Addressing choking and controlling external bleeding are two skills that can be easily overlooked when it comes to in-service training. Both are land skills and perceived as easy, so instructors often just verbalize instructions or provide partial training.
For a conscious choking victim, lifeguards should review the necessary and subtle steps for adult, child and infant. When a victim goes from conscious to unconscious, lifeguards need to practice lowering a victim to the ground (adult and child) or moving to an elevated surface (infant) safely.
I emphasize “safely,” for both the victim and the lifeguard.
When it comes to controlling external bleeding, most lifeguards know how to treat cuts and scrapes, as well as apply direct pressure.
However, during the primary assessment, lifeguards are checking for a pulse, breathing and any severe bleeding. If severe bleeding is present, lifeguards must control the bleed first before moving forward and providing additional patient care. Practicing the skill of controlling severe bleeding is rarely bundled with ventilations, CPR or administration of emergency oxygen. This in-service provides in-depth drills for both choking and controlling external bleeding.
PREQUEL TO CONSCIOUS CHOKING DRILL: Lifeguards will pair up into two-person teams (Rescuer/Victim), on land facing each other, gloved and ready.
OBJECTIVE: Rescuers will go through the sequence of steps that take place prior to providing care for an active choking victim. Steps include:
° Confirm the victim is choking
° Identify yourself as a trained rescuer
° Get consent to provide care
° Activate the EMS system for additional resources
° The victim should act appropriately as a conscious choking victim.
TIMING GOAL: Eight to 10 seconds to complete the objective. Each step should be distinct. Switch roles when the rescuer has demonstrated proficiency.
RESCUER BODY AND HAND POSITION DRILL: Lifeguards will pair up into two-person teams (Rescuer/Victim), standing on land, gloved and ready.
OBJECTIVE: The rescuer will move into proper position to provide back blows, abdominal thrusts, or chest thrusts for an adult victim.
TIMING GOAL: up to 5 seconds to get into position. Once proficient, move into these variations:
° Rescuer smoothly demonstrates correct body position and hand placement for each skill (10-15 seconds)
° Victim is a child
° Victim is an infant
CHOKING VARIATIONS DRILL: Form two-person teams (Rescuer/Victim). Each rescuer will have a fanny pack, gloves and resuscitation mask. The trainer will cue the rescue teams on the variation that is being presented by the victim. The rescuers need to perform the proper skill sequence depending on the variation.
OBJECTIVE: The rescuers complete the correct skills sequence based on the variation.
TIMING GOAL: Dependent on variation.
Here is the list of variations:
° Conscious victim who becomes unconscious. (Skill: Rescuer safely lowers the victim to the ground — up to 15 seconds)
° Unconscious adult victim is lowered to the ground. Rescuers then continue to provide care for an obstructed airway (at least three cycles)
° Unconscious child victim is lowered to the ground. Rescuers then continue to provide care for an obstructed airway (at least three cycles)
° Unconscious infant victim is moved to an elevated surface with rescuers continuing to provide care for an obstructed airway (at least three cycles)
SOLO RESCUER SIZE-UP DRILL: Lifeguards will pair up into two-person teams (Rescuer/Victim). The victim is unconscious and has uncontrolled bleeding from a limb.
OBJECTIVE: The lifeguard will arrive on scene, do a scene size up, apply PPE, and do a primary assessment. During the primary assessment, the lifeguard will determine that the patient has a pulse and is breathing, but has severe bleeding in an extremity. The lifeguard will need to activate EAP and apply direct pressure. NOTE: Direct pressure can be provided via gloved hands directly on injury or with available towel.
TIMING GOAL: Scene size-up, primary assessment, activate EAP, and provide direct pressure in less than 20 seconds.
SEVERE BLEEDING DRILL: Lifeguards will pair up into two-person teams (Rescuer/Victim). The victim is conscious and has severe bleeding from a limb.
OBJECTIVE: The lifeguard will quickly and effectively apply a pressure gauze with a roller bandage to the victim’s injury.
TIMING GOAL: Pressure gauze and roller bandages effectively secured to the victim’s injury in less than 90 seconds. Once proficient, add these variations while providing control to severe bleeding:
° Victim loses consciousness and lifeguard needs to continue to provide care.
° Victim stops breathing, and requires ventilations in addition to bleeding control.
° Victim goes into shock and requires the administration of emergency oxygen.
° There are two lifeguards on scene to provide care.
MISTAKES TO LOOK FOR
The trainer’s critical eye is needed so participants don’t make mistakes that could delay or compromise care. Here are some errors you might see:
° The lifeguard’s body position doesn’t ergonomically support the lifeguard when providing back blows or abdominal thrusts to the victim.
° The lifeguard’s body position doesn’t ergonomically support the lifeguard when they lower the victim to the ground.
° The lifeguard doesn’t protect the victim’s head or neck when lowing the victim to the ground.
° The lifeguard fails to quickly glove up.
° The lifeguard delays in care due to spending a large amount of time gloving up.
° The lifeguard fails to provide adequate pressure to stop the bleeding.
° The lifeguard fails to treat for shock after the pressure gauze and roller bandage are applied.
For a 30-minute in-service to be effective, it must be compact, in the best setting, and with the right materials and resources available. Encourage your lifeguards to be quick in clearing a victim’s airway for choking and in applying direct pressure followed with proper application of a gauze and bandage. Both choking and severe bleeding can be fatal if not addressed immediately.
Good luck and keep training.