Throw What? Evaluation of Different Rescue Tools Used by Middle-Aged and Older Bystanders During a Drowning Incident: A Pilot Study

Introduction

Late middle-aged and older adults have been identified as a population at risk for drowning, and mortality prevalence in numerous countries is notably high. ¹ Although there is no universally accepted definition, late middle age is considered the intermediate stage of adulthood and is typically defined as beginning at age 50 y, a threshold commonly used to study aging and frailty. Analyses drawing on cross-national data from countries in the Americas, Europe, and Asia collectively represent roughly half the world's population aged 50 y and older. ² An older person is typically defined by many countries as someone eligible for public benefits after retiring, typically between the ages of 60 and 65 y. The global population is aging at an accelerating pace. Projections reported by the United Nations and World Health Organization indicate that the proportion of people aged 60 y and older will nearly double from 12% in 2015 to 22% by 2050, with an estimated 80% of older adults residing in low- and middle-income countries by midcentury. ³

A systematic review by Peden et al on risk factors and prevention strategies for drowning among adults aged 50 y and older highlighted the limited number of scientific studies addressing prevention strategies in this population. ⁴ The existing evidence base is narrow and is focused predominantly on the use of life jackets. This gap underscores the need for broader, age-appropriate interventions that consider the specific characteristics of older adults. ⁴

Older adults differ from other age groups in several relevant aspects: They are more susceptible to falls, have a higher prevalence of comorbidities, and experience declines in physical capacities. In addition, in many contexts they serve as caregivers for grandchildren or for other adults of a similar age. These factors may influence both their risk of drowning and their capacity to engage in safe rescue behaviors, whether as potential victims or as bystanders.

Within drowning-prevention strategies, safe rescue remains a core component. Expert guidance for bystander rescuers emphasizes that the safest approach is to avoid entering the water and instead assist by reaching with, throwing, or dropping a buoyant aid. ⁵ This principle is commonly summarized in drowning-prevention practice as “reach, throw, row, and don’t go.” ⁶

A key unresolved issue is identifying which types of aquatic rescue devices enable a layperson or bystander to most effectively assist a drowning victim. Current recommendations of rescue equipment including throw ropes, lines, and ring buoys for effective use by bystanders. ⁷ However, it is not clear whether conventional rescue devices are the most suitable for individuals whose physical capacities are diminished, whether due to being very young (children) or older (late middle age and older adults). Weight, grip, and ease of handling may be especially critical for these populations.

Although the ring buoy is the most internationally standardized and widely mandated throwable rescue device, as reflected in global maritime safety regulations, we hypothesized that its weight and shape might hinder its use by untrained bystanders during a drowning incident. In contrast, lighter and more ergonomic devices such as a rescue buoy or even a do-it-yourself (DIY) aid such as a plastic handled jug, commonly referred to as a PET (polyethylene terephthalate) bottle, might be more effective for some users. Therefore, this pilot study aimed to evaluate the effectiveness of throw-based rescues in a real aquatic environment (a river) by comparing 3 devices: a ring buoy, a rescue buoy, and a simple PET bottle.

Method

Rescue Trial, Rescue Device, Environmental Characteristics, and Variables

Rescue Trial.

Each participant was required to perform 3 rescue throws, 1 with each material, from the edge of the pontoon (Figure 1). They were instructed to throw as far as possible with maximal accuracy (aiming for the rescue device to land on the measuring tape floating on the water). The trial was conducted at the Lerez River (Pontevedra, Spain) from an elevated wooden pontoon above the water surface. A measuring tape was secured at the pontoon edge and extended along the water surface to record throwing distance, and an instructor positioned in the water served as the simulated victim and target reference. At the time of testing, weather conditions were favorable, with no wind or rain that could interfere with the throws, and no significant water current was present that could influence throwing outcomes. None of the participants were familiar with the rescue equipment, and no practice throws were allowed prior to testing because the intention was to simulate a first-time use.

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Figure 1.

Flowchart of design.

The order of throws was randomized, and a 15-min interval was provided between throws for each participant to mitigate fatigue effects.

Rescue Device Characteristics.

Ring buoy: Outer diameter 75.0 cm, inner diameter 44 cm, and weight 2.80 kg.

Rescue buoy: Dimensions 67.0 × 23.0 × 13.5 cm and weight 1.20 kg.

PET bottle: Dimensions 27 × 19 × 14 cm, an empty weight of ∼300 g.

Variables.

Two variables were analyzed: mean throwing distance in meters and throwing accuracy, coded dichotomously as accurate or inaccurate. ¹ Accuracy was defined as the device landing within 1 m of the target midline, that is, the axis extending from the pontoon edge toward the simulated victim (instructor) in the water (see Figure 1).

Results

Table 1 shows the differences in throwing distance and accuracy according to the object used. The results of the repeated-measures ANOVA indicated significant differences among the rescue devices (F=11.430; P<0.001). Specifically, participants were able to throw the rescue buoy (P=0.001; d=0.95) and the PET bottle (P=0.002; d=0.82) significantly farther than the ring buoy. No significant differences were found between the rescue buoy and PET bottle (P=1.000; d=0.13). Regarding throwing accuracy, no significant differences were found in the percentage of subjects who were able to accurately throw each object (χ²=4.000; P=0.135).

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Table 1.

Differences in Throwing Distance (Mean ± SD) and Accuracy (%) According to the Object Used.

	Ring buoy	Rescue buoy	PET bottle
Throwing distance (m)	5.6±2.1	8.0±3.2 a	7.7±2.3 a
Accuracy	70.6%	94.2%	82.4%

Note. PET, polyethylene terephthalate.

^a Significant difference (P<0.05) with ring buoy.

Figure 2 displays the mean and individual performance for each throw. Most participants achieved their greatest distance with the PET bottle (52.9%) or the rescue buoy (41.2%), whereas only 1 participant reached their greatest distance using the ring buoy.

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Figure 2.

Individual throwing performance for each rescue device.

Discussion

The objective of this pilot study was to assess the throwing distance and accuracy achieved with different rescue devices by late middle-aged and older adults acting as bystanders during a simulated drowning event. The principal findings indicate no differences in throwing accuracy across devices but clear differences in distance. The ring buoy yielded the shortest throwing distances, whereas the lighter and smaller devices (ie, the rescue buoy and PET bottle) were predominantly thrown the farthest.

As noted earlier, the “reach, throw, row, don’t go” paradigm remains the central guidance for bystanders witnessing a drowning event. ⁶ This approach aims to prevent lay rescuers from exposing themselves to fatal risk during rescue attempts. ⁸ This phenomenon—where the would-be rescuer becomes the victim—is referred to as the aquatic victim instead of rescuer (AVIR) syndrome. ⁹ The risk may be heightened among older adults, for whom age-related declines in physical capacity and increased prevalence of comorbidities ¹⁰ can further compromise safety during improvised rescue efforts. It is worth noting that real-world rescue effectiveness depends not only on reaching the victim with a thrown device but also on maintaining contact and facilitating retrieval—aspects not evaluated in this study.

The central question of this pilot study was whether conventional rescue equipment is optimal for lay bystanders during aquatic incidents. Although Hawaii has adopted rescue tubes as publicly accessible equipment, ¹¹ the ring buoy remains the most widely disseminated device globally and is ubiquitous in marinas, ports, and riverside settings.

A recent study by Peixoto-Pino et al demonstrated in children what is intuitively plausible: The heavier the rescue device (such as a rescue buoy), the shorter is the achievable throwing distance. ¹² Our findings are consistent with this pattern, with a key distinction: Whereas the children's throws were assessed in a terrestrial physical education setting, our study with older adults introduced greater ecological validity by conducting trials in a natural aquatic environment, from an elevated platform (pontoon) and toward a visible target in the water (an instructor simulating a potential victim).

For older adults acting as lay rescuers, practical implications include outfitting environments with lighter, easy-to-grip throw devices positioned at accessible heights to minimize overhead lifting. Evidence and expert recommendations indicate that teaching throwing skills can help reduce the burden of drowning.^12–14 Therefore, brief, targeted training should reinforce “reach, throw, row, [and] don’t go.” Additionally, future studies could investigate whether low-cost DIY alternatives—such as PET bottles equipped with an attached rope to address the absence of a retrieval mechanism—could build motor and cognitive skills and serve as an educational tool for drowning prevention when used in training activities individually, in groups, or with grandchildren. Training and DIY rescue-tool initiatives for older adults can be promoted and organized by universities (as in this study), municipalities, residential care facilities, and other public health or drowning-prevention entities. These activities should be complemented by clear operational protocols displayed on signage near rivers, ports, and other aquatic settings (eg, “alert EMS, maintain verbal contact, avoid water entry, and throw a rescue device”) to further enhance safety and effectiveness for this population.

This study has important limitations. The findings derive from a small convenience sample of older adults enrolled in a university education program, which limits generalizability to broader older adult populations, other age groups, cultural settings, or real-world aquatic rescue environments. As an exploratory pilot, it aims to stimulate scientific discussion on the utility and usability of rescue devices when used by laypersons, particularly older adults. A critical limitation is the absence of a retrieval component: No rope or tethering mechanism was used, meaning that the study assessed only the ability to project the device toward the victim, not the ability to bring the victim to safety. PET bottles, as improvised devices, lack standardization and tethering features essential for effective real-world rescue, and findings regarding their use should be interpreted with appropriate caution. Future research should evaluate the appropriateness of these devices in more representative samples and, if warranted, refine their design to enhance real-world effectiveness in drowning prevention.

Conclusions

Lighter rescue devices, such as the rescue buoy and PET bottle, may allow late middle-aged and older adults to achieve greater throwing distances without compromising accuracy in simulated rescue scenarios. The ring buoy was the least effective in terms of distance. This study supports consideration of age-appropriate rescue tools tailored to each population profile.

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