CPR is a complex skill that requires constant training to be performed well under stress. Mastering breathing and compressions is only one aspect. Lifeguards need to be able to perform CPR without hesitation, effectively use gloves, a resuscitation mask and an AED. There is also a good chance that a bag valve mask (BVM) will be incorporated, along with emergency oxygen. Depending on the level of training the lifeguards have, suctioning and the use of airway adjuncts such as an oral airway (OPA) or nasal airway (NPA) also may be used for airway management. Staffing levels will affect the execution of the response; responding personnel may range from a single lifeguard to a team. Most facilities operate with multiple lifeguards. With this in mind, the following drills will be broken into two-, three- and four-rescuer responses.

TWO-RESCUER CPR PROGRESSION DRILL Both rescuers should be equipped with gloves and resuscitation masks within their fanny packs. Rescuer placement around the victim’s body should be limited to the head (cephalic) and the side (lateral). All drills will be considered a response to a dry victim unless stated.

Objective: Complete the following skills:

> Lifeguards are gloved up

> EMS is activated

> Primary assessment completed

> CPR in progress

Timing goal: 30 seconds.

Once the lifeguard team has accomplished the objective within the timing goal, incorporate the progression steps listed below and adjust the timing goal.

> Secondary lifeguard has a five-second delay in arriving on scene (no time change)

> Secondary lifeguard has a 10-second delay in arriving on scene (no time change)

> BVM is at the scene; needs to be assembled and used after first round of CPR, two breaths (add 15 seconds)

> BVM is brought by secondary lifeguard, who has a five-second delay (add 15 seconds)

> BVM is brought by secondary lifeguard, who has a 10-second delay (add 15 seconds)

> Victim is wearing a shirt, which needs to be removed or cut off (no time change)

> AED is brought by secondary lifeguard, used on victim with AED analyzing (60 seconds to complete drill). Once this variation is accomplished, reduce the time by 10 seconds.

> AED water variation: Same drill variation, but state that the victim is removed from water and the chest must be dried prior to AED attachment (add 10 more seconds for drying)

THREE-RESCUER CPR POSITION DRILL

Lifeguards will move into position around a manikin to provide care; avoid clustering.

Objective: Quickly move into proper positions to provide care. Bring the appropriate equipment. Have the lifeguards start 10 feet from the victim.

> CPR with BVM use

> CPR and AED

> CPR and AED with BVM use

Timing goal: Five seconds to complete the objective of getting into proper positions.

Once proficient, move to the variations.

Variations of Three-Rescuer CPR Position Drill

> Remove one lifeguard after the lifeguard team has positioned itself. The two lifeguards remaining need to adapt and provide patient care (add five seconds)

> Add one lifeguard after the team has positioned itself. The team must incorporate the additional lifeguard into the patient care plan, or decide to utilize him/her for a secondary assignment (add five seconds)

> Transition one lifeguard in and one lifeguard out, testing the team’s ability to continue providing uninterrupted patient care (add five seconds)

THREE-RESCUER CPR PROGRESSION DRILL

Rescuers should have gloves and resuscitation masks in their fanny packs. Rescuer placement around the victim’s body should be limited to the head (cephalic) and the side (lateral). All drills will be considered responses to a dry victim unless stated.

Objective: Complete the following skills:

> All skills from Two-Rescuer CPR Progression Drill

> BVM is assembled and ready to use

Timing goal: 30 seconds.

Once the lifeguard team has accomplished the objective within the timing goal, incorporate the progression steps listed below and adjust the timing goal.

> Use all progression steps listed for the Two-Rescuer CPR Progression Drill

> BVM has emergency oxygen attached and flowing (add 15 seconds); emergency oxygen will be brought in by secondary lifeguards

> Primary and secondary lifeguards are stationed at two separate lifeguard towers, tertiary lifeguard is on break, AED/BVM equipment is at in-service storage location. Primary lifeguard initiates victim contact. Drill ends when AED is analyzing victim, and lifeguards are administering proper care (60 seconds to complete drill). Once this variation is accomplished, reduce the time by 10 seconds, then reduce by five to 10 seconds more.

> Same variation above, except secondary lifeguard makes initial contact with the victim (60 seconds to complete drill), then reduce time.

FOUR-RESCUER CPR PROGRESSION DRILL

Rescuers should have gloves and resuscitation masks in their fanny packs. Rescuer placement around the victim’s body should be limited to the head (cephalic) and the side (lateral). All drills will be considered responses to a dry victim unless stated.

Objective: Complete the following skills:

> All skills from Three-Rescuer Response Progression Drill

> AED pads in place and AED is analyzing

Timing goal: 60 seconds.

Once the lifeguard team has accomplished the objective within the timing goal, incorporate the progression steps listed below and adjust the timing goal.

> Reduce timing goal from 60 to 50, then to 45, then to 40 seconds

> Emergency oxygen is attached and flowing to BVM (add 10 seconds), then repeat with no additional time

> If a lifeguard is trained to use, OPA is inserted (no time change)

> Change out one rescuer for another rescuer (add 10 seconds), then repeat with no additional time

The beginning of any critical incident is chaotic and stressful. A rapid response with quick, effective care demonstrates a lifeguard team that has developed an unconscious competence with its skills. Train on.