If we’re doing one-rescuer CPR for a child or an adult, the situation is dire. Let’s go over the possible scenarios: pre-existing medical condition that leads to cardiac arrest, either on land or in the water; a traumatic event that leads to cardiac arrest, either on land or in the water; or drowning.
If the lifeguard is working solo on land, then they should be proficient in:
Safely and quickly rolling/moving a victim
Performing a primary assessment
Performing effective, efficient compressions
Performing effective and efficient ventilations with a resuscitation mask
Getting assistance from the public
Moving the victim if necessary
Assisting in CPR
GLOVING UP DURING SCENE/SIZE-UP DRILL: Lifeguards line up with gloves in hand.
Objective: Each lifeguard must have their gloves on in the time that it takes to verbalize all the components of a scene size-up. Performing the scene size-up involves a scan that includes:
Checking the scene for environmental dangers
Determining the number of victims
Assessing whether additional resources are needed
Determining the mechanism of injury to the victim
Assessing whether there is a need for extrication of the victim
Determining if spinal precautions are needed (depending on state and local protocols)
Timing goal: 10-12 seconds to complete the objective.
Once proficient in the drill, move to these variations:
Lifeguards pulls gloves from their fanny pack (no time change)
BODY ROLL DRILL: Lifeguards form pairs, one being the rescuer and the other being the victim 5 to 10 feet away.
Objective: Rescuer checks responsiveness of the victim, says, “No response,” then body rolls the victim to a supine position. Care should be taken on head, neck and back while rolling the victim.
Timing goal: 5-7 seconds to complete the objective.
Once proficient, move to the variations:
Victim starts in prone position (10 seconds)
PRIMARY ASSESSMENT DRILL: Lifeguards form pairs, with one being the rescuer and the other being the victim 5 to 10 feet away.
Objective: Complete the following skills:
Gloved up during scene size-up
Check for responsiveness
Roll victim to a supine position (if necessary)
Look, listen and feel for breathing with a pulse check, look for severe bleeding no more than 10 seconds
Resuscitation mask assembled and ready to use
Timing goal: 20-30 seconds to complete the objective.
ACTIVATING EMS DRILL: Lifeguards form pairs, with one being the rescuer and the other being 9-1-1.
Objective: Lifeguards relay the necessary information when calling 9-1-1 or activating EMS:
Identify yourself (your name)
State your position (lifeguard)
Name your location
State, “There’s an emergency.”
State the nature of the emergency (heart attack, etc.)
Say what’s being done (CPR in progress)
Explain what resources are needed (Police, Fire, EMS)
Name the best entrance to reach you
Timing goal: 30 seconds to complete the objective.
THE LONE LIFEGUARD DRILL: Lifeguards form pairs, with one being the rescuer and the other being the proctor. A manikin is set up 5-10 feet away.
Objective: The lifeguard gloves up during the scene size-up, checks for responsiveness, activates the emergency action plan, performs a primary assessment, and begins CPR. The lifeguard performs CPR for two minutes.
Timing goal: 3 minutes
THE LONE LIFEGUARD SCENARIO: Lifeguards form pairs, with one being the rescuer and the other being the proctor. A manikin is set up 5-10 feet away.
Objective: The lifeguard gloves up during the scene size-up, checks for responsiveness, activates the emergency action plan, performs a primary assessment, and begins CPR. Provide uninterrupted CPR for 4 minutes.
Timing goal: 6 minutes. Below are the different types of scenarios that should be addressed:
The victim is a child on land
The victim is an adult pulled from the water
The victim is a child pulled from the water
Here are factors that can be incorporated into the scenario that will stretch your lifeguards’ skills and critical thinking:
The lifeguard must speak with 9-1-1 throughout the entire drill
The lifeguard must leave the scene to activate 9-1-1 prior to beginning CPR
The lifeguard is empowered to request assistance from a bystander(s)
The scene becomes unsafe, and victim must be moved
The scenario extends for another 4-6 minutes of uninterrupted CPR
The victim vomits during the scenario
The lifeguard needs to expose the victim’s chest in anticipation of using an AED
MISTAKES TO LOOK FOR
As the trainer, your critical eye is needed so participants don’t make mistakes that could result in delay or compromises in care. Here are some errors you might see:
The lifeguard’s body position doesn’t support how the victim’s airway is opened or doesn't provide an effective seal with the mask
When sealing the mask, the lifeguard is smashing the mask onto the victim’s face, which has the high potential of closing their airway
The lifeguards either under inflate or over inflate the victim’s chest. Remember, just enough to allow the chest to rise
The lifeguard fails to activate EMS
The lifeguard delays in care due to spending a large amount of time gloving up
Improper chest compression depth, ratio, and pace
Improper ventilation ratio and volume
To make the 30-minute in-service compact and effective, plan on using the setting at your facility that is most suited for the exercise. Make sure that you have enough equipment and manikins with working lungs. Have extra lungs on hand, and make sure lifeguards are proficient at doing a quick lung change-out.
Remember: Less talk and more skill repetition. The priority for your lifeguard doing solo CPR is to be proficient in their skills and get additional resources on scene.
Good luck and keep training.