Primary assessment: hazards & ABCs Item 11

Rookie Patrol Primary assessment: hazards & ABCs Item 11 Demonstrate a primary assessment including hazards and ABCs on an unconscious, breathing victim. To assess an unconscious breathing victim with respect to hazards and ABCs. Victim is classified as an adult. If alone, rescuer phones Emergency Medical System (EMS) right away. If another person is available, rescuer directs him or her to phone EMS. To establish unresponsiveness, rescuer may shake shoulder and ask "Are you OK?" Other techniques are acceptable. Rescuer opens airway using head-tilt/chin-lift technique. See suggested learning activities, p. 81 Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System Position victim (turn if necessary) Open airway Check for breathing: look, listen and feel (no more than 10 sec.) Recovery position for breathing victim 12 SWIM PATROL AWARD GUIDE

Rescue breathing Rookie Patrol Item 12 Demonstrate rescue breathing on a manikin. To support breathing in an unconscious, non-breathing victim. Victim is classified as an adult. Send bystander to phone EMS. If alone, rescuer phones EMS right away. Rescuer opens airway using head-tilt/chin-lift technique. Rescue breaths: rescuer delivers normal breaths (each over 1 second) that make chest rise. See suggested learning activities, p. 83-4. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System Open airway Check for breathing: look, listen and feel (no more than 10 sec.) 2 rescue breaths: observe chest rise Continue rescue breathing and attempt to recruit a CPR-qualified person for assistance 13 SWIM PATROL AWARD GUIDE

Rescue breathing Ranger Patrol Item 13 Demonstrate rescue breathing and the ability to manage vomiting. To support breathing in an unconscious, non-breathing victim. Victim is classified as an adult. Send bystander to phone EMS. If alone, rescuer phones EMS right away. Rescuer opens airway using head-tilt/chin-lift technique. Rescue breaths: rescuer delivers normal breaths (each over 1 second) that make chest rise. See suggested learning activities, p. 84 See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System Open airway Check for breathing: look, listen and feel (no more than 10 sec.) 2 rescue breaths: observe chest rise Continue rescue breathing and attempt to recruit a CPR-qualified person for assistance Ability to clear the airway when victim vomits 32 SWIM PATROL AWARD GUIDE

Ranger Patrol Obstructed airway conscious victim Item 14 Simulate the appearance and treatment of a conscious victim with an obstructed airway. To acquaint lifesavers with the appearance of a conscious victim with an obstructed airway and to introduce the appropriate lifesaving skills. Supervise candidates carefully during training in obstructed airway techniques. Caution rescuers to simulate treatment: misplaced or excessive thrusts can be dangerous. Conscious victim simulates either mild or severe airway obstruction. To signal the type of assistance needed, teach the universal choking signal. Rescuer assumes severe obstruction if victim nods yes when asked Are you choking? or if victim clutches neck or cannot speak or breath. See suggested learning activities, p. 84-5. Assessment of degree of obstruction ask: Are you choking? Selection of appropriate procedures Mild obstruction Coughing encouraged Reassurance for victim Severe obstruction Shout for help Careful landmarking Repeated abdominal thrusts (chest thrusts for pregnant or obese victim) until the airway is clear If successful, victim directed to see a physician to rule out complications from the obstruction or treatment 33 SWIM PATROL AWARD GUIDE

Star Patrol Obstructed airway unconscious victim Item 15 Simulate the treatment of an unconscious victim with an obstructed airway. To clear airway obstruction and restore normal breathing in an unconscious victim. Victim is classified as an adult. Send bystander to phone EMS. If alone, rescuer phones EMS right away. If practicing this skill item on a person (versus a manikin) rescuers simulate compressions to prevent injury. Victim simulates severe airway obstruction. Candidates should also practice a sequence that begins with a conscious victim who becomes unconscious. Rescuer begins with ABC assessment of unconscious victim. Use of barrier devices is recommended. See suggested learning activities, p. 85 Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System Attempt to recruit a CPR-qualified person for assistance Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise If unsuccessful, reposition airway and re-attempt to ventilate If unsuccessful, careful landmarking and 30 chest compressions Foreign body check: look in mouth and if object can be seen, attempt to remove it Attempt to ventilate: if successful, reassess responsiveness and breathing and treat appropriately If unsuccessful, repeat sequence (reposition head, re-attempt to ventilate, chest compressions, foreign body check) until successful. 54 SWIM PATROL AWARD GUIDE

Adult CPR Bronze Star Item 10 Demonstrate single rescuer adult cardiopulmonary resuscitation (CPR) on a manikin. To restore breathing and circulation in an unconscious, non-breathing and pulseless victim. Send bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AEDtrained responder are available, rescuer should send for them after activating EMS and assist the AED responder as directed. Rescuer opens airway using head-tilt/chin-lift technique. Rescue breaths: rescuer delivers normal breaths (each over 1 second) that make chest rise. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System Attempt to obtain AED and recruit AED-trained responder if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise Careful landmarking and chest compressions (30 compressions: 2 rescue breaths) CPR continued until EMS takes over treatment, or an AED-trained responder begins treatment with an AED, or the victim begins to move If victim begins to move, reassess ABCs and treat appropriately Compressions: push hard and fast allowing chest to recoil completely between compressions. Use of barrier devices is recommended. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. CLM Chapter 7.2 The ABC Priorities; 7.4 Rescue Breathing; 7.5 Cardiopulmonary Resuscitation 11 BRONZE MEDAL AWARDS

Bronze Medallion * One-rescuer CPR: adult & child Item 7 Demonstrate rescue breathing and cardiopulmonary resuscitation (CPR) on a manikin, including: Adult and child victims Complications in resuscitation (vomiting) Adaptations (mouth-to-nose, stoma) To support breathing and circulation in an unconscious, non-breathing, and pulseless victim. Send bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AEDtrained responder are available, rescuer should send for them after activating EMS and assist the AED responder as directed. Rescuer opens airway using head-tilt/chin-lift technique. Rescue breaths: rescuer delivers normal breaths (each over 1 second) that make chest rise. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System (EMS) Attempt to obtain AED and recruit AED-trained responder if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise Careful landmarking and chest compressions (30 compressions: 2 rescue breaths) CPR continued until EMS takes over treatment, or an AED-trained responder begins treatment with an AED, or the victim begins to move If victim begins to move, reassess ABCs and treat appropriately Compressions: push hard and fast allowing chest to recoil completely between compressions. Use of barrier devices is recommended. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. CLM Chapter 7.2 The ABC Priorities; 7.4 Rescue Breathing; 7.5 Cardiopulmonary Resuscitation 26 BRONZE MEDAL AWARDS

* Obstructed airway: conscious victim Bronze Medallion Item8a Simulate the treatment of: A conscious adult or child with an obstructed airway Complications a pregnant woman and a person who is obese To enable lifesavers to recognize a conscious victim with an obstructed airway and to perform the appropriate lifesaving techniques. Supervise candidates carefully during training in obstructed airway techniques. Caution rescuers to simulate treatment misplaced or excessive thrusts can be dangerous. Conscious victim simulates either mild or severe airway obstruction. To signal the type of assistance needed, teach the universal choking signal. Rescuer assumes severe obstruction if victim nods yes when asked Are you choking? or if victim clutches neck or victim cannot speak or breath. CLM Chapter 7.2 The ABC Priorities; 7.3 Coping with Complications during the ABCs; 8.3 Airway and Breathing Problems Assessment of degree of obstruction ask, Are you choking? Selection of appropriate procedures: Mild obstruction Coughing encouraged Reassurance for victim Severe obstruction Shout for help Careful landmarking Repeated abdominal thrusts (chest thrusts for pregnant or obese victim) until the airway is clear If successful, victim directed to see a physician to rule out complications from the obstruction or the abdominal thrusts 27 BRONZE MEDAL AWARDS

* Obstructed airway: unconscious victim Bronze Medallion Item8b Simulate the treatment of an unconscious adult or child with an obstructed airway. To clear an airway obstruction and restore normal breathing in an unconscious victim. Send bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AEDtrained responder are available, rescuer should send for them after activating EMS and assist the AED responder as directed. If practicing this skill item on a person (versus a manikin) rescuers simulate compressions to prevent injury. Victim simulates severe airway obstruction. Candidates should also practice a sequence that begins with a conscious victim who becomes unconscious. Rescuer begins with ABC assessment of unconscious victim. Use of barrier devices is recommended. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical Services (EMS) Attempt to obtain AED and recruit AED-trained responder if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise If unsuccessful, reposition airway and re-attempt to ventilate If unsuccessful, careful landmarking and 30 chest compressions Foreign body check: look in mouth and if object can be seen, attempt to remove it Attempt to ventilate: if successful continue CPR sequence If unsuccessful, repeat sequence (reposition head, re-attempt to ventilate, chest compressions, foreign body check) until successful CLM Chapter 7.2 The ABC Priorities; 7.3 Coping with Complications during the ABCs; 8.3 Airway and Breathing Problems 28 BRONZE MEDAL AWARDS

Bronze Cross * First aid assessment Item 4 Demonstrate primary assessment of a conscious victim and an unconscious victim, including: Level of consciousness Airway Breathing Circulation Major bleeding Mechanism of injury Demonstrate secondary assessment of a victim including: Vital signs Head-to-toe survey History This item is designed to emphasize the principles and procedures of victim assessment. Candidates assess both conscious and unconscious victims. Candidates are not expected to demonstrate treatment of injuries. Scene survey includes mechanism of injury and assessing risk of spinal injury. CLM Chapter 6.2 6.6 : The Rescue Process; 7.2 The ABC Priorities To demonstrate proficiency in assessing an injured victim. Evaluation of the rescue scene Removal of or from danger with assistance as required Appropriate communication with victim Appropriate assessment technique for the victim type conscious versus unconscious Care taken in moving victim with assistance as required especially if further injuries suspected (for example, spinal injury) Primary assessment Level of consciousness Determine mechanism of injury Assessment of airway, breathing, circulation (bleeding, and shock) Check for major bleeding Secondary assessment Relevant history (accident, medical, personal) Taking and recording vital signs (level of consciousness, respiration, pulse, pupils, skin colour and temperature) Systematic head-to-toe examination Airway maintained 43 BRONZE MEDAL AWARDS

* One-rescuer CPR Bronze Cross Item 5 Demonstrate rescue breathing and cardiopulmonary resuscitation (CPR) on a manikin, including: Adult, child, and infant victims Complications in resuscitation (vomiting) Adaptations (mouth-to-nose, stoma) To support breathing and circulation in an unconscious, non-breathing, and pulseless victim. Send bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AEDtrained responder are available, rescuer should send for them after activating EMS and assist the AED responder as directed. Rescuer opens airway using head-tilt/chin-lift technique. Rescue breaths: rescuer delivers normal breaths (each over 1 second) that make chest rise. Compressions: push hard and fast allowing chest to recoil completely between compressions. Use of barrier devices is recommended. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System (EMS) Attempt to obtain AED and recruit AED-trained responder if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise Careful landmarking and chest compressions (30 compressions: 2 rescue breaths) CPR continued until EMS takes over treatment, or an AED-trained responder begins treatment with an AED, or the victim begins to move If victim begins to move, reassess ABCs and treat appropriately CLM Chapter 7.2 The ABC Priorities; 7.4 Rescue Breathing; 7.5 Cardiopulmonary Resuscitation 44 BRONZE MEDAL AWARDS

* Two-rescuer CPR Bronze Cross Item 6 Demonstrate two-rescuer adult, child, and infant cardiopulmonary resuscitation (CPR) on a manikin. To support breathing and circulation in an unconscious, non-breathing, and pulseless victim. Two-rescuer CPR: both rescuers are trained. Two options: rescuers take turns doing one-rescuer CPR, or one rescuer performs chest compressions while the other does rescue breathing. Rescuers switch roles approsimately every 2 minutes (5 cycles of 30:2) to minimize fatigue. Rescuers communicate and cooperate in decision-making and CPR performance. Use of barrier devices is recommended. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. Rescuer #1 Performs one-rescuer CPR sequence Rescuer #2 Identifies self as CPR trained and confirms EMS activation Both rescuers Continue CPR and switch roles with as little interruption as possible Continue CPR until EMS takes over, or an AED-trained responder begins treatment with an AED unit, or the victim begins to move If the victim begins to move, reassess ABCs and treat appropriately CLM Chapter 7.2 The ABC Priorities; 7.4 Rescue Breathing; 7.5 Cardiopulmonary Resuscitation 45 BRONZE MEDAL AWARDS

* Obstructed airway: conscious adult or child Bronze Cross Item7a Simulate the treatment of: A conscious adult or child with an obstructed airway Complications a pregnant woman and a person who is obese To enable lifesavers to recognize a conscious victim with an obstructed airway and to perform appropriate lifesaving techniques. Supervise candidates carefully during training in obstructed airway techniques. Caution rescuers to simulate abdominal or chest thrusts. Misplaced or excessive thrusts can be dangerous. Conscious victim simulates either mild or severe airway obstruction. To signal the type of assistance needed, teach the universal choking signal. Rescuer assumes severe obstruction if victim nods yes when asked Are you choking? or if victim clutches neck or victim cannot speak or breath. CLM Chapter 7.2 The ABC Priorities; 7.3 Coping with Complications during the ABCs; 8.3 Airway and Breathing Problems Assessment of degree of obstruction ask, Are you choking? Selection of appropriate procedures: Mild obstruction Coughing encouraged Reassurance for victim Severe obstruction Shout for help Careful landmarking Repeated abdominal thrusts (chest thrusts for pregnant or obese victim) until the airway is clear If successful, victim directed to see a physician to rule out complications from the obstruction or the abdominal thrusts 46 BRONZE MEDAL AWARDS

* Obstructed airway: conscious infant Bronze Cross Item7b On a manikin, demonstrate the treatment of a conscious infant with an obstructed airway. To enable lifesavers to recognize a conscious infant with an obstructed airway and to perform appropriate lifesaving techniques. Rescuer assumes severe obstruction if victim cannot cough or make any sound. Use a manikin for safe teaching and practice. CLM Chapter 7.2 The ABC Priorities; 7.3 Coping with Complications during the ABCs; 8.3 Airway and Breathing Problems Assessment of degree of obstruction Selection of appropriate procedures: Mild obstruction Coughing encouraged Reassurance for victim Severe obstruction Shout for help 5 back blows and 5 chest thrusts Repeat back blows and chest thrusts until object is expelled or infant becomes unresponsive If successful, caregiver directed to take victim to see physician to rule out complications from the obstruction or treatment 47 BRONZE MEDAL AWARDS

* Obstructed airway: unconscious victim Bronze Cross Item7c Simulate the treatment of an unwitnessed unconscious adult, child, or infant with an obstructed airway. To clear airway obstruction and restore normal breathing to an unconscious victim. Send bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AEDtrained responder are available, rescuer should send for them after activating EMS and assist the AED responder as directed. If practicing this skill item on a person (versus a manikin) rescuers simulate compressions to prevent injury. Victim simulates severe airway obstruction. Candidates should also practice a sequence that begins with a conscious victim who becomes unconscious. Rescuer begins with ABC assessment of unconscious victim. Use of barrier devices is recommended. See Canadian Lifesaving Manual, Appendix B for guidelines on rescue breathing practice. Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System (EMS) Attempt to obtain AED and recruit AED-trained responder if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise If unsuccessful, reposition airway and re-attempt to ventilate If unsuccessful, careful landmarking and 30 chest compressions Foreign body check: look in mouth and if object can be seen, attempt to remove it Attempt to ventilate: if successful continue CPR sequence If unsuccessful, repeat sequence (reposition head, re-attempt to ventilate, chest compressions, foreign body check) until successful CLM Chapter 7.2 The ABC Priorities; 7.3 Coping with Complications during the ABCs; 8.3 Airway and Breathing Problems 48 BRONZE MEDAL AWARDS

Spinal injury management Bronze Cross Recognition & Rescue Item10 Recover and immobilize a face-down breathing victim with a cervical spinal injury found in deep water. Transport to shallow water. Recruit and direct a trained bystander to assist. Demonstrate the ability to manage vomiting while maintaining immobilization. To demonstrate the treatment of a breathing victim with a suspected spinal injury. This is a skill demonstration, not a rescue. Bystander is trained to the Bronze Cross level. Recognition is based on an understanding of mechanism of injury. The distance of the carry from deep to shallow water should be short (e.g., 5 m). Use of a spineboard is not recommended and must not be evaluated. CLM Chapter 5.10 Rescue Procedures for Spinal Injuries; 7.2 The ABC Priorities; 9.3 Swimming Skills Quick, accurate recognition and appropriate entry Immobilization of head and neck Smooth turnover Effective carry Victim assessment ABCs Movement of victim minimized throughout Effective direction of bystander Activate Emergency Medical System (EMS) Ability to clear the airway while maintaining immobilization 51 BRONZE MEDAL AWARDS

* Management of submerged non-breathing victim Demonstrate effective management of a submerged non-breathing victim. National Lifeguard Core Item 3b To demonstrate effective individual skills in the management of a submerged non-breathing victim. Emphasis is on the candidate s individual skill ability rather than a team response. Item is performed without an aid. Deep-water rescue breathing should not be performed unless all complications can be dealt with adequately. Victim condition may include any combination of: Airway obstruction Vomiting Canadian Lifesaving Manual, Chapter 4 The Rescue of Others; Chapter 7 Lifesaving Priorities: The ABCs: Rescue breathing Quick entry and descent Rapid ascent Secure hold on victim during ascent Protection of airway during ascent and thereafter Quickest route to point where CPR may be effectively initiated and complications dealt with (side of pool, shallow water, rescue craft) Victim assessment (ABCs) and effective CPR (See Appendix A for s) Ability to deal with complications (vomiting, obstructed airway) at any point in performance Safe and effective removal with lifeguard or bystander assistance EMS activated at earliest possible moment Effective use of barrier devices where appropriate Appropriate and effective direction of bystanders when applicable 6 NATIONAL LIFEGUARD AWARD GUIDE

* National Lifeguard Core Management of spinal-injured victim Item 3c Demonstrate effective management of a victim with a suspected spinal injury. Emphasis is on the candidate s individual skill and ability rather than a team response. The skill is demonstrated with other lifeguards as back-up. Design the evaluation activity to permit each candidate to demonstrate all s. Instructors must take care to ensure that evaluation results relate directly to a candidate s skill and not a team performance. Instructors should NOT evaluate scenarios with only one trained responder. Types of spinal injuries include cervical and lumbar. Victims are located in deep or shallow water, on land, or walking. Deep-water victims are removed from shallow water where possible. Victim condition might include any combination of: Breathing Non-breathing Airway obstruction Vomiting To demonstrate effective individual skills in the management of a breathing or non-breathing victim with a spinal injury. Quick, accurate recognition and appropriate entry Smooth rollover performed if necessary Immobilization of the spine during rollover and throughout (to extent possible) Victim assessment: level of consciousness and ABCs Effective CPR if required EMS activated at earliest possible moment Ability to deal with complications (vomiting, obstructed airway) Effective use of barrier devices where appropriate Stabilization with spineboard or other appropriate device (in-water victim only) Preparation for transportation and removal (in-water victim only) Safe removal from water where possible (in-water victim only) Secondary assessment where feasible Appropriate and effective direction of bystanders when applicable Aim for prompt removal and preparation for transport. Alert Lifeguarding in Action, Chapter 3 Aquatic Emergencies: Recognition and Intervention; Chapter 4 Lifeguarding Skills and Procedures: Management of spinal injuries Canadian Lifesaving Manual, Chapter 5 Specialized Lifesaving Skills: Rescue procedures for spinal injuries 7 NATIONAL LIFEGUARD AWARD GUIDE

* Entries and removals National Lifeguard Waterpark Option Item 6 Demonstrate entries and removals appropriate to wave pools, slides, catch basins, and other waterpark apparatus. To use an appropriate entry for the situation and to safely remove a victim from further danger. Encourage candidates to wear anti-skid shoes for maximum grip in the event that they must descend a flume. Be aware of potential danger due to wall height and the effects of waves and moving water. Advise candidates to avoid entering a wave pool or catch basin with anything that could be tightened around their neck, especially a whistle on a lanyard. Demonstrate an effective beach entry for a wave pool. Unassisted removals are not a requirement of this item. A single lifeguard may recruit bystanders for assistance. Appropriate, safe, and efficient entries Maintenance of ABCs Care of victim, especially the head Choice of removal appropriate for the condition of the victim Recruitment of other lifeguards or bystanders if necessary Effective communication with victim and assistants Safe lifting techniques for rescuer Effective removal Alert: Lifeguarding in Action, Chapter 4 Lifeguarding Skills and Procedures; Chapter 13 Waterpark Operation and Safety Canadian Lifesaving Manual, Chapter 4 The Rescue of Others 27 NATIONAL LIFEGUARD AWARD GUIDE

* Spinal injury National Lifeguard Waterpark Option Item 8 As a member of a team, perform a rescue of a victim with a suspected spinal injury who is located in a catch basin, wave pool, channel, stairs, or who has fallen from a height. To recover and immobilize a spinal-injured victim in a difficult location. In this rescue item, candidates respond as part of a team (which may vary in number). Nevertheless, the individual s performance is evaluated, not the performance of the team as a group. Use a manikin to practice recovery of a victim in a flume. Alternate the condition of the victim: conscious or unconscious, breathing or non-breathing, etc. Aim for prompt removal from water and preparation for transport. A run-out channel may be at the bottom of a high-speed slide or flume. Alert Lifeguarding in Action, Chapter 3 Aquatic Emergencies: Recognition and Intervention; Chapter 4 Lifeguarding Skills and Procedures: Management of spinal injuries Quick, accurate recognition and appropriate entry Smooth rollover performed if necessary Immobilization of the spine during rollover and throughout (to extent possible) Victim assessment: level of consciousness and ABCs Effective CPR if required EMS activated at earliest possible moment Ability to deal with complications (vomiting, obstructed airway) Effective use of barrier devices where appropriate Stabilization with spineboard or other appropriate device (in-water victim only) Preparation for transportation and removal (in-water victim only) Safe removal from water where possible (in-water victim only) Secondary assessment where feasible Appropriate and effective direction of bystanders when applicable Treatment for shock Canadian Lifesaving Manual, Chapter 5 Specialized Lifesaving Skills: Rescue procedures for spinal injuries 29 NATIONAL LIFEGUARD AWARD GUIDE

(Appendix A) Resuscitation & first aid evaluation criteria Send bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AED-trained responders are available, rescuer should send for them after activating EMS and assist the AED responder as directed. Rescuer opens airway using head-tilt/chin-lift technique. Rescue breaths: rescuer delivers normal breaths (each over 1 second) that make chest rise. Compressions: push hard and fast allowing chest to recoil completely between compressions. Two-rescuer CPR.Two options: rescuers take turns doing one-rescuer CPR, or one rescuer performs chest compressions while the other does rescue breathing. Rescuers switch roles approximately every 2 minutes (5 cycles of 30:2) to minimize fatigue. Rescuers communicate and cooperate in decision-making and CPR performance. Use of barrier devices is recommended. Canadian Lifesaving Manual, Chapters 6, 7 and 8 contain resuscitation and first aid technical information Cardiopulmonary resuscitation (CPR) One rescuer Assessment of environment for hazards Establish unresponsiveness EMS activated at earliest possible moment Attempt to obtain AED and recruit AED-trained personnel if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise Careful landmarking and chest compressions (30 compressions: 2 rescue breaths) CPR continued until EMS takes over treatment, or an AED-trained responder begins treatment with an AED, or the victim begins to move If victim begins to move, reassess ABCs and treat appropriately Two rescuers Rescuer #1 Performs one-rescuer CPR sequence Rescuer #2 Identifies self as CPR trained and confirms EMS activation Both rescuers Continue CPR and switch roles with as little interruption as possible Continue CPR until EMS takes over, or an AED-trained responder begins treatment with an AED unit, or the victim begins to move If the victim begins to move, reassess ABCs and treat appropriately 53 NATIONAL LIFEGUARD AWARD GUIDE

Resuscitation & first aid evaluation criteria National Lifeguard Appendix A Conscious victim Conscious victim simulates either mild or severe airway obstruction. To signal the type of assistance needed, teach the universal choking signal. Rescuer assumes severe obstruction if victim nods yes when asked Are you choking? or if victim clutches neck or cannot speak or breath. Unconscious victim Send back-up / bystander to phone EMS. If alone with an adult victim, rescuer phones EMS right away. If alone with a child or infant victim, rescuer phones EMS after about 5 cycles of 30:2 compressions to breaths. If an Automated External Defibrillator (AED) and AED-trained responders are available, rescuer should send for them after activating EMS and assist the AED responder as directed. If practicing this skill item on a person (versus a manikin) rescuers simulate compressions to prevent injury. Victim simulates severe airway obstruction. Candidates should also practice a sequence that begins with a conscious victim who becomes unconscious. Rescuer begins with ABC assessment of unconscious victim. Use of barrier devices is recommended. Canadian Lifesaving Manual, Chapters 6, 7 and 8 contain resuscitation and first aid technical information Airway obstruction Conscious adult or child Assessment of degree of obstruction ask, Are you choking? Selection of appropriate procedures Mild obstruction Coughing encouraged Reassurance for victim Severe obstruction Shout for help Careful landmarking Repeated abdominal thrusts (chest thrusts for pregnant or obese victim) until the airway is clear If successful, direct victim to see a physician to rule out complications from the obstruction or the abdominal thrusts Conscious infant Assessment of degree of obstruction Selection of appropriate procedures Mild obstruction Coughing encouraged Reassurance for victim Severe obstruction Shout for help 5 back blows and 5 chest thrusts Repeat back blows and chest thrusts until object is expelled or infant becomes unresponsive If successful, direct caregiver to take victim to see a physician to rule out complications from the obstruction or treatment Unconscious victim Assessment of environment for hazards Establish unresponsiveness Activate Emergency Medical System Attempt to obtain AED and recruit AED-trained personnel if available Open airway Check for breathing: look, listen, feel (no more than 10 sec.) If breathing is absent, 2 rescue breaths: observe chest rise If unsuccessful, reposition airway and re-attempt to ventilate If unsuccessful, careful landmarking and 30 chest compressions Foreign body check: look in mouth and if object can be seen, attempt to remove it Attempt to ventilate: if successful continue CPR sequence If unsuccessful, repeat sequence (reposition head, re-attempt to ventilate, chest compressions, foreign body check) until successful 54 NATIONAL LIFEGUARD AWARD GUIDE

Resuscitation & first aid evaluation criteria National Lifeguard Appendix A Respiratory distress Respiratory distress Asthma Candidate should determine history. Candidate demonstrates an understanding of the recognition and assessment of asthmatic condition. Candidate demonstrates an awareness of relaxed breathing as a form of treatment (for example, using diaphragm inhale through nose, hold, exhale through mouth, and repeat). Anaphylaxis Candidates must ensure that victim self-administers medication according to prescription or the manufacturer s directions in the case of an EpiPen. Only the victim s EpiPen is used. Do NOT administer another person s EpiPen. CAUTION: The black tip on the EpiPen is an auto-injector and very sensitive. Canadian Lifesaving Manual, Chapters 6, 7 and 8 contain resuscitation and first aid technical information Respiratory distress Determination of cause of distress and removal if possible Victim and scene assessment EMS activated if necessary Victim placed in semi-sitting or most comfortable position Victim reassured Airway and respiration maintained Appropriate use of barrier devices Anaphylaxis Victim assisted with administration of medication (EpiPen ) if available Asthma Victim assisted with medication (inhaler) Hyperventilation Encouragement of pursed lip breathing 55 NATIONAL LIFEGUARD AWARD GUIDE

Resuscitation & first aid evaluation criteria National Lifeguard Appendix A Burns; Facial injury; Suspected head injury; Seizure Burns Type of burns might include: First, second, or third degree burns Sunburn Chemical (dry or wet corrosive chemical) Electrical burns Stress the importance of barrier devices when dusting off dry chemicals. Flush chemical burns for 15 20 min. Facial injury Injuries might include: Foreign body in the ear or nose Laceration or contusion of eyes Chemical splashes in eyes Puncture or abrasion of eyes Burns to eyes Bleeding and fluid from ear Broken tooth, loose or displacement of tooth, laceration to mouth Nose bleed or broken nose Suspected head injury Suspected head injury refers to an internal injury, not a superficial cut/injury. Full documentation report of vital sign checks and any related change. Candidates should be able to explain reason for documentation. Seizure Candidate should demonstrate knowledge of different types of seizures and appearance of each (e.g., tonic/clonic; absence). Candidate should demonstrate understanding of the various stimuli that may cause a seizure (e.g., lack of sleep, medication, or light, drugs or alcohol abuse, high temperature, head injury, or diabetes). Candidate should recognize that there may be other injuries as a result of seizure (e.g., hitting objects). Burns Victim and scene assessment EMS activated if necessary Victim removed from source of injury Determination of burn severity Immediate immersion in cool water if available at the time of injury and if the injury is a localized burn Burn covered with dry sterile dressing Appropriate use of barrier devices Wet chemical burns Flush with lots of water Dry chemical burns Dust before flushing with water Electrical burns Check for entry and exit burns Facial injury Victim and scene assessment EMS activated if necessary Determination of cause of injury and removal from the cause if possible Selected treatment appropriate for the injury Appropriate use of barrier devices Suspected head injury Victim and scene assessment EMS activated if necessary Immobilization/bandaging if situation requires (i.e., if no bleeding or discharge, no bandage required) Vital signs monitored including level of consciousness Appropriate use of barrier devices Seizure Victim and scene assessment EMS activated if necessary Recognition of seizure Protection of head Rescuer does not restrain or immobilize victim or put anything into the victim s mouth Removal of dangers to victim Victim placed in recovery position after seizure has stopped Appropriate use of barrier devices Canadian Lifesaving Manual, Chapters 6, 7 and 8 contain resuscitation and first aid technical information 58 NATIONAL LIFEGUARD AWARD GUIDE