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The purpose of this scientific review was to address the question of what evidence-based visual surveillance/scanning skills exist in the peer-reviewed scholarly literature. It is well known that lifeguards spend a majority of their on-duty time surveying bathers and swimmers in the water. Lifeguards need to quickly distinguish among swimmers in distress and drowning persons from other bathers in order to rapidly come to their aid to prevent drowning. To be able to accomplish this task, Signal Detection Theory reveals that lifeguards need specific and extensive training in identifying the behavioral patterns associated with drowning persons and swimmers in distress. A typical drowning is not what has been popularized in the press and movies that shows a person calling for help and waving his or her arms about. Instead, drowning victims usually demonstrate the instinctive drowning response in which they are in a vertical position in the water, unable to call out because the mouth is underwater and arm and leg movements are ineffective in keeping them near the water’s surface. The literature revealed that expert lifeguard observation, scanning, and surveillance skills need to be acquired through planned systematic practice to identify the presence of the instinctive drowning response among bathers.