Lifeguarding Welcome Introductions Policies and Procedures Course Outline

Lifeguarding

Welcome! ü ü ü Introductions Policies and Procedures Course Outline Lifeguarding Standard Precautions

Purpose ü To teach lifeguard candidates the knowledge and skills needed to prevent and respond to aquatic emergencies. ü The course content and activities prepare lifeguard candidates to prevent drownings and injuries and to recognize and respond quickly and effectively to emergencies.

The Professional Lifeguard and Injury Prevention Lesson 1

Lifeguarding ü Lifeguarding is— q Dynamic! q Challenging! q Important! q Inspiring!

What were the different places shown in the video segment where you might lifeguard?

What types of decisions might a lifeguard need to make?

How did you decide to take this class? Did you flip a coin?

The FIND Model F I N D = = Figure out the problem Identify possible solutions Name the pros and cons of each solution Decide which solution is best

Legal Considerations ü ü ü Duty to act Standard of care Negligence Good Samaritan laws Consent ü ü Refusal of care Abandonment Confidentiality Documentation

The Lifeguard Team ü Whenever another lifeguard is on duty with you, you are part of a lifeguard team. ü The aquatic safety team is a network of people who prevent, prepare for, respond to and assist in an emergency at an aquatic facility.

Facility Management and Professionalism ü How does management support lifeguard professionalism? q q q By providing a policies and procedures manual By conducting an orientation and regular in-service trainings By providing opportunities for recognition and career development

Preventing Injuries—Patron Safety ü Risk management involves identifying dangerous conditions or behaviors that can cause injuries and then taking steps to minimize or eliminate them. ü Injury-prevention strategies q Communication with patrons q Facility safety checks q Patron surveillance

Communication ü Communication as an injury-prevention strategy requires lifeguards to— q Inform patrons about the potential for injury. q Educate patrons about inappropriate behavior. q Enforce rules and regulations.

How are patrons informed of a potential injury at an aquatic facility?

Rules and Regulations ü Lifeguards need to understand the rules and regulations of the facility where they work. ü Rules do not keep patrons from having fun, but are for everyone’s health and safety.

Preventing a Patron from Engaging in Risky Behavior 1. 2. 3. Get the patron’s attention, for example, by blowing your whistle, and then saying, “Excuse me, but what you are doing is dangerous. ” Explain the hazard or danger. Explain a safe alternative behavior or activity.

Enforcing Rules and Regulations ü Enforcing rules helps prevent injuries and encourages safe patron behavior. ü When enforcing rules, always be consistent and fair. ü When enforcing rules, explaining the rule is usually enough. ü Asking a patron to leave the facility should always be the last resort.

Safety Checks ü Safety checks are conducted— q Before opening the facility. q During daily operations. q At closing. ü Use the facility’s safety checklist when performing a safety check. ü What are the general areas and equipment to inspect during a safety check?

Weather Conditions ü Lightning and thunderstorms happen more often in the summertime. ü Follow your facility’s emergency action plan (EAP) for severe weather.

Management is responsible for — ü Creating, reviewing and revising a facility’s policies ü ü ü and procedures, rules and regulations and EAPs as needed. Warning staff about actual and potential dangers. Addressing unsafe or dangerous conditions. Complying with local, state and federal regulations for facility operations and employment. Maintaining records on the facility and its employees. Assisting after an emergency.

What’s Next? ü ü ü Break In-Water Skill Session q Slide-In Entry q Stride Jump q Compact Jump q Front Crawl Approach q Breaststroke Approach Assignments

Patron Surveillance and Emergency Preparation Lesson 2

Patron Surveillance ü ü ü A lifeguard’s primary responsibility is to ensure patron safety and protect lives. The primary tool to accomplish that function is patron surveillance. Effective surveillance has several elements, including— q q Victim recognition. Effective scanning. Lifeguard stations. Area of responsibility.

Effective Scanning ü Scanning is a visual technique for watching patrons in the water. ü What does effective scanning require?

Lifeguard Stations ü Patron surveillance is performed in a lifeguard chair or by standing on the deck or in the water. ü The location of your lifeguard station must enable you to see your entire area of responsibility. ü You might have to move your lifeguard stand or change your position during the day.

How do periodic rotations from one station to another, along with breaks, help keep you alert and decrease fatigue?

Area of Responsibility ü Your supervisor will establish the area of responsibility for patron surveillance. ü Areas of responsibility can include— q q q Zone coverage. Total coverage. Back-up coverage.

The RID Factor ü Most drownings at supervised swim areas happen when neither lifeguards nor patrons notice that a victim has slipped below the surface. ü RID q q q Recognition Intrusion Distraction

Patron Surveillance at Play Structures ü Consider the following elements when conducting patron surveillance at play structures: q q q Pay close attention to nonswimmers or weak swimmers. Do not let a play structure become overcrowded. Watch that patrons return to the surface after dropping into the water from a drop-off slide. Pay close attention to children playing in sprays and fountains. Pay close attention to patrons in moving water. Keep play safe and orderly.

Emergency Action Plans (EAPs) ü EAPs are detailed plans describing everyone’s responsibilities in an emergency and should be in the facility’s policies and procedures manual. ü EAPs should be practiced regularly during orientation and in-service training sessions.

What are the steps of an EAP?

What’s Next? ü ü Break In-Water Activity q q ü Safety Tour of the Facility Lifeguard Rotation Victim Recognition Putting It All Together Assignments

Rescue Skills, Part 1 Lesson 3

General Procedures for Water Emergencies ü ü ü Assess the victim’s condition. Safely enter the water, if needed. Perform an appropriate rescue. Move the victim to safety. Remove the victim from the water. Provide emergency care as needed.

What’s Next ü ü Break In-Water Skill Session q q q q ü Simple Assist Extension Assist from the Deck Reaching Assist with Equipment Throwing Assist Swimming Extension Rescue Active Drowning Victim Rear Rescue Passive Drowning Victim Rear Rescue Two-Person Removal from the Water Using a Backboard Assignments

Before Providing Care and Rescue Skills, Part 2 Lesson 4

As a professional rescuer, what responsibilities do you have related to providing care?

What standard precautions should you follow to prevent the spread of bloodborne pathogens while providing care?

Standard Precautions ü What are universal precautions? ü What are standard precautions? ü The risk of getting a disease while performing CPR is extremely low, but practicing standard precautions reduces the risk even further.

Resuscitation Masks ü What is a resuscitation mask? ü Benefits of using a resuscitation mask: q q ü A seal is created over both the victim’s mouth and nose. Air can be delivered to the victim more quickly through both the mouth and nose. The device can be connected to emergency oxygen if it has an oxygen inlet, thus increasing the oxygen concentration the victim receives. It protects against disease transmission when giving rescue breaths. Characteristics of a resuscitation mask

General Procedures in an Emergency ü What general procedures should you follow in an emergency? ü The general procedures are— q q Size up the scene. Perform an initial assessment. Summon EMS personnel, by calling 9 -1 -1 or the local emergency number. Perform a secondary assessment.

Initial Assessment ü Purpose: To identify life-threatening conditions. ü Includes checking the victim for― q q Consciousness. Signs of life (movement and breathing). A pulse. Severe bleeding.

Moving a Victim ü It is important not to move a victim unless it is necessary. ü When should you move a victim? ü What are some considerations when moving a victim?

Moving a Victim (cont. ) ü There are six ways to move a victim: q q q Clothes drag Two-person seat carry Walking assist Pack-strap carry Blanket drag Foot drag

What’s Next? ü Break ü In-Water Skill Session q q q Passive Submerged Victim Rescue—Shallow Water Multiple-Victim Rescue Feet-First Surface Dive Submerged Victim Rescue—Deep Water Front and Rear Head-Hold Escapes

Assignments

Breathing and Cardiac Emergencies Lesson 5

Breathing Emergencies ü What is a breathing emergency? ü Some reasons they occur: q q q Drowning Nonfatal submersion injuries Obstructed airway Injury to head, chest, lungs or abdomen Respiratory conditions Heart attack q q q q Coronary heart disease Allergic reactions Electrocution Shock Poisoning Drugs Emotional distress

Respiratory Distress ü Signs and symptoms: q q q q Slow or rapid breathing Unusually deep or shallow breathing Shortness of breath or noisy breathing Dizziness, drowsiness or light-headedness Changes in the level of consciousness Increased heart rate Chest pain or discomfort Flushed, pale, ashen or bluish skin

Respiratory Distress (cont. ) ü Signs and symptoms (cont. ): q q q ü Unusually moist or cool skin Gasping for breath Wheezing, gurgling or high-pitched noises Inability to speak in full sentences Tingling in hands, feet or lips What care should be given to a victim in respiratory distress?

Rescue Breathing ü ü Perform rescue breathing for a victim who has a pulse, but is not moving or breathing. To determine if a victim is not moving or breathing, perform an initial assessment. For an adult, give 1 rescue breath about every 5 seconds. For a child and infant, give 1 rescue breath about every 3 seconds. Each rescue breath should last about 1 second and make the chest clearly rise.

Bag-Valve-Mask Resuscitator ü What is a bag-valve-mask resuscitator (BVM)? ü A BVM reduces the risk of disease transmission and increases the level of oxygen being delivered to a victim. Using a BVM—Two Rescuers ü 1. 2. 3. 4. Rescuer 1 performs an initial assessment while Rescuer 2 assembles the BVM. Rescuer 1 seals the mask and opens the airway. Rescuer 2 begins ventilations. Look for movement and recheck for breathing and a pulse about every 2 minutes.

Airway Obstruction ü What is an airway obstruction? ü Steps for a conscious choking victim: q q Size up the scene and ask the victim, “Are you choking? ” Identify yourself and ask if you may help. If the victim is coughing forcefully, tell him or her to continue coughing. If the victim cannot cough, speak or breathe, summon EMS personnel. Begin back blows and abdominal thrusts for an adult or child or back blows and chest thrusts for an infant.

Airway Obstruction (cont. ) ü Steps for an unconscious choking victim: q q Size up the scene and approach the victim. Look for movement, check for breathing and give 2 rescue breaths. If the rescue breaths do not make the chest clearly rise, reposition the airway and attempt the rescue breaths again. If the rescue breaths still do not make the chest clearly rise, begin chest thrusts for an adult, child or infant. Give 5 chest thrusts, look for a foreign object and then give 2 rescue breaths.

You are responding to a call in the locker room in which a patron collapsed from cardiac arrest. What four steps need to be taken to improve this victim’s chances of survival?

The Cardiac Chain of Survival 1. 2. 3. 4. Early recognition of the emergency and early access to EMS Early cardiopulmonary resuscitation Early defibrillation Early advanced medical care

Signs and Symptoms of a Heart Attack ü Persistent chest discomfort, pain or pressure that lasts longer than 3 to 5 minutes or goes away and comes back ü Chest discomfort, pain or pressure that spreads to the shoulder, neck, jaw or arms ü Trouble breathing ü Nausea or vomiting

Signs and Symptoms of a Heart Attack (cont. ) ü Dizziness, light-headedness, loss of consciousness or fainting ü Pale or ashen skin ü Sweating—face may be moist or person may be sweating profusely ü Denial of signs and symptoms

Care for a Heart Attack ü Immediately summon EMS personnel. ü Have the victim stop what he or she is doing and rest. ü Loosen any tight or uncomfortable clothing. ü Closely monitor the victim until EMS personnel arrive and take over. ü Notice any changes in the victim’s appearance or behavior. ü Comfort the victim.

Care for a Heart Attack (cont. ) ü If medically appropriate and local protocols or medical direction permit, give aspirin if the victim can swallow and has no known contraindications. ü Assist the victim with his or her prescribed medication and give emergency oxygen, if it is available and you are trained to do so. ü Be prepared to perform CPR or use an AED.

Cardiac Arrest ü What is it and when does it occur? ü Signs and symptoms: q q q ü Unconsciousness No movement or breathing No pulse Care: q q Early CPR Early defibrillation

CPR ü Combination of rescue breaths and chest compressions ü Circulates blood that contains oxygen to vital organs, increasing the victim’s chance of survival until EMS personnel arrive ü Must be performed on a firm, flat surface ü Increases the likelihood that successful defibrillation can be delivered to a victim of sudden cardiac arrest, especially if more than 4 minutes have elapsed since the victim’s collapse

Wrap-Up ü Rescue breathing ü Conscious and unconscious choking ü CPR ü Assignments

Two-Rescuer CPR and AED Lesson 6

Two-Rescuer CPR ü What is the job of the first rescuer? ü What is the job of the second rescuer? ü To signal for a position change, the second rescuer calls “change” instead of “ 30” (for an adult) and “ 15” (for a child or infant).

Introduction to AEDs ü Most cardiac arrests occur away from the hospital. ü Early CPR can help a cardiac arrest victim. ü An electrical shock (defibrillation) is needed to correct the problem. The sooner the shock is administered, the greater the victim’s chance of survival. ü Early defibrillation is the third step in the Cardiac Chain of Survival.

When the Heart Stops ü Disease or injury can disrupt the heart’s electrical system. ü V-fib and V-tach are two of the most common treatable abnormal heart rhythms. ü Defibrillation is intended to disrupt the abnormal activity of the heart. ü Cardiac arrest can also occur in children.

Using an AED 1. 2. 3. 4. 5. 6. 7. Turn on the AED. Wipe the victim’s chest dry. Attach the pads (use pediatric pads for children). Plug the connector into the AED, if necessary. Make sure no one, including you, is touching the victim. Push the “analyze” button, if necessary. If a shock is advised, push the “shock” button.

What precautions should you take when using an AED?

First Aid Lesson 7

Secondary Assessment ü Perform a secondary assessment after you have determined there are no life-threatening conditions. ü Perform a head-to-toe examination for an adult and a toe-to-head examination for a child or infant. ü Use SAMPLE to take a brief history.

SAMPLE S A M P L E = = = Signs and Symptoms Allergies Medications Pertinent Past Medical History Last Oral Intake Events Leading Up to the Incident

Sudden Illness ü Follow the general procedures for sudden injury or illness on land. ü Common sudden illnesses include— q q q q Diabetic emergency. Seizure in the water. Stroke. Fainting. Poisoning. Insect stings. Snake and spider bites.

Wounds ü An injury to the body’s soft tissue is called a wound. ü Closed wounds occur beneath the surface of the skin. ü Four types of open wounds are— q q Abrasions. Punctures. Avulsions. Lacerations. ü Internal versus external bleeding. ü Burns are a type of soft tissue injury.

Shock ü Any serious injury or illness can result in shock. ü Signs and symptoms of shock include— q q q Restlessness or irritability. Altered levels of consciousness. Pale or ashen, cool, moist skin. Rapid breathing and pulse. Nausea or vomiting. Excessive thirst.

To minimize the effects of shock— ü ü ü ü Make sure that EMS personnel have been summoned. Monitor the victim’s ABCs. Control any external bleeding. Keep the victim from getting chilled or overheated. Have the victim lie down and elevate the legs about 12 inches if a head, neck or back injury or broken bones in the hips or legs are not suspected. Comfort and reassure the victim until EMS personnel arrive and take over. Administer emergency oxygen, if available and trained to do so.

What conditions could lead to a heat-related emergency at an aquatic facility?

Heat-Related Emergencies ü Heat Cramps—Least severe of heat-related emergencies ü Heat Exhaustion—Early indicator that the body’s cooling system is getting overwhelmed ü Heat Stroke—A life-threatening condition

On a very warm day, a lifeguard who is on surveillance duty calls the lifeguard supervisor to her lifeguard chair and complains that she has a headache, is nauseous and is sweating heavily. What heat-related condition could she be experiencing?

What care should be provided?

What is the difference between frostbite and hypothermia?

Cold-Related Emergency ü A victim suffering from frostbite experiences a loss of feeling and sensation in the affected area. ü The victim’s skin color can appear waxy, cold to the touch or discolored (flushed, white, yellow or blue). ü It does not have to be extremely cold for someone to suffer a cold-related emergency, especially if the person is wet or if it is windy.

What’s Next? ü First Aid Scenarios ü Assignments

Injuries to Muscles, Bones and Joints and Caring for Head, Neck and Back Injuries, Part 1 Lesson 8

Injuries to Muscles, Bones and Joints ü Four types of injuries: q q Fractures Dislocations Sprains Strains

Caring for Head, Neck and Back Injuries on Land ü If you suspect that a victim has a head, neck or back injury, tell him or her not to nod or shake his or head but to say yes or no. ü To care for injuries to a head, neck or back on land— q q Use personal protective equipment. Minimize movement of the victim’s head, neck and back by placing your hands on both sides of the victim’s head. Have the victim remain in the position that you found him or her until EMS personnel arrive and take over. Monitor the victim’s ABCs.

Head, Neck and Back Injuries in the Water ü The care you provide depends on— q q q The victim’s condition. The location of the victim. The availability of help. Your facility’s specific procedures. The air and water temperature.

General Rescue Procedures 1. 2. 3. 4. 5. 6. 7. 8. Activate the facility’s EAP. Assess the victim’s condition. Safely enter the water. Perform an appropriate rescue. Move the victim to shallow water whenever possible. Check for consciousness and for signs of life. Remove the victim from the water. Provide emergency care as needed.

What’s Next? ü Break ü In-Water Skills Session q q q ü Manual In-Line Stabilization Techniques―Shallow Water Manual In-Line Stabilization Techniques―Deep Water In-Line Stabilization—Submerged Victim Assignments

Caring for Head, Neck and Back Injuries, Part 2 Lesson 9

Using a Backboard ü After stabilizing the victim’s head and neck with either the head splint technique or the head and chin support, secure the victim on a backboard. ü Backboards come in different shapes and sizes. ü Backboards vary in materials, the number and size of handholds and buoyancy.

What’s Next? ü Break ü Review of Manual In-Line Stabilization Techniques ü In-Water Skill Session q q ü Using a Backboard in Shallow Water Using a Backboard in Deep Water Assignments