Well-trained lifeguards will quickly get bored with participating in the same old, tired scenarios that lifeguard instructors often rely on to confirm skills. While boredom may affect performance, real life incidents of a similar type will not all present themselves in exactly the same manner.

Scenarios should be created with twists and turns to provide lifeguards with problem-solving “tools” that they can store during practice scenarios, and retrieve when an actual event occurs. To help, think of different variations, and keep a running list in a scenario book to refer to before in-services. The more instructors prepare in this manner, the less reliant they will be on references over time.

What is a likely twist or turn in an unconscious guest scenario?

According to the American Heart Association’s latest ECC Guidelines, an unconscious guest who has just been removed from water is very likely to vomit. Incorporating vomit may be something you verbalize, but how can we make it “real”? Many instructors over the years have used cans of soup or their own fake vomit concoction that adds a smell as well as a look. A simple solution may be a can of whipped cream. It is generally liked by all, and can be used in a variety of ways. At the key moment the instructor wishes to have the patient “vomit” the instructor can simply put the nozzle of the can under the mask and discharge an appropriate amount of whipped cream to replicate vomiting during BLS care.

Guards will then need to determine if the mask is still usable (replacing if it is not) while treating the guest with the appropriate procedure with exam gloves and perhaps suction (if trained).

Whipped cream is sticky and, if not handled properly by the guards, it will get on everything. Did the guards wipe their faces with their gloved hands or put their hands on their legs? The realistic lesson of how vomit or other body fluids can be transferred will be clear if you show the lifeguards where the whipped cream ended up on the deck and on the team.

Other simple items also may be used to enhance the realism of scenarios. If you’re teaching the care of soft-tissue injuries, strawberry syrup makes excellent “blood” and may be used for the creation of a convincing wound. Washable markers (nontoxic children’s variety) can be used to create skin discolorations consistent with the symptoms of burns or other skin injuries.

Consider shopping for first aid items at Halloween time, when stores stock things such as fake teeth (dental emergencies), severed limbs (severe injuries/broken bones), and other novelties certain to make learning and practicing first aid not only more realistic, but more fun.

Beyond props and creating physical realism, think about how you prompt guards. If an instructor wants to suggest that the airway may be blocked or closed due to failure to maintain an open airway position while performing ventilations, the instructor may simply say “breaths did not go in” or “airway is blocked.” What does that teach the lifeguard?

During an actual incident, the guard will need to recognize visual cues while providing care. In this case, the visual cue is that the chest failed to rise and fall with the ventilation. The visual cue thus can be reinforced with a prompt of “the chest did not rise with that last ventilation.” This will cause the guard to associate the visual cue with the cause and the appropriate skill to correct the problem. Other BLS prompting can be similarly framed to make the guard think about what the prompt is indicating, then use their reasoning skills to determine the next step.

Instructors also must ensure prompting doesn’t pre-empt skills practice. When checking for a pulse during a scenario, lifeguards may be tempted to put their fingers on the approximate location and wait for the instructor to deliver a prompt indicating what they’ve found. Did they really locate a pulse? Ask the guards to raise the hand not checking when they do feel a pulse. At the end of the 10-second check, give the prompt you intended. If some hands fail to go up, provide specific help. It will result in frequent, real pulse check practice. This is especially important given AHA’s findings in its ECC Guidelines that it is difficult to assess a pulse.

While aquatic scenarios are a lifeguard’s most frequently practiced, remember other incidents that may occur at a facility. Often lifeguards are the highest trained first responders and may be called upon to assist with various nonaquatic first aid or basic life support incidents that occur away from the aquatic area. Are these nonaquatic emergencies practiced? If so, is it done using realistic scenarios following an established EAP?

For example, if your aquatics facility operates within a recreation center, do you practice responding to an incident on, say, the running track or basketball court? Consider creating an in-service scenario where lifeguards respond to emergencies at their actual locations, with the aquatic area as a starting point. Consider variables such as maintaining lifeguard supervision of the aquatic area, equipment retrieval and how guards are alerted to the incident.

Realism not only makes for more interesting scenarios, but it provides lifeguards with a more complete skill set for the work they may be asked to perform. While keeping safety in mind, instructor creativity in facilitating realistic scenarios will provide lifeguards with an enhanced “tool kit” that will be invaluable when it matters most.