In-service training is precious time. Trainers face multiple challenges in providing quality in-service including: many topics to cover, limited time and pool space, and the lifeguard/victim factor.
What is the lifeguard/victim factor? It is the ability of the lifeguard to perceive their co-worker as the “victim” and for the co-worker to depict a “true” version of a victim. Both lifeguard and victim must take their roles seriously for the in-
service to be effective. Many lifeguards struggle transitioning their rescue skills from a manikin to a live person. Skills that were once easy on a manikin become very difficult with a real person: pulse check on a carotid or brachial artery; the victim has to actually take breaths; dealing with the victim’s body that has arms, legs, and substantial weight; and the weight distribution of victims varies depending on the size and shape of the victim. Lifeguards must be able to maintain an open airway on a real victim with a proper fit of a resuscitation mask that doesn’t put too much pressure on the bridge of the nose or press on the eyeballs. Rescuers need to check with the victim to determine if they are claustrophobic before sealing a mask on them. Lifeguards also need to get comfortable being in the personal space of the victim and conduct a proper “look, listen and feel.”
In the water, lifeguards should monitor their own personal safety when it comes to active and passive rescues. When the lifeguard is doing a front approach for an active victim, they should be cognizant not to enter the victim's “danger zone” — the area in front of the victim where, if the lifeguard gets too close, the victim will be able to grab the lifeguard.
“Muscling through a rescue” or “rough handling” is another common mistake made by lifeguards. Forcing the victim into the proper position during a rescue or care can work sometimes, but may injure the victim or rescuer.
On the opposite end of the spectrum, lifeguards can be so gentle that they fail to rescue with any sense of urgency. This gentleness often comes across as hesitation, and also opens the rescuer up for potential risk of personal injury. This type of hesitation confuses secondary rescuers in how to support the primary rescuer during patient care.
Additionally, lifeguards should be comfortable doing any of the rescue and first aid skills on either a male or female victim.
Portraying the behavior of a realistic victim is critical for lifeguards to learn proper rescue and first aid skill. Unrealistic behavior skews the perception of what lifeguards will encounter during an emergency. Most lifeguards who also play the role of the victim fail to understand that most active victims will relax and comply with the rescuer's instructions once they are provided flotation. Victims usually don’t fight the rescuers.
When portraying a passive victim, keep in mind that passive doesn't necessarily mean unconscious. Passive victims don’t always have floppy arms and legs; they can have neck strength to keep the head from resting in the water once the rescue has been made. For training, passive victims can be categorized as either passive conscious or passive unconscious. Passive conscious portrays a victim who is too exhausted or incapacitated. In other words, this victim is just too weak to help themselves to safety. Passive unconscious is an unresponsive victim in the water.
Additional good victim traits:
- Holds their breath to maintain the appearance of a face-down victim
- Stays submerged to maintain the appearance of a submerged victim
- Is able to lie on the bottom of the pool and stay there
- Floats or sinks face down, never stands with face down
- Complies after being rescued
- Maintains a limp body during extrication if an unconscious victim
- Never readjusts their body into the correct position for a rescue or for patient care
Carotid Pulse Drill
Have rescuers pair up and face each other. Both rescuers should do a carotid pulse check. Once the carotid pulse is located, mark the site with a marker pen. Then locate the carotid pulse on the opposing side and mark it. Have one rescuer become the victim and perform a primary assessment on an unconscious victim. Objective: Locate carotid pulse as quickly as possible. Timing goal: 3-5 seconds to complete the objective. This drill helps develop an accurate carotid pulse palpation for the rescuer that the trainer can see.
Variations (no time change)
- Have the rescuer perform a primary assessment and locate the pulse blindfolded
- Remove the pen mark, then perform the drill and locate the pulse
- Primary assessment with a pulse — check from a lateral or cephalic position
This drill focuses specifically on separating the rescuer from their equipment and moving away safely in case the rescuer and the victim become entangled in the rescue tube cord or the victim grabs the rescue tube rope or strap. Personal safety is always the priority. Prior to the drill, establish a safety word and a safety tap/pinch in case the rescuer or victim are unable to escape the entanglement. Start in shallow water, and once your rescuers become proficient, move to mid-depth, and then deep water. Objective: Safely separate from the rescue tube and swim underwater to a safe distance. Timing goal: Once entanglement occurs, escape under 5 seconds, and swim to a safe distance within 5 seconds.
Variations (no time change)
- Victim grabs the rescue strap on the front of the rescuer
- Victim grabs the rescue strap on the back of the rescuer
- Victim grabs the rescue tube rope and pulls rescuer in close, then tries to grab the rescuer. Rescuer performs a disentanglement and possibly an escape
In-service training requires lifeguards to be good rescuers as well as good victims. When both roles are performed correctly, in-service training improves tenfold. Good luck, and keep training.