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    PHOTO COURTESY JEFF ELLIS and ASSOCIATES

Nothing will be more “real” to a lifeguard than a drowning incident. The look, the feel and the potential for panic are always at the forefront of the mind of anyone who has experienced a drowning.

While it is impossible to accurately re-create every nuance of an aquatic incident, it is vital that the first time a lifeguard is exposed to the realism of an event not be during an actual incident.

For a realistic simulation of an aquatic event, it's important to begin with the person playing the guest in distress. It may seem second nature for someone to “pretend to drown,” but it can be more complex if realism is the goal.

You must ensure that the individual serving as the guest in distress knows how to emulate a conscious or unconscious individual in the water.

Spend time reviewing signs and symptoms of both with those who will be called upon to play these roles. For example, how should an individual relax when “unconscious”? Does this person tend to help the responding lifeguard with tube placement, tensing and relaxing at key moments? Beyond this, you want to ensure variability in the size of the selected guest in distress in relation to the size of the lifeguard. Instructors do their guards a disservice making in-water rescues too easy or ideal.

Putting together all facets of the facility’s emergency action plan (EAP) into a complete start-to-finish scenario will be the next critical element in a realistic simulation. This means starting with a lifeguard recognizing a guest in distress within a particular zone area and finishing with responding EMS taking over several minutes later. To help with this timing, determine the likely response time of local EMS and use that as a starting point for practice. For example, if it typically takes 12 minutes for EMS to arrive at your facility, consider timing your scenarios to last 15 minutes to ensure lifeguards are ready to commit to that length of care.

Instructors should avoid placement of equipment on the pool edge, making it “ready to go” as soon as the guest in distress is removed from the water, or pre-assigning specific roles. Establish who will portray the guest and the initial responder and then put any other responding lifeguards and support staffers in likely locations in the facility. Perhaps someone is on break and another is helping a guest on the far end of the facility. Equipment should always be positioned where it is typically stored, requiring the appropriate person in the EAP to retrieve it.

Scenarios should include with more frequency those symptoms and conditions that a guest in distress involved in a submersion event would most likely suffer. Likewise, instructors should avoid adding unrealistic “fluff” or content that distracts from objective performance of skills.

To further establish realism, scenarios should require actual action rather than verbalization. Even perceived “simple” tasks such as putting on exam gloves with wet hands require practice if they are expected in an actual aquatic event. If an AED is used at the scene, to what extent is the actual procedure practiced?

Facilitate realism by having lifeguards cut off the T-shirt of a patient or manikin and actually dry off the chest before pad placement. Use masking tape with “medication patch” written on it and placed in appropriate locations on the patient or manikin, requiring removal and cleaning with a wipe. The act of doing these steps prepares lifeguards for the tasks they may encounter when providing lifesaving care in a way that verbalization of these steps cannot duplicate.

Realism demands different circumstances to drive key points home. With a human patient, a bag-valve-mask resuscitator (BVM) can be placed on the face with an open airway maintained, allowing for the actual feel of the skill. The drawback is that one cannot actually deliver the ventilation, requiring a manikin for true practice. Similarly, a pulse can be felt in the neck or arm of a human patient, allowing for practice of a vital skill across many different body types. However, actual CPR chest compression practice requires a manikin to capture the depth and rhythm needed for efficient delivery. Striking a balance between the use of these facsimiles will assist the instructor in providing adequate realism and practice.

Instructors need to consider the features of their facilities, staffing, equipment, programming and clientele. Additionally, they must evaluate what is likely to occur by reviewing internal incident data, trends available in publications such as Aquatics International, and through networking with other aquatics professionals.

Lifeguard instructors and supervisors are in the unique position of being able to fully prepare their staffs for the realities of their positions. It requires creativity, thoughtfulness and a logical review of what that “reality” is likely to be at your facility. Once that reality estimate is known, look for ways to replicate it during aquatic incident scenarios.

Such practice will provide your staff with an enhanced view of what they may face and a means for the facility to truly evaluate the effectiveness of existing emergency action plans. Most importantly, it will give guards additional tools and experience that may make the difference when it counts most.