International Lifeguard Training Program PDF

 International Lifeguard Training Program Skill Competency Workbook Table of Contents Content Page Introduction 2 Summary of Concept and Skill Competency Obje...

 International Lifeguard Training Program Skill Competency Workbook Table of Contents Content Page Introduction 2 Summary of Concept and Skill Competency Objectives 3 Objective 1 4 Objective 2 4 Objective 3 5 Objective 4 5 Objective 5 6 Objective 6 6 Objective 7 7 Objective 8 7 Objective 9 8 Objective 10 8 Objective 11 9 Objective 12 9 Objective 13 10 Objective 14 10 Objective 15 11 Objective 16 12 Objective 17 13 Objective 18 14 Objective 19 15 Objective 20 16 Objective 21 16 Objective 22 17 Objective 23 17 Objective 24 18 1  International Lifeguard Training Program Skill Competency Workbook Lifeguard Candidate Introduction ILTP® Instructors use the Skill Competency Objectives described in this workbook as a tool to evaluate each lifeguard candidate's ability to perform each of the critical concept and skill competency objectives of the ILTP® Curriculum. The workbook is in turn given to lifeguard candidates prior to the start of the class. Combined with other resources (described below), this workbook will aid you as you prepare and contribute to your overall success. How to use this Workbook to Prepare for your Training In addition to this document, you are provided the following resources to aid in your preparation: ILTP® Student Manual and the ILTP® EAsy Guide Access to eLearning content and various video clips describing skills in the Pectora library Additional handouts (course and facility specific items) and pre-course communications from your instructor(s) Thoroughly review all provided resources and corelate these to the overall evaluated objectives provided in this document. Before the start of class, test your pre-course study knowledge by attempting to answer the objective components that require an explanation, identification, or definition. This, combined with in classroom or elearning coverage of the concepts will greatly contribute to your mastery of the content. The majority of the items herein are skills that require demonstration as an individual or as part of a team. Consider reviewing the resources which correspond to those skills before class to maximize your confidence going into the class. If you have access to a swimming pool and equipment, this may also include attempting in-water skills and/or BLS & First Aid practice. If you know someone in the class, partner up to quiz each other. While it is not required that you prepare in this way before attending class, it may improve your chances of success. Any pre-course preparation, study and practice you can perform prior to the first day of class will give you a definite advantage and is highly encouraged. How to use this Workbook during your Class Please bring either an electronic or printed version of this document to each class session and reference as needed or requested by your instructor. Take advantage of the time in class provided to review, drill, and discuss these objectives. Your instructor(s) have many options on how to confirm your accomplishment of each skill competency objective. For example, your instructor may confirm your skill competency as skills are introduced and practiced in the pool or classroom. Alternatively, your instructor(s) may prefer a designated time or set of times in class to go through and check off all objectives with students. This may be completed in stations or it may be done as you and a partner work on a skills and then announce you are ready to have your skills confirmed by an instructor. Your instructor(s) may use a combination of methods to accomplish this task in class. If you are unable to perform to the level needed, your instructor may provide more time for you to practice along with specific feedback on performance and suggestions on how to improve to meet the specific metric we are looking for you to accomplish. Your mastery of this content will establish your readiness to move on to the course practical examinations. Your instructor(s) are eager to help you in any way they are able, as you work to become a highly effective and fully competent professional lifeguard! 2  International Lifeguard Training Program Skill Competency Workbook Summary of Skill Competency Objectives Objective Competency to be Demonstrated Completed? Fundamental Lifeguard Concepts and Skills 1 Identifying and behaving as a professional lifeguard 2 Identifying and utilizing lifeguard safety precautions 3 Maintain safety through positive guest interactions 4 Recognizing a guest in distress 5 Maintain guest safety through vigilance 6 Understanding an Emergency Action Plan (EAP) In-water Demonstration of Skills 7 Demonstration of basic swimming ability (prerequisites) 8 Entering and moving through the water safely 9 Helping responsive guests in distress 10 Unresponsive guest rescues 11 In-water care for unresponsive guests 12 Rapid extrication for unresponsive guests 13 In-water SMR for guests with a suspected spinal injury 14 Backboarding and safe removal of a guest with a suspected spinal injury Professional Rescuer and First Responder Skills 15 Maintaining Safety while Assessing a Potential Emergency 16 Rescue Breathing Delivery Quality 17 Quality CPR Delivery 18 AED Administration 19 Management of Airway Complications during BLS Care 20 Managing foreign body airway obstructions (Responsive Adults and Children) 21 Managing foreign body airway obstructions (Responsive Infants) 22 Readying the Trauma Bag and Preparing Oxygen Delivery Equipment 23 Providing BLS Care as an active member of a response team 24 Demonstration of First Aid Response 3  International Lifeguard Training Program Skill Competency Workbook Objective 1 Identifying and behaving as a professional lifeguard Completion Check The Lifeguard Candidate can: A. Explain why lifeguards are important. B. Identify the components of a proper uniform & equipment and why each is critical. C. Describe the behavior expected of a professional lifeguard. D. Provide the ways and to whom a lifeguard can be held accountable. E. Describe how lifeguards maintain their skills at a “test-ready” level. F. Describe a lifeguard’s primary and secondary responsibilities and why the primary responsibilities cannot be compromised with the secondary concerns. Objective 2 Identifying and utilizing lifeguard safety precautions Completion Check The Lifeguard Candidate can: A. Describe and demonstrate how a lifeguard utilizes and safely wears a rescue tube. B. Describe the measures lifeguards take to protect themselves from the effects of the sun and how each one specifically offers protection. C. Explain the impact of sleep, diet, exercise, and hydration on lifeguard safety. D. Explain how disease is transmitted and ways to avoid exposure. E. “Standard Precautions” and BSI. Describe why, how, what, and when PPE is used by lifeguards. 1) Define “Standard Precautions” and Body Substance Isolation (why PPE). 2) Describe the PPE used by lifeguards, when it is appropriate to use, and how it protects F. Demonstrate properly putting on, removing, and disposing of exam gloves, with: 1) Dry hands – use good strategies, show speed improvement (example target time, 10 seconds or less). 2) Wet hands – use good strategies, show speed improvement (example target time, 10 seconds or less). G. Describe facility controls in place mitigate exposure to bloodborne & airborne pathogens and what a lifeguard should do if a potential exposure is suffered (Exposure Control Plan). 4  International Lifeguard Training Program Skill Competency Workbook Objective 3 Maintain safety through positive guest interactions Completion Check The Lifeguard Candidate can: A. Define and describe how lifeguards: 1) CARE for guests; 2) DEAL with difficult situations. 3) LEAD when enforcing pool or attraction rules. B. Describe ways lifeguards effectively enforce rules. C. Provide examples of situations that require supervisor involvement and why. 1) Participate in a role play scenario. D. Describe the value and use of life jackets by guests at an aquatic facility. E. Describe situations when guests may need to be cleared from the water and why. Objective 4 Recognizing a Guest in Distress (“GiD”) Completion Check The Lifeguard Candidate can: A. Define the 10/20 Protection™ standard and its impact on keeping guests safe. 1) Explain the significance of up to 30 seconds (target) for lifeguard contact with GiD. B. Describe what a Zone of Protection® area is and what documentation aids lifeguards’ understanding about each at their aquatic facility. C. Demonstrate in the pool: the signs, characteristics, and behaviors of a responsive guest in distress. In-water class participation in activities related to recognition. D. “If you don’t know, GO!” Identify the “normal” characteristics of the training pool, including the: 1) Features & Water Conditions at the surface, below the surface, and at the bottom. Then when to “GO!” 2) Effects of glare/reflection/refraction, & shadow at the surface, below the surface, and at the bottom. Then when to “GO!” 3) Colors, color variations, contours, lines, stains, of the pool/attraction. Then when to “GO!” E. Demonstrate the ability to identify objects on the pool bottom that are not normal such as manikins, silhouettes, diving bricks, etc. F. Describe the Drowning Process, including details of what occurs to the guest throughout the process and what the guest needs to survive each stage. 5  International Lifeguard Training Program Skill Competency Workbook Objective 5 Maintain safety through vigilance Completion Check The Lifeguard Candidate can (performed at the pool): A. Demonstrate different scanning patterns and techniques used by lifeguards. B. Describe common distractions to vigilance; how lifeguards avoid them and why. C. During the lifeguard training class, provide vigilant surveillance of a designated area of the pool (instructor defined zone at the training pool). D. Demonstrate performance of the 10/20 Protection™ standard by recognition and recovery of a submerged manikin or silhouette in the training pool. E. Perform a lifeguard rotation with a partner (with or without equipment exchange)*: a) As the incoming lifeguard: perform a proactive bottom scan, communicating that the bottom is clear, then take over scanning until their partner is ready relinquish the station. The lifeguard takes the station and begins 10/20 scanning. b) As the outgoing lifeguard: maintain 10/20 until the incoming is ready, then get into position to watch the zone to allow the incoming lifeguard to take the station. When ready, perform an outgoing proactive bottom scan and communicate that the bottom is clear. * To the extent possible at the training location, instructors replicate a typical rotation that would occur at the operational facility, including the station type, proactive bottom scan procedures, arrival with equipment or equipment exchange and any other site-specific point, where applicable or available during training. Objective 6 Understanding an Emergency Action Plan (EAP) Completion Check The Lifeguard Candidate can: A. Describe the types of emergencies lifeguards may face at aquatic facilities. B. Define what an “Emergency Action Plan” is and how these are utilized by aquatic facilities during an emergency. C. Explain how supplemental responders may aid lifeguards during an emergency. D. Describe the importance of teamwork when responding to an emergency. E. Demonstrate common whistle codes and hand signals used at aquatic facilities. F. Demonstrate how to contact EMS at your facility, including what should be communicated and why. 6  International Lifeguard Training Program Skill Competency Workbook Objective 7 Demonstration of basic swimming and water ability (prerequisites) Completion Check The Lifeguard Candidate can: A. Swim, using the front crawl and/or the breaststroke without stopping: 1) Shallow Water Attraction Candidates: 25 yards/meters. 2) Shallow Water Candidates: 50 yards/meters. 3) Pool Candidates: 100 yards/meters. 4) Special Facilities Candidates: 200 yards/meters. B. Retrieve the 10lb/4.5kg Brick off the pool bottom: 1) Shallow Water Attraction Candidates: i. Brick placed at a depth of 3.0 ft/0.91m or the deepest shallow water attraction depth at work facility if less than 3.0 ft/0.91m. ii. While standing directly above, retrieve; return the brick to the surface. 2) Shallow Water Candidates: i. Brick placed at a depth of 5 ft/1.52m or deepest shallow depth at work facility, if less. ii. 10ft/3.04m underwater swim to retrieve the brick at 5 ft/1.52m depth and return to the surface. 3) Pool/Special Facilities Candidates i. Brick placed at 8 ft/2.43m or the deepest point in the training pool or the deepest depth at work facility. ii. Surface dive to bottom to retrieve the brick and return to the surface. C. Tread water without the use of hands: 1) Shallow Water Attraction Candidates: not required. 2) Shallow Water Candidates: not required. 3) Pool Candidates: 1-minute. 4) Special Facilities Candidates: 2-minutes. D. Exit the pool without requiring the use of a ladder. In-water Objective 8 Entering and moving through the water safely Completion Check The Lifeguard Candidate can safely: A. Activate the EAP and perform a compact jump from deck and/or from a stand*. B. Activate the EAP and perform an ease in entry*. C. Perform an approach stroke with the rescue tube, using a modified breaststroke and/or modified front crawl stroke (distance appropriate for typical Zone of Protection® area size at the aquatic facility/credential level of candidate). *Stand or deck level starting points matching site specific set up. 7  International Lifeguard Training Program Skill Competency Workbook Objective 9 Helping Responsive Guests in Distress Completion Check The Lifeguard Candidate can: A. Demonstrate a guest assist from the deck. B. Perform a Grab and Lift rescue and take the guest to safety (optional) (If a zero-depth entry or shallow water pool is operated at training facility, otherwise discuss and perform during pre-service training at facility). C. Perform a Front Hug rescue and take the guest to safety. D. Perform a Front Drive rescue and take the guest to safety. E. Perform the Rear Hug rescue and take the guest to safety. F. Perform a Duck Pluck rescue and take the guest to safety. G. Perform the Deep Water submerged rescue and take the guest to safety.* H. Describe the communication between lifeguard and guest that occurs during each rescue and the steps they would take following bringing the guest to safety. *Performed at the deepest depth at candidate’s work facility. Not required for Shallow Water Attraction Candidates & Shallow Water candidates (can perform what is appropriate at work facility). In-water Objective 10 Unresponsive Guest Rescues Completion Check The Lifeguard Candidate can: A. Safely perform the Unresponsive Guest Rear Hug Rescue. 1) Position the guest face up on the rescue tube, with tube below shoulder blades (rescue phase complete). B. Safely perform the Unresponsive Duck Pluck Rescue. 1) Position the guest face up on the rescue tube, with tube below shoulder blades (rescue phase complete). C. Safely perform the Unresponsive Deep Water Submerged Rescue* 1) Position the guest face up on the rescue tube, with tube below shoulder blades (rescue phase complete). *Performed at the deepest depth at candidate’s work facility. Not required for Shallow Water Attraction Candidates & Shallow Water candidates (can perform what is appropriate at work facility). 8  International Lifeguard Training Program Skill Competency Workbook In-water Objective 11 In-water Care of Unresponsive Guests Completion Check The Lifeguard Candidate can safely: A. Move with guest to the extrication point; Open the airway and check for breathing: 1) Perform and maintain a jaw thrust with head-tilt & Quick Check (about 3-5 seconds max) for return of spontaneous breathing while moving toward the extrication point. 2) If the guest remains unresponsive, regardless of breathing status, maintain open airway to extrication point. B. Extrication Point – Determine Rapid Extrication or In-water Rescue Breathing*: 1) Secondary responders at extrication point with backboard? i) Yes – Begin Rapid Extrication (guest to board – proceed to Objective 12). ii) No – Begin In-water Rescue Breathing (go to “C” below). C. Open the airway, seal the mask – simulate rescue breathing starting with 2 breaths: 1) Shake excess water, properly position the mask on the guest’s face – (mouthpiece over mouth). 2) Seal the mask onto the guest’s face with the jaw thrust with head-tilt – (partner thumbs up if correct). 3) Simulate 2 initial breaths – (each ventilation lasting up to 1 second, monitoring the chest, nose/mouth above water always). 4) After the second breath, count out loud the seconds to next breath, then simulate delivery: i) Deliver 1 breath every 6 seconds (counting out loud) for an adult (simulation). ii) Deliver 1 breath every 2-3 seconds (counting out loud) for a child (simulation). *Lifeguard candidates demonstrate both options. In-Water Objective 12 Rapid Extrication of Unresponsive Guests Completion Check The Lifeguard Candidate can: A. Perform the in-water portion of the Pool Edge technique: 1) Place guest against the board, help on-deck responder grab the guest’s arm/wrist, and remove the rescue tube; 2) Assist by pushing the board while the on-deck responder pulls, sliding the guest safely out of the water. B. Perform the on-deck portion of the Pool Edge technique: 1) Retrieve the backboard, remove head immobilizer and put on exam gloves; 2) Position the board at the edge, awaiting the in-water Primary lifeguard to arrive; 3) Grab the guest’s arm/wrist with one hand, while holding the board with the other hand, slide and pull the board and guest out of the water. C. Positively contribute as a lifeguard team member using the Carry Out technique.* 1) Safely remove a guest from the water in a coordinated effort with other lifeguard responders. *Performed, if possible, at the training pool using stairs or zero-depth area. 9  International Lifeguard Training Program Skill Competency Workbook Objective 13 SMR for guests with a suspected spinal injury Completion Check The Lifeguard Candidate can safely perform: A. In extremely shallow water and/or when caring for a guest who is standing or sitting in an aquatic attraction (not practical to backboard), initiate and maintain an appropriate SMR technique while communicating with the guest. B. In shallow water, initiate and maintain SMR underarm vise grip technique, while communicating with the guest. 1) Switch to overarm to facilitate backboarding when secondary responder(s) is ready (Go to Objective 14). C. In deep water (cannot touch the bottom), initiate and maintain SMR with an underarm vise grip technique utilizing the rescue tube for support, while communicating with the guest. * D. In deep water, retrieve a submerged guest utilizing the SMR underarm vise grip technique; rotate and maintain SMR when breaking the surface, confirm responsiveness and/or breathing. Take the guest to the extrication point with secondary assistance. * *Performed at the deepest depth at candidate’s work facility. Not required for Shallow Water Attraction Candidates & Shallow Water candidates (candidates perform what is appropriate at work facility). Objective 14 Backboarding and safe removal of a guest with a suspected spinal injury Completion Check The Lifeguard Candidate can demonstrate: A. Using the pool edge technique, as the in-water lifeguard: 1) Guest positioned on the board; straps adjusted/put in place to secure guest to board. 2) Employ the squeeze play to allow head immobilizer placement. 3) Help slide the guest and board safely out of the water. B. Using the pool edge technique, as an on-deck guard: 1) Position the backboard at the pool edge, angle/adjust to allow guest placement. 2) Take over SMR to allow straps to be applied. 3) Once the squeeze play is secured, properly place head immobilizer. 4) Help slide the guest and board safely out of the water. C. As a member of a team using the Carry Out technique actively contributes to securing the guest to the board and safely carrying out the board with the team. D. Proper communication with the guest and lifeguard team in each role. 10  International Lifeguard Training Program Skill Competency Workbook Objective 15 Maintaining Safety while Assessing a Potential Emergency Completion The Lifeguard Candidate can, on a live guest or manikin (where indicated): Check A. Perform an effective survey of the scene, including what may be happening and if it is safe to approach. B. Determine assistance/equipment needs, put on available PPE. C. Perform the “Tap & Shout” technique to determine responsiveness on a live guest. D. Activate EAP/EMS using simulated/verbalized communication. 1) Facility whistle code or radio code, hand signals, verbal shouts, etc. 2) Describe what a completely alone responder (no bystanders, away from work) would do if the patient is an adult, a child, and an infant. E. Position the patient face up, on a firm (hard), flat surface. 1) Carefully place an unresponsive adult patient (live guest) who is face down, face up. 2) Carefully place an unresponsive infant (manikin) on to a secure platform, face up. F. Perform an effective assessment of pulse & breathing for up to 10 seconds (live guest): 1) Open airway (head-tilt, chin-lift) and get positioned to observe and listen for breathing. 2) Locate the carotid pulse (everyone over the age of 1 year – Children/Adults). i. Indicate when pulse if felt; provide a verbal description of pulse. 3) Place “infant” head in a neutral position, with only a slight head tilt. 4) Locate the brachial pulse (infants under the age of 1 year). * i. Indicate when pulse if felt; provide a verbal description of pulse. G. Perform Basic Airway Management techniques (partners): 1) Head-tilt, chin-lift on a live guest. 2) Jaw Thrust with head-tilt performed on a live guest. 3) Jaw Thrust without head tilt performed on a live guest. 4) Recovery position for on an unresponsive but breathing live guest. 5) Infant airway in neutral position (on an infant manikin). H. Describe the difference between normal breathing and agonal breathing. I. Describe situations where a lifeguard should assume no pulse is felt during the 10 second check and why. J. Describe when a lifeguard may suspect that the patient is a victim of an opioid overdose and care if: 1) The patient is breathing. 2) The patient is not breathing but has a pulse. 3) The patient is not breathing and has no detectable pulse. * An “infant” brachial pulse will be located on partner. 11  International Lifeguard Training Program Skill Competency Workbook Objective 16 Rescue Breathing Delivery Quality Completion The Lifeguard Candidate can, on a live guest or manikin (where indicated): Check A. Perform Rescue Breathing for an Adult using a resuscitation mask for 2 min. or 20 breaths (on a manikin). 1) 1 breath every 6 seconds, counting out loud, delivering a ventilation at the 6th (uncounted) second. i) Each delivered breath lasts up to 1 second. ii) Each delivered breath stops as soon as the chest starts to rise. 2) 1 ventilation does not go in – stop breath, adjust mask, airway, reattempt (goes in). B. Perform Rescue Breathing for Child using a resuscitation mask for 2 min or at least 40 breaths (on a manikin)*. 1) 1 breath every 2-3 seconds, (training target of 3 seconds) counting out loud, delivering a ventilation at the 3rd (uncounted) second. i) Each delivered breath lasts up to 1 second. ii) Each delivered breath stops as soon as the chest starts to rise. 2) 1 ventilation does not go in – stop breath, adjust mask, airway, reattempt (goes in). C. Perform Rescue Breathing for an Infant using a resuscitation mask for 2 min or at least 40 breaths (on a manikin)*. 1) 1 breath every 2-3 seconds, counting out loud, delivering a ventilation at the 3rd (uncounted) second. i) Each delivered breath lasts up to 1 second. ii) Each delivered breath stops as soon as the chest starts to rise. 2) 1 ventilation does not go in – stop breath adjust mask, airway, reattempt (goes in). D. Perform Rescue Breathing using a BVM for each age group on manikins with mask that is original to the BVM (switching with a partner, demonstrating all skills): 1) At the airway position for an adult for 1 minute. i. 1 ventilation does not go in – stop delivery, adjust mask, airway, reattempt (goes in) 2) At the bag position for an adult for 1 minute. i. Each delivered breath lasts up to 1 second. ii. Each delivered breath stops as soon as the chest starts to rise. 3) At the airway position for a child for 1 minute. i. 1 ventilation does not result in chest rise – stop delivery, adjust mask, airway, reattempt (goes in). 4) At the bag position for a child for 1 minute. ii. Each delivered breath lasts up to 1 second. iii. Each delivered breath stops as soon as the chest starts to rise. 5) At the airway position for an infant 1 minute. i. 1 ventilation does not go in – stop delivery, adjust mask, airway, reattempt (goes in) 6) At the bag position for an infant 1 minute. i. Each delivered breath lasts up to 1 second. ii. Each delivered breath stops as soon as the chest starts to rise. * Pediatric masks are recommended for infants and toddler sized guests (manikins). 12  International Lifeguard Training Program Skill Competency Workbook Objective 17 Quality CPR Delivery Completion Check The Lifeguard Candidate can, using a manikin*: A. Perform Single Rescuer CPR appropriate for an adult (2-min). 1) 30 chest compressions followed by two ventilations with a mask: i) Hand Placement: Two hands, center of chest at nipple line; ii) Consistent compressions:2-2.4 inches depth. iii) Compressions with full recoil at a rate of100–120 compression/release per min. iv) Ventilations: Open airway, proper mask position/placement. v) Ventilations: Up to 1 second delivery, stopping when the chest starts to rise. B. Perform Single Rescuer CPR appropriate for a child (2-min). 1) 30 chest compressions followed by two ventilations with a mask: i) Hand Placement: One or two hands, center of chest at nipple line; ii) Consistent compressions: 2-inches depth (1/3 chest depth) iii) Compressions with full recoil at a rate of100–120 compression/release per min. iv) Ventilations: Open airway, proper mask position/placement. v) Ventilations: Up to 1 second delivery, stopping when the chest starts to rise. C. Perform Single Rescuer CPR appropriate for an infant (2-min). 1) 30 chest compressions followed by two ventilations with a mask: i) Hand Placement: Two fingers, center of chest, finger width below nipple line; ii) Consistent compressions: 1.5 inches depth (1/3 chest depth). iii) Compressions with full recoil at a rate of100–120 compression/release per min. iv) Ventilations: Open airway (neutral position), proper mask position/placement. v) Ventilations: Up to 1 second delivery, stopping when the chest starts to rise. * Manikins that can provide feedback information on compression depth/rate. 13  International Lifeguard Training Program Skill Competency Workbook Objective 18 AED Administration Completion The Lifeguard Candidate can, as simulated using a manikin and AED Trainer*: Check A. Retrieve and turn on the AED. 1) Prepare the guest for application (see item “D”) 2) Apply the electrode pads as shown on the provided diagram and/or as prompted. 3) Follow AED prompts, allowing the AED to analyze the guest’s heart rhythm. B. If the AED Prompts: 1) Shock advised – confirm all are clear, press indicated shock button and begin CPR. 2) Shock not advised – immediately begin CPR (adult). C. Perform CPR for approximately two minutes and then allow the AED to reanalyze: 1) Respond to AED prompts, start CPR (scenario may stop after initiation of compressions) D. Describe adjustments when confronted with: a) A child or an infant. b) Water present on the chest. c) Excessive hair in pad placement locations. d) Jewelry or piercings. e) Medication patch. f) Internal defibrillator. g) Pregnancy. * Candidate is the lone rescuer; scenario should reach at least the initiation of CPR after the 2-min. re-analysis by the AED. 14  International Lifeguard Training Program Skill Competency Workbook Objective 19 Management of Airway Complications during BLS Care Completion The Lifeguard Candidate can: Check A. Demonstrate how to respond if an unresponsive guest vomits during BLS care: 1) Roll the guest onto their side (recovery position); 2) Clean out the airway using gloved fingers and with the v-vac (simulation); 3) Return the guest face up and resume care B. Demonstrate how to respond if the chest does not rise following a ventilation due to improper / inadequate airway management technique: 1) Stop delivery, remove the mask. 2) Readjust airway, reposition, reseal mask – confirm everything looks good. 3) Reattempt 1 second ventilation (Chest Rises – if everything in “B 2” was performed correctly). C. Demonstrate how to respond if the chest does not rise following a ventilation due to an airway obstruction (FBAO): 1) Stop delivery, remove the mask. 2) Readjust airway, reposition, reseal mask. 3) Reattempt 1 second ventilation (Still does not go in). 4) Begin CPR: 30 compressions. 5) Before breaths: check the mouth, remove anything found with a finger sweep. 6) Attempt two ventilations (chest rise accomplished). D. Provide explanation for / discussion about: 1) Guest vomiting or regurgitation (lung aspiration) – Why would this happen? Does this prevent chest rise? 2) FBAO during care (an object of sufficient size/location is physically blocking the airway) – Under what circumstances would this situation be likely? 3) Why CPR (chest compressions) is effective to relieve an airway obstruction. 4) Why an improper or inadequate airway technique is most likely the cause of a suspected airway obstruction. 5) If the chest fails to rise when two initial ventilations are given to an in-water unresponsive guest (at the start of in-water rescue breathing or on deck following the quick check) – what should you do? 15  International Lifeguard Training Program Skill Competency Workbook Objective 20 Managing foreign body airway obstructions (Responsive Adults and Children) Completion The Lifeguard Candidate can, using a live guest: Check A. Assess and manage the scene: 1) Quickly determine through signs that a guest may be choking. 2) Identify as a lifeguard, offer to help; Call for assistance. B. Encourage the guest to cough if air exchange is still possible. 1) Put on medical exam gloves during time cough is productive (if not on when complete airway obstruction occurs – can no longer cough - care should begin, unless body substances are present – instructor scenario options). C. Determine when the obstruction is total then take steps to relieve obstruction. 1) Manage scene safety - quickly move any objects around the guest out of the way, get into position behind the guest. 2) Position hands correctly and deliver upward/inward thrusts (Heimlich maneuver). 3) Continue Heimlich maneuver until the guest’s airway is relieved or becomes unresponsive. D. The guest becomes unresponsive: 1) Bring arms up under the guest’s armpits to support weight. 2) Slowly walk the guest down to the ground, protecting the back and head. 3) Immediately begin CPR, starting with 30 chest compressions. 4) Check the airway, remove anything seen, attempt two ventilations. Objective 21 Managing foreign body airway obstructions (Responsive Infants) Completion The Lifeguard Candidate can: Check A. Assess the scene: 1) Quickly determine through signs and symptoms that an infant may be choking. 2) Identify as a lifeguard, offer to help; Call for assistance / Activate the EAP. B. Allow the infant to cough if it is attempting to do so (air exchange is occurring). 1) Put on medical exam gloves during time cough is productive (if not on when complete airway obstruction occurs – can no longer cough - care should begin, unless body substances are present – instructor scenario options). C. Determine when the obstruction is total, then take steps to relieve the obstruction: 1) Take the infant and safely position for back blows. 2) Deliver 5 firm back blows between the shoulder blades of the infant; 3) Safely position yourself for 5 chest thrusts (CPR Compressions to relieve FBAO); 4) Deliver 5 chest thrusts in the same location and depth as infant CPR; 5) Check the mouth, removing anything found. 6) Repeat these steps (listed here in “C”) until the infant’s airway is relieved or becomes unresponsive. D. If the infant becomes unresponsive: 1) Gently set the infant onto a firm (hard), flat surface. 2) Immediately begin CPR starting with 30 chest compressions; 3) Check the airway, remove anything seen, attempt two ventilations 16  International Lifeguard Training Program Skill Competency Workbook Objective 22 Readying the Trauma Bag and Preparing Oxygen Delivery Equipment Completion The Lifeguard Candidate can: Check A. Locate in the trauma bag, and prepare for use: 1) The Supplemental Oxygen Tank with regulator (locate). 2) Bag Valve Masks, each size (open, confirm components are attached and functional). 3) Spare HEPA Filters or B/V Filters for BVM/Resuscitation masks (unused/original packaging). 4) Resuscitation Mask with available filter, O2 port (or O2 adapter) and oxygen tubing. 5) Manual suction device (assemble and confirm functionality). B. Demonstrate proper device attachment and set oxygen regulator to 15 lpm (if adjustable) to deliver O2 connected to: 1) Assemble component parts, including filter. 2) BVM – tube to oxygen regulator and/or oxygen tube to the O2 port on resuscitation mask. C. Disassemble and/or return each item to its correct location in the trauma bag.* *Include only if a functional trauma bag that matches operational equipment is available. Objective 23 Providing BLS Care as an active member of a response team Completion The Lifeguard Candidate/Response Team can: Check A. Demonstrate application of skills as the first responder to arrive at the scene: 1) Scenario 1: Non-aquatic situation (scene safety, check for responsiveness, Primary Check, initial care after Primary Check). 2) Scenario 2: Initial care of unresponsive in-water guest upon extrication (quick check for spontaneous breathing, two initial ventilations, start of the Primary Check). 3) Scenario 3: Initial care of an in-water unresponsive infant or toddler who upon removal from the water following in-water rescue. i) For both scenarios: (1) Perform all assessments, communication, and initiate care based on signs found. (2) Communicate the situation effectively with responding team members as they arrive. B. Demonstrate application of skills at the “Airway/Breathing” position C. Demonstrate application of skills at the “Ventilation/Oxygen” position. D. Demonstrate application of skills at the “CPR/AED” position E. Demonstrate ability to switch positions when initiated (AED re-analysis at 2-min.) F. Limit interruptions in care to what is necessary (no more than 10 seconds). G. Demonstrate confidence, efficiency, adaptability, and effective communication. H. Provide an accurate verbal summary. 17  International Lifeguard Training Program Skill Competency Workbook Objective 24 Demonstration of First Aid Response Completion From a selection of possible first aid emergencies*, the Lifeguard Candidate can: Check A. Perform a Secondary Check on an unresponsive guest. 1) Head-to-toe, verbalize what is being looked for and why. 2) Questions to ask if the guest becomes responsive. B. Demonstrate proper care for a guest who “feels like they will faint”. 1) Counter-pressure maneuvers. 2) Assist to the ground. 3) Care for a possible head or spinal injury. C. Demonstrate proper care for a guest suffering from a severe allergic reaction. 1) Guest interaction to determine cause & if they have an epinephrine autoinjector. 2) Guest positioning. 3) Calling for assistance, retrieving epinephrine. 4) Administration of epinephrine. 5) Monitoring, providing a second dose if needed. Preparing for CPR/AED if needed. D. Demonstrate proper care for a guest experiencing respiratory distress. 1) Scenario 1: Opioid Overdose – breathing poorly, in and out of responsiveness. 2) Scenario 2: Hypoxia (no specific cause – instructor choice). 3) For each scenario: i) Determining/keeping the guest responsive and interaction / scene safety to determine cause, bystanders, family/friends. ii) Guest positioning; calling for assistance, retrieving medicine (if available) / Naloxone for the opioid scenario. iii) Providing Supplemental Oxygen with a non-rebreather mask; monitoring with pulse oximetry; removing oxygen when it is no longer needed. iv) Maintaining scene safety / agitated or aggressive after medication begins to take effect. E. Demonstrate proper care for a moderate-to-major bleeding emergency. 1) Scene safety and Standard Precautions (Body Substance Isolation). 2) Guest interactions to calm, determine cause. Direct Pressure wound. 3) Bandaging applied, soaks through. Guests suffer from hypovolemic shock (care). 4) Bleeding continues, apply tourniquet. 5) Bleeding stops, note timing, monitor, provide care. F. Demonstrate proper care for a guest with a possible heart attack OR stroke.* G. Demonstrate proper care for a guest who ingested a poison OR inhaled a poison.* H. Demonstrate proper care for a guest suffering a seizure OR diabetic emergency.* I. Demonstrate proper care for a puncture wound or snake bite.* J. Demonstrate proper care for an eye injury or nosebleed or dental injury.* K. Demonstrate proper care for a muscle, bone or joint related injury.* L. Demonstrate proper care for heat exhaustion or frost bite.* M. Demonstrate proper care for a guest with a pregnancy complication or burn wound* *Beginning at Item “F”. The instructor may select one or more emergencies per letter to complete as listed (student should be prepared for any emergency). Students need to perform A-E, hitting each key skill benchmark presented. 18