you faster, and we don't have the complicating factor of aspirating water, which is the definition of drowning. Under the water we may not see you. You may be disguised by the ripple effect on the surface, and we just assume that you're safe. That's why I'm against hypoxic training. We can train kids hard and long without restricting their airways and without restricting the need to breathe.
I might also say that many people who believe in hypoxic training, and believe in breath holding training, they said, "Well, these are the warning symptoms. The tingling of the lips, the tingling of the fingers." But going back to A.B. Craig back in the 60s, he interviewed many, many survivors of shallow water blackout who were pulled from pools and resuscitated successfully. He surveyed them and he said, "What was the last thing that you remembered before blacking out?" And they said, I think 100% said, "I thought I could swim forever. I felt great. I thought I could swim 10 laps under the water." And he said, "Well what about, did you have any warning signs?" Very few mentioned any warning signs whatsoever. The other thing we know that is with, if you reduce your oxygen levels long enough, you can have a sense of euphoria because the endorphins kick in like runners high. So many breath holders for either time or distance experience this high underwater, which supersedes any symptoms that they may have. So basically, you can black out without any symptoms.
Britt
Tell me, what can we do to protect the general public from shallow water blackout? What can we do?
Tom
Yeah. I think every pool, and many agencies have signed onto this, many pool has to have conspicuous warnings saying, "No breath holding in this pool. No prolonged or extreme breath holding in this pool." They need to use signage that uses warning shapes, warning colors, and warning symbols. Not a lot of verbiage, but like highway signs for deer crossing or whatever, but include a breath-holding symbol. Warning symbols, warning shapes, warning colors. That's the way you communicate globally. And then have lifeguards and others enforce it.
Now, there's been a disconnect, lifeguards sometimes get the message that this is dangerous, but then they don't do anything about it when they see it. So we have to tell lifeguards, "If you can't stop someone from breath holding, then get someone higher up who can." But, it has to be on websites. It has to be on aquatic facility newsletters. It has to be in the locker rooms. It has to be at poolside, that breath holding is dangerous. You can black out. You can die underwater. This happens quickly and quietly. Just like the Nike commercial. They say, "Just do it." With shallow water blackout, "Just don't do it." "Breath holding underwater, just don't do it."
Britt
Do you have any other things to add to the topic of lifeguards and safety personnel who are poolside or on the\ waterfront side, that they should be diligent to do? Any tips?
Tom
Yeah. The Red Cross talks about it and so do the other agencies like the YMCA and Ellis & Associates and all the other good ones. StarGuard, I don't want to forget about them. At every aquatic facility, you have to have a safety team. Most of us rely exclusively on the lifeguard. But, just like it takes a village to raise a child, it takes a village, it takes a big team, to prevent drowning. Like the Pool Management Group does out of Atlanta, they tell all their pools around the country that the clients, that the people at the pool, they're part of the safety team. They tell the parents, "If you see something, say something. If you see someone underwater that isn't moving, tell the lifeguards or jump in and tap them on the shoulder."
In my experience with drowning lawsuits that I've been involved with, and I've been involved with many, the number one excuse for not entering the water to rescue a swimmer who's submerged has been, "I thought he or she was holding their breath." And so for no other reason, to speed up the detection recognition process and the rescue and resuscitation process, we say, "More than 10, get them." You don't even have to count to 10. But if they're not moving by 10 seconds, 10 seconds is a long time. You got to go in and get them up out of the water.
Britt
Absolutely. Okay. For the people who are watching this who are active in a sport or hobby that requires underwater breath holding. Freediving, big wave surfing, synchronized swimming, is there a safe way to do this? Talk to us about the safety best practices for sports like this.
Tom
Yeah, to me, it's breath control and relaxation. Is, work on your breathing. Deep breathing out of the water before you participate. Work on relaxing. Work on meditating and mindfulness. I think as you participate in your sport, that will develop over time if you keep in mind, staying relaxed, controlling your breathing. I like to say breath control and relaxation. I wouldn't do any timed competitive breath holding skills, but if you are, do that on land. To me, that's the approach. But you know, all these drills, these underwater drills that are being done are just tempting the hand of fate. And if they're going to do that, I don't agree with it, but do it with a partner, do it with a person who knows that you could black out. Know what the risks are. That you could become unconscious suddenly without warning. And you could die.
Britt
Well, even our friend, Michael Phelps, has said publicly that, could he hold his breath under the water for a long time? Sure, he probably could, but he doesn't because it's not safe. It really is that simple and he is the best. So he would know, right?
Tom
Right.
Britt
I have heard that extreme underwater breath holding, you talked about this a little bit already, that it can be healthy and rewarding mentally, physically. I know a lot of people are ascribing to that now. Is there any truth to that?
Tom
I think it's hype with the water. It's different. "You're underwater, wow, get a load of that." They're, they're doing these breath-holding drills underwater. I believe in mindfulness, and mindful breathing and meditation and deep breathing, but I don't believe there's any suggestion, scientific suggestion, that the relaxation or the benefits that you receive from doing that underwater is significantly different from what you can do on land. I just think it's cool that it's underwater. The water feels good. Swimming has benefits in itself. I think people are going a little bit overboard, no pun intended, when they combine the benefits of being immersed in water with the benefits of holding their breath and doing breath holding skills. It's a little bit too much for me because it's dangerous. Do your mindful breathing and your mindfulness and your breath control and relaxation out of the water before you participate in your activity, and then try to stay as loose and as relaxed as you can and you'll derive many benefits from that in and of itself.
Britt
Yes. I want to talk briefly about a report we had a few months ago about a father of four boys who was participating, he was doing meditation, breath holding in his backyard spa and he suffered a blackout and his wife found him. They weren't able to resuscitate him. They had no idea that this was a possibility. It's very real, and it happens so much more often than we want. I am just so grateful for you to be here and talk to us about this and ways that we can prevent it. Is there anything else that you want to add before we wrap up?
Tom
I would just say that continue what you're doing, but I think the warning message has to go out to the people who sell pools, who install pools, the people who run pools. This can happen in the open water as well, but the real breath holders oftentimes practice in pools and do this at the end of the workout. People who sell swimming pools are in the swimming pool industry, aquatic directors, college swim coaches, they really have to get the message that this is a dangerous practice. We lose the people who we taught how to swim so they wouldn't drown. We taught them how to swim at a very early age. They learned to like swimming, and as a result, because they love being in the water so much, they do this dangerous practice because we, the educators, have not stopped them and not told them about the hazards and risks. It's a shame. These are kids and people that should never drown, because they're great athletes and great swimmers, but yet we didn't warn them sufficiently. They didn't get the message. So we have to kick it up a notch with the message.
Britt
Yes, absolutely. That's why we're here. We want to do everything we can to do that. Tell me where people can find you if someone wants to reach out and connect with you. I'm sure, LinkedIn, social media?
Tom
My daughter, Rachel, Dr. Rachel Griffiths, is good with the social media. I am terrible with social media. You can call me. You can go to my website, aquaticsafetygroup.com, www.aquaticsafetygroup.com. Actually, I'm on the east coast. You could actually call me if you wanted.
Britt
Okay. Well, we will definitely link to your website wherever this interview is played so people can reach out to you and Rachel, just a wealth of information and support.