Student died in hospital after drowning in River Park Leisure Centre swimming pool

Zhaojing Zeng had been swimming at the deep end of the main pool at River Park Leisure Centre on June 17 last year when she suddenly became incapacitated and submerged underwater.

Despite resuscitation attempts, the Winchester School of Art student died at Royal Hampshire County Hospital the following morning.

Footage played at Winchester Coroner's Court showed Ms Zeng had not moved on the floor of the pool for several seconds before lifeguards were alerted to her by another swimmer.

The inquest heard at the time of the incident lifeguards alternated every five seconds between monitoring a screen with images from eight underwater cameras and observing their designated area of the pool with their own eyes.

Safety and training consultant Andrew Ebben told the inquest this approach to lifeguard observation was common in the industry but it was "extremely difficult" to frequently switch from distance vision looking at the pool to close vision on the camera monitor.

Recording a conclusion of accidental death, senior coroner Grahame Short said there were "unrealistic expectations" for lifeguards to view the eight images for five seconds then the pool for five seconds.

"I believe he (Mr Ebben) is absolutely right," said Mr Short. "Simply to assimilate those images and what you are seeing with your own eyes is all but impossible.

"It does seem, however, to be an industry norm and I do accept that this is a situation which is evolving significantly and has evolved since this sad incident."

The inquest heard Ms Zeng, who lived in Athelstan Road, Winchester, sunk to the bottom of the water and went into cardiac arrest. She was spotted by a fellow swimmer who alerted lifeguard Sam Manley.

He sounded the alarm, dived in the water to rescue Ms Zeng and brought her to the surface before she was lifted from the pool but she was not breathing, the inquest heard.

Staff started CPR and called for an ambulance before using a defibrillator.

Ms Zeng's heart was restarted 22 minutes after it had initially arrested but she went into cardiac arrest again. The 25-year-old was taken to hospital and died at around 7.30am on June 18 2018.

The inquest heard neither Mr Manley or the lifeguard at the shallow end, who observed the same CCTV footage as part of his duties, saw Ms Zeng at the bottom of the pool before the member of the public called for help.

Mr Short said there was a "slight delay between the time that Ms Zeng was submerged and that he (Mr Manley) brought her to the surface" but he found this was "not a causative fact in the sequence of events leading to her death the following morning".

Professor Gavin Perkins, clinical care medicine expert, told the hearing, based on the CCTV footage, he believed Ms Zeng probably suffered a sudden irregular heartbeat – a cardiac dysrhythmia – which led to her drowning.

As such, he described the incident as "secondary drowning", whereby her submersion was caused by the medical event, which progressed to cardiac arrest.

Prof Perkins said the efforts by the lifeguards gave Ms Zeng "opportunities for survival which she would not have had had they not made those efforts".

Dr Adnan Al-Badri provided a cause of death of multiple organ failure caused by hypoxic brain injury due to submersion in a swimming pool.

A statement from River Park operators Places for People Leisure Management Ltd issued after the inquest said: “At the conclusion of the inquest, Places for People Leisure Management Ltd again wishes to pass our sincere condolences to Ms Zeng’s family. We thank the coroner for his attention and take the comments in his conclusion about Ms Zeng’s sad death very seriously. Places for People Leisure Management Ltd is committed to learning lessons arising from the outcome of the inquest. We have already implemented actions that will improve standards and safety for all our pools.

"The underwater camera system has been enhanced at every leisure centre and we have retrained all our staff. We manage 71 pools at our leisure centres and give the highest priority to safety, always striving to provide high standards of care for everyone.

"Places for People Leisure Management Ltd will continue to work closely with the Royal Life Saving Society UK following the conclusion of this inquest, to address the issues raised by the coroner. The Royal Life Saving Society UK will hold working groups with industry leaders and Places for People Leisure Management Ltd will be part of those groups to pass on the recommendations made by the coroner during Ms Zeng’s Inquest. All our thoughts remain with Zhaojing’s family and friends during this time.”

Laura Taylor, chief executive of Winchester City Council, said: "We were deeply saddened to learn of the tragic death of Zhaojing Zeng following an incident at River Park Leisure Centre.

"Winchester City Council’s environmental health team investigated the incident under the Health and Safety at Work Act and provided evidence to the Coroner’s Court to aid their consideration.

"All our thoughts have been with Zhaojing’s family and friends through this extremely difficult time."