Lifeguard Skin Cancer Protection
An Approach to Protecting Health and Promoting Image

B. Chris Brewster, Former Lifeguard Chief
San Diego Lifeguard Service

A Paper Delivered to the
International Life Saving Federation
International Medical/Rescue Conference
September, 1997

Introduction

The problem of skin cancer is insidious. As a result of high levels of sun exposure, many lifeguards have sustained this disease, even at a young age. Throughout the world however, lifeguards can be seen working under the sun with little protection, wearing a minimum of clothing, even during the most severe hours of the mid-day sun.

Lifesaving is a hazardous profession. Orthopedic injuries abound, trauma injuries can occur due to wave action and other factors, and, occasionally, death can result. For this reason, in Southern California, many professional lifeguards are classified as having high risk jobs and are given enhanced injury and retirement benefits in recognition of that risk. The high risk designation was not conferred with skin cancer in mind, but beginning several years ago, skin cancer emerged as a significant injury source.

In the early 1980's, the San Diego Lifeguard Service realized that it had a problem. Lifeguards were contracting skin cancer at a seemingly accelerating rate, some forced to retire early. Experienced lifeguards seemed most susceptible. They had been guarding the beaches long before sunblock became commonly available and fully recognized as a valuable protectant; but even younger lifeguards were developing this disease. In fact, from 1984 to 1989, 25 San Diego lifeguards sought treatment or medical evaluation for suspected skin cancer.

In some cases, the cancer was treated and resolved, with doctors determining that the lifeguards could continue to work, using proper precautions. In other cases, the cancer was treated, but doctors determined that the lifeguards could no longer return to their customary and usual assignments. They were disabled and forced to retire - some while only in their 30's.

In either case, the results were costly, both to the physical well-being of the lifeguards and the financial well-being of their employer. California maintains employment laws that require both treatment of injured workers and certain payments to workers when they are permanently injured on the job. When they are forced to retire early, there is an additional cost borne by the employee retirement system. In the case of retirements, the employer must hire new, less experienced personnel to take the place of those departing, and incur the costs of training. Such was the case for City of San Diego.

Lifeguards and Sun Exposure

Part of problem of lifeguard skin cancer rates is founded in the very culture of lifeguarding. Persons drawn to lifeguarding are typically highly physically fit and desirous of displaying their physical fitness. Those with light skin coloring often consider a deep, dark tan to be an essential part of their self-image and personal appearance. Meanwhile, they are sustaining accelerated damage to their skin and apparently greatly enhancing the likelihood of becoming skin cancer victims.

The fact that lifesaving disproportionately attracts the youthful only compounds the problem. Youths rarely worry about problems they might experience later in life. They are known to be higher risk takers than the general populace and they are particularly concerned with personal physical attractiveness.

To address these issues, prudent lifeguard employers need to take strong steps to ensure that their employees are adequately protected. Lifeguard employers commonly distribute sunblock to their personnel and some require its application. Lifeguard station designs should take sun protection into account, not only to reduce skin cancer problems, but also to counter the accelerated fatigue which results from over-exposure to the elements, sapping attentiveness and physical readiness. Unfortunately, the San Diego Lifeguard Service found that these steps were not enough. In consulting experts, we learned that the only true protection came from covering up the body, particularly areas of the body that are frequent skin cancer sites.

The Professional Image

Skin cancer aside, lifesaving has an image problem. Too often, lifesavers are inadequately recognized for the essential role they play. Although lifeguards probably have a greater impact on the saving of human life than any other public safety providers, they are sometimes seen as having a less important role than, for example, police or firefighters. This, in turn, has a deleterious impact on lifeguard budgets, equipment, and public recognition, all of which are inextricably intertwined.

There are many reasons for this, including the fact that lifesaving is often, literally, a day at the beach, which most people identify with recreation and relaxation. Some are jealous of the person who is able to work daily where most can only vacation occasionally. Thus lifesavers are sometimes seen as having a role that is more of a vacation itself than a serious public safety job. This is far from the truth, but it is a part of the image lifesavers must continually work to shed if they are to attract the funding and support necessary to ensure that they can adequately do their job.

There are many ways to improve image. One of the most obvious is through uniforms. Police and firefighters are almost always attired in official and readily identifiably uniforms which are clean and authoritative. They imply professionalism, whether the individual employees deserve that image or not. To the general public, these are people who, if necessary, have committed to risk their lives for the lives of others and their uniform tells this story.

Contrast this image with that of a lifeguard, perhaps slouching in an elevated chair for all to see, with only a pair of trunks on, relaxed and seemingly "catching rays." Perhaps then one can understand a primary reason that fire and police agencies are typically better funded, equipped, and paid than lifesaving agencies. For all three, professional image is essential to ensuring public support, but in many places, lifesavers are losing the public relations battle over professional image.

Lifeguards too, wear uniforms, but often the uniform is just a pair of trunks with a small patch, and perhaps a T-shirt occasionally worn. To a degree, dressing light is necessary. Lifeguards must be ready at a moment's notice to enter the water and make a rescue. They also need to keep cool. Improvements are possible however, which do not impede a lifeguard's response.

Perhaps more important than image is the need for the beachgoer and other lifeguards to readily identify the lifeguard in a crowd or at an emergency scene. It is essential that the lost child, the distraught parent, the arriving ambulance crew, the patrolling police officer can quickly and easily find the lifeguard, but this is often a difficult task. Perhaps the lifeguards' swimsuits are of consistent color, but rarely are they of a color or design unavailable to the general public. A small patch on the suit may be the only distinction. How often is the lifeguard at an emergency scene brushed aside by other emergency workers, partly perhaps by negative stereotyping, but partly due to lack of a professional image as compared to other emergency services workers?

Uniforms are also important for proper attribution and visibility when the news media visits a rescue scene or other event. Many years ago, firefighters took to placing their names and that of their agencies on the upper back of their uniforms, probably to help identify each other while assaulting a house fire or similar calamity. Today however, one of the most photographed images in local and national news stories is the backs of firefighters prosecuting a fire or rescue, with their agency's name widely credited. On their chests too, and their helmets, their agency's name is available for all to see. And those who are inspired by the heroism of emergency workers are moved to support them all the more as a result.

In San Diego, we found that too often, news accounts of beach emergencies identified all of the emergency workers except the lifeguards. Less experienced reporters would identify a lifeguard rescue boat as belonging to the police or fire department. They might assume that a cliff rescue could not have been performed by lifeguards, so they reported that firefighters had accomplished the rescue, even if none were there. This led to great frustration on the part of lifeguards whose deeds were not recognized or, seemingly, even appreciated.

Protecting Health and Image

In the early 1980’s, theSan Diego Lifeguard Service decided to address both of these issues in an effort to protect it’s personnel and burnish its professional image. In 1984, it adopted a standardized uniform policy including everything from wetsuits to T-shirts and the dress uniforms worn by its personnel on formal occasions. A standard logo for the shirts was chosen, which is also an educational depiction of a person in distress in the water, waving for assistance. The backs of all uniforms state LIFEGUARD in bold letters, and SAN DIEGO. The front of beach uniforms of full time employees includes a silk-screened badge, as well as the employee's name. For seasonal employees, the front of the shirt includes a smaller version of the logo on the back. The colors of the shirts too, are consistent. This logo arrangement is also used on uniform sweatshirts, jackets, wetsuits, and personal flotation devices.

For trunks, tanksuits, and dress uniforms, the San Diego Lifeguard Service retained the traditional patch. It is worn on the lower left thigh of trunks or lower left abdomen of tanksuits. It is also worn on both shoulders of Class A (dress) uniforms, which include a metal badge and nametag. The patch, which is red, white and blue, appears at left.

The policy regarding the wearing of uniforms and sunblock, both for personal protection and professional image, is perhaps the most strict of any lifeguard service. It includes:

• Uniform shirts of a consistent color must be worn at all times unless actively involved in a water rescue.
• All upper body uniform items, including wetsuits, personal floatation devices, etc. must be emblazoned back and front with standard, identifying logos.
• Hats must be worn whenever the lifeguard will be exposed to the sun for more than 15 minutes.
• Sunscreen must be applied regularly to all exposed areas.

These requirements ensure that the upper bodies of lifeguards, excluding the necks and lower arms, are protected from the sun at all times, greatly reducing sun exposure of areas of the body heavily susceptible to skin cancer. They also ensure that San Diego lifeguards are immediately identifiable to the public they serve, fellow safety providers, and to persons watching news media accounts.

Initially there was great resistance to the policy. Lifeguards rejected the shirts and strong supervision was required to keep the policy in force. Today, discipline is still occasionally meted out to lifeguards who decide that tanning is more important than personal protection, public identification, and professional image; but this is the exception.

Outcome

Has San Diego's initiative accomplished its twin goals? In regard to skin cancer, it appears that there has been a significant reduction, both in severity and frequency. Obviously this has also come during a time of heightened awareness of skin cancer and the need for sunblock, and skin cancer can take many years to develop, so the full effect of this policy may take decades to fully evaluate. No one however, would dispute the fact that covering up is the most effective way to protect against the ravages of the sun. The following charts give some specific data on our history of skin cancer problems:

As for the benefits of professional image, San Diego lifeguards have progressed tremendously over the past several years. Since implementation of the uniform policy, San Diego lifeguards have developed a much stronger public image within and outside their community. One reason is that San Diegans watching the local news regularly see the word "lifeguard" in local news accounts of beach area emergencies, be they cliff rescues, water rescues, boat fires, river rescues, etc. Even if the reporter gets the story wrong, the video identifies the rescuers. National news accounts of major disasters in our area, such as flooding, as well as reenactment shows, have also shown San Diego lifeguards involved in rescue work. Each time, we believe that it gives the public a sense that their tax dollars are well spent on lifeguards.

Once a district within a division of the Park and Recreation Department, the San Diego Lifeguard Service was made a full division in 1988, then combined with the Fire Department to form a new organization called Fire and Life Safety Services in 1995. On July 30, 1997, a City Council committee discussed a proposal to make the San Diego Lifeguard Service an independent department.

Since 1985, the annual budget of the San Diego Lifeguard Service has grown significantly, from $2.7 million to $6.5 million. The number of budgeted full time equivalent positions in the Lifeguard Service has increased from 72 to 107 during that same period. Recently, the City Council voted to increase the annual budget of the Lifeguard Service by $300,000, which translates to five additional full time lifeguard positions.

Certainly all of these improvements cannot be singularly attributed to uniforms and the professional image they bring. Professionalism, after all, goes well beyond image, but ensuring that the public we serve knows who made the rescue is very important. There is little doubt that the palpable change in public support for the San Diego Lifeguard Service and the various enhancements in pay, budget, and positions are owed to a large part to the improved image presented by the uniforms worn by its employees. Certainly each of them is better protected and better respected since this policy was implemented.

About the Author . . .

B. Chris Brewster is former Lifeguard Chief for the City of San Diego and was also concurrently Harbormaster for Mission Bay. Brewster edited The United States Lifesaving Association Manual of Open Water Lifesaving, as well as USLA's Guidelines for Open Water Lifeguard Training and Standards and Guidelines for Training and Standards of Aquatic Rescue Response Teams. He serves as Vice-President of the International Life Saving Federation and President of the Americas Region. He also serves as Chair of the National Certification Committee of the United States Lifesaving Association.

Phone: 619-221-8832
Fax: 619-581-1227
E-mail him by clicking here

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