Training your lifeguard staff to gain a high level of readiness and efficiency using a bag valve mask (BVM) requires an in-service trainer to dedicate time and resources to this skill. Let’s look at BVM use and clarify its role in providing patient care.
If a victim is either breathing inadequately or not breathing at all, a BVM can provide several benefits. They provide a higher level of oxygen (21%) than the victim would receive from a rescuer using a resuscitation mask (16%). If attached to emergency oxygen, a BVM can provide 100% oxygen. The device also can offer more effective tidal volume to assist in rising the victim’s chest as opposed to relying on the rescuer’s ability to provide the tidal volume with their own lung capacity and proficiency.
A BVM can and should be used on a victim who is not breathing but has a pulse. BVM use is one important aspect of airway management that should be utilized when available and when appropriate.
But these challenges can hamper effective BVM use in real-life situations:
• Inadequate seal of the mask due to lack of proficiency;
• Inadequate seal of the mask because of the victim’s beard or dentures, or from obesity;
• Improper head position to keep the victim’s airway open;
• Rescuers failing to provide enough tidal volume to make the victim’s chest rise with each ventilation;
• Rescuers’ failure to synchronize their delivery of care to the victim;
• Rescuers not recognizing an equipment failure that must be addressed.
These potential training gaps are commonly seen when in-service training doesn’t translate to real-life situations, compromising rescuer readiness and patient care:
• Training BVMs don’t match ready-to-use BVMs either in brand or availability of sizes (adult, child, and infant). This might also be true of resuscitation mask that lifeguards carry in their hip packs.
• On training BVMs the original resuscitation mask or emergency oxygen reservoir often is missing or damaged, and the emergency oxygen adjunct attachment can be broken off.
• Ready-to-use BVMs are stored new, unopened in their original bags. This means the BVM is unassembled and NOT ready-to-use.
• Ready-to-use BVMs are stored in the first-aid station (only one location) and not near lifeguard stands. This becomes problematic if the first-aid station is far from the aquatics incident.
• Rescuers neglecting to train for BVM equipment failures and on how to continue to provide uninterrupted care to the victim as equipment is traded out.
• Rescuers rarely train at providing uninterrupted care for extended periods of time. If it takes 5 minutes for Fire/EMS to arrive on the scene, rescuers should train at providing 8 minutes of uninterrupted care, which could equate to 96 ventilations for adults or 160 ventilations for an infant/child.
• Training manikins do not have working lungs, so effective ventilations cannot be observed.
As an in-service trainer, your job is to address the equipment challenges and gaps to improve the readiness and efficiency of your lifeguard staff. Listed below are several drills to increase your lifeguard team’s readiness.
BVM ASSEMBLY DRILL (3 or more lifeguards, preferably 6+)
Lifeguards are in a circle configuration facing each other. Each lifeguard has one component of the BVM: mask, bag, oxygen reservoir, etc. At the trainer’s direction, lifeguards begin to pass the components with only one component being held by a lifeguard at a time. The trainer will call, “Assemble!” Lifeguards then assemble the BVM as quickly as possible.
Objective: When the trainer signals, the lifeguard team assembles the BVM as quickly as possible.
Timing Goal: 10-15 seconds. Once proficient, incorporate these variations quickly and safely.
For a larger group of lifeguards:
• Provide additional BVM components (working or non-working), to challenge the lifeguards on quick decision making;
• Mix BVM components (adult and child) to force the lifeguards to separate out and assemble the BVM correctly;
• All lifeguards who end up with no BVM component must glove up by the time the BVM is assembled and be ready to provide care;
• Place a manikin some distance away, and have the lifeguards assemble the BVM while in transit to the manikin;
UNINTERRUPTED CARE DRILL
Three-person teams provide uninterrupted ventilations on an adult manikin for 1 minute, equating to 12 ventilations. Two lifeguards will ventilate the manikin while the third tallies 12 effective ventilations, making the manikin’s chest clearly rise.
Objective: Provide 12 steady-uninterrupted ventilations.
Timing Goal: 15 seconds to position lifeguards, 1 minute for ventilations. Once proficient, incorporate these variations quickly and safely:
• Each lifeguard must seal the mask and ventilate the manikin six times;
• Half the ventilations are performed with a BVM, half with a resuscitation mask;
• All three lifeguards must share the responsibility and ventilate the manikin four times.
BVM REPLACEMENT PART DRILL
Two-person teams provide uninterrupted ventilations on an adult manikin for 1 minute. A third lifeguard arrives with a spare BVM part.
Objective: Provide steady, uninterrupted ventilations while simultaneously replacing the BVM part. If necessary, continue giving ventilations with a resuscitation mask while the BVM is repaired.
Timing Goal: 15 seconds to position rescuers, 1 minute for the ventilations. Once proficient, incorporate these variations quickly and safely:
• Extend the time to 2 minutes, and incorporate multiple BVM replacement parts at a staggered interval;
• The third lifeguard joins ventilating the manikin, replacing one of the original two lifeguards. The replaced lifeguard leaves and joins a different lifeguard team. This “leap frog” continues until all lifeguard teams have experienced the join/replace cycle.
It is easy to overlook BVM drills and focus on other rescue skills that seem more engaging. Remember, BVM proficiency and readiness is a necessary skill for airway management, which is fundamental for lifeguarding and all EMS professionals. If CPR continues to be a regular training topic, make sure to provide adequate time for BVM training as well.
Good luck and keep training.