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.