Last February, I touched on a primary assessment drill. Here, we’ll break primary assessment into five drills using a single rescuer. Primary assessment can lead to caring for and monitoring an unconscious victim, dealing with severe bleeding, providing rescue breathing, or CPR. It includes:
Check for responsiveness/summons EMS (body rolling victim when necessary).
Look, listen and feel for breathing with a pulse check.
If there’s severe bleeding, provide care.
Sound easy? It’s not! Primary assessment with a progression to the appropriate patient care should take under a minute. Also, most PA training is done in a quiet setting and several steps skimmed over verbally rather than done physically.
Speed and proficiency are mandatory for effective assessment. Train with these drills to get your team ready for the challenge. The rescuer’s personal safety is key, and a scene size-up with gloving up is the prequel to every primary assessment.
Gloving up during scene size-up drill: Have the team line up with gloves in hand. Objective: Each must have their gloves on in the time it takes to verbalize all components of a scene size-up. Scene size-up should be a scan including the following:
Check for environmental dangers.
Determine the number of victims.
Assess if more resources are needed.
Determine the cause of victim’s injury.
Assess if the victim should be extricated.
Depending on your agency, local protocols and training level, scene size-up could include if spinal precautions are needed.
This is all done before entering the scene and making contact with patient while simultaneously pulling gloves from a fanny pack and putting them on. Timing goal: 10-12 seconds to finish the objective with a trainer reciting the components.
Once proficient, move to variations:
Lifeguards start with gloves in their fanny packs (no change).
In verbal unison, guards recite the components of scene size-up while gloving up (15 seconds, then reduce to 10-12 seconds once proficient).
Combine the two variations above: Guards verbalize scene size-up starting with gloves in fanny packs (15 seconds, then reduce to 10-12 seconds) .
Body roll drill: Form teams of three: a primary rescuer, a secondary rescuer and a victim. Victim is on their side, rescuer(s) 5-10 feet away. Objective: Primary rescuer checks victim’s responsiveness, states, “No response,” body rolls victim to a supine position. Be careful with head, neck and back while rolling the victim. A secondary rescuer arrives. The primary rescuer tells the secondary rescuer to “activate EMS.” Timing goal: 5-7 seconds to finish objective.
Once proficient, move to variations:
Victim is in prone position (10 seconds).
Rescuers start with gloves on (no change).
Once victim is supine, rescuer takes lateral or cephalic position (no change).
Victim is prone; rescuers body roll them. Once victim is supine, secondary rescuer leaves to activate EMS and the primary moves to lateral or cephalic position on victim (5-7 seconds).
Airway maneuver progression drill: This drill was mentioned in Nov./Dec. 2013 and is integral to PA. Several variations have been modified to include quickly checking for breathing and pulse for no more than 10 seconds.) Pair the guards as rescuer and victim. Victim is supine on ground; rescuer, 5-10 feet away. Objective: Rescuer moves to victim’s lateral side; opens airway with head-tilt/chin-lift. Rescuer now can look, listen, feel for breathing. Timing goal: 5 seconds to finish objective. Once proficient, move to variations:
Rescuer in cephalic position does jaw-thrust with head extension (5 seconds).
Rescuer checks pulse after opening airway in lateral position (no change).
Rescuer checks pulse after opening airway in cephalic position (no change).
Rescuer opens airway in lateral position, checks for breathing and pulse for no more than 10 seconds (up to 15 seconds).
Rescuer opens airway in cephalic position, checks for breathing and pulse for no more than 10 seconds (up to 15 seconds).
Scan for bleeding drill: Guards are paired as rescuer and victim. Victim is supine on ground; rescuer checks for breathing, pulse. Rescuer says, “Scanning for severe bleeding,” and awaits trainer’s cue for type of care to provide. Objective: Rescuer provides the appropriate care based within time frame allowed. Timing goal: Vary depending on the victim’s medical condition.
Trainer states that the victim has:
“No severe bleeding; victim is breathing.” Rescuer maintains an open airway on the victim. (5 seconds).
“Severe bleeding from (L or R) leg.” Rescuer requests assistance, provides direct pressure to control bleeding (10 seconds).
“No severe bleeding, no breathing, but there’s a pulse.” Rescuer provides adult rescue breathing with a pocket mask for three breaths, making chest rise (18 seconds).
“No severe bleeding, no breathing, no pulse.” Rescuer does CPR for one cycle, 30 compressions with 2 breaths (30 seconds). Once proficient, reduce to 24 seconds.
Add another rescuer and modify care that supports two rescuers.
“No severe bleeding; victim’s breathing.” Rescuers keep airway open (5 seconds).
“Severe bleeding from (L or R) leg.” Primary rescuer provides direct pressure to control bleeding, secondary rescuer retrieves first aid kit; both rescuers use bandages, gauze to stop bleeding (20 seconds).
“No severe bleeding, no breathing, but there’s a pulse.” Primary rescuer provides adult rescue breathing with pocket mask; secondary rescuer retrieves BVM and assembles as other rescuer performs three breaths, making chest rise. Rescuers use BVM for one breath (25 seconds).
“No severe bleeding, no breathing, no pulse.” Rescuers provide two-person CPR for one cycle, 30 compressions with 2 breaths (30 seconds). When proficient, reduce to 24 seconds.
Once the team is proficient in all the drills, link them together with the primary assessment combination drill: End goal is to do a sequence connecting all 4 drills into one fluid drill. First, combine two drills, then add more once the team shows proficiency. Objective: Rescuer(s) finish combined drills within the timing goals. To attain success, it will likely take several in-service trainings. Timing goal: The timing goal from each drill and variation should be added together; it varies depending on the drill combination (45-90 seconds).
Remember, practice builds skill, which in turn builds personal empowerment, elevating the rescuer to an aquatics professional. Train often, and with a passion.