Well-trained lifeguards will quickly get bored with participating in the same old, tired scenarios that lifeguard instructors often rely on to confirm skills. While boredom may affect performance, real life incidents of a similar type will not all present themselves in exactly the same manner.
Scenarios should be created with twists and turns to provide
lifeguards with problem-solving “tools” that they can
store during practice scenarios, and retrieve when an actual event
occurs. To help, think of different variations, and keep a running
list in a scenario book to refer to before in-services. The more
instructors prepare in this manner, the less reliant they will be
on references over time.
What is a likely twist or turn in an unconscious guest scenario?
According to the American Heart Association’s latest ECC
Guidelines, an unconscious guest who has just been removed from
water is very likely to vomit. Incorporating vomit may be something
you verbalize, but how can we make it “real”? Many
instructors over the years have used cans of soup or their own fake
vomit concoction that adds a smell as well as a look. A simple
solution may be a can of whipped cream. It is generally liked by
all, and can be used in a variety of ways. At the key moment the
instructor wishes to have the patient “vomit” the
instructor can simply put the nozzle of the can under the mask and
discharge an appropriate amount of whipped cream to replicate
vomiting during BLS care.
Guards will then need to determine if the mask is still usable
(replacing if it is not) while treating the guest with the
appropriate procedure with exam gloves and perhaps suction (if
Whipped cream is sticky and, if not handled properly by the guards,
it will get on everything. Did the guards wipe their faces with
their gloved hands or put their hands on their legs? The realistic
lesson of how vomit or other body fluids can be transferred will be
clear if you show the lifeguards where the whipped cream ended up
on the deck and on the team.
Other simple items also may be used to enhance the realism of
scenarios. If you’re teaching the care of soft-tissue
injuries, strawberry syrup makes excellent “blood” and
may be used for the creation of a convincing wound. Washable
markers (nontoxic children’s variety) can be used to create
skin discolorations consistent with the symptoms of burns or other
Consider shopping for first aid items at Halloween time, when
stores stock things such as fake teeth (dental emergencies),
severed limbs (severe injuries/broken bones), and other novelties
certain to make learning and practicing first aid not only more
realistic, but more fun.
Beyond props and creating physical realism, think about how you
prompt guards. If an instructor wants to suggest that the airway
may be blocked or closed due to failure to maintain an open airway
position while performing ventilations, the instructor may simply
say “breaths did not go in” or “airway is
blocked.” What does that teach the lifeguard?
During an actual incident, the guard will need to recognize visual
cues while providing care. In this case, the visual cue is that the
chest failed to rise and fall with the ventilation. The visual cue
thus can be reinforced with a prompt of “the chest did not
rise with that last ventilation.” This will cause the guard
to associate the visual cue with the cause and the appropriate
skill to correct the problem. Other BLS prompting can be similarly
framed to make the guard think about what the prompt is indicating,
then use their reasoning skills to determine the next step.
Instructors also must ensure prompting doesn’t pre-empt
skills practice. When checking for a pulse during a scenario,
lifeguards may be tempted to put their fingers on the approximate
location and wait for the instructor to deliver a prompt indicating
what they’ve found. Did they really locate a pulse? Ask the
guards to raise the hand not checking when they do feel a pulse. At
the end of the 10-second check, give the prompt you intended. If
some hands fail to go up, provide specific help. It will result in
frequent, real pulse check practice. This is especially important
given AHA’s findings in its ECC Guidelines that it is
difficult to assess a pulse.
While aquatic scenarios are a lifeguard’s most frequently
practiced, remember other incidents that may occur at a facility.
Often lifeguards are the highest trained first responders and may
be called upon to assist with various nonaquatic first aid or basic
life support incidents that occur away from the aquatic area. Are
these nonaquatic emergencies practiced? If so, is it done using
realistic scenarios following an established EAP?
For example, if your aquatics facility operates within a recreation
center, do you practice responding to an incident on, say, the
running track or basketball court? Consider creating an in-service
scenario where lifeguards respond to emergencies at their actual
locations, with the aquatic area as a starting point. Consider
variables such as maintaining lifeguard supervision of the aquatic
area, equipment retrieval and how guards are alerted to the
Realism not only makes for more interesting scenarios, but it
provides lifeguards with a more complete skill set for the work
they may be asked to perform. While keeping safety in mind,
instructor creativity in facilitating realistic scenarios will
provide lifeguards with an enhanced “tool kit” that
will be invaluable when it matters most.