SINGAPORE - Four minutes after getting into a lap pool at the Bukit Batok Civil Service Club, an eight-year-old boy became motionless and was facing downwards, a coroner's court heard.
After Muhammad Adil Mohd Shafiee was pulled out of the 1.5m-deep pool by a lifeguard with the help of others, an automated external defibrillator (AED) was administered at 4.58pm, some 10 minutes after the Primary 3 pupil had come to a complete standstill in the water on May 14.
Resuscitation efforts continued until paramedics arrived. The boy, who has three older sisters, was taken to Ng Teng Fong General Hospital where he had multiple episodes of cardiac arrest. He was then transferred to KK Women's and Children's Hospital where he died 10 days later.
At an inquest into his death on Monday (Oct 16), the court heard that four lifeguards were at the swimming complex, including the lead lifeguard, Mr Paul Wilfred Santhanasamy.
Shortly after their duty started, the lap pool's lifeguard, Mr Md Yusman Jumaat, had to leave as his mother had reportedly suffered a fall. No one was re-deployed there as Mr Wilfred felt that lifeguard Mohamad Mossudiq Ashaari's station, at the pavilion near the drift pool, was high enough for him to see the area where Adil had entered the water.
Minutes before Adil was found in the pool, Mr Mossudiq had gone to the toilet.
The inquest heard that none of the lifeguards saw Adil going to the lap pool. He would have been stopped if a lifeguard had seen him going there. Adil had been swimming for a full six minutes before he was discovered.
There was a sign near the various swimming pools reminding parents or guardians to accompany children below the age of 12 at all times.
Associate member Victor Seah was walking along the pool when he spotted the boy floating in the water, apparently holding onto a pair of goggles.
He continued walking but turned back a second time and saw the boy motionless 2 to 3m from the bank.
Sensing something amiss, he waved to lifeguard Rashid Abdul Rahman, who was at the foot of the slide tower about 75m away.
Mr Rashid ran over and brought the boy out from the pool. Adil was unresponsive by then and had vomit around his mouth. Others, including a woman visiting the club and the boy's 19-year-old sister, helped to bring Adil up to the deck where resuscitation efforts began.
According to the club manager, a minimum of two lifeguards would be on duty at the swimming complex. But now, five lifeguards will work on weekends.
Colourful pink wrist bands would be issued to young children to help in their identification within the pool complex, and to prompt parents and lifeguards to closely supervise the children.
In his findings, Coroner Marvin Bay said Adil's drowning was a "tragic misadventure". His death is the 12th accidental drowning of a child aged 12 and below since January 2014.
Children need to be taught never to swim alone and without adult supervision, even if the child had taken swimming classes, he said.
He said parents should be mindful not to overestimate their children's swimming ability and underestimate the need for adult supervision.
"A sufficient number and strategic placement of lifeguards who are equipped with adequate visual scanning techniques are relevant factors in the prevention of drowning. It would be ideal for lifeguards to cover colleagues who have to momentarily leave their station," he said.
But a lifeguard may not be able to supervise all swimmers at the same time, and a designated adult caregiver should keep children under constant surveillance.
"Drowning is a 'silent killer'. The child often will not be able to shout, and can struggle to keep his head above the water for only a very short period of time before he is overwhelmed," said Coroner Bay.
It also takes less than a minute for a child to be overwhelmed by water submersion, and under five minutes for permanent brain death, and then death, to occur.