In April 2013, I wrote about extrication and the need to dedicate separate in-service trainings on just this skill. The common problem, which continues, is that extrication was only practiced during spinal emergency training, making extrication slow, methodical, and complex. I offered some drills that could speed up getting the victim out of the water, and synchronize the rescue team.
Extrication, as a lifeguarding skill, often is overlooked and infrequently practiced. However, it is the vital link between rescue and patient care. Some trainers have a tendency to be rigid and inflexible when instructing this skill due to the adherence of perceived strict guidelines for spinal immobilization. But extrication and spinal immobilization are two different skills that occasionally are required to be performed at the same critical incident. However, that is not always the case: Extrication of a non-spinal victim happens all the time. Let’s review:
- If the victim is conscious and has no difficulty breathing or other critical condition, the rescuer has time to bring the victim to the side of the pool and get them onto the deck
- If the victim is conscious and has no difficulty breathing, but has the potential of a spinal injury, the rescuer has time to upgrade the Emergency Action Plan, requesting a backboard and additional rescuers to assist in the spinal immobilization in water and extrication onto land
- However, if the victim is unconscious or has some other critical condition (chest pain, diabetic issue, or altered level of consciousness) rapid extrication is needed.
The rescuer mantra for rapid extrication of an unconscious or critical victim: Be Safe, Be Fast. “Be Safe,” means do no harm to the victim or the rescuers throughout the extrication/rescue process. “Be Fast” means move and extricate quickly as possible while being safe.
When dealing with an unconscious and non-spinal victim, there are multiple ways to extricate with or without a backboard. The article assumes an unconscious victim because critical patients are similar in that they often cannot assist in their rescue.
Before training on extrication, rescuers should show solid skills when rescuing submerged victims and victims on the surface. This should include transitioning a victim from a vertical to a horizontal position on the surface with the victim face-up and their head pointed toward the side of the pool. If the rescuer uses a rescue tube, it is imperative that he or she can place the victim onto the rescue tube into a self-supported position that allows the victim’s airway to fall into an open position. This allows the rescuer to provide a more effective one-arm tow or to be hands-free and to reach for and make ready a pocket mask.
In-service trainers should teach staff to know what possible skills can be performed immediately after the rescue and just before extrication. Those skills could include requesting additional equipment and personnel to assist, performing a primary assessment, and providing in-water ventilations.
During the in-service, the trainer should focus on the speed of the rescue and the extrication, good understanding between everyone’s role in the extrication, and your rescuer’s ability to foresee and adapt to environmental changes or shifts in the victim’s status. It’s often helpful to have someone specifically available to extradite the process by supporting the extrication of the victim onto the deck and assist with patient care.
Good rescues are fast and can progress from rescue to extrication without losing much momentum. These rescuers take advantage of the speed that is generated from the entry to propel them to the victim, the power they can get from pushing off the bottom to get the victim to the surface, and swimming a submerged victim up at an angle as they approach the surface so the distance to the side of pool is reduced and forward motion is uninterrupted.
Rescuers and support staff need to understand their individual assignments within the extrication of the victim and to remember that the overall objective is to provide the best and quickest care possible. Assignments could include rescuers sharing the responsibility of making the rescue and the extrication of the victim, or it could mean that each rescuer only does one component of the rescue and extrication to keep the fluidity and speed constant. Rescuers could even transition to an assisting role, depending on the availability of staff.
Adaptability comes after the rescue team has demonstrated proficiency in extricating a victim. The team should be tested on what to do if the rescue equipment fails or is simply not available. Rescuers should train on what to do with or without rescue tubes; how to give appropriate victim support during the extrication and at the side of the pool if there is delay in getting them onto the deck; or how to deal with extremely large victims. Practice in-water ventilations if there is delay in extrication, or if the victim’s status is unconscious and not breathing.
The rescue team must demonstrate excellent communication skills. If there is a need for additional help in any part of the rescue — extrication or patient care — it needs to be voiced immediately.
Here are some variations — and sub-variations — to practice:
Extrication with a backboard
• One rescuer and one trained staff. Using the YMCA Speed Board, attempt exit in deep water. You can try this two ways: starting from the water, and starting from the deck.
• One or two rescuers and two trained staff. Perform both shallow and deep-water rescues.
• Two person removal with a backboard, without a rescue tube (an American Red Cross drill)
Extrication without a backboard
Direct lift child or adult in shallow water.
• One rescuer and one trained staff.
• One rescuer and two trained staff.
With the list of extrication variations, the team will realize that no two rescues are alike. The goal of the rescue team is to be proficient in skills, unafraid to communicate when things don’t go as planned and to fluidly work together to meet the objective: rescuing the victim.
Good luck, and keep training.