Color-Coded Safety Glossary 

First Aid/CPR - Health/Well-being - Home and Workplace Safety - Lifeguarding/Water Safety - Swimming/Aquatics

A-B     C-D     E-F     G-H     I-J     K-L     M-N     O-P    Q-R     S-T     U-V     W-X-Y-Z

A

AAI

(1) Adapted aquatics instructor. (2) Atlantoaxial instability.

abandonment

A legal concept for the withdrawal of protection, support, or help from a patient without the patient’s consent and before someone of equal or greater training can take over.

abdomen

The part of the human body (or the body of any vertebrate) that contains the stomach, intestines, and other organs, usually situated between the pelvis and the thorax (chest).

abdominal cavity

The superior portion of the abdominopelvic cavity. The abdominal cavity contains the stomach, spleen, liver, gallbladder, small intestine and most of the large intestine.

abdominal thrust

A forceful, inward-and-upward compression of the abdomen just above the navel to exert pressure on the diaphragm and force air from the lungs to expel an object obstructing the airway. Essentially, this amounts to an artificial cough. Sometimes, abdominal thrusts are known as the Heimlich Maneuver® after Dr. Henry Heimlich who first described the procedure in 1974.

For more information about abdominal thrusts, check out the following:

• Choking First Aid by the Mayo Clinic - This is an excellent description of American Red Cross and American Heart Association procedures!
• Heimlich Manuever at Mary (an RN) at Howcast - Great descriptive video demonstration.
• Heimlich Manuever at Howcast - Standard Howcast step-by-step instructive video.

abdominal thrusts for drowning victims

A practice once promoted by Dr. Henry Heimlich in which a lifeguard performs abdominal thrusts (also known as the Heimlich Maneuver®) during a swimming rescue of an unconscious, nonbreathing victim in an effort to remove water “from the lungs.” Opponents of this technique for drowning victims have stated that it delays CPR and can cause complications such as vomiting and abdominal injuries. It has been largely discredited by the worldwide scientific and medical community since the mid-1990s.

The National Lifeguard Safety Company (NASCO) was the only nationally recognized lifeguarding certification company that taught this technique, until an article in the Houston Press published on 01/27/2016 reported that NASCO has now dropped the technique. Even information from the Heimlich Institute no longer mentions the Heimlich Maneuver for drowning cases.

To see some of the controversy over this procedure, follow these links:

• Heimlich Maneuver vs. Mouth-to-Mouth in Drownings, 1994 (NY Times)
• North Virginia Regional Park Authority Discards Use of Heimlich Maneuver for Drowning Victims, 2011 (Washington Post)
• Dangerous Maneuvers, 2012 (Aquatics International Magazine)

abdominopelvic cavity

The large hollow area of the trunk, subdivided into abdominal and pelvic cavities. The abdominopelvic cavity extends from the diaphragm to the groin and is encircled by the abdominal wall and the bones and muscles of the pelvis.

abnormal

Differing from the usual state, structure, condition, or rule.

ABO blood types

The major human blood group system, consisting of type A, AB, B, and O, depending on the presence of A and B genes that determine the configuration of the surface of red blood cells. Type A indicates the presence of two A genes; type B means two B genes; type AB is one A gene and one B gene; and type O means that neither the A or the B gene is present. Blood typing is important in blood banking and blood transfusions. It is most important to determine ABO status of both the donor and recipient in transplants and transfusions. ABO incompatibility in such procedures can be life-threatening. 

For more information, go to ABO Blood Types by WebMD.

above-ground pool

An assembled or portable pool that sits on the ground or in the bed of a truck, usually of limited depth.

abrasion

A wound in which the skin has been scraped or rubbed away. An abrasion is usually less severe than a laceration, and bleeding, if present, is minimal. Mild abrasions, also known as grazes or scrapes, do not scar or bleed, but deep abrasions may lead to the formation of scar tissue.

Like burns and frostbite, abrasions can be describes as first-, second-, or third-degree, based on wound depth. A first-degree abrasion involves the upper layer of the skin (epidermis) only. A second-degree abrasion involves both layers of skin (epidermis and dermis), and third-degree abrasion is deep enough to involve both layers of skin and the underlying tissue (hypodermis or subcutaneous tissue). Second- and third-degree abrasions are also known as avulsions, skin-flap injuries, or deglovings if tissue has been torn away.

To care for an abrasion:

1. Clean the area by flushing with water (do not use soap in the wound).
2. Stop any bleeding with direct pressure.
3. If bleeding is not severe, consider applying an antibiotic ointment such as bacitracin, if local protocol permit it.
4. Cover the wound with a sterile dressing and bandage.
5. Call 911 or the local emergency number for abrasions that cover a wide surface area, abrasions that are deep or have torn-away tissue, any wound with severe bleeding, or a wound with a severed body part.

Click for more information about treating avulsions and abrasions. See also wound care on the Doctors.

abscess

A collection of pus in any part of the body that usually causes swelling and inflammation around it. Diagram on the right courtesy of “Blausen gallery 2014“. Wikiversity Journal of Medicine. DOI:10.15347/wjm/2014.010. ISSN 20018762.

absence seizure

A nonconvulsive seizure in which the patient displays minimal or no movement and appears to have a blank stare. This type of seizure is also known as a petit mal seizure.

• See a message from The Center of Epilepsy and Seizure Education in BC.
• See Tyler perform a test for absence seizures and have three.
• See River have absence seizures.

absorbed poison

A toxic substances that enters the body through contact with the skin or mucous membranes.

access

The plan, path, technique, and equipment involved in reaching a patient for the purpose of first aid care or extrication.

accident

An unforeseen and unplanned event or circumstance often resulting in harm, injury, damage, or loss.

accident causation

The factors that act together to cause accidents. They include personal factors (e.g., lack of knowledge/skill or motivation), job factors (e.g., inadequate supervision or work standards), and lack of management control factors (e.g., inadequate safety policies/programs).

accident investigation

The process of systematically gathering and analyzing information about an accident. This is done for the purposes of identifying causes and making recommendations to prevent future accidents of the same kind.

accident prevention

The systematic application of recognized principles to reduce incidents, accidents, or the accident potential of a system or organization.

accident report

A form filled out to record the objective details of an injury or medical condition suffered by a customer, participant in an event, or employee. Sometimes this report is known as an incident report and is used to report a broader range of unusual happenings, including fight, civil disturbances, theft, property destruction, etc. (all of which may not be accidents).

For sample accident reports, follow these links:

• How to Write a Good Accident or Incident Report (EHS Safety News America)
• Sample Accident Report Form (CSUN)
• Sample Accident Report Form (NonProfitRisk.org)
• Sample Completed Accident Report (Imperial College London)

accidental fecal release (AFR)

A term used by lifeguards and pool operators to describe the sudden appearance of poop in a swimming pool. Also known as a fecal incident.

The appearance of an AFR in the swimming pool is a concern for participants, lifeguards, and pool operators alike. Despite normal disinfection and filtration processes in the pool, the pool must be closed so that stronger measures can be taken to remove the waste and kill any pathogens in the water. Keeping participants in the water can result in the spread of a recreational water illness (RWI).

The procedure to remove fecal waste and to kill potential pathogens in the water depends on the following factors:

• Consistency of the AFR. A diarrheal fecal incident is a higher-risk event than a formed-stool incident. With most diarrheal illnesses, the number of infectious germs found in each bowel movement decreases as the diarrhea stops and the person’s bowel movements return to normal. A formed stool may contain no germs, a few, or many that can cause illness. You won’t know. The germs that may be present are less likely to be released into the pool because they are mostly contained within the stool. However, formed stool also protects germs inside from being exposed to the chlorine in the pool, so prompt removal is necessary. 
• The quantity of chlorine used to disinfect the water. Chlorine kills pathogens in the water, but it does not work immediately. According to the Centers for Disease Control (CDC), if pool water contains 1 part free chlorine to 1 million parts water, the E. coli bacterium would be inactive in less than a minute, but the Giardia parasite would last 45 minutes and the Cryptosporidium parasite (Crypto) would last over 10 days! Higher concentrations of chlorine in pool water kills pathogens quicker; for example, at 10 parts per million, Crypto is destroyed in 25.5 hours.

To respond to an AFR in a swimming pool:

1. Close the pool immediately.
2. Remove any solid pieces of feces without causing it to break apart. Use a scooping tool attached to a pole. Do not vacuum.
3. Increase the free chlorine residual in the water to the following levels and times:
   • For formed feces: At least 2 ppm for 25 minutes
   • For diarrheal feces: At least 20 ppm for 13 hours
4. Be sure to maintain a pH reading of 7.5 or less and a water temperature of 77° F (25° C) or higher during the entire time.
5. For a diarrheal incident, backwash the filters after the time in step 3 has passed. If appropriate, replace the filter media.
6. Maintain a record of the incident in a fecal incident log. Record the time of the incident, the type of feces, and the measures taken in response (see steps 1 to 5).

To learn more about AFRs and RWIs, go to the CDC’s Disinfection & Remediation of Pools & Hot Tubs web page. (Just for fun, here is the classic Caddyshack Poop in the Pool Scene with Bill Murray-Careful! Brief nudity!)

Achilles tendon

The large rope-like band of fibrous tissue in the back of the ankle that connects the calf muscles to the heel bone (calcaneus). Sometimes called the heel cord or calcaneal tendon, it is the largest tendon in the human body.

Achilles tendon rupture

A breaking of the Achilles tendon due to sudden forceful use or over-extension, especially after the Achilles tendon has grown weak and thin with age or lack of use or because of certain illnesses (such as arthritis and diabetes) or medications (such as corticosteroids and some antibiotics). 

Signs and symptoms of Achilles tendon rupture include sudden, severe pain in the area often described as “being hit with a rock”; a loud snap or popping sound; bruising in the area; inability to point the toe; and swelling and stiffness.

First aid care for Achilles tendon rupture includes RICE:

• Rest the injured part. Pain is the body’s signal to not move an injury.
• Ice the injury. This will limit the swelling and help with the spasm.
• Compress the injured area. This again, limits the swelling. Be careful not to apply a wrap so tightly that it might act as a tourniquet and cut off the blood supply.
• Elevate the injured part. This lets gravity help reduce the swelling by allowing fluid and blood to drain downhill to the heart.

acid

A chemical substance containing hydrogen that can be used to neutralize alkaline materials and lower the pH of swimming pool water. The most common acids used in swimming pool chemistry are hydrochloric (muriatic) acid and sodium bisulfate (dry acid).

acid demand

The amount of acid required to reduce a high pH or total alkalinity reading to the desired value, as determined by an acid demand test.

acidosis

Excessive blood acidity caused by an overabundance of acid in the blood or a loss of bicarbonate from the blood (metabolic acidosis), or by a buildup of carbon dioxide in the blood that results from poor lung function or slow breathing (respiratory acidosis).

ACLS

Advanced cardiac (or cardiovascular) life support.

acquired immune deficient disorder (AIDS)

A serious condition caused by the human immunodeficiency virus (HIV) that destroys the body’s ability to fight infection. AIDS occurs when a person’s immune system is too weak to fight off many infections, and develops when the HIV infection is very advanced. This is the last stage of HIV infection where the body can no longer defend itself and may develop various diseases, infections and if left untreated, death.

There is no cure for HIV or AIDS. However, with the right treatment and support, people can live long and healthy lives with HIV. To do this, it is especially important to take treatment correctly and deal with any possible side-effects. See more at: http://www.avert.org/about-hiv-aids/what-hiv-aids#sthash.gGRgj9JW.dpuf.

Someone with AIDS may develop a number of opportunistic infections and diseases, including cytomegalovirus, fungal infections, pneumonia, thrush, toxoplasmosis, or tuberculosis. There is also an increased risk of developing life-limiting conditions, such as cancer or brain diseases.

active drowning victim

A person exhibiting struggling behaviors in deep water that include a maintaining a vertical position in the water with head held back and eyes wide open, thrashing arms that may look like “climbing the rungs of a ladder,” absence of a supporting kick, and inability to move forward or tread water. Taken together, these behaviors are sometimes called the instinctive drowning response.

active victim front rescue

An equipment-based swimming rescue in the American Red Cross Lifeguarding Program performed by swimming to the front of a distressed or active drowning victim and pushing the rescue tube  into the victim’s chest with arms straight. While continuing to keep arms straight, the lifeguard kicks the victim to safety, driving the victim backwards. Also called the front drive rescue in the International Lifeguard Training Program (ILTP) of Ellis and Associates.

active victim rear rescue

An equipment-based swimming rescue performed by swimming to the rear of an active drowning victim with a rescue tube in front of the lifeguard and under the armpits. As contact with the victim is made, the lifeguard keeps the rescue tube in position and reaches under the victim’s armpits and locks the victim’s shoulders with bent elbows and forearms. At this point, the lifeguard pulls the victim back onto the rescue tube while, at the same time, turning the face away from the victim to avoid being hit with the back of the victim’s head.

Once the victim is on top of the rescue tube and the lifeguard has control of the victim’s shoulders, the lifeguard uses a strong leg kick (e.g., eggbeater kick) to move the victim to safety. 

The lifeguards at City of Aurora, CO, show how to do the active victim rear rescue.

acute

(1) Characterized by sharpness or severity; (2) having a sudden onset, a sharp rise, and a short course.

acute respiratory distress syndrome (ARDS)

A buildup of fluid in the tiny air sacs in the lungs called alveoli. This means less oxygen can get to the brain and other vital organs, which is very dangerous. ARDS occurs when there is significant trauma that either affects the lungs directly or indirectly. Some examples of trauma include sepsis (a blood infection), breathing in smoke from a house fire, near-drowning, severe pneumonia, major trauma, and shock from any cause. Your body responds to this trauma with an inflammatory reaction that releases many natural molecules into the bloodstream. Normally, this inflammatory reaction would be protective and help you fight infection or heal from an injury. However, in some people, these inflammatory molecules lead the smallest blood vessels in the lungs to leak fluid. Fluid leaves these small vessels and goes into the alveoli. The alveoli fill with this fluid, making it difficult for oxygen to get into the bloodstream.

ADA

Americans with Disabilities Act.

adult

For the purposes of receiving emergency medical treatment or first aid, an adult is a person who is old enough to have achieved puberty (10 to 14 years old) and older.

advance directive

Written instructions signed by the patient and his/her physician outlining the patient’s wishes for health care should the patient be unable to express his/her wishes.

advanced cardiac (or cardiovascular) life support (ACLS)

A set of clinical interventions for the urgent treatment of cardiac arrest, stroke, and other life-threatening medical emergencies as well as the knowledge and skills to deploy those interventions.

AED

Automated external defibrillator. 

aerobic exercise

Rhythmic, physical exercise that is sustained for a continuous period and requires extra effort by the heart and lungs to meet the body’s increased demand for oxygen.

AFR

Accidental fecal release (into a swimming pool).

agent

Any substance, force, organism, or influence that affects the body, a part of the body, or any of its functions. The effects may be beneficial or harmful.

agonal breath

An abnormal brainstem reflex characterized by irregular gasping, sometimes accompanied by strange vocalizations and muscle spasms. This is not true breathing or movement indicative of a return of spontaneous circulation.

AIDS

Acquired immune deficiency syndrome.

air sparging system

Also known as a diving well bubbler system.  A mechanism that creates a cushion of aerated water on the surface of the pool, allowing springboard and platform divers to practice new dives while reducing the risk of severe injury as a result of a poor landing.

all-hazards approach

An approach to disaster readiness that calls for the capacity of responding to any type of disaster with the range of available equipment and resources.

ALTE

Apparent life-threatening event.

albuterol

The generic form of the brand-name drugs Proventil, ProAir, and Ventolin, which are used to treat lung diseases such as asthma and chronic obstructive pulmonary disease (COPD).

Albuterol can quickly relieve shortness of breath, coughing, wheezing, and chest tightness. It’s in a class of drugs known as bronchodilators, which work by relaxing and opening air passages to the lungs.

This medicine is sometimes used to treat or improve muscle paralysis in people with a condition that causes paralysis attacks (such as hyperkalemic periodic paralysis).

The Food and Drug Administration (FDA) approved albuterol in 1982.

For more information about albuterol, use the links below:

• Albuterol (Everyday Health)
• Albuterol (Mayo Clinic)
• Albuterol (Medline Plus)
• Albuterol Sulfate (RxList)

allergen

A usually harmless substance capable of triggering a response that starts in the immune system and results in an allergic reaction. For example, if a patient has an allergy to pollen, the immune system identifies pollen as an invader or allergen. The immune system responds by releasing chemicals that typically cause symptoms in the nose, throat, eyes, ears, skin, or roof of the mouth.

In addition to pollen, other common allergens include dust mites, animal dander, mold, medications, insect venoms, and various foods.

allergy

A chronic condition involving an abnormal reaction to an ordinarily harmless substance called an allergen.

If a person has an allergy, the immune system views the allergen as an invader and a chain reaction is initiated. White blood cells of the immune system produce IgE antibodies. These antibodies attach themselves to special cells called mast cells, causing a release of potent chemicals such as histamine. These chemicals cause symptoms such as:

• Itching in the nose, roof of the mouth, throat, eyes
• Sneezing
• Stuffy nose (congestion)
• Runny nose
• Tearing eyes
• Dark circles under the eyes

To learn more about allergies, check out the Allergies page of the AAAAI.

alveolus (plural: alveoli)

One of the many small air-containing compartments of the lungs in which the bronchioles terminate and from which respiratory gases are exchanged with the pulmonary capillaries. The alveolar membrane is the gas-exchange surface. Carbon dioxide rich blood is pumped from the rest of the body into the alveolar blood vessels where, through diffusion, it releases its carbon dioxide and absorbs oxygen. A typical pair of human lungs contain about 700 million alveoli. Each alveolus is wrapped in a fine mesh of capillaries covering about 70% of its area. An adult alveolus has an average diameter of about 8/1000 of an inch (200 micrometers), with an increase in diameter during inhalation.

Ambu bag

The name given to the first bag-valve-mask (BVM) resuscitator, developed in 1953 by German engineer, Holger Hesse, and his partner, Danish anaesthetist Henning Ruben. The two inventors founded the company Ambu and began selling the Ambu bag in 1956.

American National Standards Institute (ANSI)

A privately funded, voluntary membership organization that develops consensus standards for a wide variety of devices and procedures. ANSI oversees the creation, promulgation, and use of thousands of norms and guidelines that directly impact businesses in nearly every sector: from acoustical devices to construction equipment, from dairy and livestock production to energy distribution, and many more. ANSI is also actively engaged in accreditation, assessing the competence of organizations and determining conformance to standards.

To learn more, go to www.ansi.org.

American Red Cross

A humanitarian organization that provides emergency assistance, disaster relief, and health and safety education inside the United States.

Americans with Disabilities Act (ADA)

A federal law that prohibits discrimination against people with disabilities. For more information, go to www.ada.gov.

anaerobic exercise

Brief, high-intensity activity, where the demand for oxygen by the muscles exceeds the available supply.

anatomical position

The position of the body used in anatomical descriptions in which the body is erect, the head is level, the eyes face forward, the upper limbs are at the sides, the palms face forward, and the feet are flat on the floor and directed forward.

aneurysm

An abnormal weakening or ballooning-out of a vessel wall of an artery. Weakening of the blood vessel wall may be due to disease, injury or an abnormality present at birth. Some common locations for aneurysms include the aorta (the major artery leading away from the heart), the brain (called a cerebral aneurysm), leg, intestine, and spleen.

angina

Chest pain or discomfort due to coronary heart disease. It occurs when the heart muscle doesn’t get as much blood as it needs. This usually happens because one or more of the heart’s arteries is narrowed or blocked, also called ischemia. Stable angina refers to “predictable” chest discomfort associated with exertion or stress. Unstable angina refers to unexpected chest pain and usually occurs at rest. It is typically more severe and prolonged. Unstable angina should be treated as an emergency.

ANSI

American National Standards Institute.

anticoagulants

Substances, including certain drugs, that prevent the clotting properties of blood. These substances, also known as blood thinners, can keep harmful blood clots from forming in your heart, veins, or arteries, which can block blood flow to the heart or brain, causing, respectively, a heart attack or a stroke. Drugs with blood thinning properties include apixaban (Eliquis®), aspirin, clopidogrel (Plavix®), dabigitran (Pradaxa®), heparin, rivoraxaban (Xarelto®), and warfarin (Coumadin® or Jantoven®).

Most anticoagulants must be prescribed by a physician. However, aspirin is an over-the-counter medicine. If your doctor prescribes an anticoagulant, you should not take aspirin, vitamins, cold medicine, antibiotics, or sleeping pills without asking your doctor first. These drugs can make anticoagulants stronger or weaker, which may be harmful. Your doctor may also advise you not to eat or drink certain foods and beverages while taking anticoagulants.

Ticks, leeches, and blood-sucking insects have natural substances that act as anticoagulants to help them feed on your blood.

antioxidants

Natural substances found vitamins and minerals that are believed to help prevent disease by fighting free radicals, which are substances that can harm the body. Examples of free radicals are environmental contaminants such as cigarette smoke. Without adequate amounts of antioxidants, these free radicals can damage cells which can lead to heart disease.

aorta

A large artery that receives blood from the heart’s left ventricle and distributes it to the body.

APGAR scoring system

A universally accepted method of assessing a newborn’s health at 1 minute and 5 minutes after birth. APGAR is an acronym that stands for (see list below and table to the right):

• Activity
• Pulse
• Grimace
• Appearance
• Respiration

The newborn is assigned a score of 2, 1, or 0 for each sign, so 10 is the total possible score.

• A score of 7 to 10 is a active and vigorous newborn. The newborn is ready for routine care and to be placed with the mother.
• A score of 4 to 6 is a moderately depressed newborn, requiring stimulation and oxygen.
• A score of 0 to 3 is a severely depressed or unresponsive newborn. Provide extensive care, including CPR and bag-valve-mask ventilations with emergency oxygen.

If it is immediately apparent that the newborn is unresponsive or severely depressed, the APGAR test should be postponed until the newborn is revived through extensive care. 

To learn more about the APGAR test:

• About the Apgar Test (KidsHealth)
• The Apgar Score (BabyCenter)

aphasia

The total or partial loss of the ability to use words. It may be caused by brain injury or disease, but most often it’s caused by a stroke that injures the brain’s language center. Sometimes recovery is quick and complete after a stroke, but in other cases there may be permanent speech and language problems.

apnea

The absence of breathing.

apparent life-threatening event (ALTE)

The sudden occurrence of certain alarming symptoms such as prolonged periods of no breathing (apnea), change in color or muscle tone, coughing, and gagging in children under 1 year of age. ALTE is not a specific disorder. It is a group of symptoms that occur suddenly in young children. Although ALTE would seem to be related to sudden infant death syndrome (SIDS), there is no clear relationship between the two disorders.

The most common causes of ALTE include gastroesophageal reflux disease, nervous system disorders (such as seizures or brain tumors), and infections (such as meningitis). Less common causes include heart disorders, metabolic disorders, child abuse, and narrowing or complete blockage of the airways. A cause cannot be determined in about 50% of cases.

Parents and caregivers should be trained in CPR for infants and in general safe infant care (such as putting infants to sleep on their back and eliminating exposure to tobacco smoke). Doctors sometimes recommend home apnea monitoring devices for a limited period of time. Monitors that can record breathing patterns and heart rates are preferred to those that simply sound an alarm. Recording monitors may help doctors distinguish false alarms from real events.

To learn more about ALTE, follow these links:

• Apparent Life-Threatening Event (eMedicine Medscape)
• Apparent Life-Threatening Event (Merck Consumer)
• Apparent Life-Threatening Event (Merck Professional)
• Evaluation and Management of Apparent Life-Threatening Events in Children (AAFP)

applied ethics

The philosophical examination, from a moral standpoint, of particular issues in private and public life that are matters of moral judgment. The attempt to use philosophical methods to identify the morally correct course of action in various fields of human life.

aquatic exercise

Also known as aqua aerobics. An in-water fitness activity generally performed in a vertical position with the face out of the water.

aquatic safety team

A network of people and emergency medical services who plan for, respond to, and aid in an emergency at an aquatic facility.

ARDS

Acute respiratory distress syndrome.

armpit carry

A nonequipment swimming rescue performed by swimming to the rear of the victim, grabbing the victim by one or both armpits, and towing the victim to safety using a modified sidestroke, elementary backstroke, or eggbeater kick on the back. Also called the armpit tow.

armpit drag

An emergency move, similar to the beach drag, performed by standing behind an unconscious patient, holding onto the patient’s torso at the chest or armpits, and walking backwards to drag the patient to safety.

This technique should not be used if you suspect a head, neck, or back injury.

arrhythmia

An abnormal heart rhythm that, when severe or long-lasting, can prevent the heart from pumping enough blood to the body. Damage to the heart muscle from a heart attack can make someone prone to arrhythmias, as can some congenital heart conditions. A variety of minerals, such as potassium, magnesium and calcium, with high or low concentrations in the blood and tissue can cause arrhythmias. So can alcohol, cigarettes and recreational drugs.

arteriole

A small, muscular branch of an artery. When arterioles contract, they increase resistance to blood flow, and blood pressure in the arteries goes up.

artery

One of a series of vessels that carry oxygenated blood from the heart to the various parts of the body. The thick elastic walls expand as blood flows through the arteries.

articulation

A joint of the body (a joining of two or more bones). Different articulations include ball and socket, ellipsoid, gliding plane, hinge, pivot, and saddle.

asphyxia

A condition arising when the body is deprived of oxygen, causing unconsciousness or death; suffocation.

asphyxiant

A vapor or gas that either reduces the oxygen content in the air or interferes with the body’s ability to use oxygen. Exposure to an asphyxiant can result in unconsciousness or death due to being unable to breathe.

aspirin and heart disease

Aspirin can help prevent blood clots from forming and is often used to prevent recurrent heart attacks. The American Heart Association recommends that people at high risk of heart attack take a daily low dose of aspirin, as instructed by their healthcare provider. Heart attack survivors often take a regular low dose of aspirin. Do not start aspirin therapy without getting approval from your healthcare provider.

Chewing an aspirin may also help when a heart attack is in progress. It is best to call 911 before chewing an aspirin. The EMS operator can tell you if giving the patient an aspirin is the right thing to do. When EMS personnel arrive, tell them about any medication the patient has taken, including aspirin. EMS may give the patient aspirin or other medication to relieve heart attack symptoms and help with recovery.

aspirin and stroke

Aspirin can also help prevent blood clots from forming that cause strokes. A healthcare provider may prescribe aspirin therapy or another anticoagulant (blood-thinner) as a preventive measure for patients that are at increased risk for strokes.

Taking aspirin isn’t advised during a stroke, however, because not all strokes are caused by blood clots.  Although most are caused by clots, some are caused by ruptured blood vessels.  Taking aspirin could potentially make bleeding strokes more severe.

assault

In common law, the threat of harmful or offensive contact with a person. An assault is carried out by a threat of bodily harm coupled with an apparent, present ability to cause the harm that causes the intended recipient to feel afraid or intimidated. It is often listed with battery (actual unlawful touching) as in assault and battery.

asthma

A chronic disease involving the airways of the lungs called bronchial tubes. These bronchial tubes allow air to pass into and out of the lungs. With asthma, these airways are always inflamed, and they can become even more swollen when the person comes in contact with a condition or substance that triggers an asthma attack. Common trigger include:

• Allergies, such as pet dander, peanuts, or pollen (allergic asthma).
• Dust, fumes, gases, smoke, and other hazardous substances (occupational asthma).
• Infections, such as a cold or the flu.
• Physical activity or stress (exercise-induced asthma).
• Temperature extremes or sudden changes in temperature.

There is no cure for asthma, but treatment plans can help to manage symptoms. Even with a treatment plan, asthma attack may still happen. Severe asthma attacks can be life-threatening. Persons with asthma should work with their doctor to determine what to do when you need emergency treatment.

For more information about asthma, heck out the links below:

• About Asthma (Asthma.com)
• Asthma (AAAAI)
• Asthma (Mayo Clinic)
• Asthma Action Plan (AAAAI)
• What Is Asthma? (ACAAI)

asthma attack

A sudden onset of asthma symptoms due to contact with an asthma trigger, such as allergies, an infection, smoke or fumes, etc. The signs and symptoms of an asthma attack include:

• Shortness of breath.
• Chest tightness or pain.
• Anxiety.
• Trouble sleeping due to shortness of breath, coughing, or wheezing.
• A whistling or wheezing sound when exhaling (wheezing is a common sign of asthma in children).
• Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu.

To care for an asthma attack:

1. Obtain consent to help the patient.
2. Assist the patient in using the patient’s prescribed quick-relief inhaler. Do not use medicine that is prescribed for someone else.
3. Call 911 or the local emergency number if the patient does not have an inhaler or if signs and symptoms of the asthma attack do not subside within about 10 minutes of taking medication.
4. Monitor the patient’s breathing until the patient is breathing normally or EMS personnel arrive. Be prepared to give CPR if the patient stops breathing.

asthma emergency

A life-threatening asthma attack, characterized by the following signs and symptoms:

• Rapid worsening of shortness of breath or wheezing.
• No improvement even after using a quick-relief inhaler, such as albuterol.
• Shortness of breath when you are doing minimal physical activity.

If a patient is having a severe asthma emergency:

1. Call 911 or the local emergency number.
2. Have the patient assume a position that makes breathing easier.
3. Monitor the patient’s breathing until EMS personnel arrive. Be prepared to give CPR if the patient stops breathing.
4. Stay with the patient and try to keep the patient calm.

asymptomatic

Having no symptoms of illness or injury.

asystole

A life-threatening condition of the heart characterized by no electrical activity. Because there is no electrical activity, there is no heartbeat. This condition can lead to death if not treated and reversed immediately.

atlantoaxial instability (AAI)

A condition of the cervical section of the spine characterized by excessive movement at the junction between the atlas (C1) and axis (C2) as a result of either a bony or ligamentous abnormality. Neurologic symptoms can occur when the spinal cord or adjacent nerve roots are involved.

This instability can originate from congenital conditions, but in adults, it is primarily seen in the setting of acute trauma or degenerative changes due to the inflammatory pannus of rheumatoid arthritis (RA). Infection has been found to be an additional cause of instability, with the rich arterial supply and venous plexus in this region of the body providing a route for secondary infection.

Congenital causes are multiple and include Down syndrome, osteogenesis imperfecta, neurofibromatosis, Morquio syndrome, Larsen syndrome, spondyloepiphyseal dysplasia (SED), chondrodysplasia punctata, metatropic dysplasia, and Kniest syndrome. Other formative characteristics include diseases that impact bone metabolism or structure and ligament characteristics.

atrium

Either of the heart’s two upper chambers in which blood collects before being passed to the ventricles, the heart’s two lower chambers.

atropine

An anticholinergic drug used in antidotes to counteract the effects of poisoning and nerve agents.

automated external defibrillator (AED)

A computerized medical device that can check a person’s heart and, upon detecting a “shockable rhythm,” can shock the heart back to a normal rhythm. It can help save the life of someone who has suffered sudden cardiac arrest, the abrupt loss of heart function. The AED uses voice prompts, lights and text messages to tell the rescuer the steps to take. AEDs are very accurate and easy to use. With a few hours of training, anyone can learn to use an AED safely.

automated internal defibrillator

Also called an implantable cardioverter defibrillator. A small battery-powered device that treats life-threatening irregular heartbeats (arrhythmias), including those that cause sudden cardiac arrest. The device is implanted under the skin of the chest with wires that connect to the heart. If the device detects an irregular heart rhythm, it sends electrical impulses to restore a normal rhythm.

AVPU

A simple scoring system to determine the patient’s level of consciousness (LOC) with 4 levels:

• Alert
• Verbal responsive
• Painful responsive
• Unresponsive

avulsion

A type of wound in which upper layers of the skin are torn away from the body and/or forcibly detached from the body or left hanging by a strip of intact skin, exposing underlying tissue and structures. The severity of avulsion ranges from skin flaps (minor) to degloving (moderate) and amputation of an entire body part (severe). Suprafascial avulsions are those in which the depth of the removed skin reaches the subcutaneous tissue layer, while subfascial avulsions extend deeper than the subcutaneous layer. Small suprafascial avulsions can be repaired by suturing, but most avulsions require skin grafts or reconstructive surgery.

If an avulsed wound leaves some skin in the wound, the wound will heal itself and skin will grow back from the bottom of the wound and along the wound edges. If all layers of skin are removed from the wound (a full-thickness avulsion), however, the wound will only heal from the edges of the wound toward the middle. This takes longer to heal and the chance for infection and tissue necrosis is greater.

If an avulsion exposes fat and muscle tissue or is larger than 0.25 inches by 0.25 inches (6.5 mm x 6.5 mm), the wound should be evaluated by a physician. Skin-flaps and degloving alvusions that expose deep tissue may not be able to heal on their own with permanent damage.

To care for an avulsed wound:

1. Call 911 or the local emergency number for all injuries that cause severe bleeding or that have the possibility of permanent damage.
2. Unless there is severe bleeding, irrigate the wound with tap water and blot the area dry with sterile gauze pads.
3. Reposition the skin flap, if possible, and apply direct pressure to stop bleeding. Never remove tissue still attached to the body.
4. Bandage the wound.
5. If tissue has been completely removed from the wound, collect it, do not irrigate it, but wrap it in sterile gauze and place it in a plastic bag and place the plastic bag on ice. Make sure the severed tissue goes to the emergency department with the patient.

The severed tissue will probably not be reattached, but it may give the physician more information about the injury. Avulsed teeth are handled a little differently than alvused skin tissue. See severed body parts and knocked out teeth.

Avulsion injuries are usually treated by physicians in one of the following ways:

• Allowing the wound to heal on its own, growing new skin from the edges into the middle
• Stitching the edges of the wound together, if the wound is small
• Reattaching the avulsed skin
• Grafting skin over the wound

To learn more about avulsion wounds, click these links:

• Deep Skin Avulsion (Baylor Scott & White Health)
• Finger avulsion injuries: A report of four cases (Indian Journal of Orthopaedics)
• How to Treat an Alvulsion (also Abrasion) (eHow Health)
• Jimmy Fallon Raises Awareness About Ring Avulsion (c|net)

avulsion fracture

An injury to the bone in a location where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of the bone. This is a more common occurrence in children than adults. In adults, the ligaments and tendons tend to be injured first, whereas in children the bone may fail before the ligament or tendon is injured. Avulsion fractures can occur anywhere in the body, but they are more common in a few specific locations.

Children have a particularly weak point in their skeleton called the growth plate. This is the area of bone that is actively growing. In children, tendons or ligaments near a growth plate can pull hard enough to cause the growth plate to fracture. This often occurs when there is a sudden forceful pull on a tendon while the bone is moving in the opposite direction.  

In many cases, an avulsion fracture can be treated without surgery. Only when the pulled off fragment of bone is pulled more than several centimeters from its normal position does surgery need to be considered.

In addition, some avulsion fractures occur with such small pieces of bone, that often the fragment need not be fixed.  For example, ankle sprains can often cause small avulsion fragments.  These injuries can typically be treated as an ankle sprain, because the small fracture really does not affect the treatment decisions or outcome of the patient.

There are some concerns about treatment when the avulsion fracture involves the growth plate in a growing child. Because growth plates are important for normal skeletal development, these injuries must be carefully treated. If there is concern that a growth plate is not correctly positioned, surgery may be performed to align and stabilize the growth plate.

Surgery may not be needed if the avulsion fracture is well aligned, or if the patient is near enough to growth plate closure that this injury will not cause lasting growth problems.

For more information, follow these links:

• Ankle Avulsion Fracture (Sports Injury Clinic)
• Avulsion Fracture: How Is it Treated? (Mayo Clinic)
• Pelvic Avulsion Fracture (Children’s Hospital Colorado Orthopedics Institute)

axiom

An established rule or principle of intrinsic merit or self-evident truth. Many Health & Safety, Lifesaving, and Water Safety Programs are replete with axioms like “never swim alone,” “stay with the boat,” “reach or throw, don’t go,” “life before limb,” “don’t just pack it, wear your [life] jacket,” etc.

[Editor’s Note: We could have colored axiom red, blue, or purple since there are many axioms in first aid/CPR, swimming, and lifesaving/water safety. That being the case, green seemed like a good compromise.]

B

B NICE

An acronym for the 5 main type of terrorist weapons: biological contamination, nuclear detonation, incendiary devices, chemical weapons, and explosives.

backboard

A large rigid splint used to immobilize the head, neck, spine, hips, and/or legs. In first aid situations, the backboard is often used by lifeguards to remove the patient with a suspected spinal injury from the water. If patients are not in the water and they are lying in a comfortable position, it may not be necessary to use a backboard to hold their head and spine still until EMS personnel arrive and take over.

To learn how NYC, in accordance with New York State EMS Authority, is changing spinal injury management protocols to eliminate use of the backboard, check out Date of Extermination for Spinal backboards in New York City Announced by Dave Konig of The Social Medic.

backbone

A common name for the spinal column.

back crawl

A long-axis stroke performed on the back by alternating arms in a circular manner with body roll, bent-arm pulling, out-of-the water recovery, and an inverted flutter kick. Also called the backstroke, it is one of the four competitive swimming styles, and the only regulated style swum on the back. It is also the only competition swimming style that has an in-water start. In the individual medley, backstroke is the second style swum; in the medley relay, it is the first style swum (because the in-water start works best for the first “leg” of the race).

Back crawl is an old swimming stroke, popularized by Henry Hebner, a competitive swimmer and water polo player, who won a gold medal for the United States in the 1912 Olympics for the 100-meter backstroke. The backstroke had been an Olympic event since the 1900 Olympics held in Paris.

In back crawl, the arms contribute most of the forward movement. From the initial position, one arm sinks slightly under water and turns the palm outward to start the catch (the beginning of the power phase). The hand enters downward, little finger first, and then pulls out at a 45-degree angle, catching the water. From the catch, the hand follows a semi-circular path to the side of the hip with the palm facing away from the swimming direction and the elbow always pointing downward. The arms and the elbow push against the resistance of the water back to move the body forward. At the height of the shoulders, a part of the power phase called the mid-pull, the upper and lower arms should have their maximum angle of about 90 degrees.

The palm of the hand pushes as far down as possible with the fingers pointing upward until, at the very end of the mid-pull, the palm flaps down for a last push forward and down, creating the finish of the power phase. Besides pushing the body forward, this also helps with the rolling back to the other side as part of the body movement. During the power phase, the fingers of the hand can be slightly apart, as this will increase the resistance of the hand in the water due to turbulence.

To prepare for the recovery phase, the hand is rotated so that the palm faces the leg with the thumb side of the hand pointing upwards. To begin the recovery, the arm remains extended and exits the water, thumb side first, continuing to a position where it extends beyond the head, rotates, and enters the water with little finger leading to start another power phase. As each arm begins its recovery, the other arm begins its power phase. This is called opposition rhythm. This alternating arm action allows the swimmer to time rhythmic inhalation and exhalation, one action for each stroke.

While the arms alternate, the legs perform an inverted flutter kick. Each leg alternates, with one leg sinking down straight to about 30 degrees and then making a fast upward thrust, slightly bending the knee at the beginning and then stretching it again in the horizontal. Sprinters usually perform six kicks (three from each leg) during the power phase of both arms, while distance swimmers might employ a two-beat kick.

To view training videos for the back crawl (backstroke), check out the links below:

• Backstroke for Beginners (Chris Burton)
• Backstroke (Speedo International with Ryan Lochte)
• How to Swim the Full Backstroke (eHowSports with Mary Kerr)
• Performing the Backstroke Kick (eHowSports with Mary Kerr)
• Speedo Swim Technique-Backstroke (ProSwimwear)

back pain

Soreness, aching, or discomfort due to physical damage to one of the structures in the spinal column (bones, disks, or nerves) or related muscles, tendons, or ligaments. Back pain is one of the most common reasons people go to the doctor or miss work; it is a leading cause of disability worldwide. Most people have had back pain at least once in their lifetime.

Call EMS or see a doctor if:

• Back pain is the result of serious trauma.
• A fever is associated with back pain.
• The patient has bowel or bladder problems related to back pain or injury.
• The pain radiates to the lower legs or causes difficulty walking.
• The pain is severe and is not relieved by rest. 

In older adults (more than 50 years old), back pain can be caused by arthritis, disk disease, osteoporosis, and structural irregularities of the spine.

To learn more about back pain and back pain treatment, click on the links below:

• Back Pain (Mayo Clinic)
• Back Pain Health Center (WebMD)
• Camel Pose Yoga Relieves Back Pain (Health Blog)

backstroke

(1) A common name for the back crawl. (2) A competitive swimming event in which the participants swim the back crawl or any swimming style on the back. (3) Any stroke performed on the back, including back crawl, elementary backstroke, and inverted breaststroke.

backwash

The flow of water from the shore back toward the sea that naturally follows the swash.

bag-valve-mask (BVM) resuscitator

A hand-held, positive-pressure ventilation device consisting of a self-inflating bag, a one-way valve, and a face mask. The bag-valve mask concept was developed in 1953 by the German engineer Holger Hesse and his partner, Danish anaesthetist Henning Ruben, following their initial work on a suction pump. They named their resuscitator the Ambu bag, and then formed their own company, also called Ambu, to manufacture and market the device beginning in 1956. As the first brand of manual resuscitator to go to market, this has led to the name Ambu becoming a generic trademark, with resuscitators from any manufacturer commonly being referred to as ambu bags.

The BVM causes air inside the inflatable bag to be pushed to the patient via a one-way valve and the mask when the bag is compressed by the rescuer. Air passes through a mask and into the patient’s airway and into the lungs. To be effective, a BVM must deliver between 500 and 800 milliliters of air to a normal male adult patient, but, if supplemental oxygen is attached, 400 ml of gas may be adequate. Squeezing the bag once every 5–6 seconds for an adult or once every 3 seconds for an infant or child provides an adequate respiratory rate (10-12 ventilations per minute for an adult and 20 per minute in a child or infant).

To ensure air passes into the patient’s lungs, the mask portion of the BVM must be properly sealed around the patient’s face. This can be difficult when a single rescuer attempts to maintain a face mask seal with one hand while squeezing the bag with other. Therefore, common protocol uses two rescuers: one rescuer to hold the mask to the patient’s face with both hands and focus entirely on maintaining a leak-proof mask seal, while the other rescuer squeezes the bag and focuses on ventilations and timing.

battery

The intentional striking of someone, with intent to harm, or in a “rude and insolent manner” even if the injury is slight. Negligent or careless unintentional contact is not battery no matter how great the harm. Battery is a crime and also the basis for a lawsuit as a civil wrong if there is damage. It is often coupled with assault (which does not require actual touching) in assault and battery.

beach drag

A technique for removing an unconscious victim from the water at a sloping beach or zero-depth pool. To perform the beach drag, stand behind the first-up victim, grasp the victim at the armpits and walk backwards up the slope to shore or the deck. As you move the victim, keep as much of the victim’s body in the water so the weight is partially cancelled out by buoyancy. This technique should not be used if you suspect a head, neck, or back injury.

The beach drag can be performed by one rescuer or two (one rescuer holding an armpit). When this technique is used as a first aid emergency move, it is called the armpit drag.

Berkoff blastoff

An underwater inverted dolphin kick technique used for the first 25-40 meters of each length of a backstroke race to reduce resistance and increase speed and efficiency. This technique was perfected by David Berkoff, a Harvard junior, to win the World Championships in the long-course 100-meter backstroke in 1987. It was also used subsequently by Berkoff and Daichi Suzuki, a Japanese Olympic swimmer, in the 1988 Seoul Olympics. On this occasion, Suzuki beat Berkoff using the Berkoff’s technique.

A change in international swimming rules in 1991 limited the distance underwater in backstroke races to the first 15 meters of each length.

biohazard

Any living organism or its byproducts that present a risk to human health.

biological agent

Any living organism (e.g., virus or bacteria) that affects the body, a part of the body, or any of its functions. The effects may be beneficial or harmful.

biological death

Irreversible cellular damage due to lack of oxygen. Compare with clinical death.

bioterrorism

The deliberate release of harmful bacteria, viruses, or other pathogens for the purpose of causing illness or death to the target population, their livestock, and/or their crops.

blast lung

Damage to a victim’s lungs caused by the sudden over-pressurization wave of high explosives. Blast lung is the most common fatal injury associated with explosives.

blind spot

Areas within a lifeguard’s area of responsibility that are obstructed from the lifeguard’s view by bulkheads or other structures.

blood

A body fluid composed of various blood cells suspended in blood plasma that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells. When blood reaches the lungs, gas exchange occurs as carbon dioxide is diffused out of the blood into the pulmonary alveoli and oxygen is diffused into the blood. Blood has antibodies, nutrients, oxygen, and much more to help the body work.

blood cell

One of the various cellular components of blood tissue, making up about 45% of blood by volume. The remaining 55% of blood is the liquid plasma in which blood cells are suspended. There are three types of blood cells: red blood cells, white blood cells, and platelets.

blood clot

A jelly-like mass of blood tissue formed by coagulating factors in the blood. Clots are a normal reaction to stop the bleeding if a blood vessel is injured. Blood clots can also form when plaque deposits in the blood vessel walls rupture. Clots can become dangerous if they get into the bloodstream, because they can block the flow of blood to the heart or brain and cause a heart attack or stroke. A blood clot in an artery is called an arterial thrombosis. A blood clot in the vein is called a venous thrombosis.

blood glucose

Also called blood sugar. One of the simplest forms of sugar. It is the main sugar found in the blood and the body’s main source of energy.

blood pressure

The force of the blood against the walls of the arteries. It is measured by a ratio of two numbers (measures as millimeters of mercury): the force during each heartbeat (systolic) and the force between heartbeats (diastolic). Optimal blood pressure is less than 120/80 mm Hg. In general, the lower your blood pressure is, the better.

blood thinners

Drugs that decrease the ability of the blood to clot. They are used to treat certain blood vessel and heart and lung conditions. They are also given to some people at high risk for blood clots, including those with atrial fibrillation or artificial heart valves. Blood thinners do not dissolve clots but may prevent existing clots from becoming larger and causing more serious problems. They are often prescribed to prevent first or recurrent heart attack or stroke. Also called anticoagulants. 

blood vessels

Muscular tubes that carry blood from the heart and lungs to every cell in the body, and back to the heart and lungs. These flexible vessels can change in diameter in response to the blood flow needs of the body. Arteries are blood vessels that carry blood from the heart. Veins are blood vessels that carry blood back to the heart. Illustration by Merck.

body cavities

Confined spaces within the body that help protect, separate, and support internal organs. Body cavities includes the cranial cavity, the vertebral cavity, the thoracic cavity, and the abdominopelvic cavity.

body mass index (BMI)

A calculation made based on a person’s weight and height that is commonly used to screen for overweight and obesity.

body mechanics

The use of the body to produce motion that is safe, energy conserving, and efficient, while maintaining balance and control. General guidelines for good body mechanics include:

• Staying close to the patient or object being moved.
• Keeping your center of gravity (COG) close to the patient’s or object’s COG.
• Widening your stance to shoulder width and position your feet in the direction of travel. This forms a base of support (BOS).
• Using the muscles of your legs, not your back. Avoid twisting or bending over.
• When possible, pushing, pulling, rolling, or sliding a patient or object rather than lifting.
• Know your limitations and ask for help.
• Plan how you will move and give clear instructions to the patient and other rescuers before starting the move. Give a cue to coordinate the move.

body roll

A rotating movement from side to side around the midline of the body performed in the front crawl and back crawl swimming strokes.

box crib

A temporary wooden structure used to support a damaged vehicle or unstable structure. See cribbing.

breakpoint

The location in a swimming pool where the depth changes from shallow to deep.

breakpoint chlorination

The process of adding free chlorine to a swimming pool to the point that all combined chlorine molecules are broken apart and all organic material has been oxidized. Free chlorine added after breakpoint is achieved will be available for disinfection.

breaststroke

A swimming stroke considered to be a resting stroke for leisure swimming, a lifesaving stroke for approaching a drowning victim, and a competitive swimming stroke. It begins in the glide position with the swimmer prone, the head just under the surface of the water, arms extended in front, and legs extended behind with toes pointed. To perform the stroke, the swimmer sweeps the arms out and back simultaneously in a circular motion with elbows bent and hands coming together under the chest. The swimmer lifts the head to breathe and, without hesitation, extends the arms straight out from under the chest. As the swimmer breathes, the legs are drawn up together with the feet turned out so they whip around in a circular pattern, catching the water with the soul of each foot and then extending and coming together with toes pointed as the swimmer’s arms extend to the front. When done efficiently, the “whip” kick provides enough power for a brief glide in this extended position before stroking again. The arms and legs remain underneath the water at all times.

The history of breaststroke goes back to the Stone Age, as depicted in the Cave of Swimmers near Wadi Sora in the southwestern part of Egypt near Libya. Depictions of breaststroke variants are also found in Babylonian bas-reliefs and Assyrian wall drawings. This verse in Isaiah (approximately 700 BC) may describe the variation of the breaststroke:

Isaiah 25:11: And he shall spread forth his hands in the midst of them, as he that swimmeth spreadeth forth his hands to swim: and he shall bring down their pride together with the spoils of their hands. [boldface added]

In 1538, Nicolas Wynman, a German professor of languages and poetry, wrote the first swimming book, Colymbetes (the diver). His goal was not to promote exercise, but rather to reduce the dangers of drowning. Nevertheless, the book contained a good, methodical approach to learning breaststroke. In 1696, the French author and poet Melchisédech Thévenot wrote The Art of Swimming, describing a breaststroke very similar to the modern stroke. The book (Benjamin Franklin was one of its readers) popularized this technique.

In the pre-Olympic era, competitive swimming in Europe started around 1800, mostly using breaststroke. A watershed event was a swimming competition in 1844 in London, notable for the participation of some Native Americans. While the British raced using breaststroke, the Native Americans swam a variant of the front crawl. The British continued to swim only breaststroke until 1873.

Captain Matthew Webb was the first man to swim the English channel (between England and France), in 1875. He used breaststroke, swimming 21.26 miles (34.21 km) in 21 hours and 45 minutes.

The 1904 Summer Olympics in St. Louis, Missouri were the first Olympics to feature a separate breaststroke competition, over a distance of 440 yards (402 m). These games differentiated breaststroke, backstroke, and freestyle for the first time. Here is a vintage video showing the evolution of breaststroke into butterfly from International Swimming Hall of Fame.

To see a few training videos on the breaststroke, check out these links:

• Breaststroke for Beginners (Chris Burton)
• How to Do the Breaststroke (Phillip Toriello for Livestrong.com)
• Long Stroke Breaststroke (GoSwim.com)
• Perfect Breaststroke Advice (www.simplyswim.com)
• Speedo UK Swim Technique: Breaststroke

breaststroke turn

A racing turn for the breaststroke which includes a two-handed touch on the wall, a pivot and push-off followed by an underwater pull-down, a dolphin kick, and a whip kick before surfacing and continuing to swim. (The same underwater pull-down and kicks are also performed upon entry into the water at the start of the race.)

To see videos on the breaststroke turn, check out these links:

• Breaststroke Turn (Howdini with Rebecca Soni)
• Breaststroke Turn Technique (Speedo International with Ryan Lochte)
• Breaststroke Underwater Pulldown and Arm Recovery (GoSwim)
• Breaststroke Underwater Pulldown Power Phase and Dolphin Kick (Go Swim)
• Breaststroke Underwater Pulldown Fine Tuning (Go Swim)
• Breaststroke Underwater Pullout of World Class Swimmers (Vincent Vega)

bronchial tube

Any of the airway passages in the lungs.

bronchiole

Any of the minute branches in the lungs into which a bronchus divides.

bronchodilator

A substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lungs. Albuterol is an example of a bronchodilator.

bronchospasm

A contraction of the muscular coat of the bronchial tubes. This results in a narrowing and obstruction of the breathing airways. Bronchospasm is a symptom of asthma.

bronchus (plural: bronchi)

A passage of airway in the respiratory tract that conducts air into the lungs. There is a right bronchus and a left bronchus and these bronchi branch into smaller secondary and tertiary bronchi which branch into smaller tubes, known as bronchioles.

bulkhead

A movable wall placed in a swimming pool to separate activities or water of different depths.

buoyancy

The upward force on a body immersed in water that is equal to the weight of the water displaced.

butterfly

A competitive stroke performed in prone position a double-arm circular stroke pattern with out-of-water recovery and one or two dolphin kicks per arm cycle. The movements of the arms and legs are similar to those of the front crawl (freestyle) except that the arms and legs move simultaneously and there is no body roll or side breathing. The symmetry of the stroke and kick and the absence of body roll require that arms sweep around like wings and enter the water with arms extended to create a “Y.” As the arms move through the power phase, the head is lifted to breathe either every arm cycle or every other arm cycle.

To maintain this momentum, the swimmer’s body moves in a wave-like fashion, controlled by the core. As the head and chest press down, the hips go up, and the posterior breaks the water surface and transfers into a fluid kick. As the head and chest go up so the swimmer can breathe, the hips are at their lowest position. Then follows a second kick, usually stronger than the first, as the arm strokes finish and the arms begin their recovery.

The butterfly stroke is the newest of the competitive strokes, originally developed to improve the breaststroke. David Armbruster, swimming coach at the University of Iowa, researched the breaststroke and the problem of drag due to the underwater recovery. In 1934, Armbruster refined a method to bring the arms forward over the water in a breaststroke. He called this style “butterfly.” One year later, Jack Sieg, a swimmer from the University of Iowa, developed a kick similar to the thrashing of a fish tail, which he called the dolphin fishtail kick. Armbruster and Sieg quickly found that combining these techniques created a very fast swimming style consisting of butterfly arms with two dolphin kicks per cycle.

Other stories concerning the origin of the butterfly include the following:

• Sydney Cavill, an amateur swimming champion, developed a butterfly style of swimming in Australia in the late 1890s. Cavill, who was the son of “Swimming Professor” Frederick Cavill, later traveled to San Francisco where he coached several world-class swimmers.
• In late 1933, Henry Myers swam a butterfly stroke in competition at the Brooklyn Central YMCA.
• Richard Rhodes claimed that Volney Wilson invented the ‘dolphin’ after studying fish, and used it to win the 1938 US Olympic Trials, though it earned him a disqualification.

However this new style came about, it was considerably faster than a regular breaststroke. Using this technique Jack Sieg swam 100 yards in 1:00.2. However, the dolphin fishtail kick violated the breaststroke rules and was not allowed. Therefore, the butterfly arms with a breaststroke kick were used by a few swimmers in the 1936 Summer Olympics in Berlin for the breaststroke competitions. In 1938, almost every breaststroke swimmer was using this butterfly style, yet this stroke was considered a variant of the breaststroke until 1952, when it was accepted as a separate style with its own set of rules. The 1956 Summer Olympics were the first Olympic games where the butterfly was swam as a separate competition, 100 m (women) and 200 m (men). 

Because of its evolution from the breaststroke, a two-handed touch is required at the finish and every turn in a butterfly race. The underwater pulldown, legal in a breaststroke race, is not performed with the butterfly. Here is a vintage video showing the evolution of breaststroke into butterfly from International Swimming Hall of Fame.

Here are a few training videos for the butterfly:

• Butterfly stroke (Everybodyswims)
• How to Breathe in Butterfly (Effortless Swimming)
• How to Do a Dolphin Kick (Phillip Toriello for livestrong.com)
• How to Swim the Butterfly (Phillip Toriello for livestrong.com)
• Perfect Butterfly Advice (SimplySwim.com)

We thought we would take Phillip Toriello’s advice to heart. He said that it may be worthwhile to watch dolphins swim, so here you are:

• Spinner Dolphins Freedive
• Swimming with Wild Dolphins in the Bahamas
• Professional Mermaid Kat Swims with Dolphins in the Red Sea-You can watch a mermaid dolphin kick in this video!

BVM

Bag-valve-mask resuscitator.

bystander

An individual present during an emergency. Often, bystanders watch and do not get involved, but they may be asked to call 911 and assist with emergency care as needed.