I’ve always advocated the need for aquatics facilities to collaborate and coordinate lifeguard and water rescue training and emergency operations with community fire, rescue, emergency medical services (EMS) and law enforcement agencies. This includes combined
emergency response drills. Such training gives lifeguards a better
understanding of what’s expected of them before and after the
arrival of responding professional rescue services personnel and
It also allows public safety and rescue agencies to evaluate the
operations and capabilities of lifeguards, as well as their EMS and
rescue equipment. And it lets first responders assess the
facility’s rescue and safety equipment. This ensures that
it’s compatible within the communitywide EMS system, and that
the equipment also is state-of-the-art and appropriate for its
Case in point: A national distributor was marketing a brand of
bag-valve-mask (BVM) resuscitators that was promoted and sold as a
one-size-fits all device intended for use on adult, child and
infant patients. During my travels, I’ve seen this device at
a number of aquatics facilities. It would not be accepted or used
by any EMS agency within the United States, yet it’s being
marketed and sold to numerous aquatics facilities.
The CPR protocols established by the American Heart Association and
the American Red Cross recognize three classifications of patients
— adult, child, and infant. The rescue protocols for these
patients are unique, as should the rescue equipment used for these
patients while providing positive pressure ventilation via the use
of a bag-valve-mask resuscitator.
I’ve also seen backboards at numerous aquatics facilities
with so much flex in them that to immobilize patients on them would
aggravate or compromise a suspected spinal injured patient. In the
same way, I’ve seen backboards that are so tall and wide,
they would not fit into a ground or air ambulance.
During an actual emergency, this problem would require EMS
personnel to remove the patient from the facility’s backboard
and transfer him or her onto one of their own backboards, prior to
transport. In attempting to do so, the risk of secondary cord
injury is increased, thereby jeopardizing the patient’s
Backboards should be constructed of plastic and a maximum of 18
inches wide and 72 inches tall. Wooden backboards cannot be
adequately disinfected and should not be considered for
pre-hospital EMS use.
Other equipment that should be considered for proper spinal
injury management are cervical extrication collars. Cervical
immobilization devices (head immobilizers) are only designed to
minimize lateral and anterior movement of the head and/or neck. A
cervical collar is designed to minimize flexion and extension of
the neck. For proper immobilization, the combination of a CID and
cervical extrication collar must be used.
The American Red Cross eliminated the use of cervical extrication
collars from its training some time ago. With so many extrication
collars on the market, ARC didn’t believe it could adequately
instruct guards in the various brands, according to an
administrative blue letter issued by the organization.
But, in reality, regardless of the extrication collar brand, only
two types are used in pre-hospital EMS care — a one-piece or
two-piece rigid collar. And approximately 98 percent of
pre-hospital EMS services within the United States use one-piece
rigid cervical extrication collars. Regardless of the brand, all
one-piece cervical extrication collars are sized and applied the
EMS systems typically have exchange programs with hospitals.
When a patient is transported there with a cervical extrication
collar, the hospital provides the EMS with a replacement and
charges the patient for the collar. If the aquatics facility used
the same collar brand, the responding EMS could easily provide it
with a replacement collar prior to transporting the patient.
Similar equipment that can be exchanged would be non-rebreather
oxygen masks, bag-valve-mask resuscitators, suction catheters, and
even backboards and strap systems. At the very least, cooperative
agreements should be established with the EMS agency that when a
patient is transported on the aquatics facility’s backboard,
along with the head immobilizer, and strap system, that equipment
could be provided until it can be recovered from the hospital.
Another concern for proper spinal injury management is the use
of an effective immobilization strapping system.
We’ve found an immobilization harness (spider strap)
provides the most effective immobilization to prevent anterior,
lateral and head-to-toe movement. And the use of these systems
allows for rapid immobilization.
There’s a concern, however, if the harness has Velcro straps
and will be used in water; rescuers must know how to keep them from
tangling. They should peel and seal one strap at a time, and be
cautioned against bringing the system into water with all the
Velcro straps exposed because they tend to bind together.