The Case Study:
Mid-afternoon on a very hot day in August in the southern United States, a mother, her two children and a friend entered a hotel water park, anticipating a relaxing afternoon in the water playground. This was not intended as an area for adults except as observers and guardians for their children. It was filled with several slides, and many spray venues, both overhead and ground level. In a corner of the area was a circular hot tub, a carry-over from the previous facility which was more adult-centric with a full pool.
The temperature was 100° on this cloudless day following a lengthy period of extended heat wave. The environment looked very appealing. The mother and her children sat on recliners in the vicinity of the hot tub which was empty at the time and still. The mother assumed because the jets were not on that the tub had been turned off. The younger children asked if they could go into the hot tub. The mother consented, and the two youngest entered the tub using the stairs. The youngest child exited to play in the spray features, and the 6-year-old, a skilled swimmer, remained in the tub seated on the bench edge inside the tub with water nearly reaching her neck. The mother was observing all of the children across the area while her oldest child departed to change into his swim suit. As he returned from the changing room, he saw that his sister was face down in the tub and called to his mother. The mother and brother immediately pulled the unconscious girl from the tub onto the concrete pool deck, calling for help. A nurse visiting in the pool area was alerted to the situation, ran to the child and assessed her, finding no pulse or respiration. She asked for a towel to be placed under her and immediately initiated CPR with another medical professional pool guest assisting. 911 was called. After several cycles of CPR, the young girl began breathing and her pulse returned, She vomited frothy material, but she remained unconscious. EMTs arrived and assessed the situation, supplying oxygen via facemask, and noting labored respiration, with lungs, sounding wet. They recorded that her skin was very hot to touch and that the young girl was unconscious with a Glasgow score of 8. She was then evacuated on a to the closest emergency room after their arrival. In route she had a seizure, without any prior seizure history. Her temperature on ED arrival was 104.7° F. She remained very febrile for a period of days with very low consciousness scores. Medical imaging demonstrated significant brain injury. After a series of transfers between hospitals over a period of several weeks she was discharged to home with very apparent severe brain damage. Years later, she remains very impaired.