Picture this: It is a hot summer day at the pool and the water is filled with patrons attempting to escape the heat. As you sit in the lifeguard stand, you notice multiple victims needing to be rescued. After you get the victims out of the pool, you complete your assessment and determine they all require attention and possibly CPR.

Who do you save first, second and last? During the lifeguard course, this decision is never mentioned. So who receives the majority of your lifesaving efforts and who receives the minimum?

As an EMT, in a mass casualty incident, we are told to make the most effort to save those who have the best chance of survival. Making that determination can be challenging and you only have a split second to make a decision. This could include saving a victim who has a weak pulse vs. a victim who has no pulse. A victim who has shallow respirations vs. a victim who has no respirations.

On the other hand, it could be approached from the view that the victim showing little to no sign of life should receive the most attention vs. the person who has a weak pulse or shallow respirations because they are still breathing and/or exhibiting some slight signs of life.

As a Lifeguard Instructor, when this question arises during a training, I instruct the lifeguard candidates that there really is not a right or wrong victim to save first. If a child is involved, I personally would make more effort to save the child. However, someone else may preform CPR on the victim who was underwater the least amount of time.

In addition, if there is an event involving multiple victims and multiple rescuers and/or bystanders, a lifeguard (or someone who is trained in CPR) can instruct bystanders to do CPR because compressions are vital in the cardiac chain of survival.

It may not be the answer one wants to hear, but unfortunately, one lifeguard cannot save everyone by themselves. It is imperative, however, in any situation, if a bystander is available, instruct them to call “911” immediately to get assistance there as soon as possible.

For more information, feel free to refer to the mass causality and triage from EMS and Incident Command System, according to the Federal Emergency Management Agency guidelines. Materials to reference also include the American Heart Association’s guidelines on calling “911.”