Lifeguards: Training to Work as a Team

When it comes to performing rescues, your lifeguards should be moving quickly, with an emphasis on, “doing whatever it takes to stop the drowning process, and when necessary, avoiding delay in patient care.”

New lifeguards will be easily drawn to demonstrating proficiency in solo skills — solo water rescues, both active and passive, and water extrication from the rescue point to the side of the pool. Who could blame them? Most of the written and video content that is available in some lifeguard certification courses only demonstrates water rescues, extrication and primary assessment skills being done with a solo rescuer.

This should not extend to in-service training. In-services that only focus on solo rescuer skills and scenarios do not prepare your lifeguard staff to be rescue-ready. As an in-service trainer, you should develop an Emergency Action Plan (EAP) that includes a team effort on all aspects of the job: rescuing the victim, extricating them from the rescue point to the side of the pool, extrication from the water, and providing patient care. This applies to all parts of patient care, which could include ventilations with use of a resuscitation mask and/or bag-valve-mask (BVM), CPR, use of an AED, and administration of emergency oxygen. And all needs to take place within 90 seconds or less.

It's common to alternate between solo and multi-lifeguard tasks within a rescue — for example, starting with a solo lifeguard water rescue and extrication from the rescue point to the side of the pool, then using multiple lifeguards for the extrication from the water and patient care response. For the first half, the extra lifeguards just stand and watch, when they could be helping to speed up the process. That's time potentially lost in patient care.

Avoid this hodgepodge of solo and multi-lifeguard tasks within the EAP and use the staff you have on hand.

My most recent article focused on such team efforts when it comes to water rescues. Here, let’s review several drills involving the land portion of the EAP.

GLOVING UP/PRIMARY ASSESSMENT COMBO DRILL: Pair up lifeguards and switch primary rescuer position when necessary. Manikins will be used for this drill. Primary and secondary lifeguards are 10 feet away from the manikin. Spinal injury is not suspected.

Objective: The primary lifeguard will quickly move to the manikin and perform a primary assessment. The secondary lifeguard will glove up while moving to the manikin. Both tasks must be completed for the drill to end.

Timing goal: 15 seconds.

Once the lifeguards have demonstrated proficiency in each role, move to the variations:

• Manikin is face down in prone position, and needs to be rolled into the supine position.

• The secondary lifeguard is delayed in responding by 5-10 seconds, meaning the primary lifeguard must begin to provide care while the secondary lifeguard is still gloving up. The victim has a pulse but is not breathing and needs to be ventilated with a resuscitation mask.

• The victim is pulled from the water and is unresponsive. The primary guard needs to provide two ventilations before beginning primary assessment. The victim has a pulse but is not breathing, and the primary lifeguard needs to continue ventilations.

• Replace the manikin with a real person.

RESUSCITATION MASK TRANSITION TO BVM DRILL: Pair up lifeguards and switch primary rescuer position when necessary. Manikins will be used for this drill. Primary and secondary lifeguards are 10 feet away from the manikin. Spinal injury is not suspected.

Objective: The primary lifeguard will be ventilating the manikin with a resuscitation mask. The secondary lifeguard will arrive and assemble the BVM. Once the BVM is assembled, lifeguards will begin to ventilate the manikin with the BVM. Uninterrupted care must be maintained.

Timing goal: 30 seconds.

Once the lifeguards have demonstrated proficiency in each role, move to the variations:

• A primary assessment must be performed prior to ventilations. If the secondary lifeguard assembles the BVM before the primary assessment is completed, the lifeguard team can initiate ventilations with the BVM

• Once three ventilations with the BVM have been delivered, state that the mask is compromised, and lifeguards must remove the BVM and replace it with a resuscitation mask, and continue to provide ventilations.

• Both lifeguards must glove up while ventilations are in progress, and uninterrupted care must be maintained

THREE-RESCUER CPR PROGRESSION DRILL: All lifeguards should be equipped with gloves and resuscitation masks. A manikin and an unassembled BVM will be used, and all drills will be considered a response to a dry victim unless stated.

Objective: Lifeguards glove up during the scene size-up, then EMS is activated. Primary assessment is completed, then a resuscitation mask or BVM is assembled and ready to use. CPR is performed for two minutes.

Timing goal: Three minutes to complete the objective.

Once the lifeguard team has accomplished the objective, incorporate these variations to stretch the lifeguards’ abilities:

• After one minute, remove one lifeguard from providing patient care. The two remaining lifeguards will adapt and continue to provide uninterrupted care.

• After 30 seconds, remove one lifeguard from providing patient care. The two remaining lifeguards will adapt and continue to provide uninterrupted care. After an additional 30 seconds, the third lifeguard will rejoin the group to assist in providing uninterrupted care. Continue to pull one lifeguard out, and put one lifeguard in every 30 seconds for the remainder of the timing goal.

• The drill starts with a solo lifeguard arriving and initiating care, then the second lifeguard arriving 30 seconds later, and the third lifeguard arriving 60 seconds later.

• The victim is a child, so change ratios according to guidelines.

GROUP BEACH DRAG/WALKING ASSIST DRILL: The lifeguards work in pairs. One additional guard is needed to be the victim.

Note: Do a refresher on proper lifting techniques and practice lifting and lowering commands before the drill. Excuse any lifeguard who has a history of back pain or injury.

Objective: Move the victim from point A to point B utilizing two lifeguards.

Timing goal: 15-30 seconds to complete the objective.

Once the lifeguards have practiced and become proficient at supporting the victim from the left and right sides for both the beach drag and the walking assist, move to the variations:

• Initial beach drag or walking assist is done by one lifeguard, and a secondary lifeguard arrives 10 seconds later to assist.

• One lifeguard loses the ability to support the victim, the lone lifeguard must reassess and continue to do the drag or walking assist safely.

MISTAKES TO LOOK FOR

As the trainer, you must use your critical eye so lifeguards don’t make mistakes that could delay in care or compromise care.

Here are some errors you might see:

• Failing to seal the mask.• Over- or under-inflation of the victim’s chest with the BVM.
• Fails to open the airway during primary assessment.
• Fails to maintain an open airway when providing ventilations.

As the trainer, your job is to make sure lifeguard safety is the priority, especially when moving a real victim. Keep your lifeguards focused, proficient, and rescue ready.

Good luck and keep training.