the aquatic therapist

Health Care and the Death of the Aquatic Therapy Industry: An Opinion

Many are hailing this week's passage of the health care reform bill to be a panacea for the medical industry. ARN does not share their euphoria and predicts it will doom the nascent aquatic therapy industry.

From Day One, politicians have made it apparent that the bill's overarching goal is that of saving money, not lives. This is perhaps the most alarming and heartless aspect of the legislation. It means that government's priorities are not our priorities (i.e. patients) and it goes against the ethics healthcare providers have sworn to uphold. This is a no-win dilemma for it either turns us into an enemy-of-the-state for serving the people that need us the most or turns us into cold, heartless bureaucrats for following the law. Both are criminal.

Apart from the moral toll, this bill will also impact the industry financially. Saving money means making cuts and that means your wages and your reimbursements. This was best seen in last year's budget shortfalls that caused many states to cut basic therapy coverage. If a governor can refuse payment for physical therapy, imagine what the feds have planned for your aquatic therapy practice.

Finally, government good-intentions never turn out as planned. The Virginia Graeme Baker Act is one especially-relevant example. Passed in 2007, this sweeping legislation was meant to prevent entrapment deaths in all the nation's pools. What it has resulted in is a muddle of regulations, closed pools and the potential for more drowning deaths.

We at Aquatic Resources Network believe in private enterprise; the hospital who sees a need and makes the risky move of building a new rehab clinic for their community. We believe in personal spirit and the power of the individual; the therapist who breaks out into private practice because she believes she can make things better. These freedoms benefit others because they first benefit us. And while private enterprise may not be perfect, it is far better than the alternative: government-run monopolies who have no incentive to improve their service and can employ force-of-arms to get its way. 

We love a challenge and in keeping with our goal of seeing all clinics "feet-wet by '38", know that we will fight as long as we can to see that you succeed. Because if you are out of business, we are out of business.

Lee Salzman, CEO

Help: We have an allergic reaction everytime we get into the therapy pool

HELP! We have a pool that uses chlorine and two aquatic therapists have developed a sensitivity to it with severe skin outbreaks. What can we do?

ANSWER: Sorry you are having problems. Unfortunately, it can be an occupational hazard of being an aquatic therapist especially if you spend more than 4 hours in the water a day.

Unfortunately, a halogen sensitivity, once developed, usually remains. So what does a chlorine allergy look like? For one, exposure to the same levels of chlorine will typically result in a similar response.

The best answer is to add  a supplemental disinfection system (such as ultraviolet light, or an ozone generator) to your pool. It can reduce the amount of chloramines in your water dramatically. Also, it is now much cheaper than it used to be. It is possible to add an UV component to your system for under $5,000.

More info on how to reduce chlorine with supplemental systems (especially Tips #36, #47, #54).

One last point. Everyone assumes that skin rashes are due to exposure to chlorine. Often times, it can be an improper pH that is causing the problem. First rule of thumb, check the pH religously. Human skin will not tolerate exposure to pH which is not at or near 7.3-7.4 for long.

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Rashes are a common complaint with both pool and spa users. Rashes may be caused by a reaction to chemicals in the water or by a bacterial infection. The first step in investigating rash outbreaks should be to identify the cause. The simplest way to differentiate chemically- and bacterially-induced rashes is the incubation period (onset longer than 12 hrs; probably not chemically induced).

Best Practices to Reduce Chemical Rashes

• Maintain the proper sanitizer level at all times – this not only provides oxidation but also prevents bacterial growth, including Pseudomonas aeruginosa that will cause bacterial rashes.
• Maintain proper pH and alkalinity – improper pH has been linked to some irritant rashes.
• Use routine supplemental oxidation to reduce combined chloramines and bromamines. Supplemental treatments include quick-dissolving chlorine compounds (cal hypo, dichlor, granular trichlor, lithium hypo, and bleach), non chlorine shock-oxidizers (monopersulfate), and ozone. Supplemental oxidation is particularly important when using bromine compounds (BCDMH, DBDMH or sodium bromide).
• In spas, routinely replace the water. There are several guides available for this, including one from the APSP (visit APSP’s website at http://apsp.org/54/index.aspx for a free download of APSP’s complete Water Treatment Information Bulletins.)
• When the water appears cloudy or foamy, the facility should be closed at once.

These all seem rather obvious. Yet in reported cases one or more of these were not followed by the operator.

The single largest group reporting chemical rashes is hydrotherapists (therapists providing therapy in aquatic settings). These individuals are exposed to chlorine- or bromine-treated water up to ten hours per week. The temperature and bather loading of these therapy pools resembles hot tubs.

One Israeli study revealed that 45 percent of the 190 therapists surveyed developed skin disease after beginning work (Lazarov, Nevo, Pardo, and Froom. 2005. Self-reported skin disease in hydrotherapists working in swimming pools. Contact Dermatitis 53:327-331). The authors concluded that skin disease for hydrotherapists is an occupational hazard resulting from cumulative exposure.

So what is the exact cause of chemical rashes? We don’t know. The published cases do not provide enough information on the treatment system being used by the facility or chemistry discovered during the incident investigation.

We do know that hypobromous acid (the active portion in “bromine”) is a poor oxidizer when compared to hypochlorous acid (the active portion in “free chlorine”). We also know that hypobromous acid reacts with organic matter to form combined bromamines, just as free chlorine does. And bromamines and chloramines are known skin irritants.

A further complication is that there is no readily available test to determine the concentration of combined bromamines. OTO and DPD kits measure only total bromine, which includes the free bromine and combined bromine.

Excerpted from: The Association of Pool and Spa Professionals.  Chemically-induced Rashes. Recreational Water Quality. (A Publication of the APSP Recreational Water Quality Committee). Jan 2008. Available at: http://apsp.org/APSPRWQE-news/Jan16/rash.htm