American Red Cross

Lifeguarding

INSTRUCTOR’S MANUAL

This instructor’s manual is part of the American Red Cross Lifeguarding program. Visit redcross.org to learn more about this program.

The emergency care procedures outlined in this book reflect the standard of knowledge and accepted emergency practices in the United States at the time this book was published. It is the reader’s responsibility to stay informed of changes in emergency care procedures.

PLEASE READ THE FOLLOWING TERMS AND CONDITIONS BEFORE AGREEING TO ACCESS AND DOWNLOAD THE AMERICAN RED CROSS MATERIALS. BY DOWNLOADING THE MATERIALS, YOU HEREBY AGREE TO BE BOUND BY THE TERMS AND CONDITIONS.

The downloadable electronic materials, including all content, graphics, images, and logos, are copyrighted by and the exclusive property of The American National Red Cross (“Red Cross”). Unless otherwise indicated in writing by the Red Cross, the Red Cross grants you (“recipient”) the limited right to download, print, photocopy and use the electronic materials, subject to the following restrictions:

    The recipient is prohibited from selling electronic versions of the materials.

    The recipient is prohibited from revising, altering, adapting, or modifying the materials.

    The recipient is prohibited from creating any derivative works incorporating, in part or in whole, the content of the materials.

    The recipient is prohibited from downloading the materials and putting them on their own website without Red Cross permission.

Any rights not expressly granted herein are reserved by the Red Cross. The Red Cross does not permit its materials to be reproduced or published without advance written permission from the Red Cross. To request permission to reproduce or publish Red Cross materials, please submit your written request to The American National Red Cross.

© 2012 American National Red Cross. ALL RIGHTS RESERVED.

The Red Cross emblem, American Red Cross® and the American Red Cross logo are trademarks of The American National Red Cross and protected by various national statutes.

Published by Krames StayWell Strategic Partnerships Division.

Printed in the United States of America.

ISBN: 978-1-58480-488-8

ACKNOWLEDGMENTS

This manual is dedicated to the thousands of employees and volunteers of the American Red Cross who contribute their time and talent to supporting and teaching lifesaving skills worldwide and to the thousands of course participants and other readers who have decided to be prepared to take action when an emergency strikes.

This manual reflects the 2010 Consensus on Science for CPR and Emergency Cardiovascular Care and the Guidelines 2010 for First Aid. These treatment recommendations and related training guidelines have been reviewed by the American Red Cross Scientific Advisory Council, a panel of nationally recognized experts in fields that include emergency medicine, occupational health, sports medicine, school and public health, emergency medical services (EMS), aquatics, emergency preparedness and disaster mobilization. This manual also reflects the United States Lifeguarding Standards: A Review and Report of the United States Lifeguard Standards Coalition, a collaborative effort of the American Red Cross, the United States Lifesaving Association and the YMCA of the USA.

Many individuals shared in the development and revision process in various supportive, technical and creative ways. The American Red Cross Lifeguarding Instructor’s Manual was developed through the dedication of both employees and volunteers. Their commitment to excellence made this manual possible.

The American Red Cross team for this edition included:

Jean Erdtmann

Senior Director

Program Development and Sales Support

Kamenna Lee

Vice President

Business Marketing

Jennifer Deibert

Manager

Program Development

Connie Harvey

Manager, Aquatics Program Development

Project Manager

Kara L. Desmarais, MPA

Project Manager

Information Technology

Denise González Hensal

Business Analyst

Information Technology

Gina Gunn

Project Manager, Aquatics Sales Support

Sales Support

Tom Heneghan

Senior Associate, Business Planning

Business Planning

Don Lauritzen

Senior Associate

Operations

Stephen Lynch

Senior Analyst

Retail Product Development and Distribution

Stacey Ryan

Director, Service Delivery

Division 6

Mark Schraf

Senior Associate

Business Planning

Charles Snyder

Associate

Program Development

Stephanie Shook, CPRP

Senior Associate

Program Development

John Thompson

Senior Associate

Program Administration

Joy Zukauskas

Senior Associate

Divisional Support

The following individuals provided guidance and support:

Jack McMaster

President

Preparedness and Health and Safety Services

Steven Glockenmeier

Vice President

Preparedness and Health and Safety Services

Don Vardell

National Chair

Preparedness and Health and Safety Services

The StayWell team for this edition included:

Nancy Monahan

Senior Vice President

Paula Batt

Vice President

Sales and Client Services

Reed Klanderud

Vice President

Marketing and Communications

Ellen Beal

Executive Director

Content and Delivery Platforms

David Cane

Managing Editor

Danielle DiPalma

Senior Content Manager

Bryan Elrod

Senior Developmental Editor

Kate Plourde

Marketing Manager

Shannon Bates

Senior Production Manager

Michelle Clark

Senior Graphic Designer

The following members of the American Red Cross Scientific Advisory Council also provided guidance and review:

David Markenson, MD, FAAP, EMT-P

Chair, American Red Cross Scientific Advisory Council

Chief, Pediatric Emergency Medicine

Maria Fareri Children’s Hospital

Westchester Medical Center

Valhalla, New York

Peter Wernicki, MD

Aquatics Chair, American Red Cross Scientific Advisory Council

Sports Medicine Orthopedic Surgeon

International Lifesaving Federation Medical

Committee Past Chair

U.S. Lifesaving Association

Medical Advisor

Vero Beach, Florida

Roy R. Fielding

Member, American Red Cross Scientific Advisory Council

University of North Carolina—Charlotte

Department of Kinesiology

Coordinator, Exercise Science/Director of Aquatics

Charlotte, North Carolina

Terri Lees

Member, American Red Cross Scientific Advisory Council

Aquatic Supervisor

North Kansas City Community Center

North Kansas City, Missouri

Francesco A. Pia, PhD

Member, American Red Cross Scientific Advisory Council

Water Safety Films, Inc.

President, Pia Consulting Services

Larchmont, New York

S. Robert Seitz, M.Ed., RN, NREMT-P

Member, American Red Cross Scientific Advisory Council

University of Pittsburgh

Center for Emergency Medicine

Pittsburgh, Pennsylvania

The Sounding Board for this edition included:

Joyce A. Bathke

Chief Administrative Officer

American Red Cross St. Louis Area Chapter St. Louis, Missouri

David W. Bell, PhD

National Aquatic Committee

National Health and Safety Committee

Boy Scouts of America

Ponca City, Oklahoma

Pete DeQuincy

Aquatic Supervisor

East Bay Regional Park District

Oakland, California

Shawn DeRosa, JD, EMT-B

Manger of Aquatic Facilities and Safety Officer for Intercollegiate Athletics

The Pennsylvania State University

University Park, Pennsylvania

Scott E. Gerding

Sales Manager

Mid-East Division

American Red Cross

Columbus, Ohio

Juliene R. Hefter

Deputy Director

Wisconsin Park & Recreation Association

Owner, Safety First Aquatics, LLC

Greendale, Wisconsin

Carolyn Hollingsworth-Pofok

Director of Recreation and Events

Millcreek MetroParks

Canfield, Ohio

William A.J. Kirkner, JD

Aquatics Director

JCC of Greater Baltimore

Reisterstown, Maryland

Joetta R. Jensen

Assistant Professor and Director of Aquatics

Hampton University

Hampton, Virginia

Rhonda Mickelson

Director of Standards

American Camp Association
Estes Park, Colorado

Billy Pounds

Aquatics Manager

City of Pearland

Pearland, Texas

Clayton D. Shuck

Deputy Manager of Recreation

South Suburban Parks and Recreation

Centennial, Colorado

Thomas C. Werts

President

Aquatics Safety Consulting

Kissimmee, Florida

The following individuals participated as Waterpark and Waterfront Working Group members:

Adam Abajian

Recreation Program Manager/ Lakefront Operations

City of Evanston

Evanston, Illinois

Darwin DeLappa

Director of Water Safety

New York State Parks and Recreation

Queensbury, New York

Luiz A. Morizot-Leite

Captain, Ocean Rescue Lifeguard, Miami-Dade

Fire Rescue Department

Miami-Dade County, Florida

Robert E. Ogoreuc

Assistant Professor

Slippery Rock University

Slippery Rock, Pennsylvania

William J. Frazier

Aquatic Operations Manager

Massanutten Resort

McGaheysville, Virginia

Lee Hovis

Director of Recreation Operations

Nocatee Waterpark Recreation

Ponte Vedra Beach, Florida

Danial Llanas

Director of Support Services

Busch Entertainment Corporation

San Antonio, Texas

Scott Mersinger

Aquatics Director

Lost Rios Waterpark

Wisconsin Dells, Wisconsin

The following individuals provided external review:

Alex Antoniou

Director of Educational Programs

National Swimming Pool Foundation

Colorado Springs, Colorado

Jerome H. Modell, MD, D Sc (Hon.)

Emeritus Professor of Anesthesiology

Courtesy Professor of Psychiatry

Courtesy Professor of Large Animal Clinical Sciences

Colleges of Medicine & Veterinary Medicine

University of Florida

Gainesville, Florida

The American Red Cross thanks Jorge L. Olaves H., Ed S, Florida A&M University, for his contributions to this manual, as well as Pat Bennett and Lindsay O’Donnell for their assistance in writing the instructor’s manual and supplementary materials.

CONTENTS

SECTION A | ADMINISTRATION

CHAPTER 1 INTRODUCTION

Course Purpose

Course Objectives

Course Participants

Instructor’s Responsibilities

CHAPTER 2 COURSE DESIGN

Course Content

Participant Resources

Lifeguarding Manual

Instructor Resources

Lifeguarding Instructor’s Manual

Video Segments

Materials, Equipment and Supplies

Course Presentation

Activity Worksheets

Instructor’s Corner

Additional Resources for Instructors and Participants

Training Equipment and Red Cross Retail Products

Additional Red Cross Courses

Refresher Program

CHAPTER 3 SETTING UP AND RUNNING THIS COURSE

Recommended Class Size

Course Length

Classroom Space

Swimming Area

Setting Up and Running Skills Sessions

Class Safety

Health Precautions for Course Participants

Participants With Disabilities and Special Health Considerations

CHAPTER 4 REQUIREMENTS FOR SUCCESSFUL COURSE COMPLETION

Criteria for Course Completion and Certification

Final Written Exams

Final In-Water Skill Scenarios

Exam Security

Reporting Procedures

Participant Course Evaluation

Awarding Certificates

Continuing Education Units for Professionals

SECTION B | THE LIFEGUARDING AND SHALLOW WATER LIFEGUARDING COURSES

Lifeguarding Course Outline

Shallow Water Lifeguarding Course Outline

Precourse Session

LESSON 1: The Professional Lifeguard and Facility Safety

LESSON 2: Facility Safety, Patron Surveillance and Injury Prevention

LESSON 3: Injury Prevention and Rescue Skills, Part 1

LESSON 4: Rescue Skills, Part 2

LESSON 5: Before Providing Care, Victim Assessment and Breathing Emergencies

LESSON 6: Cardiac Emergencies and Using an Automated External Defibrillator

LESSON 7: First Aid

LESSON 8: Head, Neck and Spinal Injuries in the Water

LESSON 9: Final Written Exam and Final In-Water Skill Scenarios

Activity Worksheets

ACTIVITY WORKSHEET 1.1—Reasons for the Rules

ACTIVITY WORKSHEET 2.1—Guarding Special Attractions

ACTIVITY WORKSHEET 3.1—Strategies for a Safe Group Visit

ACTIVITY WORKSHEET 6.1—Using an AED in Unique Situations—Fact or Fiction

SECTION C | WATERFRONT SKILLS

Module Outline

Waterfront Skills Module Lesson Plan

SECTION D | WATERPARK SKILLS

Module Outline

Waterpark Skills Module Lesson Plan

SECTION E | LIFEGUARDING FINAL WRITTEN EXAMS

Lifeguarding

SECTION 1—CPR/AED for the Professional Rescuer and First Aid, Exams A and B

SECTION 2—Lifeguarding Skills Exams A and B

Shallow Water Lifeguarding

SECTION 2—Shallow Water Lifeguarding Skills Exams A and B

Waterfront Skills Module

Waterfront Skills Module Exam, Exams A and B

Waterpark Skills Module

Waterpark Skills Module Exam, Exams A and B

Final Written Exam Answer Sheets

Index

Final Written Exam Answer Keys

SECTION A | ADMINISTRATION

CHAPTER 1

INTRODUCTION

This manual is intended to serve as a resource for instructors of the American Red Cross Lifeguarding program. The information and teaching strategies it provides will help you to teach the program. You should be familiar with the material in the American Red Cross Lifeguarding Manual (Stock No. 655735) and in this instructor’s manual before you teach the course.

COURSE PURPOSE

The purpose of the American Red Cross Lifeguarding course is to provide entry-level lifeguard participants with the knowledge and skills to prevent, recognize and respond to aquatic emergencies and to provide care for breathing and cardiac emergencies, injuries and sudden illnesses until emergency medical services (EMS) personnel take over.

The purpose of the Shallow Water Lifeguarding course is to learn the knowledge and skills needed to prevent and to respond to aquatic emergencies in shallow water up to 5 feet deep. The purpose of the Waterfront Skills module is to teach lifeguards the skills and knowledge needed to prevent and respond to emergencies in nonsurf, open-water areas found at public parks, resorts, summer camps and campgrounds. The purpose of the Waterpark Skills module is to teach lifeguards the skills and knowledge needed to prevent and respond to emergencies in aquatic facilities with waterpark features.

The care steps outlined within this product are consistent with the Guidelines 2010 for First Aid and the 2010 Consensus on Science for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This manual also reflects the United States Lifeguarding Standards: A Review and Report of the United States Lifeguard Standards Coalition, a collaborative effort of the American Red Cross, the United States Lifesaving Association and the YMCA of the USA.

The course content and activities will prepare participants to make appropriate decisions about the care to provide in an aquatic emergency and a medical emergency.

COURSE OBJECTIVES

It is your responsibility as an instructor to see that participants meet the learning objectives listed at the beginning of each lesson in this instructor’s manual.

COURSE PARTICIPANTS

Many of the course participants will be in, or preparing for, positions that require a background in lifeguarding. Participants may include camp counselors, water safety instructors, swim coaches, public safety personnel, adult youth leaders and the general public. Participants may represent a broad range of backgrounds and differ in levels of education and experience. They may be taking courses in the Lifeguarding program to fulfill employment requirements, to complete requirements for a major area of study or certification or for personal satisfaction.

Prerequisites for each course or module are listed in the Precourse Session in this instructor’s manual. Before having the participants break to change into their swimsuits for the prerequisite swimming skills evaluation, orient them to the locker rooms and the pool area where they are to meet.

INSTRUCTOR RESPONSIBILITIES

Your responsibilities as a certified Red Cross instructor include:

    Providing for the health and safety of participants by always ensuring:

    Manikins have been properly cleaned according to “Recommendations on Manikin Decontamination," which is available on Instructor’s Corner.

    Other course equipment (medical and first aid supplies) is clean and in good working order.

    Participants are aware of health precautions and guidelines concerning the transmission of infectious diseases.

    All participants have the physical ability to perform the skills and know to consult you if they have concerns about their physical ability to do so.

    The classroom, aquatic facility and all practice areas are free of hazards.

    Being familiar with and knowing how to effectively use program materials and training equipment.

    Ensuring there are lifeguards on duty during the in-water skill sessions with the proper safety equipment, and that the swimming area is the proper water quality.

    Maintaining adequate supervision at all times during in-water skill sessions.

    Foreseeing hazards and taking steps to eliminate or control them before participants arrive or step into the water.

    Planning, coordinating and managing training with the Red Cross, including advising the Red Cross in advance of any classes you are scheduled to teach.

    Informing participants about knowledge and skills evaluation procedures and course completion requirements.

    Creating a non-threatening environment that is conducive to achieving the learning objectives.

    Preparing participants to meet the course objectives.

    Providing participants an opportunity to evaluate the course.

    Adapting your teaching approach to match the experience and abilities of the participants, identifying participants who are having difficulty and developing effective strategies to help them meet course objectives.

    Supervising participants while they are practicing course skills and providing timely, positive and corrective feedback as they learn.

    Evaluating participants as they perform skills, focusing on critical performance steps as described in the skill charts.

    Administering and scoring the final written exams.

    Conducting courses in a manner consistent with course design.

    Submitting completed course records and reports to the Red Cross representative within 10 working days from course completion.

    Being familiar with and informing participants of other Red Cross courses and programs.

    Being prepared to answer participants’ questions or knowing where to find the answers.

    Providing a positive example by being neat in appearance and not practicing unhealthy behaviors while conducting American Red Cross courses.

    Identifying potential instructor candidates and referring them to the appropriate Red Cross representatives.

    Abiding by the obligations in the Instructor Agreement and Code of Conduct and, if applicable, the Authorized Provider Agreement.

    Representing the Red Cross in a positive manner.

    Promoting volunteer opportunities available through the Red Cross.

CHAPTER 2

COURSE DESIGN

COURSE CONTENT

The course is designed to be flexible in delivery. You should not modify course content, but you have flexibility to select teaching methods to meet the needs and interests of the participants as long as these participants can meet the course objectives. You may wish to emphasize certain aspects of the content.

PARTICIPANT RESOURCES

Lifeguarding Manual

The manual has been designed to simplify learning and understanding of the material. The manual reinforces key points from the lecture portions of the course and contains skill sheets. It also serves as a reference after the course. The manual is available for purchase (Stock No. 655735) or as a downloadable digital version, which can be printed. Participants must have a Lifeguarding Manual at the start of the course.

Free electronic versions are available on redcross.org.

INSTRUCTOR RESOURCES

Lifeguarding Instructor’s Manual

This instructor’s manual contains all the information necessary to conduct the American Red Cross Lifeguarding program. The manual is divided into five parts—Section A: Administration, Section B: The Lifeguarding and Shallow Water Lifeguarding Courses, Section C: The Waterfront Skills Module, Section D: The Waterpark Skills Module and Section E: Final Written Exams, Answer Sheets and Answer Keys.

    Section A: Administration contains information needed to conduct the course and provides a course overview, explains how to set up and teach the course, gives requirements for successful course completion and describes what to do when the course is completed.

    Sections B-D include the course outline and the lesson plans to teach the Lifeguarding and Shallow Water Lifeguarding courses and the Waterfront Skills and Waterpark Skills modules. The lesson plans provide the instructor with the primary points to be covered in each lesson and with guidelines for classroom activities.

    Section E: Final Written Exams, Answer Sheets and Answer Keys includes the final written exams for CPR/AED for the Professional Rescuer and First Aid and the final written exams for Lifeguarding/Shallow Water Lifeguarding Skills. It also includes the final written exams for the Waterfront Skills and Waterpark Skills modules.

The instructor’s manual can also be viewed online on Instructor’s Corner (redcross.org/instructorscorner).

Lesson Plans

Several items in the lesson plans can help you conduct the course. These include the following:

Lesson Objectives

The knowledge and skill objectives are presented at the beginning of each lesson.

Lecture Points

The lecture points summarize the critical material from the lesson that is most important for the participants to understand. They also represent the information participants need to meet the objectives, successfully complete the skill sessions and pass the written exams.

Activities

The activities that are part of the lesson plans involve participants in guided discussion, viewing video segments and course presentations, activity worksheets and scenarios. Most lessons contain at least one activity.

Where the lesson has an alternate activity, the instructor should use these when conducting the Shallow Water Lifeguarding course as they apply to water less than 5 feet deep.

Skill Drills

Skill drills are used to help reinforce the skills learned up to that point in the lesson and require participants to perform multiple skills in succession. Skill drills provide an immediate opportunity to put the “total picture" into practice.

Assignments

At the end of each lesson is an assignment for the next lesson.

Land-Based Skills Practice

In some of the land-based skill practice sessions, participants practice the skill on one another and/or on manikins. Practice on a “real-life" victim is important to give participants experience in handling a real person. Skills that require mouth-to-mouth contact, such as giving ventilations and performing CPR, however, are practiced only on manikins. Suctioning and airway insertion also should be done only on manikins.

Request that participants with special needs, including medical conditions or physical disabilities, bring these to your attention privately to determine if reasonable accommodations can be made while still accomplishing the course objectives.

In-Water Skill Practice

The in-water rescue skills performed in the Lifeguarding courses and modules have multiple actions occurring simultaneously. If a skill is only demonstrated from one side or angle, the secondary actions may be missed and the total picture will be incomplete. This is true for skills that involve actions both above and below water. For example, in demonstrating how to turn a victim face-up using the head splint, participants may clearly see the rescuer’s hand and arm position above the water, but may not notice the rescuer’s leg action. Since supporting the victim and avoiding unnecessary movement are important when performing the rescue, the rescuer’s underwater actions are significant elements in the total skill.

Skills Assessment Tools

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level on the skill assessment tools to be checked off for a skill. Assessment criteria that are general for the category of skills, as well as specific to the skill, must be met.

Scenarios

Scenarios help to reinforce learning by drawing on participants’ skills and decision-making abilities in various situations. They also are included as a review during which participants can recall and apply the information learned in the course.

Final Written Exams

Two exams, Section 1—CPR/AED for the Professional Rescuer and First Aid and Section 2—Lifeguarding Skills are included in Section E of this manual. Two versions are available for each exam. Participants must pass each exam with a minimum score of 80 percent as part of the requirements for receiving American Red Cross course completion certificates.

Additional exams for the Waterfront Skills and Waterpark Skills modules are also included in Section E of this manual.

Video Segments

The Lifeguarding DVD Set (Stock No. 655739) is designed specifically for use during the courses in the Lifeguarding program. The video segments can also be viewed on Instructor’s Corner. Instructors are required to use the video segments because they contain model demonstrations that combine real-life scenarios with studio-based skill segments to help ensure lesson objectives are met. The course cannot be conducted if the video segments are not available. A detailed menu of the Lifeguarding DVD Set and running times is included on Instructor’s Corner.

Instructors can also use the Lifeguarding DVD Set to teach the Administering Emergency Oxygen and Bloodborne Pathogens Training: Preventing Disease Transmission courses and the asthma inhaler and epinephrine auto-injector trainings.

Materials, Equipment and Supplies

Specific materials, equipment and supplies needed for each lesson are included at the beginning of the lesson. Instructors should have the specific equipment needed for the lessons ready prior to the start of the lesson.

    For the course, instructors must have the following:

    Newsprint and marker pens, easel or tape

    Equipment for viewing the video segments and/or the course presentation, including a DVD player and monitor or LCD projector, extension cord and grounded plug adaptor if needed, Lifeguarding DVD Set and the applicable course presentation

    Diving bricks and a stopwatch or pace clock

    Rescue tubes (one for every two participants)

    Hip packs

    For the Lessons 5, 6 and 9, each class must have the following:

    Manikin decontamination supplies including decontamination solution, 4-inch x 4-inch gauze pads, soap and water, brush, basins or buckets, and any accessories that may be recommended by the manufacturer of the manikin

    Blankets or mats (one for every two participants)

    Adult and infant manikins (one of each for every two participants)

    Child manikins are optional (one for every two participants)

    Adult and pediatric bag-valve-mask resuscitators

    AED training devices (one for every two participants)

    Adult AED training pads (one set for each training device)

    Pediatric AED training pads (one set for each training device)

    A towel

    For the Lessons 7 and 8, each class must have the following:

    External bleeding control materials for each pair of participants, including two 3-inch roller bandages and four nonsterile dressings or gauze pads

    Splinting materials for each pair of participants, including four triangular bandages, one 3-inch roller bandage, a blanket or pillow and a rigid splint such as a magazine, cardboard or long and short boards

    Spinal immobilization materials

    Backboards, each equipped with 3 straps and head immobilizers (one backboard for every three participants is recommended); if fewer backboards are available, additional time may be required

For each lesson, lifeguard candidates must have the Lifeguarding Manual and should have a pencil or pen, a name tag, the activity worksheets, non-latex disposable gloves in multiple sizes and a resuscitation mask (adult and pediatric). For the final lesson, each candidate should have a final written exam and answer sheet for the applicable course and/or module.

Instructors must have American Red Cross identification; the Lifeguarding Manual; the Lifeguarding Instructor’s Manual; a name tag; answer keys for the course and/or module exams; extra manikin lungs, airways and faces; Course Record and Course Record Addendum; Participant Progress Log; and extra pens or pencils.

Course Presentation

Another resource for instructors is the Lifeguarding course presentations. Similar to a PowerPoint presentation, the course presentation is an in-class visual aid that is projected onto a screen or viewing area. Instructors click through the presentation slides as they progress through the lessons.

The course presentation is designed to include all the visual information necessary to conduct the Lifeguarding courses. The course presentation includes lecture points, video segments and selected skill sheets. Cross-references appear in this manual to assist in teaching along with the course presentation.

Before conducting the course, become familiar with the presentation software and test the display of the system to be used. It is recommended you have backup copies of the presentation in case technical difficulties occur.

Course Presentation System Requirements:

    Adobe Reader 9

    Flash Player 8, 9 for Windows and Mac

    Flash Player 9 for Linux and Solaris

Equipment Requirements:

    Laptop/desktop computer

    Power source

    Projector

    Projection screen/area

    Computer speakers

The presentation is available to download on Instructor’s Corner. The presentation is saved in PDF format. To view the presentation, save the file to your computer and double click on the PDF icon to open it. Additional directions for using the course presentation are available on Instructor’s Corner.

Activity Worksheets

The Lifeguarding program uses activity worksheets in some of the lessons to help reinforce course material. Activity worksheets for participants can be found at the end of Section B. The activity worksheets should be given to each participant during the appropriate lessons. Answers to the activity worksheets are included in the appropriate lessons within the course.

Instructor’s Corner

As an instructor, it is very important that you register on Instructor’s Corner (redcross.org/instructorscorner) and visit the site regularly for program information and updates. Once you have completed the brief registration process, you will have free access to many important resources for instructors.

Lifeguarding program materials on Instructor’s Corner include:

    Administrative Terms and Procedures.

    Course Fact Sheets.

    Sample Letter to Lifeguarding course participants.

    Course Record and Course Record Addendum.

    Americans with Disabilities Act (ADA) Resource Guide.

    Lifeguarding DVD Menu and Run Times.

    Teaching Strategies.

    Participant Progress Log.

Additional resources on Instructor’s Corner:

    Administrative forms and policies, including the Instructor Agreement and Code of Conduct and the Manual of Administrative Policies and Procedures (MAPP)

    Information about other Red Cross training and education programs

    Frequently asked questions and expert answers to your technical questions

    Link to the Learning Center Web site

    Links to redcrossstore.org and shopstaywell.com for training supplies and Red Cross retail products

ADDITIONAL RESOURCES FOR INSTRUCTORS AND PARTICIPANTS

Training Equipment and Red Cross Retail Products

Equipment used during the course, such as CPR breathing barriers, first aid kits and a wide range of Red Cross retail products, are available through the Red Cross or the Red Cross store at redcrossstore.org.

Additional Red Cross Courses

A wide range of additional training opportunities in safety and preparedness are offered through the Red Cross. Additional Red Cross programs include:

    Swimming and Water Safety.

    Babysitter’s Training.

    Family Caregiving.

    Nurse Assistant Training.

    CPR/AED for Professional Rescuers and Health Care Providers.

    Wilderness and Remote First Aid.

Refer participants to the Red Cross for more information about scheduled courses in their community.

Refresher Program

CPR and AED knowledge and skills begin to decline within as little as 3 months after training. That is why refreshers—a series of short, online learning exercises and quizzes—are included in the Lifeguarding program. Refreshers help skills retention by giving participants opportunities to test and reaffirm CPR, AED and lifeguarding knowledge and skills learned in class. The goal of the refresher program is to keep the knowledge and skills learned in class fresh in participants’ minds. Participants will receive an e-mail with the link to their first refresher about 3 months after class. From then, they will receive additional refreshers throughout the certification period. While participation in the refresher program is voluntary, all participants are strongly encouraged to complete the refreshers on schedule.

CHAPTER 3

SETTING UP AND RUNNING THIS COURSE

This chapter explains how to organize the American Red Cross Lifeguarding program.

RECOMMENDED CLASS SIZE

The course outline and lesson plans have been developed for a class of approximately 10 participants. If your class is larger, you probably will need to allow more time or have co-instructors or instructor aides help you. The amount of available equipment and assistance from additional instructors may limit class size. Personal supervision is necessary to ensure effective practice and the safety of participants. If the class is too large, you may not be able to provide proper supervision or complete class activities in the allotted time. It is strongly recommended that you have additional instructors help during skill practice sessions.

COURSE LENGTH

The course length varies depending on which Lifeguarding course is taught. The Lifeguarding course is designed to be taught in approximately 25 hours, 20 minutes. The Shallow Water Attendant course is designed to be taught in approximately 24 hours. The Waterfront Skills module will add 5 hours, 40 minutes to the core Lifeguarding course. The Waterpark Skills module will add 3 hours, 40 minutes to the core Lifeguarding course.

You must carefully consider the issues of time when planning each class session. The lesson plans in this instructor’s manual should be followed as closely as possible, but facility constraints, specific instructor-to-participant ratios, equipment-to-participant ratios, as well as participant needs such as breaks, may increase course length.

Other factors that may influence lesson planning include:

    Classroom availability and layout.

    Aquatic facility availability and layout.

    Equipment availability.

    Number of participants.

    Skill level of participants.

    Instructor experience.

    Number of instructors.

CLASSROOM SPACE

The lessons described in this instructor’s manual require classroom space suitable for lecture, class discussions, small group activities, DVD presentations and skill practice sessions. The classroom should provide a safe, comfortable and appropriate learning environment. The room should be well lit and well ventilated and have a comfortable temperature. If the practice area is not carpeted, provide some knee protection, such as folded blankets or mats, for use by participants or allow them to bring their own padding materials.

SWIMMING AREA

A pool is recommended for skill practice, in-water activities and skills evaluation. The pool must meet the requirements needed to conduct the following:

    Prerequisite swimming skills evaluation

    Submerged victim rescue (7-10 feet)

    Caring for head, neck and spinal injuries in deep water

    Final In-Water Skill Scenarios 1-3

When teaching the Lifeguarding course, if the pool has a maximum depth of 6 feet, an alternate timed event can be used as part of the prerequisite swimming skills evaluation. All other class activities must be taught in water depth as described in the activity or skill session directions.

For pools with maximum water depth of 6 feet deep, candidates should complete the following timed event within 1 minute, 40 seconds.

    Starting in the water, swim 20 yards. The face may be in or out of the water. Swim goggles are not allowed.

    Surface dive to a depth of 6 feet, swim 10 to 15 feet along the bottom to retrieve a 10-pound object.

    Return to the surface and swim on the back to the starting point with both hands holding the object at the surface and the face remaining at or near the surface or able to get a breath. Candidates should not swim the distance underwater.

If a waterfront or waterpark facility is used for teaching the Lifeguarding course, a swimming area should be chosen that is free from surf or obstructions and has sufficient space and depth (7-10 feet) for skill practice, in-water activities and skills evaluation. The facility must meet the same standards as listed above for swimming pools.

To ensure consistency in course delivery, facilities must be used that meet the guidelines for conducting the course activities. More than one facility can be used to accommodate the lesson plan activities.

SETTING UP AND RUNNING SKILL SESSIONS

The instructions in the skills practice sessions are condensed for ease of use. However, during every skill practice session, circulate among groups to monitor progress and provide assistance when necessary. Lifeguards should practice the skills until they are able to meet performance criteria. Observe each participant’s performance of the skill and provide corrective feedback using the skill charts and skill assessment tools. Record their progress on the Participant Progress Log (redcross.org/instructorscorner).

Land-Based Skill Practice

The skill sessions are conducted in one of two ways. Some skills are learned via the Watch-Then-Practice instructional method while others offer a choice of how the skill session is conducted (Practice-While-You-Watch or Watch-Then-Practice). Skill charts and skill assessment tools are located in the instructor’s manual at the end of the lessons that include skill sessions.

In-Water Skill Practice

Whenever possible, the skill should be demonstrated, and then practiced, on land first. Demonstrations should be performed as slowly as possible without losing the integrity of the skill. Whenever possible, skills should be demonstrated in exactly the same manner from the front, back and both sides. This allows participants to see all sides and angles of a sequence.

In some cases, this may not be possible, such as with an entry from a lifeguard stand. However, the more participants can see, the better they will conceptualize a skill.

Training to the Standard but Testing to the Objective

Instructors must focus on the successful completion of an objective as opposed to perfecting every individual skill. For example:

    A person with one arm may not be able to perform a front crawl or breaststroke approach. However, he or she may be able to perform a modified sidestroke to reach a victim in distress. If the “objective” is for the lifeguard to reach a victim, the person with one arm will fully satisfy that objective even though he or she has not performed a conventional approach stroke in the process.

    A person may not be able to support the head and neck in the standard way for manual stabilization, but if the person is able to hold the victim’s head stable, the objective is met.

    A person may not be able to perform either a compact jump or a stride jump perfectly and may have to modify the skill to enter the water in a safe way. It is not essential that a lifeguard enter the water in a specific manner during a rescue, only that he or she can do it safely.

In all these situations, the participant may continue the course and still receive certification, since he or she is capable of performing the function of a lifeguard during a rescue. Additional information on adjustments to training can be found in the Americans with Disabilities Act (ADA) Accommodation Resource Guide found on Instructor’s Corner at www.redcross.org/instructorscorner.

CLASS SAFETY

As a Red Cross instructor, it is important for you to make the teaching environment as safe as possible. Participants who feel they are at risk for injury or illness may become distracted. These same feelings may also affect your ability to teach. There are several steps you can take to help increase class safety:

    Instructor Preparation: Consider possible hazards and manage safety concerns before a course starts. Often, you can foresee hazards and take steps to eliminate or control them long before participants arrive.

    Assisting Instructors and Co-Instructors: Assisting instructors and co-instructors can help decrease risks by giving more supervision and reducing the instructor-to-participant ratio. They also increase participation and learning by providing more one-on-one attention to participants. When using assisting instructors or co-instructors, clearly define their roles and responsibilities. Doing so will help eliminate confusion and lapses in supervision. Remember that you are ultimately responsible for your participants’ safety. To determine your staffing needs, consider the different ages and the individual abilities of participants. If your course has a large number of participants, you will need additional help.

    Instructor Aides: Individuals who express an interest in becoming an instructor but do not, for example, meet the minimum age, can participate as an instructor aide. Instructor aides must always be under the direct supervision of an instructor and should never be left alone to supervise course participants. Instructor aides may not evaluate or certify a participant’s skill performance. An instructor aide must possess a basic-level certificate(s) in the applicable program or course for which he or she wishes to assist. Lifeguarding instructors can train instructor aide candidates. Contact the Red Cross to get further information about instructor aide training. In general, duties and responsibilities of instructor aides include:

    Handling registration and record keeping.

    Setting up classrooms and handing out supplies.

    Assisting with equipment (e.g., setup, cleaning and distribution of materials).

    Helping participants with skill practice or small group activities.

HEALTH PRECAUTIONS FOR COURSE PARTICIPANTS

As a Red Cross instructor, one of your responsibilities is to protect participants from health risks. The materials and procedures for teaching these courses are designed to:

    Limit the risk of disease transmission.

    Limit the risk of one participant injuring another when practicing with a partner.

    Limit the risk that the activity involved in skill practice could cause injury or sudden illness.

When possible, prospective participants should be provided information about health requirements and safety before enrolling in the course. The Sample Letter to Lifeguarding Program Participants on Instructor’s Corner is one way to communicate that information. Ask participants to talk with you before any practice session if they doubt they can participate.

People with certain health conditions may be hesitant to take part in the practice sessions. These could include a history of heart attack or other heart conditions or respiratory problems. Suggest that these participants check with their health care provider before participating in practice sessions involving physical activity. Inform participants who take the course, but cannot demonstrate the skills taught in the practice sessions, that they cannot receive an American Red Cross course completion certificate. Encourage them, however, to participate to whatever extent possible. The Red Cross advocates that, whenever possible, the instructor adjust participants’ activity levels as necessary to facilitate learning and help participants meet course objectives.

PARTICIPANTS WITH DISABILITIES AND SPECIAL HEALTH CONSIDERATIONS

People with disabilities and other conditions may be able to perform first aid, CPR and other EMR skills. Some skills may need to be modified, but the result is the same. Instructors should focus on the critical components of a skill that are needed to successfully meet the objective.

Detailed guidance on these topics is included in the Health Precautions and Guidelines During Training and the Americans with Disabilities Act (ADA) Resource Guide, both of which are available on Instructor’s Corner (redcross.org/instructorscorner).

CHAPTER 4

REQUIREMENTS FOR SUCCESSFUL COURSE COMPLETION

CRITERIA FOR COURSE COMPLETION AND CERTIFICATION

On successful completion of the Lifeguarding course, participants receive American Red Cross certificate for Lifeguarding/First Aid/CPR/AED. On successful completion of the Shallow Water Lifeguarding course, participants receive an American Red Cross certificate for Shallow Water Lifeguarding/First Aid/CPR/AED.

To successfully complete the Lifeguarding/Shallow Water Lifeguarding course, the participant must:

    Attend and participate in all class sessions.

    Demonstrate competency in all required skills and activities.

    Demonstrate competency in all required final rescue skill scenarios.

    Pass both the Section 1—CPR/AED for the Professional Rescuer and First Aid and Section 2— Lifeguarding/Shallow Water Lifeguarding Skills final written exams with minimum grades of 80 percent.

Participants should be told of the requirements when they enroll for the course and again during the course introduction. For successful completion of the Waterfront Skills module, participants must pass the Waterfront Skills Final Written Exam as well. For successful completion of the Waterpark Skills module, participants also must pass the Waterpark Skills Final Written Exam.

FINAL WRITTEN EXAMS

Two exams, Section 1—CPR/AED for the Professional Rescuer and First Aid and Section 2—Lifeguarding/Shallow Water Lifeguarding Skills, are included in Section E of this manual. Two versions are available for each exam. Participants must pass each exam with a minimum score of 80 percent as part of the requirements for receiving American Red Cross course completion certificates.

Additional exams for the Waterfront Skills and Waterpark Skills modules are also included in Section E of this manual. Participants must pass the exam with a minimum score of 80 percent as part of the requirement for receiving an American Red Cross course completion certificate for the corresponding module.

FINAL IN-WATER SKILLS SCENARIO

Participant skills are evaluated and feedback given throughout the course. The purpose of the final inwater skills scenarios is to ensure that participants have achieved a level of competency and retention of the skills learned in the course.

Participants will have to demonstrate competency in the following areas for the Lifeguarding course:

    Head, Neck or Spinal Injury in Shallow Water

    Active Victim in Deep Water

    Submerged Victim in Deep Water— Timed Response

Participants will have to demonstrate competency in the following areas for the Shallow Water Lifeguarding course:

    Head, Neck or Spinal Injury in Shallow Water

    Active Victim in Shallow Water

    Submerged Victim in Shallow Water— Timed Response

There are not separate final in-water skills scenarios for the Waterfront Skills module or the Waterpark Skills module. Participants must successfully complete the final in-water skills scenario as outlined in the Lifeguarding course.

Lifeguarding instructors are encouraged to use additional instructors to help administer the final skills evaluation.

EXAM SECURITY

Exam security is your responsibility. It is not recommended that participants be allowed to see the written exam before it is distributed. As participants hand in their answer sheets, you may quickly grade the exam and return it to the participant. This way, the participant can review any incorrect answers. Be sure to collect all answer sheets and exams before participants leave the class.

REPORTING PROCEDURES

You must submit a completed course record to the Red Cross within 10 working days of course completion. While the course record can be submitted in hard copy, the Red Cross encourages instructors to submit their course records electronically through the Learning Center (https://classes.redcross.org/Saba/Web/Main). Check with the Red Cross for procedures to submit course records.

PARTICIPANT COURSE EVALUATION

Gaining feedback from participants is an important step in any evaluation process. Participants should have an opportunity to tell you what they thought about the course. Have participants complete evaluations each time you teach this course. This information will provide you with feedback concerning the course and its instruction and help the Red Cross maintain the high quality of the course. A copy of the evaluation form is available on Instructor’s Corner.

AWARDING CERTIFICATES

Discuss with the Red Cross the procedures for obtaining American Red Cross course completion certificates. Sign the certificates before giving them to participants. If you receive certificates after the course is over, make arrangements to get them to participants. (Iacet.org). IACET’s Criteria for Quality Continuing Education and Training Programs are the standards by which hundreds of organizations measure their educational offerings. For additional information, contact the Red Cross.

CONTINUING EDUCATION UNITS FOR PROFESSIONALS

Many course takers are professionals who need continuing education units to maintain a license and/or certification. The American Red Cross is approved as an authorized provider by the International Association of Continuing Education and Training (IACET) (Iacet.org). IACET’s Criteria for Quality Continuing Education and Training Programs are the standards by which hundreds of organizations measure their educational offerings. For additional information, contact the Red Cross.

SECTION B | THE LIFEGUARDING AND SHALLOW WATER LIFEGUARDING COURSES

LIFEGUARDING COURSE OUTLINE

PRECOURSE SESSION

Activity

Time

Introduction to the Precourse Session

10 minutes

Verification of Age Prerequisite

5 minutes

Prerequisite Swimming Skills Evaluation

40 minutes

Wrap-Up

5 minutes

Precourse Session, Total Time

60 minutes

LESSON 1 —THE PROFESSIONAL LIFEGUARD AND FACILITY SAFETY

Activity

Time

Introduction to the Course

15 minutes

The Professional Lifeguard
Video: The Professional Lifeguard

15 minutes

Decision Making

5 minutes

Legal Considerations

10 minutes

Continuation of Training

10 minutes

Being Part of a Team

15 minutes

Facility Safety

10 minutes

Weather Conditions

5 minutes

Rules and Regulations

20 minutes

Entries and Approaches
Video: Entries and Approaches

10 minutes

In-Water Skill Session: Entries and Approaches
Skill: Slide-in Entry and Walking Approach
Skill: Slide-in Entry and Swimming Approach
Skill: Stride Jump and Swimming Approach
Skill: Compact Jump and Swimming Approach

40 minutes

Putting It All Together

10 minutes

Lesson 1, Total Time

2 hours 45 minutes

LESSON 2—FACILITY SAFETY, PATRON SURVEILLANCE AND INJURY PREVENTION

Activity

Time

Management and Facility Safety

10 minutes

The Drowning Process

10 minutes

Effective Surveillance—Victim Recognition
Video: Surveillance

10 minutes

Effective Surveillance—Scanning Video: Scanning

10 minutes

Effective Surveillance—Zones of Surveillance Responsibility
Video: Zones of Surveillance

10 minutes

Injury Prevention Strategies Video: Injury Prevention

15 minutes

Guarding a Variety of Activities

10 minutes

Guarding Play Structures, Special Attractions and Water Slides

20 minutes

In-Water Skill Session: Review Skills, Victim Recognition and Lifeguard Rotation

45 minutes

Putting It All Together

25 minutes

Lesson 2, Total Time

2 hours 45 minutes

LESSON 3—INJURY PREVENTION AND RESCUE SKILLS, PART 1

Activity

Time

Guarding for Organized Recreational Swim Groups

20 minutes

Emergency Action Plans
Video: Emergency Action Plans

20 minutes

Rescue Skills, Part 1: Distressed and Active Victim Rescues
Video: Water Rescue Skills—Rescues At or Near the Surface

10 minutes

In-Water Skill Session—Rescue Skills, Part 1
Skill: Reaching Assist from the Deck
Skill: Simple Assist
Skill: Active Victim Front Rescue
Skill: Active Victim Rear Rescue
Skill: Passive Victim Rear Rescue
Skill: Multiple Victim Rescue

85 minutes

Putting It All Together

35 minutes

Lesson 3, Total Time

2 hours 50 minutes

LESSON 4—RESCUE SKILLS, PART 2

Activity

Time

Surveillance Activity I
Video: Review—Surveillance Activity I

10 minutes

Rescue Skills, Part 2: Submerged Victim Rescues
Video: Water Rescue Skills—Submerged Victim Rescues

10 minutes

In-Water Skill Session: Rescue Skills, Part 2
Skill: Submerged Passive Victim in Shallow Water
Skill: Feet-First Surface Dive in Deep Water
Skill: Head-First Surface Dive in Deep Water
Skill: Submerged Victim in Deep Water
Skill: Two-Person Removal from the Water Using a Backboard

70 minutes

Putting It All Together

45 minutes

Lesson 4, Total Time

2 hours 15 minutes

LESSON 5—BEFORE PROVIDING CARE, VICTIM ASSESSMENT AND BREATHING EMERGENCIES

Activity

Time

Standard Precautions
Video: Standard Precautions
Skill: Removing Disposable Gloves

10 minutes

General Procedures for an Emergency on Land

5 minutes

Performing a Primary Assessment
Video: Primary Assessment—Adult
Skill: Performing a Primary Assessment—Adult, Child and Infant
Video: Primary Assessment—Child and Infant
Skill: Using a Resuscitation Mask
Skill: Performing a Primary Assessment—Child or Infant

50 minutes

Moving a Victim

5 minutes

Recognizing and Caring for Breathing Emergencies

5 minutes

Giving Ventilations
Video: Giving Ventilations—Adult, Child and Infant
Skill: Giving Ventilations—Adult
Skill: Giving Ventilations—Child or Infant

15 minutes

Giving Ventilations Using a Bag-Valve-Mask Resuscitator
Video: Using a Bag-Valve-Mask Resuscitator—Two Rescuers
Skill: Giving Ventilations Using a BVM—Two Rescuers

15 minutes

Airway Obstruction
Video: Conscious Choking—Adult and Child
Skill: Conscious Choking—Adult and Child
Video: Conscious Choking—Infant
Skill: Conscious Choking—Infant
Video: Unconscious Choking—Adult, Child and Infant
Skill: Unconscious Choking—Adult and Child
Skill: Unconscious Choking—Infant

30 minutes

In-Water Skill Session: Putting It All Together

30 minutes

Lesson 5, Total Time

2 hours 45 minutes

LESSON 6—CARDIAC EMERGENCIES AND USING AN AUTOMATED EXTERNAL DEFIBRILLATOR

Activity

Time

Recognizing and Caring for a Heart Attack

15 minutes

Cardiac Arrest
Video: Heart Attack and the Cardiac Chain of Survival

5 minutes

CPR
Video: CPR—Adult and Child
Skill: CPR—Adult and Child
Video: CPR—Infant
Skill: CPR—Infant

40 minutes

Two-Rescuer CPR
Video: Two-Rescuer CPR—Adult and Child
Skill: Two-Rescuer CPR—Adult and Child
Video: Two-Rescuer CPR—Infant
Skill: Two-Rescuer CPR—Infant

15 minutes

When the Heart Stops and AEDs

5 minutes

Using an AED
Video: Using an AED
Skill: Using an AED
Video: Using an AED—CPR in Progress

15 minutes

AED Precautions and Maintenance

10 minutes

Putting It All Together: Multiple-Victim Response
Video: Putting It All Together: Multiple-Rescuer Response—CPR in Progress

5 minutes

In-Water Skill Session: Putting It All Together

40 minutes

Lesson 6, Total Time

2 hours 30 minutes

LESSON 7—FIRST AID

Activity

Time

Review—Surveillance Activities
Video: Review—Surveillance Activity 2

5 minutes

Secondary Assessment

5 minutes

Sudden Illness
Video: Responding to Sudden Illnesses

10 minutes

Responding to Injuries
Video: Responding to Injuries
Skill: Controlling Bleeding
Skill: Splinting

45 minutes

Putting It All Together—First Aid Scenarios

20 minutes

Caring for Head, Neck and Spinal Injuries on Land
Video: Head, Neck and Spinal Injuries on Land
Skill: Caring for a Nonstanding Victim of a Suspected Head, Neck or Spinal Injury on Land
Skill: Caring for a Standing Victim of a Suspected Head, Neck or Back Injury on Land

10 minutes

When Things Do Not Go as Practiced
Video: When Things Do Not Go as Practiced

5 minutes

In-Water Skill Session: When Things Do Not Go as Practiced

30 minutes

In-Water Skill Session: Rescue Skill Review

30 minutes

Lesson 7, Total Time

2 hours 40 minutes

LESSON 8—HEAD, NECK AND SPINAL INJURIES IN THE WATER

Activity

Time

Final Written Exam: Section 1—CPR/AED for the Professional
Rescuer and First Aid

40 minutes

Caring for Head, Neck and Spinal Injuries in the Water
Video: Head, Neck and Spinal Injuries in the Water

10 minutes

In-Water Skill Session: Head, Neck and Spinal Injuries
Skill: Head Splint—Face-Up Victim At or Near the Surface in Shallow Water
Skill: Head Splint—Face-Down Victim At or Near the Surface in Shallow Water
Skill: Head Splint—Submerged Victim in Shallow Water
Skill: Spinal Backboarding Procedure—Shallow Water
Skill: Head Splint—Face-Up and Face-Down Victim At or Near the Surface in
Deep Water
Skill: Head Splint—Submerged Victim in Deep Water
Skill: Spinal Backboarding Procedure—Deep Water

100 minutes

Lesson 8, Total Time

3 hours 10 minutes

LESSON 9—FINAL WRITTEN EXAM AND FINAL IN-WATER SKILL SCENARIOS

Activity

Time

Review of the Final Written Exam: Section 1—CPR for the Professional Rescuer and First Aid

5 minutes

Final Written Exam: Section 2—Lifeguarding Skills

30 minutes

In-Water Skill Session: General Skills Review

30 minutes

Final In-Water Skill Scenarios
Skill: Final Scenario: Head, Neck or Spinal Injury in Shallow Water
Skill: Final Scenario: Active Victim in Deep Water
Skill: Final Scenario: Submerged Passive Victim in Deep Water—Team Response

90 minutes

Closing

5 minutes

Lesson 9, Total Time

2 hours 40 minutes

TOTAL COURSE TIME

25 hours 20 minutes

SHALLOW WATER LIFEGUARDING COURSE OUTLINE

PRECOURSE SESSION

Activity

Time

Introduction to the Precourse Session

10 minutes

Verification of Age Prerequisite

5 minutes

Prerequisite Swimming Skills Evaluation

40 minutes

Wrap-Up

5 minutes

Precourse Session, Total Time

60 minutes

LESSON 1 —THE PROFESSIONAL LIFEGUARD AND FACILITY SAFETY

Activity

Time

Introduction to the Course

15 minutes

The Professional Lifeguard
Video: The Professional Lifeguard

15 minutes

Decision Making

5 minutes

Legal Considerations

10 minutes

Continuation of Training

10 minutes

Being Part of a Team

15 minutes

Facility Safety

10 minutes

Weather Conditions

5 minutes

Rules and Regulations

20 minutes

Entries and Approaches
Video: Entries and Approaches

10 minutes

In-Water Skill Session: Entries and Approaches
Skill: Slide-in Entry and Walking Approach
Skill: Slide-in Entry and Swimming Approach
Skill: Compact Jump and Swimming Approach

40 minutes

Putting It All Together

10 minutes

Lesson 1, Total Time

2 hours 45 minutes

LESSON 2-FACILITY SAFETY, PATRON SURVEILLANCE AND INJURY PREVENTION

Activity

Time

Management and Facility Safety

10 minutes

The Drowning Process

10 minutes

Effective Surveillance—Victim Recognition
Video: Surveillance

10 minutes

Effective Surveillance—Scanning
Video: Scanning

10 minutes

Effective Surveillance—Zones of Surveillance Responsibility
Video: Zones of Surveillance

10 minutes

Injury Prevention Strategies
Video: Injury Prevention

15 minutes

Guarding a Variety of Activities

10 minutes

Guarding Play Structures, Special Attractions and Water Slides

20 minutes

In-Water Skill Session: Review Skills, Victim Recognition and Lifeguard Rotation

45 minutes

Putting It All Together

25 minutes

Lesson 2, Total Time

2 hours 45 minutes

LESSON 3—INJURY PREVENTION AND RESCUE SKILLS, PART 1

Activity

Time

Guarding for Organized Recreational Swim Groups

20 minutes

Emergency Action Plans
Video: Emergency Action Plans

20 minutes

Rescue Skills, Part 1: Distressed and Active Victim Rescues
Video: Water Rescue Skills—Rescues At or Near the Surface

10 minutes

In-Water Skill Session—Rescue Skills, Part 1
Skill: Reaching Assist From the Deck
Skill: Simple Assist
Skill: Active Victim Front Rescue
Skill: Active Victim Rear Rescue
Skill: Multiple Victim Rescue

85 minutes

Putting It All Together

35 minutes

Lesson 3, Total Time

2 hours 50 minutes

LESSON 4—RESCUE SKILLS, PART 2

Activity

Time

Surveillance Activity 1
Video: Review—Surveillance Activity 1

10 minutes

Rescue Skills, Part 2: Submerged Victim Rescues
Video: Water Rescue Skills—Submerged Victim Rescues

10 minutes

In-Water Skill Session: Rescue Skills, Part 2
Skill: Submerged Passive Victim in Shallow Water
Skill: Two-Person Removal from the Water Using a Backboard

30 minutes

Putting It All Together

45 minutes

Lesson 4, Total Time

1 hour 35 minutes

LESSON 5—BEFORE PROVIDING CARE, VICTIM ASSESSMENT AND BREATHING EMERGENCIES

Activity

Time

Standard Precautions
Video: Standard Precautions
Skill: Removing Disposable Gloves

10 minutes

General Procedures for an Emergency on Land

5 minutes

Performing a Primary Assessment
Video: Primary Assessment—Adult
Skill: Performing a Primary Assessment—Adult, Child and Infant
Video: Primary Assessment—Child and Infant
Skill: Using a Resuscitation Mask
Skill: Performing a Primary Assessment—Child or Infant

50 minutes

Moving a Victim

5 minutes

Recognizing and Caring for Breathing Emergencies

5 minutes

Giving Ventilations
Video: Giving Ventilations—Adult, Child and Infant
Skill: Giving Ventilations—Adult
Skill: Giving Ventilations—Child or Infant

15 minutes

Giving Ventilations Using a Bag-Valve-Mask Resuscitator
Video: Using a Bag-Valve-Mask Resuscitator—Two Rescuers
Skill: Giving Ventilations Using a BVM—Two Rescuers

15 minutes

Airway Obstruction
Video: Conscious Choking—Adult and Child
Skill: Conscious Choking—Adult and Child
Video: Conscious Choking—Infant
Skill: Conscious Choking—Infant
Video: Unconscious Choking—Adult, Child and Infant
Skill: Unconscious Choking—Adult and Child
Skill: Unconscious Choking—Infant

30 minutes

In-Water Skill Session: Putting It All Together

30 minutes

Lesson 5, Total Time

2 hours 45 minutes

LESSON 6—CARDIAC EMERGENCIES AND USING AN AUTOMATED EXTERNAL DEFIBRILLATOR

Activity

Time

Recognizing and Caring for a Heart Attack

15 minutes

Cardiac Arrest
Video: Heart Attack and the Cardiac Chain of Survival

5 minutes

CPR
Video: CPR—Adult and Child
Skill: CPR—Adult and Child
Video: CPR—Infant
Skill: CPR—Infant

40 minutes

Two-Rescuer CPR
Video: Two-Rescuer CPR—Adult and Child
Skill: Two-Rescuer CPR—Adult and Child
Video: Two-Rescuer CPR—Infant
Skill: Two-Rescuer CPR—Infant

15 minutes

When the Heart Stops and AEDs

5 minutes

Using an AED
Video: Using an AED
Skill: Using an AED
Video: Using an AED—CPR in Progress

15 minutes

AED Precautions and Maintenance

10 minutes

Putting It All Together: Multiple-Victim Response
Video: Putting It All Together: Multiple-Rescuer Response—CPR in Progress

5 minutes

In-Water Skill Session: Putting It All Together

40 minutes

Lesson 6, Total Time

2 hours 30 minutes

LESSON 7—FIRST AID

Activity

Time

Review—Surveillance Activities
Video: Review—Surveillance Activity 2

5 minutes

Secondary Assessment

5 minutes

Sudden Illness
Video: Responding to Sudden Illnesses

10 minutes

Responding to Injuries
Video: Responding to Injuries
Skill: Controlling Bleeding
Skill: Splinting

45 minutes

Putting It All Together—First Aid Scenarios

20 minutes

Caring for Head, Neck and Spinal Injuries on Land
Video: Head, Neck and Spinal Injuries on Land
Skill: Caring for a Nonstanding Victim of a Suspected Head, Neck or Spinal Injury on Land
Skill: Caring for a Standing Victim of a Suspected Head, Neck or Back Injury on Land

10 minutes

When Things Do Not Go as Practiced
Video: When Things Do Not Go as Practiced

5 minutes

In-Water Skill Session: When Things Do Not Go as Practiced
Skill: Front Head—Hold Escape in Shallow Water
Skill: Rear Head—Hold Escape in Shallow Water
Skill: In-Water Ventilations—Shallow Water

30 minutes

In-Water Skill Session: Rescue Skill Review

30 minutes

Lesson 7, Total Time

2 hours 40 minutes

LESSON 8—HEAD, NECK AND SPINAL INJURIES IN THE WATER

Activity

Time

Final Written Final Exam: Section 1—CPR/AED for the Professional Rescuer and First Aid

40 minutes

Caring for Head, Neck and Spinal Injuries in the Water
Video: Head, Neck and Spinal Injuries in the Water

10 minutes

In-Water Skill Session: Head, Neck and Spinal Injuries
Skill: Head Splint—Face-Up Victim At or Near the Surface in Shallow Water
Skill: Head Splint—Face-Down Victim At or Near the Surface in Shallow Water
Skill: Head Splint—Submerged Victim in Shallow Water
Skill: Spinal Backboarding Procedure

100 minutes

Lesson 8, Total Time

2 hours 30 minutes

LESSON 9—FINAL WRITTEN EXAM AND FINAL IN-WATER SKILL SCENARIOS

Activity

Time

Review of the Final Written Exam: Section 1—CPR for the Professional Rescuer and First Aid

5 minutes

Final Written Exam: Section 2—Shallow Water Lifeguarding Skills

30 minutes

In-Water Skill Session: General Skills Review

30 minutes

Final In-Water Skill Scenarios
Skill: Final Scenario: Head, Neck or Spinal Injury in Shallow Water
Skill: Final Scenario: Active Victim in Deep Water
Skill: Final Scenario: Submerged Passive Victim in Deep Water—Team Response

90 minutes

Closing

5 minutes

Lesson 9, Total Time

2 hours 40 minutes

TOTAL COURSE TIME

24 hours

PRECOURSE SESSION

MATERIALS, EQUIPMENT AND SUPPLIES

    A 10-pound object (a diving brick or weight; one for every five participants)

    Stopwatch

    Lifeguarding Precourse Skills Checklist (redcross.org/instructorscorner)

TOPIC: INTRODUCTION TO THE PRECOURSE SESSIONimages

Activity

    Welcome prospective participants and introduce yourself. Identify yourself as an American Red Cross instructor. Briefly tell about your background in aquatics. Include co-instructors and aides, if applicable.

    Review facility policies, including emergency procedures. Give the locations of restrooms, locker rooms, water fountains and details unique to your facility. Also, identify the location of the automated external defibrillator (AED) and first aid kit.

    Have participants briefly introduce themselves.

    Explain the purpose of the Lifeguarding course is to teach the knowledge and skills needed to help prevent and respond to aquatic emergencies. This includes land and water rescue skills as well as first aid and CPR/AED.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, explain that the purpose of the course is to teach the knowledge and skills needed to help prevent and respond to aquatic emergencies in water up to 5 feet deep.

    Explain to prospective participants that this precourse session is designed to evaluate their swimming skills. Participants who successfully complete the precourse skills evaluation should be able to participate in the Red Cross Lifeguarding course.

Instructor’s Note: Review the prerequisite skills only for the course and/or modules you are teaching.

    Review the prerequisite skills to be performed for their course and/or module:

    Lifeguarding course or Waterpark Skills module prerequisite skills:

1.    Swim 300 yards continuously demonstrating breath control and rhythmic breathing. Candidates may swim using the front crawl, breaststroke or a combination of both but swimming on the back or side is not allowed. Swim goggles may be used.

2.    Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

3.    Complete a timed event within 1 minute, 40 seconds.

    Starting in the water, swim 20 yards. The face may be in or out of the water. Swim goggles are not allowed.

    Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object.

    Return to the surface and swim 20 yards on the back to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. Candidates should not swim the distance under water.

    Exit the water without using a ladder or steps.

    Waterfront Skills module prerequisite skills:

1.    Swim 550 yards continuously demonstrating breath control and rhythmic breathing. Candidates may swim using the front crawl, breaststroke or a combination of both but swimming on the back or side is not allowed. Swim goggles are allowed.

2.    Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

3.    Complete a timed event within 1 minute, 40 seconds.

    Starting in the water, swim 20 yards. The face may be in or out of the water. Swim goggles are not allowed.

    Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object.

    Return to the surface and swim 20 yards to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. Candidates should not swim the distance under water.

    Exit the water without using a ladder or steps.

4.    Swim 5 yards, submerge and retrieve three dive rings placed 5 yards apart in 4 to 7 feet of water, resurface and continue to swim another 5 yards tocomplete the skill sequence.

    Shallow Water Lifeguarding course prerequisite skills:

1.    Swim 100 yards continuously demonstrating breath control and rhythmic breathing. Candidates may swim using the front crawl, breaststroke or a combination of both but swimming on the back or side is not allowed. Swim goggles are allowed.

2.    Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

3.    Complete a timed event within 50 seconds.

    Starting in the water, swim 20 yards using the front crawl or breaststroke. The face may be in or out of the water. Swim goggles are not allowed.

    Submerge to a depth of 4 to 5 feet to retrieve a 10-pound object.

    Return to the surface and walk or swim 20 yards to return to the starting point with both hands holding the object at the surface of the water.

    Exit the water without using a ladder or steps.

Instructor’s Notes:

    When teaching the Lifeguarding course, if the maximum water depth is 6 feet, an alternate timed event is permitted as described in the swimming skills evaluation section below.

    If a Waterfront Skills module is scheduled to immediately follow the Lifeguarding course and all candidates are enrolled in both the Lifeguarding course and Waterfront Skills module, you should conduct the precourse session for the Waterfront Skills module instead of the Lifeguarding precourse session.

    If the prerequisite evaluation for Waterfront Lifeguarding is not completed at this time, then it must be completed as a precourse session for the Waterfront Skills module.

TOPIC: VERIFICATION OF AGE PREREQUISITEimages

Activity

    Tell prospective participants that to participate in any Red Cross Lifeguarding course or module they must be at least 15 years of age on or before the final scheduled session of this course.

    Verify the eligibility of participants to participate in the course by checking their proof of age, which can be a driver’s license, state identification, birth certificate or passport.

    If an individual does not meet the age requirements for course participation, suggest that he or she enroll in the next available Lifeguarding course once the age requirement is met.

    Orient them to the locker rooms and the pool area where they are to meet for the prerequisite swimming skills evaluation.

TOPIC: PREREQUISITE SWIMMING SKILLS EVALUATIONimages

Instructor’s Note: Have participants perform the prerequisite skills only for the course and/or module you are teaching.

Activity

    Explain to prospective participants that they must successfully complete three swimming prerequisites to continue in the Lifeguarding course.

    Refer to the Skill Assessment Chart to evaluate performance of each prospective participant. Record completion of each skill on the Lifeguarding Precourse Skills Checklist.

Lifeguarding Course and Waterpark Skills Module

Prerequisite 1—300-Yard Swim

    Explain to prospective participants that they must perform a 300-yard continuous swim using the front crawl, breaststroke or a combination of both. Swimming on the back or side is not permitted. Swim goggles are allowed.

Prerequisite 2—Tread Water

    Explain to prospective participants that they must tread water for 2 minutes without support and without stopping. When treading, only the legs can be used. Candidates should place their hands under the armpits. The head must remain above the surface of the water.

Prerequisite 3—Timed Event

    Arrange the swim distance of 20 yards and place a 10-pound object at a depth of 7 to 10 feet.

    Explain that goggles are not allowed for this event.

    Evaluate each prospective participant on the following skill to be performed within 1 minute and 40 seconds

    Starting in the water, swim 20 yards. The face may be in or out of the water

    Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object

    Return to the surface and swim 20 yards to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. The participants should not swim the distance under water

    Exit the water without using a ladder or steps.

Waterfront Skills Module

Prerequisite 1—550-Yard Swim

    Explain to prospective participants that they must perform a 550-yard continuous swim using the front crawl, breaststroke or a combination of both. Swimming on the back or side is not permitted. Swim goggles are allowed.

Prerequisite 2—Tread Water

    Explain to prospective participants that they must tread water for 2 minutes without support and without stopping. When treading, only the legs can be used. Candidates should place their hands under the armpits. The head must remain above the surface of the water.

Prerequisite 3—Timed Event

    Arrange the swim distance of 20 yards and place a 10-pound object at a depth of 7 to 10 feet.

    Explain that goggles are not allowed for this event.

    Evaluate each participant on the following skill to be performed within 1 minute and 40 seconds

    Starting in the water, swim 20 yards using the front crawl or breaststroke. The face may be in or out of the water

    Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object

    Return to the surface and swim 20 yards to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. The participants should not swim the distance under water

    Exit the water without using a ladder or steps.

Prerequisite 4—UnderwaterSwim

    Arrange the swim distance area, placing three dive rings 5 yards apart in 4 to 7 feet of water.

    Explain that goggles are not allowed for this event.

    Evaluate each participant on the following skill

    Starting in the water, swim 5 yards. The face may be in or out of the water

    Submerge, swim under water and retrieve three dive rings placed 5 yards apart in 4 to 7 feet of water

    Return to the surface after picking up all three dive rings and continue to swim another 5 yards to complete the skill sequence.

Shallow Water Lifeguarding Course

Prerequisite 1—100-Yard Swim

    Explain to prospective participants that they must perform a 100-yard continuous swim using the front crawl, breaststroke or a combination of both. Swimming on the back or side is not permitted. Swim goggles are allowed.

Prerequisite 2—Tread Water

    Explain to prospective participants that they must tread water for 2 minutes without support and without stopping. When treading, only the legs can be used. Candidates should place their hands under the armpits. The head must remain above the surface of the water.

Prerequisite 3—Timed Event

    Arrange the swim distance of 20 yards and place a 10-pound object at a depth of 4 to 5 feet.

    Explain that goggles are not allowed for this event.

    Evaluate each participant on the following skill to be performed within 50 seconds

    Starting in the water, swim 20 yards using the front crawl or breaststroke or a combination of both. The face may be in or out of the water

    Submerge to a depth of 4 to 5 feet to retrieve a 10-pound object.

    Return to the surface and walk or swim 20 yards to return to the starting point with both hands holding the object at the surface of the water

    Exit the water without using a ladder or steps.

    For pools with maximum water depth of 6 feet deep, candidates should complete the following alternate timed event:

    Starting in the water, swim at the surface for 20 yards. The face may be in or out of the water. Swim goggles are not allowed/

    Surface dive to a depth of 6 feet, swim 10 to 15 feet along the bottom and retrieve a 10-pound object

    Return to the surface and swim on the back to the starting point with both hands holding the object at the surface and the face remaining at or near the surface or able to get a breath. Candidates should not swim the distance underwater.

Instructor’s Note: When determining a participant’s ability to pass the prerequisite swimming skills evaluation and successfully participate in the course, the instructor must evaluate the individual’s overall performance. The prerequisite swimming skills evaluation is designed to assess the individual’s strength, endurance and comfort in the water. The individual should not be judged on stroke mechanics, but rather on his or her overall demonstration of swimming strength, endurance, comfort in the water and ability to meet the time requirements.

If a candidate is not successful on the first attempt, he or she has only one opportunity to reattempt the prerequisites after sufficient rest. If the candidate does not successfully perform the prerequisites, ask him or her to see the instructor after class to schedule a retest to take place before the first scheduled class session, time permitting.

TOPIC: WRAP-UPimages

    Respond to participants’ questions.

    Provide participants with information on the first class session, including the time of the class and location. Review the full course schedule and basic course outline, including test dates.

    Provide participants who have passed the precourse evaluation with a copy of the American Red Cross Lifeguarding Manual. All participants must have a copy of the manual—digital or print—for use during the course. Instruct participants to read Chapter 1, The Professional Lifeguard, and Chapter 2, Facility Safety, in the Lifeguarding Manual before the first class session.

Counseling After the Precourse Session

    On an individual basis, after the precourse session has ended, advise each participant who did not meet the prerequisites that:

    Entry into the Red Cross Lifeguarding course is strictly limited to those who meet the minimum age requirement and have successfully completed the prerequisite swimming skills evaluation

    Failure to have attained the appropriate skill level could pose a safety threat to themselves and to others in the class.

    Suggest appropriate developmental training opportunities and explain the specific skills that the individual needs to improve to be eligible to take the Lifeguarding course in the future.

    Direct individuals to contact the local Red Cross chapter for more information.

SKILL ASSESSMENT TOOL

Participants must meet the criteria listed at the proficient level to be checked off as passing the prerequisite skill evaluation.

SKILL ASSESSMENT TOOL: LIFEGUARDING AND SHALLOW WATER LIFEGUARDING COURSES AND WATERFRONT AND WATERPARK SKILLSMODULES PREREQUISITES

Criteria

Proficient

Not Proficient

Continuous swim

    Swims designated distance continuously using front crawl, breaststroke or a combination of both without stopping to rest

    Demonstrates comfort in deep water

    Swims with face in the water and demonstrates breath control (slight hesitation during breathing acceptable)

    Maintains body position that is nearly horizontal to the surface

    Uses above-water arm recovery for the front crawl

    Leg action contributes to forward momentum

    Cannot swim designated distance continuously

    Swims on the back or side

    Stops to rest during a turn at a wall

    Stops swimming, stands on the bottom or clings to rope, lane line or other support

    Refuses to swim in deep water

    Swims with head or face out of the water

    Does not demonstrate breath control or rhythmic breathing

    Body position is near vertical

    Uses underwater arm recovery for the front crawl

    No leg action or leg action that does not contribute to forward momentum

Tread water

    Treads water for 2 minutes

    Body position is near vertical

    Head remains above the surface

    Uses legs only

    Unable to tread water for 2 minutes

    Body position is near horizontal—prone or supine

    Stands on the bottom or clings to rope, lane line or other support

    Swims rather than treads

    Mouth sinks below the surface

    Uses arms while treading

Timed event

    Completes the prerequisite event within the designated time

    Submerges and retrieves a 10-pound object

    Swims back to the side, holding the object in both hands while keeping the face at or near the surface of the water (Note: Shallow Water Lifeguarding candidates can swim or walk)

    Exits the water without using ladder or stairs

    Does not complete the prerequisite event within the designated time

    Does not submerge far enough to reach the 10-pound object

    Does not locate the 10-pound object

    Does not lift the 10-pound object and return to the surface

    Returns to the side holding the object in one hand

    Returns to the side underwater with the object and without taking a breath

    Unable to exit the water without ladder or stairs

Waterfront Skill Module Only
Underwater swim event

    Swims 5 yards

    Submerges, swims and retrieves three dive rings

    Swims to the side with three dive rings

    Walks along the bottom

    Does not submerge enough to reach the dive ring(s)

    Surfaces before retrieving all three dive rings

    Does not retrieve all three dive rings

    Does not swim back with three dive rings

LESSON 1

THE PROFESSIONAL LIFEGUARD AND FACILITY SAFETY

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Describe the characteristics and responsibilities of a professional lifeguard.

    Define certain legal considerations and apply them to situations that might be encountered in lifeguarding.

    Describe ongoing training for lifeguards.

    Describe what it means to work as part of a lifeguard and safety team.

    Describe the role lifeguards play in ensuring facility safety.

    Identify how to ensure the safety of patrons when weather conditions create safety concerns.

    Explain the reasons for common rules and regulations at aquatic facilities.

    Demonstrate how to safely and effectively enter the water and approach a victim.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Activity Worksheet 1.1—Reasons for the Rules

TOPIC: INTRODUCTION TO THE COURSEimages

Welcome and Introduction to the Course

Activity

    Welcome participants and introduce yourself, including your background in aquatics and certification as an American Red Cross instructor. Include co-instructors and aides if applicable.

    Have participants introduce themselves.

    Review facility policies and procedures, and give locations of restrooms, water fountains, break areas and details unique to your facility. Also, point out where the exits are located as well as where the automated external defibrillators (AEDs) are located.

    Review the course schedule and basic outline, including written exam dates.

    Explain to participants that the primary purpose of the Lifeguarding course is to learn the knowledge and skills needed to prevent and to respond to aquatic emergencies. The course content and activities prepare participants to recognize and respond quickly and effectively to emergencies and prevent drowning and injuries.

    SHALLOW WATER LIFEGUARDING

    When conducting the Shallow Water Lifeguarding course, explain to participants that the primary purpose of the course is to learn the knowledge and skills needed to prevent and to respond to aquatic emergencies in shallow water up to 5 feet deep.

    Explain the requirements for successful completion of the course:

    Attend and participate in all class sessions.

    Demonstrate competency in all required skills and activities.

    Demonstrate competency in all required final rescue skill scenarios.

    Correctly answer at least 80 percent of the questions in each of the two sections of the final written exam.

    Explain that upon successful completion of the Lifeguarding course, each participant will receive an American Red Cross Universal Certificate for Lifeguarding/First Aid/CPR/AED, which is valid for 2 years.

    SHALLOW WATER LIFEGUARDING

    Explain that upon successful completion of the Shallow Water Lifeguarding course, each participant will receive an American Red Cross Universal Certificate for Shallow Water Lifeguarding (up to 5 feet)/First Aid/CPR/AED, which is valid for 2 years.

    Explain the ground rules for the course.

    Participants must demonstrate a professional attitude and mature behavior, including, but not limited to:

    Being prepared for all class activities, including appropriate swimwear for all in-water skill sessions.

    Completing reading assignments.

    Behaving appropriately during activities.

    Making an effort to improve skills during practice sessions.

    Treating others with respect.

    Following all pool safety rules and any additional safety precautions as explained throughout the course.

    Demonstrating respect for the facility and equipment used in the course.

    Ask participants to turn off or silence cell phones and refrain from using electronic devices during all class sessions, with the exception of accessing digital course materials.

    Explain that participants should secure any items of value or avoid bringing them to class if possible.

TOPIC: THE PROFESSIONAL LIFEGUARDimages

PRESENTATION: THE PROFESSIONAL LIFEGUARD

Video Segment

    Explain to participants that as they begin their training as lifeguards it is important to understand that they:

    Must take responsibility to help protect the lives of people in a variety of aquatic activities.

    Must maintain a high level of knowledge and skills for being a professional rescuer.

    Will have the legal responsibility to act in an emergency.

    Will need to develop skills for effective communication with the public.

    Must be willing to be a leader as well as a good team member.

    Will need to demonstrate maturity, professionalism and competence in specialized rescue techniques.

    Explain to participants that the following video segment will introduce them to the professional aspects of lifeguarding.

    Show the video segment, “The Professional Lifeguard.”

    Answer participants’ questions about the video segment.

Guided Discussion

    Ask participants: What characteristics of a professional lifeguard were discussed or illustrated in the video segment?
Answers: Responses should include the following:

    Knowledgeable

    Able to perform appropriate skills

    Reliable

    Mature

    Courteous and consistent

    Positive

    Professional

    Healthy and fit

    Ask participants: What behaviors would demonstrate a lack of professionalism?
Answers: Responses should include the following:

    Leaving lifeguard station while on surveillance duty

    Using mobile phones or other electronic devices while on duty

    Slouching posture

    Talking with others while on surveillance duty

    Eating while on surveillance duty

    Your primary responsibility as a lifeguard is to help ensure patron safety and protect lives.

    Ask participants: What are some tasks that should be the lifeguard’s primary responsibility?
Answers: Responses should include the following:

    Monitoring activities in and near the water through patron surveillance

    Preventing injuries by minimizing or eliminating hazardous situations or behaviors

    Enforcing facility rules and regulations and educating patrons about them

    Recognizing and responding quickly and effectively to all emergencies

    Administering first aid and CPR or using an AED in an emergency and, if trained, administering emergency oxygen when necessary

    Working as a team with other lifeguards, facility staff and management

    Ask participants: What are some examples of secondary tasks that a lifeguard might be asked to perform while not responsible for primary responsibilities?
Answers: Responses should include the following:

    Testing pool water chemistry

    Assisting patrons (e.g., conducting safety orientations, administering swim tests and fitting life jackets)

    Cleaning or performing maintenance

    Completing records and reports

    Performing opening duties, closing duties or facility safety checks and inspections.

    Ask participants: What are the different places shown in the video where a person might work as a lifeguard?
Answers: Responses should include the following:

    Swimming pools

    Multi-attraction aquatic facilities

    Waterfronts with nonsurf swimming areas

    Waterparks

    Shallow Water Lifeguarding is available for lifeguards who plan to work at shallow water facilities only with a water depth not to exceed 5 feet deep.

    Additional training, such as the Waterfront Skills or Waterpark Skills modules, are required for work in some of the environments shown in the video.

    Lifeguards who plan to work in a waterpark or waterfront setting should complete the appropriate additional module to be equipped with the additional skills needed.

    The prerequisites for the Waterpark Skills module are the same as for the Lifeguarding course.

    The Waterfront Skills module includes additional prerequisites that must be completed prior to participating in the module.

TOPIC: DECISION MAKINGimages

PRESENTATION: DECISION MAKING

Lecture

    Decision making is an important component of lifeguarding. In an emergency, such as a situation requiring a water rescue or performing CPR, your facility should have established emergency action plans (EAPs) that enable you to act quickly.

    In a non-emergency situation, such as working with your manager or deciding how to address inappropriate patron behaviors, you can take more time in deciding how best to respond.

TOPIC: LEGAL CONSIDERATIONSimages

PRESENTATION: LEGAL CONSIDERATIONS

Guided Discussion

    Refer participants to Chapter 1, The Professional Lifeguard, in the Lifeguarding Manual to answer the questions in the guided discussion activity and to apply the legal considerations to the scenario.

    As a lifeguard, you need to understand the legal principles involved in being a professional rescuer.

Scenario: You are the lifeguard on duty when you see a young boy running on the deck.

    You have a duty to act to prevent injuries. What should you do to prevent the child from slipping and falling?
Answer: Tell the child to walk on the deck and explain that he could get hurt by slipping and falling.

    If you had not tried to stop the child from running and then the child got hurt, what legal principle could be a problem for you?
Answer: Negligence. Lifeguards have a duty to help prevent patron behaviors that place them at risk of injury.

After you warn the child about the dangers, he once again runs and now slips and falls on the deck. His knee is bleeding and he complains that it hurts. His mother arrives on the scene.

    What must you do before you can provide care for this child?
Answer: Ask the mother for her consent to allow you to help the child.

    What should be stated when asking for consent?
Answers: Responses should include the following:

    State your name.

    State your level of training.

    Ask the mother if you may help her son.

    Explain to the mother what you think may be wrong.

    Explain what you plan to do to provide care (clean the wound, apply ice, etc.).

The child is very frightened so the mother takes the child in her arms and refuses the lifeguard’s offer to care for the child’s injury.

    How should you respond to the mother at this point since she has refused care?
Answers: Responses should include the following:

    You should explain why he needs care.

    You should let the mother know that you are there to help if she changes her mind.

    What should you do if the mother continues to refuse care for her son?
Answer: You must document any refusal of care. Someone else, such as another lifeguard, should witness the person’s refusal of care and sign the incident report as a witness to the refusal of care. If the person who refuses is willing, have him or her sign the report as well.

The mother decides to allow you to care for the child’s injury after all.

    If you failed to provide the proper care or provided care that was beyond your level of training, and as a result, the boy suffers further injury, what legal principle could be a problem for you?
Answer: Negligence.

You are treating the injury and realize it is time for your shift to end.

    What legal problem could come about if you stop caring for the young boy?
Answer: Abandonment, which is a type of negligence.

TOPIC: CONTINUATION OF TRAININGimages

PRESENTATION: CONTINUATION OF TRAINING

Lecture and Guided Discussion

    Successfully completing the Lifeguarding course does not guarantee employment. You can expect that employers will require their own evaluation of your swimming and rescue skills before deciding whether to hire you as a lifeguard.

    The skills learned in the Lifeguarding course need to be practiced frequently.

    Ask participants: What do you think should be included in an orientation session for new lifeguards at a facility?
Answers: Responses should include the following:

    Features of the facility that might differ from the place where the lifeguard was trained

    Job responsibilities

    Facility operations

    Management’s expectations

    Facility rules that need to be enforced

    Annual or preseason orientation and training often occurs prior to the summer season since summer typically the busiest season for aquatic facilities. This training should include a review of knowledge and skills for:

    Lifeguarding.

    CPR/AED.

    First aid.

    Facility-specific protocols.

    Facility management also must provide training to meet government requirements for occupational safety, including yearly bloodborne pathogen training.

    A policies and procedures manual provides you with important information, including:

    Administrative policies and procedures, such as job descriptions.

    Personnel policies and guidelines, such as uniform requirements, scheduling information and job performance evaluation procedures.

    Standard operating procedures, such as facility rules and emergency procedures.

    In-service training should take place on a regular basis at the facility where you work. It is designed to help you maintain your knowledge and skills at a professional level. It also provides an opportunity for lifeguards to practice working as a team in emergencies.

    It is a best practice of many well-managed facilities that lifeguards participate in a minimum of 4 hours of in-service training each month.

    Topics that might be covered during in-service training include:

    Surveillance and recognition.

    Water and land rescue skills.

    Emergency response drills.

    Decision-making protocols.

    Facility rules and regulations.

    Customer service.

    Records and reports.

    Physical conditioning.

    Periodic lifeguard evaluations may be performed by your employer or through a contracted agency, such as the Red Cross, or a combination of both. The evaluations may be announced or unannounced and may include observation of lifeguards performing patron surveillance, skills evaluations and a check of the aquatic facility related to lifeguard operations.

    Facilities also may offer lifeguards the opportunity to pursue further training for other jobs in the area of aquatics as well as preparation for a full-time career. For example:

    The Red Cross Lifeguarding Instructor course, for ages 17 and up, provides training for teaching Lifeguarding courses.

    The Red Cross Lifeguard Management course provides training for head lifeguards and managers of an aquatic facility.

    The Red Cross Water Safety Instructor course, for ages 16 and up, provides training for teaching Red Cross swim lessons and water safety courses.

    Various organizations offer pool operator training for those that will be responsible for the actual mechanical and chemical operations of the pool.

TOPIC: BEING PART OF A TEAMimages

PRESENTATION: BEING PART OF A TEAM

Human Knot Team-Building Activity

Activity

    Divide the class into teams of six to eight people. Have each team move to a location that allows them to stand shoulder to shoulder in a small circle.

    Instruct members of each team to form a human pretzel by having each person extend the left hand across the circle and grasp the left hand of someone else not directly next to him or her. Then have each person extend his or her right hand across the circle and grasp the right hand of another, different person.

    Inform the teams that their task is to unravel their interlocking arms without letting go of anyone’s hands and without causing injury. If group members break the chain, they must repair the break the way it was or start over.

    Stop the activity after about 8 minutes if the group is unsuccessful at making the circle without breaking the chain of hands. It is sometimes impossible to get to a single circle.

Guided Discussion

    Ask participants the following:

    How did it feel to be successful or unsuccessful?

    What strategy did your team use to complete the task?

    Who were the leaders in this activity?

    Did the team reach consensus on a plan of action or take action without a plan?

    How well did your team communicate during this activity?

    If you could do it again, what would you change?

    Just as in the human-knot activity, the lifeguard team must communicate and work together effectively when responding to emergencies.

    Effective communication, trust, mutual respect, commitment and cooperation are crucial elements for working effectively as a team.

    Ask participants: In your job as a lifeguard, aside from being a team player while responding to emergencies, what can you do as an individual to have a positive effect on the team?
Answers: Responses should include the following:

    Arriving to work on time

    Rotating stations on time

    Attending in-service trainings

    Enforcing safety rules in a consistent manner

    Communicating clearly while treating others with respect

    Being prepared by maintaining knowledge, skills and physical fitness

    Completing secondary responsibilities in a timely and acceptable fashion

    As lifeguards, you should be given an EAP that guides the actions of lifeguards and other team members in emergencies. The EAP describes what needs to be done and who does it in the event of an emergency. EAPs are discussed in more detail later in the course.

    The lifeguard team is part of the broader facility safety team.

    The safety team includes management and maintenance staff who provide assistance in maintaining a safe environment and providing emergency care.

    Local emergency response personnel also are part of the safety team.

TOPIC: FACILITY SAFETYimages

PRESENTATION: FACILITY SAFETY

Lecture and Guided Discussion

    Aquatic facilities must have the appropriate rescue equipment available and in proper working order at all times for emergency response.

    As a lifeguard, you must always wear or carry certain equipment so that it is instantly available in an emergency, including a rescue tube, resuscitation mask and gloves. You also must have a whistle to signal an emergency.

Activity

    Ask a volunteer to come forward to demonstrate how to wear the rescue tube while in an elevated lifeguard station and a ground-level station.

    The demonstration should include the following:

    Keep the strap of the rescue tube over the shoulder and neck.

    Hold or gather the excess line to keep it from getting caught in the chair or other equipment when you move or start a rescue.

    Hold the rescue tube across the thighs in an elevated station.

    Hold the rescue tube across the stomach when standing.

    Ask participants: Why should you wear the hip pack at all times, whether or not you are on surveillance duty?
Answer: To be prepared to respond to an emergency at all times, whether or not performing surveillance duty.

    Explain that the type of rescue equipment, such as backboards, can vary among facilities and they will need to be trained to use the specific pieces of equipment at the facility where they will be employed.

    Explain that rescue equipment can be expensive to purchase and maintain and should be treated respectfully.

Activity

    Explain to participants that one of their most important responsibilities as a lifeguard will be to help ensure that the aquatic facility is safe.

    Lead participants through the following scenarios to review what they should do during a facility safety check when an issue or problem is found.

Scenario 1: You are conducting an opening facility safety check and you find a loose bolt on a pool ladder.

    Ask participants: What should you do?
Answers: Responses should include the following:

    Document and report the loose bolt to management staff, identifying the specific ladder and bolt.

    Fix the problem by seeing that the bolt is tightened properly before the facility is opened.

    If the bolt cannot be tightened, block off the ladder so that it cannot be used until it is repaired.

Scenario 2: You are on duty conducting patron surveillance and a patron reports to you that someone spilled shampoo in the locker room and the floor is very slippery.

    Ask participants: What should you do?
Answers: Responses should include the following:

    Thank the patron for bringing it to your attention.

    Clarify the specific location.

    Signal for assistance from another staff member who is not performing patron surveillance so they can take care of it.

    Remind participants that facility safety checks are a secondary responsibility and must not be done while performing patron surveillance.

    Explain that if during your surveillance you observe problems with equipment or other problems are rported to you, you should notify a member of the safety team, a lifeguard supervisor or another lifeguard who is not performing surveillance.

TOPIC: WEATHER CONDITIONSimages

PRESENTATION: WEATHER CONDITIONS

Lecture

    Weather affects the safety of swimmers both outdoors and indoors.

    Facility management should monitor weather alerts using a weather radio or other electronic communications. Management should keep lifeguards informed when there are severe weather alerts, and lifeguards should keep management informed when they see indications of severe weather.

    You will need to know and follow facility procedures to clear patrons from the water and deck before an impending storm.

    If thunder or lightning occur:

    Clear everyone from the water at the first sound of thunder or first sight of lightning.

    If you are in an elevated station, get down immediately.

    Move everyone to a safe area free from contact with water, plumbing or electrical circuits.

    For outdoor facilities, move everyone inside, if possible.

    Keep patrons and staff out of showers and locker rooms during a thunderstorm as water and metal can conduct electricity.

    Do not use a telephone connected to a landline except in an emergency.

    Keep everyone away from windows and metal objects.

    Watch for more storms and monitor weather reports on a radio or TV broadcast, weather radio or website.

    The National Lightning Safety Institute recommends waiting 30 minutes after the last lightning sighting or sound of thunder before resuming activities.

    If caught outside in a thunderstorm and there is not enough time to reach a safe building:

    Keep away from tall trees standing alone and any tall structures.

    Keep away from water and metal objects.

    Keep as low to the ground as possible but do not lie on the ground: squat or crouch with the knees drawn up, both feet together and hands off the ground.

    Other weather conditions, such as fog, wind or heavy rain, also may cause safety concerns. Clear the pool or waterfront if visibility is impaired by waves or increased turbidity.

    In the event of a power failure, you should clear the pool because circulation and filtration of pool water will not be possible. If weather conditions cause safety concerns, you also should clear the deck.

TOPIC: RULES AND REGULATIONSimages

PRESENTATION: RULES AND REGULATIONS

Activity

    Explain that each aquatic facility establishes its own set of rules and regulations. Some are required by the state or local health department, whereas others are determined by the facility itself. Lifeguards must know and enforce all facility rules.

    Explain that rules are communicated to patrons by signage as well as verbally when lifeguards enforce the rules.

    Divide the class into small groups. Distribute Activity Worksheet 1.1—Reasons for the Rules. Assign each group different sections of the worksheet.

    Refer participants to Chapter 2, Facility Safety, in the Lifeguarding Manual for information to help them with this activity. Explain that there are five common rules for each category or type of facility or attraction. These are not the “most important” rules, but rather common rules. The intent of this activity is to provide a wide range of rules so that participants gain an understanding of the rationale for different types of rules.

    Allow approximately 5 minutes for groups to discuss the reasoning behind the assigned rules.

    Reassemble the class and call on group leaders to share their answers.

Activity Worksheet 1.1—Reasons for the Rules

Answers: Responses should include the following:

Aquatic Facilities—General

Reason

1.   Swim only when a lifeguard is on duty.

There are inherent risks in aquatic environments, and lifeguards are trained to respond to aquatic emergencies. Statistics indicate that survival rates after emergencies are higher in areas where lifeguards are present.

2.   No running, pushing or rough play.

Running, pushing and rough play can result in injuries, especially in an aquatic environment with slippery surfaces, such as the tile deck of an indoor pool.

3.   Dive only in designated areas.

Diving head-first in shallow water can result in head, neck and spinal injuries.

4.   No diving in shallow water (water up to 5 feet deep).

Diving head-first in shallow water can result in head, neck and spinal injuries.

5.   No glass containers in the pool area and locker rooms.

Broken glass poses several dangers, including bleeding injuries and exposure to infectious body fluids.

6.   No alcoholic beverages or other drug use allowed.

The use of alcohol and drugs can impair a patron’s judgment, balance and motor skills.

Waterfront Facilities

1.   No playing or swimming under piers, rafts, platforms or play structures.

Lifeguards cannot see under these structures. Patrons may surface quickly and injure themselves on these structures without the lifeguard observing them.

2.   No running and diving head-first into shallow water.

Diving head-first in shallow water or under a breaking wave can result in a head, neck or spinal injury.

3.   No fishing near swimming areas.

Fishing hooks and tackle left in swimming areas can present a risk of injury.

4.   No umbrellas at the waterline.

Beach umbrellas positioned close to the shoreline may obstruct the view of the lifeguard.

5.   No swimming in unauthorized areas.

Unauthorized areas are not protected by lifeguards, and may have hidden hazards, such as drop-offs or underwater obstructions. Watercraft could be present in unauthorized areas, posing a danger to swimmers.

Waterpark Facilities, including Winding Rivers and Waterslides

1.   Designated age, height or weight requirements for using an attraction

Age, height or weight requirements are designated to help ensure that patrons can safely enjoy the attraction. For example, some attractions require a certain minimum weight for it to function properly, whereas others are designed only for persons with the small build of young children.

2.   Enter and exit the winding river only at designated places.

Entrance and exit areas typically are recessed from the winding river, creating an area where the water current is minimized and patrons can enter and exit without interfering with patrons in the main current.

3.   Stay in tubes at all times.

Stray tubes obstruct a lifeguard’s view of patrons who are not riding on tubes. Lifeguards are trained to suspect problems when tubes are floating without riders.

4.   No metal objects, locker keys, jewelry, metal snaps/zippers, eyewear or watches, including metal rivets, buttons or fasteners on swimsuits or shorts.

These items can cause injury to the person riding the waterslide. Sharp objects also can scratch or gouge the waterslide, causing rough edges that then could hurt others using the slide.

5.   No running, stopping, standing, kneeling, rotating or tumbling on the slides.

These behaviors can cause a patron to become more disoriented when riding in the slide or entering the catch pool, creating the potential for injury.

Diving Areas

1.   Patrons must demonstrate their swimming ability before entering deep water.

Anyone swimming in deep water should be competent, comfortable and able to swim to the side of the pool from any spot in the deep area.

2.   Only one patron on the diving board at a time.

By maintaining orderly use of the diving board, such as allowing only one patron on the diving board itself and one patron on the ladder at a time, lifeguards help to create a safer environment. Patrons can get restless waiting in line, which can result in rough play on either the ladder or the diving board; a patron could slip on either the board or ladder, causing injury to him- or herself or others. Allowing multiple patrons on a diving board also may affect its spring, which may result in injury for the patron using the diving board.

3.   Only one bounce allowed on the diving board.

Multiple bounces on the diving board can impact balance or body control and can result in a patron slipping on the board, possibly hitting the diving board on the way in.

4.   Dive or jump forward, straight out from the diving board.

The areas to each side of the diving board must remain clear to prevent injury. Jumping to the side could result in striking the side of the pool or colliding with another patron.

5.   Swim immediately to the closest ladder or wall.

Clearing the area immediately allows the next patron to use the diving board without danger to the patron in the water.

Spas, Hot Tubs and Therapy Pools

1.   Shower with soap and water before entering the water.

The temperature of the hot tub creates an environment where germs can thrive. Washing with soap and water can help keep the hot tub clean and safe for all.

2.   People with certain medical conditions are not allowed to use the spa or hot tub.

High temperatures can stress a person’s circulatory and energy systems and also can cause problems for some neurological conditions.

3.   Pregnant women and young children should seek their doctor’s approval before using a spa or hot tub.

The potential for hyperthermia is a danger for pregnant women and young children because they are less able to tolerate heat.

4.   Do not allow anyone to sit or play near the drain or suction fittings.

The suction has the potential for entrapment (i.e., holding a patron to the drain).

5.   Limit time in the spa to 10 minutes. Patrons then may shower, cool down and return briefly.

A prolonged stay in the hot tub can cause the internal body temperature to elevate to a range that can result in nausea, dizziness, fainting or hyperthermia.

TOPIC: ENTRIES AND APPROACHESimages

PRESENTATION: ENTRIES AND APPROACHES

Video Segment

    Explain that the video segment will illustrate skills for entering the water and approaching a victim, which will be practiced in the pool.

    Refer participants to the skills sheets in Chapter 6, Water Rescue Skills, in the Lifeguarding Manual.

    Show the video segment, “Entries and Approaches.”

    Answer participants’ questions about the video segment.

IN-WATER SKILL SESSION: ENTRIES AND APPROACHESimages

PRESENTATION: NEXT STEPS

Skill Practice

    Explain to participants that during the water rescue skill sessions you will demonstrate skills and guide them through practice.

    For each skill, be sure to review key points from the text and video, including instructions on how to perform each skill and reminders about when each entry or approach is appropriate.

    Explain that every rescue should begin by activating the EAP. Participants should simulate this during each practice session.

    Explain that the signals used to activate the EAP may vary among facilities. Define the method that will be used in skill sessions, including the following:

    Announce the activation of the EAP with a loud signal either mimicking a whistle or making a verbal announcement.

    Point to the victim that is in need of help.

    Lead them through the following skills using a rescue tube:

    Slide-in entry and walking approach

    Especially useful in shallow water, crowded pools or when a victim with a head, neck or spinal injury is close to the side of the pool

    Slide-in entry and swimming approach

    Especially useful in shallow water, crowded pools or when a victim with a head, neck or spinal injury is close to the side of the pool

    Stride jump and swimming approach

    When you are less than 3 feet above the water and the water is at least 5 feet deep

    Compact jump and swimming approach

    When you are more than 3 feet above the water and the water is at least 5 feet deep

    Jump from the deck into the water.

    SHALLOW WATER LIFEGUARDING

    When conducting the Shallow Water Lifeguarding course, omit the stride jump and swimming approach. The compact jump should be performed when the lifeguard is 3 feet or less above the water.

    Remind participants that if the tube slips out or if they need to swim a longer distance, let the tube trail behind. They should reposition the tube as appropriate before making contact with the victim.

    Observe each participant’s performance of the skill several times and provide corrective feedback.

    Participants should practice the skills several times. Time permitting, participants should practice the skills until they are able to meet performance criteria. Participants who cannot meet the performance criteria should be counseled to practice outside of class times if possible.

    Observe each participant’s performance of the skill and provide corrective feedback.

Skill Drill-Entries and Approaches

    Explain to participants that they now are going to practice the entry and approach skills to make decisions as to when it is appropriate to use the different entries and approaches and build fitness.

    Keep participants moving throughout these activities to develop conditioning for speed and endurance:

    Have participants simulate activating the EAP, perform a designated entry and then swim an approach stroke with a rescue tube as fast as they can for a significant distance, 25 yards if possible, climb out without using the ladder and walk quickly back to the starting point. Repeat until participants have done this several times, sometimes swimming the approach stroke with the rescue tube under their armpits and sometimes with the rescue tube trailing behind.

    Continue to follow the skill drill using the same pattern but give participants a scenario and let them decide what entry to use, such as:

    The water is murky and they cannot see the bottom. Slide-in entry

    They are guarding on the deck and the water is 4-feet deep. Compact jump

    The pool is crowded and swimmers are directly in front of them. Slide-in entry

    They are in an elevated lifeguard station that is 4 feet above the level of the water and the water is 7-feet deep. Compact jump

    They are in an elevated guard chair that is not suitable for a jump so they must climb down to enter the water. The chair could be situated in a shallow water area or not secured adequately to allow the lifeguard to jump from it. Simulate stepping down from the stand and perform a compact jump or slide-in entry

    They suspect a spinal injury close to the edge of the pool. Slide-in entry

    They are guarding a deep water area on the deck and suspect a spinal injury at the far side of the pool. Compact jump, stride jump or slide-in entry

PUTTING IT ALL TOGETHERimages

Activity

    Gather participants in the deep end to tread water. Explain that you are going to lead them through three scenarios. Have participants tread water with both hands in the air if they agree with the lifeguard’s actions.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, have participants gather at one end of the pool. Explain that you are going to lead them through three scenarios. Have participants perform a breaststroke rescue approach using a rescue tube if they agree with the lifeguard’s actions.

    For each scenario, ask several participants to share their reasons for agreeing or disagreeing.

    In between each scenario, allow participants an opportunity to rest while you facilitate a brief review of the lifeguard’s actions. Then have participants tread water again while presenting the next scenario.

Scenario 1: You are lifeguarding when your friend comes to the pool to swim with her little brother. The friend stops to talk to you about last night’s soccer game. You talk with your friend for several minutes, believing that you are demonstrating professionalism in this situation because you are being friendly with a customer. Do you agree or disagree with the lifeguard’s actions?

    Ask participants about the importance of providing undivided attention to the job, the perception of other customers who may have observed this behavior and suggestions for how the lifeguard could have handled this situation more professionally. Review other aspects of professionalism that should be demonstrated by a lifeguard.

Scenario 2: You are lifeguarding and there are only two people in the pool, a father and his child. Although you still need to inventory the first aid supplies and the father and child are in shallow water, you decide that your primary responsibility is to watch the swimmers to make sure they are safe. Do you agree or disagree with the lifeguard’s actions?

    Ask participants about the primary and secondary responsibilities of a lifeguard and how to accomplish the inventory of the first aid supplies, such as completing it at a later time or having another lifeguard do it.

Scenario 3: You are at work getting ready for your lifeguard shift when another lifeguard comments on the in-service reminder posted on the bulletin board that states that the focus of the in-service will be customer service. You state that you do not need to go because you already know how to make customers happy by letting them do what they want. Do you agree or disagree with the lifeguard’s actions?

    Ask participants about the importance of enforcing rules as well as other types of ongoing training needed by lifeguards. Discuss what constitutes good customer service. Is it just making customers happy? Emphasize that in-service training allows lifeguards to be part of the solution to problems since they can share and discuss customers’ complaints. The team of lifeguards and management personnel then can develop strategies to resolve the issues.

ASSIGNMENT

    Read Chapter 2, Facility Safety, Chapter 3, Surveillance and Recognition, and Chapter 4, Injury Prevention, in their Lifeguarding Manual before the next class session.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill.

ENTRIES

SKILL CHART: SLIDE-IN ENTRY

1.   Sit down on the edge facing the water. Place the rescue tube next to you or in the water.

2.   Lower your body into the water feet-first.

3.   Retrieve the rescue tube.

4.   Place the rescue tube across your chest with the tube under your armpits, focus on the victim and begin the approach.

SKILL CHART: STRIDE JUMP (Lifeguarding Course only)

1.   Squeeze the rescue tube high against your chest with the tube under your armpits.

2.   Hold the excess line to keep the line from getting caught on something when jumping into the water.

3.   Leap into the water with one leg forward and the other leg back.

4.   Lean slightly forward, with your chest ahead of your hips, and focus on the victim when you enter the water.

5.   Squeeze or scissor your legs together right after they make contact with the water for upward thrust.

6.   Focus on the victim and begin the approach.

SKILL CHART: COMPACT JUMP

1.   Squeeze the rescue tube high against your chest with the tube under your armpits.

2.   Hold the excess line to keep it from getting caught on the lifeguard chair or other equipment when jumping into the water.

3.   Jump out and away from the lifeguard chair, pool deck or pier. In a wave pool, time the jump to land on the crest (top) of a wave.

4.   Bend your knees and keep your feet together and flat to absorb the shock if you hit the bottom. Do not point your toes or keep your legs straight or stiff.

5.   Let the buoyancy of the rescue tube bring you back to the surface.

6.   Focus on the victim when surfacing and begin the approach.

SKILL ASSESSMENT TOOL: ENTRIES

Criteria

Proficient

Not Proficient

Equipment is properly positioned for the appropriate entry

    Control of the rescue tube maintained

    Tube held securely to the chest for the compact jump and stride jump

    Excess line held to keep it from getting caught on the lifeguard stand or other equipment

    Contact with the rescue tube not maintained

    Tube not held securely to the chest for the compact jump and stride jump

    Excess line not held

Appropriate entry is selected for the situation

Entry is safe for the rescuer, victim and surrounding persons

Entry causes a safety hazard

Focus on the victim is maintained

Upon entering (or resurfacing after a compact jump), focus on the victim or the site where the victim was last seen is maintained

Fails to look toward the victim or site where the victim was last seen

RESCUE APPROACHES

SKILL CHART: WALKING APPROACH

1.   Walk to the victim.

2.   Hold the rescue tube at your side and walk quickly toward the victim.

3.   If necessary, position the tube in front of you before contacting the victim.

SKILL CHART: SWIMMING APPROACH

1.   Swim to the victim using a modified front crawl or breaststroke.

2.   Keep the rescue tube under your armpits or torso and swim toward the victim with your head up, keeping the rescue tube in control at all times.

3.   For longer distances, or if the rescue tube slips out from under your arms or torso while you are swimming, let the tube trail behind.

4.   If necessary, reposition the rescue tube in front of you before contacting the victim.

SKILL ASSESSMENT TOOL: APPROACHES

Criteria

Proficient

Not Proficient

Approaches victim safely and quickly

Effective propulsion used for safe approach

    No effective propulsion

    Approach causes a safety hazard

Focus on the victim is maintained

Focus on the victim or the site where the victim was last seen is maintained

Fails to look toward the victim or site where the victim was last seen

Equipment is properly positioned for the appropriate approach

    Control of rescue tube is maintained during approach

    Tube is strapped on during approach

    Tube remains in position or is repositioned as needed before contact with victim

    Fails to maintain contact with the rescue tube

    Does not strap on tube during approach

    Tube is not in position for the selected rescue before contact with victim

LESSON 2

FACILITY SAFETY, PATRON SURVEILLANCE AND INJURY PREVENTION

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Describe the role that facility management plays in facility safety.

    Describe the drowning process.

    Identify the behaviors of a swimmer, distressed swimmer, and an active and a passive victim.

    Identify and define elements of effective surveillance.

    Explain proper scanning techniques and identify tactics to overcome scanning challenges.

    Identify various types of zones of surveillance.

    Explain how communication with patrons plays a role in preventing injuries.

    Explain patron surveillance techniques for various activities.

    Explain patron surveillance techniques for facilities with special attractions.

    Explain and demonstrate lifeguard rotations.

    Demonstrate how to perform effective surveillance including scanning, victim recognition and lifeguard rotations.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Activity Worksheet 2.1—Guarding Special Attractions

    Diving brick(s)

    Stopwatch or pace clock

TOPIC: MANAGEMENT AND FACILITY SAFETYimages

PRESENTATION: MANAGEMENT AND FACILITY SAFETY

Lecture

    As a lifeguard, your job is to follow and enforce your facility’s rules and regulations. The job of your facility’s management team is to ensure that the facility is in compliance with the law and to make sure you are enforcing facility rules correctly.

    Management is responsible for:

    Creating, reviewing and revising facility policies and procedures, rules and regulations and emergency action plans (EAPs) as needed.

    Addressing unsafe conditions.

    Complying with federal, state and local laws and regulations for facility operations and employment.

    Maintaining records regarding the facility and its employees.

    Assisting after an emergency.

    Ask participants: What can you do, as a lifeguard, to assist management in addressing unsafe conditions?
Answer: Report any unsafe conditions and take action to limit use of an unsafe area or help correct the unsafe conditions.

    Federal, state and local regulations affect the operation of aquatic facilities. Your employer should inform you as to regulations that affect your facility, such as:

    Lifeguard certification requirements.

    Facility design and safety features.

    Pool capacities.

    Staff training requirements and lifeguard competencies.

    Ratio of lifeguards to patrons.

    Water sanitation procedures.

    First aid equipment and supplies.

    Lifeguarding equipment.

    Diving depths.

    Federal and state labor laws affect which tasks lifeguards younger than 18 years may perform, including the hours they may work. These regulations generally are more stringent for 15-year-old lifeguards than for 16- and 17-year-old lifeguards.

    The Occupational Safety and Health Administration (OSHA) established regulations designed to keep employees safe while on the job.

    The purpose of the Hazard Communication Standard is to inform and protect employees from exposure to hazardous chemicals in the workplace.

    Each chemical has an information sheet called a Material Safety Data Sheet (MSDS), which describes special precautions to take when storing or using the chemical in addition to safety precautions needed when cleaning up chemical spills. The MSDS also explains what to do should you come into contact with the chemical.

    These documents must be easy to find and use. Be sure to know where MSDSs are kept and how to find the information.

    Employees have a right to know:

    Which hazardous chemicals are in the facility.

    Where those chemicals are stored in the facility.

    The specific dangers of those chemicals.

    How to identify chemical hazards in the facility.

    How to protect themselves and others from being exposed to hazardous chemicals.

    What to do if they or others are exposed to such hazards.

    The Bloodborne Pathogens Standard is an OSHA regulation designed to reduce the risk of disease transmission while on the job. Your employer must provide an exposure control plan to help protect employees from being exposed to disease-causing bacteria and viruses, called bloodborne pathogens, and instruct employees about what to do if an exposure occurs.

TOPIC: THE DROWNING PROCESSimages

PRESENTATION: THE DROWNING PROCESS

Lecture

    Your primary responsibility as a lifeguard is to help ensure patron safety and protect lives.

    You will spend most of your time on patron surveillance—keeping a close watch over the people in the facility and intervening when necessary.

    For effective patron surveillance, you must understand the drowning process and be alert and attentive at all times.

    Drowning is a continuum of events that begins when a victim’s airway becomes submerged under the surface of the water. The process can be stopped, but if not, it will end in death.

    The process of drowning begins when water enters the victim’s airway.

    This causes involuntary breath holding and then laryngospasm (a sudden closure of the larynx or windpipe). When this occurs, air cannot reach the lungs. During this time, the victim is unable to breathe but may swallow large quantities of water into the stomach.

    As oxygen levels are reduced, the laryngospasm begins to subside and the victim may gasp for air but instead inhales water into the lungs.

    Due to inadequate oxygen to body tissues, the victim may suffer cardiac arrest. This can occur in as little as 3 minutes after submerging. Brain damage or death can occur in as little as 4 to 6 minutes.

    Many intervening variables can affect the outcome, including underlying medical conditions of the victim, and the time until advanced medical care intervenes.

    In general giving ventilations often will resuscitate the victim if they are given within 1½ to 2 minutes of submerging.

    When you are providing care, an unconscious victim may have isolated or infrequent gasping in the absence of other breathing, called agonal gasps.

    Agonal gasps can occur even after the heart has stopped beating.

    Normal, effective breathing is regular, quiet and effortless. Agonal gasps are not breathing—care for the victim as though he or she is not breathing at all by giving ventilations or providing CPR.

    Ask participants: What does this understanding of the drowning process mean for you as a lifeguard?
Answers: Responses should include the following:

    Practice preventive lifeguarding and enforce rules to keep patrons safe.

    Stay alert to recognize when a patron is drowning.

    Respond with urgency.

    Get the victim’s airway out of the water and provide care for a breathing emergency as quickly as possible.

    If a victim is in cardiac arrest, begin CPR as quickly as possible.

    Practice emergency care skills frequently to be ready to respond quickly and with confidence.

    To give a victim the greatest chance for normal survival, you must recognize when a person needs help or is in danger of drowning. The sooner the drowning process is stopped by getting the victim’s airway out of the water, opening the airway and providing resuscitation (ventilations or CPR), the better is the chance for survival without permanent brain damage.

TOPIC: EFFECTIVE SURVEILLANCE-VICTIM RECOGNITIONimages

PRESENTATION: EFFECTIVE SURVEILLANCE—VICTIM RECOGNITION

Video Segment

    Tell participants: Effective surveillance involves not only recognizing behaviors or situations that might lead to life-threatening emergencies, such as drowning or injuries to the head, neck or spine, but also taking effective action to modify the behavior or control the situation.

    Explain that swimmers and nonswimmers, adults and children, all can become victims very quickly.

    Show the video segment, “Surveillance.”

    Answer participants’ questions about the video segment.

Guided Discussion

    Ask participants: What are some situations that could lead to trouble for a weak or nonswimmer?
Answers: Responses should include the following:

    Bobbing in or near water over his or her head

    Hand-over-hand wall crawling

    Being beyond arm’s reach of a supervising adult, even if wearing inflatable water wings or swim rings

    Clinging to something or struggling to grab something to stay afloat

    Wearing a life jacket improperly

    Ask participants: What are some situations that could lead to trouble for a swimmer?
Answers: Responses should include the following:

    Breath-holding or swimming underwater for an extended period after hyperventilating

    Participating in a high-risk/high-impact activity, such as diving

    Experiencing a medical emergency, such as a sudden illness

    Refer participants to Table 3-1: Behaviors of Distressed Swimmers and Drowning Victims in the Lifeguarding Manual.

    Ask participants: What are the characteristics of a distressed swimmer?
Answers: Responses should include the following:

    Able to keep his or her face out of the water

    Able to call for help

    Able to wave for help

    Horizontal, vertical or diagonal body position, depending on what the person is using for support

    Floating, sculling or treading water

    Ask participants: What instinctive drowning response behaviors would you see in a drowning victim who is struggling at or near the surface?
Answers: Responses should include the following:

    Cannot call out for help/his or her efforts are on getting a breath

    Struggles to keep the face above water in an effort to breathe

    Has arms extended to the side or in front, pressing down for support

    Has a vertical body position in the water with no supporting kick

    Might continue to struggle underwater

    Might eventually lose consciousness and stop moving

    Ask participants: In some cases, what might a very small child look like when in trouble in the water?
Answers: Responses should include the following:

    Appears to be doing the “doggy paddle” but is not making forward progress

    In a horizontal position at the surface but not able to raise the face up out of the water

    Underwater, struggling to get to the surface

    Ask participants: What are some conditions that could lead to a patron becoming a drowning victim who appears to be unconscious?
Answers: Responses should include the following:

    Lack of timely rescue of an active victim

    Heart attack or stroke

    Seizure

    Head injury

    Heat-related illness

    Hypothermia (below-normal body temperature)

    Hyperventilation and prolonged underwater breath-holding activities

    Use of alcohol and other drugs

TOPIC: EFFECTIVE SURVEILLANCE-SCANNINGimages

PRESENTATION: EFFECTIVE SURVEILLANCE—SCANNING

Video Segment

    Explain that effective surveillance also includes scanning, a visual technique for deliberately observing patron behaviors and actively looking for signals that someone in the water needs help.

    Show the video segment, “Scanning.”

    Answer participants’ questions about the video segment.

Guided Discussion

    Ask participants: What are some important factors for effective scanning?
Answers: Responses should include:

    Know what to look for to determine if a victim is in trouble in the water.

    Deliberately and actively observe swimmer’s behavior.

    Scan the entire volume of water: bottom, middle and surface.

    Move your eyes and head while scanning and look directly at the patron’s body movements.

    Maintain an active, rescue-ready posture.

    Refer participants to Table 3-2: Scanning Challenges in the Lifeguarding Manual to see some of the challenges for effective scanning.

    Tell participants that you will present some challenges for scanning and they are to provide you with what tactics could help to overcome the challenge.

Answers: Responses should include the following:

Challenge

Tactic

Monotony

    Stay fully engaged in what you are seeing—do not let your attention drift.

    Change body position and posture periodically.

    Sit upright and slightly forward.

    Rotate stations.

Fatigue

    Request additional lifeguard coverage.

    Keep hydrated, cool off and get out of the sun when on break.

    Exercise during one of your breaks.

Distraction

    Stay focused on patron surveillance.

    Do not daydream, have conversations with co-workers or patrons or watch events outside of your area.

    Keep patron activities safe and orderly. Signal for an additional lifeguard or supervisor if assistance is needed.

Blind spots

    Adjust your location or body position or stand up.

    Check all potential blind spots: under the stand, at play features or any part of the zone.

Glare (from the sun or overhead lighting)

    Use polarized sunglasses.

    Change body position—stand up and look around and through glare spots.

    Reposition your lifeguard station with permission of your supervisor.

Water movement and surface distortion of the water

    Adjust your body position.

    Be aware of the normal appearance of the bottom of the pool; know the appearance of drains, colored tiles or painted depth markings.

    Scan the bottom carefully.

Murky water

    Adjust your location or body position.

    Stay alert for high-risk activities.

    Signal for additional assistance to get extra coverage for the area.

Heavy patron loads

    Stand up frequently.

    Signal for additional assistance to get extra coverage for your area.

Low patron loads

    Change body position and posture frequently.

    Change to a ground-level station, if appropriate.

Hot air temperature

    Use fans to cool the surrounding air in an indoor setting.

    Stay in the shade; use umbrellas.

    Cool off by getting wet during your break.

    Rotate more frequently.

    Stay in cooler areas during breaks.

    Stay hydrated by drinking plenty of water.

TOPIC: EFFECTIVE SURVEILLANCE-ZONES OF SURVEILLANCE RESPONSIBILITYimages

PRESENTATION: EFFECTIVE SURVEILLANCE—ZONES OF SURVEILLANCE RESPONSIBILITY

Video Segment

    Explain that another element of effective surveillance involves the assignment of zones of surveillance responsibility. The video segment will introduce participants to various types of zone coverage, including zone coverage, total coverage and emergency back-up coverage in various types of facilities.

    Show the video segment, “Zones of Surveillance.”

    Answer participants’ questions about the video segment.

Guided Discussion

    Ask participants: What should you do if the number of patrons increases in your zone and you feel unable to adequately provide surveillance?
Answer: Signal for assistance for another lifeguard to help cover the zone.

    Ask participants: You are seated in an elevated lifeguard station and there is a glare on the surface of the water making it difficult for you to see. What should you do?
Answer: While maintaining surveillance, get down from the chair and adjust your position so you can see all areas of your zone or reposition your lifeguard station with permission from your supervisor.

    Ask participants: A group of preschool-aged children enter your zone. They are all weak swimmers. Although there are not many children, you feel that you are not able to watch the area adequately. What should you do?
Answer: Signal for assistance for another lifeguard to help cover the zone.

TOPIC: INJURY PREVENTION STRATEGIESimages

PRESENTATION: INJURY PREVENTION STRATEGIES

Lecture

    Aquatic injury prevention is part of your facility’s risk management program.

    Risk management involves identifying dangerous conditions or behaviors that can cause injuries and then taking steps to minimize or eliminate them. Even though lifeguarding requires performing emergency rescues, one of your goals is preventive lifeguarding, trying to make sure emergencies do not happen in the first place.

    Ask participants: What are some examples of life-threatening conditions?
Answers: Responses should include the following:

    Unconsciousness

    Breathing and cardiac emergencies

    Severe bleeding

    Drowning

    Ask participants: What could be some causes of non-life-threatening conditions?
Answers: Responses should include the following:

    Diving in shallow water could result in a spinal injury.

    Slipping and falling on the deck could result in wounds, fractures, dislocations, joint sprains or muscle strains.

    Exposure to sun could result in sunburn.

    Exposure to heat could result in dehydration.

    It is important to understand how injuries occur so you can help prevent them. As a lifeguard you need to:

    Increase your awareness of risks and hazards.

    Help patrons avoid risky behavior.

    Help develop a safety-conscious attitude at your facility.

Lecture and Guided Discussion

    Communicating with patrons is an important injury-prevention strategy. It requires you to inform and educate patrons about inappropriate behavior and the potential for injury. Communication also includes enforcing rules and regulations.

    Facilities use a variety of strategies to inform patrons of potential risks.

    Signs are displayed listing the rules. Universal symbols may be used on signs in place of or in addition to words. For example, an illustration of a person diving with a circle around it and a line through it is a universal symbol for “No Diving.”

    Patrons may be given printed material listing rules when entering the facility or as part of membership.

    As a lifeguard, you also are a part of the communication strategy since it is your job to inform patrons of the possible consequences if they are not following the rules.

    Ask participants: What information do patrons need to know concerning risky behaviors?
Answers: Responses should include the following:

    Why the behavior is dangerous

    Possible consequences of the risky behavior

    Safe options

    Ask participants: How can you politely get a patron’s attention?
Answers: Responses should include the following:

    Blowing a whistle

    Saying, “Excuse me,” to the patron

    Using a visual signal, such as a nod of the head or a hand signal, if you have the attention of the patron

    Your whistle is a communication tool to get the attention of patrons. It also is a communication tool that can be used to activate the EAP.

    Your facility’s EAP should specify a certain number and type of whistle blasts to indicate certain emergency situations. For example, one long, loud blast might signal to clear the pool, whereas three loud, short blasts might signal a water rescue.

    You will need to practice using your whistle blowing so you can blow it loud enough to be heard above the surrounding noise and others can distinguish which specific signal you are trying to communicate.

    Use your whistle cautiously since it might be ignored by staff and patrons if you use it too frequently.

Video Segment and Guided Discussion

    Explain to participants that the following video segment will provide them with some strategies to use to help keep their facility safe.

    Show the video segment, “Injury Prevention.”

    Pause the video for discussion of the thunder scenario—rule enforcement and customer service.

    Ask participants: What did the lifeguard do to protect patrons when thunder was heard?
Answers: Responses should include the following:

    Cleared the pool.

    Got down from the guard chair once the zone was cleared to get the patron’s attention rather than just continue to blow the whistle.

    Ask participants: What strategies did the lifeguard use to try to get the resistant man to understand the importance of clearing the pool?
Answers: Responses should include the following:

    Spoke with the man, explaining that thunder had been heard in the area.

    Used a rescue tube to get the attention of the man and stop him at the wall.

    Explained that the need to exit the pool was a safety issue.

    Requested help from management.

    Explained firmly that if he did not comply with the request the consequence could be that he could lose his membership at the pool.

    Answer participants’ questions about the video segment.

TOPIC: GUARDING A VARIETY OF ACTIVITIESimages

PRESENTATION: GUARDING A VARIETY OF ACTIVITIES

Lecture and Guided Discussion

    Ask participants: What types of activities might take place when you are lifeguarding?
Answers: Responses should include the following:

    Open or recreational swimming

    Water exercise, such as water walking and lap swimming

    Instructional classes, such as swim lessons, water therapy, water exercise and SCUBA lessons

    Team practices, such as swim team, water polo or synchronized swimming

    Competitive events, such as swim meets and triathlons.

    Special events such as movie nights, pool parties and after-hours rentals.

    Open or recreational swimming typically involves patrons of various ages and swimming abilities. Challenges in guarding recreational swimming are numerous, and may include:

    Young children who are not adequately supervised.

    Patrons engaging in risky behaviors in or out of the water.

    A child who has wandered off from parents or caretakers.

    Nonswimmers who have ventured into water that is too deep.

    A patron that suffers a sudden illness.

    When guarding for organized activities, it is helpful to understand the unique aspects and risks of the activity. Questions that need to be answered for effective guarding include:

    What things could go wrong that are unique about this activity?

    What is the swimming ability or comfort level in the water of patrons involved in this activity?

    Are there any unique challenges or obstacles to recognizing an emergency, approaching a victim or performing a rescue?

    Do participants have any medical conditions that increase thechances for sudden illness or injury due to the nature of the activity?

    Instructional classes have the benefit of additional supervision by trained personnel, including instructors for swim lessons, lifeguarding or fitness classes and coaches for competitive sports, such as swimming and diving, water polo or synchronized swimming.

    Facility management should consider instructors or coaches to be part of the safety team and provide them with training to help ensure the safety of participants.

    Instructors and coaches are responsible for the safety of their classes or teams but this does not in any way relieve you of your responsibilities. You are expected to recognize inappropriate behavior that could lead to injury and emergencies. You still must scan every person in the water and enforce rules for participants and instructional staff, perform rescues and provide first aid as appropriate.

    Ask participants: What might be some unique risks of participants in a water exercise class for older adults?
Answers: Responses should include the following:

    Participants may have risks associated with exercise such as over-exertion and possibly heat illness.

    Participants may have risks associated with medical problems such as hypertension, diabetes or arthritis.

    Participants may be using water exercise or therapy to rehabilitate from surgery or injury and may have less balance or stamina.

    Ask participants: What might be some unique risks of participants in swim lessons?
Answers: Responses should include the following:

    Participants who do not know how to swim may be unaware of dangers and slip into water that is too deep for them.

    Participants may not follow the instructions of the instructor and attempt to leave the class.

    Participants may attempt skills that are too difficult for them in an effort to please the instructor or the parent or to impress peers.

    Participants may have fears that overcome their ability to react in an emergency situation. A participant might suddenly panic when discovering that he or she is in deep water.

    Participants in competitive aquatic sports, such as swimming and diving, water polo or synchronized swimming, or participants in open water swimming events, such as triathlons, typically are skilled swimmers but are not exempt from potentially needing assistance, particularly after suffering sudden illness or injury. Some participants may be novice swimmers who could become tired when swimming longer distances.

    Ask participants: What might be some unique risks of participants in competitive sports?
Answers: Responses should include the following:

    Swimmers may have exercise-related risks from overexertion or dehydration during practice or a competition, such as a triathlon.

    Injuries can occur in overcrowded lap lanes during practice or warm-ups for a competition, from being hit by a ball during water polo, or from being hit by the springboard when diving.

    Swimmers may hyperventilate when trying to swim longer distances without breathing.

TOPIC: GUARDING SPECIAL ATTRACTIONSimages

PRESENTATION: GUARDING SPECIAL ATTRACTIONS

Lecture

    Many facilities have special attractions that create challenges for lifeguarding, such as:

    Water-play areas specifically for young children.

    Play structures, such as sprays, fountains and dumping buckets; floating obstacle courses; inflatable play structures or sports structures for volleyball or basketball.

    Special rides and attractions, such as bowl slides, multiperson raft rides, uphill water coasters, high-speed water slides; or other attractions including diving platforms, cable swings, and hand-overhand rope, nets and rings.

    Water slides, including open and enclosed slides, drop slides and speed slides.

    Winding rivers.

    Wave pools.

Activity

    Divide the participants into small groups and provide each group with Activity Worksheet 2.1—Guarding Special Attractions.

    Refer participants to Chapter 4, Injury Prevention, in the Lifeguarding Manual for information to help them with this activity.

    Instruct groups to list unique concerns for guarding each of the special attractions listed on the worksheet or assign specific topics to individual groups.

    Allow up to 5 minutes for the group work. Circulate among groups to monitor progress and provide assistance when necessary.

    Reassemble the class and call on group leaders to share their answers to the questions.

Activity Worksheet 2.1 —Guarding Special Attractions

Answers: Responses should include the following:

    Areas Specifically for Young Children
Answers: Responses should include the following:

    Enforce height and age requirements since older children may be too large for some structures or too rough for young children.

    Ask adults to actively supervise their children.

    Watch out for young children using the pool as a toilet.

    Watch children for sunburn or signs of overexposure to cold or heat.

    Play Structures
Answers: Responses should include the following:

    Do not let a play structure become overcrowded.

    Do not allow patrons to swim underneath structures.

    Watch that patrons return to the surface after dropping into the water.

    Pay close attention to children playing in and around sprays, fountains and interactive water-play structures. Excited children may run and fall and be injured.

    Pay close attention to patrons in moving water. They might lose their balance and be unable to stand up again.

    Watch for overcrowding and horseplay on floating structures.

    Keep play safe and orderly.

    Special Rides and Attractions
Answers: Responses should include the following:

    Watch patrons as they enter and exit an attraction. Dispatch patrons safely on a ride at set intervals.

    Carefully watch both the water below and the activities overhead.

    Keep patrons in view as long as possible.

    Ensure that patrons who fall off a structure return to the surface.

    Be aware of any special risks.

    Enforce rules for safe behaviors allowed on the attraction.

    Water Slides
Answers: Responses should include the following:

    Check that patrons are tall enough to use the slide.

    Instruct riders how to ride down the slide and make sure they are in the correct position.

    Help riders with the equipment.

    Confirm that the riders are ready to go and signal them to start.

    If assisting riders to take off, use tube handles when available. Avoid pushing or pulling riders by their shoulders, arms or legs.

    Dispatch next riders at the proper intervals.

    Signal the lifeguard at the bottom when a rider has been dispatched. If the lifeguard at the bottom can be seen, you can use a hand signal or a whistle.

    Watch for riders who stop, slow down, stand up or form a chain.

    Watch for riders who lose their mat, tube or raft or have trouble getting down the slide.

    Watch for riders who hit their heads on the side of the slide.

    Observe all riders exit the slide into the catch pool.

    Assist riders who appear off balance or get caught under water in the strong downward flow of water in the catch pool.

    Ensure that riders do not cross in front of any slide when getting out of the runout or catch pool.

    Help riders, if needed, from the runout or catch pool.

    Signal the lifeguard at the top when each rider has moved out of the catch pool or runout and it is clear to send the next rider.

    Winding Rivers
Answers: Responses should include the following:

    Ensure that patrons enter and exit at designated locations.

    Watch for inexperienced swimmers falling off their inner tubes or inflatable rafts.

    Watch carefully for, and correct, risky behavior.

    Wave Pools
Answers: Responses should include the following:

    Ensure that patrons enter only in the shallow end.

    When the waves are on, stand up to get a better view of patrons.

    Watch for swimmers who get knocked over by the waves or carried into deeper water by the undercurrent.

    Do not let patrons dive into the waves.

    Keep the areas around ladders and railings clear so that patrons can exit from the pool quickly.

    Keep other swimmers out of the pool during special activities, such as surfing.

    Before performing an emergency rescue, turn the waves off using the emergency stop button.

IN-WATER SKILL SESSION: REVIEW SKILLS, VICTIM RECOGNITION AND LIFEGUARD ROTATIONimages

PRESENTATION: NEXT STEPS

Skill Review

Activity

    Explain to participants that they are going to participate in a review session for entries and approaches.

    Lead a brief review discussion of the entries they learned in Lesson 1, asking participants when they would use them and why.

    Slide-in entry

    Stride jump

    Compact jump

    Have participants practice each of the entries, including approach strokes several times.

    Clearly observe each participant’s performance of the skill and provide corrective feedback.

Effective Scanning and Lifeguard Rotations

Activity

    Explain to participants that they are going to participate in an activity to experience effective scanning and lifeguard rotations.

    Two participants will be positioned on deck as lifeguards, equipped with rescue tubes and hip packs. The remaining participants will be in the water as if it were a recreational swim time.

    Assign each participant a number and record it with their name to avoid calling the number of one of those playing the lifeguard role. When their number is called, they will know it is their turn to play the role of either a distressed swimmer, an active victim or a passive victim. The victim should not react immediately but should allow the lifeguards some time to scan the pool before presenting them with the challenge of victim recognition.

    Assign zones of coverage for the lifeguards. When a victim is recognized, the lifeguard should activate (or simulate) the EAP, point to the victim and state what type of victim they observe.

    Place an extra rescue tube and hip pack on the deck for the incoming lifeguard. Explain that the participant who was the victim will exit the water, put on a rescue tube and hip pack and rotate into the position of one of the lifeguards. The lifeguard who is being replaced will rotate to the position of the other lifeguard; afterward, he or she will place the rescue tube and hip pack on the deck and enter the water to join the recreational swim group. Follow the same pattern of rotation throughout the activity.

    Remind participants that they need to follow rotation procedures that maintain patron surveillance.

    Each lifeguard should carry his or her own rescue tube during the rotation.

    The incoming lifeguard should be aware of the patrons and activity level of the zone and begin scanning while walking toward the station, checking all areas of the water from the surface to the bottom.

    The outgoing lifeguard should inform the incoming lifeguard of any situations that need special attention. The exchange of information should be brief, and patron surveillance must be maintained throughout the entire rotation.

    Once in position, with the rescue tube strapped on, the incoming lifeguard makes any adjustments needed, such as removing shoes or adjusting an umbrella, before confirming to the outgoing lifeguard that he or she “owns the zone.” The outgoing lifeguard should continue scanning as he or she is walking toward the next station.

    Begin the activity with the lifeguards that have been assigned to be on deck. Call out a number that has been assigned to one of the participants that is in the water.

    Provide guidance as needed for both victim recognition and for the lifeguard rotation.

    Continue the activity until everyone has had the opportunity to play the role of a lifeguard.

PUTTING IT ALL TOGETHERimages

Activity

    Gather participants and explain that they will be participating in two activities to challenge their physical fitness, entries and approaches.

Activity 1: Round Robin Brick Drill

    Have participants form a circle in deep water and begin treading.

    Hand one participant a brick and have him or her tread water while holding the brick at the surface of the water with both hands for 20 seconds. At your signal, have him or her pass it to the person on the right. Participants who are not currently supporting the brick will alternate between treading water by kicking only, then using their arms and legs each time you signal.

    Anyone who drops the brick must retrieve it.

    Continue this activity for about 7 to 10 minutes.

    You can vary this activity adding additional items to the circle, such as another brick and a tennis ball.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, place three bricks on the bottom of the shallow end of the pool, starting at the edge of the pool; there should be 5 feet between each brick.

    At your signal, have participants swim under water to the first brick, pick up the brick and stand up, bringing the brick to the surface of the water.

    After placing the brick back on the bottom of the pool, have participants swim to the next brick and repeat the drill.

    Continue this activity until every participant has retrieved all three bricks two times.

Activity 2: Rescue Tube Relay

    Explain to participants that this is a swimming relay activity to practice entries and approach strokes combined with speed.

    Divide the group into two or more teams with an equal number of participants.

    Each team member, wearing a hip pack, must either do a stride jump or compact jump into the water and swim to the other side using a modified front crawl or breaststroke while keeping the rescue tube under his or her armpits.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, participants should use the compact jump to enter the water.

    When each team member reaches the other end of the pool, he or she should hand off the rescue tube and hip pack to the next person in line. The next person in line performs a stride jump or compact jump into the water and swims with the rescue tube back to the starting point.

    Continue this process until each team member has participated or continue for about 7 to 10 minutes.

    You can vary this activity by changing the type of entry, approach stroke or letting the tube trail behind.

ASSIGNMENT

    Review Chapter 4, Injury Prevention, and Chapter 5, Emergency Action Plans, in the Lifeguarding Manual before the next class session.

LESSON 3

INJURY PREVENTION AND RESCUE SKILLS, PART 1

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Explain patron surveillance techniques for organized groups.

    Explain the purpose and general procedures of an emergency action plan (EAP).

    Demonstrate how to safely and effectively assist a distressed swimmer, rescue an active and passive victim and rescue multiple victims.

    Demonstrate the ability to implement an EAP and perform a rescue.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Activity Worksheet 3.1—Strategies for a Safe Group Visit

TOPIC: GUARDING FOR ORGANIZED RECREATIONAL SWIM GROUPSimages

PRESENTATION: GUARDING FOR ORGANIZED RECREATIONAL SWIM GROUPS

Lecture

    Organized groups, such as day care groups, camps and youth organizations, may visit your facility. These groups may be a part of your organization or may be outside groups.

    Groups should be accompanied by leaders, such as camp counselors or chaperones.

    Groups may reserve the entire facility for a specific activity.

    Facility management can contribute to the safety of groups by putting in place strategies such as:

    Gathering important information as part of the booking procedure when the group schedules their visit.

    Ensuring a safety orientation with all members of the visiting group to explain the rules and expectations.

    Developing a classification system based on swimming ability that easily identifies patron swim levels, such as using color-coded wrist bands or swim caps.

    Designating the swimming areas based on ability and intended use.

    Orienting the group as to the design of the swimming area, including water depth, and identifying where groups may swim.

    Using an identification system for group leaders or adult chaperones, such as laminated lanyard or a brightly colored baseball cap or T-shirt.

    Pairing swimmers of like ability as buddies to watch one another.

    Implementing periodic buddy checks so that leaders can identify and account for all of their group members.

Activity

    Assign participants to small groups and assign each group one of the scenarios in Activity Worksheet 3.1—Strategies for a Safe Group Visit to each group. Give groups 5 minutes to develop a list of strategies for a safe group visit.

    Have each group present their strategies to the class.

    Upon completion, discuss any considerations for group visits that were not addressed.

Activity Worksheet 3.1 —Strategies for a Safe Group Visit

Answers: Responses should include the following:

    Scenario 1: You are guarding multiple activities using the pool in addition to an organized group of 30 preschool-aged children with four group leaders. In general, what should you ensure and be aware of while guarding the activity?
Answers: Responses should include the following:

    Ensure that swimming areas are clearly marked according to their predetermined swimming abilities.

    Ensure that patrons stay in the sections appropriate for their swimming abilities. Be aware that weak or nonswimmers, excited to be together enjoying a recreational activity, may attempt to venture into areas that are beyond their swimming ability.

    Provide U.S. Coast Guard-approved life jackets for weak or nonswimmers.

    Know how to identify group leaders or chaperones.

    Ensure that chaperones are actively supervising the members of their group and that the appropriate swimmer-to-chaperone ratio is being met. If it appears that they are not doing so, alert your facility’s manager.

    Signal for additional lifeguard coverage, such as a roving lifeguard, if you feel you cannot effectively guard your zone. You may need to do this at the beginning of the swim time while the group gets adjusted to the facility’s rules or if large groups are concentrated in one area.

    Scenario 2: You are tasked with giving a quick safety orientation to a camp group that will be using the diving boards. Group members took the facility swim test, and all are approved to swim in deep water. List some common rules that you will review for the safe use of the diving boards and briefly describe how you would cover the information.
Answers: Responses should include:

    Only one person on the diving board at a time.

    Only one person on the ladder at a time.

    Look before diving or jumping to make sure the diving area is clear.

    Only one bounce allowed on the diving board.

    Dive or jump forward and straight out from the diving board.

    Swim immediately to the closest ladder or wall.

    Start by asking what the group members already know about the diving area rules to gauge their level of understanding and then explain any rules that the group did not understand.

Note to instructors teaching the Shallow Water Lifeguarding course: While shallow water lifeguards may not work in a deep-water environment, this scenario can still be used in the Shallow Water Lifeguarding course so participants can understand common rules for all areas of swimming facilities.

    Scenario 3: You will be working a private rental at your facility for families with children of all ages from your local athletic association. You will be doing a safety orientation for the group. Who will you be instructing during the orientation and what items will you be sure to cover?
Answers: Responses should include the following:

    The safety orientation will be given to all members of the group, including the adults. It should cover the following:

    General aquatic safety rules

    Swimming area sections

    Water depths

    Features or play structures

    Equipment

    How to use approved floatation devices

    Rule signage locations

    Operational information, such as buddy checks or breaks

TOPIC: EMERGENCY ACTION PLANSimages

PRESENTATION: EMERGENCY ACTION PLANS

Video Segment

    Explain to participants that the importance of activating an EAP already has been discussed as a part of performing a rescue. In this lesson, they will learn more details about EAPs.

    Show the video segment, “Emergency Action Plans.”

    Explain that a new hire orientation should include their assigned responsibilities in the facility’s EAP. Regular in-service training and simulation drills to practice EAP procedures also should occur throughout their employment.

    Answer participants’ questions about the video segment.

Lecture and Guided Discussion

    Ask participants: What is the purpose of an EAP?
Answer: The purpose of an EAP is to describe everyone’s responsibility in an emergency.

    During orientation, in-service training and in simulation drills, you will learn and practice your assigned EAP responsibilities.

    Aquatic facilities often have a general plan for water or land rescues, as well as additional plans designed to address specific situations, such as an active victim, a passive victim, a spinal injury, a missing person or an injury or illness. Activate your facility’s EAP whenever you recognize an emergency.

    Refer participants to Chapter 5, Emergency Action Plans, in the Lifeguarding Manual and discuss the sample EAP flow charts.

    In a water emergency, the rescuing lifeguard should:

    Signal: Activate the EAP

    Rescue: Perform an appropriate rescue by following the general procedures for a water emergency.

    Care: Provide emergency care as needed

    Report, advise and release: Complete a report of the incident and advise the victim as to precautions they should take to prevent the situation from occurring again. If the victim is a minor, he or she should be released to the appropriate person. Gather information that is needed from the victim and complete the report after releasing the victim.

    During the emergency, assisting lifeguards or other members of the safety team should:

    Provide back-up surveillance coverage or clear the area.

    Assist with the rescue and emergency care if needed.

    Summon EMS personnel if needed.

    Bring additional rescue equipment if needed.

    Assist with crowd control.

    Meet and direct EMS personnel.

    Ask participants: What other situations at a facility may require different EAPs?
Answers: Responses should include the following:

    Evacuations

    The need to shelter in place

    Severe weather

    Chemical spills or leaks

    Power failures

    Violence

    Ask participants: What information should be communicated when calling 9-1-1 or the local emergency number?
Answers: Responses should include the following:

    Identify yourself.

    Explain the situation briefly (e.g., unconscious child pulled from the water).

    Explain the purpose of the call (e.g., need an ambulance, need police).

    Give the location.

    Answer questions to the best of your knowledge.

    Do not hang up until the emergency medical services (EMS) call-taker tells you to do so.

    Ask participants: Outside of the immediate aquatic area, where might you be needed in an emergency?
Answers: Responses should include the following:

    Locker rooms

    Concession areas

    Entrance or lobby areas

    Adjacent recreational facilities, such as exercise facilities or playgrounds

    Mechanical rooms

    Parking lots

TOPIC: RESCUE SKILLS, PART 1.—RESCUES AT OR NEAR THE SURFACEimages

PRESENTATION: WATER RESCUE SKILLS–RESCUES AT OR NEAR THE SURFACE

Video Segment

    Explain to participants that the following video segment will provide demonstrations of the first set of rescue skills they will learn for distressed and active victims.

    Refer participants to the skill sheets in Chapter 6, Water Rescue Skills, in the Lifeguarding Manual.

    Show the video segment, “Water Rescue Skills—Rescues At or Near the Surface.”

    Answer participants’ questions about the video segment.

IN-WATER SKILL SESSION—RESCUE SKILLS, PART 1images

PRESENTATION: NEXT STEPS

Skill Practice

    Explain to participants that during water rescue skill sessions you will demonstrate skills and guide them through practice.

    Pair up participants and explain that they will take turns as a victim and rescuer for each skill. For the multiple victim rescuer, reassign participants into groups of three.

    For each skill, organize participants so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    Lead them through the following skills for victims at or near the surface:

    Reaching assist from the deck

    Lifeguards: on the edge of the deck

    Victims: about 3 feet from the edge of the pool; distressed swimmer

    Simple assist

    Lifeguards: standing in shallow water

    Victims: standing in shallow water; losing balance

    Active victim front rescue

    Lifeguards: in the water

    Victims: at least 10 yards from the edge of the pool facing the lifeguard; struggling in deep water

    Active victim rear rescue

    Lifeguards: in the water

    Victims: at least 10 yards from the edge of the pool facing away from the lifeguard; struggling in deep water

    Passive victim rear rescue

    Lifeguards: on the edge of the deck

    Victims: in deep water, passive

    Multiple victim rescue

    Lifeguards: lifeguard in the water

    Victims: Two victims per rescuer in deep water. When playing the role of the victims they should face each other, one victim holding securely to the other victim.

    Observe each participant’s performance of the skill and provide corrective feedback.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, practice the simple assist and reaching as noted above.

    For the active victim front rescue, active victim rear rescue and multiple victim rescue, practice in water up to 5 feet deep.

    For the passive victim rear rescue, the victim should be at or near the surface of the water.

Skill Drill-Active Victim Rescues

    Explain to participants that they are going to participate in an activity to practice recognizing a victim, simulating activating the EAP, entering the water, approaching a victim, performing a rescue and returning the victim safely to the side of the pool. This is designed to allow participants to practice rescuing a variety of victims in rapid succession.

    Divide the class in half and assign one group as lifeguards and the other group as victims. Line up lifeguards stationed on the deck, one per victim in the water:
VICTIMS X X X X X
LIFEGUARDS O O O O O

    Explain that when you say, “Go!” (all victims and lifeguards will go at the same time):

    The victims will simulate an active victim facing the lifeguard.

    The lifeguards will simulate the EAP signal, enter the water, rescue the victim and return the victim to a point of safety at the wall where the rescuer started the rescue.

    Lifeguards exit the water and the victims will return to their same spot in the water to be victims again.

    Once out of the water and standing in front of their victims again, have each lifeguard move one spot down so they are stationed in front of the next victim in line. Have the last rescuer in line move to the first position so that each lifeguard has a new victim in front of them. On your instruction to go, lifeguards will repeat the front active victim rescue with the new victim.

    Continue until all lifeguards have rotated down the line to rescue each victim and they are back in front of the victim they started with.

    Repeat the drill with the victim facing away from the rescuer.

    After the lifeguards have performed both types of active victim rescues on each victim in the line, switch the groups—the victim group becomes the lifeguard group and the lifeguard group becomes the victim group—and repeat the activity.

PUTTING IT ALL TOGETHERimages

Activity

    Explain to participants that they are going to participate in an activity to practice an EAP for an active victim or distressed swimmer.

    Assign one lifeguard who is performing patron surveillance and one back-up lifeguard who is not on surveillance duty. Assign the zone and have the lifeguard go to the lifeguard station and have the back-up lifeguard go to an area on the deck where he or she can see the lifeguard station.

    Explain to participants that upon recognizing a victim, the lifeguard will:

    Activate the EAP.

    Enter the water using the appropriate entry.

    Perform the appropriate rescue.

    Bring the victim to a point of safety at the side of the pool.

    Explain to participants that when the EAP signal is activated, the back-up lifeguard will get a rescue tube, go to the lifeguard station and assume coverage of the zone.

    Gather the rest of the group so that the lifeguards cannot hear. Assign someone to simulate a victim (active or distressed) after a prearranged signal from you, such as a head nod.

    Begin the activity by allowing the swimmers to swim and play until you give the signal and the drowning simulation begins.

    Once the rescue is complete, gather the group and discuss how it went and what the next steps of the EAP would be.

    Repeat the activity until all participants have had the opportunity to be a lifeguard or back-up lifeguard.

ASSIGNMENT

Review Chapter 5, Emergency Action Plans, in the Lifeguarding Manual.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general for the category of skills, as well as specific to, the skill must be met.

ASSISTS

SKILL CHART: REACHING ASSIST FROM THE DECK

1.   Extend the tube to the victim, keeping your body weight on your back foot and crouching to avoid being pulled into the water.

    Remove the rescue strap from your shoulder if necessary to reach the victim and hold the shoulder strap in one hand and extend the tube to the victim with the other hand.

2.   Tell the victim to grab the rescue tube.

3.   Slowly pull the victim to safety.

SKILL CHART: SIMPLE ASSIST

1.   Approach the person who needs help while keeping the rescue tube between you and that person.

2.   Reach across the tube and grasp the person at the armpit to help the person maintain his or her balance.

    If the person is under water, grasp under the person’s armpits with both hands and help him or herstand up.

3.   Assist the person to the exit point, if necessary.

SKILL ASSESSMENT TOOL: ASSISTS

Criteria
Proficient
Not Proficient

Communicates with the victim
Victim is reassured and told what to do
No attempted verbal communication with the victim

Maintains balance
Assumes a sturdy posture and stable footing
Stumbles, falls or knocks victim under the water

Equipment is properly positioned for the assist
Control of the rescue tube is maintained between victim and rescuer
Rescue tube is not kept between victim and rescuer

Maintains support until victim is safe

    Supports the victim so that the mouth and nose are above water

    Assists the victim to a safe position

    Victim’s mouth or nose is under water

    Lets go of victim withoutensuring that the victim is at a position of safety

    Does not assist the victim out of the water if needed

RESCUES AT OR NEAR THE SURFACE

SKILL CHART: ACTIVE VICTIM FRONT RESCUE

1.   Approach the victim from the front.

2.   As you near the victim, grab the rescue tube from under your arms with both hands and begin to push the tube out in front of you. Continue kicking to maintain momentum.

3.   Thrust the rescue tube slightly under water and into the victim’s chest, keeping the tube between you and the victim. Encourage the victim to grab the rescue tube and hold onto it.

4.   Keep kicking, fully extend your arms and move the victim to a safe exit point. Change direction, if needed.

SKILL CHART: ACTIVE VICTIM REAR RESCUE

1.   Approach the victim from behind with the rescue tube across your chest.

2.   With both arms, reach under the victim’s armpits and grasp the shoulders firmly. Tell the victim that you are there to help and continue to reassure the victim throughout the rescue.

3.   Using your chest, squeeze the rescue tube between your chest and the victim’s back.

4.   Keep your head to one side to avoid being hit by the victim’s head if it moves backwards.

5.   Lean back and pull the victim onto the rescue tube.

6.   Use the rescue tube to support the victim so the victim’s mouth and nose are out of the water.

7.   Tow the victim to a safe exit point.

SKILL CHART: PASSIVE VICTIM REAR RESCUE

1.   Approach a face-down victim from behind with the rescue tube across your chest.

2.   With both arms, reach under the victim’s armpits and grasp the shoulders firmly. You may be high on the victim’s back when doing this.

3.   Using your chest, squeeze the rescue tube between your chest and the victim’s back.

4.   Keep your head to one side to avoid being hit by the victim’s head if it moves backwards.

5.   Roll the victim over by dipping your shoulder and rolling onto your back so that the victim is face-up on top of the rescue tube. Keep the victim’s mouth and nose out of the water. Place the tube under the victim below the shoulders so that the victim’s head naturally falls back to an open-airway position.

6.   Tow the victim to a safe exit point. For greater distances, use one hand to stroke. For example, reach your right arm over the victim’s right shoulder and grasp the rescue tube. Then use the left hand to stroke.

7.   Remove the victim from the water, assess the victim’s condition and provide appropriate care.

SKILL ASSESSMENT TOOLS: RESCUES AT OR NEAR THE SURFACE

Criteria
Proficient
Not Proficient

Communicates with the victim
Victim is reassured and told what to do
No attempted verbal communication with the victim

Equipment is properly positioned for the appropriate rescue

    Rescue tube is kept between the lifeguard and the victim

    Rescue tube is positioned to support the victim at the surface of the water

    Rescue tube is not maintained between the victim and the rescuer

    The victim is not supported by the rescue tube

Victim’s mouth and nose above water
Victim’s mouth and nose are maintained above water
Victim’s mouth or nose is under water

Tows the victim to a safe exit point
Victim is towed to a safe exit point using the rescue tube to support the victim

    Unable to tow the victim to a safe exit point

    Victim is not supported by the rescue tube

    Releases contact with the victim

ACTIVE VICTIM FRONT RESCUE

Rescue tube is placed to provide support for the victim and safety for the rescuer

    Rescue tube is slightly submerged and thrust into the victim’s chest to provide support

    Lifeguard’s arms are extended with elbows locked

    Rescue tube is thrust above victim’s armpits or in the stomach area and does not provide support

    Lifeguard’s arms are not fully extended

Move the victim to a safe exit point
Forward momentum and kick are used to move the victim to a safe exit point

    Little to no forward movement

    Unable to move the victim to a safe exit point

ACTIVE VICTIM REAR RESCUE

Lifeguard squeezes the rescue tube against the victim’s back to provide support for the victim and safety for the rescuer
Rescue tube remains in place and is repositioned if it slips out

    Rescue tube slips out and is not supporting the victim at the surface

    Is not successful in repositioning the rescue tube

PASSIVE VICTIM REAR RESCUE

Maintain head in an open airway position at the surface
Rescue tube is placed under the victim’s back so that the victim’s head falls back to an open airway position
Victim’s head is tilted forward (chin toward chest)

Turn the victim to a face-up position

    Rescue tube is squeezed between rescuer’s chest and victim’s back

    Leans back to pull victim face-up

    Rescue tube is not maintained between the victim and the rescuer

    Unable to reposition the tube if it slips out

    Unable to pull victim to a face-up position

MULTIPLE-VICTIM RESCUE

SKILL CHART: MULTIPLE-VICTIM RESCUE

If you are the only one rescuing two victims who are clutching each other:

1.   Approach one victim from behind.

2.   With both arms, reach under the victim’s armpits and grasp the shoulders. Squeeze the rescue tube between your chest and the victim’s back, keeping your head to one side of the victim’s head.

3.   Use the rescue tube to support both victims with their mouths out of the water. Talk to the victims to help reassure them.

4.   Support both victims until other lifeguards arrive or the victims become calm enough to move to a safe exit.

SKILL ASSESSMENT TOOLS: MULTIPLE VICTIM RESCUE

Criteria
Proficient
Not Proficient

Communicates with the victim
Victim is reassured and told what to do
No attempted verbal communication with the victim

Equipment is properly positioned for the appropriate rescue

    Rescue tube is kept between the lifeguard and the victim

    Rescue tube positioned to support the victim at the surface of the water

    Rescue tube is not maintained between the victim and the rescuer

    Victim is not supported by the rescue tube

Victim’s mouth and nose above water
Victim’s mouth and nose are maintained above water
Mouth or nose are under water

Tows the victim to safety
Victim is towed to safety using the rescue tube to support the victim

    Unable to tow the victim to safety

    Victim is not supported by the rescue tube

    Releases contact with the victim

Rescue tube is placed to provide support for victims and safety for rescuer
Maintains firm hold of one victim and rescue tube effectively supports both victims’ heads above water
Both victims are not supported

LESSON 4

RESCUE SKILLS, PART 2

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Demonstrate how to safely and effectively rescue a submerged victim in shallow or deep water.

    Demonstrate how to safely and effectively perform feet-first and head-first surface dives. (Lifeguarding course only)

    Demonstrate how to safely and effectively perform a two-person removal of a victim from the water using a backboard.

TOPIC: SURVEILLANCE ACTIVITY Iimages

PRESENTATION: REVIEW—SURVEILLANCE ACTIVITY

Video Segment and Activity

    Explain that this activity provides an opportunity to practice their surveillance skills.

    Show the video segment, “Review—Surveillance Activity I.”

    Lead a discussion of what they see in each segment.

    Are there any hazards that could cause an injury?

    Are there any patrons who would be of special concern?

    Are there any rules being broken that could lead to an injury or emergency situation?

    Are there any distracting situations for the lifeguard?

TOPIC: RESCUE SKILLS, PART 2: SUBMERGED VICTIM RESCUESimages

PRESENTATION: WATER RESCUE SKILLS—SUBMERGED VICTIM RESCUES

Video Segment

    Explain to participants that the following video segment will cover rescue skills for passive victims.

    Refer participants to the skill sheets in Chapter 6, Water Rescue Skills, in the Lifeguarding Manual.

    Show the video segment, “Water Rescue Skills—Submerged Victim Rescues.”

    Answer participants’ questions about the video segment.

IN-WATER SKILL SESSION: RESCUE SKILLS, PART 2images

PRESENTATION: NEXT STEPS

Safety Tips: For practicing rescues of victims submerged in deep water:

    Instruct participants that if they experience difficulty when playing the role of a victim, they should signal “let go” to the lifeguard by a predetermined signal, such as a tap or gentle pinch.

    Explain that ear and sinus squeeze can be uncomfortable and for those with congestion, it can be painful or even cause damage to the ear. In this course, when practicing rescues of submerged victims, participants are required only to go to a depth of 7 to 10 feet. However, when hired to work at a facility with deeper water, they would be expected to be able to go all the way to the bottom.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, participants are required only to go to a maximum depth of 5 feet.

    Explain that swim goggles may not be used for rescues of submerged victims since they have no mechanism for pressure relief, which could result in injury to the eyes when swimming in deeper water. They will be expected to open their eyes under water to perform rescues.

Skill Practice

    Explain to participants that during the water rescue skill sessions you will demonstrate skills and guide them through practice.

    Pair up participants and explain that they will take turns as victim and rescuer for each skill. For the two-person removal from the water using a backboard skill, participants should form groups of three.

    For each skill, organize participants so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    Explain to them that for each rescue skill, they should begin by simulating the activation of the emergency action plan (EAP) (except when learning the surface dives).

    Lead them through the following skills for submerged victims:

    Submerged passive victim in shallow water

    Lifeguards: on the edge of the deck

    Victims: at least 10 yards from the edge of the pool submerged in shallow water; passive

    Feet-first surface dive in deep water

    Head-first surface dive in deep water

    Submerged victim in deep water

    Lifeguards: on the edge of the deck

    Victims: at least 10 yards from the edge of the pool submerged in deep water; passive

    SHALLOW WATER LIFEGUARDING

     For the Shallow Water Lifeguarding course, omit the feet-first and head-first surface dives and the submerged victim in deep water rescue unless necessary to get to the bottom.

    Two-person removal from the water using a backboard

    Lifeguard 1: bringing victim to the edge of the pool after a passive victim rescue

    Lifeguard 2: on deck with backboard

    Victim: passive

    Observe each participant’s performance of the skill and provide corrective feedback

PUTTING IT ALL TOGETHERimages

Skill Drill

    Assemble the participants on the deck and explain they will be practicing team rescues for a submerged passive victim in deep water, removing the victim from the water on a backboard and preparing to provide care by putting on disposable gloves.

Part 1

    Explain that they will be practicing how to put on gloves in a wet environment. They will learn the method for glove removal in lesson 5.

    Explain that putting on gloves with wet hands can be challenging.

    Lead them through the skill of putting on gloves with wet hands. One method is to dip the glove in the pool and fill with water and insert your hand in the glove.

    Participants should practice the skill until they are comfortable doing it quickly.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, have teams practice rescues for a submerged passive victim in shallow water, removing the victim from the water on a backboard and preparing to provide care by putting on disposable gloves.

    Participants will complete part 1 as it is described above. For part 2, the victim will submerge to the bottom in shallow water at the same time as the rescuer. The rescuing lifeguard will rescue a victim who is submerged in shallow water and passive.

Part 2

    Divide the participants into groups of four and assign one rescuing lifeguard, one victim and two assisting lifeguards for each group. Have each lifeguard wear a hip pack with gloves inside.

    Explain for each group:

    The rescuing lifeguard will simulate activating the EAP and enter the water.

    The victim will submerge to the bottom in deep water at the same time as the rescuer. The rescuing lifeguard will rescue a victim who is submerged in deep water and passive.

    While the rescuing lifeguard supports the victim at the edge, the two assisting lifeguards will bring the backboard and then will remove the victim from the water, demonstrating team communication skills between all three lifeguards.

    Once removed from the water, the victim will remain passive on the backboard until all three lifeguards have put on their gloves.

    Repeat the drill until each person in the group has performed as a rescuing lifeguard and an assisting lifeguard at least once.

ASSIGNMENT

     Read Chapter 7, Before Providing Care and Victim Assessment, and Chapter 8, Breathing Emergencies, in the Lifeguarding Manual before the next class session.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general for the category of skills, as well as specific to the skill, must be met.

SUBMERGED VICTIMS

SKILL CHART: PASSIVE SUBMERGED VICTIM IN SHALLOW WATER

1.    Swim or quickly walk to the victim's side. Let go of the rescue tube but keep the strap around your shoulders.

2.    Submerge and reach down to grab the victim under the armpits.

3.    Simultaneously, pick up the victim, move forward and roll the victim face-up upon surfacing.

4.    Grab the rescue tube and position it under the victim's shoulders. The victim's head should naturally fall back into an open-airway position. If an assisting lifeguard is there with the backboard, skip this step and proceed to remove the victim from the water.

5.    Move the victim to a safe exit point, remove the victim from the water, assess the victim's condition and provide appropriate care.

SKILL CHART: SUBMERGED VICTIM IN DEEP WATER(LIFEGUARDING COURSE ONLY)

1.    Release the rescue tube, perform a feet-first surface dive and position yourself behind the victim.

2.    Reach one of your arms under the victim's arm (your right arm under their right arm or your left arm under their left arm) and across the victim's chest. Hold firmly onto the victim's opposite side.

3.    Once you have hold of the victim, reach up with your free hand and grasp the towline. Pull it down and feed the line to the hand that is holding the victim. Keep feeding the towline this way until nearing the surface.

4.    As you surface, tilt the victim back so he or she is face-up. Grasp and position the rescue tube so it is squeezed between your chest and the victim's back. For a passive victim, place the tube below the victim's shoulders so the victim's head naturally falls back into an open-airway position. A victim may begin to struggle, requiring you to grasp tighter.

5.    Reach under the victim's armpits and grasp the shoulders.

6.    Tow the victim to a safe exit point. Remove the victim from the water, assess the victim's condition and provide appropriate care.

Note: As you descend into deep water, be sure to equalize pressure early and often. If you are unable to equalize pressure, return to the surface.

SKILL ASSESSMENT TOOL: SUBMERGED VICTIM RESCUES

Criteria
Proficient
Not Proficient

Equipment is properly positioned to provide support for the victim upon rolling over or surfacing
Rescue tube is positioned under the victim's back and is supporting the victim at the surface

    Victim slides off tube

    Victim's head submerges

Victim is face-up upon surfacing
Victim is quickly brought to a face-up position

    Victim is face-down

    Unable to turn victim to a face-up position upon surfacing

Victim's mouth and nose are above water.
Victim's mouth and nose are maintained above water.
Victim's mouth or nose is under water.

Maintain head in an open airway position at the surface
Rescue tube is placed under the victim's back so that the victim's head falls back to an open airway position
Victim's head is tilted forward (chin toward chest)

Tow the victim to safety
Victim is towed to a safe exit point using the rescue tube to support the victim

    Unable to make progress in the water to move the victim to a safe exit point

    Victim is not supported by the rescue tube and slips off or submerges

SUBMERGED PASSIVE VICTIM IN SHALLOW WATER

Equipment is properly positioned to start the rescue
Rescue strap is around the shoulder of the rescuer

    Tries to submerge with the rescue tube

    Rescue tube strap is not worn over the shoulder

Victim brought to the surface

    Submerges to grasp victim

    Maintains grasp of the victim and brings to the surface

    Unable to submerge

    Does not make contact with victim

    Drops victim

    Unable to return to the surface with victim

SUBMERGED VICTIM IN DEEP WATER (LIFEGUARDING COURSE ONLY)

Equipment is properly positioned appropriate to the rescue

    Rescuer releases rescue tube so it remains at the surface

    Rescue tube strap is worn around the shoulder

    For water deeper than the tube strap length, strap is removed from the shoulder and held

    Tries to submerge with the rescue tube

    Loses contact with the rescue tube strap—not worn around the shoulder or not held

    Unable to grasp rescue tube once returned to the surface to place under the victim's back

Victim brought to the surface

    Submerges to grasp the victim

    Maintains grasp of the victim and brings to the surface

    Rescue tube placed under the victim's back upon surfacing

    Unable to submerge

    Cannot grasp the victim

    Does not make contact with the victim

    Drops the victim

    Unable to return to the surface with the victim

    Unable to grasp or place rescue tube under the victim upon surfacing

SURFACE DIVES

SKILL CHART: FEET-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)

1.    Swim to a point near and above the victim. Release the rescue tube but keep the strap around your shoulders.

2.    Position your body vertically, then at the same time press both hands down to your sides and kick strongly to raise your body out of the water.

3.    Take a breath then let your body sink under water as you begin to extend your arms outward with palms upward pushing against the water to help you move downward. Keep your legs straight and together with toes pointed. Tuck your chin and turn your face to look down toward the bottom.

4.    As downward momentum slows, repeat the motion of extending your arms outward and sweeping your hands and arms upward and overhead to go deeper.

5.    Repeat this arm movement until deep enough to reach the victim.

If you must swim under water, such as for a deep-water line search, also perform these steps:

1.    When deep enough, tuck your body and roll to a horizontal position.

2.    Extend your arms and legs and swim under water.

Note: As you descend into deep water, be sure to equalize pressure early and often. If you are unable to equalize pressure, return to the surface.

SKILL CHART: HEAD-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)

1.    Swim to a point near the victim and release the rescue tube.

2.    Gain momentum using a swimming stroke.

3.    Take a breath, sweep your arms backwards to your thighs and turn them palms-down.

4.    Tuck your chin to your chest and flex at the hip sharply while your arms reach downward toward the bottom.

5.    Lift your legs upward, straight and together so that their weight above the water helps the descent. Get in a fully extended, streamlined body position that is almost vertical.

6.    If you need to go deeper, such as in a diving well, do a simultaneous arm pull with both arms to go deeper, then level out and swim forward under water.

Tip: If the depth of the water is unknown or the water is murky, hold one or both arms extended over the head toward the bottom or use a feet-first surface dive.

Note: As you descend into deep water, be sure to equalize pressure early and often. If you are unable to equalize pressure, return to the surface.

SKILL ASSESSMENT TOOL: SURFACE DIVES

Criteria
Proficient
Not Proficient

Submerge to appropriate depth
Submerges to appropriate depth
Unable to submerge to appropriate depth

Look toward bottom while descending
Face is looking down toward bottom while descending
Face is looking forward or upward while descending

FEET-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)

Body descends feet-first in a streamlined position

    Legs are held together

    Arms are fully extended overhead

    Legs are apart and impede descent

    Arm positioning impedes descent

HEAD-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)

Body descends head-first in a streamlined position

    Legs are held together and lifted upward toward the surface to aide descent

    Arms reach downward toward the bottom

    Legs are apart

    Body is not nearly vertical during descent

    Arms are not in front reaching downward

REMOVAL FROM THE WATER

SKILL CHART: TWO-PERSON REMOVAL FROM THE WATER USING A BACKBOARD

1.    The primary lifeguard brings the victim to the side and turns him or her to face the wall. Another lifeguard brings a backboard with the head immobilizer and the straps removed, if possible.

2.    The assisting lifeguard on land crosses his or her own hands to grab the victim's wrists and pulls the victim up slightly to keep the head above the water and away from the wall. Support the victim's head so that the head does not fall forward.

3.     The primary lifeguard ensures that the victim's face is out of the water and then climbs out of the water, removes the rescue tube and gets the backboard.

4.    The primary lifeguard guides the backboard, foot-end first, down into the water along the wall next to the victim- The second lifeguard immediately begins to turn the victim onto the backboard- Each lifeguard then quickly grasps one of the victim's wrists and one of the handholds of the backboard.

5.    When the primary lifeguard gives the signal, both lifeguards pull the backboard and victim onto land, until the underside of the board is safely away from the edge. (Remember to lift with the legs and not with the back.) The lifeguards step backward and then carefully lower the backboard onto the ground. If other lifeguards or additional help is available, they can provide assistance by pulling or pushing the backboard.

6.     Lifeguards provide immediate and appropriate care based on the victim's condition. Continue care until emergency medical services (EMS) personnel arrive and assume control over the victim's care.

Tips:

    It may be easier to submerge the board initially if the board is angled, foot-end first, toward the wall.

    As soon as the board is submerged, turn the victim onto the board then allow the board to float up beneath the victim.

    Once the board is submerged, the second lifeguard can help to stabilize the board against the wall, placing his or her foot against the backboard, if necessary.

SKILL ASSESSMENT TOOL: TWO-PERSON REMOVAL FROM THE WATER USING A BACKBOARD

Criteria
Proficient
Not Proficient

Victim is brought to a position facing the side of the pool with the head out of the water
Victim is facing the side of the pool with head tipped back, out of the water

    Victim is not facing the side of the pool

    Victim's head is leaning forward

    Victim's face is in the water

Lifeguards communicate with each other
Lifeguard(s) communicates what, how and/or when actions happen
Lifeguards cannot proceed with removing the victim from the water

Victim's head remains above the surface of the water
Victim's mouth and nose are maintained out of the water
Victim's mouth or nose is in the water

Assisting lifeguard(s) maintains contact with the victim
Assisting lifeguard(s) maintains grip of the victim's wrists
Assisting lifeguard(s) loses grip of the victim

Backboard is submerged into position
Backboard is submerged along the wall next to the victim

    Unable to submerge the backboard

    Backboard cannot be placed under the victim

Victim is placed onto the board

    Victim is turned onto backboard

    Each lifeguard grasps one of the victim's wrists and has a handhold of the backboard

    Unable to place victim on the backboard

    Loses contact with backboard or victim

Victim is pulled out on the backboard in a safe manner for rescuers and victim

    Lifeguards pull the backboard and victim onto land

    Backboard is carefully lowered to the ground

    Unable to remove the backboard and the victim

    Victim's body is hanging off the board, which may cause injury

    Backboard is dropped on land

Lifeguard(s) move into position to start a primary assessment of the victim
Lifeguard(s) open the victim's airway
Lifeguard(s) does not open the victim's airway

LESSON 5

BEFORE PROVIDING CARE, VICTIM ASSESSMENT AND BREATHING EMERGENCIES

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Describe what standard precautions to take to prevent disease transmission when providing care.

    Demonstrate proper removal of disposable gloves.

    Describe the general procedures for injury or sudden illness on land.

    Identify items of concern when conducting a scene size-up.

    Demonstrate how to perform a primary assessment and place a victim in the H.A.IN.E.S. recovery position.

    Identify victim conditions that indicate the need to summon emergency medical services (EMS) personnel.

    Understand how to safely and effectively move a victim on land.

    Demonstrate how to use a resuscitation mask.

    Recognize and care for a breathing emergency.

    Demonstrate how to safely and effectively give ventilations.

    Demonstrate how to safely and effectively use a bag-valve-mask (BVM) resuscitator with two rescuers.

    Demonstrate how to safely and effectively care for an obstructed airway for a conscious and an unconscious victim.

    Demonstrate the ability to work as a team to implement an EAP, perform a rescue and perform emergency care.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Manikins (one adult and one infant manikin per two participants, child manikins optional)

    Pediatric resuscitation masks (one per participant)

    Bag-valve-mask (BVM) resuscitators (one per two participants)

    Decontamination supplies

TOPIC: STANDARD PRECAUTIONS images

PRESENTATION: STANDARD PRECAUTIONS

Video Segment

    Remind participants that they have already discussed disease transmission related to safety and explain that in this lesson they will learn more about the specific diseases of concern and how they are transmitted.

    Show the video segment, “Standard Precautions.”

    Answer participants’ questions about the segment.

    Ask participants: What are the diseases that are of primary concern for you as a lifeguard?
Answers: Responses should include the following:

    Hepatitis B

    Hepatitis C

    HIV

Removing Disposable Gloves

Skill Practice

    Provide all participants with disposable non-latex gloves.

    Explain that participants will have many opportunities to practice glove removal since they will be following these procedures each time they remove gloves throughout the remainder of this course.

    Lead participants through the skill of Removing Disposable Gloves.

    Observe each participant’s performance of the skill and provide corrective feedback.

Lecture

    Facility management should abide by Occupational Safety and Health Administration (OSHA) requirements regarding job-related exposure to bloodborne pathogens, which are designed to protect you from disease transmission.

    You should participate in annual bloodborne pathogens training to learn and review the procedures that protect you from exposure at your worksite.

    Standard precautions are safety measures that combine universal precautions and body substance isolation (BSI) precautions by assuming that all body fluids may be infectious.

    Standard precautions can be applied through the use of:

    Personal protective equipment (PPE), such as non-latex disposable gloves and a resuscitation mask.

    Good hand hygiene, which includes washing your hands thoroughly after removing gloves or after any direct or indirect contact with body fluids.

    Engineering controls, such as the use of biohazard bags to dispose of items that may be contaminated with body fluids.

    Work practice controls, such as using the proper procedure for removing disposable gloves that protect you from exposure to body fluids.

    Proper steps for cleaning equipment that will be re-used following an incident involving body fluids.

    Spill clean-up procedures, such as cleaning up blood spills from the pool deck.

TOPIC: GENERAL PROCEDURES FOR AN EMERGENCY ON LAND images

PRESENTATION: GENERAL PROCEDURES FOR AN EMERGENCY ON LAND

Lecture

    If someone is suddenly injured or becomes ill, activate the facility’s emergency action plan (EAP) for an emergency on land and follow these general procedures.

    Size up the scene to:

    Check for hazards that could present a danger to you or the victim.

    Determine what caused the injury or the nature of the illness.

    Determine the number of victims to prioritize care.

    Determine what additional help may be needed.

    Put on the appropriate PPE.

    Perform a primary assessment to determine life-threatening conditions.

    Be sure to obtain consent if the victim is conscious.

    Summon emergency medical services (EMS), if needed.

    Perform a secondary assessment if no life-threatening conditions are found.

    Provide care for the conditions found.

    Complete follow-up reports, advise the victim, if warranted, and release the victim.

Scene Size-Up

Guided Discussion

    Tell participants that the first step in the general procedures is the scene size-up. A scene size-up is the careful and systematic approach of a scene to get a full picture of the emergency situation.

    Ask participants: Using your senses, what information can you gather about the scene of an emergency?
Answers: Responses should include the following:

    Sight: Hazardous conditions, number of victims, number of bystanders

    Smell: Odors that might suggest chemical release, intoxication, diabetic emergency or burning objects

    Hearing: Unusual sounds, cries for help, splashing

    Ask participants: Why else is a scene size-up necessary?
Answers: Responses should include the following:

    To ensure scene safety for the rescuers, the victims and any bystanders

    To identify necessary PPE

    To determine the mechanism of injury or nature of the illness

    To determine the number of victims

    To identify what additional help may be required

TOPIC: PERFORMING A PRIMARY ASSESSMENT images

PRESENTATION: PERFORMING A PRIMARY ASSESSMENT

Lecture

    A primary assessment is done to identify any life-threatening conditions.

    The steps for a primary assessment include the following:

    Check the victim for responsiveness.

    Open the victim’s airway and check for breathing and a pulse.

    If the victim is alert and speaking, the airway is open.

    If the victim is unconscious and you do not suspect a head, neck or spinal injury, use the head-tilt/chin-lift technique to open the airway. If you suspect a head, neck or spinal injury, use the jaw-thrust (without head extension) maneuver to open the airway.

    Agonal gasps, which are irregular, gasping or shallow breaths, may occur. These gasps are not considered normal breathing. If you detect agonal gasps, care for the victim as though he or she is not breathing.

    Check for a carotid pulse in an adult and a child. Check for a brachial pulse in an infant.

    For a child or an infant, give 2 initial ventilations if the victim is not breathing. For an adult, give 2 initial ventilations only if he or she is not breathing because of drowning or another respiratory cause.

    Scan for severe bleeding.

    In general, if a person is unconscious but breathing, leave that person in a face-up position and maintain an open airway, especially if there is a suspected spinal injury. However, if you are alone and must leave the person (e.g., to call for help), or you cannot maintain an open and clear airway because of fluids or vomit, place the person in a modified high arm in endangered spine (H.A.IN.E.S.) recovery position. Do this whether or not a spinal injury is suspected.

Performing a Primary Assessment—Adult

Video segment

    Explain to participants that the video segment demonstrates the procedures used for a primary assessment for an adult to identify life-threatening conditions. These procedures also are followed for any victim of a witnessed sudden collapse.

    Show the video segment, “Primary Assessment—Adult.”

    Answer participants’ questions about the segment.

Skill Practice

    Ask participants to take their participant’s manual and disposable gloves to the practice area.

    Ask participants to find a partner. One person will be the responder while the other person will be the injured or ill person, then they will switch roles.

    Guide participants through the steps listed on the Performing a Primary Assessment—Adult skill chart. Once participants have completed the primary assessment, have them practice the modified H.A.IN.E.S. recovery position. Guide them through the steps listed on the Modified H.A.IN.E.S. Recovery Position skill chart.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Be sure to point out any common errors, such as failing to size up the scene, failing to determine consciousness, failing to follow standard precautions, improperly opening the airway, checking an inappropriate pulse site or pressing the pulse site too hard.

Performing a Primary Assessment—Child and Infant

Video segment

    Explain to participants that there are some differences in technique in the primary assessment for children and infants. Remind them that for children and infants as well as for any victim of a drowning or another respiratory cause, the primary assessment also includes giving 2 ventilations.

    Explain that since the skill for this age victim includes giving ventilations, this segment covers the primary assessment skill as well as how to give ventilations using a resuscitation mask. It shows how to use the resuscitation mask from different positions and for different situations.

    Show the video segment, “Primary Assessment—Child and Infant.”

    Answer participants’ questions about the segment.

    Ask participants: What are the differences to be aware of when performing a primary assessment on a child versus an infant?
Answers: Responses should include the following:

    The position of the head should be slightly past the neutral position for a child and in the neutral position for an infant.

    For an infant, feel for the brachial pulse on the inside of the upper arm, between the elbow and the shoulder.

    Ask participants: In what circumstances do you give 2 ventilations when performing a primary assessment?
Answers: Responses should include the following:

    For a child or infant that is not responsive and not breathing

    For an adult victim of a drowning or other respiratory cause

Using a Resuscitation Mask

Skill Practice

    Ask participants to bring their participant’s manual, disposable gloves and resuscitation masks to the practice area.

    Using a manikin, guide participants through the three methods for giving ventilations using each of the following methods:

    Head-tilt/chin-lift technique

    Jaw-thrust (with head extension) maneuver

    Jaw-thrust (without head extension) maneuver

    Observe each participant’s performance of the skill and provide corrective feedback.

    Be sure to point out any common errors, such as improperly opening the airway, not obtaining a seal with the resuscitation mask, or not making the chest rise and fall.

Primary Assessment—Child or Infant

Skill Practice

    Using a manikin, guide participants through the steps listed on the Primary Assessment—Child and Infant skill chart.

    Once participants have completed the primary assessment, have them practice the modified H.A.IN.E.S. recovery position. Guide participants through the steps listed on the Modified H.A.IN.E.S. Recovery Position skill chart.

    Observe each participant’s performance of the skills and provide corrective feedback.

Summoning EMS Personnel

Lecture

    Summon EMS personnel for any of the following conditions:

    Unconsciousness or altered level of consciousness (LOC)

    Breathing problems

    Chest pain, discomfort or pressure lasting more than a few minutes or that goes away and comes back or that radiates to the shoulder, arm, neck, jaw, stomach or back

    Persistent abdominal pain or pressure

    No pulse

    Severe external bleeding (bleeding that spurts or gushes steadily from a wound)

    Vomiting blood or passing blood

    Severe (critical) burns

    Suspected poisoning

    Seizures on land, unless the person is known to have periodic seizures

    Stroke

    Painful, swollen, deformed areas or an open fracture

    Victim’s physical condition is unclear or is worsening

    Ask participants: What other conditions that may occur in the aquatic environment might require summoning EMS personnel?
Answers: Responses should include the following:

    Any victim recovered from underwater who may have inhaled water

    Seizures in the water

    Suspected or obvious injuries to the head, neck or spine

TOPIC: MOVING A VICTIM images

PRESENTATION: MOVING A VICTIM

Lecture

    Moving a victim needlessly or improperly can lead to further pain and injury.

    Ask participants: What factors should be considered when deciding whether or not to move a victim?
Answers: Responses should include the following:

    You are faced with immediate danger.

    You need to get to other victims who have more serious injuries or illnesses.

    It is necessary to provide appropriate care (e.g., moving a victim to the top or bottom of a flight of stairs to perform CPR).

    If you must leave a scene to ensure your personal safety, you should make reasonable attempts to move the victim to safety as well.

    Ask participants: If the decision is made to move a victim, what factors should be considered in deciding what method to use?
Answers: Responses should include the following:

    The victim’s height and weight

    Your physical strength

    Obstacles, such as stairs and narrow passages

    The distance to be moved

    Whether others are available to assist

    The victim’s condition

    Whether aids to transport are readily available

TOPIC: RECOGNIZING AND CARING FOR BREATHING EMERGENCIES images

PRESENTATION: RECOGNIZING AND CARING FOR BREATHING EMERGENCIES

Guided Discussion

    In a breathing emergency, a person’s breathing can become so impaired that life is threatened. As a lifeguard, it is important for you to know how to recognize and care for these emergencies.

    Hypoxia is a condition in which insufficient oxygen reaches the cells.

    Ask participants: What are possible causes of hypoxia?
Answers: Responses should include the following:

    Obstructed airway

    Shock

    Inadequate breathing

    Fatal and nonfatal drowning

    Strangulation

    Choking

    Suffocation

    Cardiac arrest

    Head trauma

    Carbon monoxide poisoning

    Anaphylactic shock

    There are two types of breathing (also referred to as respiratory) emergencies:

    Respiratory distress is a condition in which breathing becomes difficult.

    Respiratory arrest is a condition in which breathing stops.

    Respiratory distress may lead to respiratory arrest.

    Ask participants: What signs and symptoms might indicate that a person is experiencing respiratory distress?
Answers: Responses should include the following:

    Slow or rapid breathing

    Unusually deep or shallow breathing

    Shortness of breath or noisy breathing

    Dizziness, drowsiness or light-headedness

    Changes in level of consciousness

    Increased heart rate

    Chest pain or discomfort

    Skin that is flushed, pale, ashen or bluish

    Unusually moist or cool skin

    Gasping for breath

    Wheezing, gurgling or high-pitched noises

    Inability to speak in full sentences

    Tingling in the hands, feet or lips

    Apprehensive or fearful feelings

    Caring for respiratory distress includes:

    Maintaining an open airway.

    Summoning EMS personnel.

    Helping the victim to rest in a comfortable position that makes breathing easier.

    Reassuring and comforting the victim.

    Assisting the victim with taking any of his or her prescribed medication.

    Keeping the victim from getting chilled or overheated.

    Administering emergency oxygen, if it is available and you are trained to do so.

    Someone with asthma or emphysema who is in respiratory distress may try to do pursed-lip breathing.

    To assist with this, have the person assume a position of comfort. After or she inhales, have the person slowly exhale through the lips, pursed as though blowing out candles.

    The use of emergency oxygen can help a conscious person who is in respiratory distress or may be used for an unconscious victim who is not breathing. Additional American Red Cross training is available to teach you how to administer emergency oxygen.

    Refer participants to Chapter 8, Breathing Emergencies, in the Lifeguarding Manual. Point out the sidebars on asthma and anaphylaxis. Explain that if they will be required to administer epinephrine, they may need to undergo additional training conducted at their facility.

Instructor’s Note: Training information and skill sheets for the administration of epinephrine and for the administration of inhalers can be found on redcross.org/instructorscorner.

TOPIC: GIVING VENTILATIONS images

PRESENTATION: GIVING VENTILATIONS—ADULT, CHILD AND INFANT

Giving Ventilations—Adult

Skill Practice

    Choose either the practice-while-you-watch or watch-then-practice method for this skill practice.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Be sure to point out any common errors, such as tilting the head too far back, failing to reassess for breathing and pulse, not leaving the victim in a face-up position with return of breathing, not obtaining a seal with the resuscitation mask or using an improperly sized mask for the victim.

Practice-While-You-Watch

    Ask participants to take their disposable gloves and resuscitation masks to the practice area.

    Explain to the participants that, for this skill, they will follow along with and practice the steps for giving ventilations as they are guided by the video.

    Show the video segment, “Giving Ventilations—Adult, Child and Infant.”

    Do not interrupt this skill session to lecture or communicate anything other than guidance related to skill practice. In general, answering questions should occur after the video segment (and skill session) has ended.

Watch-Then-Practice

    Tell participants that, for this skill, they will watch the video segment without practicing until you pause it, even though the narration may say to follow along.

    Show the video segment, “Giving Ventilations—Adult, Child and Infant.”

    Ask participants to take their disposable gloves and resuscitation masks to the practice area.

    Guide participants through the steps of the skill.

Giving Ventilations—Child or Infant

Skill Practice

Instructor’s Notes: Participants need only demonstrate how to provide ventilations for either a child or infant and be able to point out the differences for the other, such as how far to tilt the head or using a pediatric resuscitation mask for a child.

    Guide participants through the steps of the skill.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Point out any common errors for giving ventilations, such as tilting the head too far back, failing to recheck for breathing and a pulse, giving ventilations that are too hard or too fast, not properly sealing the resuscitation mask or using an improperly sized mask for the victim.

TOPIC: GIVING VENTILATIONS USING A BAG-VALVE-MASK RESUSCITATOR images

PRESENTATION: GIVING VENTILATIONS USING A BVM—TWO RESCUERS

Activity

    Briefly show participants a BVM and point out the three parts—bag, valve and mask—demonstrating how squeezing the bag opens the one-way valve, forcing air into the lungs, and how releasing the bag closes the valve, allowing environmental air to refill it.

    Emphasize the need for two rescuers: one to position and seal the mask and one to squeeze the bag.

Video segment

    Explain to participants that the video segment demonstrates how to use a BVM.

    Show the video segment, “Using a Bag-Valve-Mask Resuscitator—Two Rescuers.”

    Answer participants’ questions about the segment.

Giving Ventilations Using a Bag-Valve-Mask Resuscitator—Two Rescuers

Skill Practice

    Divide participants into pairs and guide them through the steps listed on the Giving Ventilations Using a Bag-Valve-Mask Resuscitator—Two Rescuers skill chart.

    Guide participants through the steps of the skill.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Point out any common errors for giving ventilations using a BVM, such as not maintaining a seal with the resuscitation mask, not squeezing the bag hard enough or squeezing the bag too hard.

TOPIC: AIRWAY OBSTRUCTION images

PRESENTATION: AIRWAY OBSTRUCTION

Conscious Choking—Adult and Child

Video segment

    Explain to participants that the video segment will demonstrate how to care for a conscious choking adult or child.

    Show the video segment, “Conscious Choking—Adult and Child.”

    Answer participants’ questions about the segment.

Lecture

    The most common cause of respiratory emergencies is airway obstruction.

    Mechanical obstructions result from a foreign body lodged in the airway, generally food or other small objects.

    Anatomical obstructions are caused mostly by the tongue. When a person becomes unconscious, the tongue loses muscle tone and falls back, blocking the airway.

    The universal sign for choking in a conscious person is clutching the throat.

    Encourage coughing as long as the person can cough forcefully.

    If the person cannot cough, speak, cry or breathe, immediate action is needed.

Skill Practice

    Divide participants into two lines facing the same direction or have them partner and arrange each pair so you can see all groups. Designate victims and lifeguards.

    Instruct participants not to give actual back blows or abdominal thrusts to their partners.

    Guide them through the steps listed on the Conscious Choking—Adult and Child skill chart.

    Have participants change roles and repeat the guided skill practice.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Point out any common errors, such as failing to obtain the victim’s consent, performing abdominal thrusts before back blows, positioning the hands improperly or not using the thumb side of the fist to give abdominal thrusts.

    Participants only need to demonstrate how to care for either a conscious choking adult or a child and be able to point out the differences for the other, such as kneeling if the victim is shorter.

    Remind participants that if a conscious choking victim is too large to reach around or if the victim is obviously pregnant or known to be pregnant, back blows and chest thrusts are used.

Conscious Choking—Infant

Video segment

    Explain that the video segment will demonstrate how to care for a conscious choking infant.

    Show the video segment, “Conscious Choking—Infant.”

    Answer participants’ questions about the segment.

Skill Practice

    Ask participants to return to the practice area.

    Divide participants into pairs and guide them through the steps listed on the Conscious Choking—Infant skill chart.

    Have each participant practice clearing the airway of a conscious choking infant on a manikin while the other participants use their skill sheets to give feedback.

    Follow the same steps as in the previous skill session:

    Have participants practice the skill.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Point out any errors, such as not keeping the infant’s head lower than the chest, not supporting the head and neck securely when turning the infant, not placing the fingers correctly for chest thrusts or the hand for back blows.

Unconscious Choking—Adult and Child

Lecture

    A drowning victim may likely present a complication with an obstructed airway.

    If there is a white or pink froth in and around the victim’s mouth, wipe it away and proceed with care.

    If there is vomit or heavy mucus, use chest compressions to try to clear the obstruction.

    More advanced skills, such as suctioning and the use of airway adjuncts, may help to clear an obstructed airway. These methods require additional training.

Video segment

    Explain that the video segment demonstrates how to clear an obstruction from the airway for an unconscious choking adult, child and infant

    Show the video segment, “Unconscious Choking—Adult, Child and Infant.”

    Answer participants’ questions about the segment.

Skill Practice

    Ask participants to take their disposable gloves and resuscitation masks to the practice area.

    Divide participants into pairs and guide them through the steps listed on the Unconscious Choking—Adult and Child skill chart.

    Have each participant practice clearing the airway of an unconscious choking adult or child on a manikin while the other participants use their skill sheets to give feedback.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Point out any common errors, such as using abdominal thrusts instead of chest thrusts, failing to check the mouth for an object, compressing too little or too much, failing to give ventilations or using the wrong finger to clear the object from the mouth.

    Participants only need to demonstrate care for an airway obstruction for either an unconscious adult or child and be able to point out the differences, such as how far to tilt the head and how deep to compress the chest.

Unconscious Choking—Infant

Skill Practice

    Guide participants through the steps listed on the Unconscious Choking—Infant skill chart.

    Follow the same steps as in the previous skill session:

    Have participants practice the skill.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Point out any common errors for caring for an unconscious choking infant, such as not keeping the infant’s head lower than the chest, not supporting the head and neck securely when turning the infant, not placing the fingers correctly for chest thrusts or the hand for back blows, or failing to give ventilations.

IN-WATER SKILL SESSION: PUTTING IT ALL TOGETHER images

PRESENTATION: NEXT STEPS

Skill Drill

    Assemble the participants on the pool deck and explain they will be practicing team rescues for a submerged passive victim in deep water, removing the victim from the water on a backboard, doing a primary assessment and caring for a victim who is not breathing but has a pulse.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, participants will practice rescuing a submerged passive victim in shallow water.

    Divide the participants into groups of three and assign one rescuing lifeguard, one assisting lifeguard and one victim for each group. Have each lifeguard wear a hip pack containing gloves and a resuscitation mask.

    Have a manikin available to substitute into the drill once the primary assessment is complete.

    Explain that for each group:

    The rescuing lifeguard will simulate activating the EAP and enter the water.

    The victim will get into position and submerge as the rescuing lifeguard gets near. The rescuing lifeguard will perform a submerged passive victim rescue.

    The assisting lifeguard will bring the backboard and assist the rescuing lifeguard in removing the victim from the water, demonstrating team communication skills between the lifeguards.

    Once removed from the water, the lifeguards should do a primary assessment on the victim (simulating breaths) and then provide care for a victim who is not breathing but has a pulse on the manikin. The lifeguards should give ventilations using a BVM.

    Repeat the drill until each person in the group has performed as a rescuing lifeguard and an assisting lifeguard.

ASSIGNMENT

    Read Chapter 9, Cardiac Emergencies, in the Lifeguarding Manual before the next class session.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general for the category of skills, as well as specific to the skill, must be met.

REMOVING DISPOSABLE GLOVES

SKILL CHART: REMOVING DISPOSABLE GLOVES

1.   Pinch the glove.

    Pinch the palm side of one glove near your wrist.

    Carefully pull the glove off so that it is inside out.

2.    Slip two fingers under the glove.

    Hold the glove in the palm of your gloved hand.

    Slip two fingers under the glove at the wrist of the remaining gloved hand.

3.    Pull the glove off.

    Pull the glove until it comes off, inside out.

    The first glove should end up inside the glove you just removed.

4.    Dispose of gloves and wash hands.

    Dispose of gloves and other PPE in a proper biohazard container.

    Wash your hands thoroughly with soap and running water, if available. Otherwise, rub hands thoroughly with an alcohol-based sanitizer if hands are not visibly soiled.

SKILL ASSESSMENT TOOL: REMOVING DISOSABLE GLOVES

Criteria
Proficient
Not Proficient

Removes gloves
Bare skin does not come into contact with outside surface of gloves
Bare skin comes into contact with outside surface of glove(s)

PRIMARY ASSESSMENT

SKILL CHART: PRIMARY ASSESSMENT—ADULT

Size up the scene for safety and then:

1.    Check for responsiveness.

    Tap the shoulder and ask, “Are you okay?”

2.    If no response, summon EMS personnel.

    If the victim is face-down, roll the victim onto his or her back while supporting the head, neck and back.

3.    Open the airway and quickly check for breathing and a pulse for no more than 10 seconds.

    To open the airway:

    From the side, use the head-tilt/chin-lift technique.

    From above the victim’s head, use the jaw-thrust (with head extension) maneuver.

    If a head, neck or spinal injury is suspected, use the jaw-thrust (without head extension) maneuver.

    Look, listen and feel for breathing.

    Feel for a carotid pulse by placing two fingers in the middle of the victim’s throat and then sliding them into the groove at the side of the neck closest to you. Press lightly.

Note: For a breathing emergency (e.g., drowning, hypoxia), give 2 ventilations before scanning for severe bleeding. If at any time the chest does not rise, the airway might be blocked. Provide care for an unconscious choking victim.

4.    Quickly scan for severe bleeding.

5.    Provide care as needed.

    If no breathing or pulse, perform CPR.

    If no breathing but there is a pulse, give 1 ventilation about every 5 seconds.

    If there is severe bleeding and the victim is breathing, provide first aid care for the bleeding.

    If unconscious but breathing, leave the victim in a face-up position. Place in a modified H.A.IN.E.S. recovery position only if you:

    Are alone and must leave the victim (e.g., to call for help).

    Cannot maintain an open and clear airway because of fluids or vomit.

SKILL CHART: PRIMARY ASSESSMENT—CHILD AND INFANT

Size up the scene for safety and then:

1.    Check for responsiveness.

    For a child, tap the shoulder and shout, “Are you okay?”

    For an infant, tap the shoulder or flick the underside of the foot and shout.

2.    If no response, summon EMS personnel.

    If the victim is face-down, roll the victim onto his or her back while supporting the head, neck and back.

3.    Open the airway and check for breathing and a pulse for no more than 10 seconds.

    To open the airway:

    From the side, use the head-tilt/chin-lift technique.

    From above the victim’s head, use the jaw-thrust (with head extension) maneuver.

    If you suspect a head, neck or spinal injury, use the jaw-thrust (without head extension) maneuver.

    Look, listen and feel for breathing.

    Check for a pulse.

    For a child, feel for a carotid pulse by placing two fingers in the middle of the victim’s throat and then sliding them into the groove at the side of the neck closest to you. Press in lightly.

    For an infant, feel for the brachial pulse on the inside of the upper arm between the infant’s elbow and shoulder. Press lightly.

Note: If you witnessed a child or an infant suddenly collapse, skip Step 4.

4.    If no breathing, give 2 ventilations. Each ventilation should last about 1 second and make the chest clearly rise.

    The chest should fall before the next ventilation is given.

Note: If at any time the chest does not rise during Step 4, the airway might be blocked. Provide care for an unconscious choking victim.

5.    Quickly scan for severe bleeding.

6.    Provide care as needed.

    If no breathing or pulse, perform CPR.

    If no breathing but there is a pulse, give 1 ventilation about every 3 seconds.

    If there is severe bleeding and the victim is breathing, provide first aid care for the bleeding.

    If unconscious but breathing, leave the victim in a face-up position. Place in a modified H.A.IN.E.S recovery position only if you:

    Are alone and have to leave the victim (e.g., to call for help).

    Cannot maintain an open and clear airway because of fluids or vomit.

SKILL ASSESSMENT TOOL: PRIMARY ASSESSMENT—ADULT, CHILD AND INFANT

Criteria
Proficient
Not Proficient

Open the airway

    Tilts head back so that jaw line is at an angle of 80° to 100° to the floor

    Maintains open airway throughout primary assessment

    Tilts head back so that jaw line is at an angle less than 80° or greater than 100° to the floor

    Does not maintain an open airway throughout primary assessment

Feel for a pulse

    For adult or child, feels for carotid pulse

    For infant, feels for brachial pulse

    Feels for a pulse for more than 5, but no more than 10 seconds

    Feels for pulse in incorrect location

    Feels for a pulse for less than 5 or more than 10 seconds

Give ventilations (child or infant, or in cases of a breathing emergency [e.g., drowning or hypoxia] in an adult)

    Gives 2 ventilations that make the chest clearly rise and last about 1 second each

    Allows the chest to fall between ventilations

    Gives 2 ventilations that do not make the chest clearly rise and last 2 or more seconds each

    Does not allow chest to fall between ventilations

RECOVERY POSITIONS

SKILL CHART: FACE-UP POSITION

If unconscious but breathing, leave the victim in a face-up position.

SKILL CHART: MODIFIED H.A.IN.E.S. RECOVERY POSITION

1.    Kneel at the victim’s side.

2.    Roll the victim away from you.

    Reach across the victim’s body, lift up the arm farthest from you and place it next to the head with the palm facing up.

    Take the person’s arm closest to you and place it next to his or her side.

    Grasp the leg farthest from you and bend it up.

    Using your hand that is closest to the victim’s head, cup the base of the victim’s skull in the palm of your hand and carefully slide your forearm under the victim’s shoulder closest to you. Do not lift or push the head or neck.

    Place your other hand under the arm and hip closest to you.

    Using a smooth motion, roll the victim away from you by lifting with your hand and forearm. Keep the victim’s head in contact with his or her extended arm and be sure to support the head and neck with your hand.

    Stop all movement when the victim is on his or her side.

3.    Place the top leg on the other so that both knees are in a bent position.

4.    Make sure the arm on top is in line with the upper body.

    If you must leave the person to get help, place the hand of the upper arm palm side down with the fingers under the armpit of the extended lower arm.

SKILL CHART: INFANT RECOVERY POSITION (ALTERNATE)

1.    Carefully position the infant face-down along your forearm.

2.    Support the infant’s head and neck with your other hand while keeping the infant’s mouth and nose clear.

SKILL ASSESSMENT TOOL: RECOVERY POSITIONS

Criteria
Proficient
Not Proficient

Face-Up Position

Maintain an open airway
Victim is breathing, lying face-up and head is tilted in an open airway position
Head is not tilted back in an open airway position

H.A.IN.E.S Recovery Position

Maintain an open airway
Rolls victim onto side
Victim is vomiting but left lying face-up

Support head, neck and spine
Rolls victim in a smooth motion until on his or her side
Lifts or pushes the head or neck

Infant (Alternate)

Maintain an open airway
Mouth and nose are clear
Infant’s mouth or nose is blocked by forearm or hand

Support head and neck

    Infant face-down along the rescuer’s forearm

    Head and neck supported by other hand

Infant’s head or body is sideways or dangling from forearm

USING A RESUSCITATION MASK

SKILL CHART: HEAD-TILT/CHIN-LIFT TECHNIQUE

1.    Kneel to the side of the victim’s head.

2.    Position the mask.

    Place the rim of the mask between the victim’s lower lip and chin.

    Lower the mask until it covers the victim’s mouth and nose.

3.    Seal the mask.

    Place the thumb and fingers of one hand around the top of the mask.

    Place the thumb of your other hand on the bottom of the mask and slide your first two fingers onto the bony part of the victim’s chin.

    Press downward on the mask with your top hand and the thumb of your lower hand to seal the top and bottom of the mask.

4.    Tilt the victim’s head back and lift the chin to open the airway.

5.    Blow into the mask.

    Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next ventilation is given.

SKILL CHART: JAW-THRUST (WITH HEAD EXTENSION) MANEUVER

1.    Position the mask.

    Kneel above the victim’s head.

    Place the rim of the mask between the lower lip and chin.

    Lower the resuscitation mask until it covers the victim’s mouth and nose.

2.    To seal the mask and open the airway:

    Using the elbows for support, place your thumbs and index fingers along each side of the resuscitation mask to create a “C.”

    Slide your 3rd, 4th and 5th fingers into position to create an “E” on both sides of the victim’s jawbone.

    Hold the mask in place while you tilt the head back and lift the jaw into the mask.

3.    Blow into the mask.

    Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next ventilation is given.

SKILL CHART: JAW-THRUST (WITHOUT HEAD EXTENSION) MANEUVER

1.    Position the mask.

    Kneel above the victim’s head.

    Place the rim of the mask between the lower lip and chin.

    Lower the resuscitation mask until it covers the victim’s mouth and nose

2.    To seal the mask and open the airway:

    Place your thumbs and index fingers along each side of the resuscitation mask to create a “C.”

    Slide your 3rd, 4th and 5th fingers into position to create an “E” on both sides of the victim’s jawbone.

    Without moving or tilting the head back, lift the lower jaw up with your fingers along the jawbone to seal the mask to the face.

3.    Blow into the mask.

    Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next ventilation is given.

SKILL ASSESSMENT TOOL: USING A RESUSCITATION MASK

Criteria
Proficient
Not Proficient

Open the airway:

    Head-tilt/chin-lift or jaw thrust (with head extension) maneuver

    Jaw thrust (without head extension) maneuver

Tilts the head back so that the jaw line is at an angle of 80° to 100° to the floor
Lifts the victim’s jaw to open the airway
Tilts head back so that jaw line is at an angle less than 80° or greater than 100° to the floor
Tilts the victim’s head back

Give ventilations
Gives ventilations that make the chest clearly rise and last about 1 second each

    Ventilations do not make the chest clearly rise

    Ventilation lasts 2 or more seconds

GIVING VENTILATIONS USING A BAG-VALVE-MASK RESUSCITATOR

SKILL CHART: GIVING VENTILATIONS USING A BAG-VALVE-MASK RESUSCITATOR—TWO RESCUERS

1.    Rescuer 1 kneels behind the victim’s head and positions the mask over the victim’s mouth and nose.

2.    Rescuer 1 seals the mask.

3.    Rescuer 1 opens the airway using the jaw-thrust (with head extension) maneuver.

    Using the elbows for support, place your thumbs and index fingers along each side of the resuscitation mask to create a “C.”

    Slide your 3rd, 4th and 5th fingers into position to create an “E” on both sides of the victim’s jawbone.

    Hold the mask in place while you tilt the head back and lift the jaw into the mask.

4.    Rescuer 2 gives ventilations.

    Squeeze the bag slowly with both hands.

    For an adult, give 1 ventilation about every 5 seconds.

    For a child or infant, give 1 ventilation about every 3 seconds.

    Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before the next breath is given.

5.    Rescuer 2 rechecks for breathing and a pulse about every 2 minutes.

    Remove the mask and look, listen and feel for breathing and a pulse for no more than 10 seconds.

SKILL ASSESSMENT TOOL: GIVING VENTILATIONS USING A BVM—TWO RESCUERS

Criteria Proficient
Proficient
Not Proficient

Open airway
Performs a jaw-thrust (with head extension) maneuver

    Tilts the head from the side

    Unable to open the airway

Deliver the appropriate volume of air with each ventilation
Squeezes the bag to give ventilations that make the chest clearly rise
Victim’s chest does not rise

Give ventilations at the correct ratio for the victim
Adult ratio: Squeezes the bag to give 1 ventilation about every 5 seconds

    Gives ventilations too slow or too fast:

    Less than 1 ventilation every 3 seconds

    Greater than 1 ventilation every 7 seconds

Child or Infant ratio: Squeezes the bag to give 1 ventilation about every 3 seconds

    Gives ventilations too slow or too fast:

    Less than 1 ventilation every second

    Greater than 1 ventilation every 5 seconds

AIRWAY OBSTRUCTION

SKILL CHART: CONSCIOUS CHOKING—ADULT AND CHILD

If the victim cannot cough, speak or breathe:

1.    Give 5 back blows.

    Position yourself slightly behind the victim.

    Place one arm diagonally across the victim’s chest and bend the victim forward at the waist. The victim’s upper airway should be at least parallel to the ground.

    Firmly strike the victim between the shoulder blades with the heel of your hand.

    Each thrust should be a distinct attempt to dislodge the object.

2.    Give 5 abdominal thrusts.

    Stand behind the victim.

    For a child, stand or kneel behind the child, depending on the child’s size. Use less force on a child than you would on an adult.

    Place the thumb side of your fist against the middle of the abdomen, just above the navel.

    Grab your fist and give quick, upward thrusts.

    Each thrust should be a distinct attempt to dislodge the object.

SKILL CHART: CONSCIOUS CHOKING—INFANT

If the victim cannot cough, speak or breathe:

1.    Carefully position the infant face-down along your forearm.

    Support the infant’s head and neck with your hand.

    Lower the infant onto your thigh, keeping the infant’s head lower than his or her chest.

2.    Give 5 back blows.

    Give back blows with the heel of your hand between the infant’s shoulder blades.

    Each back blow should be a distinct attempt to dislodge the object.

3.    Position the infant face-up along your forearm.

    Position the infant between both of your forearms, supporting the infant’s head and neck.

    Turn the infant face-up.

    Lower the infant onto your thigh with the infant’s head lower than his or her chest.

4.    Give 5 chest thrusts.

    Put two or three fingers on the center of the chest just below the nipple line and compress the chest about 1½ inches.

    Each chest thrust should be a distinct attempt to dislodge the obiect.

SKILL ASSESSMENT TOOL: CONSCIOUS CHOKING—ADULT OR CHILD

Criteria
Proficient
Not Proficient

Bend the person forward at the waist for back blows
Positions person with upper airway (person’s head and neck) parallel to the ground or angled slightly downward
Positions person with upper airway (person’s head and neck) angled upward

Give 5 back blows

    Strikes the back with heel of one hand

    Strikes the center of the back between shoulder blades

    Each back blow is a separate and distinct attempt to dislodge the object

    Strikes the back with closed hand

    Strikes the back with palm

    Strikes the back more than 2 inches from the center of both shoulder blades

    Each back blow is not a separate and distinct attempt to dislodge the object

Give 5 abdominal thrusts

    Places fist within 2 inches of navel

    Places fist 1 inch or more away from lower tip of breastbone

    Each abdominal thrust is a separate and distinct attempt to dislodge the object

    Places fist more than 2 inches from navel

    Places fist less than 1 inch from the lower tip of breastbone (too close to breastbone)

    Each abdominal thrust is not a separate and distinct attempt to dislodge the object

SKILL ASSESSMENT TOOL: CONSCIOUS CHOKING—INFANT

Criteria
Proficient
Not Proficient

Keep the head lower than the chest
Positions infant with upper airway (infant’s head and neck) angled downward, lower than chest
Positions infant with upper airway (infant’s head and neck) parallel to ground or angled upward

Support the head and neck securely
Places thumb and fingers on infant’s jaw

    Places thumb on front of infant’s neck

    Places fingers on front of infant’s neck

Maintain firm support
Holds infant securely

    Drops infant

    Loses control of infant

Give back blows

    Strikes the back with the heel of one hand

    Strikes the center of the back between the shoulder blades

    Strikes the back with a closed hand

    Strikes the back with a palm

    Strikes the back more than 1 inch from the center of both shoulder blades

Give chest thrusts

    Places fingers in line with the breastbone (not across/ perpendicular to the breastbone)

    Places fingers in center of chest not more than 1 inch below nipple line

    Places fingers perpendicular to breastbone

    Places fingers outside center of chest

    Places fingers more than 1 inch below nipple line

    Places fingers more than 1 inch above nipple line

UNCONSCIOUS CHOKING

SKILL CHART: UNCONSCIOUS CHOKING

If at any time the chest does not rise:

1.    Re-tilt the head and give another ventilation.

2.    If the chest still does not clearly rise, give 30 chest compressions.

    Place the heel of one hand on the center of the chest.

    Place the other hand on top of the first hand and compress the chest 30 times.

    For an adult, compress the chest at least 2 inches.

    For a child, compress the chest about 2 inches.

    Compress at a rate of about 100 compressions per minute.

3.    Look for an object inside the mouth.

    Grasp the tongue and lower jaw between your thumb and fingers and lift the jaw.

4.    If you see an object, remove it.

    Slide your finger along the inside of the victim’s cheek using a hooking motion to sweep the object out.

5.    Give 2 ventilations.

    Replace the resuscitation mask and give 2 ventilations.

SKILL ASSESSMENT TOOL: UNCONSCIOUS CHOKING—ADULT, CHILD AND INFANT

Criteria
Proficient
Not Proficient

Responds to the chest not rising
Re-tilts the head and attempts another ventilation

    Does not re-tilt the head

    Continues to attempt ventilations without the chest rising

Compress the chest
Compresses the chest 30 times
Does not compress the chest

Look inside the mouth and remove an object if seen
Grasps the tongue and lower jaw between the thumb and fingers and lifts the jaw.

    Does not open mouth

    Does not look in mouth

    Does not remove an object

Re-attempt 2 ventilations
After compressions or removing an object, re-attempts 2 ventilations that make the chest clearly rise and that last about 1 second each
Does not attempt ventilations that make the chest clearly rise and lasts 2 seconds or more

LESSON 6

CARDIAC EMERGENCIES AND USING AN AUTOMATED EXTERNAL DEFIBRILLATOR

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Identify the four links in the Cardiac Chain of Survival and identify the importance of each.

    Recognize the signs of a heart attack.

    Identify the steps for caring for a victim of a heart attack.

    Identify signs and symptoms of cardiac arrest.

    Demonstrate how to safely and effectively perform one-rescuer CPR and two-rescuer CPR.

    Demonstrate how to use an automated external defibrillator (AED).

    Identify precautions for using an AED.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Activity Worksheet 6.1—Using an AED in Unique Situations—Fact or Fiction

    Manikins (one adult and one infant manikin per two participants, child manikins optional)

    Pediatric resuscitation masks (one per participant)

    Decontamination supplies

    Automated external defibrillator (AED) training devices (one per two participants)

    AED training pads (one set of adult and one set of pediatric training pads per two participants)

    Stopwatch or pace clock

    Additional items for scenarios:

    Two hip packs

    Adult and pediatric bag-valve-mask (BVM) resuscitators

TOPIC: RECOGNIZING AND CARING FOR A HEART ATTACK images

PRESENTATION: RECOGNIZING AND CARING FOR A HEART ATTACK

Video Segment

    Explain to participants that the video segment will provide important information to help them recognize and provide care for a victim experiencing a heart attack.

    Show the video segment, “Heart Attack and the Cardiac Chain of Survival.”

    Answer participants’ questions about the segment.

Lecture and Guided Discussion

    Present the following scenario: A patron walking on the pool deck suddenly collapses.

    Ask participants: What four links in the Cardiac Chain of Survival are necessary to improve this victim’s chance for survival?
Answers: Responses should include the following:

    Early recognition and early access to the emergency medical services (EMS) system

    Early cardiopulmonary resuscitation (CPR)

    Early defibrillation

    Early advanced medical care

    Present the following scenario: You are on duty at a first aid station when an adult male patron comes to you for help. He is sweating profusely and is having trouble breathing. He is complaining of pain in his chest and arm that comes and goes.

    Ask participants: What condition does he appear to be experiencing?
Answer: Heart attack

    Ask participants: What care should you provide for a victim possibly having a heart attack?
Answers: Responses should include the following:

    Take immediate action and summon EMS personnel.

    Have the victim stop any activity and rest in a comfortable position.

    Loosen any tight or uncomfortable clothing on the victim.

    Closely monitor the victim until EMS personnel take over, noting any changes in appearance or behavior.

    Comfort the victim.

    Assist the victim with prescribed medication, such as nitroglycerin, and administer emergency oxygen, if available and trained to do so.

    Be prepared to perform CPR and use an AED.

    Ask questions to get information that relates to the victim’s condition, such as what happened, whether he has any medical conditions or is taking any medications or when was the last time he had anything to eat or drink.

    Aspirin can help the victim of a heart attack if taken soon after the symptoms begin.

    If your facility allows you to dispense aspirin, you will need to follow procedures to assess if a victim of a heart attack should be given aspirin.

TOPIC: CARDIAC ARREST images

PRESENTATION: CARDIAC ARREST

Lecture and Guided Discussion

    Cardiac arrest is a life-threatening situation in which the heart stops beating or beats too irregularly or too weakly to circulate blood effectively.

    Heart attack, electrocution, respiratory arrest, drowning or other conditions may cause cardiac arrest.

    Signs of cardiac arrest include:

    Sudden collapse.

    Unconsciousness.

    Absence of breathing.

    Absence of a pulse.

    Ask participants: What is the difference between a heart attack and cardiac arrest?
Answers: Responses should include the following:

    A heart attack occurs when the heart muscle experiences a loss of oxygenated blood.

    Cardiac arrest occurs when the heart stops beating or the heart is beating too irregularly or too weakly to circulate blood effectively. The victim is unconscious, is not breathing and does not have a pulse. A heart attack may cause cardiac arrest.

TOPIC: CPR images

PRESENTATION: CPR

Lecture and Guided Discussion

    CPR is a combination of chest compressions and ventilations to circulate blood that contains oxygen to the brain and other vital organs of a person whose heart and breathing have stopped. CPR should be performed on a firm, flat surface.

    CPR is used in combination with an AED according to local protocols until EMS personnel take over.

    Ask participants: How can you make sure that your chest compressions are effective?
Answers: Responses should include the following:

    Placing the victim on a firm, flat surface

    Correctly positioning the hands

    Compressing the chest in a straight-down manner to the proper depth

    Performing compressions at the proper rate

    Making sure the chest recoils fully between each compression

    Minimizing interruptions in CPR

    Once started, do not stop CPR except in one of these situations:

    You notice an obvious sign of life, such as breathing.

    An AED is available and ready to use.

    Another trained responder takes over.

    EMS personnel take over.

    You are too exhausted to continue.

    The scene becomes unsafe.

    Ask participants: What should you do if, at any time, you notice breathing?
Answer: Stop CPR and continue to monitor the victim’s condition. Be prepared to resume care if necessary.

    Even with the best of preparation and effort, complications can arise, including broken ribs, separation of cartilage, vomiting, frothing at the mouth and chaos at the scene. Despite your best efforts to provide quality care, not all victims of cardiac arrest survive.

    Even so, you can and should continue to provide care.

CPR—Adult and Child

Skill Practice

    Choose either the practice-while-you-watch or watch-then-practice method for this skill practice.

    Participants need only demonstrate adult CPR and be able to point out how one differs from performing CPR on a child, such as compressing the chest to a depth less than that for an adult.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Be sure to point out any common errors, such as compressions that are too shallow or too deep, interrupting compressions for too long or too frequently, incorrect hand position, failure to allow full recoil after each compression or inappropriate rate (speed) of compressions.

Practice-While-You-Watch

    Ask participants to take their disposable gloves and resuscitation masks to the practice area.

    Explain to the participants that, for this skill, they will follow along with and practice the steps for performing CPR as they are guided by the video segment.

    Show the video segment, “CPR—Adult and Child.”

    Do not interrupt this skill session to lecture or communicate anything other than guidance related to skill practice. In general, answering questions should occur after the video segment (and skill session) has ended.

Watch-Then-Practice

    Tell participants that, for this segment, they will watch the video segment without practicing until you pause it, even though the narration may say to follow along.

    Show the video segment, “CPR—Adult and Child.”

    Ask participants to take their disposable gloves and resuscitation masks to the practice area.

    Guide participants through the steps of the skill and evaluate completion of the skill using the skill chart.

CPR—Infant

Video Segment

    If using the Practice-While-You-Watch method, move to the skill practice and show the video segment as you conduct the skill practice.

    Explain to participants that the video segment will demonstrate the procedures for one-rescuer CPR for an infant.

    Show the video segment, “CPR—Infant.”

    Answer participants’ questions about the video segment.

Skill Practice

    Follow the same steps as in the previous skill practice:

    Have participants practice the skill.

    Observe and evaluate each participant’s performance of the skill.

    Point out any common errors, such as compressions that are too shallow or too deep, interrupting compressions for too long or too frequently, incorrect hand position and failure to allow full recoil after each compression or inappropriate rate (speed) of compressions.

TOPIC: TWO-RESCUER CPR images

PRESENTATION: TWO-RESCUER CPR

Two-Rescuer CPR—Adult and Child

Lecture

    Two-rescuer CPR is used when two rescuers arrive on the scene at the same time or when one rescuer arrives on the scene when CPR is in progress.

    In two-rescuer CPR, one rescuer gives ventilations while the other performs chest compressions.

    Rescuers switch positions about every 2 minutes.

    When CPR is in progress by one rescuer and a second rescuer arrives, the second rescuer should confirm whether EMS personnel have been summoned. If not, the second rescuer does so before getting the AED or assisting with care.

Video Segment

    Explain to participants that the video segment will demonstrate the procedures for Two-Rescuer CPR for an adult or child.

    Show the video segment, “Two-Rescuer CPR—Adult and Child.”

    Answer participants’ questions about the video segment.

Skill Practice

    Pair up participants and, using a manikin and a resuscitation mask, conduct the skill practice.

    Participants only need to demonstrate either adult two-rescuer CPR or child two-rescuer CPR and be able to point out how one differs from the other, such as depth of compressions and ratio of compressions to ventilations.

    Guide participants through the steps of the skill.

    Observe and evaluate each participant’s performance of the skill.

    Point out any common errors, such as compressions that are too shallow or at an inappropriate rate, compressing and ventilating at the same time, failing to call for a position change or using an incorrect cycle of compressions and ventilations.

Two Rescuer CPR—Infant

Video Segment

    Explain to participants that the video segment will demonstrate the procedures for Two-Rescuer CPR for an infant.

    Show the video segment, “Two-Rescuer CPR—Infant.”

    Answer participants’ questions about the video segment.

Skill Practice

    Pair up participants and, using a manikin and a resuscitation mask, conduct the skill practice.

    Guide participants through the steps of the skill.

    Observe and evaluate each participant’s performance of the skill.

    Point out any common errors, such as compressions that are too shallow or at an inappropriate rate, compressing and ventilating at the same time, failing to call for a position change or using an incorrect cycle of compressions and ventilations.

TOPIC: WHEN THE HEART STOPS AND AEDs images

PRESENTATION: WHEN THE HEART STOPS AND AEDS

Lecture

    Any damage to the heart muscle from disease or injury can disrupt the heart’s electrical system.

    The two most common treatable abnormal rhythms associated with sudden cardiac arrest are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach).

    With V-fib, the ventricles quiver without any organized rhythm, the electrical impulses fire at random, creating chaos, and the heart is unable to pump and circulate blood.

    V-tach occurs when an abnormal electrical impulse originates in the ventricles instead of at the sinoatrial (SA) node. The impulse fires rapidly, preventing the chambers from filling, and the heart is not able to pump effectively.

    AEDs are portable electronic devices that analyze the heart’s rhythm and provide an electrical shock.

    Defibrillation is the delivery of an electrical shock that may help re-establish an effective rhythm.

    Each minute that CPR and defibrillation are delayed, the victim’s chance for survival is reduced by about 10 percent.

TOPIC: USING AN AED images

PRESENTATION: USING AN AED

Lecture Points

    When cardiac arrest occurs, use an AED as soon as it is ready to use.

    If the AED advises that a shock is needed, follow protocols to provide 1 shock followed by about 2 minutes of CPR.

    If CPR is in progress, do not interrupt chest compressions until the AED is turned on, the AED pads are applied and the AED is ready to analyze the heart rhythm.

    AEDs may be equipped with pediatric AED pads; however, pediatric pads are appropriate only for use on infants and children up to 8 years of age or weighing less than 55 pounds.

    If pediatric-specific equipment is not available and local protocols allow, you can use an AED designed for adults.

    If the AED pads risk touching each other because of the smaller chest size, use the anterior (front)/posterior (back) method of pad placement.

Video Segment

    Explain to participants that the video segment will demonstrate the procedures for using an AED.

    Show the video segment, “Using an AED.”

    Answer participants’ questions about the segment.

Skill Practice

    Using manikins, resuscitation masks and training AEDs with the appropriately sized AED training pads, have participants work in pairs with their Using an AED skill sheets to lead each other as they practice the skill.

    Participants only need to demonstrate how to use an AED on either an adult, a child or an infant and be able to point out the differences in the use of an AED for the other two age groups.

    Observe each participant’s performance of the skill and provide corrective feedback.

    Be sure to point out any common errors, such as not wiping the victim’s chest, using pediatric AED pads on an adult or failing to resume CPR after delivery of a shock.

Using an AED—CPR in Progress

Lecture Points

    When one rescuer is on the scene, that rescuer begins CPR and instructs someone to summon EMS personnel and obtain the AED, if one is available.

    When the second rescuer arrives, that rescuer prepares the AED for use while the first rescuer continues CPR.

    If at any time either rescuer notices an obvious sign of life, such as breathing, he or she should stop CPR and monitor the victim’s condition and administer emergency oxygen, if it is available and you are trained to do so.

Video

    Show the video segment, “Using an AED—CPR in Progress.”

    Answer participants’ questions about the segment.

TOPIC: AED PRECAUTIONS AND AED MAINTENANCE images

PRESENTATION: AED PRECAUTIONS AND AED MAINTENANCE

Lecture and Guided Discussion

    Ask participants: What are the general precautions to take when using an AED?
Answer: Responses should include the following:

    Do not use alcohol to wipe the victim’s chest dry.

    Do not use an AED and/or pads designed for adults on an infant or childyounger than 8 years of age or weighing less than 55 pounds, unless pediatric pads specific to the device are not available.

    Do not use pediatric AED pads on an adult older than 8 years of age or weighing more than 55 pounds.

    Do not touch the victim while the AED is analyzing.

    Before shocking a victim with an AED, make sure that no one is touching or is in contact with the victim or any resuscitation equipment.

    Do not touch the victim while the device is defibrillating.

    Do not administer defibrillation to someone when around flammable or combustible materials.

    Do not use an AED in a moving vehicle.

    Do not use an AED on a victim who is in contact with water.

    Do not use an AED on a victim wearing a nitroglycerin patch or other patch on the chest.

    Do not use a mobile phone or radio within 6 feet of an AED.

    Ask participants: What precautions would you take when using an AED around water?
Answers: Responses should include the following:

    Remove the victim from freestanding water.

    Make sure there are no puddles of water around the rescuer, victim and AED.

    Remove the victim’s wet clothing.

    Dry the victim’s chest.

    Keep the victim as dry as possible.

    Shelter the victim from the rain (if raining).

    AEDs require minimal maintenance; however, responders should be familiar with the various visual and audible prompts to warn of malfunction or low battery.

    Read the operator’s manual thoroughly.

    Periodically check equipment; have a fully charged backup battery and properly sealed, unexpired and correct AED pads available; replace all used accessories; and make sure the machine is in proper working order before placing it back in service.

Activity

    Divide the participants into small groups and provide each group with Activity Worksheet 6.1—Using an AED in Unique Situations—Fact or Fiction.

    Refer participants to Chapter 9, Cardiac Emergencies, for information to help them with this activity. Circulate among the groups to monitor progress and provide assistance when necessary.

    Instruct groups to indicate if each statement is fact or fiction and provide a rationale for their answer along with any other important information regarding the statement.

    Allow up to 5 minutes for the group work. Re-assemble the class and call on group leaders to share their answer to the questions; offer corrections when needed.

Activity Worksheet 6.1 —Using an AED in Unique Situations— Fact or Fiction

Answers: Responses should include the following:

Fact
Fiction

1.    It is safe to use an AED in rain or snow.

It is safe to use AEDs in all weather conditions. However, if possible, move the victim to a shelter to protect him or her from rain or snow.

    If the victim is lying in water, move him or her to a relatively dry area. Be sure there are no puddles of water around you, the victim or the AED.

    Remove the victim’s wet clothing and wipe the chest dry before placing the AED pads.

    Do not delay defibrillation when taking steps to provide for a dry environment.

    Check the manufacturer’s instructions for specific information about the AED you will be using.

Fact
Fiction

2.    An AED cannot be used on a pregnant woman.

Defibrillation shocks transfer no significant electrical current to the fetus. Local protocols and medical direction should be followed.

Fact
Fiction

3.    If someone has chest hair, you should shave it before using the AED.

Because the time to delivery of the first shock is critical, and chest hair rarely interferes with pad adhesion, press firmly on the pads to attach them to the victim’s chest. If you get the “Check pads” message, remove the first set of AED pads, shave the victim’s chest and attach new pads to the victim’s chest.

Fact
Fiction

4.    If a victim has a body piercing or is wearing jewelry, you should remove the item before using an AED.

Jewelry and body piercings do not need to be removed when you use an AED. However, do not place the AED pads directly over metallic jewelry or body piercings.

Fact
Fiction

5.    Never shock someone who has an implantable cardioverter-defibrillator (ICD) or pacemaker device.

If the implanted device is visible, or you know that the victim has one, do not place the AED pads directly over the device.

Fact
Fiction

6.    If you see a transdermal medication patch you should use a gloved hand to remove it.

Avoid wasting time trying to identify patches. Since you might absorb nitroglycerin or other medications, remove any patch you see on the victim’s chest with a gloved hand.

Fact
Fiction

7.    Never shock a person who is suffering from traumatic injuries.

If a victim is in cardiac arrest resulting from traumatic injuries, you may still usean AED.

Fact
Fiction

8.    Never shock a victim on a metal surface.

It is safe to deliver a shock to a victim in cardiac arrest on a metal surface. Care should be taken that AED pads do not contact the conductive (metal) surface and that no one is touching the victim when the shock button is pushed.

Fact
Fiction

9.    Never shock a victim suffering from hypothermia.

During your primary assessment of a victim suffering from hypothermia, you may have to check for breathing and a pulse for up to 30 to 45 seconds. If the victim is not breathing and does not have a pulse, begin CPR until an AED becomes available, according to local protocols.

PUTTING IT ALL TOGETHER: MULTIPLE-RESCUER RESPONSE images

PRESENTATION: MULTIPLE-RESCUER RESPONSE

Video Segment

    Explain to participants that the video segment will demonstrate the procedures for a multiple-rescuer response with CPR in progress.

    Show the video segment, “Putting It All Together: Multiple-Rescuer Response—CPR in Progress.”

    Answer participants’ questions about the segment.

IN-WATER SKILL SESSION: PUTTING IT ALL TOGETHER images

PRESENTATION: NEXT STEPS

Skill Drill—Timed Response

    Assemble the participants on the deck and explain they will be practicing rescuing a submerged passive victim in deep water, removing the victim from the water on a backboard, performing a primary assessment and caring for a victim who is not breathing and does not have a pulse.

    Note to instructor: because this person is a drowning victim, lifeguards will have to give 2 ventilations as part of their primary assessment.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, participants will practice rescuing a submerged passive victim in shallow water, removing the victim from the water on a backboard, performing a primary assessment and caring for a victim who is not breathing and does not have a pulse.

    Explain that this is a timed scenario, with 2 minutes allotted for the water rescue and removal of the victim from the water, followed by 3 minutes of one-rescuer CPR.

    Divide the participants in groups of three and assign one rescuing lifeguard, one assisting lifeguard to help with removal from the water, one victim and one manikin for each group.

    Explain that for each group:

    The rescuing lifeguard, wearing a hip pack containing gloves, will simulate activating the EAP and enter the water. Once the EAP has been activated, the stopwatch must be started.

    The victim will get into position about 30 feet from the edge and submerge as the rescuing lifeguard gets near. The rescuing lifeguard will perform a submerged passive victim rescue.

    The assisting lifeguard will bring the backboard and assist the rescuing lifeguard in removing the victim from the water, demonstrating team communication skills between the lifeguards.

    Once removed from the water, the rescuing lifeguard will do a primary assessment on the victim, then switch to a manikin and provide one-person CPR for 3 minutes. Once the rescuer begins CPR, the stopwatch must be started.

    Repeat the drill until each person in the group has performed as a rescuing lifeguard and an assisting lifeguard at least once.

    Inform each participant of his or her time and provide feedback for improvement, as necessary.

Skill Drill—Multiple-Rescuer Response

    Assemble the participants on the deck and explain that they will now put their multiple-rescuer response skills into practice.

    Divide participants into groups of five: four lifeguards and one victim.

    Conduct the scenarios and ensure that lifeguards provide care according to the Flow Chart: Example of a Multiple-Rescuer Response in Chapter 9.

    Have a manikin available to substitute into the scenario once the primary assessment is complete.

    Explain that for each group:

    Four lifeguards will be equipped with hip packs containing their gloves and resuscitation masks.

    One victim will get into position and submerge as the rescuing lifeguard approaches. The rescuing lifeguard will perform a submerged passive victim rescue.

    Two assisting lifeguards will assist with removal from the water.

    Another assisting lifeguard will provide the supplemental equipment (BVM and AED).

    Once the victim is removed from the water, the lifeguards should communicate as a team and perform a primary assessment on the victim (simulating ventilations) and then provide care for a victim who is not breathing and does not have a pulse on the manikin.

    Repeat the drill three times ensuring each person in the group has rotated to different roles at least once. Be sure to change the situations slightly each time so that lifeguards are required to practice their decision-making skills each time. For example, at one time you could state the victim is vomiting; another time, the initial breaths do not make the chest rise. The intent is for participants to apply what they are learning through the class; it is not intended to make it complicated or convoluted.

ASSIGNMENT

    Read Chapter 10, First Aid, and Chapter 11, Caring for Head, Neck and Spinal Injuries, in the Lifeguarding Manual.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general for the category of skills, as well as specific to the skill, must be met.

ONE-RESCUER CPR

SKILL CHART: ONE-RESCUER CPR—ADULT, CHILD AND INFANT

If the victim is not breathing and has no pulse:

1.    Give 30 chest compressions.

    Push hard, push fast.

    Compress the chest at least 2 inches for an adult, about 2 inches for a child and about 1½ inches for an infant at a rate of at least 100 per minute.

    Let the chest rise completely before pushing down again.

    For an adult or a child:

    Place the heel of one hand on the center of the chest with the other hand on top.

    Keep your arms as straight as possible and shoulders directly over your hands.

    For an infant:

    Place one hand on the infant’s forehead.

    Place two or three fingers on the center of the chest just below the nipple line (toward the infant’s feet).

2.    Give 2 ventilations.

3.    Perform cycles of 30 compressions and 2 ventilations.

Do not stop CPR except in one of the following situations:

    You see an obvious sign of life, such as breathing.

    An AED is ready to use.

    Another trained responder takes over.

    More advanced medical personnel take over.

    You are too exhausted to continue.

    The scene becomes unsafe.

SKILL ASSESSMENT TOOL: CPR—ADULT OR CHILD

Criteria
Proficient
Not Proficient

Victim is on a flat, firm surface
If necessary, moves victim to a flat, firm surface
Attempts CPR on a soft surface

ADULT:
Compress chest at least 2 inches deep for an adult
Compresses the chest straight down at least 2 inches for at least 24 of the 30 compressions
Compresses the chest less than 2 inches for 7 or more times per 30 compressions

CHILD:
Compress chest about 2 inches deep for a child
Compresses the chest straight down about 1¾ inches for at least 24 of the 30 compressions
Compresses the chest less than 1¾ inches for 7 or more times per 30 compressions

Let chest rise completely before pushing down again
Compresses and fully releases the chest without pausing or taking hands off chest for 24 of the 30 compressions
Pauses while compressing or releasing the chest for 7 or more times per 30 compressions

Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds)
Compresses center of the chest 24–36 times in about 18 seconds
Compresses the chest less than 24 or more than 36 times in about 18 seconds

Give ventilations
Gives 2 ventilations that make the chest clearly rise and that last about 1 second each
Gives 2 ventilations that do not make the chest clearly rise and that last 2 or more seconds each

Return to compressions
Gives ventilations and returns to chest compressions within 3–6 seconds
Gives ventilations and returns to compressions but takes 7 or more seconds

SKILL ASSESSMENT TOOL: CPR—INFANT

Criteria
Proficient
Not Proficient

Victim is on a flat, firm surface
If necessary, moves victim to a flat, firm surface
Attempts CPR on a soft surface

Compress chest about 1½ inches deep for an infant
Compresses the chest straight down at least 1¼ inches for at least 24 of the 30 compressions
Compresses the chest less than 1¼ inches for 7 or more times per 30 compressions

Let chest rise completely before pushing down again
Compresses and releases the chest without pausing for 24 of the 30 compressions
Pauses while compressing or releasing the chest for 7 or more times per 30 compressions

Compress chest at a rate of at least 100 times per minute (30 compressions in about 18 seconds)
Compresses center of the chest 24–36 times in about 18 seconds
Compresses the chest less than 24 or more than 36 times in about 18 seconds

Give ventilations
Gives 2 ventilations that make the chest clearly rise and that last about 1 second each
Gives 2 ventilations that do not make the chest clearly rise and that last 2 or more seconds each

Return to compressions
Gives ventilations and returns to chest compressions within 3–6 seconds
Gives ventilations and returns to compressions but takes 7 or more seconds

TWO-RESCUER CPR

SKILL CHART: TWO-RESCUER CPR—ADULT AND CHILD

If the victim is not breathing and has no pulse:

1.    Rescuer 2 finds the correct hand position to give chest compressions.

    Place two hands on the center of the chest.

2.    Rescuer 2 gives chest compressions.

    Push hard, push fast.

    Compress the chest at least 2 inches for an adult and about 2 inches for a child at a rate of at least 100 per minute.

3.    Rescuer 1 gives 2 ventilations.

4.    Perform about 2 minutes of compressions and ventilations.

    Adult: Perform cycles of 30 compressions and 2 ventilations.

    Child: Perform cycles of 15 compressions and 2 ventilations.

5.    Rescuers change positions about every 2 minutes.

    Rescuer 2 calls for a position change by using the word “change” at the end of the last compression cycle:

    For an adult, use the word “Change” in place of saying “30.”

    For a child, use the word “Change” in place of saying “15.”

    Rescuer 1 gives 2 ventilations.

    Rescuer 2 quickly moves to the victim’s head with his or her own mask.

    Rescuer 1 quickly moves into position at the victim’s chest and locates correct hand position on the chest.

    Changing positions should take less than 5 seconds.

6.    Rescuer 1 begins chest compressions.

    Continue cycles of compressions and ventilations.

SKILL CHART: TWO-RESCUER CPR—INFANT

If the victim is not breathing and has no pulse:

1.    Rescuer 2 finds the correct hand position to give chest compressions.

    Use the two-thumbs-encircling technique on the infant’s chest.

    Place thumbs next to each other on the center of the chest just below the nipple line.

    Place both hands underneath the infant’s back and support the infant’s back with your fingers.

    Ensure that your hands do not compress or squeeze the side of the ribs.

    If available, a towel or padding can be placed under the infant’s shoulders to help maintain the head in the neutral position.

2.    Rescuer 2 gives chest compressions.

    Push hard, push fast.

    Compress the chest about 1½ inches for an infant at a rate of at least 100 per minute.

3.    Rescuer 1 gives 2 ventilations.

4.    Perform about 2 minutes of compressions and ventilations.

    Perform cycles of 15 compressions and 2 ventilations.

5.    Rescuers change positions about every 2 minutes.

    Rescuer 2 calls for a position change by using the word “change” in place of saying “15” at the end of the last compression cycle.

    Rescuer 1 gives 2 ventilations.

    Rescuer 2 quickly moves to the victim’s head with his or her own mask.

    Rescuer 1 quickly moves into position at the victim’s chest and locates correct hand position on the chest.

    Changing positions should take less than 5 seconds.

6.    Rescuer 1 begins chest compressions.

    Continue cycles of compressions and ventilations.

Do not stop CPR except in one of the following situations:

    You see an obvious sign of life, such as breathing.

    An AED is ready to use.

    Another trained responder takes over.

    EMS personnel take over.

    You are too exhausted to continue.

    The scene becomes unsafe.

SKILL ASSESSMENT TOOL: TWO-RESCUER CPR—ADULT, CHILD AND INFANT

Criteria
Proficient
Not Proficient

Change positions
Changes positions in 5–7 seconds
Changes positions but takes more than 7 seconds

Compress the chest and give ventilations at the appropriate rate
ADULT:
Cycles consist of 30 compressions and 2 ventilations
CHILD AND INFANT:
Cycles consist of 15 compressions and 2 ventilations
ADULT:
Cycles consist of less or more than 30 compressions and 2 ventilations
CHILD AND INFANT:
Cycles consist of less or more than 15 compressions and 2 ventilations

AED

SKILL CHART: USING AN AED

If the victim is not breathing and has no pulse:

1.    Turn on the AED and follow the voice and/or visual prompts.

2.    Wipe the victim’s bare chest dry.
Tip: Remove any medication patches with a gloved hand.

3.    Attach the AED pads to the victim’s bare, dry chest.

    Place one pad on the victim’s upper right chest and the other pad on the left side of the chest.

    For a child or an infant: Use pediatric AED pads, if available. If the pads risk touching each other, place one pad in the middle of the child’s chest and the other pad on the child’s back, between the shoulder blades.

4.    Plug in the connector, if necessary.

5.   Stand clear.

    Make sure no one, including you, is touching the victim.

    Say, “Everyone, stand clear!”

6.    Analyze the heart rhythm.

    Push the “Analyze” button, if necessary. Let the AED analyze the heart rhythm.

7.    Deliver a shock or perform CPR based on the AED recommendation.

    If a shock is advised:

    Make sure no one, including you, is touching the victim.

    Say, “Everyone, stand clear!”

    Deliver the shock by pushing the “Shock” button, if necessary.

    After delivering the shock, perform about 2 minutes of CPR.

    Continue to follow the prompts of the AED.

    If no shock is advised:

    Perform about 2 minutes of CPR.

    Continue to follow the prompts of the AED.

SKILL ASSESSMENT TOOL: USING AN AED—ADULT, CHILD OR INFANT

Criteria
Proficient
Not Proficient

Attach AED pads to bare chest
Places one pad on the upper right chest and one on the left side of the chest

    Places one pad on the upper left chest

    Places one pad on the lower right side of the chest

    Places one or more pads on a location other than the chest

Make sure that pads do not touch (child or infant)

    Places pads on the chest so that they are separated from each other

    Places one pad in the middle of the chest and one on the back centered between the shoulder blades

    Places pads so that the heart is between the two pads

    Places pads on the chest, but pads touch each other

    Places the center of one pad more than 2 inches from the center of the chest

    Places the center of one pad more than 2 inches from the center of both shoulder blades

Make sure that no one is touching the victim

    Says, “Everyone, stand clear!” before pushing the “Analyze” button, if necessary

    Says, “Everyone stand clear!” before pushing the “Shock” button, if necessary

    Does not say, “Everyone, stand clear!”

    Pushes the “Analyze" button if necessary, before saying, “Everyone, stand clear!”

    Pushes the “Shock” button, if necessary, before saying, “Everyone, stand clear!”

After delivering the shock, or if no shock is advised, perform about 2 minutes of CPR
Returns to chest compressions within 5 seconds
Returns to chest compressions after 6 or more seconds

FLOW CHART

EXAMPLE OF A MULTIPLE-RESCUER RESPONSE

Instructor’s Note: This example assumes that the EAP has been activated, EMS personnel have been called and a primary assessment has been done. The victim is not breathing and has no pulse. Additional rescuers are coming in to support the efforts of the initial rescuers and are bringing equipment.

1.    The initial rescuers begin two-rescuer CPR.

    Rescuers 1 and 2 perform two-rescuer CPR.

    Rescuer 1 gives ventilations while Rescuer 2 gives chest compressions.

2.    An additional rescuer arrives with the AED. CPR continues until the AED pads are placed on the victim and it is ready to begin analyzing.

    Rescuer 3:

    Turns on the AED and follows the prompts.

    Attaches the pads to the victim’s bare chest.

    Plugs in the connector, if necessary.

    Says, “Everyone, stand clear!”

    Pushes the “Analyze” button, if necessary.

    If a shock is advised, delivers the shock by pressing the “Shock” button, if necessary.

3.    After the shock or if no shock is advised, Rescuers 1, 2 and 3 perform about 2 minutes of CPR.

4.    An additional rescuer arrives with the BVM and assists with care.

    Rescuer 4 assembles the BVM, if necessary. Administer emergency oxygen if trained to do so.

    Rescuer 1 places and seals the mask of the BVM and maintains an open airway.

    Rescuer 4 provides ventilations by squeezing the bag.

    Rescuer 2 performs compressions.

    If the victim vomits:

    Rescuers quickly roll the victim onto the side.

    After vomiting stops, a rescuer on the side of the victim clears the victim’s mouth using a finger sweep and suction, if necessary.

    Turn the victim onto the back and continue providing care.

    If ventilations do not make the chest clearly rise:

    Rescuer 1 re-tilts the head.

    Rescuer 3 attempts 1 ventilation.

    If ventilation attempt still does not make the chest clearly rise:

    Rescuer 2 gives 30 chest compressions.

    Rescuer 3 looks inside the mouth and removes any visible large debris from the mouth using a finger sweep and suction, if necessary.

    Rescuer 4 replaces the mask.

    Rescuer 1 opens the airway and seals the mask.

    Rescuer 4 provides ventilations.

    Rescuer 2 performs compressions.

LESSON 7

FIRST AID

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Demonstrate how to perform a secondary assessment.

    Identify how to recognize and care for a victim of sudden illness, injuries and shock.

    Demonstrate how to control external bleeding.

    Identify how to recognize and care for a victim of poisoning, heat-related illnesses and cold-related emergencies.

    Demonstrate how to immobilize muscle, bone and joint injuries.

    Demonstrate the ability to work as a team to implement an EAP, perform a secondary assessment and provide first aid care.

    Identify possible causes of head, neck or spinal injuries on land.

    Identify signs and symptoms of head, neck or spinal injuries.

    Demonstrate how to care for victims with head, neck or spinal injuries on land.

    Demonstrate how to perform front and rear head-hold escapes.

    Demonstrate how to give in-water ventilations.

    Demonstrate how to perform a quick removal of a victim from the water.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Non-latex disposable gloves (one pair per participant)

    Backboards, each equipped with 3 straps and head immobilizers (one backboard for every three participants is recommended; if fewer backboards are available, additional time may be required)

    Dressing and bandages (one per every two participants)

TOPIC: REVIEW–SURVEILLANCE ACTIVITIESimages

PRESENTATION: REVIEW–SURVEILLANCE ACTIVITIES

Video Segment

    Explain that you will be giving them an opportunity to see how their surveillance skills should be used to detect an emergency situation. Explain that they should watch each video segment and note the problems they see developing.

    Show the video segment, “Review–Surveillance Activity 2.”

    Lead a discussion of what they see in each segment.

    Are there any hazards that could cause an injury?

    Does it appear that all the required equipment is available for the lifeguard?

    Are there any patrons who could be of special concern?

    Are there any rules being broken that could lead to an injury or emergency situation?

    Are there any customer service issues to be addressed?

    Are there any distracting situations for the lifeguard?

TOPIC: SECONDARY ASSESSMENTimages

PRESENTATION: SECONDARY ASSESSMENT

Guided Discussion

    After you have completed a primary assessment and determined that there are no life-threatening conditions, perform a secondary assessment to determine if there are any additional non-life-threatening conditions that would require you to provide care.

    Ask participants: What information should you check for when using SAMPLE to take a brief history related to the injury or illness?
Answers: Responses should include the following:

    S = Signs and symptoms

    A = Allergies

    M = Medications

    P = Pertinent past medical history

    L = Last oral intake

    E = Events leading up to the incident

    Ask participants: What should be included when performing a secondary assessment?
Answers: Responses should include the following:

    Visually inspect the person’s body looking carefully for any bleeding, cuts, bruises and obvious deformities.

    Look for a medical identification (ID) tag, necklace or bracelet on the person’s wrist, neck or ankle.

    Check the person’s ability to move body parts. Caution the person to not move any parts if he or she experiences discomfort or pain. If the person is unable to move a body part or is experiencing dizziness or pain on movement:

    Help the person rest in a comfortable position.

    Keep the person from getting chilled or overheated.

    Reassure the person.

    Determine whether to summon emergency medical services (EMS) personnel.

    Continue to watch for changes in the level of consciousness (LOC) and breathing.

TOPIC: SUDDEN ILLNESSESimages

PRESENTATION: SUDDEN ILLNESSES

Video Segment

    Explain to participants that the video segment will provide important information regarding sudden illnesses.

    Show the video segment, “Responding to Sudden Illnesses.”

    Answer participants’ questions about the segment.

Lecture

    In most cases, it is not necessary to know the cause or type of sudden illness because the care that you provide will be the same with few exceptions.

    What are the general steps to take to care for a sudden illness?
Answer: Responses should include the following:

    Care for any life-threatening conditions first.

    Monitor the victim’s condition and watch for changes in LOC.

    Keep the victim comfortable and reassure him or her.

    Keep the victim from getting chilled or overheated.

    Do not give the victim anything to eat or drink unless the victim is fully conscious and is not in shock.

    Care for any other problems that develop, such as vomiting.

    If you think something is wrong, check the victim and look for a medical ID bracelet or necklace. Do not be afraid to ask questions.

    Remember that the victim’s condition may worsen rapidly if care is not provided.

TOPIC: RESPONDING TO INJURIESimages

PRESENTATION: RESPONDING TO INJURIES

Video Segment

    Explain to participants that the video segment will provide important information regarding injuries.

    Show the video segment, “Responding to Injuries.”

    Answer participants’ questions about the segment.

Controlling Bleeding

Lecture

    An injury to soft tissue, such as the skin, fat, or muscle, is called a wound.

    The first aid supplies needed to care for most wounds should be carried in the lifeguard’s hip pack.

    Closed wounds occur beneath the surface of the skin.

    Internal bleeding may occur when the skin’s surface is not broken and damage to soft tissue and blood vessels happens below the surface of the skin.

    The four main types of open wounds are abrasion, laceration, avulsion and puncture.

Skill Practice

    Pair up participants. One participant will be the lifeguard and the other will be the victim; they will switch roles for the second scenario.

    Provide each participant with a pair of non-latex disposable gloves.

    Provide a bandage and dressing for each pair of the participants.

    Guide participants through the steps listed on the Controlling External Bleeding skill sheet in Chapter 10, First Aid, in the Lifeguarding Manual.

    Have participants switch roles and repeat the skill practice.

    Clearly observe each participant’s performance and provide corrective feedback.

Shock

Lecture

    Any serious injury or illness can cause the condition known as shock.

    Shock is a natural reaction by the body. It usually signals that the victim’s condition is serious.

    Signs and symptoms of shock include:

    Restlessness or irritability.

    Altered LOC.

    Pale or ashen, cool, moist skin.

    Nausea or vomiting.

    Rapid breathing and pulse.

    Excessive thirst.

    To minimize the effects of shock:

    Make sure that EMS personnel have been summoned.

    Monitor the victim’s condition and watch for changes in LOC.

    Control any external bleeding.

    Keep the victim from getting chilled or overheated.

    Have the victim lie flat on his or her back.

    Cover the victim with a blanket to prevent loss of body heat. Do not overheat the victim–your goal is to maintain a normal body temperature.

    Comfort and reassure the victim until EMS personnel take over.

    Administer emergency oxygen, if available and trained to do so.

    Do not give food or drink to a victim of shock, even if the victim asks for them.

Common Injuries

Activity

    Explain that Chapter 10, First Aid, of the Lifeguarding Manual is a resource for first aid care for many specific types of injuries.

    Divide the participants into small groups. Assign each group one of the following types of injury:

    Nosebleeds

    Mouth and Teeth Injuries (No Head, Neck or Spinal Injury Suspected)

    Knocked-Out Tooth

    Animal or Human Bites

    Insect Stings

    Burns

    Ask participants to research and report their findings to the class as to what care should be provided for their assigned type of injury.

    Allow up to 3 to 5 minutes for the group work. Circulate among groups to monitor progress and provide assistance when necessary.

    Re-assemble the class and call on group leaders to share the group’s findings.

Answers: Responses should include the following:

Injury or Illness
Care Steps

Nosebleeds

    Have the victim sit leaning slightly forward to prevent swallowing or choking on the blood.

    Pinch the nostrils together for about 5 to 10 minutes or until the bleeding stops.

    After the bleeding stops, have the victim avoid rubbing, blowing or picking the nose.

    Medical attention is needed if the bleeding persists or recurs or if the victim says the nosebleed was a result of high blood pressure.

    If the victim loses consciousness, place the victim on his or her side to allow blood to drain from the nose. Summon EMS personnel immediately.

Mouth and Teeth Injuries (No Head, Neck or Spinal Injury Suspected)

    Rinse the victim’s mouth with cold tap water, if available.

    Have the victim lean slightly forward or place the victim on his or her side to prevent the victim from swallowing the blood, which could cause nauseaor vomiting.

    Apply a dressing.

Knocked-Out Tooth

    Rinse the victim’s mouth with cold tap water, if available.

    Have the victim bite down on a rolled sterile dressing in the space left by the tooth (or teeth).

    Save any displaced teeth.

    Carefully pick up the tooth by the crown (white part), not the root.

    Rinse off the root of the tooth in water if it is dirty. Do not scrub it or remove any attached tissue fragments.

    Place the tooth in milk. If milk is not available, place the tooth in clean water and keep it with the victim.

    Advise the victim to get to a dentist with the tooth as soon as possible.

Animal or Human Bites

    Summon EMS personnel if the wound bleeds severely or if the animal is suspected to have rabies.

    For severe bleeding, control the bleeding first. Do not clean the wound. It will be properly cleaned at the hospital.

    If the bleeding is minor:

    Wash the wound with large amounts of clean water.

    Control the bleeding.

    Cover with a sterile bandage.

Burns

    Stop the burning by removing the person from the source of the burn.

    Cool the burned area with large amounts of cold tap water at least until pain is relieved.

    Cover the burned area loosely with a sterile dressing.

    Take steps to minimize shock, such as by keeping the victim from getting chilled or overheated.

    Comfort and reassure the victim.

Poisoning

Lecture

    To determine how to care for a victim of poisoning:

    Call Poison Control Center at 1-800-222-1222.

    Refer to the Material Safety Data Sheet (MSDS) for information regarding the poisonous substances used at your facility if exposure to one of these is believed to be the cause.

    If the victim was exposed to a chemical poison at your facility and is showing signs of life-threatening conditions, send the MSDS with the victim to the doctor or the hospital.

    To care for a victim of an inhaled poison:

    Size-up the scene to be sure it is safe for you to help the victim.

    Summon EMS personnel.

    Move the victim to fresh air.

    Care for life-threatening conditions.

    Monitor the victim’s condition and watch for changes in the LOC.

    If conscious, keep the victim comfortable.

    To care for a victim of an absorbed poison:

    Remove exposed clothing and jewelry and immediately rinse the exposed area thoroughly with water for 20 minutes, using a shower or garden hose if possible.

    If a rash or wet blisters develop, advise the victim to see his or her health care provider.

    If the condition spreads to large areas of the body or face, have the victim seek medical attention.

Heat-Related Illnesses

Guided Discussion

    Ask participants: What is the least serious type of heat-related illness? Answer: Heat cramps

    Ask participants: What are some signs that a person has progressed to the stage of heat exhaustion?
Answer: Responses should include the following:

    Cool, moist, pale, ashen or flushed skin

    Headache, nausea, dizziness

    Weakness, exhaustion

    Heavy sweating

    Ask participants: What care should be provided for a person experiencing heat stroke?
Answer: Responses should include the following:

    Summon EMS personnel.

    Move the victim to a cool place.

    Loosen tight clothing and remove perspiration-soaked clothing.

    Cool the victim by spraying with cool water or applying cool, wet towels to the skin.

    Fan the victim.

    Encourage the victim to drink small amounts of a commercial sports drink, milk or water if the victim is conscious and able to swallow.

Cold-Related Emergencies

Lecture

    It does not have to be very cold for someone to suffer a cold-related emergency. Cold water, air temperature and windy conditions can contribute to hypothermia.

    The victim’s skin color may appear waxy, cold to the touch or discolored (flushed, white, yellow or blue).

    It is important to dry off the victim. Remove wet clothing and warm the victim gradually.

    The victim’s heart rate may be slowed. If the victim is unconscious and you are performing a primary assessment, check for a pulse for 30 to 45 seconds.

Injuries to Muscles, Bones and Joints

Guided Discussion

    Ask participants: What are the four types of injuries that can occur to muscles, bones and joints?
Answers: Responses should include:

    Fracture–A complete break, a chip or a crack in a bone. Fractures can be open or closed.

    Dislocation–Displacement of a bone away from its normal position at a joint.

    Sprain–Tearing of ligaments at a joint.

    Strain–Stretching and tearing of muscles or tendons.

Splinting

Skill Practice

    Refer participants to the skill sheet in Chapter 10, First Aid, in the Lifeguarding Manual and have them bring their book to the practice area.

    Pair up participants and provide each participant with a pair of disposable gloves.

    For every pair of participants you will need:

    Two triangular bandages for the arm injury skill.

    Four triangular bandages for the leg injury skill.

    Three triangular bandages and one large towel or blanket for the foot injury skill.

    Guide participants through the steps listed on the skill sheet for an arm injury and either the leg or the foot injury.

    Have participants switch roles and repeat the skills.

    Observe each participant’s performance and provide corrective feedback.

TOPIC: PUTTING IT ALL TOGETHER—FIRST AID SCENARIOSimages

PRESENTATION: FIRST AID SCENARIOS

Activity

    Tell participants that they will now participate in two first aid scenarios that will require them to perform a secondary assessment.

    Explain that they will work in groups of three for each scenario. Some of the scenarios require one lifeguard, a child victim and a parent whereas others assume that two lifeguards are providing care to one victim.

    Assign the scenarios randomly, such as through a drawing. A total of six scenarios are provided. It is acceptable for more than one group to complete the same scenario.

    Allow a few minutes for those playing the role of victim to review the signs and symptoms of the condition assigned using the Lifeguarding Manual.

    Explain that lifeguards should perform a secondary assessment and provide care for the conditions found.

    Be sure to have the appropriate equipment and supplies available for use in the scenarios, including personal protective equipment (PPE) and first aid supplies.

    After they have completed two scenarios, re-assemble the group and discuss the activity. Each group should:

    Explain the scenario.

    Describe initial steps taken, such as calling for backup coverage, if necessary.

    Describe the injury or illness, including signs and symptoms.

    Explain the care steps provided, including summoning EMS personnel, if appropriate.

    Explain any follow-up instructions given to the victim.

Scenario 1: You are on duty lifeguarding at an outdoor pool. A child comes to you saying that she was just in the concession area eating a snack when she was stung by a bee. Her parent is swimming laps in the adult lap swim lane.

Answers: Responses should include the following:

Initial Steps

    Signal to obtain backup coverage for your zone.

    Get the attention of the child’s parent and obtain consent.

    Ask if the child has a known allergy to bee stings.

Signs and Symptoms

    Pain

    Redness or swelling

    Possible presence of a stinger

    Signals of an allergic reaction:

    Rash or hives

    Feeling of tightness in the chest and throat

    Shortness of breath

    Swelling of the face, neck or tongue

Care Steps

    Examine the sting site to see if the stinger is in the skin. If it is still present, remove the stinger by scraping it away with the edge of a plastic card, such as a credit card.

    Wash the wound with soap and water.

    Cover the site with a dressing and keep the wound clean.

    Apply a cold pack to the site to reduce pain and swelling.

    Watch the victim for signals of an allergic reaction.

    Monitor the victim’s condition and look for changes in LOC.

    Keep the victim comfortable.

    Summon EMS personnel for any life-threatening conditions, such as a breathing emergency.

Follow-Up

    Have the child remain in the first aid area for a few minutes and watch the child for signs of an allergic reaction.

    Tell the child and parent to alert a lifeguard or other staff member if symptoms get worse.

Scenario 2: You are on break when an adult tells you that his friend is not feeling well and needs help. The patron tells you that he is wearing a diabetic ID bracelet.

Answers: Responses should include the following:

Initial Steps

    Obtain consent from the patron who is not feeling well.

Signs and Symptoms

    The patron told you he is not feeling well and his medical ID bracelet tells you of the condition.

Care Steps

    If the person is conscious and can safely swallow fluids or food, give him sugar. Give glucose paste, tablets or sugar in liquid form (e.g., 12 oz of orange juice), milk or nondiet soft drink, or table sugar, either dry or dissolved in a glass of water.

    Summon EMS personnel if:

    The person is unconscious or about to lose consciousness.

    The person is conscious but unable to swallow.

    The person does not feel better within about 5 minutes after taking the sugar.

    A sugar source cannot be found immediately. Do not spend time looking for it.

Follow-Up

    Ask the patron to remain there until he clearly feels better, at least 5 minutes.

    Tell the person to alert a lifeguard or staff member if symptoms recur.

Scenario 3: You are on a break in the lifeguard room. Through the window, you notice a patron on the deck who appears to be having a seizure.

Answers: Responses should include the following:

Initial Steps

    Activate the EAP.

Signs and Symptoms

    May last 1 to 3 minutes and can produce a wide range of signs and symptoms

    May lose consciousness and fall

    May become rigid and then experience sudden, uncontrollable muscular convulsions lasting several minutes

    Breathing may become irregular and even stop temporarily

Care Steps

    Protect the person from injury by moving nearby objects away from the person.

    Position the person on his or her side, if possible, after the seizure passes so that fluids (saliva, blood, vomit) can drain from the mouth.

    Check to see if the person was injured during the seizure.

Follow-Up

    Stay with the person until he or she is fully conscious and aware of his or her surroundings.

    Offer to let the person remain in a first aid area to rest.

Scenario 4: You are hosing down a Section of the deck as part of your secondary responsibilities. A regular patron approaches and tries to ask you a question. Her speech seems impaired and you cannot understand what she is saying.

Answers: Responses should include the following:

Initial Steps

    Activate the EAP.

    Obtain consent if able to do so.

Signs and Symptoms

    Sudden change in how the body is working or feeling, such as sudden weakness or numbness of the face, an arm or a leg; often only on one side of the body

    Difficulty with speech (trouble speaking and being understood and difficulty understanding others)

    Blurred or dimmed vision

    Sudden, severe headache; dizziness; or confusion

    Loss of balance or coordination

    Trouble walking

    Ringing in the ears

Care Steps

    Summon EMS personnel immediately.

    Think FAST:

    Face–Ask the person to smile. This will show if there is drooping or weakness in the muscles on one side of the face. Does one side of the face droop?

    Arm–Ask the person to raise both arms to find out if there is weakness in the limbs. Does one arm drift downward?

    Speech–Ask the person to speak a simple sentence to listen for slurred or distorted speech. Example: “The sky is blue.” Can the victim repeat the sentence correctly?

    Time–Note the time that the signs and symptoms began and summon EMS personnel immediately.

Follow-Up

    Comfort and reassure the person until EMS personnel arrive.

    Collect any of the person’s belongings and give to EMS.

Scenario 5: You are on duty as a lifeguard. Your guard station is on the deck at the shallow end of the pool. An adult is exiting the pool using the ladder, then slips and hits his mouth on the railing. When you approach the victim, you notice that he is missing a tooth, which he holding in his hand, and bleeding from the mouth.

Answers: Responses should include the following:

Initial Steps

    Activate the EAP.

Signs and Symptoms

    Tooth is missing and he has it in his possession

    Bleeding from the area

Care Steps

    Rinse the victim’s mouth with cold tap water, if available.

    Have the victim bite down on a rolled sterile dressing in the space left by the tooth.

    Save the displaced tooth.

    Carefully pick up the tooth by the crown (white part), not the root.

    Rinse off the root of the tooth in water if it is dirty. Do not scrub it or remove any attached tissue fragments.

    Place the tooth in milk. If milk is not available, place the tooth in clean water and keep it with the victim.

Follow-Up

    Advise the victim to get to a dentist with the tooth as soon as possible.

Scenario 6: You are on break when a concession worker comes to you and tells you help is needed. Another concession worker has been burned by hot oil from the popcorn machine.

Answers: Responses should include the following:

Initial Steps

    Obtain consent.

Signs and Symptoms

    Burned area on an arm and hand–red skin with blisters beginning to form

Care Steps

    Stop the burning by removing the person from the source of the burn.

    Cool the burned area with large amounts of cold tap water at least until pain is relieved.

    Cover the burned area loosely with a sterile dressing.

    Take steps to minimize shock, such as by keeping the victim from getting chilled or overheated.

    Comfort and reassure the victim.

Follow-Up

    Advise the person to follow up with a doctor.

TOPIC: CARING FOR HEAD, NECK AND SPINAL INJURIES ON LANDimages

PRESENTATION: CARING FOR HEAD, NECK AND SPINAL INJURIES ON LAND

Guided Discussion

    When deciding whether a person may have a head, neck or spinal injury, first think about what caused the injury.

    Head, neck or spinal injuries can happen on land or in the water.

    In aquatic environments, examples of injuries on land include:

    Tripping or falling on a pool deck.

    Slipping in a locker room.

    Falling from greater than a standing height

    Falling off pool features, such as a diving board ladder.

    Ask participants: What signs and symptoms might indicate a possible head, neck or spinal injury?
Answers: Responses should include the following:

    Unusual bumps, bruises or depressions on the head, neck or back

    Heavy external bleeding of the head, neck or back

    Bruising of the head, especially around the eyes and behind the ears

    Blood or other fluids in the ears or nose

    Seizures

    Changes in level of consciousness

    Impaired breathing or vision

    Nausea or vomiting

    Partial or complete loss of movement of any body area

    Loss of balance

    Victim holds the head, neck or back

    Behavior resembling intoxication

    Severe pain or pressure in the head, neck or back

    Back pain, weakness, tingling or loss of sensation in the hands, fingers, feet or toes

    Persistent headache

Video Segment

    Explain to participants that the video segment demonstrates backboarding a victim of a spinal injury on land.

    Show the video segment, “Head, Neck and Spinal Injuries on Land.”

    Answer participants’ questions about the segment.

Skill Practice-On Land

    Explain to participants that during the skill session you will demonstrate skills and guide them through practice.

    Pair up participants for the first skill and explain that they will take turns as victim and lifeguard. For the second skill, divide participants into groups of four–three are in the role of lifeguards and one as a victim.

    For each skill, organize them so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    Lead them through the following skills:

    Caring for a nonstanding victim

    Caring for a standing victim

    Participants should practice the skills until they are able to meet performance criteria.

    Observe each participant’s performance of the skill and provide corrective feedback.

TOPIC: WHEN THINGS DO NOT GO AS PRACTICED images

PRESENTATION: WHEN THINGS DO NOT GO AS PRACTICED

Video Segment

    Explain to participants that the video segment will provide important information regarding the techniques to use when things do not go as practiced. The skills in this video will be practiced later in the water. They include:

    Front and rear head-hold escapes.

    Quick removal from shallow water for a small victim.

    In-water ventilations.

    Refer participants to the skill sheets in Chapter 6, Rescue Skills, in the Lifeguarding Manual.

    Show the video segment, “When Things Do Not Go as Practiced.”

    Answer participants’ questions about the video segment.

IN-WATER SKILL SESSION—WHEN THINGS DO NOT GO AS PRACTICED images

PRESENTATION: NEXT STEPS

Activity

    Explain to participants that during the skill session you will demonstrate skills and guide them through practice.

    Pair up participants and explain that they will take turns as a victim and a rescuer for each skill.

    For each skill, organize them so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    Lead them through the following skills:

    Front head-hold escape

    Lifeguards: deep water, facing victim

    Victims: deep water

    Rear head-hold escape

    Lifeguards: deep water, back to victim

    Victims: deep water

    In-water ventilations–shallow water

    Lifeguards: standing in shallow water

    Victims: passive

    In-water ventilations–deep water

    Lifeguards: treading in deep water

    Victims: passive

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, participants will practice the front and rear head-hold escapes in shallow water.

    Omit the in-water ventilations–deep water when teaching the Shallow Water Lifeguarding course.

    Participants should practice the skills until they are able to meet performance criteria.

    Observe each participant’s performance of the skill and provide corrective feedback.

IN-WATER SKILL SESSION–RESCUE SKILLS REVIEWimages

Activity

    Designate three stations for review skills and divide participants into three groups. Count off participants as “ones” and “twos” so that you can easily assign roles at each station and for each skill practice.

    Participants will practice the rescues as many times as possible in about a 5-minute period.

    Rotate groups every 5 to 7 minutes.

    Observe participants and provide feedback.

    Stations:

    Shallow Water

    Simple Assist for a Distressed Swimmer

    Submerged Passive Victim

    Reaching Assist from the Deck for a Distressed Swimmer

    Deep Water

    Active Victim on the Surface–Front Approach

    Passive Victim on the Surface–Rear Approach

    Deep Water

    Submerged Passive Victim

    Two-Person Removal Using a Backboard

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, designate three stations for review skills and divide participants into three groups.

    Participants will practice the rescues as many times as possible in about a 5-minute period.

    Rotate groups every 5 to 7 minutes.

    Stations:

    Passive Victim

    Submerged Passive Victim

    Passive Victim on the Surface–Rear Approach

    Two-Person Removal Using a Backboard

    Distressed Swimmer

    Simple Assist for a Distressed Swimmer

    Reaching Assist from the Deck for a Distressed Swimmer

    Active Victim

    Active Victim on the Surface–Front Approach

    Active Victim on the Surface–Rear Approach

    Multiple Active Victim Rescue

ASSIGNMENT

    Remind participants to prepare for the final written exam on CPR/AED and first aid by reviewing Chapters 7 through 10.

    Read Chapter 11, Caring for Head, Neck and Spinal Injuries, of the Lifeguarding Manual before the next class session.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general for the category of skills, as well as specific to the skill, must be met.

SECONDARY ASSESSMENT

SKILL CHART: USING SAMPLE TO TAKE A BRIEF MEDICAL HISTORY

Take a brief history using SAMPLE:

1.   Signs and symptoms:

    What happened?

    Where do you feel any pain or discomfort?

    Do you have any numbness or loss of sensation? If so, where?

2.   Allergies:

    Do you have any allergies, such as to medications or food? If so, what type of reactions have you experienced when you were exposed?

3.   Medications:

    Do you have any medical conditions or are you taking any medications? If so, what conditions do you have or what medications are you taking?

    Have you taken any medications in the past 12 hours?

4.   Pertinent past medical history:

    Have you recently been ill?

    Do you have any medical conditions?

    Have you experienced any recent falls, accidents or blows to the head?

    Have you had surgery, been in a traumatic accident or had a medical emergency?

5.   Last oral intake:

    When did you last eat or drink?

    What did you last eat or drink?

6.   Events leading up to the incident:

    What were you doing before the incident occurred?

    What were you doing when the incident occurred?

SKILL CHART: CHECKING A CONSCIOUS PERSON

1.   Check the head.

    Look at the scalp, face, ears, eyes, nose and mouth for cuts, bumps, bruises and depressions.

    Note if the victim has any changes in the level of consciousness, such as dizziness, or feels light-headed.

2.   Check skin appearance and temperature.

    Feel the victim’s forehead with the back of your hand and note if the skin is cold or hot.

    Look at the coloring of the victim’s face and lips.

    Look at the victim’s skin and note if the skin is moist or dry or if it is red, pale, flushed or ashen.

3.   Check the neck.

    Ask the victim to move his or her head from side to side if there is no discomfort and if an injury to the neck is not suspected.

    Note pain, discomfort or inability to move.

4.   Check the shoulders.

    Ask the victim to shrug his or her shoulders.

5.   Check the chest and abdomen.

    Ask the victim to take a deep breath and blow air out.

    Listen for difficulty or changes in breathing.

    Ask the victim if he or she is experiencing pain during breathing.

6.   Check the arms.

    Check one arm at a time.

    Ask the victim to move his or her hand and fingers and to bend the arm.

7.   Check the legs.

    Check one leg at a time.

    Ask the victim to move his or her foot and toes and to bend the leg.

8.   Provide care for any conditions found.

9.   Have the victim rest in a comfortable position if he or she can move all body parts without pain or discomfort and has no other apparent signs or symptoms of injury or illness. Continue to watch for changes in consciousness and breathing.

SKILL ASSESSMENT TOOL: USING SAMPLE TO TAKE A BRIEF MEDICAL HISTORY

Criteria
Proficient
Not Proficient

Ask questions to determine a brief history
Gathers information about what happened, possible signs and symptoms or brief medical history

    Does not ask any questions

    Does not ask questions about what happened, possible signs and symptoms or brief medical history

Checking a Conscious Person

Check for signs and symptoms of injuries or sudden illnesses
Visual inspection from head to toe looking carefully for any bleeding, cuts, bruises and obvious deformities

    Does not perform an assessment

    Does not recognize obvious signs or symptoms

Check for medical conditions that may need to be considered
Visual inspection looking for a medical ID tag, necklace or bracelet
Does not look for medical ID tag, necklace or bracelet

Monitor the person’s condition
Watches for changes in consciousness or breathing
Does not look at victim

CONTROLLING EXTERNAL BLEEDING

SKILL CHART: CONTROLLING EXTERNAL BLEEDING

To control external bleeding:

1.   Cover the wound with a dressing, such as a sterile gauze pad.

2.   Apply direct pressure firmly against the wound until bleeding stops.

3.   Cover the dressing with a roller bandage and secure it directly over the wound.

4.   Check for circulation beyond the injury (check for pulse, skin temperature and feeling).

If the bleeding does not stop:

    Apply additional dressings and bandages on top of the first ones and continue to apply direct pressure.

    Take steps to minimize shock.

    Summon EMS personnel.

    Follow local protocols when considering other methods of bleeding control, such as applying a tourniquet.

SKILL ASSESSMENT TOOL: CONTROLLING EXTERNAL BLEEDING

Criteria
Proficient
Not Proficient

Use personal protective equipment
Puts on disposable gloves before covering wound

    Does not put on disposable gloves

    Puts on disposable gloves after covering wound

Cover the wound with a (sterile) dressing and apply direct pressure until bleeding stops

    Places dressing over wound

    Applies pressure to wound

    Secures dressing in place with roller gauze

    Places dressing away from wound area

    Does not apply pressure

    Uses pressure points instead of direct pressure

    Roller gauze does not stay in place

Apply additional dressings and more direct pressure (if bleeding does not stop)

    Adds additional dressings to initial dressing

    Applies pressure to wound

    Removes initial dressing

    Does not add additional dressings

    Does not apply pressure

SPLINTING

SKILL CHART: ARM INJURIES

1.   Leave the arm in the position in which it was found or in the position in which the victim is holding it.

2.   Place a triangular bandage under the injured arm and over the uninjured shoulder to form a sling.

3.   Tie the ends of the sling at the side of the neck. Place gauze pads under the knots to make it more comfortable for the victim.

4.   Secure the arm to the chest with a folded triangular bandage.

SKILL CHART: LEG INJURIES

1.   Place several folded triangular bandages above and below the injured body area.

2.   Place the uninjured leg next to the injured leg.

3.   Tie triangular bandages securely with knots.

SKILL CHART: FOOT INJURIES

1.   Place several folded triangular bandages above and below the injured area.

2.   Gently wrap a soft object (pillow or folded blanket) around the injured area.

3.   Tie bandages securely with knots.

SKILL CHART: RIB AND BREASTBONE INJURIES

1.   Place a pillow or folded towel between the victim’s injured ribs and arm.

2.   Bind the arm to the body to help support the injured area.

SKILL CHART: HAND AND FINGER INJURIES

1.   For a hand injury, place a bulky dressing in the palm of the victim’s hand and wrap with a roller bandage.

2.   For a possible fractured or dislocated finger, tape the injured finger to the finger next to it.

SKILL ASSESSMENT TOOL: SPLINTING

Criteria
Proficient
Not Proficient

Immobilize the injured part
Secures splint with sufficient tension to prevent injured part from moving more than 1 inch from splinted position
Secures splint with insufficient tension–injured part can move more than 1 inch from splinted position

Ensure the splint is not too tight (except for a sling)

    Secures splint without causing skin to discolor or become cool discolor to touch or creating a tingling sensation beyond the injury

    Checks pulse, skin temperature and feeling

    Secures splint causing skin to discolor

    Secures splint causing skin to become cool to the touch

    secures splint creating a tingling sensation beyond the injury

    Does not check pulse, skin temperature and feeling

CARING FOR HEAD, NECK OR SPINAL INJURY ON LAND

SKILL CHART: CARING FOR A STANDING VICTIM WHO HAS A SUSPECTED HEAD, NECK OR SPINAL INJURY ON LAND

1.   Lifeguard 1 approaches the victim from the front and performs manual stabilization of the victim’s head and neck by placing one hand on each side of the head.

2.   Lifeguard 2 retrieves a backboard and places it against the victim’s back, being careful not to disturb stabilization of the victim’s head. Lifeguard 3 helps to position the backboard so that it is centered behind the victim.

3.   While Lifeguard 3 holds the backboard, Lifeguard 2 secures the victim to the backboard by placing and securing straps across the victim’s chest, under the armpits, and across the hips and thighs. Lifeguard 2 rechecks the straps to be sure that they are secure, then secures the victim’s head to the backboard using a head immobilizer and strap across the victim’s forehead.

4.   The lifeguards at the victim’s side each place their inside hands underneath the victim’s armpit, in between the victim’s arm and torso, and grasp the backboard at a handhold at the victim’s armpit level or higher.

5.   When the victim is secured to the board, the other lifeguard grasps the top. Lifeguard 1 informs the victim that they will lower him or her to the ground. When ready, signal to the other two lifeguards to begin. While lowering the victim, the lifeguards at the victim’s sides should walk forward and bend at the knees to avoid back injury.

If the position of head immobilizer cannot be adjusted to the height of a victim, consider one of the following options:

    Place the blocks on either side of the victim’s head flush against the backboard. Place an additional strap across the victim’s forehead.

    If this is not possible, have another lifeguard provide manual stabilization from the head of the board. At the beginning, this lifeguard stands behind the board and reaches around to provide stabilization. As the board is lowered, this lifeguard steps back, while maintaining stabilization, until the board is on the ground.

    If the victim is taller than the backboard, place an object, such as a folded blanket or towel, under the foot of the backboard so that the victim’s head does not extend beyond the end of the board.

SKILL CHART: MANUAL STABILIZATION FOR A NONSTANDING VICTIM OF A HEAD, NECK OR SPINAL INJURY ON LAND

1.   Minimize movement by placing your hands on both sides of the victim’s head.

2.   Support the head in the position found.

    Do not align the head and neck with the spine if the head is sharply turned to one side, there is pain on movement or if you feel any resistance when attempting to align the head and neck with the spine.

3.   Maintain an open airway.

4.   Keep the victim from getting chilled or overheated.

Note: Gently position the victim’s head in line with the body if you cannot maintain an open airway.

SKILL ASSESSMENT TOOL: CARING FOR A STANDING VICTIM WHO HAS A SUSPECTED HEAD, NECK OR SPINAL INJURY ON LAND

Criteria
Proficient
Not Proficient

Maintain stabilization
Primary lifeguard maintains stabilization while backboard is being positioned

    Loss of stabilization during the rescue

    Loss of contact with the victim

    Lack of communication between lifeguards as needed

Position the backboard behind the victim

    Backboard is placed to support the victim’s head, neck and body

    Backboard is against the victim’s body

    Victim’s head is not supported against the backboard

    Victim is not aligned and against the backboard

Secure straps

    Strapping begins with chest strap, then the strap over the hips and then the strap over the thighs

    Hip strap is placed across the hips with the hands secured underneath the strap

    Straps are tight and once all straps are secured, they are re-checked

    Strapping is done in some other order

    Hands are not strapped inside the strap

    Straps are loose and victim can easily fall

    Straps are not re-checked for tightness

    Straps are not tightened if loose

Immobilize the victim’s head (Options described on page 130 are permitted if the head immobilizer cannot be adjusted to the height of the victim.)

    Head immobilizer is placed to immobilize the victim’s head

    Head strap is secured across the victim’s forehead

    Head immobilizer is not used

    Head immobilizer is placed and moves victim’s head or neck

    No strap is used across the victim’s forehead

Lower the victim to the ground

    Lifeguards communicate what, how or when actions happen

    Backboard is lowered carefully to the ground

    No verbal communication

    Communication does not result in effective actions

    Backboard is dropped

    Victim falls

SKILL ASSESSMENT TOOL: MANUAL STABILIZATION FOR A NONSTANDING VICTIM OF A HEAD, NECK OR SPINAL INJURY ON LAND

Criteria
Proficient
Not Proficient

Stabilize the victim’s head

    Places one hand on each side of the victim’s head and applies gentle pressure

    Victim’fs head remains in the position found

    Places only one hand on the side of victim’s head

    Does not stabilize the head

    Moves the victim’s head in line with body

WHEN THINGS DO NOT GO AS PRACTICED

SKILL CHART: FRONT HEAD-HOLD ESCAPE

1.   As soon as the victim grabs hold, take a quick breath, tuck your chin down, turn your head to either side, raise your shoulders and submerge with the victim.

2.   Once under water, grasp the victim’s elbows or the undersides of the victim’s arms just above the elbows. Forcefully push up and away. Keep your chin tucked, your arms fully extended and your shoulders raised until you are free.

3.   Quickly swim under water, out of the victim’s reach. Surface and reposition the rescue tube and try the rescue again.

SKILL CHART: REAR HEAD-HOLD ESCAPE

1.   Take a quick breath, tuck your chin down, turn your head to either side, raise your shoulders and submerge with the victim.

2.   Once under water, grasp the victim’s elbows or the undersides of the victim’s arms just above the elbows. Forcefully push up and away while twisting your head and shoulders. Keep your chin tucked, your arms fully extended and your shoulders raised until you are free.

3.   Quickly swim under water out of the victim’s reach. Surface and reposition the rescue tube and try the rescue again.

SKILL ASSESSMENT TOOL: ESCAPES

Criteria
Proficient
Not Proficient

Lifeguard releases the victim’s hold
Lifeguard presses victim’s arms up and pushes victim away
Does not release the victim’s hold

Lifeguard swims away to safety
Lifeguards swims under water to a safe distance from the victim
Victim grabs rescuer again

Lifeguard re-attempts the rescue
Lifeguard repositions the rescue tube and attempts to rescue the victim again
Does not re-attempt a rescue

IN-WATER VENTILATIONS

SKILL CHART: IN-WATER VENTILATIONS

1.   Ensure that the rescue tube is placed under the victim so the victim’s head naturally falls back to an open-airway position.

2.   From behind the victim’s head, position the resuscitation mask, seal the mask and open the airway.

3.   Give ventilations.

4.   Remove the victim from the water as soon as conditions allow, then immediately resume providing care.

Instructor’s note: Remind participants not to give ventilations but rather to simulate ventilations on their partner.

SKILL ASSESSMENT TOOL: IN-WATER VENTILATIONS

Criteria
Proficient
Not Proficient

Open the airway
Performs a jaw-thrust maneuver
Does not open the airway by using a jaw-thrust maneuver

Seal mask and give simulated ventilations
Properly seals mask and simulates ventilations

    Mask is not properly sealed

    Simulated ventilations are not given

LESSON 8

HEAD, NECK AND SPINAL INJURIES IN THE WATER

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Demonstrate how to care for victims with head, neck and spinal injuries in shallow and deep water.

    Demonstrate how to care for victims with head, neck and spinal injuries in shallow water only. (Shallow Water Lifeguarding)

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Final Written Exam: Section 1, Exams A and B, and answer sheets (one for each participant)

    Answer keys for Final Written Exam: Section 1

    Non-latex disposable gloves (one pair per participant)

    Rescue tubes (one for every three participants)

    Backboards, each equipped with 3 straps and head immobilizers (one backboard for every three participants is recommended; if fewer backboards are available, additional time may be required)

FINAL WRITTEN EXAM: SECTION 1 – CPR/AED FOR THE PROFESSIONAL RESCUER AND FIRST AIDimages

Activity

    Tell participants that they will now take Section 1 of the final written exam on the information covered in Lessons 5, 6 and 7. They may not use their manual or notes to find the answers.

    Hand out an exam and answer sheet to each participant. Tell participants to write only on the answer sheet and mark answers clearly.

    Tell participants to come to you or raise their hands when they have finished the exam or if they have questions.

    Once exams are completed, collect all exams and answer sheets. Before the next lesson, grade the exam using the answer key.

    At the beginning of Lesson 9, hand back the exam and review it with participants. Make arrangements for those participants who score less than 80 percent to review the material and retake the opposite version of the exam.

TOPIC: CARING FOR HEAD, NECK AND SPINAL INJURIES IN THE WATERimages

PRESENTATION: CARING FOR HEAD, NECK AND SPINAL INJURIES IN THE WATER

Video Segment

    Show the video segment, “Head, Neck and Spinal Injuries in the Water.”

    Answer participants’ questions about the segment.

Lecture

    Head, neck or spinal injuries often are caused by high-impact/high-risk activities. In aquatic environments, examples of these activities include:

    Entering head-first into shallow water.

    Entering the water from a height, such as a diving board, water slide, an embankment, cliff or tower.

    Striking a submerged or floating object.

    Receiving a blow to the head.

    Colliding with another swimmer.

    Striking the water with high impact, such as falling while water skiing or surfing.

    When a head, neck or spinal injury is suspected, the goal is to minimize movement.

    If you suspect a head, neck or spinal injury, tell the victim to say “yes” or “no” in response to your questions instead of nodding or shaking his or her head.

    Whether on land or in the water, care for life-threatening conditions is the number one priority. If a spinal injury is suspected and the victim is not breathing, remove the nonbreathing victim from the water and resuscitate him or her by the fastest means available. Do not delay removal from the water by strapping the victim to the board or using a head immobilizer device.

    If the victim is in the water and is breathing, immobilize him or her using a backboard equipped with straps and a head-immobilizer device. This needs to be done quickly but carefully.

    The type of care that you provide to a victim with an injury to the head, neck or spine depends on:

    The victim’s condition, including whether he or she is conscious and breathing.

    The location of the victim (shallow or deep water, at the surface of the water, submerged or not in the water).

    The availability of additional help, such as other lifeguards, bystanders, fire fighters, police or emergency medical services (EMS) personnel.

    The facility’s specific procedures.

    The air and water temperature.

Team Spinal Backboarding

Lecture

    Team spinal backboarding requires communication by all lifeguards involved and an understanding of each person’s role in the process.

    A minimum of two lifeguards is needed to place and secure a victim on a backboard, but additional lifeguards also should help, if available.

    Throughout the backboarding process, you or another lifeguard must maintain stabilization of the victim’s head and neck.

    Rescue tubes can be used to aid in flotation of the backboard. Additional lifeguards also can assist in keeping the board afloat.

    Communication with the victim also is important. Let the victim know what you are doing and reassure him or her along the way. Instruct the victim to avoid moving his or her head, such as by nodding, when communicating with you.

    Once the victim is secured onto the backboard, remove the victim from the water.

    After the victim is out of the water, assess his or her condition and provide the appropriate care. Place a towel or blanket on the victim to keep him or her warm if needed.

IN-WATER SKILL SESSION: HEAD, NECK AND SPINAL INJURIESimages

PRESENTATION: NEXT STEPS

Skill Practice–Shallow Water

    Explain to participants that during the skill session you will demonstrate skills and guide them through practice.

    For the first three skills, pair up participants and explain that they will take turns as victim and rescuer for each skill. For the shallow water backboarding procedure, divide participants into groups of three–two are in the role of lifeguard and one as a victim. Each group should practice the backboarding procedure at least two times so that all participants have the opportunity be in the role of lifeguard.

    For each skill, organize participants so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    Lead them through the following shallow water skills:

    Head splint–face-up victim at or near the surface in shallow water

    Lifeguards: in shallow water

    Victims: face-up in shallow water, responsive

    Head splint–face-down victim at or near the surface in shallow water

    Lifeguards: in shallow water

    Victims: face-down in shallow water, responsive once face-up at surface

    Head splint–submerged victim in shallow water

    Lifeguards: in shallow water

    Victims: submerged in shallow water, responsive once face-up at surface

    Spinal backboarding procedure

    Lifeguards: in shallow water

    Victims: face-down in shallow water, responsive once face-up at surface

    Participants should practice the skills until they are able to meet performance criteria.

    Observe each participant’s performance of the skill and provide corrective feedback.

Skill Practice–Deep Water

    Explain to participants that during the skill session you will demonstrate skills and guide them through practice.

    For the first two skills, pair up participants and explain that they will take turns as victim and rescuer for each skill. For the deep water backboarding procedure, divide participants into groups of five–four are in the role of lifeguard and one as a victim. Each group should practice the backboarding procedure at least two times so that all participants have the opportunity to be in the role of lifeguard.

    Reinforce to them that the mechanics of the skills are essentially the same in deep water as in shallow water. The skills are more challenging, however, because lifeguards are unable to stand to accomplish the skills. Rescue tubes can provide support to lifeguards as well as the victim. Additional lifeguards also can provide assistance.

    Prior to the spinal backboarding procedure, remind participants that backboards, straps and head immobilizers may vary at different facilities. When employed as a lifeguard, they should expect to be trained on the use of the backboard as part of a new employee orientation and in-service training.

    Ask participants: What are the steps they will use to secure a victim to a backboard?
Answers: Responses should include:

    Position the backboard under the victim.

    Secure the chest strap high into the armpits.

    Secure the hip strap with the hands also secured in the strap.

    Secure the strap across the thighs.

    Place the head blocks next to the head.

    Secure the head blocks with the head strap.

    For each skill, organize participants so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    SHALLOW WATER LIFEGUARDING

    For the Shallow Water Lifeguarding course, omit the skill practice in deep water.

    However, before giving participants the assignment for the next lesson, ask participants, What are the steps you will use to secure a victim to a backboard?
Answers: Responses should include:

    Position the backboard under the victim.

    Secure the chest strap high into the armpits.

    Secure the hip strap with the hands also secured in the strap.

    Secure the strap across the thighs.

    Place the head blocks next to the head.

    Secure the head blocks with the head strap.

    Lead them through the following deep water skills:

    Head splint–face-down victim at or near the surface in deep water

    Lifeguards: in deep water

    Victims: face-down in deep water, responsive once face-up at surface

    Head splint–submerged victim in deep water

    Lifeguards: in deep water

    Victims: submerged in deep water, responsive once face-up at surface

    Spinal backboarding procedure

    Lifeguards: in deep water

    Victims: face-down in deep water, responsive once face-up at surface

    Participants should practice the skills until they are able to meet performance criteria.

    Observe each participant’s performance of the skill and provide corrective feedback.

ASSIGNMENT

    Remind participants to prepare for the final written exam on lifeguarding skills by reviewing Chapters 1 to 6 and Chapter 11 of the Lifeguarding Manual before the next class session.

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general for the category of skills, as well as specific to the skill, must be met.

IN-LINE STABILIZATION–IN-WATER

SKILL CHART: HEAD SPLINT–FACE-UP VICTIM AT OR NEAR THE SURFACE

1.   Approach the victim’s head from behind or stand behind the victim’s head.

    In shallow water, lower your body so that the water level is at your neck.

    In deep water, use the rescue tube under both of your arms for support.

2.   Grasp the victim’s arms midway between his or her shoulder and elbow. Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand. Gently move the victim’s arms up alongside the head. Position yourself to the victim’s side while trapping the victim’s head with his or her arms.

3.   Slowly and carefully squeeze the victim’s arms against his or her head to help hold the head in line with the body. Do not move the victim any more than necessary.

4.   Position the victim’s head close to the crook of your arm, with the head in line with the body.

5.   Check for consciousness and breathing.

    If the victim is not breathing, immediately remove the victim from the water using a technique, such as the two-person-removal-from-the-water, and provide resuscitative care. Do not delay removal from the water by strapping the victim in or using the head immobilizer.

    If the victim is breathing, hold the victim with the head in line with the body and move toward safety until the backboard arrives. In deep water, move the victim to shallow water, if possible.

6.   Continuously monitor for consciousness and breathing. If at any time the victim stops breathing, immediately remove the victim from the water and then provide appropriate care.

SKILL CHART: HEAD SPLINT–FACE-DOWN VICTIM AT OR NEAR THE SURFACE

1.   Approach the victim from the side.

    In deep water, use the rescue tube under both of your arms for support.

2.   Grasp the victim’s arms midway between the shoulder and elbow. Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand. Gently move the victim’s arms up alongside the head.

3.   Squeeze the victim’s arms against his or her head to help hold the head in line with the body.

4.   Glide the victim slowly forward.

    In shallow water, lower your body to shoulder depth before gliding the victim forward.

    Continue moving slowly and turn the victim until he or she is face-up. To do this, push the victim’s arm that is closest to you under the water while pulling the victim’s other arm across the surface toward you.

5.   Position the victim’s head in the crook of your arm, with the head in line with the body.

6.   Check for consciousness and breathing.

    If the victim is not breathing, immediately remove the victim from the water using a technique, such as the two-person-removal-from-the-water, and provide resuscitative care. Do not delay removal from the water by strapping the victim in or using the head immobilizer device.

    If the victim is breathing, hold the victim with the head in line with the body and move toward safety until the backboard arrives. In deep water, move the victim to shallow water, if possible.

7.   Continuously monitor for consciousness and breathing. If at any time the victim stops breathing, immediately remove the victim from the water and then provide appropriate care.

SKILL CHART: HEAD SPLINT–SUBMERGED VICTIM

1.   Approach the victim from the side. In deep water, release the rescue tube if the victim is more than an arm’s reach beneath the surface.

2.   Grasp the victim’s arms midway between the shoulder and elbow. Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand. Gently move the victim’s arms up alongside the head.

3.   Squeeze the victim’s arms against his or her head to help hold the head in line with the body.

4.   Turn the victim face-up while bringing the victim to the surface at an angle. To turn the victim face-up, push the victim’s arm that is closest to you down and away from you while pulling the victim’s other arm toward you. The victim should be face-up just before reaching the surface or at the surface.

5.   Position the victim’s head close to the crook of your arm, with the head in line with the body. Another lifeguard can place a rescue tube under your armpits to help support you and the victim.

6.   Check for consciousness and breathing.

    If the victim is not breathing, immediately remove the victim from the water using a technique, such as the two-person-removal-from-the-water, and provide resuscitative care. Do not delay removal from the water by strapping the victim in or using the head immobilizer device.

    If the victim is breathing, hold the victim with the head in line with the body and move toward safety until the backboard arrives. In deep water, move the victim to shallow water, if possible.

7.   Continuously monitor for consciousness and breathing. If at any time the victim stops breathing, immediately remove the victim from the water and then provide appropriate care.

Note: If the victim is submerged but face-up, approach the victim from behind and follow the same steps for a Face-Up Victim At or Near the Surface while you bring the victim to the surface.

SKILL ASSESSMENT TOOL: HEAD SPLINT–IN-LINE STABILIZATION FOR A VICTIMIN THE WATER

Criteria
Proficient
Not Proficient

Provide in-line stabilization

    Moves victim’s arms to a secure position against the victim’s head

    Equal pressure on both arms is maintained throughout rescue

    Does not move victim’s arms against the victim’s head or maintain pressure

    One arm is pressed against head and one is not

Victim’s face remains out of the water

    Victim’s face does not submerge

    Mouth and nose are above water

    Victim’s face submerges under water

    Victim’s mouth or nose is under water

Move victim to a safe location to prepare for backboarding

    Moves victim to shallow water if safe and possible

    If rescue involves moving water, moves victim to a sheltered area

    Does not move to shallow water to stand up if it is safe and possible

    Remains in moving water when access to a sheltered area is possible

SPINAL BACKBOARDING AND REMOVAL FROM WATER

SKILL CHART: SPINAL BACKBOARDING PROCEDURE–SHALLOW WATER

1.   The first lifeguard (primary rescuer) provides in-line stabilization until another lifeguard arrives with the backboard.

2.   The assisting lifeguard removes the head-immobilizer device, enters the water, submerges the backboard and positions the board under the victim so that it extends slightly beyond the victim’s head. The victim’s head should be centered on the backboard’s head space.

3.   While an assisting lifeguard raises the backboard into place, the primary rescuer moves the elbow that is under the victim toward the top of the backboard while continuing to apply pressure on both of the victim’s arms, using the victim’s arms as a splint.

4.   Once the backboard is in place, an assisting lifeguard then stabilizes the victim by placing one hand and arm on the victim’s chin and chest, the other hand and arm under the backboard. The primary rescuer then releases his or her grip on the victim’s arms.

5.   The primary rescuer lowers the victim’s arms, moves behind the victim’s head and places the rescue tube under the head of the backboard to aid in flotation of the board.

6.   The primary rescuer balances the backboard on the rescue tube with his or her forearms and stabilizes the victim’s head by placing his or her hands along each side of the victim’s head.

7.   An assisting lifeguard secures the victim on the backboard with a minimum of three straps: across the victim’s chest, hips and thighs. Secure the straps in the following order:

    Strap high across the chest and under the victim’s armpits. This helps to prevent the victim from sliding on the backboard during the removal.

    Strap across the hips with the victim’s arms and hands secured under the straps.

    Strap across the thighs.

    Recheck straps to be sure that they are secure.

8.   The rescuers secure the victim’s head to the backboard using a head immobilizer and a strap across the victim’s forehead.

9.   If not done already, bring the victim to the side of the pool.

SKILL CHART: SPINAL BACKBOARDING PROCEDURE–DEEP WATER (LIFEGUARDING COURSE ONLY)

1.   The first lifeguard (primary rescuer) provides in-line stabilization. If the victim is face-down, the primary rescuer turns the victim into a face-up position. If necessary, an assisting lifeguard retrieves the primary rescuer’s rescue tube and inserts it under the primary rescuer’s armpits.

2.   The primary rescuer moves the victim to the side, if possible, toward a corner. An assisting lifeguard places a rescue tube under the victim’s knees to raise the legs. This makes it easier to place the backboard under the victim.

3.   An assisting lifeguard places the backboard under the victim while the primary rescuer maintains stabilization.

4.   As an assisting lifeguard raises the backboard into place, the primary rescuer moves the elbow that is under the victim toward the top of the backboard while continuing to apply pressure on both of the victim’s arms. An assisting lifeguard stabilizes the victim with one hand and arm on the victim’s chin and chest, and the other hand and arm under the backboard.

5.   Once the backboard is in place, the primary rescuer then lowers the victim’s arms, moves behind the victim’s head and places a rescue tube under the head of the backboard. The primary rescuer balances the board on the rescue tube with his or her forearms and stabilizes the victim’s head by placing his or her hands along each side of the victim’s head. The assisting rescuer moves to the foot of the board and removes the rescue tube under the victim’s knees by sliding the rescue tube toward him or herself.

6.   An assisting lifeguard secures the victim on the backboard by placing straps at least across the victim’s chest, hips and thighs. After all the straps have been checked and properly secured, the rescuers secure the victim’s head using a head immobilizer and a strap across the victim’s forehead.

SKILL CHART: SPINAL INJURY REMOVAL FROM THE WATER ON A BACKBOARD

1.   Once the victim is properly secured to the backboard, position the backboard with the head end by the side of the pool and the foot end straight out into the water.

2.   With one lifeguard at each side, lift the head of the backboard slightly and place it on the edge. Use one or two rescue tubes if needed to support the foot end of the board.

3.   One lifeguard gets out of the pool while the other maintains control of the backboard. Once out of the water, the lifeguard on land grasps the head of the backboard while the other gets out of the water.

4.   Together the lifeguards stand and step backward, pulling the backboard and sliding it up over the edge and out of and away from the water. If available, an assisting lifeguard remains in the water to help push the board.

5.   If available, additional lifeguards can help to guide and remove the backboard out of the water and onto land, then begin to assess the victim’s condition and provide the appropriate care.

SKILL ASSESSMENT TOOL: SPINAL BACKBOARDING PROCEDURE

Criteria
Proficient
Not Proficient

Maintain in-line stabilization

    Primary lifeguard maintains in-line stabilization while backboard is being positioned.

    Assisting lifeguard maintains in-line stabilization while victim is being strapped to the board and while head immobilizers are being secured.

    Loss of in-line stabilization during the rescue

    Loss of contact with the victim

    Lifeguards do not communicate as needed when switching

Victim’s face remains out of the water

    Victim’s face does not submerge

    Mouth and nose are above water

    Victim’s face submerges under water

    Victim’s mouth or nose is under water

Position the victim on the backboard

    Backboard is raised to support the victim’s head with the head aligned with the backboard’s head space

    Victim’s body is on the backboard

    Victim’s head is not aligned on the backboard’s head space

    Victim is not aligned and on the backboard.

Secure straps

    Strapping begins with chest strap, then the strap over the hips and then the strap over the thighs

    Hip strap is placed across the hips with the victim’s hands secured underneath the strap

    Straps are tight, and once all straps are secured, they are rechecked

    Strapping is done in some other order

    Hands are not strapped inside the strap

    Straps are loose so that victim can easily slide

    Straps are not rechecked for tightness

    Straps are not tightened if discovered to be loose

Immobilize the victim’s head

    Head immobilizer is placed to immobilize the victim’s head

    Head strap is secured across the victim’s forehead

    Head immobilizer is not used

    Head immobilizer is placed but moves victim’s head or neck

    No strap is used across the victim’s forehead

SPINAL INJURY REMOVAL FROM THE WATER ON A BACKBOARD

Lifeguards communicate as a team to remove the victim from the water
Lifeguards communicate what, how or when actions happen

    No verbal communication

    Communication does not result in effective actions

Victim’s face remains out of the water

    Victim’s face does not submerge

    Mouth and nose are above water

    Victim’s face submerges under water

    Victim’s mouth or nose is under water

Lifeguards remove the backboard and victim from the water

    Backboard removed from the water by sliding it along the edge

    Backboard held steady during removal

    Backboard is lifted in the air, causing the victim to move or slide

    Backboard is near vertical, and victim is slipping or moving

    Backboard is jerking or rocking from side to side

LESSON 9

FINAL WRITTEN EXAM AND FINAL IN-WATER SKILL SCENARIOS

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

images    Demonstrate how to care for a victim with a head, neck or spinal injury in shallow water.

images    Demonstrate how to rescue an active victim in deep water.

images    Demonstrate how to rescue a submerged passive victim in deep water and provide care.

images    Demonstrate how to rescue an active victim in shallow water. (Shallow Water Lifeguarding only)

images    Demonstrate how to rescue a submerged passive victim in shallow water and provide care. (Shallow Water Lifeguarding only)

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

images    Final Written Exam: Section 2, Exams A and B, and answer sheets (one for each participant)

images    Answer keys for Final Written Exam: Section 2

images    Backboards (one for each test group and at least one for practice)

images    Adult manikins (at least two so they can be rotated and decontaminated)

images    Decontamination supplies

images    Towel (to dry the manikin when using the AED training device)

images    Bag-valve-mask resuscitator (BVM) (one for each test group; one for practice)

images    AED training devices (one for each test group)

images    AED training pads (one set for each AED training device)

TOPIC: REVIEW OF FINAL WRITTEN EXAM: SECTION 1—CPR/AED FOR THE PROFESSIONAL RESCUER AND FIRST AIDimages

Activity

images    Return the final written exam and answer sheets for Section 1—CPR/AED for the Professional Rescuer and First Aid to participants for them to review.

images    Answer participants’ questions about the exam.

images    Make arrangements for those participants who need to retake the exam.

images    Collect the exams and answer sheets.

FINAL WRITTEM EXAM: SECTION 2—LIFEGUARDING SKILLSimages

Activity

images    Tell participants that they will now take Section 2 of the final written exam on the information covered in Lessons 1 through 4 and Lesson 8. They may not use their manual or notes to find the answers.

images    Hand out an exam and answer sheet to each participant. Tell participants to write only on the answer sheet and mark answers clearly.

images    SHALLOW WATER LIFEGUARDING

images  If teaching the Shallow Water Lifeguarding course, hand out Final Written Exam: Section 2—Shallow Water Lifeguarding Skills and answer sheet to each participant.

images    Tell participants to come to you or raise their hand when they have finished the exam or if they have questions.

images    Once exams are completed, collect all exams and answer sheets. Before the next lesson, grade the exam using the answer key.

images    Hand back the exam and review it with participants. Collect all exams, as the exam is a standard exam that participants should not be allowed to keep. Make arrangements for those participants who score less than 80 percent to review the material and retake the opposite version of the exam.

TOPIC: IN-WATER SKILL SESSION: GENERAL SKILLS REVIEWimages

Activity

images    This time is allotted for general skills review to meet the needs of each class. As the instructor, you should set up and facilitate a session to help participants practice skills before the final skill scenarios.

images    SHALLOW WATER LIFEGUARDING

images    If teaching the Shallow Water Lifeguarding course, pre-assign the groups for the Skills Scenario 3: Submerged Passive Victim in Shallow Water Timed Response.

FINAL IN-WATER SKILL SCENARIOSimages

Activity

images    Tell participants that there are three skill scenarios.

images    All skills must be performed according to the proficiency requirements to meet the objective of the skills.

images    Each participant has only two opportunities to complete each scenario successfully.

images    If a participant does not successfully complete a scenario during the first attempt, options include:

images   Reattempting the scenario during the normal lesson after a brief consultation on the corrective actions needed to complete the scenario successfully.

images   If additional practice is needed and time and resources permit, asking the participant to see you after class to schedule a re-evaluation of the unsuccessful scenarios at a later time.

images    To set up each scenario:

images   Assign one participant to simulate drowning victim behaviors as instructed.

images   Instruct the rescuing lifeguard to simulate activating an emergency action plan (EAP) and perform the appropriate rescue based on the type of victim observed.

images   Provide each rescuing lifeguard a rescue tube and hip pack containing non-latex disposable gloves and a resuscitation mask.

images   Have a manikin available to substitute into the scenario for a passive victim once the primary assessment is complete.

Final Scenario 1: Head, Neck or Spinal Injury in Shallow Water

Instructor’s Note: This scenario does not include immobilizing the victim on a backboard or removal from the water.

images    Assign a primary lifeguard to a ground-level station for a shallow water zone.

images    Assign a participant to be a victim of a suspected head, neck or spinal injury in shallow water and face-down at the surface. The victim will be responsive when turned face-up.

images    Begin the scenario by prompting the victim to simulate a spinal injury victim in shallow water.

images    Repeat the scenario until each participant has performed in-line stabilization for a spinal injury in shallow water.

Final Scenario 2: Active Victim in Deep Water

Instructor’s Note: The lifeguard must use the appropriate active victim rescue depending on the direction the active victim is facing. This scenario does not include removal from the water.

images    Assign a primary lifeguard to an elevated or ground-level station for a deep water zone.

images    Assign a victim to role-play an active victim in deep water facing any direction he or she chooses.

images    Begin the scenario by prompting the victim to begin simulating an active victim.

images    Repeat the scenario until each participant has performed an active victim rescue.

images    SHALLOW WATER LIFEGUARDING

images    For the Shallow Water Lifeguarding course, follow the directions for the Active Victim in Deep Water with the exception of having the lifeguard and victim stationed in shallow water.

Final Scenario 3: Submerged Passive Victim in Deep Water—Timed Response

images    Explain to participants that this is a timed scenario, with 2 minutes allotted for the water rescue and removal of the victim from the water (with an assisting lifeguard who will bring the backboard), followed by 3 minutes of one-rescuer CPR.

Note:

images    Divide the participants into groups of three and assign one rescuing lifeguard, one assisting lifeguard to help with removal from the water, one victim and one manikin for each group.

images    Tell the victim to get into position about 30 feet from the edge and submerge as the rescuing lifeguard gets near.

images    Start the stopwatch once the EAP has been activated, and again once the rescuer begins CPR.

images    Repeat the drill until each person in the group has performed as a rescuing lifeguard.

images    SHALLOW WATER LIFEGUARDING

images    For the Shallow Water Lifeguarding course, follow the directions for the Submerged Passive Victim in Shallow Water—Timed Response with the exception of having the lifeguard and victim stationed in shallow water.

TOPIC: CLOSINGimages

Activity

images    Thank all participants for attending the course.

images    Congratulate participants on successful completion.

images    Explain that they will receive a certificate that indicates Lifeguarding/First Aid and CPR/AED for Lifeguard, all valid for 2 years.

images    SHALLOW WATER LIFEGUARDING

images    For the Shallow Water Lifeguarding course, explain that participants will receive a certificate that indicates Shallow Water Lifeguarding (up to 5 ft)/First Aid and CPR/ AED for Lifeguard, all valid for 2 years.

images    Make arrangements to retest any participants who did not pass the final written exam(s) or scenario(s).

Activity Worksheet 1.1—Reasons for the Rules

Aquatic Facilities—General

Reason

1.   Swim only when a lifeguard is on duty.

2.   No running, pushing or rough play.

3.   Dive only in designated areas.

4.   No diving in shallow water (water up to 5 feet deep).

5.   No glass containers in the pool area and locker rooms.

6.   No alcoholic beverages or other drug use allowed.

Waterfront Facilities

1.   No playing or swimming under piers, rafts, platforms or play structures.

2.   No running and diving head-first into shallow water.

3.   No fishing near swimming areas.

4.   No umbrellas at the waterline.

5.   No swimming in unauthorized areas.

Waterpark Facilities, Including Winding Rivers and Waterslides

1.   Designated age, height or weight requirements for using an attraction.

2.   Enter and exit the winding river only at designated places.

3.   Stay in tubes at all times.

4.   No metal objects, locker keys, jewelry, metal snaps/zippers, eyewear or watches, including metal rivets, buttons or fasteners on swimsuits or shorts.

5.   No running, stopping, standing, kneeling, rotating or tumbling on the slides.

Diving Areas

1.   Patrons must demonstrate their swimming ability before entering deep water.

2.   Only one patron on the diving board at a time.

3.   Only one bounce allowed on the diving board.

4.   Dive or jump forward, straight out from the diving board.

5.   Swim immediately to the closest ladder or wall.

Spas, Hot Tubs and Therapy Pools

1.   Shower with soap and water before entering the water.

2.   People with certain medical conditions are not allowed to use the spa or hot tub.

3.   Pregnant women and young children should seek their doctor’s approval before using a spa or hot tub.

4.   Do not allow anyone to sit or play near the drain or suction fittings.

5.   Limit time in the spa to 10 minutes. Patrons then may shower, cool down and return briefly.

Activity Worksheet 2.1—Guarding Special Attractions

Attractions

Issues for Guarding the Special Attraction

Areas Specifically for Young Children

Play Structures

Special Rides and Attractions

Water Slides

Winding Rivers

Wave Pools

Activity Worksheet 3.1—Strategies for a Safe Group Visit

Scenarios

Guarding Strategies

Scenario 1: You are guarding multiple activities using the pool in addition to an organized group of 30 preschool-aged children with four group leaders. In general, what should you ensure and be aware of while guarding the activity?

Scenario 2: You are tasked with giving a quick safety orientation to a camp group that will be using the diving boards. Group members took the facility swim test, and all are approved to swim in deep water. List some common rules that you will review for the safe use of the diving boards and briefly describe how you would cover the information.

Scenario 3: You will be working a private rental at your facility for families with children of all ages from your local athletic association. You will be doing a safety orientation for the group. Who will you be instructing during the orientation and what items will you be sure to cover?

Activity Worksheet 6.1—Using an AED in Unique Situations—Fact or Fiction

Fact
Fiction

1.   It is safe to use an AED in rain or snow.

Fact
Fiction

2.   An AED cannot be used on a pregnant woman.

Fact
Fiction

3.   If someone has chest hair, you should shave it before using the AED.

Fact
Fiction

4.   If a victim has a body piercing or is wearing jewelry, you should remove the item before using an AED.

Fact
Fiction

5.   Never shock someone who has an implantable cardioverter-defibrillator (ICD) or pacemaker device.

Fact
Fiction

6.   If you see a transdermal medication patch you should use a gloved hand to remove it.

Fact
Fiction

7.   Never shock a person who is suffering from traumatic injuries.

Fact
Fiction

8.   Never shock a victim on a metal surface.

Fact
Fiction

9.   Never shock a victim suffering from hypothermia.

SECTION  C | WATERFRONT SKILLS

MODULE OUTLINE

Activity

Time

Introduction to the Waterfront Skills Module
10 minutes

Verification of Certification Prerequisite
5 minutes

Verification of Swimming Skills
40 minutes

Unique Aspects of Waterfront Lifeguarding
45 minutes

Waterfront Rescue Skills
10 minutes

   Video: Waterfront Rescue Skills

In-Water Skill Session: Waterfront Rescue Skills
180 minutes

   Skill: Run-and-Swim Entry

   Skill: Walking Assist

   Skill: Beach Drag

   Skill: Front-and-Back Carry

   Skill: Head Splint—Face-Down in Extremely Shallow Water

   Skill: Searching Shallow-Water Areas

   Skill: Entering the Water While Wearing Mask and Fins

   Skill: Feet-First Surface Dive with Mask and Fins

   Skill: Head-First Surface Dive with Mask and Fins

   Skill: Searching Deep-Water Areas

   Skill: Approaching a Victim on a Rescue Board

   Skill: Rescuing an Active Victim with a Rescue Board in Deep Water

   Skill: Rescuing a Passive Victim with a Rescue Board in Deep Water

Putting It All Together
20 minutes

Final Written Exam: Waterfront Skills Module
25 minutes

Closing
5 minutes

Total Time
5 hours 40 minutes

WATERFRONT SKILLS MODULE

MODULE NOTES

The purpose of the Waterfront Skills module is to teach lifeguards the knowledge and skills needed to prevent and respond to emergencies in nonsurf, open-water areas found at public parks, resorts, summer camps and campgrounds.

MODULE PREREQUISITES

images    Age Prerequisite: Candidates must be 15 years old by the last day of the module.

images    Certification Prerequisite: Candidates must have a current American Red Cross Lifeguarding/First Aid/CPR/AED.

images    Skill Prerequisites: Candidates must successfully complete the following:

1.  Swim 550 yards continuously in a prone position demonstrating breath control and rhythmic breathing. Swimming on the back is not allowed. Swim goggles are allowed.

2.  Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

3.  Complete a timed event within 1 minute, 40 seconds.

   Starting in the water, swim 20 yards using front crawl or breaststroke. The face may be in or out of the water. Swim goggles are not allowed.

   Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object.

   Return to the surface and swim 20 yards to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. Candidates should not swim the distance under water.

   Exit the water without using a ladder or steps.

4.  Swim 5 yards, submerge and retrieve three dive rings placed 5 yards apart in 4 to 7 feet of water, resurface, and swim 5 yards to the side of the pool.

images    If conducting this module immediately following a full or review Lifeguarding, it is recommended that participants perform the prerequisites for the Waterfront Skills module at the start of the Lifeguarding course. If the prerequisite evaluation for Waterfront Skills module is not completed at this time, then it must be completed as a precourse session for the Waterfront Skills module.

MODULE LENGTH

This module is designed to be taught in approximately 5 hours, 40 minutes, which includes the minimum time needed for conducting the prerequisites, presenting information, practicing skills and conducting written exams. This estimate is based on:

images    Ten participants per instructor.

images    The recommended equipment needed to conduct the module. If working with a limited amount of equipment, build additional practice time into the module.

CLASS SIZE

It is recommended that there be one instructor for every 10 participants. If the class has more than 10 participants, you should have a co-instructor or aide or extend the class length.

FACILITY REQUIREMENTS

Classroom space should be equipped with the ability to show video segments. The swimming area must be free of surf and obstructions and meet requirements to perform skills. A zero-depth or gradual sloping area is ideal for practicing entry and exit skills; however, shallow water can be used. An extreme shallow water area is required for practicing care for spinal injuries.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

images    Waterfront Skills Module Course Presentations

images    Waterfront Skills segment on the Lifeguarding DVD Set

images    DVD player and monitor

images    A 10-pound object (a diving brick or weight; one for every five participants)

images    Stopwatch

images    Three diving rings

images    Masks, assorted sizes, one per participant

images    Fins, assorted sizes, one pair per participant

images    Rescue board (one for every five participants)

images    Waterfront Skills Checklist

images    Copies of Waterfront Skills Written Exams (exams A and B) and answer sheets (one for each participant)

images    Answer keys for Waterfront Skills Written Exams

TESTING AND CERTIFICATES

images    To receive the module completion certificate for American Red Cross Waterfront Skills, the participant must:

images   Demonstrate competency in all required skills and activities.

images   Correctly answer at least 80 percent of the questions of the written exam.

images    Upon successful completion of the module, participants will receive an American Red Cross certificate indicating Waterfront Skills that is valid for no more than 2 years. The Waterfront Skills certificate is only valid when accompanied by a current Lifeguarding/First Aid/CPR/AED certificate.

images    Skills in the module include the following:

images   Run-and-swim entry

images   Walking assist

images   Beach drag

images   Front-and-back carry

images   Head splint—face-down in extremely shallow water

images   Searching shallow-water areas

images   Proper use of mask and fins

images   Feet-first surface dive with mask and fins

images   Head-first surface dive with mask and fins

images   Searching deep-water areas

images   Approaching a victim on a rescue board

images   Rescuing an active victim with a rescue board

images   Rescuing a passive victim with a rescue board

WATERFRONT SKILLS MODULE LESSON PLAN

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

images    Describe the unique aspects of waterfront lifeguarding.

images    Demonstrate how to perform the waterfront rescue skills safely and effectively.

TOPIC: INTRODUCTION TO THE WATERFRONT SKILLS MODULEimages

Activity

images    Welcome participants and introduce yourself, including your background in aquatics and certification as a Red Cross instructor. Include co-instructors and aides if applicable.

images    Have participants introduce themselves.

images    Review facility policies, including emergency procedures. Give the locations of restrooms, locker rooms, water fountains and details unique to your facility. Also, identify the location of the AED and first aid kit.

images    Explain that the purpose of the Waterfront Skills module is to teach lifeguards the skills and knowledge needed to prevent and respond to emergencies in nonsurf, open-water areas found at public parks, resorts, summer camps and campgrounds.

images    Explain the requirements to pass the module:

images   Demonstrate competency in all required skills and activities.

images   Correctly answer at least 80 percent of the questions in the written exam.

images    Explain that upon successful completion of the module, participants will receive an American Red Cross certificate indicating Waterfront Skills that is valid for no more than 2 years. The Waterfront Skills certificate is only valid when accompanied by a current Lifeguarding/First Aid/CPR/AED certificate.

images    If a Waterfront Skills module is immediately following the Lifeguarding course and all candidates are enrolled in both the Lifeguarding course and Waterfront Skills module, the precourse session for the Waterfront Skills module should have been used instead of the Lifeguarding precourse session. If this is the case, then it is not necessary to repeat the Waterfront Skills swimming prerequisites. If the prerequisite evaluation for Waterfront Skills was not completed during the Lifeguarding precourse session, then it must be completed at this time.

images    Explain to participants that they must successfully complete the swimming prerequisites to verify swimming ability to continue in the Red Cross Waterfront Skills module:

1.  Swim 550 yards continuously demonstrating breath control and rhythmic breathing. Candidates must demonstrate the ability to swim both the front crawl and breaststroke. Swimming on the back or side is not allowed. Swim goggles are allowed.

2.  Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

3.  Complete a timed event within 1 minute, 40 seconds.

images   Starting in the water, swim 20 yards using front crawl or breaststroke. The face may be in or out of the water for this. Swim goggles are not allowed.

images   Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object.

images   Return to the surface and swim 20 yards to return to the starting point with both hands holding the object.

images   Exit the water without using a ladder or steps.

4.  Swim 5 yards, submerge and retrieve three dive rings placed 5 yards apart in 4 to 7 feet of water, resurface, and swim 5 yards to the side of the pool.

TOPIC: VERIFICATION OF CERTIFICATION PREREQUISITEimages

Activity

images    Check the eligibility of participants to participate in the module by checking their American Red Cross Lifeguarding/First Aid/CPR/AED certification.

TOPIC: VERIFICATION OF SWIMMING SKILLSimages

Activity

images    Explain to prospective participants that they must successfully complete four swimming prerequisites to continue in the Waterfront Skills module.

images    Refer to the Skill Assessment Chart to evaluate performance of each prospective participant. Record completion of each skill on the Waterfront Skills Checklist.

Waterfront Skills

Activity 1—550-Yard Swim

images    Explain to prospective participants that they must perform a 550-yard continuous swim using the front crawl, breaststroke or a combination of both. Swimming on the back or side is not permitted. Swim goggles are allowed.

Activity 2—Tread Water

images    Explain to prospective participants that they must tread water for 2 minutes without support and without stopping. When treading, only the legs can be used. Candidates should place their hands under the armpits. The head must remain above the surface of the water.

Activity 3—Timed Event

images    Arrange the swim distance of 20 yards and place a 10-pound object at a depth of 7 to 10 feet.

images    Explain that swim goggles are not allowed for this event.

images    Evaluate each prospective participant on the following skill to be performed within 1 minute and 40 seconds.

images   Starting in the water, swim 20 yards using the front crawl or breaststroke. The face may be in or out of the water.

images   Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a 10-pound object.

images   Return to the surface and swim 20 yards to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. The participants should not swim the distance under water.

images   Exit the water without using a ladder or steps.

Activity 4—Underwater Swim Event

images    Arrange the swim distance area, placing three dive rings 5 yards apart in 4 to 7 feet of water.

images    Explain that swim goggles are not allowed for this event.

images    Evaluate each participant on the following skill.

images   Starting in the water, swim 5 yards. The face may be in or out of the water.

images   Submerge, swim under water and retrieve three dive rings placed 5 yards apart in 4 to 7 feet of water.

images   Return to the surface after picking up all three dive rings and continue to swim another 5 yards to complete the skill sequence.

Instructor’s Note: If any participant is unable to complete the verification of swimming ability, he or she is not eligible to continue in the Waterfront Skills module. Privately advise any participant who did not successfully demonstrate the skills that he or she may not continue.

TOPIC: UNIQUE ASPECTS OF WATERFRONT LIFEGUARDINGimages

PRESENTATION: UNIQUE ASPECTS OF WATERFRONT LIFEGUARDING

Lecture and Guided Discussion

images    The Waterfront Skills module builds on the knowledge and skills learned in the Lifeguarding course. Because many aquatic facilities now have a variety of features and attractions, much of the knowledge and skills were covered in that course.

images    The purpose of the Waterfront Skills module is to teach lifeguards the knowledge and skills needed to prevent and respond to emergencies in nonsurf, open-water areas found at public parks, resorts, summer camps and campgrounds.

images    Remember, your primary responsibility is to help ensure patron safety and protect lives. The main tool used to accomplish this is patron surveillance—keeping a close watch over the people in the facility and intervening when necessary.

images    Ask participants: What are the elements of effective surveillance?
Answers: Responses should include the following:

images   Recognition of dangerous behaviors

images   Victim recognition

images   Effective scanning

images   Zone of surveillance responsibility

images   Lifeguard stations

images    When considering the unique challenges for lifeguarding at a waterfront, consider what is unique to waterfront facilities:

images   Underwater hazards, including plant and marine life.

images   Physical structures, such as piers and docks.

images   Changing water conditions.

images   Water quality.

Facility Safety

Lecture and Guided Discussion

images   Ask participants: What underwater hazards might present concerns for waterfront facility safety?
Answers: Responses should include the following:

images   Holes in the swimming area.

images   Sudden drop-offs.

images   Submerged objects, such as rocks, tree stumps and underwater plants.

images   Bottom conditions (sand, rock, silt, weeds and mud).

images   Slope of the bottom and water depth.

images   Shells and barnacles.

images   Broken glass or other sharp objects.

images   Marine life.

images    You should check for and, if possible, remove underwater hazards. If hazards cannot be removed, swimming areas should be positioned away from them. Floating buoys can be used to mark underwater hazards to warn patrons of their danger.

images    Physical structures in the water, such as piers or docks, are often used for different activities.

images    Ask participants: What precautions should be taken with physical structures?
Answers: Responses should include the following:

images   Ensure that floating piers, docks and rafts are anchored securely.

images   Adjust attachment points between floating sections to minimize hazards.

images   Be aware of and take steps to eliminate blind spots (obstructed views) caused by physical structures.

images   Ensure that patrons dive only in designated areas. Check the water depth daily. Be aware of bottom and tidal changes before allowing head-first entries.

images   Prohibit swimming in fishing areas around piers or docks or adjacent to boat activity.

images    Many factors can influence water conditions, which in turn can affect patron safety including:

images   Water depth and currents.

images   Water quality.

images   Debris or cloudiness in the water.

images   Water temperature.

images    Ask participants: What occurrences might cause changes in water depth and water currents?
Answers: Responses should include the following:

images   A dam that releases water, causing the water depth above the dam to drop and the river depth below the dam to rise.

images   Heavy rainfall that makes a lake or river rise, or a long, dry period that makes it too shallow for diving.

images   Tidal changes.

images   A seiche in a large lake. The danger from a seiche comes from rapidly rising and falling lake levels and can sweep people off piers and breakwaters and pull swimmers far away from shore.

images   Sand bars that can move and shift from season to season or from heavy rain that produces strong currents. These changes in the waterfront floor can create unexpected drops or new shallow-water features.

images    Ask participants: What might cause concerns with water quality?
Answers: Responses should include the following:

images   Insufficient flow may lead to stagnant water and compromise water quality.

images   Pollutants, such as waste and storm water runoff.

images   Periods during and after heavy rain.

images    When dealing with changing water conditions:

images   Warn patrons of hazards by using signs, buoys and safety announcements.

images   Check for objects that may have washed into the area.

images   Check for changes in bottom conditions, water depth and water quality.

images   Alert patrons to cold water, and watch for potential signs of hypothermia.

images   Check and document scheduled high and low tides in the daily log each morning before opening, and plan for depth changes.

images    Ask participants: What aspects of a facility safety check may be unique to a waterfront facility?
Answers: Responses should include the following:

images   Bottom is free of hazards.

images   Shoreline is free of sharp objects, broken glass, rocks, litter and wildlife droppings.

images   Sand in front of and around lifeguard stands is clear of objects.

images   Docks and piers are stable—no protruding nails, rotting wood or weak or frayed anchor lines.

images   Rescue craft, such as rescue boards, rowboats and kayaks, are in proper operating condition and contain appropriate rescue equipment.

images   Communication devices, such as phones, two-way radios, air horns and megaphones, are in good working order.

images    Ask participants: What rules might a waterfront facility adopt that would be specific to safety at waterfronts?
Answers: Responses should include the following:

images   No playing or swimming under structures, such as docks, piers, rafts, platforms or play structures.

images   No boats, sailboards, or personal water craft in swimming areas.

images   No running or diving head-first into shallow water.

images   No fishing near swimming areas.

images   No umbrellas at the waterline (umbrellas present a surveillance obstruction).

images   No swimming in unauthorized areas.

Additional Facility Safety Concerns at Waterfronts

Lecture

images    Additional safety concerns at waterfront facilities can include cold water and rip currents.

images    Body heat can be lost much faster in cold water than in cold air.

images    Be aware of signs and symptoms of hypothermia in swimmers, which can occur in situations, such as:

images   In the spring and early summer, when water temperatures are cooler.

images   After rain.

images   Extended periods of time in cooler water, cooler temperatures and/or windy conditions.

images   Sudden immersion in cold water.

images    To perform a rescue in cold water, remove a victim from the water as quickly as possible. Because you will also be affected by cold water, you should attempt the rescue without entering the water.

images   You can extend a rescue tube to reach the victim, but the victim might not be able to maintain a hold on the equipment due to the cold.

images   If you must enter the water as a last resort, take a rescue tube and try to keep your head out of the water while swimming.

images   When the victim is out of the water, assess his or her condition. Victims who have been submerged in cold water may still be alive even with:

images   A decreased or undetectable pulse rate.

images   No detectable breathing.

images   Bluish skin that is cold to the touch.

images   Muscle rigidity.

images   Begin giving ventilations or CPR, as needed, and provide first aid for hypothermia as soon as possible. If not done so already, summon emergency medical services personnel immediately. The sooner the victim receives advanced medical care, the better the chances are for survival.

images    If you are lifeguarding at a facility where sudden immersion in cold water is possible, you should receive specialized training in cold water rescue.

images    Another potential safety concern at some waterfront facilities are rip currents.

images    A rip current is a strong channel of water that flows seaward beginning near the shore and often extending well beyond the breakers. They are often associated with underwater features, such as sand bars, and also commonly occur near physical structures, such as piers, groins and natural outcroppings.

images    According to the National Weather Service, common indicators of a rip current include:

images   A channel of churning, choppy water,

images   An area having a noticeable difference in water color.

images   A line of foam, seaweed or debris moving steadily away from shore.

images   A break in the incoming wave pattern.

images    Although these are good indicators, they are not always present. Consequently, it is not always possible even for an experienced lifeguard or surfer to spot a rip current.

images    All swimmers should swim near a lifeguard—this includes other lifeguards and experienced swimmers.

images    On many beaches, color coded flags are flown to indicate the presence of hazardous surf and rip currents. Anytime you see a red or double red flag stay out of the water; use extreme caution when there is a yellow flag.

images    If caught in a rip current:

images   Do not panic.

images   Never attempt to swim against the current—fighting the current will cause you to become exhausted and possibly drown.

images   Allow the current to take you away from shore.

images   Once the current weakens, swim parallel to the beach then back to shore at an angle. Try to swim in the direction of least resistance to the current.

images   If you are too exhausted to swim to shore, signal by calling and waving for help.

images    If you are lifeguarding on a waterfront where there is the possibility of rip currents, it is critical to receive specialized training in the specific conditions and hazards that exist in your area and to learn how to identify rip currents and to help someone who is caught in them.

Patron Surveillance

Lecture

images    Waterfront activities vary and can include swimming, boating, water skiing, sailing, canoeing, as well as use of personal watercraft and SCUBA diving.

images    Patron surveillance at a waterfront can be challenging due to water conditions that can cause visibility to be difficult.

images    The swimming area should have a buffer zone of no boating buoys. In addition to watching your zone of surveillance, you may need to warn people on boats, personal watercraft or water skiers to stay out of the No Boating area.

images    Ask participants: What unique challenges for effective scanning might you experience at a waterfront facility?
Answers: Responses should include the following:

images   Blind spots underneath or around structures, such as docks, piers and floating rafts.

images   Water movement (i.e., waves).

images   Murky water.

images    When a drowning victim submerges at a waterfront, you may not be able to see the location of the victim as you approach. A sighting or a cross-bearing is used to keep track of where the victim went underwater.

images    If a person is reported as missing in or near the water, or you have attempted and are unable to locate a victim after submersion, a search is necessary.

images    In many waterfront facilities, additional lifeguards are stationed to watch swimmers from a watercraft, typically patrolling the outer edge of a swimming area. Often, someone in trouble in the water can be reached more quickly from watercraft than from a lifeguard station on the shore.

images    In a small, calm area, a rescue board, kayak or flat-bottom rowboat might be used while conducting patron surveillance. In rough water, rowboats might be used. Powerboats, inflatable boats and personal watercraft also can be used as rescue watercraft.

images    If stationed on watercraft in water with a current, you might have to row or paddle to stay in position. Some watercrafts use a special anchor line with a quick release for making a rescue. In some larger watercraft, one lifeguard maintains the craft’s position while a second watches the swimming area.

images    Make sure you are well trained in operating the facility’s watercraft before using it for surveillance or to make a rescue. Use caution with motorized watercraft to avoid injuring swimmers or damaging lifelines when crossing into the swimming area to make a rescue.

images    Most states require that boat operators pass a boating education course. In motorized craft, operators must have a state-approved boating education certificate.

images    For personal watercraft, operators should have additional training in the operation and use as a rescue craft.

Injury Prevention

Lecture

images    Organizations, such as day cares or youth camps, may bring groups to waterfront facilities for recreation. These groups may be based out of your facility and swim regularly or visit one or more times as a field trip.

images    Group leaders, chaperones or camp counselors may assist with discipline but do not take the place of lifeguards.

images    Some youth camps operate their own waterfront facilities. Youth camps may implement additional layers of safety precautions. These additional layers are not a replacement for continuous scanning of your area.

images    Additional supervision may be provided by camp staff that have been trained to serve as spotters or lookouts. These staff members should never take the place of lifeguards.

images    Swim tests may be used to identify the swimming ability of both campers and staff and assign them to designated swimming areas.

images    Buddy systems with buddy boards and buddy checks may be used to help account for swimmers by having buddies look out for one another.

images   Buddies are paired according to swimming ability as much as possible. If buddies do not have similar swimming skills, they should remain in the swimming area that is suitable for the weakest swimmer’s ability. Buddies are to stay together and be responsible for each other, informing a lifeguard at any time that their buddy is in trouble or missing.

images   Buddy checks are used to account for all swimmers and to teach buddies to continuously monitor their partners. Buddy checks are often set for specific timed intervals. A lifeguard, lookout or supervisor gives a pre-arranged signal, such as a whistle blast. The buddies grasp each other’s hands, raise their arms over their heads and hold still while the staff confirms that everyone has a buddy and is accounted for.

images   Buddy boards provide a system of checking campers in and out of the water.

images   A lifeguard or other staff member is stationed at the buddy board to make sure the tags are placed correctly and that no one enters or leaves the swimming area without moving their tags appropriately.

images   Each swimmer has a tag that may designate swimming ability, camp group or the name of the individual camper.

images   The buddy board has an “in” area and an “out” area. The “in” area may be divided according to specific sections of the swimming area. Before buddies enter the water they hang their tags next to each other on the board in the designated area for where they will be in the water.

images   When buddy checks are done, a count of people in the water is verified with the number of tags on the buddy board.

images   If buddies move to another swimming area or leave the swimming area they are to change their tags on the buddy board accordingly.

images    In general, when guarding groups, you should:

images   Ensure that swimming areas are clearly marked and determined by swimming abilities.

images   Ensure that patrons stay in the sections appropriate for their swimming abilities.

images   Provide U.S. Coast Guard-approved life jackets for weak or nonswimmers.

images   Know how to identify group leaders or chaperones.

images   Ensure that chaperones are actively supervising the members of their group and that the appropriate swimmer-to-chaperone ratio is being met.

images   Signal for additional lifeguard coverage, such as a roving lifeguard, if you feel you cannot effectively guard your zone.

Emergency Action Plans

Lecture

images    Ask participants: What communication systems might lifeguards use at a waterfront facility?
Answers: Responses should include the following:

images   Two-way radios

images   Whistles

images   Hand signals or signals using rescue equipment

images   Public address systems

images   Telephones

images   Flags

images   Horns

images   Megaphones

images   Electronic devices (buttons or switches) that must be triggered

images    Be sure you understand the methods of communication used at your facility.

images    Include communication systems in daily facility safety checks, including battery charge for battery-operated equipment.

images    EAPs may include additional steps because of the environment, weather, the size of the waterfront and its surroundings and possibly a longer response time for EMS personnel.

images    It is important to understand the role played by other members of the safety team including camp staff, which may include medical personnel, park rangers, as well as maintenance and security personnel.

images    Refer participants to Chapter 5: Emergency Action Plans in the Lifeguarding Manual to review the sample missing person procedure.

TOPIC: WATERFRONT RESCUE SKILLSimages

PRESENTATION: WATERFRONT RESCUE SKILLS

Video Segment

images    Explain that the video segment will demonstrate skills for rescues at waterfronts.

images    Show the video segment, “Waterfront Rescue Skills.”

images    Answer participants’ questions about the segment.

IN-WATER SKILL SESSION: WATERFRONT RESCUE SKILLSimages

PRESENTATION: NEXT STEPS

Skill Practice—Entries Assists and Head Neck and Spinal Injury

images    Explain to participants that during the skill session you will demonstrate skills and guide them through practice.

images    For each skill, organize participants so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

images    Pair up participants and explain that they will take turns as victim and rescuer for each skill.

images   For the run-and-swim entry, have participants line up along the edge of a zero-depth area or simulated shoreline and have them perform the run-and-swim entry. If simulating this skill, have participants perform the skill on dry land in a suitable area with a dry surface that is free of obstructions or have the participants perform the entry in a shallow water area.

images   For the beach drag and front-and-back carry, reorganize participants into groups of three and have them perform the skills as a team of two lifeguards.

images    Remind participants to simulate activating the emergency action plan before entering the water.

images    Lead them through the following skills:

images   Run-and-swim entry

images   Lifeguards: on the edge of a zero-depth area

images   Walking assist

images   Lifeguards: in the water

images   Victims: in shallow water about 5 yards from the edge of the zero-depth area, distressed swimmer

images   Beach drag—one person and two person

images   Lifeguards: in the water

images   Victims: in shallow water about 5 yards from the edge of the zero-depth area, face-up passive victim

images   Front-and-back carry

images   Lifeguards: in the water

images   Victims: in shallow water about 5 yards from the edge of the zero-depth area or simulated shoreline, face-up passive victim

images   Head splint—face-down in extremely shallow water

images   Lifeguards: in the water

images   Victims: face down in extremely shallow water, approximately one foot deep

images    Participants should practice the skills until they are able to meet performance criteria.

images    Observe each participant’s performance of the skill and provide corrective feedback.

Skill Practice—Searches and Using Masks and Fins

images    Organize participants into a group and lead them through the skill of searching a shallow water area. Be sure to cover how to shift the line or turn.

images    Next, explain that the next several skills deal with rescues in deep water.

images    Explain that as they descend into deep water, water pressure increases and presses against the empty spaces in your skull, especially those inside the ears. This can cause pain or even injury. To relieve this pressure, they need to equalize the pressure by forcing more air into the empty spaces so that the air pressure matches the water pressure. Explain that they should equalize early and often.

images    Guide them through the steps of equalizing by simulating the following:

1.  Place your thumb and finger on your nose.

2.  Pinch your nose and keep your mouth shut. Try to exhale gently through your nose until the pressure is relieved.

3.  Repeat this as needed to relieve ear pressure. If your ears hurt, do not attempt to go deeper until successfully equalizing the pressure.

images    Have each participant put on a mask and ensure that it properly fits. To check that it properly fits, have them:

1.  Place the mask against his or her face without using the strap.

2.  Inhale slightly through the nose to create a slight suction inside the mask. This suction should keep the mask in pace without being held.

3.  Adjust the strap so the mask is comfortable. The mask should be placed on the crown of the head for a proper fit.

4.  Try to mask in the water. Make adjustments as needed.

images    Guide them through the steps of equalizing while wearing a mask by simulating the following:

1.  Place your thumb on finger on the nosepiece of the mask.

2.  Pinch your nose and keep your mouth shut. Try to exhale gently through your nose until the pressure is relieved.

3.  When descending, the increased water pressure will cause the mask to squeeze your face. To relieve the squeezing, exhale a small amount of air through your nose into the mask.

images    Have each participant put on a pair of fins then practice swimming with fins. Have them practice the following:

images   Use a modified flutter kick: the kicking action is deeper and slower, with a little more knee bend than the usual flutter kick.

images   Swim with the legs only; keep the arms relaxed at the side.

images    Lead participants through the following skills:

images   Entering the water while wearing mask and fins

images   Feet-first surface dive with mask and fins

images   Head-first surface dive with mask and fins

images    Organize participants into a group and lead them through the skill of searching a deep water area.

images    Participants should practice the skills until they are able to meet performance criteria.

images    Observe each participant’s performance of the skill and provide corrective feedback.

Skill Practice—Using a Rescue Board

images    Lead participants through the following skills using a rescue board.

images    Approaching a victim on a rescue board

images   Lifeguards: on edge of zero-depth, going out to deep water

images   Victims: on the surface in deep water, active victim

images    Rescuing an active victim with a rescue board

images   Lifeguards: on the rescue board in deep water

images   Victims: on the surface in deep water, active victim

images    Rescuing a passive victim with a rescue board

images   Lifeguards: on the rescue board in deep water

images   Victims: on the surface in deep water, passive victim

images    Participants should practice the skills until they are able to meet performance criteria.

images    Observe each participant’s performance of the skill and provide corrective feedback.

PUTTING IT ALL TOGETHERimages

Skill Drill—Timed Response

images    Assemble the participants on the shoreline and explain they will be practicing rescuing a submerged passive victim in shallow water, removing the victim from the water, doing a primary assessment and caring for a victim who is not breathing and does not have a pulse.

images    Explain that the goal of this water rescue and removal of the victim from the water is to be completed within 2 minutes. Timing starts once the lifeguard simulates the EAP. One-rescuer CPR should be performed for 3 minutes.

images    Divide the participants into groups of three and assign one rescuing lifeguard, one assisting lifeguard to help with removal from the water, one victim and one manikin for each group. Explain that for each group:

images   The rescuing lifeguard, wearing a hip pack with gloves inside, will simulate activating the EAP and enter the water. Once the EAP has been activated, the stopwatch must be started.

images   The victim will get into position about 30 feet from the rescuer and submerge as the rescuing lifeguard gets near. The rescuing lifeguard will perform a submerged passive victim rescue.

images   The assisting lifeguard will assist the rescuing lifeguard in removing the victim from the water demonstrating team communication skills between the lifeguards.

images   Once removed from the water, the rescuing lifeguard will perform a primary assessment on the victim, then switch to a manikin and provide one-person CPR for 3 minutes. Once the rescuer begins CPR, the stopwatch must be started.

images    Repeat the drill until each person in the group has performed as a rescuing lifeguard and an assisting lifeguard at least once.

FINAL WRITTEN EXAM: WATERFRONT SKILLS MODULEimages

images    Tell participants that they will now take a final written exam on the information covered in the module. They may not use their manual or notes to find the answers.

images    Hand out an exam and answer sheet to each participant. Tell participants to write only on the answer sheet and mark answers clearly.

images    Tell participants to come to you or raise their hands when they have finished the exam or if they have questions.

images    Once exams are completed, collect all exams and answer sheets. Before the next lesson, grade the exam using the answer key.

images    Hand back the exam and review it with participants. Collect all exams as the exam is a standard exam that participants should not be allowed to keep. Make arrangements for those participants who score less than 80 percent to review the material and retake the opposite version of the exam.

TOPIC: CLOSINGimages

images    Thank all participants for attending the course.

images    Congratulate participants on successful completion.

images    Explain that they will receive an American Red Cross certificate indicating Waterfront Skills that is valid for no more than 2 years. The Waterfront Skills certificate is only valid when accompanied by a current Lifeguarding/First Aid/CPR/AED certificate.

images    Make arrangements to retest any participants who did not pass the final written exam(s).

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill.

ENTRIES

SKILL CHART: RUN-AND-SWIM ENTRY

1.   Hold the rescue tube and the excess line and run into the water, lifting your knees high to avoid falling. Swing your legs wide as you run.

2.   When you can no longer run, either put the rescue tube across your chest and lean forward or drop the tube to the side and start swimming, letting the rescue tube trail behind. Do not dive or plunge head-first into the water; this could cause a serious head, neck or spinal injury.

SKILL ASSESSMENT TOOL: RUN-AND-SWIM ENTRY

Criteria

Proficient

Not Proficient

Properly positions equipment for the entry

images    Control of the rescue tube is maintained

images    Excess line held to keep it from getting caught on the lifeguard stand or other equipment

images    Contact with the rescue tube not maintained

images    Excess line not held

Uses appropriate entry for the situation

Entry is safe for the rescuer, victim and surrounding persons

Entry causes a safety hazard

Maintains balance while running in the water

Lifts knees high to step over the water

images    Fails to lifts knees high enough to step over the water

images    Loses balance when entering the water

images    Dives forward when entering the water

Begins swimming when no longer able to run

Leans forward into water with head up to begin swimming

Does not keep head up while swimming toward victim

Maintains focus on the victim

Upon entering, focus on the victim or the site where the victim was last seen is maintained

Fails to look toward the victim or site where the victim was last seen

REMOVAL FROM THE WATER

SKILL CHART: WALKING ASSIST

1.   Place one of the victim’s arms around your neck and across your shoulder.

2.   Grasp the wrist of the arm that is across your shoulder. Wrap your free arm around the victim’s back or waist to provide support.

3.   Hold the victim firmly and assist him or her in walking out of the water.

4.   Have the victim sit or lie down while you monitor his or her condition.

SKILL ASSESSMENT TOOL: WALKING ASSIST

General Criteria

Proficient

Not Proficient

Communicates with the victim

Victim is reassured and told what to do

No attempted verbal communication with victim

Maintains balance

Assumes a sturdy posture and stable footing

Stumbles, falls or knocks victim under the water

Assists victim with balance and bearing weight to walk out of water

images    Holds victim’s hand securely with arm across shoulders to bear weight.

images    Supports victim across the back for balance and stability.

images    Fails to hold victim’s hand securely with arm across shoulders

images    Fails to support victim’s weight

images    Fails to provide balance and stability to victim while exiting the water

SKILL CHART: BEACH DRAG

1.   Stand behind the victim and grasp him or her under the armpits, supporting the victim’s head as much as possible with your forearms. Let the rescue tube trail behind, being careful not to trip on the tube or line. If another lifeguard is available to assist, each of you should grasp the victim under an armpit and support the head.

2.   Walk backward and drag the victim to the shore. Use your legs and not your back.

3.   Remove the victim completely from the water then assess his or her condition and provide appropriate care.

SKILL ASSESSMENT TOOL: BEACH DRAG

General Criteria

Proficient

Not Proficient

Securely holds victim

Grasps victim securely under the armpits

Does not grasps victim securely under the armpits

Supports victim’s head

Forearms held close together to support victim’s head if possible

images    Fails to attempt to support victim’s head between forearms

images    Forearms are positioned so victim’s head falls back

Keeps victim’s head above the surface of the water

Mouth and nose of victim maintained out of the water

Mouth or nose of victim is in the water

SKILL CHART: FRONT-AND-BACK CARRY

1.   From behind the victim, one lifeguard reaches under the victim’s armpits. This lifeguard grasps the victim’s right wrist with his or her right hand and the victim’s left wrist with his or her left hand. Then the lifeguard crosses the victim’s arms across the victim’s chest.

2.   The second lifeguard stands between the victim’s legs, facing the victim’s feet. This lifeguard bends down and grasps the victim under the knees. On signal, both lifeguards lift the victim and carry him or her out of the water while walking forward.

SKILL ASSESSMENT TOOL: FRONT-AND-BACK CARRY

General Criteria

Proficient

Not Proficient

Securely holds victim

images    Lifeguard 1 grasps victim securely under the armpits

images    Lifeguard 1 grasps wrists

images    Lifeguard 2 grasps victim securely under the knees

images    Lifeguards fail to support victim under the armpits or knees

images    Victim is dropped

SUSPECTED SPINAL INJURIES

SKILL CHART: HEAD SPLINT—FACE-DOWN IN EXTREMELY SHALLOW WATER

1.   Approach the victim from the side. Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand, trapping the victim’s head between his or her arms.

2.   After the victim’s head is trapped between his or her arms, begin to roll the victim toward you.

3.   While rolling the victim, step from the victim’s side toward the victim’s head and begin to turn the victim face-up.

4.   Lower your arm on the victim’s side that is closest to you so that the victim’s arms go over the top of your arm as you step toward the victim’s head. Maintain arm pressure against the victim’s head, since your hand rotates during this maneuver. You are now positioned above and behind the victim’s head.

5.   Check for consciousness and breathing.

images   If the victim is not breathing, immediately remove the victim from the water and give the appropriate care.

images   If the victim is breathing, hold the victim in this position. Place a towel or blanket on the victim to keep him or her from getting chilled.

6.   Continuously monitor for consciousness and breathing. If at any time the victim stops breathing, immediately remove the victim from the water then provide appropriate care.

Note: If unable to keep the victim from getting chilled and there are enough assisting lifeguards, follow the care steps for Spinal Backboarding Procedure and Removal from Water—Speed Slide.

SKILL ASSESSMENT TOOL: HEAD SPLINT—FACE-DOWN IN EXTREMELY SHALLOW WATER

General Criteria

Proficient

Not Proficient

Provides in-line stabilization

images    Moves victim’s arms to a secure position against the victim’s head

images    Equal pressure on both arms is maintained throughout rescue

images    Does not move victim’s arms against the victim’s head or maintain pressure

images    One arm is pressed against head and one is not

Keep victim’s face out of the water

images    Victim’s face does not submerge

images    Mouth and nose are above water

images    Victim’s face submerges under water

images    Victim’s mouth or nose is under water

Moves victim to a safe location to prepare for backboarding

images    If victim’s condition is life-threatening, moves victim out of water quickly to perform care as needed

images    If victim is conscious, monitors victim’s condition

images    Follows facility procedures for backboarding

images    Does not move victim to a safe location

images    Fails to check victim’s condition

IN-WATER SEARCHES

SKILL CHART: SEARCHING SHALLOW-WATER AREAS

1.   Have a lifeguard oversee the search.

2.   Ask adult volunteers and staff to link their arms and hold hands to form a line in the water. The shortest person should be in the shallowest water, and the tallest person should be in water no more than chest deep.

3.   Have the whole line slowly move together across the area, starting where the missing person was last seen.

4.   As the line moves forward, have searchers sweep their feet across the bottom with each step. If there is a current, walk downstream.

SKILL ASSESSMENT TOOL: SEARCHING SHALLOW-WATER AREAS

General Criteria

Proficient

Not Proficient

Lead lifeguard organizes search

Communication is clear so searchers know what to do and function as a team.

Lifeguards cannot proceed with removing the victim from the water

Bottom of shallow-water area searched thoroughly

images    Line moves slowly to allow time to sweep their feet across the bottom.

images    If the search does not result in finding the victim, the line searches the area again moving at a different angle.

images    Lifeguards move too quickly or become out of line

images    Lifeguards fail to sweep the bottom with their feet

images    Lifeguards do not move to search at a different angle if victim not found

ENTRIES WITH MASK AND FINS

SKILL CHART: ENTERING THE WATER WITH MASK AND FINS

1.   Put one hand over the mask to hold it in place, keeping your elbow close to your chest.

2.   Make sure no swimmers or other objects are below.

3.   Step out with a long stride over the water, but do not lean forward. While entering the water, the fins will slow your downward motion.

4.   Swim keeping the arms at the side and face in the water or hold your arms out in front to protect your head.

SKILL ASSESSMENT TOOL: ENTERING THE WATER WITH MASKS AND FINS

General Criteria

Proficient

Not Proficient

Holds mask place

Holds the mask against the face with elbow tucked by side

images    Fails to hold mask in place

images    Mask slips off from face when entering

Enters water feet-first, vertical with legs in a stride position

Stands upright while stepping out in a stride position while entering the water

images    Does not enter water in a vertical position

images    Does not use stride position to enter water

SURFACE DIVES WITH MASK AND FINS

SKILL CHART: FEET-FIRST SURFACE DIVE WITH MASK AND FINS

1.   Swim to a point near the victim. Release the rescue tube but keep the strap around your shoulders.

2.   Position your body vertically, then at the same time press both hands down to your sides and kick strongly to raise your body out of the water.

3.   Take a breath then let your body sink underwater as you begin to extend your arms outward with palms upward pushing against the water to help you move downward. Keep your legs straight and together with toes pointed. Tuck your chin and turn your face to look down toward the bottom.

4.   As downward momentum slows, repeat the motion of extending your arms outward and sweeping your hands and arms upward and overhead to go deeper.

5.   Repeat this arm movement until deep enough to reach the victim.

If you must swim underwater, such as for a deep-water line search, also perform these steps:

6.   When deep enough, tuck your body and roll to a horizontal position.

7.   Extend your arms and legs and swim underwater.

Note: As you descend into deep water, be sure to equalize pressure early and often. If you are unable to equalize pressure, return to the surface.

SKILL CHART: HEAD-FIRST SURFACE DIVE WITH MASK AND FINS

1.   Swim to a point near the victim and release the rescue tube.

2.   Gain momentum using a swimming stroke.

3.   Take a breath, sweep your arms backwards to your thighs and turn them palms down.

4.   Tuck your chin to your chest and flex at the hip sharply while your arms reach downward toward the bottom.

5.   Lift your legs upward, straight and together so that their weight above the water helps the descent. Get in a fully extended, streamlined body position that is almost vertical.

6.   If you need to go deeper, such as for a deep-water line search, do a simultaneous arm pull with both arms to go deeper, then level out and swim forward underwater.

Note: As you descend into deep water, be sure to equalize pressure early and often. If you are unable to equalize pressure, return to the surface.

SKILL ASSESSMENT TOOL: SURFACE DIVES WITH MASK AND FINS

Criteria

Proficient

Not Proficient

Submerges to appropriate depth

Submerges to appropriate depth

Unable to submerge to appropriate depth

Feet-First Surface Dive with Mask and Fins

Kick and arm press to raise out of the water

Kick and arm press are effective at lifting the shoulders and upper chest out of the water

Ineffective kick or arm pull results in inability to lift shoulders and upper chest out of water

Body descends feet-first in a streamlined position

images    Legs are held together

images    Arms are fully extended overhead

images    Legs are apart and impede descent

images    Arm positioning impedes descent

Head-First Surface Dive with Mask and Fins

Head position directs upper body down into the water

Chin is tucked to lower head into the water

Does not tuck chin on descent

Arms assist in pulling body into head-first position

Arms pull to hips then toward tucked head to pull head deeper into the water.

Does not use an arm pull to descend

Legs rise out of the water

From either a tuck or pike position, legs are lifted out of the water

images    Fails to use either a tuck or pike position

images    Fails to lift legs out of water

Body descends head-first in a streamlined position

images    Legs are held together and lifted upward toward the surface to aid descent

images    Arms reach downward toward the bottom

images    Legs are apart

images    Body is not nearly vertical during descent

images    Arms are not in front reaching downward

SEARCHES

SKILL CHART: SEARCHING DEEP-WATER AREAS

1.   Wearing masks and fins, several lifeguards form a straight line an arm’s length from each other.

2.   One lifeguard should serve as the safety lookout above the water level on a dock, pier, raft or watercraft with rescue equipment in case a searcher gets in trouble or the missing person is found.

3.   On command from the lead lifeguard, all lifeguards do the same type of surface dive (feet-first or head-first) to the bottom and swim forward a predetermined number of strokes—usually three. If the water is murky, searchers check the bottom by sweeping their hands back and forth in front of them, making sure to cover the entire area. To keep the water from becoming cloudier, try to avoid disturbing silt and dirt on the bottom. Do not miss any areas on the bottom when diving and resurfacing.

4.   Lifeguards return to the surface as straight up as possible.

5.   The lead lifeguard accounts for all searchers, reforms the line at the position of the person farthest back and backs up the line one body length. On command, the team dives again.

6.   Lifeguards repeat this procedure until the victim is found or the entire area has been searched.

7.   If the missing person is not found, lifeguards expand the search to nearby areas. Consider whether currents may have moved the victim.

8.   Lifeguards continue to search until the person is found, emergency personnel take over or the search has been called off by officials.

9.   If a lifeguard finds the victim, the lifeguard should bring the victim up by grasping the victim under the armpits and returning to the surface. Swim the victim to safety, keeping the victim on his or her back, with his or her face out of the water. A lifeguard with equipment should take over to maintain an open airway while moving the victim to safety. Remove the victim from the water, assess the victim’s condition and provide appropriate care.

Note: As you descend into deep water, be sure to equalize pressure early and often. If you are unable to equalize pressure, return to the surface.

SKILL ASSESSMENT TOOL: SEARCHING DEEP WATER AREAS

General Criteria

Proficient

Not Proficient

Lead lifeguard organizes the search

Communication is clear so searchers know what to do and function as a team

Unclear communication by lead lifeguard, delaying search

Bottom of deep-water area thoroughly searched

images    Searchers use masks and fins to surface dive to get to the bottom

images    Lead lifeguard re-positions the line after each surface dive to make sure the area is covered thoroughly

images    Searchers fails to reach appropriate depth or fail to descend quickly or in a streamlined position

images    Lifeguards move too quickly or become out of line

images    Lifeguards fail to sweep the bottom with their hands

images    Lifeguards do not move to a different angle if victim not found

Safety of searchers is monitored

images    Lifeguard stationed as a look-out observes searchers for safety concerns

images    Lead lifeguard verifies that all are OK after each surface dive.

Lead lifeguard fails to verify that all other lifeguards return to surface

USING A RESCUE BOARD

SKILL CHART: APPROACHING A VICTIM ON A RESCUE BOARD

1.   Hold onto the sides about mid-board when entering the water.

2.   When the water is knee-deep, lay the rescue board on the water and push it forward. Climb on just behind the middle and lie down in the prone position. For better balance, place a foot on either side of the rescue board in the water.

3.   Paddle with the front of the board toward the victim, using either a front-crawl or a butterfly arm stroke. To change to a kneeling position, which may provide better visibility in some situations, paddle a few strokes first.

4.   Continue paddling with your head up and the victim in your sight until you reach the victim. Place your foot into the water to help steer if necessary.

SKILL ASSESSMENT TOOL: APPROACHING A VICTIM ON A RESCUE BOARD

General Criteria

Proficient

Not Proficient

Uses quick approach

Uses rescue board proficiently with balance and speed

images    Fails to reach victim quickly

images    Slips off rescue board

Focus on the victim is maintained during approach

images    Upon entering, focus on the victim or the site where the victim was last seen is maintained

images    Holds head up while paddling on rescue board to keep victim in sight

Fails to look toward the victim or site where the victim was last seen

Properly positions board for the rescue when reaching victim

Aims the board to a spot beside victim

Fails to place board in proper position beside victim

SKILL CHART: RESCUING AN ACTIVE VICTIM WITH A RESCUE BOARD

1.   Approach the victim from the side so that the side of the rescue board is next to the victim.

2.   Grasp the victim’s wrist and slide off the rescue board on the opposite side.

3.   Help the victim reach his or her arms across the rescue board. Encourage the victim to relax while you kick to turn the board toward shore.

4.   Hold the rescue board stable and help the victim onto the board.

5.   Tell the victim to lie on his or her stomach facing the front of the board.

6.   Carefully climb onto the board from the back with your chest between the victim’s legs. Be careful not to tip the rescue board, and keep your legs in the water for stability.

7.   Paddle the rescue board to shore.

8.   Slide off the board and help the victim off the board and onto shore with a walking assist.

SKILL ASSESSMENT TOOL: RESCUING AN ACTIVE VICTIM WITH A RESCUE BOARD

General Criteria

Proficient

Not Proficient

Makes contact with victim

Grasps victim’s wrist while sliding off the board on the opposite side

Grasps victim’s arm or shoulder

Communicates with victim

Reassures victim and gives direction as to how to get on the rescue board

No attempted verbal communication with the victim

Climbs onto board from the back

images    Gets on back of board and brings board to a safe exit point

images    Removes victim from the water

Unable to climb on board to return to safe exit point

SKILL CHART: RESCUING A PASSIVE VICTIM WITH A RESCUE BOARD

To rescue someone who is unconscious or cannot hold or climb onto the rescue board:

1.   Approach the victim from the side. Position the rescue board so that the victim is slightly forward of the middle of the rescue board.

2.   Grasp the victim’s hand or wrist and slide off the board on the opposite side, flipping the rescue board over toward you. Hold the victim’s arm across the board with the victim’s chest and armpits against the far edge of the board.

3.   Grasp the far edge of the rescue board with the other hand.

4.   Kneel on the edge of the rescue board using your own body weight to flip the board toward you again. Catch the victim’s head as the rescue board comes down.

5.   Position the victim lying down lengthwise in the middle of the rescue board with the victim’s head toward the front of the rescue board.

6.   Kick to turn the board toward shore. Carefully climb onto the board from the back with your chest between the victim’s legs. Be careful not to tip the rescue board, and keep your legs in the water for stability.

7.   Paddle the rescue board to shore.

8.   Help the victim to safety with the beach drag or other removal technique.

SKILL ASSESSMENT TOOL: RESCUING A PASSIVE VICTIM WITH A RESCUE BOARD

General Criteria

Proficient

Not Proficient

Makes contact with victim

Grasps victim’s wrist while sliding off the board on the opposite side.

images    Grasps victim’s arm or shoulder

images    Releases contact with the victim

Positions victim so mouth and nose are above water

Uses technique of flipping rescue board to get victim onto the board with his or her face out of the water.

images    Victim’s mouth and nose are in the water

images    Fails to place victim on board

Climbs onto board from the back and returns to safe exit point

images    Gets on back of board and brings board to a safe exit point

images    Removes victim from water

Unable to climb on board to return to safe exit point

SECTION D | WATERPARK SKILLS

MODULE OUTLINE

Activity | Time
Introduction to the Waterpark Skills Module | 10 minutes
Verification of Certification Prerequisite | 5 minutes
Verification of Swimming Skills | 20 minutes
Unique Aspects of Waterpark Lifeguarding | 35 minutes
Waterpark Rescue Skills | 10 minutes
Video: Waterpark Rescue Skills
In-Water Skill Session: Waterpark Rescue Skills | 90 minutes
    Skill: Run-and-Swim Entry
    Skill: Walking Assist
    Skill: Beach Drag
    Skill: Front-and-Back Carry
    Skill: Head Splint—Face-down in Extremely Shallow Water
    Skill: Head Splint—Moving Water (winding river or catch pool)
    Skill: Suspected Spinal Injury—Moving Water: Speed Slide Runout
Putting It All Together | 20 minutes
Final Written Exam: Waterpark Skills Module | 25 minutes
Closing | 5 minutes
Total Time | 3 hours 40 minutes

WATERPARK SKILLS MODULE

MODULE NOTES

The purpose of the Waterpark Skills module is to teach lifeguards the knowledge and skills needed to prevent and respond to emergencies in aquatic facilities with waterpark features.

MODULE PREREQUISITES

    Age Prerequisite: Candidates must be 15 years old by the last day of the module.

    Certification Prerequisite: Candidates must possess and present a current American Red Cross Lifeguarding/First Aid/CPR/AED.

    Skill prerequisites: Candidates must successfully complete the following:

    Swim 300 yards continuously demonstrating breath control and rhythmic breathing. Candidates must demonstrate the ability to swim both the front crawl and breaststroke. Swimming on the back or side is not allowed. Swim goggles may be used.

    Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

    Complete a timed event within 1 minute, 40 seconds.

    Starting in the water, swim 20 yards. The face may be in or out of the water. Swim goggles are not allowed.

    Surface dive, feet-first or head-first, to a depth of at least 5 feet (but no more than 10 feet) to retrieve a 10-pound object.

    Return to the surface and swim 20 yards on the back to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. Candidates should not swim the distance under water.

    Exit the water without using a ladder or steps.

    If conducting this module immediately following a full or review Lifeguarding course, the skill prerequisites do not need to be repeated as part of this module.

MODULE LENGTH

This module is designed to be taught in approximately 3 hours, 40 minutes, which includes the minimum time needed for conducting prerequisites, presenting information, practicing skills and conducting written exams. This estimate is based on:

    Ten participants per instructor.

    The recommended equipment needed to conduct the module. If working with a limited amount of equipment, build additional practice time into the module.

CLASS SIZE

It is recommended that there be 1 instructor for every 10 participants. If the class has more than 10 participants, you should have a co-instructor or aide or extend the class length.

FACILITY REQUIREMENTS

Classroom space should be equipped with the ability to show video segments. The swimming area meet requirements to perform skills. A zero-depth area is ideal for practicing entry and exit skills; however, shallow water can be used. An extreme shallow water area as well as moving water are required, such as a winding river or water slide with a catch pool, for practicing care for spinal injuries. A speed slide runout is preferred for practicing backboarding in the confined space; however, this can be practiced/simulated on land.

ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

    Waterpark Skills Module Course Presentations

    Waterpark Skills segment on the Lifeguarding DVD Set

    DVD player and monitor

    A 10-pound object (a diving brick or weight; one for every five participants)

    Stopwatch

    Waterpark Skills Checklist

    Copies of Waterpark Skills Final Written Exam (exams A and B) and answer sheets (one for each participant)

    Answer keys for Waterpark Skills Final Written Exam

TESTING AND CERTIFICATES

    To receive the module completion certificate for American Red Cross Waterpark Skills, the participant must:

    Demonstrate competency in all required skills and activities.

    Correctly answer at least 80 percent of the questions of the written exam.

    Upon successful completion of the module, participants receive an American Red Cross certificate indicating Waterpark Skills that is valid for no more than 2 years. The Waterpark Skills certificate is only valid when accompanied by a current Lifeguarding/First Aid/CPR/AED certificate.

    Skills in this module include the following:

    Run-and-swim entry

    Walking assist

    Beach drag

    Front-and-back carry

    Suspected spinal injury:

    In-line stabilization: Head splint—face-down in extremely shallow water

    In-line stabilization: Head splint—face-up in moving water (winding river or catch pool)

    Backboarding and removal from the water: Speed slide

WATERPARK SKILLS MODULE LESSON PLAN

LESSON OBJECTIVES

After completing this lesson, participants will be able to:

    Describe the unique aspects of waterpark lifeguarding.

    Demonstrate how to perform the waterpark rescue skills safely and effectively.

TOPIC: INTRODUCTION TO THE WATERPARK SKILLS MODULEimages

Activity

    Welcome participants and introduce yourself, including your background in aquatics and certification as a Red Cross instructor. Include co-instructors and aides if applicable.

    Have participants introduce themselves.

    Review facility policies, including emergency procedures. Give the locations of restrooms, locker rooms, water fountains and details unique to your facility. Also, identify the location of the AED and first aid kit.

    Explain that the purpose of the Waterpark Skills module is to teach lifeguards the skills and knowledge needed to prevent and respond to emergencies in aquatic facilities with waterpark features.

    Explain the requirements to pass the module:

    Demonstrate competency in all required skills and activities.

    Correctly answer at least 80 percent of the questions in the written exam.

    Explain that upon successful completion of the module, participants receive an American Red Cross certificate indicating Waterpark Skills that is valid for no more than 2 years. The Waterpark Skills certificate is only valid when accompanied by a current Lifeguarding/First Aid/CPR/AED certificate.

    Explain to participants that they must successfully complete the swimming prerequisites to verify swimming ability to continue in the Red Cross Waterpark Skills module.

1.  Swim 300 yards continuously demonstrating breath control and rhythmic breathing. Candidates must demonstrate the ability to swim both the front crawl and breaststroke. Swimming on the back or side is not allowed. Swim goggles may be used.

2.  Tread water for 2 minutes using only the legs. Candidates should place their hands under the armpits.

3.  Complete a timed event within 1 minute, 40 seconds.

    Starting in the water, swim 20 yards. The face may be in or out of the water. Swim goggles are not allowed.

    Surface dive, feet-first or head-first, to a depth of at least 5 feet (but no more than 10 feet) to retrieve a 10-pound object.

    Return to the surface and swim 20 yards on the back to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. Candidates should not swim the distance under water.

    Exit the water without using a ladder or steps.

    If conducting this module in conjunction with a Lifeguarding review course or challenge, it is not necessary to repeat these prerequisites.

TOPIC: VERIFICATION OF CERTIFICATION PREREQUISITEimages

Activity

    Check the eligibility of participants to participate in the module by checking their American Red Cross Lifeguarding/First Aid/CPR/AED certification.

TOPIC: VERIFICATION OF SWIMMING SKILLS images

Activity

    Explain to prospective participants that they must successfully complete three swimming prerequisites to continue in the Waterpark Skills module.

    Refer to the Skill Assessment Chart to evaluate performance of each prospective participant. Record completion of each skill on the Waterpark Skills Checklist.

Waterpark Skills

Activity 1—300-Yard Swim

    Explain to prospective participants that they must perform a 300-yard continuous swim using the front crawl and breaststroke. Swimming on the back or side is not permitted. Swim goggles are allowed.

Activity 2—Tread Water

    Explain to prospective participants that they must tread water for 2 minutes without support and without stopping. When treading, only the legs can be used. Candidates should place their hands under the armpits. The head must remain above the surface of the water.

Activity 3—Timed Event

    Arrange the swim distance of 20 yards and place a 10-pound object at a depth of 7 to 10 feet.

    Explain that goggles are not allowed for this event.

    Evaluate each prospective participant on the following skill to be performed within 1 minute and 40 seconds.

    Starting in the water, swim 20 yards. The face may be in or out of the water.

    Surface dive, feet-first or head-first, to a depth of at least 5 feet (but no more than 10 feet) to retrieve a 10-pound object.

    Return to the surface and swim 20 yards to return to the starting point with both hands holding the object and keeping the face at or near the surface so they are able to get a breath. The participants should not swim the distance under water.

    Exit the water without using a ladder or steps.

Instructor’s Note: If any participant is unable to complete the verification of swimming ability, he or she is not eligible to continue in the Waterpark Skills module. Privately advise any participant who did not successfully demonstrate the skills that he or she may not continue.

TOPIC: UNIQUE ASPECTS OF WATERPARK LIFEGUARDING images

PRESENTATION: UNIQUE ASPECTS OF WATERPARK LIFEGUARDING

Lecture and Guided Discussion

    The Waterpark Skills module builds on the knowledge and skills learned in the Lifeguarding course. Because many aquatic facilities now have a variety of features and attractions, much of the knowledge and skills were covered in that course.

    Remember, your primary responsibility is to help ensure patron safety and protect lives. The main tool used to accomplish this is patron surveillance—keeping a close watch over the people in the facility and intervening when necessary.

    Ask participants: What are the elements of effective surveillance?
Answers: Responses should include the following:

    Recognition of dangerous behaviors

    Victim recognition

    Effective scanning

    Zone of surveillance responsibility

    Lifeguard stations

    The purpose of the Waterpark Skills module is to teach lifeguards the knowledge and skills needed to prevent and respond to emergencies in aquatic facilities with waterpark features.

    When considering the unique challenges for lifeguarding at a waterpark, consider what is unique to waterpark facilities, such as:

    Variety and number of attractions and features.

    Where and how lifeguards are positioned, especially related to the various attractions and features.

    Patrons’ familiarity with the facility (i.e., they are often first time visitors).

    Water depth and movement throughout the facility.

Facility Safety

Lecture and Guided Discussion

    Ask participants: What types of features might you encounter when working at a waterpark?
Answers: Responses should include the following:

    Play areas for young children.

    Play structures, such as lily pads and rope swings.

    Water slides with and without rafts, drop slides, “toilet bowl/tornado” slides, speed slides, free-fall slides.

    Winding rivers.

    Wave pools.

    Wave rides.

    Facilities should follow the manufacturer’s guidelines for installation, safe inspection, maintenance, operations and use of its various attractions and features.

    Ask participants: Even if an attraction or feature has been inspected during the facility safety check, what types of problems may develop that you should stay alert for?
Answers: Responses should include the following:

    Loose or rusted bolts.

    Cracks.

    Broken or missing pieces.

    Frayed, loose or mildewed safety nets.

    Unusual noises.

    Increased frequency of injury to patrons.

    At waterparks, rules and regulations should be posted, but they may also be played over a public address system as recorded messages. Rules may vary based on the type of attractions available.

    For example, U.S. Coast Guard-approved life jackets may be required on certain attractions but not allowed on others.

    Waterparks should have signage at every attraction stating the water depth, height or age requirements and how to use the attraction safely. This is to prevent patrons from finding themselves in water that is deeper or shallower than they expected.

    For example, some pools at the end of a slide are shallow so patrons can stand up, but others are very deep. Without signage to warn them, patrons may expect a shallow catch pool and be surprised to find themselves in deep water.

    Additional rules for each attraction typically cover:

    The minimum or maximum number of people allowed on an attraction or a tube at a time.

    The maximum height or age requirements in some areas designated for small children for safety reasons.

    The minimum patron height or weight requirements for using an attraction.

    Ask participants: What are some common rules for safety in winding rivers?
Answers: Responses should include the following:

    Enter and exit the winding river only at designated places.

    No jumping or diving into the water. No people on shoulders.

    Stay in tubes at all times, if tubes are used.

    No walking or swimming in the winding river if tubes are used.

    Only one properly fitted life jacket per patron.

    No stacking of tubes or life jackets.

    No forming chains of tubes or life jackets.

    Only one patron allowed per tube, except for an adult holding a small child. The child must be wearing a U.S. Coast Guard-approved life jacket in case the adult tips over.

    Ask participants: What are some common rules for safety in water slides?
Answers: Responses should include the following:

    Enter, ride and exit the slide feet-first.

    No stopping in the slide.

    No running, standing, kneeling, rotating or spinning on the slides.

    No metal objects, locker keys, jewelry, metal snaps/zippers, eyewear or watches, including metal rivets, buttons or fasteners on swimsuits or shorts.

    No aqua socks or aqua shoes.

    No eyeglasses, sunglasses or goggles.

    Keep hands and feet inside the slide.

    There are other rules for specific equipment and structures. These rules depend on the facility and may include:

    One person at a time on a ladder or attraction.

    Do not sit or hang on lifelines or lane lines.

    Do not climb on lifeguard stands or towers.

    Starting blocks may be used only by swim team members inscheduled practices, competitions and instruction when supervised by a certified coach or instructor.

Injury Prevention

Lecture and Guided Discussion

    As part of patron surveillance, you may have specific responsibilities based on the facility’s activities or features to help prevent injuries.

    Ask participants to think of specific waterpark features and attractions. Explain to participants that you will state a responsibility of the lifeguard’s that is intended to prevent injuries, and they are to identify the waterpark attraction or feature to which the rule could apply.

Responsibility
Feature and Attraction

Enforce maximum height and age requirements.

Areas specifically for young children, such as small slides or water play structures, including sprays, fountains and dumping buckets

Watch for overcrowding and horseplay

Play structures, such as floating obstacle courses or inflatable structures

Watch patrons as they enter and exit an attraction.

Special rides and attractions, such as bowl slides, multi-person raft rides, uphill water coasters, high-speed water slides

Have a process or cues for stopping ride usage in the event of an incident requiring your attention.

Special rides and attractions, such as bowl slides, multi-person raft rides, uphill water coasters, high-speed water slides

Instruct riders how to ride and make sure they are in the correct position.

Water slides, such as open and enclosed slides, drop slides and speed slides

Enforce minimum height requirements.

Water slides, such as open and enclosed slides, drop slides and speed slides

Assist riders who appear off balance or become caught underwater in the strong downward flow of water in the catch pool.

Water slides, such as open and enclosed slides, drop slides and speed slides

Ensure that patrons enter and exit at designated locations.

Winding rivers

Stand up to get a better view of patrons.

Wave pools and winding rivers

Watch for swimmers who are knocked over by the waves or carried into deeper water by the undercurrent.

Wave pools

    Organizations such as day cares or youth camps may bring groups to waterpark facilities for recreation. These groups may be based out of your facility and swim regularly or visit one or more times as a field trip.

    Groups are often supervised by leaders, chaperones or camp counselors. These supervisors may assist with discipline but do not take the place of lifeguards. Group leaders may be in the water with the group, on the deck or shore, or a combination of both. Group leaders should know how to alert lifeguards in an emergency.

    In general, when guarding groups, you should:

    Ensure that swimming areas are clearly marked and determined by swimming abilities.

    Ensure that patrons stay in the sections appropriate for their swimming abilities.

    Provide U.S. Coast Guard-approved life jackets for weak or nonswimmers.

    Know how to identify group leaders or chaperones.

    Ensure that chaperones are actively supervising the members of their group and that the appropriate swimmer-to-chaperone ratio is being met.

    Signal for additional lifeguard coverage, such as a roving lifeguard, if you feel you cannot effectively guard your zone.

Emergency Action Plans

Lecture

    In a waterpark setting there may be additional tasks to perform, including:

    Stopping the wave generator in a wave pool by pushing the emergency stop (e-stop) button.

    Stopping the dispatch of riders in an attraction.

    Shutting off the flow of water in a slide, winding river or attraction.

    Emergency plans may include EMS personnel that are stationed on-site at the waterpark.

    Waterparks may have plans designed to address specific situations that occur at each attraction.

    Practicing EAPs should be an integral part of the facility’s in-service training program.

TOPIC: WATERPARK RESCUE SKILLS images

PRESENTATION: WATERPARK RESCUE SKILLS

Video Segment

    Explain that the video segment will demonstrate skills for rescues at waterparks.

    Show the video segment, “Waterpark Rescue Skills.”

    Answer participants’ questions about the segment.

IN–WATER SKILL SESSION: WATERPARK RESCUE SKILLS images

PRESENTATION: NEXT STEPS

Skill Practice

    Explain to participants that during the skill session you will demonstrate the skills and guide them through practice.

    For each skill, organize participants so that they can clearly see and hear. Be sure to provide any instructions related to their position in the water or how they should behave as victims.

    Pair up participants and explain that they will take turns as victim and rescuer for each skill. For the two-person beach drag, reassign participants into groups of three.

    Lead them through the following skills:

    Run-and-swim entry

    Walking assist

    Lifeguards: in the water

    Victims: in shallow water about 5 yards from the edge of the pool or zero-depth area; distressed swimmer

    Beach drag—one person and two person

    Lifeguards: in the water

    Victims: in shallow water about 5 yards from the edge of the pool or zero-depth area; face-up passive victim

    Front-and-back carry

    Lifeguards: in the water

    Victims: in shallow water about 5 yards from the edge of the pool or zero-depth area; face-up passive victim

    Explain to participants that caring for head, neck and spinal injuries in waterpark features and attractions require modification of the techniques used for in-line stabilization learned in the Lifeguarding course.

    Lead participants through the following skills:

    Head splint—face-down in extremely shallow water

    Lifeguards: in the water

    Victims: face-down in extremely shallow water, approximately one foot deep, or lying on the deck if simulating the extremely shallow water, responsive once face-up

    Head splint—moving water (winding river or catch pool)

    Lifeguards: on the edge of a winding river or catch pool

    Victims: face-up in shallow water

    With participants performing as a team, lead them through the backboarding procedure and removal from the water for a suspected spinal injury in a speed slide runout.

    Lifeguards: on the edge of a speed slide runout

    Victims: face-up in shallow water

    Participants should practice the skills until they are able to meet performance criteria.

    Observe each participant’s performance of the skill and provide corrective feedback.

PUTTING IT ALL TOGETHERimages

Skill Drill—Timed Response

    Assemble the participants on the deck and explain they will be practicing rescuing a submerged passive victim in shallow water, removing the victim from the water on a backboard, doing a primary assessment and caring for a victim who is not breathing and does not have a pulse.

    Explain that the goal of this skill practice is to complete it within 2 minutes. Timing starts once the lifeguard simulates the EAP. One-rescuer CPR should be performed for 3 minutes.

    Divide the participants into groups of three and assign one rescuing lifeguard, one assisting lifeguard to help with removal from the water, one victim and one manikin for each group. Explain that for each group:

    The rescuing lifeguard, wearing a hip pack with gloves inside, will simulate activating the EAP and enter the water. Once the EAP has been activated, the stopwatch must be started.

    The victim will get into position about 30 feet from the edge and submerge as the rescuing lifeguard gets near. The rescuing lifeguard will perform a submerged passive victim rescue.

    The assisting lifeguard will bring the backboard and assist the rescuing lifeguard in removing the victim from the water demonstrating team communication skills between the lifeguards.

    Once removed from the water, the rescuing lifeguard will do a primary assessment on the victim, then switch to a manikin and provide one-person CPR for 3 minutes. Once the rescuer begins CPR, the stopwatch must be started.

    Repeat the drill until each person in the group has performed as a rescuing lifeguard and an assisting lifeguard at least once.

FINAL WRITTEN EXAM: WATERPARK SKILLS MODULE images

    Tell participants that they will now take a final written exam on the information covered in the module. They may not use their manual or notes to find the answers.

    Hand out an exam and answer sheet to each participant. Tell participants to write only on the answer sheet and mark answers clearly.

    Tell participants to come to you or raise their hands when they have finished the exam or if they have questions.

    Once exams are completed, collect all exams and answer sheets. Before the next lesson, grade the exam using the answer key.

    Hand back the exam and review it with participants. Collect all exams as the exam is a standard exam that participants should not be allowed to keep. Make arrangements for those participants who score less than 80 percent to review the material and retake the opposite version of the exam.

TOPIC: CLOSING images

    Thank all participants for attending the course.

    Congratulate participants on successful completion.

    Explain the process for how certificates are issued through the Red Cross.

    Explain that they will receive an American Red Cross certificate indicating Waterpark Skills that is valid for no more than 2 years. The Waterpark Skills certificate is only valid when accompanied by a current Lifeguarding/First Aid/CPR/AED certificate.

    Make arrangements to retest any participants who did not pass the final written exam(s) or scenario(s).

SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the criteria listed at the proficient level to be checked off for this skill.

ENTRIES

SKILL CHART: RUN-AND-SWIM ENTRY

1.   Hold the rescue tube and the excess line and run into the water, lifting your knees high to avoid falling.

2.   When you can no longer run, either put the rescue tube across your chest and lean forward or drop the tube to the side and start swimming, letting the rescue tube trail behind. Do not dive or plunge head-first into the water; this could cause a serious head, neck or spinal injury.

SKILL ASSESSMENT TOOL: RUN-AND-SWIM ENTRY

Criteria
Proficient
Not Proficient

Properly position equipment for the entry

    Control of the rescue tube is maintained

    Excess line held to keep it from getting caught on the lifeguard stand or other equipment

    Contact with the rescue tube not maintained

    Excess line not held

Appropriate entry selected for the situation
Entry is safe for the rescuer, victim and surrounding persons
Entry causes a safety hazard

Maintain balance while running in the water
Lifts knees high to step over the water

    Fails to lifts knees high enough to step over the water

    Loses balance when entering the water

    Dives forward when entering the water

Begin swimming when no longer able to run
Leans forward into water with head up to begin swimming
Does not keep head up while swimming toward victim

Maintain focus on the victim
Upon entering, focus on the victim or the site where the victim was last seen is maintained
Fails to look toward the victim or site where the victim was last seen

REMOVAL FROM THE WATER

SKILL CHART: WALKING ASSIST

1.   Place one of the victim’s arms around your neck and across your shoulder.

2.   Grasp the wrist of the arm that is across your shoulder. Wrap your free arm around the victim’s back or waist to provide support.

3.   Hold the victim firmly and assist him or her in walking out of the water.

4.   Have the victim sit or lie down while you monitor his or her condition.

SKILL ASSESSMENT TOOL: WALKING ASSIST

General Criteria
Proficient
Not Proficient

Communicate with the victim

Victim is reassured and told what to do

No attempted verbal communication with the victim

Maintain balance

Assumes a sturdy posture and stable footing

Stumbles, falls or knocks victim under the water

Assist victim with balance and bearing weight to walk out of water

    Holds victim’s hand securely with arm across shoulders to bear weight.

    Supports victim across the back for balance and stability.

    Fails to hold victim’s hand securely with arm across shoulders

    Fails to support victim’s weight

    Fails to provide balance and stability to victim while exiting the water

SKILL CHART: BEACH DRAG

1.   Stand behind the victim and grasp him or her under the armpits, supporting the victim’s head as much as possible with your forearms. Let the rescue tube trail behind, being careful not to trip on the tube or line. If another lifeguard is available to assist, each of you should grasp the victim under an armpit and support the head.

2.   Walk backward and drag the victim to the shore. Use your legs and not your back.

3.   Remove the victim completely from the water then assess his or her condition and provide appropriate care.

SKILL ASSESSMENT TOOL: BEACH DRAG

General Criteria

Proficient

Not Proficient

Securely hold victim

Grasps victim securely under the armpits

Does not grasp victim securely under the armpits

Securely hold victim’s head

Forearms held close together to support victim’s head.

    Fails to support victim’s head securely between forearms

    Forearms are positioned so victim’s head falls back

Keep victim’s head above the surface of the water

Mouth and nose of victim maintained out of the water

Mouth or nose of victim is in the water

SKILL CHART: FRONT-AND-BACK CARRY

1.   From behind the victim, one lifeguard reaches under the victim’s armpits. This lifeguard grasps the victim’s right wrist with his or her right hand, and the victim’s left wrist with his or her left hand. Then the lifeguard crosses the victim’s arms across the victim’s chest.

2.   The second lifeguard stands between the victim’s legs, facing the victim’s feet. This lifeguard bends down and grasps the victim under the knees. On signal, both lifeguards lift the victim and carry him or her out of the water while walking forward.

SKILL ASSESSMENT TOOL: FRONT-AND-BACK CARRY

General Criteria
Proficient
Not Proficient

Securely hold victim

    Lifeguard 1 grasps victim securely under the armpits

    Lifeguard 1 grasps wrists

    Lifeguard 2 grasps victim securely under the knees

    Lifeguards fail to support victim under the armpits or knees

    Victim is dropped

SUSPECTED SPINAL INJURIES

SKILL CHART: HEAD SPLINT—FACE-DOWN IN EXTREMELY SHALLOW WATER

1.   Approach the victim from the side. Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand, trapping the victim’s head between his or her arms.

2.   After the victim’s head is trapped between his or her arms, begin to roll the victim toward you.

3.   While rolling the victim, step from the victim’s side toward the victim’s head and begin to turn the victim face-up.

4.   Lower your arm on the victim’s side that is closest to you so that the victim’s arms go over the top of your arm as you step toward the victim’s head. Maintain arm pressure against the victim’s head, since your hand rotates during this maneuver. You are now positioned above and behind the victim’s head.

5.   Check for consciousness and breathing.

    If the victim is not breathing, immediately remove the victim from the water and give the appropriate care.

    If the victim is breathing, hold the victim in this position. Place a towel or blanket on the victim to keep him or her from becoming chilled.

6.   Continuously monitor for consciousness and breathing. If at any time the victim stops breathing, immediately remove the victim from the water then provide appropriate care.

Note: If unable to keep the victim from becoming chilled and there are enough assisting lifeguards, follow the care steps for Spinal Backboarding Procedure and Removal from Water—Speed Slide.

SKILL ASSESSMENT TOOL: HEAD SPLINT—FACE-DOWN IN EXTREMELY SHALLOW WATER

General Criteria
Proficient
Not Proficient

Provide in-line stabilization

    Moves victim’s arms to a secure position against the victim’s head

    Equal pressure on both arms is maintained throughout rescue

    Does not move victim’s arms against the victim’s head or maintain pressure

    One arm is pressed against head and one is not

Keep victim’s face out of the water

    Victim’s face does not submerge

    Mouth and nose are above water

    Victim’s face submerges under water

    Victim’s mouth or nose is under water

Move victim to a safe location to prepare for backboarding

    If victim’s condition is life-threatening, moves victim out of water quickly to perform care as needed

    If victim is conscious, monitors victim’s condition

    Follows facility procedures for backboarding

    Does not move victim to a safe location

    Fails to check victim’s condition

SKILL CHART: HEAD SPLINT—FACE-UP VICTIM IN MOVING WATER

    Activate the EAP and, if applicable, signal to stop the flow of water and stop sending riders.

    Keep people or objects away from the rescuer and victim.

1.   Approach the victim’s head from behind, or stand behind the victim’s head.

    In shallow water, lower your body so that the water level is at your neck.

    In deep water, use the rescue tube under both of your arms for support.

2.   Grasp the victim’s arms midway between his or her shoulder and elbow. Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand. Gently move the victim’s arms up alongside the head. Position yourself to the victim’s side while trapping the victim’s head with his or her arms.

3.   Slowly and carefully squeeze the victim’s arms against his or her head to help hold the head in line with the body. Do not move the victim any more than necessary.

4.   Position the victim’s head close to the crook of your arm, with the head in line with the body.

5.   Check for consciousness and breathing.

    If the victim is not breathing, immediately remove the victim from the water using the two-person-removal-from-the water technique and provide resuscitative care. Do not delay removal from the water by strapping the victim in or using the head immobilizer device.

    If the victim is breathing, hold the victim with the head in line with and move toward safety until the backboard arrives.

6.   Once in-line stabilization is achieved:

    In a winding river, do not let the current press sideways on the victim or force the victim into a wall. This would twist the victim’s body. Keep the victim’s head pointed upstream into the current.

    In a catch pool, move the victim to the calmest water if water is still flowing. If there is only one slide, the calmest water is usually at the center of the catch pool. If several slides empty into the same catch pool, calmer water is usually between two slides.

7.   Continuously monitor for consciousness and breathing. If at any time the victim stops breathing, immediately remove the victim from the water then provide appropriate care.

SKILL ASSESSMENT TOOL: HEAD SPLINT—FACE-UP VICTIM IN MOVING WATER

General Criteria
Proficient
Not Proficient

Provide in-line stabilization

    Moves victim’s arms to a secure position against the victim’s head

    Equal pressure on both arms is maintained throughout rescue

    Does not move victim’s arms against the victim’s head or maintain pressure

    One arm is pressed against head and one is not

Victim’s face remains out of the water

    Victim’s face does not submerge

    Mouth and nose above water

    Victim’s face submerges underwater

    Victim’s mouth or nose are underwater

Move victim to a safe location to prepare for backboarding

    Moves victim to an area least affected by movement or current

    Remains in moving water when calmer area is possible

Move victim to a safe location to prepare for backboarding

    If condition of victim is life-threatening, moves victim out of water quickly to perform care as needed

    If victim is conscious, monitors victim’s condition

    Does not move victim to a safe location

    Fails to check victim’s level of consciousness and breathing

SKILL CHART: SPINAL BACKBOARDING PROCEDURE AND REMOVAL FROM WATER—SPEED SLIDE

1.   The primary rescuer performs in-line stabilization by placing his or her hands on both sides of the victim’s head while the victim is on the slide.

2.   Other lifeguards carefully lift the victim and slide the backboard into place from the feet to the head.

3.   Lifeguards lower the victim onto the backboard.

4.   Lifeguards secure the victim to the backboard and immobilize the head.

5.   Lifeguards lift the backboard and victim out of the slide.

SKILL ASSESSMENT TOOL: SPINAL BACKBOARDING PROCEDURE AND REMOVAL FROM WATER—SPEED SLIDE

General Criteria
Proficient
Not Proficient

Maintain in-line stabilization

Lifeguard maintains in-line stabilization while backboard is being positioned

    Loss of in-line stabilization during the rescue

    Loss of contact with the victim

Victim’s face remains out of the water

Mouth and nose above water

Victim’s mouth or nose are underwater

Position the victim on the backboard

    Victim is lifted and the backboard is slid in place

    Victim’s body is on the backboard

    Victim’s head is not aligned on the backboard’s head space

    Victim is not aligned and on the backboard

Secure straps

    Strapping begins with chest strap, then the strap over the hips and then the strap over the thighs

    Hip strap is placed across the hips with the hands secured underneath the strap

    Straps are tight and once all straps are secured, they are re-checked

    Strapping is done in some other order

    Hands are not strapped inside the strap

    Straps are loose and victim can easily slide

    Straps are not re-checked for tightness

    Straps are not tightened if discovered loose

Immobilize the victim’s head

    Head immobilizer is placed to immobilize the victim’s head

    Head strap is secured across the victim’s forehead

    Head immobilizer is not used

    Head immobilizer is placed and moves victim’s head or neck

    No strap is used across the victim’s forehead

Lifeguards communicate as a team to remove the victim from the water

Lifeguards communicate what, how or when actions happen

    No verbal communication

    Communication does not result in effective actions

Lifeguards remove the backboard and victim from the water

    Backboard and victim is removed by lifting it out of the slide

    Backboard is steady during removal

    Backboard is lifted causing the victim to move or slide

    Backboard is jerking or rocking from side to side

SECTION E | LIFEGUARDING FINAL WRITTEN EXAMS

SECTION 1-CPR/AED FOR THE PROFESSIONAL RESCUER AND FIRST AID

    Final Written Exam A

    Final Written Exam B

SECTION 2—LIFEGUARDING SKILLS

    Final Written Exam A

    Final Written Exam B

SECTION 2—SHALLOW WATER LIFEGUARDING SKILLS

    Final Written Exam A

    Final Written Exam B

WATERFRONT SKILLS MODULE

    Final Written Exam A

    Final Written Exam B

WATERPARK SKILLS MODULE

    Final Written Exam A

    Final Written Exam B

ANSWER SHEETS

    Section 1—CPR/AED for the Professional Rescuer and First Aid

    Section 2—Lifeguarding Skills

    Section 2—Shallow Water Lifeguarding Skills

    Waterfront Skills Module

    Waterpark Skills Module

ANSWER KEYS

    Answer Key—Final Written Exam A

    Section 1—CPR/AED for the Professional Rescuer and First Aid

    Section 2—Lifeguarding Skills

    Section 2—Shallow Water Lifeguarding Skills

    Waterfront Skills Module

    Waterpark Skills Module

    Answer Key—Final Written Exam B

    Section 1—CPR/AED for the Professional Rescuer and First Aid

    Section 2—Lifeguarding Skills

    Section 2—Shallow Water Lifeguarding Skills

    Waterfront Skills Module

    Waterpark Skills Module

FINAL WRITTEN EXAM: SECTION 1—CPR/AED FOR THE PROFESSIONAL RESCUER AND FIRST AID

    Final Written Exam A

    Final Written Exam B

—DO NOT WRITE ON THIS EXAM—

Section 1—CPR/AED for the Professional Rescuer and First Aid
Exam A

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Section 1—CPR/AED for the Professional Rescuer and First Aid
Exam A

1.   How can you best protect yourself from possible bloodborne pathogen transmission when providing care?

a.   Ask the victim first if he or she has any communicable diseases.

b.   Thoroughly wash your hands before providing care.

c.   Use first aid supplies, such as dressings and bandages, as a barrier when in contact with the victim.

d.   Use personal protective equipment (PPE), such as disposable gloves and a breathing barrier, when providing care.

2.   A 12-year-old boy at a swim meet grabs his chest and begins to make wheezing noises. After you obtain consent to provide care, his mother informs you that he has a history of asthma, but does not have his inhaler nearby. What care should you provide?

a.   Give 5 back blows.

b.   Summon more advanced medical personnel and place the victim into a position that helps breathing.

c.   Tell the victim to use an inhaler borrowed from a bystander.

d.   Wait 20 minutes to see if the breathing difficulty goes away.

3.   While having a snack in the concession area, a child suddenly clutches his throat with both hands. You ask him if he is choking and he frantically nods yes. You activate your facility’s emergency action plan (EAP). You identify yourself as a lifeguard and obtain consent from the parents. What should you do next?

a.   Check the victim’s carotid pulse and then give 5 back blows and 5 abdominal thrusts.

b.   Give 30 chest compressions followed by 2 ventilations.

c.   Lie the victim down and try to give 2 ventilations.

d.   Stand or kneel behind the victim and give 5 back blows and 5 abdominal thrusts.

4.   You and another lifeguard find an unconscious adult on the floor in the locker room. You activate your facility’s EAP, size-up the scene and perform a primary assessment. You find the victim is not moving or breathing, but has a pulse. You should summon EMS personnel, then:

a.   Give 1 rescue breath about every 5 seconds.

b.   Give back blows and chest thrusts.

c.   Give quick breaths at the rate of 20 to 40 a minute.

d.   Perform CPR.

5.   You come upon a scene where a patron appears to be injured. Before approaching the victim, which of the following will you not do as you size-up the scene?

a.   Use all your senses to determine if the scene is safe.

b.   Determine what happened and how many victims there are.

c.   Begin the primary assessment.

d.   Put on appropriate PPE.

6.   When providing care during an emergency, which of the following should you do first?

a.   Check for responsiveness.

b.   Perform a primary assessment.

c.   Size-up the scene.

d.   Summon more advanced medical personnel.

7.   As the first lifeguard on the scene, you are performing CPR on an adult. When performing chest compressions, how deeply should you compress the chest?

a.   About ½ inch

b.   About 1½ inches

c.   At least 1 inch

d.   At least 2 inches

8.   CPR should be performed on which of the following victims?

a.   One who is conscious and has an airway obstruction

b.   One who is experiencing difficulty breathing

c.   One who is in cardiac arrest

d.   One who responds to painful stimuli

9.   What is the first step of the Cardiac Chain of Survival?

a.   Early CPR

b.   Early defibrillation

c.   Early more advanced medical care

d.   Early recognition and access to the emergency medical services (EMS) system

10.   You are providing care to a victim having a heart attack. Which of the following would you do first?

a.   Loosen any tight clothing.

b.   Monitor the victim’s appearance.

c.   Provide comfort to the victim.

d.   Summon EMS personnel.

11.   Once you have turned on the automated external defibrillator (AED), you should:

a.   Apply the pads and allow the AED to analyze the heart rhythm.

b.   Check for breathing.

c.   Give abdominal thrusts.

d.   Give chest compressions.

12.   To ensure effective chest compressions during CPR, which of the following is most appropriate?

a.   Allowing the chest to fully recoil between compressions

b.   Compressing the chest to a shallow depth

c.   Placing the victim on a soft, flat surface

d.   Positioning the hands at the upper part of the victim’s chest

13.   You are performing CPR on a victim and a second lifeguard arrives. Which of the following is most appropriate for the second lifeguard to do first?

a.   Begin giving ventilations to the victim.

b.   Call for a change in position to assist with CPR.

c.   Check to see whether EMS personnel have been called.

d.   Have the first lifeguard stop CPR to allow for victim reassessment.

14.   Which of the following is most essential to use when giving ventilations to protect you and the victim from disease transmission?

a.   CPR breathing barriers

b.   Protective clothing

c.   Gowns

d.   Protective eye wear

15.   You are providing care to a facility maintenance worker who has fallen off the top of a ladder. The victim is conscious. Which of the following should you do first?

a.   Ask the victim what happened when he or she fell.

b.   Check the victim’s pulse.

c.   Obtain consent from the victim to provide care.

d.   Question the victim about any complaints of pain.

16.   For which of the following should you summon EMS personnel?

a.   A victim with a minor cut on the forearm that is lightly bleeding

b.   A victim with an airway obstruction who is forcefully coughing

c.   A victim with intermittent abdominal pressure

d.   A victim with an open leg wound with the bone protruding

17.   You pull an unconscious adult from the water who is taking infrequent gasps. During the primary assessment you find that the victim has a pulse. Which of the following should you do next?

a.   Begin CPR.

b.   Check for severe bleeding.

c.   Continue to monitor the victim’s breathing closely.

d.   Give 2 initial ventilations.

18.   If there is a risk of the AED pads touching each other, such as with a small child or an infant, you should:

a.   Place one pad in the middle of the chest and the other on the back.

b.   Place one pad on the stomach and one pad on the chest.

c.   Place them as usual. It does not matter if the pads touch each other.

d.   Reverse the pads’ position on the chest.

19.   You have sized up the scene and determined the scene is safe. When performing a primary assessment, which of the following would you do next?

a.   Check for responsiveness.

b.   Summon EMS personnel.

c.   Open the victim’s airway.

d.   Check for breathing and a pulse.

20.   Which of the following statements about bag-valve-mask resuscitators (BVMs) is most accurate?

a.   BVMs are readily available at all emergency scenes.

b.   Monitoring the victim for full exhalation is not required.

c.   Two rescuers need to operate the BVM.

d.   When used by a single rescuer, BVMs allow easy coordination with chest compressions.

21.   You are preparing to give ventilations to a 5-year-old boy using a resuscitation mask. You should give 1 ventilation about every:

a.   1 second.

b.   2 seconds.

c.   3 seconds.

d.   5 seconds.

22.   When compressing a child’s chest during CPR, you should compress at a rate of at least how many compressions per minute?

a.   80

b.   100

c.   120

d.   140

23.   An AED has advised that a shock should be given. Which of the following is appropriate?

a.   Apply new AED pads to the victim’s chest.

b.   Begin chest compressions immediately.

c.   Cover the AED pads with a blanket.

d.   Tell everyone to stand clear of the victim.

24.   You are about to apply AED pads to a victim’s chest when you notice that the victim has several body piercings with jewelry on his chest. Which of the following should you do?

a.   Apply the pads to the chest, making sure to avoid the jewelry.

b.   Remove the jewelry before applying the pads.

c.   Use one pad, applying it directly over the jewelry.

d.   Wipe the chest, including the jewelry, with alcohol.

25.   The cycle of chest compressions and ventilations in two-rescuer CPR for an infant is:

a.   15 chest compressions and 1 ventilation.

b.   15 chest compressions and 2 ventilations.

c.   30 chest compressions and 1 ventilation.

d.   30 chest compressions and 2 ventilations.

26.   You are positioned above the child’s head and are using a resuscitation mask to give ventilations. After you position the mask, which of the following should you do next?

a.   Blow into the mask.

b.   Lower the mask over the mouth.

c.   Open the airway.

d.   Seal the mask.

27.   You are providing care to a patron who started choking on some food. The victim becomes unconscious. Which of the following should you do first?

a.   Attempt to give ventilations to the victim.

b.   Lower the victim carefully to the ground and open his airway.

c.   Give 5 chest compressions.

d.   Look inside the victim’s mouth.

28.   Where should you place your hands when giving chest compressions to an infant during CPR?

a.   One hand on the chin and one hand on the chest

b.   One hand on the chin and two or three fingers on the center of the chest

c.   One hand on the forehead and one hand on the chest

d.   One hand on the forehead and two or three fingers on the center of the chest

29.   When giving abdominal thrusts to an adult, where should you position your fist?

a.   In the center of the breastbone

b.   In the middle of the abdomen, just above the navel

c.   In the middle of the abdomen, just below the navel

d.   On the rib cage

30.   When providing care to a conscious infant who is choking, which of the following is most appropriate?

a.   Giving 10 chest thrusts then 10 back blows

b.   Positioning the infant so the head is lower than the chest

c.   Standing slightly behind the infant with one arm around the chest

d.   Using the heel of your hand to give the chest thrusts

31.   A person has been injured and is conscious. You should:

a.   Have the victim walk with you to the first aid station so you can obtain consent and provide care.

b.   Obtain consent, check the victim for life-threatening conditions and speak with the victim to find out what happened.

c.   Provide care immediately based on the victim’s condition.

d.   Speak with the victim to find out what happened and check for non-life-threatening conditions.

32.   The purpose of the secondary assessment is to:

a.   Determine if the victim is bleeding severely.

b.   Identify and care for conditions that are not life threatening.

c.   Look for other victims you may not have noticed at first.

d.   Verify the victim has medical insurance.

33.   An injured patron is conscious and bleeding severely. After summoning EMS personnel, obtaining consent and putting on disposable gloves, what is your next care step?

a.   Treat the victim for shock by lying the victim down.

b.   Elevate the wound if you can do so without causing further pain.

c.   Let the wound bleed until it stops on its own.

d.   Press firmly against the wound with a sterile dressing and bandage.

34.   A way to remember the questions to ask when taking a brief history is to use the acronym SAMPLE. What does the A in SAMPLE stand for?

a.   Age

b.   Airway

c.   Allergies

d.   Ankle

35.   What is the first step you should take in caring for a victim with burns?

a.   Cool the burned area to stop the burning.

b.   Keep the victim comfortable.

c.   Remove the victim from the source of the burn.

d.   Take steps to minimize shock.

36.   If a victim is having a seizure in the water:

a.   Immediately get him or her out of the water.

b.   Immediately move the victim to shallow water until the seizure ends, if the victim is in deep water.

c.   Secure the victim onto a backboard.

d.   Support the victim with his or her head above water until the seizure ends.

37.   During a swim meet, the bleachers behind your guard station suddenly collapse. As you check the scene, you notice several people who appear injured. Who should you approach first?

a.   A mother holding a crying infant.

b.   A man who appears unconscious.

c.   A woman who is bleeding lightly from an injury on her leg.

d.   A child who is holding his arm, which appears to be injured.

38.   When caring for musculoskeletal injuries, what does RICE stand for?

a.   Rest, immobilize, cold, elevate

b.   Remove, immobilize, care, elevate

c.   Rest, ice, care, evaluate

d.   Remove, ice, care, evaluate

39.   Signs and symptoms of sudden illness do not include:

a.   Nausea or vomiting.

b.   Loss of vision or blurred vision.

c.   Bruising or rigidness of the abdomen.

d.   Changes in skin condition.

40.   When checking a victim during a secondary assessment you notice changes in her LOC. What does the C stand for in LOC?

a.   Condition.

b.   Comprehension.

c.   Consciousness.

d.   Complication.

—DO NOT WRITE ON THIS EXAM—

Section 1—CPR/AED for the Professional Rescuer and First Aid
Exam B

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Section 1—CPR/AED for the Professional Rescuer and First Aid
Exam B

1.   You come upon a scene where someone seems to be hurt. During the primary assessment, you should check for all of the following EXCEPT:

a.   Bleeding.

b.   Breathing.

c.   Consciousness.

d.   Swelling.

2.   How can you best protect yourself from possible bloodborne pathogen transmission when providing care?

a.   Ask the victim first if he or she has any communicable diseases.

b.   Thoroughly wash your hands before providing care.

c.   Use protective equipment, such as disposable gloves and a breathing barrier, when providing care.

d.   Use first aid supplies, such as dressings and bandages, as a barrier when in contact with the victim.

3.   Which of the following would you identify as the universal sign that a conscious person is choking?

a.   Clutching the throat

b.   Coughing

c.   Inability to speak or cry

d.   Yelling out “I’m choking”

4.   As you are giving ventilations with a resuscitation mask, the victim vomits. Which of the following would you do first?

a.   Clear the airway of the vomit immediately.

b.   Reposition the victim’s head to reopen the airway.

c.   Turn the victim as a unit onto his or her side.

d.   Use greater force when ventilating to bypass the vomit.

5.   You are providing care to a conscious infant who is choking. When giving chest thrusts, which of the following would you use?

a.   Fist of the hand

b.   Heel of the hand

c.   Two hands

d.   Two or three fingers

6.   You determine that a victim is unconscious but breathing. While waiting with the victim for EMS personnel, you would position the victim:

a.   Face-up.

b.   In a modified high arm in endangered spine (H.A.IN.E.S.) recovery position.

c.   On his or her abdomen.

d.   On his or her side.

7.   While preparing to use an automated external defibrillator (AED) on a victim, you notice a medication patch on the victim’s chest. Which action is most appropriate?

a.   Applying one of the pads directly over the patch

b.   Removing the patch with a gloved hand

c.   Placing one pad on the victim’s chest and the other on his or her back

d.   Wiping the victim’s chest dry, avoiding the patch

8.   You are giving ventilations to a 5-year-old child using a resuscitation mask. You should give 1 ventilation about every:

a.   1 second.

b.   2 seconds.

c.   3 seconds.

d.   5 seconds.

9.   Which of the following statements about bag-valve-mask resuscitators (BVMs) is most accurate?

a.   BVMs are readily available at all emergency scenes.

b.   Monitoring the victim for full exhalation is “not required.

c.   Two rescuers need to operate the BVM.

d.   When used by a single rescuer, BVMs allow easy coordination with chest compressions.

10.   When giving chest compressions to an adult, how would you position your hands?

a.   Side-by-side at the middle of the victim’s chest

b.   Encircling the chest with the thumbs centered at the nipple line

c.   Heel of one hand on the center of the chest with the other hand on top

d.   Three fingers of one hand on the chest with the palm of the other on top

11.   You are performing CPR on a victim and you notice that the victim’s chest begins to rise and fall. Which of the following would you do first?

a.   Continue to perform CPR.

b.   Place the victim face-down to maintain the airway.

c.   Stop chest compressions but continue ventilations.

d.   Stop CPR and monitor the victim’s condition.

12.   When using a resuscitation mask, which of the following should you do?

a.   Blow into the mask for at least 2 seconds to give ventilations.

b.   Cover the nose completely with the mask with the bottom edge at the upper lip.

c.   Hold the mask at the one-way valve to seal it.

d.   Place the broad end of the mask between the lower lip and chin.

13.   You are performing CPR on a victim and a second lifeguard arrives. Which of the following is most appropriate for the second lifeguard to do first?

a.   Begin giving ventilations to the victim.

b.   Call for a change in position to assist with CPR.

c.   Check to see whether EMS personnel have been called.

d.   Have the first lifeguard stop CPR to allow for victim reassessment.

14.   Which of the following findings would lead you to determine that an infant’s airway is open?

a.   The infant is crying uncontrollably.

b.   The infant is not breathing.

c.   The infant is unable to speak.

d.   The infant’s chest fails to rise and fall.

15.   During a primary assessment, which of the following should you evaluate first?

a.   Airway

b.   Breathing

c.   Circulation

d.   Check the victim for responsiveness

16.   You are walking on the pool deck when the swim team coach suddenly collapses in front of you. During your primary assessment you do not find a pulse, you should:

a.   Suspect he is an unconscious choking victim and give 2 ventilations.

b.   Suspect he is in cardiac arrest and immediately begin CPR.

c.   Suspect he has had a stroke and care for shock and maintain an open airway.

d.   Suspect he may have a head, neck or spinal injury and send someone to call EMS.

17.   Based on which of the following signs and symptoms would you determine that a victim is experiencing respiratory distress?

a.   Audible high-pitched gurgling

b.   Complaints of feeling “really thirsty”

c.   Sneezing with watery eyes

d.   Yellowish skin

18.   You and another lifeguard find an unconscious adult on the locker room floor. The other lifeguard goes to summon EMS personnel. You complete a primary assessment and find that the victim has a pulse but is not breathing. Which of the following should you do next?

a.   Give 1 ventilation about every 5 seconds.

b.   Give the victim back blows and chest thrusts.

c.   Perform a finger sweep of the victim’s mouth.

d.   Perform CPR.

19.   As the only lifeguard performing CPR on a 7-year-old child, you would perform cycles of:

a.   15 chest compressions and 1 ventilation.

b.   20 chest compressions and 1 ventilation.

c.   25 chest compressions and 1 ventilation.

d.   30 chest compressions and 2 ventilations.

20.   An AED indicates that “No shock is advised.” Which of the following is most appropriate to do next?

a.   Monitor the victim’s airway and breathing.

b.   Perform CPR for about 2 minutes.

c.   Readjust the pad placement on the victim.

d.   Turn off the AED for 5 seconds and try again.

21.   You are providing care to an adult who is unconscious and not breathing. You give 1 ventilation during CPR and notice that the chest does not rise. Which of the following should you do next?

a.   Change the position of the mask and then look for chest movement.

b.   Blow into the mask more forcefully and then look for the chest to rise.

c.   Give 5 back blows and then check the victim’s mouth.

d.   Retilt the head and then attempt another ventilation.

22.   You and a fellow lifeguard are giving ventilations using a BVM. You position the mask over the victim’s mouth and nose. What should the other lifeguard do?

a.   Ensure that the mask is sealed.

b.   Open the airway with the thumbs.

c.   Position fingers behind the jawbone.

d.   Squeeze the bag with both hands.

23.   You and another lifeguard are preparing for CPR on an adult who collapsed in the locker room. You determine that there is no breathing or pulse and state, “Victim has no pulse. Begin CPR.” Which of the following should the other lifeguard do next?

a.   Check for breathing.

b.   Begin chest compressions.

c.   Give 2 ventilations.

d.   Open the airway.

24.   Which of the following is most essential to use when giving ventilations to protect you and the victim from disease transmission?

a.   CPR breathing barriers

b.   Protective clothing

c.   Gowns

d.   Protective eyewear

25.   Which of the following should you do first when approaching the scene of an emergency?

a.   Complete a primary assessment.

b.   Obtain the victim’s consent to provide care.

c.   Size-up the scene.

d.   Summon EMS personnel.

26.   To ensure effective chest compressions during CPR, which of the following is most appropriate?

a.   Allowing the chest to fully recoil between compressions

b.   Compressing the chest to a shallow depth

c.   Placing the victim on a soft, flat surface

d.   Positioning the hands at the upper part of the victim’s chest

27.   When using an AED, which of the following should you do immediately after attaching the AED pads to the victim’s chest?

a.   Push the “Analyze” button.

b.   Tell everyone to stand clear.

c.   Turn on the AED.

d.   Wipe the victim’s chest dry.

28.   A person has been injured and is conscious. You obtain consent to check the victim for life-threatening conditions. What life-threatening condition would require you to immediately summon EMS personnel?

a.   Minor cuts and scrapes

b.   Minor headache

c.   Persistent chest pain

d.   Swollen ankle

29.   You and a patron enter the locker room and find an unconscious person lying on the floor. You size-up the scene and then you begin performing a primary assessment. The patron asks, “Should we move him to the first aid room?” What should you do next?

a.   Help the patron move the victim to the first aid room.

b.   Splash the victim’s face with cold water.

c.   Tell the patron the victim should not be moved since there is no immediate danger.

d.   Tell the patron to move the victim while you get other lifeguards to help.

30.   A 12-year-old boy at a swim meet grabs his chest and begins to make wheezing noises. After you obtain consent to provide care, his mother informs you that he has a history of asthma, but does not have his inhaler nearby. What care should you provide?

a.   Give 5 back blows.

b.   Summon EMS personnel and place the victim into a position that helps breathing.

c.   Tell the victim to use an inhaler borrowed from a bystander.

d.   Wait 20 minutes to see if the breathing difficulty goes away.

31.   A patron has cut her leg on the edge of the bleachers and is bleeding heavily. You think the patron is in shock because she:

a.   Becomes restless and irritable.

b.   Has a red rash.

c.   Has dry skin.

d.   Is calm and quiet.

32.   The purpose of a secondary assessment is to:

a.   Determine if the victim is bleeding severely.

b.   Identify and care for conditions that are not life threatening.

c.   Look for other victims you may not have noticed at first.

d.   Verify the victim has medical insurance.

33.   An injured patron is conscious and bleeding severely. After summoning EMS personnel, obtaining consent and putting on disposable gloves, what is your next care step?

a.   Clean the wound and area of bodily fluids to minimize contamination.

b.   Elevate the wound if you can do so without causing further pain.

c.   Let the wound bleed until it stops on its own.

d.   Press firmly against the wound with a sterile dressing and apply bandage.

34.   When immobilizing an injured patron’s arm:

a.   Leave the arm in the position you find it or in the position the patron is holding it.

b.   Loosely apply a sling so the patron can move the arm around.

c.   Secure the injured arm to the patron’s uninjured arm.

d.   Straighten the arm and place a folded towel between the injured arm and the patron’s ribs.

35.   A way to remember the questions to ask when taking a brief history is to use the acronym SAMPLE. What does the S in SAMPLE stand for?

a.   Safety techniques

b.   Secondary assessment

c.   Signs and symptoms

d.   Spinal injury assessment

36.   A patron seems to be having a diabetic emergency. You should:

a.   Have the victim drink a diet soda.

b.   Have the victim drink a fruit juice.

c.   Have the victim drink a glass of water.

d.   Have the victim lie down and cover him or her with a blanket.

37.   A patron has slurred speech, is unable to lift her right arm level with her left arm and is unable to smile without one side of her face drooping. You make note of the time the symptoms started. These are symptoms of:

a.   A head, neck or spinal injury.

b.   A stroke.

c.   Internal bleeding.

d.   Poisoning.

38.   A victim is having a seizure in the water, what should you do?

a.   Immediately get him or her out of the water.

b.   Immediately move the victim to shallow water until the seizure ends, if the victim is in deep water.

c.   Secure the victim onto a backboard.

d.   Support the victim with his or her head above water until the seizure ends.

39.   During a swim meet, the bleachers behind your guard station suddenly collapse. As you check the scene you notice several people who appear injured. Who should you approach first?

a.   A mother holding a crying infant

b.   A man who appears unconscious

c.   A woman who is bleeding lightly from an injury on her leg

d.   A child who is holding his arm, which appears to be injured

40.   When caring for musculoskeletal injuries, what does RICE stand for?

a.   Rest, immobilize, cold, elevate

b.   Remove, immobilize, care, elevate

c.   Rest, ice, care, evaluate

d.   Remove, ice, care, evaluate

FINAL WRITTEN EXAM: SECTION 2—LIFEGUARDING SKILLS

    Final Written Exam A

    Final Written Exam B

—DO NOT WRITE ON THIS EXAM—

Section 2—Lifeguarding Skills
Exam A

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Section 2—Lifeguarding Skills
Exam A

1.   You notice a patron that is swimming laps who suddenly slips under water without a struggle and does not resurface. This person is probably:

a.   A distressed swimmer who needs help.

b.   A passive victim who needs help.

c.   An active victim who needs help.

d.   An intermediate swimmer who does not need help.

2.   Primary responsibilities of a lifeguard include:

a.   Fixing the pool rope and lane lines and ensuring the changing rooms are clean.

b.   Following the health codes, answering a patron’s question and making sure patrons shower before using the pool.

c.   Inspecting the pool and rescue equipment before the facility opens and paying close attention to patrons in the water by actively scanning the assigned area.

d.   Passing out the pool rules to all the patrons.

3.   A man is unexpectedly pushed from behind and falls from the deck into the water and is in distress. After you activate the emergency action plan (EAP), what are included in your next steps.

a.   Clear the pool and alert management of the emergency.

b.   Encourage him to stay calm and swim back to the edge of the pool.

c.   Use an ease in entry, approach the victim and remove him from the water.

d.   Extend a rescue tube to him while remaining on deck, then provide any additional care.

4.   Which of the following is a primary responsibility of a lifeguard?

a.   Enforcing facility rules and regulations and educating patrons about them

b.   Filling out required records and reports on schedule and submitting them to the proper person or office

c.   Monitoring the performance of the other lifeguards on duty

d.   Performing opening duties, closing duties or facility safety checks and inspections

5.   For a head, neck or spinal injury in deep water:

a.   Minimize movement of the victim’s head and neck using the head splint technique.

b.   Move the victim directly onto a backboard.

c.   Remove the victim from the water without wasting time trying to stabilize the victim’s head and neck until you have the victim out of the water.

d.   Remove your rescue tube and use the head hold technique.

6.   While scanning your zone, you notice a person motionless in the water. The steps you follow in a water emergency are performed in the following order:

a.   Perform a secondary assessment, perform a primary assessment, size-up the scene, activate the emergency action plan (EAP), and summon EMS personnel.

b.   Perform a primary assessment, activate the EAP, summon EMS personnel, perform a secondary assessment and size-up the scene.

c.   Activate the EAP, enter the water, perform an appropriate rescue, move the victim to a safe exit point, remove the victim from the water and provide emergency care as needed.

d.   Size-up the scene, activate the EAP, summon EMS personnel, perform a primary assessment and perform a secondary assessment.

7.   While scanning the pool, you witness a patron struggling while swimming and then go under water. Which of the following applies?

a.   You have duty to act and perform the appropriate rescue.

b.   You would use the RID factor to determine what to do.

c.   You should continue to scan the pool until emergency back-up coverage is available.

d.   You should notify off duty lifeguards to provide care for the victim.

8.   A lifeguard can no longer see some of the patrons at one side of the swimming area from his station because of glare from the afternoon sun. To maintain effective patron surveillance, the lifeguard should:

a.   Adjust his position slightly to remove the glare spot from his surveillance area.

b.   Document the issue and present it at next month’s staff meeting.

c.   Leave the area to find the supervisor for assistance.

d.   Stay in the same position since the patrons are strong swimmers.

9.   A patron starts running on the deck. You blow your whistle to get her attention. Next, you enforce the rules and regulations by:

a.   Calling your supervisor.

b.   Giving her a warning.

c.   Telling her she could slip or fall and she must walk on the deck.

d.   Telling her she might be asked to leave and demanding she stop it now.

10.   When caring for a suspected head, neck or spinal injury in water, proper manual in-line stabilization is:

a.   Less important than on land due to the support provided by the water.

b.   Provided using the head splint technique.

c.   The only necessary technique needed if EMS personnel are close by.

d.   Provided by bystanders if the lifeguard needs to clear the pool.

11.   Working with other lifeguards, facility staff and supervisors as a team is:

a.   A topic that should be covered during an in-service meeting and new-hire orientation.

b.   One of the primary responsibilities of a lifeguard.

c.   Part of the facility’s EAP.

d.   Solely the role of facility management.

12.   You are a lifeguard on surveillance duty during a busy family swim session. It is important to:

a.   Have a first aid kit, an automated external defibrillator (AED) and a backboard immediately available to you on the pool deck next to your station.

b.   Scan all areas in your assigned zone of coverage and carry your rescue tube with you at all times.

c.   Rope off and close all areas of the facility that have water over 5-feet deep.

d.   Have enough lifejackets on hand and require all non-swimmers to use them.

13.   A head, neck or spinal injury rarely happens:

a.   In deep water at a supervised facility.

b.   When someone strikes a properly inflated inner tube.

c.   In shallow water that is clearly signed No Diving.

d.   From collisions between swimmers.

14.   Which of the following is true about accidental fecal releases (AFRs)?

a.   AFRs do not require immediate attention.

b.   Managers only need to be concerned with AFRs.

c.   Require water treatment, temporary pool closure and immediate lifeguard attention.

d.   It is part of the routine daily operation of a pool that must be done for safety.

15.   You are lifeguarding during a family swim session when you notice a swimmer swimming full lengths of the pool under water. What should you do?

a.   Activate the facility EAP, clear the pool and remove him from the pool.

b.   Immediately get the attention of the swimmer and instruct him to leave the pool for breaking pool rules.

c.   Immediately stop him from continuing the activity and explain the dangers of the activity.

d.   Alert the pool manager of the situation once your shift is over and document the event.

16.   After removing a conscious victim you suspect has a spinal injury from the water, you should do all the following except:

a.   Watch for and care for signs of shock.

b.   Protect the victim from becoming cold.

c.   Dry the victim off and apply the pads of an AED.

d.   Reassure the victim and perform a secondary assessment.

17.   Two lifeguards are on surveillance duty during a public swim. You are on a break. One lifeguard activates the facility’s EAP for a submerged passive victim and enters the water. Which steps should you take next to assist in the rescue?

a.   Notify the manager to assist.

b.   Bring the backboard to the lifeguard and assist in removing the victim from the water as the other lifeguard clears the pool.

c.   Provide emergency total zone coverage while other lifeguards assist the victim.

d.   Instruct bystanders how to assist the lifeguards, document witness accounts and provide crowd control.

18.   A lifeguard keeps an eye on the patrons of the pool, checking the bottom, middle and surface of the water. He is demonstrating:

a.   Effective communication.

b.   Effective scanning.

c.   Implied consent.

d.   The RID factor.

19.   A mother and her son walk over to you; she states that he fell on the pool deck and hit his head. You notice he has blood and fluid running from his ear and he is feeling dizzy. What steps should you take next?

a.   Have the mother transport him to the emergency room since he is already walking.

b.   Bring him to the pool office to sit down and provide manual stabilization.

c.   Have him lie down on the pool deck until EMS personnel arrive.

d.   Provide manual stabilization while the other lifeguards prepare to backboard him.

20.   The lifeguard supervisor expects the pool to be very busy in the afternoon. For effective patron surveillance, she sets up multiple lifeguard stations to reduce the number of patrons watched by each lifeguard. This type of coverage is called:

a.   Back-up coverage.

b.   Rescue coverage.

c.   Total coverage.

d.   Zone coverage.

21.   To effectively scan, you must:

a.   Count all the patrons in your zone.

b.   Focus primarily on blind spots.

c.   Keep your head still but use your eyes to scan your area.

d.   Move your head and eyes as you scan to look directly at each area rather than staring in a fixed direction.

22.   When providing care to a conscious person you suspect of having a head, neck or spinal injury and who was injured from a fall on the pool deck:

a.   You do not check the scene since the person needs immediate attention.

b.   Consent is implied because the victim needs manual stabilization to keep from being further injured.

c.   You do not need to do a secondary assessment since head, neck and spinal injuries are the most serious.

d.   You do not move the victim unless the scene becomes unsafe.

23.   A woman collides with another swimmer while diving into the pool and asks the lifeguard for help. Without doing an assessment, the lifeguard tells the woman she can continue swimming. The woman leaves the facility and seeks medical attention from a hospital after she begins to feel tingling sensations in her arms and legs. The lifeguard may be:

a.   A Good Samaritan.

b.   Following the refusal-of-care principle.

c.   Negligent.

d.   Using the RID factor.

24.   During a weather-related power failure at a facility, you should:

a.   Clear everyone from the pool.

b.   Let patrons continue swimming.

c.   Let patrons sit on the edge with their feet in the water.

d.   Monitor weather reports while patrons continue to swim.

25.   During in-service training, lifeguards practice the steps of recognizing a distressed swimmer, rescuing an active victim, informing management and speaking with witnesses. The lifeguards are practicing parts of a(n):

a.   Communication plan.

b.   Emergency action plan.

c.   Secondary assessment.

d.   Staff debriefing.

26.   You enter the mechanical room and find a maintenance worker lying on his back on the floor next to a ladder. You check the scene and determine it is safe to enter. During your primary assessment, you find the victim is unconscious but breathing. You must leave to get help, what should you do?

a.   Move him into the H.A.IN.E.S. position.

b.   Leave him just as he is.

c.   Do not leave him since he is breathing, monitor his condition and wait for additional help to come.

d.   Use a clothes drag to move him to where you can summon more help.

27.   Which of the following is true if the manager of the facility has assigned you as the only lifeguard conducting patron surveillance?

a.   You have been assigned to total coverage.

b.   You have been assigned to back-up coverage.

c.   You have been assigned to zone coverage.

d.   You have been assigned to a lifeguard station.

28.   Which of the following pieces of equipment need to be easily accessible for emergency use:

a.   Rescue tube, manual suction device

b.   Backboard, AED

c.   Resuscitation mask, bag-valve-mask resuscitator

d.   Gloves, first aid kit

29.   A technique to minimize movement for a victim with a suspected head, neck or spinal injury who is face-down, at the surface and in water less than 3 feet deep is the:

a.   Arm splint technique.

b.   Head splint technique.

c.   Head support technique.

d.   Modified jaw-thrust technique.

30.   If three lifeguards are on duty, emergency back-up coverage takes place:

a.   When a lifeguard is unable to show up to work for their shift.

b.   Whenever the facility EAP is activated.

c.   When a lifeguard enters the water for a rescue.

d.   When the facility has more patrons than its designed capacity allows.

31.   Which of the following is the least important for a safe group visit to a pool?

a.   Knowing how to identify the group’s leaders or chaperones

b.   Having appropriate number of lifeguards available to cover all zones

c.   Ensuring there are multiple activities planned for the group

d.   Ensuring that patrons stay in the sections of the pool that are appropriate for their swim ability

32.   While caring for someone with a suspected spinal injury, you secure the straps on a backboard in the following order:

a.   Feet, thighs, arms, head

b.   Hands, legs, upper chest

c.   Head, upper chest, hands, thighs

d.   Upper chest, hips, thighs

33.   It is the primary responsibility of facility management to provide all but which of the following?

a.   Creating and reviewing policy and procedures

b.   Addressing unsafe conditions

c.   Training staff

d.   Educating patrons about and enforcing facility rules

34.   The hazard communication standard includes having MSDS information available. What is included in this information?

a.   Contains information about what first aid and rescue equipment is required to have on hand

b.   Contains information about what type of chemicals are in use at the facility

c.   Contains information about areas of the facility that have unsafe conditions, which require repairs

d.   Contains information that is only important for the facility manager is required to know

35.   A patron dives into the shallow end of the lap pool. You suspect she has a head, neck or spinal injury because she has:

a.   An elevated body temperature.

b.   An irregular heartbeat.

c.   Blood in the ears and nose.

d.   Impaired hearing.

—DO NOT WRITE ON THIS EXAM—

Section 2—Lifeguarding Skills
Exam B

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Section 2—Lifeguarding Skills
Exam B

1.   During a morning adult lap swim, you notice a swimmer who slows down and is no longer able to make any forward progress. Which of the following is true?

a.   She has become a passive victim.

b.   She is in danger of becoming an active victim if not assisted.

c.   She is an active victim.

d.   You should continue to scan the pool and watch to see if her condition worsens.

2.   The hazard communication standard includes having MSDS information available. What is included in this information?

a.   Contains information about what first aid and rescue equipment is required to have on hand.

b.   Contains information about what type of chemicals are in use at the facility.

c.   Contains information about areas of the facility that have unsafe conditions, which require repairs.

d.   Contains information that is only important for the facility manager to know.

3.   For a head, neck or spinal injury in the water:

a.   Minimize movement of the victim’s head and neck using the head splint technique.

b.   Move the victim directly onto a backboard using the two person removal from water technique.

c.   Remove the victim from the water without wasting time trying to stabilize the victim’s head and neck until you have the victim out of the water.

d.   Remove your rescue tube and use the head hold technique.

4.   If three lifeguards are on duty, emergency back-up coverage takes place:

a.   When a lifeguard is unable to show up to work for their shift.

b.   Whenever the facility emergency action plan (EAP) is activated.

c.   When a lifeguard enters the water for a rescue.

d.   When the facility has more patrons than its designed capacity allows.

5.   A patron comes up to you complaining of neck pain. He says his hands and feet are tingling. What injury might you suspect, and what care would you provide?

a.   You should suspect a head, neck or spinal injury. Have the victim move his head in either direction to confirm this before applying manual stabilization.

b.   You should suspect a head, neck or spinal injury. Immediately provide manual stabilization of the victim’s head and neck and summon EMS personnel.

c.   You should suspect a seizure. Have the victim lie down immediately.

d.   You should suspect a sprained neck. Have the victim lie down and apply ice to the affected area.

6.   Which of the following is the least important for a safe group visit to a pool?

a.   Knowing how to identify the group’s leaders or chaperones

b.   Having appropriate number of lifeguards available to cover all zones

c.   Ensuring there are multiple activities planned for the group

d.   Ensuring that patrons stay in the sections of the pool that are appropriate for their swim ability

7.   Which of the following is true about accidental fecal releases (AFRs)?

a.   AFRs do not require immediate attention.

b.   Managers only need to be concerned with AFRs.

c.   Require water treatment, temporary pool closure and immediate lifeguard attention.

d.   It is part of the routine daily operation of a pool that must be done for safety.

8.   A technique used in the water to minimize movement of the victim’s head and neck is the:

a.   Beach drag.

b.   Head and body support.

c.   Head splint.

d.   Rigid splint.

9.   Which of the following is true if the manager of the facility has assigned you as the only lifeguard conducting patron surveillance?

a.   You have been assigned to total coverage.

b.   You have been assigned to back-up coverage.

c.   You have been assigned to zone coverage.

d.   You have been assigned to a lifeguard station.

10.   You enter the mechanical room and find a maintenance worker lying on his back on the floor next to a ladder. You check the scene and determine it is safe to enter. During your primary assessment, you find the victim is unconscious but breathing. You must leave to get help, what should you do?

a.   Move him into the H.A.IN.E.S. position.

b.   Leave him just as he is.

c.   Do not leave him since he is breathing, monitor his condition and wait for additional help to come.

d.   Use a clothes drag to move him to where you can summon more help.

11.   Which of the following pieces of equipment must a lifeguard have instantly accessible at all times.

a.   Rescue tube, bag valve mask, AED

b.   Rescue board, ring buoy, resuscitation mask

c.   Backboard, first aid supplies, oxygen

d.   Gloves, resuscitation mask, rescue tube

12.   During an in-service training, lifeguards practice the steps of an emergency action plan, such as:

a.   Conducting safety checks before, during and after pool hours.

b.   Following rescue procedures, informing management and conducting staff debriefings.

c.   Getting a patron’s attention, explaining unsafe behaviors and discussing safe activities.

d.   Telling patrons the rules and regulations.

13.   You are lifeguarding during a family swim session when you notice a swimmer swimming full lengths of the pool under water. What should you do?

a.   Activate the facility EAP, clear the pool and remove him from the pool.

b.   Immediately get the attention of the swimmer and instruct him to leave the pool for breaking pool rules.

c.   Immediately stop him from continuing the activity and explain the dangers of the activity.

d.   Alert the pool manager of the situation once your shift is over and document the event.

14.   Which of the following is true of a submerged unconscious victim in deep water that you suspect has a spinal injury?

a.   If the victim is not breathing, you would remove the victim from the water.

b.   You must keep your rescue tub e on throughout the rescue.

c.   To minimize movement, you should keep them in the deep end of the pool during the rescue.

d.   You should provide in-water ventilations while other lifeguards strap the victim to the backboard.

15.   You are walking through the park on your way to the pool to report for duty and witness an adult suddenly collapse while playing catch with his son. You check the scene to be sure it is safe and then decide to perform CPR on the adult victim. Which legal consideration applies?

a.   Duty to act

b.   Standard of care

c.   Good Samaritan law

d.   Negligence

16.   When caring for a suspected head, neck or spinal injury in water, proper manual in-line stabilization is:

a.   Less important than on land due to the support provided by the water.

b.   Provided using the head splint technique.

c.   The only necessary technique needed if EMS personnel are close by.

d.   Provided by bystanders if the lifeguard needs to clear the pool.

17.   Two lifeguards are on surveillance duty during a public swim. You are on a break. One lifeguard activates the facility’s EAP for a submerged passive victim and enters the water. Which steps should you take next to assist in the rescue?

a.   Notify the manager to assist.

b.   Bring the backboard to the lifeguard and assist in removing the victim from the water as the other lifeguard clears the pool.

c.   Provide emergency total zone coverage while other lifeguards assist the victim.

d.   Instruct bystanders how to assist the lifeguards, document witness accounts, and provide crowd control.

18.   A lifeguard keeps an eye on the patrons of the pool, checking the bottom, middle and surface of the water. He is demonstrating:

a.   Effective communication.

b.   Effective scanning.

c.   Implied consent.

d.   The RID factor.

19.   Signs and symptoms of a person you suspect of a head, neck, or spinal injury include:

a.   Changes in skin color, temperature and feel.

b.   Back pain or tingling.

c.   Pressure or pain in the chest.

d.   Rigid, tender, or bruised abdomen.

20.   A man is unexpectedly pushed from behind and falls from the deck into the water and is in distress. After you activate the emergency action plan (EAP), what are included in your next steps.

a.   Clear the pool and alert management of the emergency.

b.   Encourage him to stay calm and swim back to the edge of the pool.

c.   Use an ease in entry, approach the victim and remove him from the water.

d.   Extend a rescue tube to him while remaining on deck, then provide any additional care.

21.   Before providing care to a conscious person you suspect of having a head, neck or spinal injury who is injured from a fall on the pool deck:

a.   You do not check the scene since the person needs immediate attention.

b.   Consent is implied because the victim needs manual stabilization to keep from being further injured.

c.   You do not need to do a secondary assessment since head, neck and spinal injuries are the most serious.

d.   You do not move the victim unless the scene becomes unsafe.

22.   While scanning your zone, you notice a person motionless in the water. The steps you follow in a water emergency are performed in the following order:

a.   Perform a secondary assessment, perform a primary assessment, size-up the scene, activate the emergency action plan (EAP), and summon EMS personnel.

b.   Perform a primary assessment, activate the EAP, summon EMS personnel, perform a secondary assessment and size-up the scene.

c.   Activate the EAP, enter the water, perform an appropriate rescue, move the victim to a safe exit point, remove the victim from the water and provide emergency care as needed.

d.   Size-up the scene, activate the EAP, summon EMS personnel, perform a primary assessment and perform a secondary assessment.

23.   A mother and her son walk over to you; she states that he fell on the pool deck and hit his head. You notice he has blood and fluid running from his ear and he is feeling dizzy. What steps should you take next?

a.   Have the mother transport him to the emergency room since he is already walking.

b.   Bring him to the pool office to sit down and provide manual stabilization.

c.   Have him lie down on the pool deck and provide manual stabilization until EMS personnel arrive.

d.   Provide manual stabilization while the other lifeguards prepare to backboard him.

24.   Which of the following is a primary responsibility of a lifeguard?

a.   Enforcing facility rules and regulations and educating patrons about them

b.   Filling out required records and reports on schedule and submitting them to the proper person or office

c.   Monitoring the performance of the other lifeguards on duty

d.   Performing opening duties, closing duties or facility safety checks and inspections

25.   While actively scanning the pool, you witness a patron struggling while swimming and then go under water. Which of the following applies?

a.   You have duty to act and perform the appropriate rescue.

b.   You would use the RID factor to determine what to do.

c.   You should continue to scan the pool until emergency back-up coverage is available.

d.   You should notify off duty lifeguards to provide care for the victim.

26.   A lifeguard can no longer see some of the patrons at one side of the swimming area from his station because of glare from the afternoon sun. To maintain effective patron surveillance, the lifeguard should:

a.   Adjust his position slightly to remove the glare spot from his surveillance area.

b.   Document the issue and present it at next month’s staff meeting.

c.   Leave the area to find the supervisor for assistance.

d.   Stay in the same position since the patrons are strong swimmers.

27.   A large number of patrons are swimming at the facility. For effective patron surveillance, your supervisor decides to add another lifeguard station and tells you to modify the zone coverage based on the new station to:

a.   Allow the lifeguards to take turns scanning the good swimmers.

b.   Allow the lifeguards to take turns walking up and down the deck.

c.   Increase the number of patrons watched by each lifeguard.

d.   Reduce the number of patrons watched by each lifeguard.

28.   A patron starts running on the deck. You blow your whistle to get her attention. Next, you enforce the rules and regulations by:

a.   Calling your supervisor.

b.   Giving her a warning.

c.   Telling her she could slip or fall and she must walk on the deck.

d.   Telling her she might be asked to leave and demanding she stop it now.

29.   A woman collides with another swimmer while diving into the pool and asks the lifeguard for help. Without doing an assessment, the lifeguard tells the woman she can continue swimming. The woman leaves the facility and seeks medical attention from a hospital after she begins to feel tingling sensations in her arms and legs. The lifeguard may be:

a.   A Good Samaritan

b.   Following the refusal-of-care principle

c.   Negligent

d.   Using the FIND model

30.   During in-service training, lifeguards practice the steps of recognizing a distressed swimmer, rescuing a victim who is drowning, informing management and speaking with witnesses. The lifeguards are practicing parts of a(n):

a.   Communication plan.

b.   Emergency action plan.

c.   Secondary assessment.

d.   Staff debriefing.

31.   In the event of thunder and lightning at an outdoor facility, lifeguards should:

a.   Clear everyone from the water and send them into the locker room to take showers during the thunderstorm.

b.   Clear everyone from the water at the first sound of thunder or first sighting of lightning.

c.   Keep watching for lightning strikes near the facility while patrons continue to swim.

d.   Keep watching for more storms and monitor weather reports while patrons continue to swim.

32.   The lifeguard supervisor expects the pool to be very busy in the afternoon. For effective patron surveillance, she sets up multiple lifeguard stations to reduce the number of patrons watched by each lifeguard. This type of coverage is called:

a.   Back-up coverage.

b.   Rescue coverage.

c.   Total coverage.

d.   Zone coverage.

33.   You are responsible for a zone of the pool. To effectively scan, you must:

a.   Count all the patrons in your area of responsibility.

b.   Focus primarily on blind spots.

c.   Keep your head still but use your eyes to scan your area.

d.   Move your head and eyes as you scan to look directly at each area rather than staring in a fixed direction.

34.   You notice a patron that is swimming laps who suddenly slips under water without a struggle and does not resurface. This person is probably:

a.   A passive victim who needs help.

b.   A distressed swimmer who needs help.

c.   An active victim who needs help.

d.   An intermediate swimmer who does not need help.

35.   A head, neck or spinal injury rarely happens:

a.   In deep water at a supervised facility.

b.   When someone strikes a properly inflated inner tube.

c.   In shallow water that is clearly signed No Diving.

d.   From collisions between swimmers.

FINAL WRITTEN EXAM: SECTION 2—SHALLOW WATER LIFEGUARDING SKILLS

    Final Written Exam A

    Final Written Exam B

—DO NOT WRITE ON THIS EXAM—

Section 2—Shallow Water Lifeguarding Skills
Exam A

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Section 2—Shallow Water Lifeguarding Skills
Exam A

1.   A child falls backwards from a water play structure in extremely shallow water. She can not stand up. You suspect a head, neck or spinal injury. You should:

a.   Wait for other lifeguards to assist in lifting the child out of the water and onto the pool deck.

b.   Provide manual in-line stabilization by placing your hands on either side of her head until more help arrives.

c.   Use the head splint technique from the victim’s side and gently move her to deeper water.

d.   Get consent from a parent then quickly backboard her and remove her from the water.

2.   After removing a conscious victim you suspect has a spinal injury from the water, you should do all the following except:

a.   Watch for and care for signs of shock.

b.   Protect the victim from becoming cold.

c.   Dry the victim off and apply the automated external defibrillator (AED) pads.

d.   Reassure the victim and perform a secondary assessment.

3.   A large number of patrons are swimming at the facility. For effective patron surveillance, your supervisor decides to add another shallow water lifeguard station and tells you to modify the zone coverage based on the new station to:

a.   Allow the lifeguards to take more frequent rotations.

b.   Allow the lifeguards to take turns walking up and down the deck.

c.   Increase the number of patrons watched by each lifeguard.

d.   Reduce the number of patrons watched by each lifeguard.

4.   A mother walks her son over to you stating that he fell on the pool deck and hit his head. You notice he has blood and fluid running from his ear, he is feeling dizzy. What steps should you take next?

a.   Have the mother transport him to the emergency room since he is already walking.

b.   Bring him to the pool office to sit down and provide manual stabilization.

c.   Have him lie down on the pool deck and provide manual stabilization until EMS personnel arrive.

d.   Provide manual stabilization while the other lifeguards prepare to backboard him.

5.   A patron comes up to you complaining of neck pain. He says his hands and feet are tingling. What injury might you suspect, and what care would you provide?

a.   You should suspect a head, neck or spinal injury. Have the victim move his head in either direction to confirm this before applying manual stabilization.

b.   You should suspect a head, neck or spinal injury. Immediately provide manual stabilization of the victim’s head and neck and summon EMS personnel.

c.   You should inspect the head, neck and spine for injury. Have the victim move his head in either direction to confirm this before applying manual stabilization.

d.   You should suspect a sprained neck. Have the victim lie down and apply ice to the affected area.

6.   A patron starts running on the deck. You blow your whistle to get her attention. Next, you enforce the rules and regulations by:

a.   Calling your supervisor.

b.   Giving her a warning.

c.   Telling her she could slip or fall and she must walk on the deck.

d.   Telling her she might be asked to leave and demanding she stop it now.

7.   A shallow water lifeguard:

a.   Is a part of the lifeguard team and can supervise areas at an aquatic facility that have diving boards, drop slides or other attractions.

b.   Is prepared to recognize and respond to aquatic emergencies where water is up to 5 feet deep.

c.   Is prepared to recognize and respond to aquatic emergencies at an attraction where the water is up to 10 feet deep.

d.   Is separate from the lifeguard team because of his or her different training and skills.

8.   A shallow water lifeguard keeps an eye on the patrons of the pool, checking the bottom, middle and surface of the water. He is demonstrating:

a.   Effective communication.

b.   Effective scanning.

c.   Implied consent.

d.   The RID factor.

9.   A shallow water lifeguard may expect to have total coverage surveillance responsibility assigned when:

a.   There is a 5-foot plunge slide over 8 feet of water.

b.   There is only one diving board in use.

c.   There is a winding river with a current where adults are walking and some children are using lifejackets.

d.   The lap pool depth varies from 3 feet to 7 feet in depth.

10.   A shallow water lifeguard would most likely prevent patron injuries by:

a.   Enforcing facility rules and regulations and educating patrons about them.

b.   Filling out required records and reports on schedule and submitting them to the proper person or office.

c.   Monitoring the performance of the other lifeguards on duty.

d.   Ensuring that the entire assigned zone of surveillance can be effectively scanned and is free of hazards.

11.   A shallow water lifeguard is scanning his zone and can no longer see some of the patrons on the other side of the swimming area from his station because of the afternoon sun. To maintain effective patron surveillance, the lifeguard should:

a.   Adjust his position slightly to remove the glare spot from his surveillance area.

b.   Document the issue and present it at next month’s staff meeting.

c.   Leave the area to find the supervisor for assistance.

d.   Stay in the same position since the patrons are strong swimmers.

12.   A child is in distress and is near the side of the pool. When using the reaching assist with a rescue tube to help the child, you should:

a.   Extend a rescue tube to the child and pull the child to safety.

b.   Enter the water and slide the child onto a backboard.

c.   Kneel on the pool deck, extend a ring buoy to the child and pull the child to safety.

d.   Throw a rescue tube to the child and have the child swim to safety.

13.   A technique to minimize movement for a victim with a suspected head, neck or spinal injury who is face-down, at the surface and in water less than 3 feet deep is the:

a.   Arm splint technique.

b.   Head splint technique.

c.   Head support technique.

d.   Anatomical splint technique.

14.   A woman collides with another swimmer while diving into the pool and asks the lifeguard for help. Without doing an assessment, the lifeguard tells the woman she can continue swimming. The woman leaves the facility and seeks medical attention from a hospital after she begins to feel tingling sensations in her arms and legs. The lifeguard may be:

a.   A Good Samaritan.

b.   Following the refusal-of-care principle.

c.   Negligent.

d.   Using the RID factor.

15.   A woman falls off her inner tube when exiting into a catch pool and needs help. To use the simple assist to help her, you should:

a.   Extend a reaching pole to the woman and pull her to safety.

b.   Reach across the rescue tube, grasp the woman under her armpits and help her get her balance to stand up.

c.   Rest the rescue tube under the woman’s knees, help her grab onto the side of the deck and lift her out of the water.

d.   Throw a rescue tube to the woman and have her swim to safety.

16.   While scanning your zone, you notice a person motionless in the water. The steps you follow in a water emergency are performed in the following order:

a.   Perform a secondary assessment, perform a primary assessment, size-up the scene, activate the emergency action plan (EAP), and summon EMS personnel.

b.   Perform a primary assessment, activate the EAP, summon EMS personnel, perform a secondary assessment and size-up the scene.

c.   Activate the EAP, enter the water, perform an appropriate rescue, move the victim to a safe exit point, remove the victim from the water and provide emergency care as needed.

d.   Size-up the scene, activate the EAP, summon EMS personnel, perform a primary assessment and perform a secondary assessment.

17.   It is the primary responsibility of the facility management to provide all but which of the following?

a.   Creating and reviewing policy and procedures.

b.   Addressing unsafe conditions.

c.   Training staff.

d.   Educating patrons about and enforcing facility rules.

18.   Primary responsibilities of a shallow water lifeguard include:

a.   Fixing the pool rope and lane lines and ensuring the changing rooms are clean.

b.   Following the health codes, answering a patron’s question and making sure patrons shower before using the pool.

c.   Inspecting the pool and rescue equipment before the facility opens and paying close attention to patrons in the water by actively scanning the assigned area.

d.   Passing out the pool rules to all the patrons.

19.   While caring for someone with a suspected spinal injury, you secure the straps on a backboard in the following order:

a.   Feet, thighs, arms, head.

b.   Hands, legs, upper chest.

c.   Head, upper chest, hands, thighs.

d.   Upper chest, hips, thighs.

20.   The hazard communication standard includes having MSDS information available. What is included in this information?

a.   Contains information about what first aid and rescue equipment is required to have on hand

b.   Contains information about what type of chemicals are in use at the facility

c.   Contains information about areas of the facility that have unsafe conditions, which require repairs

d.   Contains information that is only important for the facility manager is required to know

21.   You notice a patron that is swimming laps who suddenly slips under water without a struggle and does not resurface. This person is probably:

a.   A distressed swimmer who needs help.

b.   A passive victim who needs help.

c.   An active victim who needs help.

d.   An intermediate swimmer who does not need help.

22.   You recognize that there is an emergency. You size-up the scene, alert other lifeguards, perform the appropriate rescue, conduct a primary assessment, care for the victim and perform a secondary assessment. You most likely are:

a.   Participating in an in-service training.

b.   Providing a demonstration during a safety presentation.

c.   Following the steps of the facility’s EAP.

d.   Preparing to give care to passive victim.

23.   Three shallow water lifeguards are on duty, emergency back-up coverage takes place when:

a.   A lifeguard is unable to show up to work for their shift.

b.   Whenever the facility EAP is activated.

c.   When a lifeguard enters the water for a rescue.

d.   The facility has more patrons than its designed capacity allows.

24.   When caring for a suspected head, neck or spinal injury in water, proper manual in-line stabilization is:

a.   Less important than on land due to the support provided by the water.

b.   Provided using the head splint technique.

c.   The only necessary technique needed if EMS personnel are close by.

d.   Provided by bystanders if the lifeguard needs to clear the pool.

25.   When providing care to a conscious person you suspect of a having head, neck or spinal injury and who was injured from a fall on the pool deck:

a.   You do not survey the scene since the person needs immediate attention.

b.   Consent is implied because the victim needs manual stabilization to keep from being further injured.

c.   You do not need to do a secondary assessment since head, neck and spinal injuries are the most serious.

d.   You do not move the victim unless the scene becomes unsafe.

26.   Which of the following is the least important for a safe group visit to a pool?

a.   Knowing how to identify the group’s leaders or chaperones

b.   Having appropriate number of lifeguards available to cover all zones

c.   Ensuring there are multiple activities planned for the group

d.   Ensuring that patrons stay in the sections of the pool that are appropriate for their swim ability

27.   Which of the following is true about accidental fecal releases (AFRs)?

a.   AFRs do not require immediate attention.

b.   Managers only need to be concerned with AFRs.

c.   Require water treatment, temporary pool closure and immediate lifeguard attention.

d.   It is part of the routine daily operation of a pool that must be done for safety.

28.   Which of the following is true if the manager of the facility has assigned you as the only lifeguard conducting patron surveillance?

a.   You have been assigned to total coverage.

b.   You have been assigned to back-up coverage.

c.   You have been assigned to zone coverage.

d.   You have been assigned to a lifeguard station.

29.   Which of the following pieces of equipment only needs to be easily accessible for emergency use:

a.   Rescue tube, manual suction device

b.   Backboard, AED

c.   Resuscitation mask, bag-valve-mask resuscitator

d.   Gloves, first aid kit

30.   While actively scanning the pool, you witness a patron struggling while swimming and then go under water. Which of the following applies?

a.   You have duty to act and perform the appropriate rescue.

b.   You would use the RID factor to determine what to do.

c.   You should continue to scan the pool until emergency back-up coverage is available.

d.   You should notify off duty lifeguards to provide care for the victim.

31.   While you are conducting a safety check, you find a section of the pool gutter cover is missing. You should:

a.   Clear the winding river and close for the day.

b.   Close off the area and tell the lifeguard supervisor right away.

c.   Make a note of it or come back to it during your next break.

d.   Watch the area closely so nobody gets hurt.

32.   Two lifeguards are on surveillance duty during a public swim. You are on a break. One lifeguard activates the facility’s EAP for a submerged passive victim and enters the water. Which steps should you take next to assist in the rescue?

a.   Notify the manager to assist.

b.   Bring the backboard to the lifeguard and assist in removing the victim from the water as the other lifeguard clears the pool.

c.   Provide emergency total coverage while the other lifeguards assist the victim.

d.   Instruct bystanders how to assist the lifeguard, document witness accounts and provide crowd control.

33.   You are responsible for a part of the kiddie pool for total zone coverage. To effectively scan, you must:

a.   Count all the patrons in your area of responsibility.

b.   Focus primarily on blind spots.

c.   Keep your head still but use your eyes to scan your area.

d.   Move your head and eyes as you scan to look directly at each area rather than staring in a fixed direction.

34.   You enter the mechanical room and find a maintenance worker lying on his back on the floor next to a ladder. You check the scene and determine it is safe to enter. During your primary assessment, you find the victim is unconscious but breathing. You must leave to get help, what should you do?

a.   Move him into the H.A.IN.E.S. position.

b.   Leave him just as he is.

c.   Do not leave him since he is breathing, monitor his condition and wait for additional help to come.

d.   Use a clothes drag to move him to where you can summon more help.

35.   You notice a patron in the water whose body is diagonal and who is waving to attract your attention. The arms and legs are moving to keep the person’s head above water, but there is no forward progress. This person is probably:

a.   A distressed swimmer who needs help.

b.   A passive victim who needs help.

c.   An active victim who needs help.

d.   An intermediate swimmer who does not need help.

—DO NOT WRITE ON THIS EXAM—

Section 2—Shallow Water Lifeguarding Skills
Exam B

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Section 2—Shallow Water Lifeguarding Skills
Exam B

1.   A child falls backwards from a water play structure in extremely shallow water. She can not stand up. You suspect a head, neck or spinal injury, you should:

a.   Wait for other lifeguards to assist in lifting the child out of the water and onto the pool deck.

b.   Provide manual stabilization placing your hands on either side of her head until more help arrives.

c.   Use the head splint technique from the victim’s side and gently move her to deeper water.

d.   Get consent from a parent then quickly backboard her and remove her from the water.

2.   A child is in distress and is near the side of the pool. When using the reaching assist with a rescue tube to help the child, you should:

a.   Extend a rescue tube to the child and pull the child to safety.

b.   Enter the water and slide the child onto a backboard.

c.   Kneel on the pool deck, extend a ring buoy to the child and pull the child to safety.

d.   Throw a rescue tube to the child and have the child swim to safety.

3.   A head, neck or spinal injury rarely happens:

a.   In deep water at a supervised facility.

b.   When someone strikes a properly inflated inner tube.

c.   In shallow water that is clearly signed No Diving.

d.   From collisions between swimmers.

4.   A shallow water lifeguard keeps an eye on the patrons of the pool, checking the bottom, middle and surface of the water. He is demonstrating:

a.   Effective communication.

b.   Effective scanning.

c.   Implied consent.

d.   The RID factor.

5.   A mother walks her son over to you stating that he fell on the pool deck and hit his head. You notice he has blood and fluid running from his ear and he is feeling dizzy. What steps should you take next?

a.   Have the mother transport him to the emergency room since he is already walking.

b.   Bring him to the pool office to sit down and provide manual stabilization.

c.   Have him lie down on the pool deck and provide manual stabilization until EMS personnel arrive.

d.   Provide manual stabilization while the other lifeguards prepare to backboard him.

6.   A shallow water lifeguard may expect to have total coverage surveillance responsibility assigned when:

a.   There is a 5-foot plunge slide over 8 feet of water.

b.   There are diving boards in use.

c.   There is a winding river with a current with adults walking and children using lifejackets.

d.   The lap pool depth varies from 3 feet to 7 feet in depth.

7.   A simple assist may be used by a shallow water lifeguard when:

a.   A passive victim is submerged in 2 feet of water.

b.   Two victims are clutching each other in 5 feet of water.

c.   A child has fallen on the pool deck and is lightly bleeding from a scraped knee.

d.   A second lifeguard is rescuing a passive victim and requires assistance.

8.   A technique used for a victim with a suspected head, neck or spinal injury who is face-down, at the surface and in water less than 3 feet deep is the:

a.   Arm splint technique.

b.   Head splint technique.

c.   Head support technique.

d.   Anatomical splint technique.

9.   During an in-service training, lifeguards practice the steps of an emergency action plan, such as:

a.   Conducting safety checks before, during and after pool hours.

b.   Following rescue procedures, informing management and conducting staff debriefings.

c.   Getting a patron’s attention, explaining unsafe behaviors and discussing safe activities.

d.   Telling patrons the rules and regulations.

10.   While scanning your zone, you notice a person motionless in the water. The steps you follow in a water emergency are performed in the following order:

a.   Perform a secondary assessment, perform a primary assessment, size-up the scene, activate the emergency action plan (EAP), and summon EMS personnel.

b.   Perform a primary assessment, activate the EAP, summon EMS personnel, perform a secondary assessment and size-up the scene.

c.   Activate the EAP, enter the water, perform an appropriate rescue, move the victim to a safe exit point, remove the victim from the water and provide emergency care as needed.

d.   Size-up the scene, activate the EAP, summon EMS personnel, perform a primary assessment and perform a secondary assessment.

11.   In the event of thunder and lightning at an outdoor facility, lifeguards should:

a.   Clear everyone from the water and send them into the locker room to take showers during the thunderstorm.

b.   Clear everyone from the water at the first sound of thunder or first sighting of lightning.

c.   Keep watching for lightning strikes near the facility while patrons continue to swim.

d.   Keep watching for more storms and monitor weather reports while patrons continue to swim.

12.   It is the primary responsibility of the facility management to provide all but which of the following?

a.   Creating and reviewing policy and procedures

b.   Addressing unsafe conditions

c.   Training staff

d.   Educating patrons about and enforcing facility rules

13.   One of the primary responsibilities of a shallow water lifeguard includes:

a.   Filling out required records and reports on schedule and submitting them to the proper person or office.

b.   Working with other lifeguards, facility staff and supervisors as a team.

c.   Monitoring the performance of the other lifeguards on duty.

d.   Performing maintenance or other tasks assigned by his or her supervisor.

14.   While caring for someone with a suspected spinal injury, you secure the straps on a backboard in the following order:

a.   Feet, thighs, arms, head.

b.   Hands, legs, upper chest.

c.   Head, upper chest, hands, thighs.

d.   Upper chest, hips, thighs.

—DO NOT WRITE ON THIS EXAM—

15.   Signs and symptoms of a person you suspect of a head, neck or spinal injury include:

a.   Changes in skin color, temperature and feel.

b.   Back pain or tingling.

c.   Pressure or pain in the chest.

d.   Rigid, tender, or bruised abdomen.

16.   The failure to recognize a victim who is drowning, the intrusion of secondary duties on a lifeguard’s primary responsibility of patron surveillance and the distraction from patron surveillance duties are elements of:

a.   A policies and procedures manual.

b.   An aquatic safety team.

c.   The FIND model.

d.   The RID factor.

17.   Three shallow water lifeguards are on duty, emergency back-up coverage takes place:

a.   When a lifeguard is unable to show up to work for their shift.

b.   Whenever the facility EAP is activated.

c.   When a lifeguard enters the water for a rescue.

d.   When the facility has more patrons than its designed capacity allows.

18.   When caring for a suspected head, neck or spinal injury in water, proper manual in-line stabilization is:

a.   Less important than on land due to the support provided by the water.

b.   Provided using the head splint technique.

c.   Is only necessary if EMS personnel are not close by.

d.   Provided by bystanders if the lifeguard needs to clear the pool.

19.   When performing patron surveillance at a pool with play structures:

a.   It is necessary to have at least one lifeguard for every three slides.

b.   It is not necessary to wear your rescue tube.

c.   Pay close attention to nonswimmers or weak swimmers.

d.   Pay less attention to sprays and fountains.

20.   When providing care to a conscious person you suspect of having a head, neck or spinal injury and who was injured from a fall on the pool deck:

a.   You do not survey the scene since the person needs immediate attention.

b.   Consent is implied because the victim needs manual stabilization to keep from being further injured.

c.   You do not need to do a secondary assessment since head, neck and spinal injuries are the most serious.

d.   You do not move the victim unless the scene becomes unsafe.

21.   Which of the following is the least important for a safe group visit to a pool?

a.   Knowing how to identify the group’s leaders or chaperones

b.   Having appropriate number of lifeguards available to cover all zones

c.   Ensuring there are multiple activities planned for the group

d.   Ensuring that patrons stay in the sections of the pool that are appropriate for their swim ability

22.   Which of the following is true if the manager of the facility has assigned you as the only lifeguard conducting patron surveillance?

a.   You have been assigned to total coverage.

b.   You have been assigned to back-up coverage.

c.   You have been assigned to zone coverage.

d.   You have been assigned to an elevated lifeguard station.

23.   Which of the following pieces of equipment must a lifeguard have instantly accessible at all times.

a.   Rescue tube, bag-valve-mask resuscitator, an automated external defibrillator (AED)

b.   Rescue board, ring buoy, resuscitation mask

c.   Backboard, first aid supplies, oxygen

d.   Gloves, resuscitation mask, rescue tube

24.   While performing patron surveillance during a beginner swim class, you would prevent patron injuries by:

a.   Helping the instructor teach the class when the students practice floating skills.

b.   Monitoring only the students who are at a distance from the side of the pool.

c.   Scanning the students in your area of responsibility.

d.   Showing the students the simple assist skill.

25.   While actively scanning the pool, you witness a patron struggling while swimming and then go under water. Which of the following applies?

a.   You have duty to act and perform the appropriate rescue.

b.   You would use the RID factor to determine what to do.

c.   You should continue to scan the pool until emergency back-up coverage is available.

d.   You should notify off duty lifeguards to provide care for the victim.

26.   While you are conducting a safety check, you find a section of the pool gutter cover is missing. You should:

a.   Clear the winding river and close for the day.

b.   Close off the area and tell the lifeguard supervisor right away.

c.   Make a note of it or come back to it during your next break.

d.   Watch the area closely so nobody gets hurt.

27.   Two lifeguards are on surveillance duty during a public swim. You are on a break. One lifeguard activates the facility’s EAP for a submerged passive victim and enters the water. Which steps should you take next to assist in the rescue?

a.   Notify the manager to assist.

b.   Bring the backboard to the lifeguard and assist in removing the victim from the water as the other lifeguard clears the pool.

c.   Provide emergency back-up coverage while the other lifeguards assist the victim.

d.   Instruct bystanders how to assist the lifeguards, document witness accounts, and provide crowd control.

28.   You are assigned zone coverage of a shallow water attraction. To provide adequate patron surveillance, you should:

a.   Follow the facility’s EAP.

b.   Make sure that other lifeguards have total coverage of the area.

c.   Check patrons in all areas of the facility during your rotation.

d.   Provide effective scanning of your assigned zone.

29.   You are responsible for a part of the pool that can be easily viewed from your lifeguard station. To effectively scan, you must:

a.   Count all the patrons in your area of responsibility.

b.   Focus primarily on blind spots.

c.   Keep your head still but use your eyes to scan your area.

d.   Move your head and eyes as you scan to look directly at each area rather than staring in a fixed direction.

30.   You are the lifeguard on duty at the spa therapy pool when you notice a patron holding her breath repeatedly for extended periods of time. What should you do?

a.   Activate the facility EAP, clear the area and remove her from the pool.

b.   Immediately get the attention of the patron and instruct her to leave the pool for breaking pool rules.

c.   Immediately stop her from continuing the activity and explain the dangers of the activity.

d.   Alert the pool manager of the situation once your shift is over and document the event.

31.   You are walking through the park on your way to the pool to report for duty and witness an adult suddenly collapse while playing catch with his son. You survey the scene to be sure it is safe and then decide to perform CPR on the adult victim. Which legal consideration applies?

a.   Duty to act

b.   Standard of care

c.   Good Samaritan law

d.   Negligence

32.   You can remain alert and reduce fatigue during your shift by:

a.   Practicing entries and rescue approaches while on surveillance duty.

b.   Practicing risk-management techniques.

c.   Rotating from station to station.

d.   Staying at one station.

33.   You enter the mechanical room and find a maintenance worker lying on his back on the floor next to a ladder. During your primary assessment, you find the victim unconscious but breathing. You must leave to get help, what should you do?

a.   Move him into the H.A.IN.E.S. position.

b.   Leave him just as he is.

c.   Do not leave him since he is breathing, monitor his condition and wait for additional help to come.

d.   Use a clothes drag to move him to where you can summon more help.

34.   You find a patron lying on the locker room floor. You suspect she has a head, neck or spinal injury because she has:

a.   An elevated body temperature.

b.   An irregular heartbeat.

c.   Blood in the ears and nose.

d.   Impaired hearing.

35.   You notice a patron who is swimming laps suddenly slips underwater without a struggle and does not resurface. This person is probably:

a.   A passive victim who needs help.

b.   A distressed swimmer who needs help.

c.   An active victim who needs help.

d.   An intermediate swimmer who does not need help.

FINAL WRITTEN EXAM:  WATERFRONT SKILLS MODULE

    Final Written Exam A

    Final Written Exam B

—DO NOT WRITE ON THIS EXAM—

Waterfront Skills Module
Exam A

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Waterfront Skills Module
Exam A

1.   You are a lifeguard on duty at a waterfront facility and notice a swimmer in distress 100 feet outside the designated swim area. You should:

a.   Ignore distractions that are outside the designated swim area and your assigned zone of coverage.

b.   Initiate the facility EAP and use the available rowboat to rescue the distressed swimmer.

c.   Alert other nearby lifeguards and monitor the situation.

d.   Prepare to use the available backboard for a two-person removal from the water and initiate the facility EAP.

2.   Which of the following is not a strategy to be used while on duty at a waterfront facility?

a.   Assigning buddy pairs and calling for periodic buddy checks

b.   Monitoring water and weather conditions

c.   Classifying swimmers and designating swimming areas based on swimmer abilities

d.   Clearing the facility for frequent facility safety checks

3.   A lifeguard at a waterfront needs to have which of the following pieces of equipment only accessible to him or her while on duty?

a.   Mask, snorkel, and fins

b.   Whistle, rescue tube and resuscitation mask

c.   Rescue tube, gloves and emergency oxygen

d.   Gloves, resuscitation mask and an automated external defibrillator

4.   A lifeguard on duty should keep which of the following in mind when working at a waterfront area:

a.   The in-water stabilization care for head, neck and spinal injuries is significantly modified.

b.   The RID factor.

c.   Specialized rescue equipment may be present.

d.   There are not a maximum number of people in his/her assigned zone of coverage.

5.   Lifeguards are conducting a deep-water line search to locate a submerged victim. To see more clearly and cover more distance with less effort, the lifeguards should:

a.   Ask patrons to participate in the search.

b.   Use a watercraft.

c.   Use extra oars and paddles.

d.   Wear a mask and fins.

6.   At a summer youth camp, lifeguards may use swim classifications as an injury-prevention strategy to:

a.   Allow campers to only enter areas appropriate to their swimming capability.

b.   Familiarize campers with water safety rules and regulations prior to in-water activities.

c.   Pair camp participants with different swimming abilities.

d.   Teach campers to continuously monitor their partners.

7.   During a safety check at a waterfront facility, you find an area with a large amount of debris in the water. You should close off the area, inform your supervisor and:

a.   Alert patrons by using signs, buoys and safety announcements.

b.   Expect the other lifeguards in the area to tell the patrons.

c.   Move your lifeguard station away from the area.

d.   Wait to see if any patrons swim in the area before alerting the patrons.

8.   During a safety check, you determine the water temperature of the lake is very cold due to a recent rain. You should:

a.   Alert patrons to the cold water and watch for signs of hypothermia.

b.   Expect the other lifeguards to warn patrons.

c.   Focus on water depth since the water temperature is safe.

d.   Wait to see if any swimmers notice the water temperature before alerting the other patrons.

—DO NOT WRITE ON THIS EXAM—

9.   At a summer youth camp, lifeguards use injury-prevention strategies, such as:

a.   Back-up coverage.

b.   Buddy pairs.

c.   The FIND model.

d.   The RID factor.

10.   High winds are creating large waves and impairing visibility at a waterfront facility. You should:

a.   Clear the patrons from the waterfront and move indoors.

b.   Let patrons continue swimming.

c.   Let patrons sit on the edge of the floating platform with their feet in the water.

d.   Monitor weather reports while patrons continue to swim.

11.   When you are performing patron surveillance at the outer edge of a waterfront swimming area, you may be watching swimmers from a:

a.   Ground-level position.

b.   Rescue tube.

c.   Rescue watercraft.

d.   An elevated station.

12.   While performing patron surveillance at a waterfront facility during a summer youth camp, you would prevent patron injuries by:

a.   Helping the staff organize a swimming game when the campers move to deep water.

b.   Monitoring only the campers who are not wearing life jackets.

c.   Scanning the campers in your area of responsibility.

d.   Showing the campers the simple assist skill.

13.   While you are conducting a safety check, you find several nails sticking out from the pier. You should:

a.   Clear the lake and close the entire swimming area for the day.

b.   Close off the area and tell the lifeguard supervisor right away.

c.   Make a note of it or come back to it during your next break.

d.   Watch the area closely so nobody gets hurt.

14.   You see a distressed swimmer in the outer boundaries of a swimming area. To approach the victim using a motorized watercraft, you should:

a.   Approach quickly to reach the victim promptly.

b.   Point the bow toward the victim.

c.   Approach from downwind and down current.

d.   Approach the victim from the side with the engine in neutral and at idle.

15.   When launching a rescue board, you should:

a.   Climb on just behind the middle of the rescue board and lie down.

b.   Hold the rescue board in the air until the water reaches your waist.

c.   Lay the rescue board on the shoreline and push it forward before you enter the water.

d.   Straddle the end of the rescue board and remain in a seated position.

Waterfront Skills Module
Exam B

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Waterfront Skills Module
Exam B

1.   Which of the following statements is true for waterfront lifeguarding?

a.   Water and weather conditions usually change slowly and only need to be checked at the beginning of the day.

b.   Motorized watercraft, rowboats and rescue boards are available at most waterfront facilities for emergency use.

c.   Lifeguards need specialized training during orientation and in-service training on the use of equipment and procedures specific to the facility.

d.   Patrons at waterfronts tend to be generally better swimmers than those at swimming pools.

2.   You are on duty at a waterfront facility and notice lightning in approaching storm clouds. You should:

a.   Immediately locate and inform the waterfront director of the situation and wait for further instruction.

b.   Initiate the facility EAP, clear the area and direct participants to areas of safety indoors.

c.   Alert other staff, monitor the situation, wait until you hear thunder or see lightening to clear the area.

d.   Initiate the facility EAP, post signs stating lifeguards are no longer on duty and inform patrons that they may continue to swim at their own risk.

3.   You approach a patron standing still in waist-deep water at a waterfront facility. The victim is shaking, not speaking clearly and has blue lips. You should most likely care for:

a.   Seizure.

b.   Choking.

c.   Hypothermia.

d.   Stroke.

4.   As you are lifeguarding a youth group using the buddy system, one of the youth tells you his buddy is missing. You should:

a.   Initiate the facility EAP and immediately perform a deep-water line search.

b.   Signal for a buddy check.

c.   Initiate the facility EAP and perform a passive victim rescue.

d.   Clear the area and perform a facility safety check.

5.   Which of the following is not a strategy to be used while on duty at a waterfront facility?

a.   Assigning buddy pairs and calling buddy checks

b.   Monitoring water and weather conditions

c.   Classifying swimmers and designating swimming areas based on abilities

d.   Clearing the facility for frequent facility safety checks

6.   A lifeguard at a waterfront needs to have which of the following pieces of equipment only accessible to him or her while on duty?

a.   Whistle, rescue tube, and resuscitation mask

b.   Rescue tube, gloves, and backboard

c.   Mask, snorkel, and fins

d.   Gloves, rescue board, AED

7.   An item of special concern at a waterfront that a lifeguard should consider is:

a.   The in-water care for head, neck and spinal injuries is significantly modified.

b.   The RID factor.

c.   Specialized rescue equipment may be present.

d.   There are not a maximum number of people in his/her assigned zone of coverage.

8.   Lifeguards are conducting a deep-water line search to locate a submerged victim. To see more clearly and cover more distance with less effort, the lifeguards should:

a.   Ask patrons to participate in the search.

b.   Use a watercraft.

c.   Use extra oars and paddles.

d.   Wear a mask and fins.

9.   A man starts to fish in the swimming area. You blow your whistle to get his attention. Next, you enforce the rules and regulations by:

a.   Calling your supervisor.

b.   Giving him a warning.

c.   Telling him he cannot fish in the swimming area and suggesting other areas where he can fish.

d.   Telling him he might be asked to leave the campground and demanding he stop it now.

10.   If the water is murky during a deep-water line search, you should:

a.   Check the bottom by sweeping your hands back and forth in front of you, making sure to cover the entire area.

b.   Move the search to shallow water.

c.   Perform a different surface dive than the lifeguard next to you and increase the number of swimming strokes.

d.   Return to the surface at an angle.

11.   Several lifeguards start a deep-water line search for a missing swimmer in a lake. The first step is to:

a.   Form a straight line an arm’s length from each other, wearing masks and fins.

b.   Have a lifeguard on a watercraft search the area.

c.   Take turns diving in different directions.

d.   Take turns diving to the bottom and returning to the surface at a 90-degree angle.

12.   To enter the water with a mask and fins, it is important to:

a.   Put both hands over the mask and keep your elbows away from your chest.

b.   Put one hand over the mask and keep your elbow close to your chest.

c.   Step out and lean forward over the water.

d.   Swim, keeping your arms extended and your face above water.

13.   To take a cross bearing, two lifeguards should:

a.   Ask bystanders to swim toward the victim along their sight lines.

b.   Swim toward the victim based on where bystanders last remember seeing the victim from one angle.

c.   Take a sighting on the spot where the victim was last seen based on who was closest to the victim.

d.   Take a sighting from two different angles on the spot where the victim was last seen going underwater.

14.   You are searching for a missing swimmer in shallow water, but cannot see the bottom. You should:

a.   Conduct a deep-water line search.

b.   Conduct a shallow-water line search.

c.   Move to water that is greater than chest depth.

d.   Wear a mask and fins.

15.   When launching a rescue board, you should:

a.   Climb on just behind the middle of the rescue board and lie down.

b.   Hold the rescue board in the air until the water reaches your waist.

c.   Lay the rescue board on the shoreline and push it forward before you enter the water.

d.   Straddle the end of the rescue board and remain in a seated position.

FINAL WRITTEN EXAM:  WATERPARK SKILLS MODULE

    Final Written Exam A

    Final Written Exam B

—DO NOT WRITE ON THIS EXAM—

Waterpark Skills Module
Exam A

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Waterpark Skills Module
Exam A

1.   A safety check at a waterpark may include which of the following?

a.   Unusual noises, missing pieces or mildewed safety netting

b.   Checking the facility grounds for a lost child

c.   Posting rules and closing attractions because of a shortage of lifeguards

d.   Checking to confirm a patron meets height restrictions for an attraction

2.   When assigned to roving station on the zero-depth area of a wave pool, a lifeguard should:

a.   Use the head and chin support for manual inline stabilization for a suspected neck injury in extremely shallow water.

b.   Use a run-and-swim entry during a rescue.

c.   Be assigned to total coverage for a large number of patrons.

d.   Assist non-swimmers with the proper fitting of lifejackets provided by the waterpark.

3.   Some of the unique challenges of a waterpark facility compared with other aquatic facilities are:

a.   The number of patrons visiting and their ages.

b.   The types of rescue equipment and supplies required.

c.   The variety and number of attractions and features at the facility.

d.   The availability of concessions stands provides greater chance of food and drinks on the pool deck.

4.   Which statement is true about rules at a waterpark?

a.   Rules do not need to be posted when announced over a public address system.

b.   Rules should only be posted in the changing room since that is the one place everyone visits.

c.   There should be limited number of rules posted so visitors will take the time to read them.

d.   Rules should be posted near each attraction providing specific information about that attraction.

5.   Every waterpark lifeguard should have which of the following equipment immediately available to them at all times?

a.   A rescue tube, gloves and resuscitation mask

b.   Personal protective equipment, bodily fluid cleanup and first aid supplies

c.   Radio, rescue tube and bag-valve-mask resuscitator

d.   An automated external defibrillator, emergency oxygen and manual suction device

6.   A person is lying in the run out area of a speed slide and does not sit up. You approach the victim and he states that his toes, feet and legs are tingling. You should:

a.   Have him rest in place and see if the condition changes.

b.   Notify the dispatch lifeguard and have staff proceed with a safety check of the attraction.

c.   Prepare to care for the victim for a head, neck or spinal injury.

d.   Ask him for consent to help and immediately perform a secondary assessment.

7.   You are assigned a zone at the deep end of a crowded wave pool. You see an active adult victim in your zone. You should:

a.   Activate the facility’s emergency action plan (EAP), wait for all the wave action to stop and enter the water.

b.   Time your entry for the trough of the next wave, rescue the victim and signal other lifeguards for assistance if needed.

c.   Activate the facility’s EAP, motion to other lifeguards the victim’s location and toss the victim a ring buoy.

d.   Activate the facility’s EAP, time you entry for the crest of the next wave, use a compact jump entry and make the appropriate rescue.

8.   A lifeguard is responsible for the splash down area of a waterslide. She notices an adult patron exit the slide and collide with a child patron moving toward the slide exit. Both victims are now submerged. The lifeguard might:

a.   Expect the child to have a head, neck or spinal injury.

b.   Activate the facility’s EAP, retrieve the backboard and request assistance.

c.   Activate the facility’s EAP, approach the victims and perform a multiple victim rescue.

d.   Monitor the victims to see if they appear to be injured or need assistance prior to taking any other action.

9.   A large number of patrons are swimming in the wave pool. For effective patron surveillance, your supervisor decides to add another lifeguard station and tells you to modify the zone coverage based on the new station to:

a.   Allow the lifeguards to take turns scanning the good swimmers.

b.   Allow the lifeguards to take turns walking up and down the deck.

c.   Increase the number of patrons watched by each lifeguard.

d.   Reduce the number of patrons watched by each lifeguard.

10.   A lifeguard starts to rescue a patron in the deep-water section of a wave pool. For effective patron surveillance, the other lifeguards should stand in their chairs and adjust their zone coverage to:

a.   Decrease the number of lifeguards with fatigue.

b.   Exclude the rescuing lifeguard’s area of responsibility.

c.   Include the rescuing lifeguard’s area of responsibility.

d.   Increase the number of safety checks at each attraction.

11.   A man exits from a drop-off slide into the catch pool. He surfaces and is in distress. You activate the EAP and then extend a rescue tube to the man. The next steps include:

a.   Completing a report and discussing the emergency with bystanders.

b.   Completing a report and talking to the media.

c.   Pulling him to safety and checking the rescue tube for damage.

d.   Pulling him to safety and providing additional care.

12.   You are responsible for a part of the wave pool that can be easily viewed from your lifeguard station. To effectively scan, you must:

a.   Count all the patrons in your area of responsibility.

b.   Focus primarily on blind spots.

c.   Keep your head still but use your eyes to scan your area.

d.   Move your head and eyes as you scan to look directly at each area rather than staring in a fixed direction.

13.   You are the dispatch lifeguard on a slide at a waterpark and notice the handrail has become detached. Which of the following statements is true?

a.   You should close the attraction as soon as those currently in line have had their turn.

b.   You should immediately close the attraction and notify the facility management.

c.   You can ignore the issue since it will be corrected during the next facility safety check.

d.   You should use signs and ropes to alert patrons of the hazard and continue operating the attraction.

14.   During an in-service training, which of the following would not be part of a facility’s EAP?

a.   Stopping the wave machine by pushing the emergency stop button.

b.   Stopping the dispatch of riders on a slide.

c.   Stopping the flow of water creating a current in a winding river.

d.   Stopping patrons from exiting the wave pool.

15.   At a waterpark, one step of an EAP may include:

a.   Assisting with in-service trainings.

b.   Monitoring the water chemistry.

c.   Opening the facility.

d.   Stopping the slide dispatch.

Waterpark Skills Module
Exam B

IMPORTANT: Read all instructions before beginning the exam.

INSTRUCTIONS: Mark all answers in pencil on a separate answer sheet. Do not write on this exam. The questions on this exam are multiple choice. Read each question carefully. Then choose the best answer and fill in that circle on the answer sheet. If you wish to change an answer, erase your first answer completely. Return this exam to your instructor when you are finished.

XX. Why does the American Red Cross teach this course?

a.   To help people stay calm in emergencies.

b.   To help people make appropriate decisions when they are confronted with an emergency.

c.   To help people in an emergency keep a victim’s injuries from getting worse until emergency medical services (EMS) personnel arrive and take over.

d.   All of the above

—DO NOT WRITE ON THIS EXAM—

Waterpark Skills Module
Exam B

1.   A person is lying in the run out area of a speed slide and does not sit up. You approach the victim and he states that his toes, feet and legs are tingling. You should:

a.   Have him rest in place and see if the condition changes.

b.   Notify the dispatch lifeguard and have staff proceed with a safety check of the attraction.

c.   Prepare to care for the victim for a head, neck or spinal injury.

d.   Ask him for consent to help and immediately perform a secondary assessment.

2.   During an in-service training, which of the following would not be part of a facility’s emergency action plan (EAP)?

a.   Stopping the wave machine by pushing the emergency stop button

b.   Stopping the dispatch of riders on a slide

c.   Stopping the flow of water creating a current in a winding river

d.   Stopping patrons from exiting the wave pool

3.   You are the dispatch lifeguard on a slide at a waterpark and notice the handrail has become detached. Which of the following statements is true?

a.   You should close the attraction as soon as those currently in line have had their turn.

b.   You should immediately close the attraction and notify the facility management.

c.   You can ignore the issue since it will be corrected during the next facility safety check.

d.   You should use signs and ropes to alert patrons of the hazard and continue operating the attraction.

4.   When assigned to a roving station on the zero depth area of a wave pool a lifeguard should:

a.   Use the head and chin support for manual inline stabilization for a suspected neck injury in extremely shallow water.

b.   Use a run-and-swim entry during a rescue.

c.   Be assigned to total coverage for a large number of patrons.

d.   Assist non-swimmers with the proper fitting of lifejackets provided by the waterpark.

5.   You are assigned a zone at the deep end of a crowded wave pool. You see an active adult victim in your zone. You should:

a.   Activate the facility’s emergency action plan (EAP), wait for all the wave action to stop and enter the water.

b.   Time you entry for the trough of the next wave, rescue the victim and signal other lifeguards for assistance if needed.

c.   Activate the facility’s EAP, motion to other lifeguards the victim’s location and toss the victim a ring buoy.

d.   Activate the facility’s EAP, time your entry for the crest of the next wave, use a compact jump entry and make the appropriate rescue.

6.   A lifeguard is responsible for the splash down area of a waterslide. She notices an adult patron exit the slide and collide with a child patron moving toward the slide exit. Both victims are now submerged. The lifeguard might:

a.   Activate the facility’s EAP, retrieve the backboard, and request assistance.

b.   Activate the facility’s EAP, approach the victims and perform a multiple victim rescue.

c.   Monitor the victims to see if they appear to be injured or need assistance prior to taking any other action.

d.   Expect the child to have a head, neck or spinal injury.

7.   A conscious patron needs help getting out of a pool that has a zero-depth exit. He does not have a head, neck or spinal injury. To effectively remove the patron from the water, you should:

a.   Have the patron swim to the closest railing.

b.   Perform the head and chin support.

c.   Slide the patron onto a backboard.

d.   Use the walking assist.

8.   A lifeguard starts to rescue a patron in a shallow-water attraction at a waterpark. For effective patron surveillance, the lifeguard nearby should:

a.   Cover both his or her area of responsibility and the rescuing lifeguard’s area of responsibility.

b.   Focus only on the rescuing lifeguard’s area of responsibility.

c.   Leave his or her area of responsibility and find other lifeguards to assist with the rescue.

d.   Signal the other lifeguards to rotate stations.

9.   A man exits from a drop-off slide into the catch pool. He surfaces and is in distress. You activate the EAP and then extend a rescue tube to the man. The next steps include:

a.   Completing a report and discussing the emergency with bystanders.

b.   Completing a report and talking to the media.

c.   Pulling him to safety and checking the rescue tube for damage.

d.   Pulling him to safety and providing additional care.

10.   At a waterpark, lifeguards can remain alert and reduce fatigue during their shift by:

a.   Completing records and reports at their lifeguard stations

b.   Performing light cleaning tasks when stationed in the water for surveillance duty

c.   Rotating through different attractions or positions at an attraction

d.   Staying at one station or position at an attraction

11.   At a waterpark, one step of an EAP may include:

a.   Assisting with in-service trainings.

b.   Monitoring the water chemistry.

c.   Opening the facility.

d.   Stopping the slide dispatch.

12.   During a weather-related power failure, you hear thunder in the distance you should:

a.   Clear everyone from the water and move them to a safe area.

b.   Let patrons continue swimming.

c.   Let patrons sit on the edge with their feet in the water.

d.   Monitor weather reports while patrons continue to swim.

13.   The lifeguard supervisor expects the wave pool to be very busy in the afternoon. For effective patron surveillance, she sets up multiple lifeguard stations to reduce the number of patrons watched by each lifeguard. This type of coverage is called:

a.   Back-up coverage.

b.   Rescue coverage.

c.   Total coverage.

d.   Zone coverage.

14.   When performing patron surveillance at a child play structure at a waterpark:

a.   It is necessary to have at least one lifeguard for every three slides.

b.   It is not necessary to wear your rescue tube.

c.   You should pay close attention to non-swimmers or weak swimmers.

d.   Pay less attention to sprays and fountains.

15.   While you are conducting a safety check, you find a section of the pool gutter cover is missing. You should:

a.   Close the entire facility for the day.

b.   Close off the area and tell the lifeguard supervisor right away.

c.   Make a note of it or come back to it during your next break.

d.   Watch the area closely so nobody gets hurt.

ANSWER SHEET: CPR/AED for the Professional Rescuer and First Aid

Name: ______________________________________ Date: _________

ANSWER SHEET: Lifeguarding Skills

Name: ______________________________________ Date: _________

ANSWER SHEET: Shallow Water Lifeguarding Skills

Name: ______________________________________ Date: _________

ANSWER SHEET: Waterfront Skills Module

Name: ______________________________________ Date: _________

ANSWER SHEET: Waterpark Skills Module

Name: ______________________________________ Date: _________

INDEX

A

Active victim rescues, 66–70, 77–78, 143, 173

Activities, 3–4

Activity worksheets, 6, 145–150

Adults

choking by, 87–90, 96, 97

CPR on, 101–102, 108–109

giving ventilations to, 86

primary assessment of, 82, 90–91

AED. See Automated external defibrillator (AED)

Age prerequisite, 27

Agonal gasps, 50, 81

Airway obstructions, 87–89, 96–98

American Red Cross Lifeguarding program, 1–11

courses, 6

refresher program, 6

reporting procedures, 11

retail products, 6

American Red Cross Universal Certificate, 10, 33

Americans with Disabilities Act (ADA) Accommodation Resource Guide, 8, 9

Approaches, 43–44, 47

Aquatic facilities

rules and regulations of, 41–43, 49, 145–147

See also specific types of facilities

Aquatic sports, 57

Aspirin in cardiac emergencies, 100

Assignments, 4

Assisting and Co-Instructors, 8

Asthma, 85

Automated external defibrillator (AED), 16, 21

activity worksheet, 150

maintenance of, 105–106

precautions with, 105–106

skill assessment tool, 112

skill chart for, 111–112

use of, 103–106, 111–112

written exam for, 193–209

B

Backboards, 134–136

Bag-valve-mask (BVM) resuscitator, 87, 95–96

Beach drag, 163, 167–168, 187

Bites, 118

Bleeding, control of, 116–117, 128

Blind spots, 53

Bloodborne pathogens, 80

Bloodborne Pathogens Standard, 49

Body substance isolation (BSI), 80

Bone injuries, 120

Breastbone injuries, 129

Breathing emergencies, 15–16, 20–21, 84–85, 87–89

Buddy systems, 161–162

Burns, 118, 123

C

Cardiac arrest, 50, 100, 103

Cardiac Chain of Survival, 99–100

Cardiac emergencies, 16, 21, 99–113

Certificates, awarding completion, 11

Certification prerequisite, 155, 176, 179

Chest compressions, 101

Children

choking by, 87–89, 96, 97

CPR on, 101–102, 108–109

giving ventilations to, 86

primary assessment of, 82–83, 91

Choking, 87–89, 96–98

Classroom space, 7

Class safety, 8–9

Class size, 7, 152, 176

Co-instructors, 8

Cold water, 159

Communication systems, 162

Compact jump, 44, 46

Continuing education units, 11

Continuous swim, 30

Course length, 7, 152, 176

Course presentation, 5–6

CPR, 101–102

final written exam for, 193–209

skill assessment tool for, 109–110

skill chart for, 108–109, 110–111

two-rescuer, 102–103, 110–111

D

Decision making, 35

Defibrillation, 103

Diabetes, 121

Disease transmission, 79–80

Disposable gloves, removal of, 80, 90

Distraction, 53

Distressed swimmers, characteristics of, 51–52

Diving areas, rules and regulations of, 42–43, 146

Drowning process, 50

Drowning response behaviors, 51–52

E

EAPs. See Emergency action plans (EAPs)

Effective surveillance, 51–54, 156, 180

Emergencies

breathing, 15–16, 20–21, 84–85, 87–89

cardiac, 99–113

cold-related, 119, 159

on land, 80–81

Emergency action plans (EAPs), 43, 64–65, 162–163, 183

Emergency medical services (EMS), 1, 83

Emphysema, 85

Entries, 43–44, 46–47, 163, 166–167, 170, 186

Equipment, 5, 6, 153, 177

Escapes, 131–132

Exams. See Final written exams

F

Face-up position, 93

Facility

safety, 13–14, 18–19, 39–40, 48–49, 157–160, 180–182

management of, 48–49

FAST, 122

Fatigue, 53

Final In-Water Skill Scenarios, 4, 143

Final written exams, 4, 10, 18, 23

answer sheets and keys for, 262–285

for CPR/AED for the professional rescuer, 133, 141, 193–209

for first aid, 133, 141, 193–209

for head, neck and spinal injuries, 142, 210–243

for lifeguarding skills, 210–243

security of, 11

for Waterfront Skills module, 166, 244–252

for Waterpark Skills module, 185, 253–261

Final written exam answer sheets and keys, 262–285, A1–A20

Finger injuries, 129

Fins, 164, 170–171

First aid, 17, 22, 114–132

final written exam for, 193–209

scenarios, 120–123

Foot injuries, 129

Front-and-back carry, 163, 168, 187–188

G

Glare, 53, 54

Group visits, 62–64, 149, 161–162, 183

H

Hand injuries, 129

Hazard Communication Standard, 49

Head-hold escape, 125, 131

Head injuries

caring for, 123–124, 129–131, 133–140

final written exam for, 210–243

in-water scenario for, 143

Head splints, 136–138, 164, 168–169, 188–189

Health precautions, 9

Heart attack, 99–100

Heat, 53

Heat cramps, 119

Heat stroke, 119

Hot tubs, rules and regulations of, 43, 147

Human-knot activity, 38

Hypothermia, 119, 159

Hypoxia, 84

I

IACET. See Internet Association of Continuing Education and Training (IACET)

Illnesses

heat-related, 119

sudden, 116

Infants

choking by, 88, 89, 96–98

CPR on, 102, 103, 109–111

giving ventilations to, 86

primary assessment of, 82, 83, 91

recovery position for, 93

Injuries

common, 117–118

foot, 129

hand and finger, 129

head, neck and spinal, 17, 22, 123–124, 129–131, 133–140, 143

leg, 129

muscle, bone, and joint, 120

responding to, 116–120

rib and breastbone, 129

Injury prevention, 14, 19, 35

strategies for, 54–56

at waterfront facilities, 161–162

at waterpark facilities, 182–183

In-service training, 37, 45

Instructional classes, 57

Instructor aids, 8–9

Instructors

resources and materials for, 3–6

responsibilities, 2

video segments for training of, 4

Instructor’s Corner, 6

Internet Association of Continuing Education and Training (IACET), 11

In-water skills scenarios, 10–11, 18, 142–143

In-water skills sessions

breathing emergency, 89

drowning victim, 107–108

entries and approaches, 43–44

head, neck and spinal injuries, 135–137

lifeguard rotations, 60–61

rescue skills, 73–74, 89, 125–126

scanning, 60–61

skills review, 60, 125–126, 142

waterfront rescue skills, 163–165

waterpark rescue skills, 184

for when things do not go as practiced, 124–125

In-water ventilations, 125

J

Jaw-thrust (with head extension) maneuver, 94

Jaw-thrust (without head extension) maneuver, 94

Joint injuries, 120

L

Labor laws, 49

Laryngospasm, 50

Lecture points, 3

Legal considerations, 35–36

Leg injuries, 129

Lessons

objectives, 3

plans, 3–4

See also individual topics

Lifeguard evaluations, 37

Lifeguarding

organized groups, 62–64, 149, 161–162, 183

special attractions, 58–59, 148

variety of activities, 56–57

waterfront, 156–163

waterpark, 180–183

Lifeguarding course

completion criteria, 10–11

design of, 3–6

introduction to, 32–33

objectives of, 1

outline, 13–18

participants in, 1–2

precourse session, 25–26

purpose of, 1

setting up and running, 7–9

swimming skills evaluation, 27

written exam for, 210–226

Lifeguarding DVD Set, 4

Lifeguarding Instructor’s Manual, 3–4

Lifeguarding Manual, 3

Lifeguard rotations, 60–61

Life-threatening conditions, 54, 81–83

Lightning, 40, 55–56

M

Masks, 164, 170–171

Materials, equipment and supplies

for the class, 5

for the instructor, 5

for participants, 5

Material Safety Data Sheet (MSDS), 49, 118

Medical history, 126–127, 128

Modified H.A.IN.E.S. recovery position, 93

Monotony, 53

Mouth injuries, 118, 123

MSDS. See Material Safety Data Sheet (MSDS)

Multiple-rescuer response, 107–108, 113

Multiple victim rescues, 71

Murky water, 53

Muscle injuries, 120

N

Neck injuries

caring for, 123–124, 129–131, 133–140

in-water scenario for, 143

written exam for, 210–243

Negligence, 36

Non-life-threatening conditions, 54–55

Nosebleeds, 118

O

Objectives, testing, 8

Occupational Safety and Health Administration (OSHA), 49, 80

Open swimming, 56

Organized activities, 56

Orientation sessions, 36–37

Oxygen, 85

P

Participants

course evaluation form, 11

with disabilities and special health considerations, 9

health precautions for, 9

resources for, 3, 6

Passive victim rescues, 69–70, 76, 143, 173–174

Patron loads

heavy, 53, 54

low, 53

Patrons, communication with, 55

Patron surveillance, 14, 19, 50–54, 160–161, 180, 182

Personal protective equipment (PPE), 80

Physical structures, in water, 157

Play structures, 58

Poison Control Center, 118

Poisoning, 118–119

Policies and procedures manual, 37

Power failures, 40

Precourse session, 13, 18, 25–31

age prerequisite verification, 27

counseling after, 29

introduction to, 25–26

swimming skills evaluation, 27–29

wrap-up, 29

Prerequisite skills, 25–26, 30–31, 154–155, 176

Primary assessments, 81–83, 90–92

Professionalism, 34, 45

Professional lifeguards, 13, 18–19, 33–35

characteristics of, 33–34

continuation of training for, 36–37

responsibilities of, 34, 45

R

Recovery positions, 93

Recreational swimming, 56

Rescue boards, 165, 173–174

Rescue equipment, 39

Rescues

active victim front, 66, 68, 70

active victim rear, 66, 69–70

in cold water, 159

deep water, 75, 76, 164, 172–174

multiple-rescuer response, 107–108, 113

multiple victim, 71

at or near surface, 65–69

passive victim, 69, 70, 76, 143, 173–174

simple assist, 68

submerged victim, 73–76, 160–161

two-person removals, 74, 77–78

Rescue skills, 14–15, 19–20

in-water skill session for, 65–67, 73–74, 125–126

waterfront, 163–165

waterpark, 183–184

Rescue tube, 39

Rescue Tube Relay, 61

Respiratory arrest, 85

Respiratory distress, 85

Resuscitation masks, using, 83, 94–95

Rib injuries, 129

Rides and attractions, 59

Rip currents, 159–160

Risk behaviors, 55

Risk management, 54

Round Robin Brick Drill, 61

Rules and regulations, 41–43, 181–182

Run-and-swim entries, 163, 166–167, 186

S

Safety orientation, for organized groups, 63–64

Scanning, 52–53, 60–61, 160–161

Scenarios, 4

Scene size-up, 81

Searches, 164, 169, 172

Secondary assessment, 115, 126–127

Seizures, 122

Shallow Water Lifeguarding course

introduction to, 32–33

outline, 18–23

precourse session, 25–26

prerequisite skills, 26

purpose of, 1

rescue skills, 74

swimming skills evaluation, 28–29

written exam for, 227–243

Shock, 117

Skill charts and assessment tools

active victim front and rear rescues, 68–69

approaches, 47

assessment tools, 4

assists, 68

beach drag, 167–168, 187

checking conscious person, 127

choking, 96, 98

compact jump, 46

control of bleeding, 128

CPR, 108–111

disposal glove removal, 90

entries, 46–47

escapes, 132

foot injuries, 129

front-and-back carry, 168, 187–188

giving ventilations, 95–96

hand and finger injuries, 129

head, neck and spinal injuries, 129–131

head-hold escape, 131

head splints, 137–138, 168, 188–189

in-water ventilations, 132

jaw-thrust (with head extension) maneuver, 94

jaw-thrust (without head extension) maneuver, 94

leg injuries, 129

masks and fins, 170–171

medical history, 128

multiple-victim rescues, 71

passive victim rescues, 69, 70

primary assessment, 90–92

reaching assist from deck, 68

recovery positions, 93

rescues at or near surface, 69

rescue board use, 173–174

resuscitation masks, 94, 95

rib and breastbone injuries, 129

run-and-swim entry, 166, 167, 186

searches, 169, 172

secondary assessment, 126–127

simple assist, 68

slide-in entry, 46

spinal backboarding, 138–140, 190

splinting, 129

stride jump, 46

submerged victim rescues, 75, 76

surface dives, 76–77, 170–171

swimming approach, 47

two-person removals, 77–78

using an AED, 111–112

walking approach, 47

walking assist, 167, 187

Skill drills, 4

Skills practice

entries and approaches, 43–44

in-water, 4, 8

land-based, 4, 8

setting up and running, 7–8

Slide-in entry, 43–44, 46

Spas, rules and regulations of, 43, 147

Special attractions, 58–59, 148

Spinal backboarding, 134–135, 138–140, 190

Spinal injuries

caring for, 123–124, 129–131, 133–140

final written exam for, 210–243

in-water scenario for, 143

suspected, 168–169, 188–190

Splinting, 120, 129

Stabilization, in-line, 137, 138

Standard precautions, 79–80

Stings, 121

Stride jump, 44, 46

Submerged victim rescues, 73–76, 160–161

Supplies, 5, 153, 177

Surface distortion, 53

Surface dives, 76–77, 170–171

Surveillance, 160–161

Surveillance skills, 72, 114–115, 156, 180

Swim lessons, 57

Swimming approach, 47

Swimming prerequisites, 154–155, 176, 178

Swimming skills evaluation, 27–29, 155–156, 179

Swim tests, 161

T

Team-building activity, 38

Teeth injuries, 118, 123

Therapy pools, rules and regulations of, 43, 147

Thunderstorms, 40

Timed event, 31, 155, 179

Training equipment, 6

Tread water, 30, 155, 179

U

Underwater hazards, 157

Underwater swim event, 31, 156

V

Ventilations

giving, 86–87, 95–96

in-water, 125, 132

Ventricular fibrillation (V-fib), 103

Ventricular tachycardia (V-tach), 103

Victim assessment, 15, 20

Victim recognition, 51–52, 60–61

Victims, moving, 84

Video segments, 4

W

Walking approach, 47

Walking assists, 163, 167, 187

Water conditions, 157–158

Watercraft, 161

Water currents, 158

Water depth, 158

Water exercise classes, 57

Waterfront facilities

rules and regulations of, 41–42, 145–146

safety issues, 157–160

Waterfront lifeguarding, unique aspects of, 156–163

Waterfront skills

deep water searches, 164

rescue, 163–165

rescue board use, 165

skill drill, 165

verification of, 155–156

Waterfront Skills module

class size for, 152

facility requirements for, 153

final written exam for, 166, 244–252

introduction to, 154–155

length of, 152

lesson plan for, 154–174

materials, equipment and supplies for, 153

outline of, 151

prerequisites for, 26, 152, 176

purpose of, 1, 152, 156

skill charts and assessment tools for, 166–174

swimming skills evaluation for, 28

testing and certificates for, 153

Water movement, 53

Waterpark facilities

group visits to, 183

injury prevention at, 182–183

rules and regulations of, 42, 146, 181–182

safety issues at, 180–182

types of features in, 180

Waterpark lifeguarding, unique aspects of, 180–183

Waterpark rescue skills, 183–184

final written exam for, 185

skill drill, 185

verification of, 179

Waterpark Skills module

class size for, 176

facility requirements for, 177

final written exam for, 253–261

introduction to, 178

length of, 176

lesson plan for, 178–190

materials, equipment, and supplies for, 177

outline of, 175

prerequisites for, 25, 178, 179

purpose of, 1, 176

skill charts and assessment tools for, 186–190

swimming skills evaluation for, 27, 179

testing and certificates for, 177

Water quality, 158

Water slides, 59, 181, 190

Wave pools, 59

Weather conditions, 40

Whistle blowing, 55

Winding rivers, 59, 181

Y

Youth camps, 161–162

Z

Zones of surveillance responsibility, 54

ANSWER KEY: CPR/AED for the Professional Rescuer and First Aid

ANSWER KEY: CPR/AED for the Professional Rescuer and First Aid

ANSWER KEY: Lifeguarding Skills

ANSWER KEY: Lifeguarding Skills

ANSWER KEY: Shallow Water Lifeguarding Skills

ANSWER KEY: Shallow Water Lifeguarding Skills

ANSWER KEY: Waterfront Skills Module

ANSWER KEY: Waterfront Skills Module

ANSWER KEY: Waterpark Skills Module

ANSWER KEY: Waterpark Skills Module