2017 Lifeguarding Summary of Program Changes

Transcription

1 2017 Lifeguarding Summary of Program Changes The following table includes a summary of changes to the 2017 American Red Cross Lifeguarding Program. references for the Lifeguarding Instructor s Manual are available in the column and references for the Lifeguarding Manual are available in the column, where applicable. New Content Global, Benchmarks Lesson 1, Being Part of a Team Lesson 1, Facility Safety Lesson 2, The Drowning Process A benchmark is a set of standards used as a point of reference for evaluating performance or level of quality. Benchmarks are included for lifeguards and lifeguard performance and lifeguarding operations. There are also benchmarks for instructors and instructor trainers for course delivery. New Options for the team-building activity to help participants break the ice and get used to working in close proximity and communicate while working together as a team. Team-building activity options include: Human Knot: Requires participants to work together to forming a human pretzel and unravel their interlocking arms without letting go or breaking the chain. Superlatives: Requires participants to work together and sort themselves into order based on prompts from an instructor. Includes new Unprofessional Lifeguard video and activity. The purpose of this new activity is for participants to identify unprofessional behavior and to understand the consequences and risks related to the behavior. Includes new Not on Your Watch video and guided discussion. The video segment contains in interview with Bill O Melia, a parent whose child fatally drowned at a lifeguarded facility. The purpose of this video is to help Lifeguarding participants understand that: o o o o They are the last, best defense against drowning incidents. Emergencies in and around the water can strike at any time and even the most accomplished swimmers can become distressed swimmers or drowning victims. While on duty as a lifeguard, patrons deserve their undivided attention and depend on them to be trained, prepared and ready to respond when an emergency strikes. While on duty, if they suspect that a person is in distress or drowning, they should respond immediately. Benchmarks appear at the end of each chapter in the Lifeguarding Manual. 72 n/a n/a 89 n/a

2 Lesson 2, Effective Surveillance Victim Recognition Lesson 2, Effective Surveillance Zones of Surveillance Responsibility NEW : Lesson 2, Lifeguarding Testing & Zone Evaluations NEW ACTIVITY: Lesson 2, In- Water Skill Session Victim School Activity Introduction of the concept of Searching vs. Watching when scanning. What is the difference between searching and watching? o Searching is deliberate, active, proactive, requires that your mind is alert. o Watching is passive, reactive i.e. waiting for something to get your attention, easy for your attention to drift. When scanning, make sure you search, don t watch. New lecture points to re-inforce recognition and response benchmarks: o Lifeguards should be able to recognize and reach a victim in their zone within 30 seconds. o In each zone, lifeguards should be able to recognize the emergency, get to the victim, extricate and begin ventilations within minutes. Regular zone tests are conducted to ensure recognition and response times are achievable in each zone. New topic designed to educate participants about lifeguard testing and zone evaluations, including drills. o Ask Drills are used to identify what lifeguards can and cannot see from each station. o Live Recognition Drills are used to evaluate the size and shape of each zone and ensure the lifeguards are able to recognize a victim and reach the extremes of each zone (furthest and deepest) in 30 seconds. o Lifeguard Station Response Time Testing Drills are used to evaluate the response time (not the recognition of a victim) for a lifeguard station and to help evaluate the ability of any lifeguard to be able reach a victim, perform a rescue, extricate the victim and begin ventilations within 1 ½ minutes. Topic also includes new activity worksheet 2.1 Zone Test Drills New activity: Victim School The purpose of this activity is for participants to learn and practice how each of the victim types should act during the rescues throughout the course, so they are getting the most realistic practice being a rescuer as the course progresses (i.e., the victim does not help the rescuer). It will also help them identify victim types throughout the course. Activity includes practice of the following victim behaviors: o Swimmers in distress o Drowning victim Active (at the surface and submerged) Drowning victim Passive (at the surface and submerged)

3 New Activity. Lesson 2, In- Water Skill Session Putting-It-All Together Activity Lesson 3, Guarding for Organized Recreational Swim Groups Lesson 3, In- Water Skill Session Rescue Skills, Part 1 Lesson 4, In- Water Skill Session Rescue Skills, Part 2 Lesson 5, General Procedures for an Emergency on Land New Ask Drill Activity The purpose of this activity is to help Lifeguards understand the Ask drill, a drill commonly used by Lifeguard managers to identify what lifeguards can and cannot see from each station. The intent of this activity is not to practice victim recognition, but to identify what the lifeguard can actually see at the top, middle or bottom of the water from their station. When conducting this activity, keep in mind that there is no wrong answer. If participants don t see a victim or object, they have identified a challenge for lifeguards at that station. New! Introduction of the Water Competency Sequence for use when conducting a swim test. New! Passive victim front rescue All passive victim rescues also include a new towing technique to help lifeguards quickly and easily swim with a victim to the exit point while maintaining an open airway position. Enhanced Skill Drill Active and Passive Victim Rescues The purpose of this skill drill is to keep lifeguard participants rotating and practicing rescues for a variety of different victim types. Instructor s Note: See the skill drill demonstration video on Instructor s Corner for an example of this drill. New! Extrication (replaces the two-person removal method) Four skill drills to give participants the opportunity to practiced team rescues are included in the Putting-It-All-Together activity. Each drill builds on the skills practiced in previous drill and challenges participants to work as a team. Drills include: o Putting on gloves in a wet environment o Submerged victim rescue, extrication and gloves o Rescue and extrication Timed challenge (performed in under 1 minute) o Rescue and Extrication with two assisting responders. Front and back carry has been deleted from the program Expanded scene size up to include: o Look for clues to what may have caused the emergency and how the victim became injured or ill. o Forming an initial impression that may indicate a lifethreatening emergency, including unconsciousness or severe bleeding , ,

4 Lesson 5, Performing a Primary Assessment The steps for performing a primary assessment include: 1. Size up the scene while forming an initial impression. Check for hazards that could present a danger to you or the victim. Use appropriate PPE Determine the number of ill or injured victims. Determine what caused the injury or nature of the illness and look for clues to what may have caused the emergency. Determine what additional resources may be needed. Note: If you see severe, life-threatening bleeding use any available resources to control the bleeding including a tourniquet if one is available and you are trained. 2. Check the victim for responsiveness using a shout-tap-shout sequence. 3. If the victim is unresponsive, summon EMS personnel 4. Open the victim s airway and check for breathing and a pulse simultaneously for at least 5 seconds but no more than 10 seconds. 5. Give two ventilations for a victim of any age ONLY IF the victim is unresponsive and not breathing as the result of a drowning. If the victim s chest does not clearly rise when attempting the first 2 ventilations, re-tilt the head and try to give another ventilation. If after the second attempt, the chest clearly rises, give 1 more ventilation so there are two successful ventilations. If after the second attempt, the chest does not clearly rise, immediately begin CPR. 6. Provide appropriate care: If the victim is not breathing and does not have a pulse, begin CPR starting with compressions. If the victim is not breathing and has a pulse, give ventilations. Adult: Give one ventilation about every 5-6 seconds Child: and Infant: Give one ventilation about every 3 seconds If the victim is unresponsive but breathing and you do not suspect a head, neck or spinal injury OR if you must leave the victim place the victim in a side-lying recovery position , Instructor s Note: The H.A.IN.E.S (high arm in endangered spine) recovery position is no longer used.

5 Lesson 5, Airway Obstruction Lesson 5, In- Water Skill Session: Putting-It-All- Together New Content Lesson 5, Opioid Overdose Conscious choking skills for adult, child and infant remain in the program and are practiced in this lesson. If a victim who is choking becomes unresponsive, carefully lower them to a firm, flat surface, send someone to get an AED and summon EMS (if you haven t already done so). Immediately begin CPR, starting with chest compressions. Unconscious choking has been replaced by CPR with Airway Obstruction, which is taught in Lesson 6. Rescue, Extrication, Primary Assessment and BVM skill drill. The purpose of this two part drill is for participants to gain experience with a scenario that includes a water rescue, extrication and providing ventilations using a BVM. Part 2 of the drill challenges participants to perform the scenario within 1 1/2 minutes. o Part 1: Rescue, Extrication, Primary Assessment and ventilations using a BVM o Part 2: New - Lifeguard Station Response Time Testing. Opioid Overdose With a growing epidemic of opioid (commonly heroin, oxycodone, fentanyl and Percoset ) overdoses in the United States, local and state departments of health have increased access to the medication naloxone (also referred to by its trade name Narcan ), which can counteract the effects of an opioid overdose, including respiratory arrest. Naloxone has few side effects and can be administered intranasally (through the nose). Responders should follow local medical protocols and regulations to determine the dosing and timing of naloxone administration. While there is no formal discussion or training on Naloxone administration during the lifeguarding course, information about Naloxone and opioid overdoses is available on pg. 237 in the Lifeguarding Manual n/a 237 Lesson 6, Recognizing and Caring for a Heart Attack Cardiac Chains of Survival Updated for Adults to include a fifth link --integrated post-cardiac arrest care. o After a person is resuscitated, an interdisciplinary team of medical professionals works to improve survival outcomes. New Pediatric Cardiac Chain of Survival , 275

6 Lesson 6, Recognizing and Caring for a Heart Attack (continued) Lesson 6, CPR Using an AED Aspirin Administration An appropriate dose of aspirin may help a victim who is awake and alert and is showing signs of a heart attack. If the victim is awake and alert and able to take medicine by mouth, ask: o Are you allergic to aspirin? o Do you have a stomach ulcer or stomach disease? o Are you taking any blood thinners, such as Coumadin (warafin)? o Have you been told by a healthcare provider not to take aspirin? If the victim answers no to all of these questions and if local protocols allow, administer two 81-mg, low-dose aspirins (162 mg total), or up to one 5-grain, 325-mg aspirin tablet. The aspirin must be chewed before swallowing. Initiation of CPR: Emphasis remains on quickly starting chest compressions for anyone in cardiac arrest. Expose the chest to ensure appropriate hand placement and monitor for full recoil. Start CPR with chest compressions for all victims including children and infants. o Exceptions include victims of any age who are not breathing and have no pulse as the result of a drowning. o In these cases, give two ventilations during the primary assessment before beginning compressions. Depth of Compressions: Adults: Compress at least 2 inches, but no more than 2.4 inches to limit the occurrence of non-life-threatening injuries. High Quality CPR including: Minimized interruptions to chest compressions. Allowing full chest recoil after each compression. Use of correct compression depths and Use or appropriate rates for the victim s age. Avoiding excessive ventilations. Two-Rescuer CPR To prevent rescuer fatigue, rescuers should switch positions at least every 2 minutes or when the AED is analyzing. When using an AED with more than one rescuer: The compressor hovers with their hands a few inches above the chest during the AED analysis and the shock (if indicated) to minimize interruptions to resuming CPR. Resume compressions immediately following the delivery of a shock or after the AED determines that no shock is advised. Rescuers should change positions at least every two minutes or each time the AED analyzes to limit rescuer fatigue. Should not wait for the AED to prompt resume CPR , , ,

7 Lesson 6, CPR with Airway Obstruction 1. Begin CPR starting with 30 chest compressions. 2. Before attempting ventilations, open the victim s mouth and look for the object. If you see an object in the victim s mouth, carefully remove it. Never perform a blind finger sweep. 3. Replace the resuscitation mask and give 2 ventilations. 4. Continue to provide care by repeating this cycle. 185, Note: Continuing cycles of 30 compressions and 2 ventilations is the most effective way to provide care. Even if ventilations fail to make the chest rise, compressions may help clear the airway by moving the blockage to the upper airway where it can be seen and removed. Continue to check the victim's mouth for an object after each set of compressions until ventilations make the chest clearly rise. New Activity Lesson 6, Putting it All Together: Multiple- Rescuer Response Scenarios The purpose of this drill is for participants to apply all the skills they have learned thus far about water rescues and CPR and to gain experience in using decision making skills, communicating with other group members in prioritizing care steps and working together to provide CPR with BVM and AED after a water rescuer and extrication. For this skill drill, instructors should use the Multiple-Rescuer Response Scenario Flow Sheets in Appendix B of the instructor manual. To track individual and team process, use the Multiple-Rescuer Response Scenario Assessment Tools in Appendix F. Assign the rescuing lifeguard and assisting responder(s) when specified in the scenario but do not assign roles to additional responders. The intent is to help participant apply their knowledge and decision making skills while working as a team n/a Sudden Illnesses Diabetic Emergencies For mild hypoglycemia (low blood sugar) where the person is able to follow simple commands and swallow, give: o Oral glucose tablets (15 20 grams or four to five tablets); this is the priority. o Glucose candies, sucrose candies, jellybeans, orange juice, fructose in the form of fruit strips or whole milk can be substituted if glucose tablets are not available. o Summon EMS if the person does not feel better within about minutes after taking the sugar. n/a 306

8 (continued) (continued) (continued) Anaphylaxis When a person experiencing anaphylaxis does not respond to the initial dose and the advanced medical care will exceed 5 10 minutes, help the person to take a second dose of epinephrine. Caring for External Bleeding Direct pressure: o Continues to be the first line of treatment o Controls bleeding in most cases Elevation/pressure points: o Continues to be no evidence to support use of elevation or pressure points. Severe, Life-Threatening Bleeding In some life-threatening circumstances, rescuers may need to use a tourniquet or hemostatic dressings to control bleeding. o A tourniquet is a device placed around an arm or leg to constrict blood vessels and stop blood flow to a wound. o A hemostatic dressing is a dressing treated with a substance that speeds clot formation. Information on use of tourniquets and hemostatic dressings is available on pages of the Lifeguarding Manual however these skills are not practiced in the lifeguarding course. Heat Related Illnesses Take the following steps to care for someone suffering from a heat-related illness: Move the victim to a cool place Loosen tight clothing Remove perspiration-soaked clothing Cool the victim by spraying them with cool water or applying cool, wet towels to the skin. Fan the victim. If the victim is responsive and able to swallow, assist or encourage the person to orally rehydrate with (in this order): o A carbohydrate-electrolyte (CE) drink (commercial sports drink) o Coconut water o Milk o Potable water if CE drink or alternatives are not available Toxic Eye Injury Rinse eyes exposed to toxic chemicals immediately and with a copious amount of tap water for at least 15 minutes or until advanced medical care arrives. If tap water is not available, use normal saline or another commercially available eye irrigation solution can be used. Contact a poison control center when caring for a chemical eye injury. n/a

9 (continued) (continued) First Aid When Things Do Not Go As Practiced Lesson 8, Caring for Head, Neck and Spinal in the Water Burns Stop the burning by removing the person from the source of the burn. Cool the burned area with large amounts of cool or cold tap water for at least 10 minutes. If cool or cold water is not available use a clean cool or cold compress. Monitor the victim for hypothermia when cooling large burns. Closed Wounds Localized Cold Therapy Responders should apply a cold pack to closed wounds, such as a bruise or hematoma of the scalp or extremities. Use caution with cold therapy application in children because of the risks of hypothermia. The following First Aid skills have been deleted and are no longer taught in the Lifeguarding course: The High Arm In Endangered Spine (H.A.IN.E.S.) recovery position has been removed from the program. The standing takedown procedure for suspected head, neck and spinal injuries on land. Splinting In-water ventilations o Remain in the Lifeguarding program and are practiced (simulated) in When Things Do Not Go As Practiced o The first priority when caring for a drowning victim who is not breathing continues to be extrication since ventilations and compressions are more effective on a firm, flat surface. o If you cannot immediately remove the victim from the water, or if doing so will delay care, perform in-water ventilations. The over-arm head splint is introduced as a new in-line stabilization technique used to place a victim with a suspected head, neck or spinal injury on a backboard. Three new techniques are available for extrication of a victim with a suspected head, neck or spinal injury. These options vary based on different pool/aquatic designs and offer fast, efficient handling of suspected spinal injuries in the water : o Spinal Backboarding Procedure o Spinal Backboarding Procedure High Edges o Spinal Backboarding Procedure Speed Slide n/a 212, n/a 161, See the Spinal Backboarding Comparison chart at the end of this document.

10 New Scenarios Lesson 9, Final In-Water Skill Scenarios Two Final In-Water Skill Scenarios Final Skill Scenario 1: Submerged Passive Victim in Deep Water Timed Response Participants are divided into groups of three with a victim, a rescuing lifeguard, and an assisting responder to assist with extrication. This timed scenario includes a submerged victim rescue, extrication, primary assessment and two ventilations performed in under 1 minute and 30 seconds followed by 3 minutes of onerescuer CPR Urgency is a common theme throughout the course, hence the time limit before care is provided. CPR is strenuous, and the second time measures stamina n/a Final Skill Scenario 2: Multiple-Rescuer Response Scenario During this team scenario, participants are expected to work with other rescuers and demonstrate clear communication and critical thinking abilities. Participants are divided into groups of five; four rescuers and one victim Instructors will not assign specific roles (e.g., Primary Rescuer or Assisting Responder with AED ) Participants will be evaluated on both: o Individual performance and their ability to achieve skill competencies for the individual skills that they are responsible for. o Overall team response performance, demonstrating the ability to work effectively as part of a team. Lesson 9, Conducting Final Skill Scenario 2: Multiple- Rescuer Response Conducting Final Skill Scenario 2: Multiple-Rescuer Response To conduct the Multiple-Rescuer Response final skill scenario, use the multiple-rescuer response scenario flow sheet in Appendix B of the instructor s manual. Read the scenario and prompts from multiple-rescuer response scenario 3. Instructor s Note: In Lesson 6, participants practiced multiplerescuer response Scenarios 1-4. In participants practiced multiple-rescuer response scenarios 5 and 6. For the final skill scenario, instructors should use multiple-rescuer response scenario n/a

11 Lesson 9, Evaluating Final Skill Scenario 2: Multiple- Rescuer Response Evaluating Final Skill Scenario 2: Multiple-Rescuer Response To evaluate the Multiple-Rescuer Response final skill scenario, use the multiple-rescuer response scenario assessment tool in Appendix F of the instructor s manual. If an individual receives a fail in any of the skills, they receive an overall fail rating. If the team receives a fail rating each participant on the team receives a fail rating. It is possible for the overall team to receive a pass rating even if one of the participants receives a fail rating. New tool The video segment on Instructor s Corner includes a demonstration of Final Skill Scenario 2: Multiple-Rescuer Response. In this scenario, the team receives a pass rating for their overall performance, but one participant receives a fail rating because he did not achieve overall skill competencies for the skills he was responsible for. 237 n/a

12 Spinal Backboarding Comparison Chart Spinal Backboarding Procedure Spinal Backboarding Procedure Rescuing Lifeguard Assisting Responder(s) Backboard Placement Victim is placed on the backboard Transfer of Control Chest Strap Placement Transfer of Control Head Immobilizer Extrication Enters the water to perform in-line stabilization using the head splint Remains on the deck and brings the backboard to the edge of the water, removes the head immobilizer. The assisting responder places the board at an angle in the water, submerging the headspace if possible. The rescuing lifeguard approaches the board, moves to the side of the board and places the victim on the center of the board so that the victim s head is on the designated headspace. With the head of the backboard resting on the pool edge, the assisting responder stabilizes the board and takes over in-line stabilization using the head splint technique. The rescuing lifeguard secures one strap across the victim s chest. The rescuing lifeguard assumes inline stabilization by placing one hand and arm on the victim s chin and chest and the other hand and arm under the backboard. The assisting responder secures the head immobilizer and strap across the victim s forehead. The rescuing lifeguard moves to the foot end of the board while the assisting responder holds the backboard at the head of the board. The assisting responder lifts the head of the backboard so that the runners are on the deck. Working together, lifeguards pull and push the backboard on to the deck. High Edges Enters the water to perform in-line stabilization using the head splint Removes the head immobilizer from the backboard and Enters the water with the backboard. The assisting responder submerged the backboard and positions the board under the victim so that it extends slightly beyond the victim s head. The rescuing lifeguard maintains inline stabilization as the assisting responder positions the backboard under the victim. The assisting responder places a rescue tube under the head end of the backboard for support and takes over in-line stabilization using the head splint technique. The rescuing lifeguard secures one strap across the victim s chest. The rescuing lifeguard assumes inline stabilization by placing one hand and arm on the victim s chin and chest and the other hand and arm under the backboard. The assisting responder secures the head immobilizer and strap across the victim s forehead. The rescuing lifeguard gets out of the water and grasps the handholds of the backboard while the assisting responder maintains control of the backboard from in the water. After the rescuing lifeguard gains control of the backboard from the pool deck, the assisting responder moves to the foot of the board. Working together, lifeguards pull and push the backboard on to the deck.