If a situation requires the use of an AED, your lifeguards will have to act quickly, efficiently and calmly.
But any scenario where this happens is going to be extremely stressful: Using a piece of equipment to shock a person’s heart in order to re-establish into an effective rhythm. No pressure, right?
Let’s go through some challenges that you might encounter as a trainer.
The AED trainer that your agency uses for lifeguard certification and in-service might not be an accurate representation of the real AED that is housed at your facility. Be sure to provide an orientation of the real AED, along with its differences from the training AED.
Both the training AED and the real AED should have the same support supplies that are stored in the carry case: razor, towel, child AED pads, etc.
EXPOSING THE VICTIM’S CHEST
Exposing the chest of a man or woman so that the AED pad can be applied could be difficult.
Some of your young lifeguards, in particular, might be hesitant or apprehensive about exposing a stranger’s chest. This reluctance or hesitancy can also happen when lifeguards encounter an extremely hairy chest on a man. Other items that could be found on a person’s chest include piercings, medical patches, or even a shirt or top that is difficult to remove.
As a trainer, you will need to teach your lifeguards to work through the situation and not allow it to result in delays providing care.
THE SIZE OF THE CHILD
Depending on what your lifeguards are familiar with, the definition of a child could vary: 1 to 8 years old, or 1 year old to the first signs of puberty.
Where this can affect a lifeguard’s performance is on the application of the AED pads. If the child is large, pad placement is the same as for an adult. If the child is small to the point where the AED pads might touch, then the proper protocol for pad placement is one pad on the front of the chest and one pad on the child’s back, with pads best aligned to provide the best charge through the heart.
Train your lifeguards to make a quick visual assessment on what would be most effective for the child prior to placing the AED pads. This helps avoid the need to remove and readjust the pads.
Use the following drills for a 30-minute in-service to help prepare your lifeguards for these situations.
LIFEGUARD AED CHANGE POSITION DRILL: Lifeguard team of four — two lifeguards positioned at the head, providing ventilations with a BVM; one lifeguard at the chest, giving compressions; and one overseeing the AED.
One adult manikin will be used. CPR is in progress, and AED is on, and pads are in place. A proctor will be needed to provide prompts.
Objective: Proctor will state that the AED is analyzing, lifeguard at the chest will change positions with the lifeguard at the AED.
Timing goal: 10 seconds.
Once proficient, move to the variations:
• Change between the lifeguard at chest and the lifeguard managing the airway
• Change between the lifeguard at chest and the lifeguard providing ventilations
• Victim is a child or infant
• Proctor does a 20-count, where lifeguards must change positions every 20 seconds.
AED WORK-THROUGH DRILL: Lifeguard team of four (two lifeguards positioned at the head providing ventilations with a BVM; one at the chest giving compressions; and one arrives with the AED.
Objective: The lifeguards must work through the scenario presented once the lifeguard with the AED arrives.
Timing goal: 30 seconds.
Here is the list of scenarios that need to be practiced:
• It is determined that EMS has not been activated. One lifeguard needs to leave while the AED set-up and used
• Lifeguards expose the chest, and find a medical patch on the victim
• Lifeguards must cut the shirt and/or the bra away from the victim to apply the AED pads
• Victim is a small child
• Victim is an infant
THE LONE LIFEGUARD AED SCENARIO: Each lifeguard is paired with an adult manikin. The manikin is set up 5-10 feet away.
Objective: The lifeguard gloves up during the scene size-up, checks for responsiveness, performs a primary assessment and determines that the victim in not breathing and has no pulse.
The lifeguard leaves to activate EMS and returns with the AED. The lifeguard turns on the AED, applies the pads, and follows the prompts. The AED informs the lifeguard that shock is needed. The lifeguard shocks the victim and begins CPR. Lifeguard provides uninterrupted CPR until the next AED analysis.
Timing goal: 6 minutes.
Once proficient, move the different types of scenarios that could be addressed:
• Multiple lifeguards respond (one leaves to activate EMS and retrieve AED)
• Multiple lifeguards staggered response (one starts CPR, one arrives with AED)
• The victim is a child on land or pulled from the water
• The victim is an infant on land or pulled from the water
• 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 delay or compromise care.
Here are some errors you might see:
• Lifeguards fail to turn on the AED
• Lifeguards tend to use the space where the manikins’ legs should be
• Failure to agree upon when the “change” of positions should be called
• Lifeguards stop providing compressions so the AED can be attached
As the trainer, to make the 30-minute in-service compact and effective, plan on using the best setting at your facility to run this in-service. Make sure that you have enough equipment and manikins that have working lungs. Make sure you have extra lungs and are proficient at doing a quick lung change-out.
Remember: less talk and more skill repetition. The priority is uninterrupted care and no delays when it comes to using the AED.
Good luck and keep training.