Drowning Risk More Acute For Minorities

Guests

Dr. Jerome Modell, author, "Prevention of Needless Deaths From Drowning"
Carol Irwin, assistant professor of health sport sciences, University of Memphis

The drowning deaths of six Louisiana teens served as a tragic reminder of how many Americans have never learned to swim. Minority children are at particular risk of drowning, but there are ways bystanders can identify and assist someone who needs help.

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

The good news is that, decade by decade, the number of accidental drownings declines, and it's projected to go down again when the 2010 census comes out. The bad news is that an average of 10 people die by drowning every day, and nearly all of those deaths are preventable.

Just a couple of weeks ago, six teens died in Shreveport, Louisiana. One after another, they slipped off a ledge from waist-deep water into the current of the Red River. They didn't know how to swim, neither did their parents, who watched helpless from the riverbank.

African-Americans, like those kids in Louisiana, and Latinos drown at much higher rates than whites. We'll explore why. We want to hear from lifeguards today. We also want to hear from those of you who don't know how to swim. Why not?

Give us a call, 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our website. That's at npr.org. Click on TALK OF THE NATION.

Later in the hour, choose your own adventure goes dig. But first, Carol Irwin joins us. She's an assistant professor in the Department of Health Sport Sciences at the University of Memphis, co-author of a recent studies on minorities and drowning and with us today from Colorado Springs. Nice to have you with us on TALK OF THE NATION.

Professor CAROL IRWIN (Assistant Professor of Health Sport Sciences, University of Memphis): It's a pleasure. Thanks for having me.

CONAN: And when you saw that story from Shreveport, well, it illustrated all too horribly many of the findings in your study.

Prof. IRWIN: Exactly. It's heartbreaking. It happens in every community. But when it happens, you just have to sit back and feel so bad for the parents and families.

CONAN: And what do you attribute people's reluctance to teach their children how to swim?

Prof. IRWIN: Well, we were able to do not only some quantitative or hard-number paper survey numbers, but we were also able to do some focus groups with more marginalized groups with our study this past winter and spring.

And we found, overall, the biggest factor was parental fear of drowning or injury with their children. And since they didn't know how to swim, they really kind of had double the amount of fear. So it was just something that was a barrier that was just hard to get over. And so they just avoided getting their children involved in swimming because of that.

CONAN: Ironically, then, because they were afraid of the water, it made their children much more vulnerable to drowning when they did go to the water.

Prof. IRWIN: Exactly.

CONAN: Yeah. And it was interesting that your study found that access to pools or even indeed the cost of - sometimes negligible cost - of swimming lessons, that didn't seem to be that much of a factor.

Prof. IRWIN: No, and we really were able to understand that particular finding more in the focus groups, as well. We were able to get deep down into what was the real issue, and yet there is financial issues, obviously, but many, you know, more racially-underrepresented groups indicated that they didn't understand that they could get free or low-cost lessons from different nonprofit groups like the YMCAs, as well as they, you know, just wanted to save their money for other, what they thought were more prioritized kind of issues like Tae Kwon Do or basketball lessons.

And I remember one particular parent in one group finally got it and said, you know what? Learning how to play basketball won't save their lives. And that's really what it came down to is when they finally figured out that swimming is a life skill. It isn't just something fun to do in the summer.

CONAN: There were also reasons of vanity in some cases.

Prof. IRWIN: Yes. And that was a very significant factor with our African-American adolescent females, specifically with hair because they spend so much money and so much time in order to make their hair fashionably, you know, acceptable, which goes to a lot of their self-esteem kind of issues, obviously. I mean, that's very important, but it's amazing how much money is spent in African-American communities on adolescent girl hair.

CONAN: And they didn't want to go swimming because they didn't want to get their hair wet.

Prof. IRWIN: Exactly.

CONAN: Joining us now also is Dr. Jerome Modell, an anesthesiologist at the University of Florida College of Medicine. He's published a book, "Drowning and Near Drowning," and has written exhaustively on the subject. He joins us from the studios of member station WUFT in Gainesville. And nice to have you with us today.

Dr. JEROME MODELL (Anesthesiologist, College of Medicine, University of Florida; Author, "Prevention of Needless Deaths From Drowning"): Thank you very much. It's a pleasure to be here.

CONAN: And indeed, people can help themselves by knowing how to swim, but your studies seem to find also there are other ways to prevent drownings and that indeed, well, is negligence too far to go?

Dr. MODELL: Well, negligence is a problem. For example, whenever we're at a pool that's lifeguarded, you tend to have a false sense of security, and it depends on the training of the lifeguards, whether they're certified or not, how cognizant they are of their surroundings, whether their undivided attention is watching the people in the pool.

They should be surveilling the pool at regular intervals and seeing every swimmer. They should not be simultaneously doing housecleaning chores like cleaning bathrooms or taking tickets. They shouldn't be distracted by holding conversations with people away from the pool. They shouldn't be reluctant to go into the pool when someone appears to be in trouble.

In a series that I looked at recently of a series of deaths that ended up in litigation, there were a number of times where the lifeguard did not enter the pool because they thought the individual was, quote, "horsing around or playing around."

And it needs to be emphasized that when you observe people, they don't all appear to drown in exactly the same way. And whenever there's any question as to whether someone's in trouble, they must be removed from the pool immediately.

CONAN: And the timing issue, that's something you've written on a lot. There was even less time than I thought before brain damage sets in and indeed death.

Dr. MODELL: The timing is very important. If you look at the drowning process, which begins when the mouth and nose first become submerged in the water, and you no longer able to breathe air, the first thing that occurs is you voluntarily breath-hold.

Then when you can't breath-hold any longer and try to take a breath, because you get water in your mouth and nasal pharynx, you go into laryngospasm. In other words, the vocal chords will shut so that you can't get water into your lungs.

And this combined time period lasts for approximately a minute and a half or, at most, two minutes. It is during that time that the amount of oxygen in your blood goes down precipitously. You become more acidotic. The blood becomes more acid, and you build up carbon dioxide.

Shortly thereafter, you will lose consciousness and then start to breathe water. As you breathe water, of course, it interferes with the ability of the lung to transport gases like oxygen across the alveolar-capillary membrane into the blood.

And if you are rescued within a period of three minutes or less, the chances of resuscitating somebody are excellent. If it extends beyond three minutes, it's been shown experimentally in experimental animals many years ago that at three to four and a half minutes of submersion, the heart will stop. In other words, you'll have a cardiac arrest. And at that point in time, it's a much more serious problem.

CONAN: We're talking with Dr. Jerome Modell and Carol Irwin about drowning and why 10 people in this country on an average day die from it. 800-989-8255. Email us, talk@npr.org. We'd like to hear from those of you who have been lifeguards or are lifeguards now. And those of you who don't know to swim, why not?

Let's start with John(ph), John with us from Tulsa, Oklahoma.

JOHN (Caller): Hi, how are you doing?

CONAN: Very well, thanks.

JOHN: I was just saying I was a lifeguard and a pool manager from high school through college. So I've had, you know, probably seven years of experience or so being in that position.

I was just saying that training and being able to pass along that training as a lifeguard and a pool manager, being able to pass along that knowledge to pool patrons and to other lifeguards, was very important.

I was fortunate enough only to have to go in once for a kid that was struggling, not really drowning. So I was pretty lucky throughout my lifeguarding career, if you will.

CONAN: Did that timeline we just heard from Dr. Modell, three minutes or less, did was that part of your training?

JOHN: I don't recall exactly how long they said, but I do remember just having it hammered it in during the training that you should always be scanning the water, always be looking for any signs of struggle. And if there was any sign of even the slightest difficulty, we usually sent someone in.

CONAN: Yeah, better be safe than sorry.

Dr. MODELL: Can I make a comment?

CONAN: Certainly, Dr. Modell, go ahead.

Dr. MODELL: Don't misinterpret the three minutes. That's not the time that the lifeguard has to get the patron out of the pool. That is the time period where you start to get cardiac arrest, and you convert what is a reversible process into one that is much more difficult to reverse or is irreversible.

The bottom line is someone should be rescued immediately if they appear to be in trouble. The shorter the time period, the more likely you're going to pull them out before they aspirate water and before they suffer irreversible hypoxic brain death.

CONAN: Okay, John, thanks very much for the phone call, appreciate it.

JOHN: Thank you.

CONAN: Bye-bye. Here's an email from David(ph) in Menlo Park, California: Just knowing how to dog paddle or tread water is enough, having enough experience and confidence in the water not to panic.

Well, Carol Irwin, easily said.

Prof. IRWIN: Yeah, I would you know, I constantly get asked this question. You know, Michael Phelps could drown if he's impaired or obviously in a choppy water situation. But the thing about swimming lessons is that kids typically get taught safety issues, safety rules. And they get them, you know, programmed in their brain on what to do, the reach, throw, don't go mantra is taught to them about what they can do when they see a friend or someone who might be in trouble.

So swimming lessons and survival swimming or dog paddling is very, very important, and also but then just knowing how listen, don't panic. This is what happens when you're in a situation. This is what you should do.

So it's I think swimming lessons is great. The sport of swimming is wonderful. But really just knowing what to do in a dangerous situation is vital.

CONAN: Stay with us if you will. Carol Irwin of the University of Memphis, co-author of "Constraint: Impacting Minority Swimming Participation." Also with us, Dr. Jerome Modell, a professor emeritus at the Department of Anesthesiology at the University of Florida College of Medicine, author of "Prevention of Needless Deaths From Drowning."

What is your story? If you've worked at a pool, give us a call, 800-989-8255. If you don't know how to swim, why not? You can also email us, talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington.

Here's the scope of the problem: By the numbers, 3,400 accidental drowning deaths in 2007, according to the CDC, more than 20 percent children under 14. Men are almost four times as likely to drown than women. African-Americans are more than three times as likely as whites.

Our focus today: Why? We want to hear from lifeguards. We also want to hear from those of you who don't know how to swim. Tell us why not? 800-989-8255. Email us, talk@npr.org. You can also join the conversation at our website. That's at npr.org. Click on TALK OF THE NATION.

Our guests: Carol Irwin, assistant professor of health sport sciences at the University of Memphis in Tennessee. She co-wrote the study "Constraints Impacting Minority Swimming Participation." Also with us, Dr. Jerome Modell, professor emeritus at the University of Florida's College of Medicine. He's the author of the article "Prevention of Needless Deaths From Drowning."

And let's go to our next caller. James(ph) is on the line from Fayetteville.

JAMES (Caller): Hello.

CONAN: Hi, go ahead, please.

JAMES: Hi, yeah, I'm a male, 29 years old, white and never learned how to swim.

CONAN: How come?

JAMES: Well, your call screener actually kind of put it very succinctly. I guess I've never really had a need to or desire to learn how.

CONAN: And do you ever go by the water, by the pool, by the beach?

JAMES: Absolutely.

(Soundbite of laughter)

CONAN: You should excuse me - and I'm not trying to be rude - doesn't that sound pretty stupid?

JAMES: Not necessarily. I mean, if you think about a pool, most, I guess, common pools, how many portions of the pool are too deep for you to walk around in, and how long do you stay in the portions that are over your neck anyway?

CONAN: Do you have kids?

JAMES: Yes. I have a daughter. She's four.

CONAN: And does she know how to swim?

JAMES: Actually, she does.

CONAN: Well, that's good. That's good.

JAMES: Because of her mother.

CONAN: Well, does her mother swim?

JAMES: Yes.

CONAN: It's interesting. Carol Irwin, I think you found the greatest predictor for those who can't swim to be those whose parents can't swim.

Prof. IRWIN: Yeah, definitely. What we did is we had a continuum scale on where people self-reported their swim ability, and then we also asked parents, too, what their swim ability was. And obviously, the higher swimming ability that parents had matched then with the higher swimming ability for children and vice versa. So that definitely is one of the predictors.

CONAN: And Dr. Modell, he was saying, well, he can just stand in the shallow end. That's not necessarily all that safe.

Dr. MODELL: Your caller has assumed that if you can stand up, and you get your head above water, you can't drown, and that just is not true. If the pool is not maintained properly, the bottom can be quite slippery, and particularly if you're near where it starts to drop off, you can slip, become submerged, and if you're unable to right yourself and get your head above water, you certainly can drown from that.

I've seen several situations where the pools were so filthy that they couldn't see somebody on the bottom of the pool until someone went in and actually surveyed the entire bottom, and it took 20, 30, 40 minutes to get them out. And if they had seen the pool, if the pool was clear and they could have seen them immediately, they could have saved that individual.

Another group that you need to be cognizant of, and this occurs primarily in young teenagers and young male adults, is what we call shallow-water blackout, people going underwater and seeing how long can they hold their breath.

They first hyperventilate to blow their carbon dioxide down so they don't have the urge to breathe, and then they submerged and sit on the bottom or swim underwater for a longer period of time because they can do it. Keep in mind that during that time, the amount of oxygen in your blood goes down, and you will lose consciousness due to cerebral hypoxia, start to breathe underwater and die.

As a matter of fact, I reviewed a case like that just this morning, where someone was trying to train for the Navy SEAL program by themselves and see how long they could hold their breath, and they were pulled out dead. So you've got to be very careful.

JAMES: I do totally agree on both parts, but neither one actually has anything to do with swimming. Am I correct?

Prof. IRWIN: Well, what you're talking about earlier in regard to if you can walk around in the shallow end.

CONAN: In the shallow end, yeah.

Prof. IRWIN: That's exactly what happened to those six kids in Louisiana. You know, they...

JAMES: Swimming wouldn't have necessarily helped as much as good safety precautions around the pool, correct?

Prof. IRWIN: Obviously.

CONAN: Yeah, but swimming couldn't hurt.

JAMES: Also, tip-toeing and bobbing your head all the way until you get to the end can also be as effective as swimming.

(Soundbite of laughter)

JAMES: I don't know. I guess maybe a little bit more of aware of the situation...

Dr. MODELL: If you can do that...

JAMES: Right, right, agreed. But people shouldn't be in a pool that's slimy to begin with, especially if you can't see the bottom I guess is what I'm getting at.

CONAN: Well, James...

JAMES: Not that I'm neglecting swimming as a good thing to know how to do, but situational awareness goes a long way, as well.

CONAN: All right, James, thanks very much for the call. And good luck.

JAMES: Thanks.

(Soundbite of laughter)

CONAN: Bye-bye. Here's an email we have from Cathy(ph). It doesn't say where she's listening. I read years ago about a technique that allows a person to bob in the water if they could not swim. Essentially, the trick is to relax, hold the arms to the ankles in a kind of fetal position and allow the head to come up and breathe when needed. Is that a practical technique?

I think we just heard from Dr. Modell probably not.

This from Helen(ph) in Plymouth, Michigan: As a WSI-certified American Red Cross swim instructor for seven years, I observed that the best thing parents can do for their children is to start swimming lessons early, second grade or earlier. Not only does this significantly help avoid fear of the water and the panic response, but it will teach children basic water safety and survival skills such as identifying safe places to swim and floating.

And let's see if we can go to another caller. This is Kathleen(ph), and Kathleen's with us from Honolulu. Kathleen, are you there? I guess Kathleen has left us. Let's see if we can go next to this is Andy(ph), Andy with us from Pepin in Wisconsin.

ANDY (Caller): Yeah, hi there.

CONAN: Go ahead, Andy.

ANDY: Yeah, I guess one of my I want to share one of my worries, and that is as a lifeguard on the beach (technical difficulty) thing that people always ask me is, you know, how many people have you saved. And what I want to kind of draw kind of everybody's look into closer is kind of the setting up the scene beforehand.

And as you're scanning, I really like and want my patrons to know that they need to look out for things that could happen before it could even happen because as a lifeguard, one of your main jobs is kind of to look out for everything in a preventative way. Before somebody drowns, you want to be analyzing the swimmer. You know, is he struggling? Is he having trouble? And I just wish more patrons and more people kind of would...

CONAN: Oh, and I think we lost Andy's call there. But Dr. Modell, I wanted to ask you. You've analyzed a lot of cases where litigation was involved. So people obviously thought somebody was to blame. But nevertheless, what Andy was just talking about, the proper equipment, obviously you mentioned proper pool maintenance, making sure the drains aren't sucking people down, that sort of thing, and having life vests and hooks available to help people. Those are all important.

Dr. MODELL: They're extremely important. And you mention the drains. I know of several people that actually were sucked into a drain by their arm and held underwater until they died.

There's no excuse for having a suction drain in a pool without a cover on it that would prevent anybody being trapped. People take shortcuts in maintaining pools, and that is to be condemned, as far as I'm concerned.

CONAN: Of the cases that you've studied, would you think that what percentage would think were - these were preventable deaths?

Dr. MODELL: Well, it's hard to put a percentage because it's a skewed series. The only ones in the series are people who died and then ended up in court, not the ones that were saved because the lifeguards or someone else did the proper things. So the numbers don't mean that much, other than even a single individual who is sucked into a drainage port is one too many, as far as I'm concerned. There is no reason for that.

The other thing I'd like to emphasize: Small children should not be taken to a pool and dropped off by their parents and think that the lifeguards are going to be babysitters. They're far too busy to babysit your child. And I think that parents have responsibility to make sure that their children who cannot swim have an adult supervising them at the site at all times.

CONAN: Here's an email from Gary(ph) in Washington, D.C.: My partner is African-American and did not get swim lessons when he was growing up in the inner city. Now we travel around the world to many locations that have water- and ocean-based activities, and although he has a basic ability to swim, I've tried to urge him to get formal lessons so he'll be truly safe and be able to enjoy all the options that the pool and the ocean offer.

However, he says he's too embarrassed to take lessons as an adult because he thinks it's something someone should learn as a kid, and he would feel extremely uncomfortable, even with private lessons in a public pool. How do I get him past this?

I imagine he's not the only adult who feels that way. Carol Irwin, is he the only adult who feels that way?

(Soundbite of laughter)

Prof. IRWIN: An adult learner in the swimming pool is one of the worst learners. They're very, very difficult to teach because of the fear issue. You know, they've just not been involved in swimming.

I used to be a lifeguard in WSI as well, and I taught one adult class, and it was hard work. So it's not just because he's African-American or hasn't been that much exposed to it. It's because he is an adult.

Dr. MODELL: I would also tell him it's much better to be alive and embarrassed than it is to be dead and not embarrassed.

CONAN: Carol Irwin, it was - we mentioned earlier in your study that people said access to a pool was not really the reason they did not necessarily learn to swim or teach their children how to swim. Nevertheless, they did say your survey did find that African-Americans, as a rule, had - and minorities, as a rule - had less access to swimming pools.

Prof. IRWIN: They did say that they had less access, but specifically, more they were worried about the safety issues around the pool. Not so much the pool itself but actually getting to the pool. And they were worried about other, you know, unsafe issues like crime and certain people being around the pool. But once they got to the pool, it was fine.

CONAN: Mm-hmm.

But access is always something that is brought up as a major barrier, and what we found was it's still kind of a barrier but it's not as huge or significant as everyone thinks it is.

CONAN: Here's another adult. I am 49 and never learned to swim. My parents signed me up for lessons once as a child, but I was afraid of the water and they gave up, faced with my resistance. When I became a parent myself, I decided that learning to swim would be non-negotiable. Not only do we live near the water, I didn't want my children to be afraid.

Now, finally, I am taking swimming lessons. I have been and embarrassed for so long, but I'll be 50 in less than a year and I'm finally - and I find I'm finally at a place where I can get past the self-consciousness and unease enough to take the leap. Seven weeks into it, I couldn't be prouder of myself. You won't see my in the Olympics anytime soon, but I'm already much more capable in the water than ever I was.

So, no doubt, due to the hard work of one of those instructors Carol Irwin's mentioned who were dealing with one of those adult classes, our Jennifer(ph) can now at least manage a little bit in the water.

Carol Irwin is assistant professor of health sport sciences at the University of Memphis, co-author of "Constraints Impacting Minority Swimming Participation." Our other guest is Dr. Jerome Modell, professor emeritus at the Department of Anesthesiology at the University of Florida's College of Medicine, also the author of "Prevention of Needless Deaths from Drowning," with us today from member station WUFT in Gainesville.

And you're listening to TALK OF THE NATION from NPR News.

And here's an email from Gregory(ph) in Oakland. I went to the University of North Carolina at Chapel Hill in the '70s. It was a requirement that you had to know how to swim to graduate. Everyone was required to take PE for one year, and they lined you up in the first day of classes to test everyone. I heard it was because a regent's child had died of drowning.

A black U.S. Olympian now has a program encouraging minority children to learn to swim. With the cutback in PE programs across the country and closure of pools due to cutbacks, I fear it will only become worse. Dr. Modell, was one of my mentors as a med student in Florida, and it is good to hear his name.

So, Dr. Modell, one of your students weighing in there.

Dr. MODELL: Terrific.

CONAN: Let's see if we can get another caller on the line. This is Ryan(ph), Ryan with us from Portland.

RYAN (Caller): Hey, how are you doing?

CONAN: Very well. Thanks.

RYAN: I was calling because I spent about seven and a half years as a lifeguard. I work primarily at pools in the city, public pools. And we had a really good policy. We had an excellent trainer training companies with Jeff Ellis and Associates. And they gave us a policy called 10-20. And with that policy, we knew that we had 10 seconds to scan our entire zone, both the surface and the depth, and then 20 seconds if we ever saw a victim to get to that victim.

CONAN: That sounds like a - did you ever have to go in?

RYAN: I made quite a few recues. Several, unfortunately, of those rescues were unneeded. They were kids who looked like they were floundering or adults, and ended up, you know, just been playing. But we were always taught if you don't know, go. And...

CONAN: And...

Dr. MODELL: I might comment.

CONAN: Go ahead, Dr. Modell.

Dr. MODELL: I might comment that Jeff Ellis and Associates has trained thousands of lifeguards in this country and they're to be congratulated.

RYAN: They're a fantastic company.

Dr. MODELL: Their 10-20 rule has been adopted by most people as the standard, as a matter of fact.

RYAN: Yeah, it's great. It's very preventative and if you look - I'm trained both as an Ellis guard and a Red Cross guard. And I would say, across the board, Red Cross does all kinds of great things for everybody, but I would say that training with them is fantastic. And the rescues that we've had to make at public pools - we're really lucky in Portland in that, you know, we really reach out to the communities to teach not only the children but adults. I've taught lots of adult lessons and children lessons.

And, thankfully, you know, I haven't had to go in after too many adults, but it is, I think, very much about, as you were saying earlier, the proper equipment and the proper training are really - it's a preventative measure rather than a reactive measure is how lifeguards should work, I believe.

CONAN: All right, Ryan. Thanks very much for the call. Appreciate it.

RYAN: Yeah. Bye-bye.

CONAN: And here's an email question. And this is from Alicia(ph) in Colorado. Could you talk about the warning signs of dry drowning? Dr. Modell, could you speak to that?

Dr. MODELL: Well, I don't believe dry drowning actually occurs anymore, and yet I believe I'm the individual that introduced that term some 40 years ago. It was based on some studies that were done in France that were perhaps misinterpreted. But about five years ago, Dr. Lunetta and I - he's the professor and chairman of Department of Forensic Science, University of Helsinki - published a paper in (unintelligible) medical literature and a book chapter, and looked at - he had, I think 1,700 cases in his file of people who died from drowning. And we found that in over 98 percent of the time, you could clearly demonstrate that water was aspirated.

If you don't find any evidence of aspiration of water in someone that was thought to have drowned, I believe that they probably died of another cause such as a sudden cardiac arrhythmia resulting in cardiac arrest before they could aspirate water.

CONAN: So dry drowning is, you think, a myth.

Dr. MODELL: Let me just say that I don't think anyone has ever proven it exists. And as a matter of fact, at the world congress on drowning in Amsterdam in 2002, in the final recommendations, it was recommended that the term be drop and not use.

CONAN: All right. Well, thank you very much for your time today, Dr. Modell.

Dr. MODELL: Thank you. It's been a pleasure being with you.

CONAN: Jerome Modell, professor emeritus at the Department of Anesthesiology at the University Forest College of Medicine. Carol Irwin, thank you also for your time.

Ms. IRWIN: Oh, thank you. It's been a pleasure.

CONAN: Carol Irwin is assistant professor of health sports sciences at the University of Memphis, co-author, "Constraints Impacting Minority Swimming Participation."

When we come back, we're going to be talking about - well, if you want to climb the tall oak tree, turn to page 12. If you want to tumble down an empty well, turn to page 90. All of you fans of the "Choose Your Own Adventure" books, there's now an app for that. Stay tuned. It's the TALK OF THE NATION from NPR News.

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