Chapter 8 Rescues, Assists and EAP’s PDF

Chapter 8: Rescues, Assists and EAP’s Section 1 - Water Rescue The water rescue is the foremost lifeguard emergency situation; it is what we are here for. Before a rescue can take place, there must be recognition of distress. Typically, a lifeguard determines through observation that a person need...

Chapter 8: Rescues, Assists and EAP’s Section 1 - Water Rescue The water rescue is the foremost lifeguard emergency situation; it is what we are here for. Before a rescue can take place, there must be recognition of distress. Typically, a lifeguard determines through observation that a person needs assistance in the water. Perhaps a swimmer has fallen off a floating support in deep water or is being swept into deep water by a current. In some cases, lifeguards are summoned to respond by beach visitors who have noticed something wrong in the water. Regardless of the source of information, the process begins when a lifeguard recognizes the need for a rescue. The three components of every rescue are as follows: Recognize and Respond Contact and Control Signal and Save 1.1 Recognize and Respond Recognition – Witness or be notified of a victim Alert – Notify other guards Equipment Selection – decide what equipment will be best to make the rescue Entry – enter the water correctly based on the equipment picked 1.2 Contact and Control The second component of a water rescue – contact and control - includes the following three steps: Approach – select your approach to the victim based on information gathered during recognition and response. Example: approach a spinal victim in a way which will not make more waves and cause movement of the spine. Determine which rescue to perform. Contact – perform rescue Stabilize – ensure the victim is well supported and begin talking to the victim to calm them down. If they are unconscious, check for breathing and a pulse. 1.3 Signal and Save The third and final component of a rescue — signal and save — includes five steps: Signal – once the situation is under control and the victim is stable give the hand on head signal to other guards. If you need further assistance with the victim, quickly hold a fist overhead and return to the rescue. If the victim was not able to be located, give code X signal. Retrieve – continue moving the victim closer to shore. Remove – remove victim from water Assess – once on shore assess victims’ condition now that more information may be gathered. If the victim is unconscious, continue emergency care. Report – fill out appropriate paperwork. 1.4 Water Rescue Fundamentals Lifeguards should be prepared to perform multiple types of rescues based on the circumstances of the drowning incident and equipment available. The location, the type of victim, the rescue equipment at your station, weather and water conditions, and other unknown factors all play a role in how to properly rescue the victim while keeping yourself and the victim safe. A common rescue is a small child in the shallow end of the swimming area who has fallen in the water, however you should be prepared for any situation, such as a boating accident or someone falling off the break wall. While no water rescue is the same, the following are guidelines you must know to help you be ready for any situation.  1.4a Equipment USE A RESCUE TUBE OR RESCUE BOARD ON ALL RESCUES. Keeping a victim afloat and their head above water is extremely difficult without a buoyant piece of lifeguard equipment, especially at long distances. 1.4b Approaching the victim Entries into the water from the lifeguard chair must be practiced to avoid injury Keep the victim in sight while jumping and approaching. Speed is essential In a situation with an active drowning victim, approach the victim from behind if possible, as this is safer for both the rescuer and victim. Keep a rescue tube or board between you and the victim. 1.4c Rescuing the victim Once you make contact, constantly maintain it unless placed in immediate danger. Talk to the victim for reassurance throughout the rescue whether or not you think they can hear you. Always watch the victim while towing, continually checking for signs of depreciating health, respirations, and pulse. 1.4d Post Rescue Complete appropriate paperwork as directed by supervisors. Do not give information to anyone other than EFD, police, and supervisors. 1.5 Water Rescue Emergency Action Plan The Water Rescue EAP is used in any situation where a rescue is needed in the water. This includes but is not limited to: distressed swimmer, active drowning swimmer, passive drowning swimmer, and spinal injury in the water. For reference in the Water rescue EAP the “Primary Rescuer” is the guard who notices and first responds to the incident. If the Primary Rescuer was in the chair or roving position, the “Secondary Guard” is the first guard to reach the surveillance position following the whistle, and climbs the chair to continue surveillance on remaining swimmers. Water Rescue Emergency Action Plan Primary Secondary Lifeguard Rescuer Guard Manager Other Guards Ripper Supervisor Coordinator Identifies 1 Victim 2 Blows Whistle. 1 Long Blast Jumps & Runs down Determine if an EFD Evaluates Evaluates Respond to Beach, Monitor radio and Grabs Tube to chair and is required, if so Situation Situation. If at ensures communication situation. If necessary, assumes contact dispatch and anytime it is with Beach Office and contact dispatch to surveillance request Water necessary, Evaston dispatch (if Request Water Rescue 3 position from Rescue Response. bring AED necessary) has occurred. Response. Confirms that Primary Direct other guards and First Aid they received emergency Rescuer. Box to scene. on EFD Main Enters water Clears water Relays Hand Signal, Assists In Returns to Upon arrival at beach, Monitor radio and approaches and relays continues Rescue. Enters gate, watches size up the scene and situation. If necessary, victim, and hand signal communication with water if for hand determine if EFD contact dispatch. gives supervisor and secondary signals response is required, if so 4 appropriate dispatch. rescuer is contact dispatch, request hand signal needed, bringing Water Rescue Response. rescue tube and spinal board if needed. Executes Continues Tells arriving Continues Updates any Perform constant scene Continue monitoring Appropriate Surveillance supervisor current Assistance In arriving staff surveillance. Ensure situation. If at any point 5 Rescue status of all guards Rescue or agencies to safety and accountability situation worsens, and situation situation of all staff involved. consider responding. Executes Continues Assists In Assists in Updates any Ensure all staff are appropriate Surveillance Appropriate Care if appropriate care arriving staff performing their duties as rescue and needed or agencies to necessary. 6 removes situation victim from water Provides Continues Assists In Assists in Updates any Begin interviewing victim appropriate Surveillance Appropriate Care if appropriate care arriving staff and collecting any vitals care needed. Begin or agencies to that have been taken. patient interview and situation Make a record of key PT 7 any necessary information. If EFD has reports been called, be prepared to provide them this information. Provides Continues Continue necessary Assists In Maintains Oversee report; assist in appropriate Surveillance reports. Check on all Appropriate ripper position release or transport 8 care staff involved. Care release of PT. Debrief with Continues Debrief with Debrief with Maintains Clear code. Consider Debrief with supervisor Supervisor Surveillance Supervisor Supervisor ripper adjusting rotation to upon their arrival back to position, temporarily remove Beach Office debrief with primary guard from 9 supervisor surveillance. Debrief code w/primary guard, and determine if they can return to service. If Victim is Passive or Submerged in the Water (1-4 from table above, continue here at Step 5) PRIMARY SECONDARY OTHER ROVING RESCUER GUARD MANAGER GUARDS RIPPER SUPERVISOR LC Executes Continues Immediately Continues Bring AED, First Ensure EFD Water Ensure Evanston Appropriate Surveillance contacts Assistance In Aid Box to scene. Rescue Response Dispatch has been Rescue dispatch over Rescue. Ensure Updates any has been requested contacted. Respond to the radio to Spinal Board is arriving staff or from Dispatch. the scene. If Marine 21 request EFD in correct agencies to Perform constant is staffed, contact them 5 Water Rescue location ready situation scene surveillance. to ensure they are Response. for victim. Ensure safety and responding. Confirms accountability of all that they received staff involved. emergency on EFD Main Executes Continues Assists in Assists in Updates any Ensure all staff are Assumes control upon appropriate Surveillance appropriate care appropriate arriving staff or performing their duties arrival to scene, rescue and if needed care agencies to as necessary. directing Manager and 6 removes victim situation/Assist in Roving Supervisor. from water appropriate care if needed Provides Continues Assists in Assists in Updates any Assists in appropriate Begin interviewing appropriate care Surveillance appropriate care appropriate arriving staff or care if needed victim/family/friends and care agencies to collecting any vitals that situation/Assist in have been taken. Make 7 appropriate care if a record of key PT needed information, be prepared to provide this information to EFD. Provides Continues Assists in Assists in Updates any Assists in appropriate Ensure victim hand off appropriate care Surveillance appropriate care appropriate arriving staff or care if needed with EFD care agencies to 8 situation/Assist in appropriate care if needed Debrief with Continues Complete any Debrief with Debrief with Debrief with Staff. Clear code. Consider Supervisor Surveillance needed Supervisor Supervisor Ensure all paperwork adjusting rotation to paperwork. is filled out correctly. temporarily remove Debrief with primary guard from 9 Supervisor surveillance. Debrief code w/primary guard, and determine if they can return to service. Section 2 - Missing Person When a missing person is reported on the beach, it is a serious situation. When they are not found on land, the severity of the situation grows exponentially as there is a great possibility that they are in the water. 2.1 Missing Person Emergency Action Plan PRIMARY RESCUER SECONDARY MANAGER OTHER RIPPER ROVING SUPERVISOR LC GUARD GUARDS Informed that a 1 person is missing. Gather information. When and Where was the person last 2 seen? What do they look like and what were they wearing? IF PERSON LAST SEEN ON LAND: PRIMARY RESCUER SECONDARY MANAGER OTHER RIPPER ROVING SUPERVISOR LC GUARD GUARDS Blow a 3-3 Whistle Run To Scene Run To Scene Run to Run To 3 Scene Scene Give appropriate Relay Hand Radio Beach Office for Relay Relay Respond to beach and Monitor radio hand signal Signal additional staff if Hand Hand scene. Relay communication needed. Signal Signal and ensure Beach Office is 4 Determine whether aware of situation. EFD and/or EPD response is required, if so contact dispatch Gather all other Receive all Receive and transfer all Receive Receive Perform constant scene Monitor radio pertinent information: patient information to other all patient all patient surveillance. Ensure safety Name, age, information staff informatio informatio and accountability of all staff description, n n involved. 5 swimming ability. Communicate information to Manager. Announce description Search Coordinate search Search Search Ensure all staff are Determine if Aquatic over megaphone; shoreline; effort, stay near the areas gate area, performing their duties as Camp is involved. If yes: continue surveillance Recruit person reporting the designate washroo necessary. notify Camp Director. All (if in chair) volunteers to missing person. Do not d by ms, AC staff should begin assist in allow them to leave and Manager concessio pulling all campers from 6 search continue interviewing ns, and water to report to their them. EFD Water surroundi counselors for a head Rescue Response ng park count. Have Camp should be requested if area Director pull ePACT the 60 second quick information. search is unsuccessful. IF PERSON LAST SEEN IN/NEAR WATER, LOCATION IS UNKNOWN, OR IS NOT FOUND IN 60 SECOND QUICK SEARCH (after completing 1 and 2 above continue here at Step 3): PRIMARY SECONDARY MANAGER OTHER GUARDS RIPPER ROVING SUPERVISOR LC RESCUER GUARD Blow 3-3-1 whistle. Participate In Coordinate Participate In Call EMS Ensure an EFD Water Rescue Broadcast alert to Clear Water. Shallow Water appropriate Shallow Water And Response was requested OR Evanston rescue Search (If not search. Contact Search (If Not Monitor initiate directly thru Dispatch. boats. Respond to Ask for assistance seen last in Dispatch for EFD Seen Last In Deep Gate Area Consider contacting Dispatch scene with 3 from patrons over deep water) Water Rescue Water) via telephone to enable full additional staff if megaphone for Response. and clear communication of possible. Confirms shallow water MP description and current that they received search. scene evaluation. emergency on EFD Main Continue Continue Continue Continue Wait for Take over interviewing Upon arrival at surveillance. Once Participation In direction of Participation In Superviso reporting party from Manager. scene, direct any water is clear, Search search. Consider Search rs and Determine if there are any additional staff, and oversee search replacing Primary EFD to other potential locations for ensure safety of all Guard in chair, brief MP. Direct reporting party to staff in water while 4 allowing them to not leave the scene. One staff overseeing the enter water to member, a supervisor if incident from the assist in search. possible, should stay with water. reporting party for the remainder of the incident Continue Continue Continue Continue After both Upon arrival of EFD Consider retrieving overseeing search Participation In Direction Of Participation In EFD and companies, Chiefs, and other additional staff and from chair, or Search Search. If Roving Search supervisor Parks/Rec staff be prepared rescue vessels to assisting in search if Supervisor is s arrive to give a report of incident, assist in search. relieved of chair available to take assist In conditions, and current 5 position by Manager over directing Search actions being taken by ELS. If or Supervisor search, enter command allows, take over water to direction of search from participate in Manager. search. 2.2 Shallow Water Search 1. When there is a missing person in the water; a shallow water search is necessary to search areas that are not visible from the lifeguard chair. 2. The primary lifeguard in the chair, or Manager/Supervisor who has relieved them for the search, oversees the shallow water search. All other guards and patrons able to help in the search should line up perpendicular to the shore, starting on one side of the beach. The line should start at the end of the beach that the current is moving towards (North to South current, start at South end of beach). The reason for this is that if a victim is submerged and unconscious underwater, that is the direction they would be moving, so it should be checked first. 3. The rescuers in the line should join hands and stand close enough together so that they will not miss anyone submerged in the water in between them. They should begin walking forward on the command of the primary guard in the chair, who should use the megaphone to direct the line if necessary. 4. The line of rescuers should walk forward at a steady pace and try to stay in as straight a line as possible. Rescuers should be constantly looking at and around their feet for submerged victims while also feeling around with their feet and legs in areas they cannot see. While walking, rescuers should be looking down in the water for a victim. Especially in murky water where they are unable to see the bottom, rescuers should sweep their feet forward, keeping their feet skimming over the bottom, and then out in a circular motion, attempting to “feel” the greatest amount of area as possible with their feet and legs. By sweeping their feet along the ground,  they will be able to feel a submerged victim on the bottom, instead of possibly stepping over them. 5. The guard in the chair should steer the line around sections of the swimming area that he/she can see. Most likely, on days where the water is clear, the guard will be able to see a good amount of the sand in the swimming area directly in front of the chair, so there would be no reason for the line to search there. 6. After the shallow water search is completed and all shallow areas of the water have been searched, guards should move on to the deep-water line search. 2.3 Deep Water Line Search 1. After the shallow water search has been completed guards should begin the deep-water line search. 2. When guards conduct a deep-water line search, patrons that were initially helping with the shallow water search can continue to search shallow areas, but the deep-water line search should be conducted by lifeguards only. 3. The line conductor, a beach manager or head lifeguard, should stand in about waist deep water with a rescue tube to be used if a victim is found during the deep-water search. The line conductor does not search or dive, they should be focused on the search pattern, and account for rescuer safety. The line conductor is in charge of the search, and is in charge of where the line moves, and how far it moves forward and back. 4. Starting at the far end of the beach and moving against the current (if waves are moving from North to South start at the South end of the area) guards should line up no more than an arm’s length apart from one another in a line perpendicular to shore. 5. On a voice command from the line conductor at the front of the line, the guards in the line dive down to the bottom, swim 3 strokes forward underwater, and then surface. While swimming underwater guards should be looking around for the victim, and in murky conditions should be feeling about with their arms and legs. 6. After surfacing as straight up as possible, the line may back up one to two strokes, a distance set by the line conductor, who should be constantly voicing commands so everyone stays in line and lines up with him/her perpendicular to the shore. It is also the line conductor’s responsibility, as well as the guards in line, to check around them to make sure after every dive all of their fellow guards’ surface safely. 7. After the line conductor has backed the guards up to where it will be certain that no area of the bottom will be missed in the search, the line conductor once again voices a loud command to make the guards dive again, as they did before in step 6. This is continued until the entire area has been searched, or EFD Command stops the search. 2.4 Determining the Emergency Search Period The term emergency search refers to the time when resources are heavily committed to recover a victim who may be successfully resuscitated. Standard practice for an emergency search period is one hour. This one-hour standard intentionally involves a period far greater than a successful resuscitation is typically likely but resuscitation after lengthy submersion has occurred, there is a possibility of error in estimating submersion time, and the concerns of family and friends of the victim must be considered. The one-hour limit notwithstanding, the USLA believes there is a “two-minute window” of enhanced opportunity for successful recovery and resuscitation of submerged victims. After this period chances of recovery and resuscitation decline rapidly due to factors such as water currents, surf, poor visibility, and obscuring of the last seen point. 2.5 Search If a lifeguard onshore determines there is a valid report of a missing swimmer, or witnesses a victim go under, the call goes out to other lifeguards and the search process begins. Estimated time of submersion and location should be established and documented at the onset. Supervisors and EFD need to be notified immediately. The search for a person underwater will be conducted and organized by EFD. If it is determined a submersion has occurred: Back up personnel should be alerted (EAP activated) The last seen point should be determined and fixed. Use cross bearings by lining up two stationary objects onshore in two separate locations, the imaginary lines for which form an X at the last seen point. 2.6 Code X The Code X signal (holding both arms crossed overhead) is used to mark the approximate spot where a victim was last seen above the surface. It is a way for a lifeguard in the water to show fellow guards on land where the position is and where the search should begin. This could be an approximate spot indicated by a witness, or the location where a lifeguard saw a victim submerge. The lifeguard gives the Code X arm signal to shore and a lifeguard onshore responds to confirm understanding of the signal. On shore lifeguards should ensure radio communication is made, conveying this approximate location to EFD through Dispatch and Supervisors. Additional available lifeguards should immediately respond to the Code X location to assist, if possible with Fins, Mask, and Rescue Board. Establish a search zone, mark with a buoy if possible, then begin search. After relaying the Code X signal, the lifeguard in the water should begin diving to search the area. However, until the spot is marked with a buoy and more rescuers are on scene, it is also important to hold that relative position in the water. 2.7 The Three General Search Methods In-Water Search – Wading and swimming lifeguards search the water. In shallow water lifeguards systematically wade back and forth along shore in a line perpendicular to the beach, searching with eyes, legs and arms. In deeper water, lifeguards use masks, fins and snorkels to search. They make surface dives when they cannot see the bottom from the surface. All searches must be coordinated thru command to ensure locations are being searched. Surface Search – Lifeguards are deployed in boats or paddleboards and search from these platforms. Helicopters can also be used. The value of this search method for submerged victims is dependent on water depth and clarity. Underwater Search – Evanston Fire and Rescue/Mabas Dive Team equipped with scuba can stay underwater and use systematic methods to search the bottom. 2.8 Recovery of a viable victim If a victim is recovered within an established time frame after submersion resuscitation efforts should be initiated immediately. Refer to the chapter Medical Care in the Aquatic Environment for specifics. 2.8a Body Recovery The Evanston Fire Department Command, agency protocol and individual circumstances will dictate when the emergency search phase terminates and becomes a body recovery phase. At this phase concern for rescuer safety is heightened.  Some lifeguards may be released to regular duties while a lesser number continue searching, and more Fire Department personnel become involved. Investigation of facts surrounding the incident becomes a focus. Lifeguards may be expected to make careful observations on land and underwater, collect evidence and complete reports. Consideration for the sensitivities of others at the scene should be addressed. Section 3 – Special Rescues 3.1 Multiple Person Rescue Lifeguards are sometimes faced with two or more victims in a distress or panic presentation. These multiple victim rescues (also known as mass rescues) present unique challenges. Multiple victim rescues commonly occur when: A panicked person grabs onto another for support, but the other person is incapable of providing support or rescue A current suddenly sweeps several people into deep water A boat capsizes or sinks forcing victims into the water An unexpected wave washes bystander into the water A would-be rescuer becomes a victim in a failed attempt at rescue The two keys to successful rescue of multiple victims are flotation and backup. Adequate flotation is essential to allow lifeguards to gain control of a rescue. Panic is usually greatly diminished once victims have something to hold onto which keeps their heads above the water. This also diminishes the immediacy of the need for immediate retrieval. The victims may still be caught in a current and being pulled away from shore, causing significant alarm, but the immediate fear of submersion is eliminated. Backup is critical on mass rescues because the responding lifeguard may be unable to complete the rescue alone. 3.2 Rescues without Equipment Effective use of lifesaving equipment increases the efficiency of rescue, while providing additional safety for the lifeguard. All lifeguards should be provided with the equipment necessary to successfully effect rescues. Nevertheless, lifeguards must be prepared to effect rescues without equipment if none is available. This may occur in a multiple victim rescue if the RFD must be given up supporting one victim, while another is aided elsewhere. Another possibility is that rescue equipment may be lost or damaged on a rescue. While off-duty, the lifeguard may be at an unguarded beach when a drowning presentation is recognized. These are just a few examples. Cross-Chest Tow — Throw one arm over the victim's shoulder and across the chest until your hand is in contact with the victim's side just below the victim's armpit. Immediately secure the victim between the arm and hip (right arm to right hip or left to left). The victim's shoulder should be secured in the rescuer's armpit. Concentrate on keeping the victim's face out of water. While this control method supports the victim, and maintains an airway, it may not place the victim in a position that produces a feeling of security, with the face and head out of the water. Struggling may continue as the victim attempts to lean forward out of the water. Modified Cross-Chest Tow — Quickly place an arm under the victim's arms and across the lower chest (or upper abdomen) of the victim to secure the victim between the arm and hip (right arm to right hip or left to left). The victim's buttocks should be supported on the rescuer's hip. This position usually provides enough support to allow the victim to lean forward and remove the head from the water. Panic usually subsides more quickly; but this position may result in the lifeguard remaining nearly or fully submerged, due to the added weight being supported out of  the water. This position should be used when there is a short retrieval distance to standing depth, since the lifeguard will not be able to maintain this tow for long. 3.3 Rock-line Rescue When compared to smooth, sandy beaches, rescues from rocky shores or reefs can be quite difficult and dangerous for lifeguards, especially in surf conditions where incoming waves can throw a lifeguard into the solid surface. Rocks can be very slippery, particularly when seaweed is attached, and it’s easy to fall during response and retrieval. Any time a Lifeguard enters the water for a rescue off the rocks or a breakwall, notify Supervisors and EFD. While rescue procedures at rock areas involve the three basic components of all rescues (recognize and respond, contact and control, signal and save), special considerations are in order. The following is a partial list: Protect Your Feet — Water entry can sometimes be made easier by donning swim fins for foot protection prior to entering the water. Another option is amphibious footwear. The benefits of foot protection should be carefully weighed against maneuverability. Wear a Wetsuit — Use of a wetsuit can greatly diminish the potential for injury from blunt force injuries or from being abraded. Use Care During Entry Dives — Shallow diving entries can be made from ledges, docks, and outcroppings, but should be made with great care to avoid head injury. Keep hands extended above the head and plan the shallowest dive possible. In surf conditions, dives should normally be timed for entry into the high point of a wave rather than the trough between waves. Wait for the upsurge of the arriving wave and jump into it. Swim Away Quickly — Begin swimming as soon as possible upon entry into the water, even in knee to waist-deep water. Continue to keep the hands in front to feel for and fend off rocks. Beware of Underwater Obstructions — Avoid ducking under incoming waves unless water depth is known. Expect Unexpected Waves — The surf can break suddenly and unexpectedly due to underwater rocks that lessen depth. This can cause unpredictable surf breaks. Retrieve to a Safe Area — Once the victim has been approached and controlled, retrieval should be made away from rock if possible, especially in surf conditions. This is an excellent circumstance for rescue boat backup. Another option is a long retrieval swim to the relative safety of a neighboring sandy beach. The time and effort involved may greatly reduce the potential for injury. Protect Yourself — A primary rule for lifeguards involved in rescues near rocks is to protect themselves first. The lifeguard will be of no assistance if injured and a severe injury to the lifeguard will greatly delay assistance to the victim. Protect Yourself and the Victim — If it is necessary to make a retrieval to a rocky shore in surf conditions, stay close to the victim rather than towing the victim behind on the RFD. If using a rescue buoy, position it in front of the victim, reach under the arms of the victim (from the victim's back) to grasp the handles, and use the RFD to fend off the rocks during retrieval as needed. Protect yourself since any injury to you may have grave consequences for both yourself and the victim. Know the Area — The greatest aid to lifeguard response at rock areas is experience and knowledge of the area. Those who work in these areas should get to know them well by studying them in all weather and tide conditions. Underwater rock formations should be of interest. 3.4 Offshore Spinal Protocol The following is a protocol for a joint effort rescue between the Evanston Lifeguards, Evanston Aquatic Camp/Sailing Staff, and the Evanston Fire Department Water Rescue Personnel. “Offshore” will be defined as any distance from shore where swimming to the victim is not possible, and rescue craft(s) are required as part of the rescue operation. Initial Considerations: In the event that a victim in deep water complains of head, neck, or back pain, spinal precautions must be taken before moving the victim to a boat or to shore. In the event of a victim who fell off of a tube or water skis, and is found unconscious, a spinal injury should be assumed and spinal precautions should be taken before moving the victim to a rescue boat. All rescuers entering the water from a rescue craft in any offshore response must wear a PFD and have a lifeguard rescue tube. Offshore victim rescue should be completed using Marine 21 if possible. Fire Department PWCs and available Lifeguard Whaler’s should be dispatched with extra rescuers and equipment. For any spinal victim, victim who is unconscious, severely injured, or otherwise incapacitated, the Marine 21 dive door entrance should be used to transport the victim to the Church Street boat ramp. Approaching the Scene/Rescue Vessel Operations All rescue crafts should approach the victim from the weather side, the waves and wind should be pushing the victim to the boat. First on scene rescue craft should approach the victim slowly and drop rescue swimmers a safe distance from the victim. Rescuers should enter the water and swim the remainder of the distance to the victim. The rescue craft should remain in close proximity to the victim until Marine 21 arrives. ○ Rescue craft operators should relay necessary information and maintain communication with dispatch, the beach office, and other incoming rescuers depending on specific position protocols. Upon arrival of Marine 21, all other rescue crafts should clear the immediate area in order to not interfere with Marine 21. Any rescue craft responding after Marine 21 should communicate with Marine 21 to see if additional rescuers are needed in the water. ○ If they are, boat operators should drive within swimming distance of the victim and rescuers should swim in to keep additional rescue crafts out of the immediate emergency scene. ○ In this instance only, rescue boats with additional rescue swimmers may approach from down waves, dropping their swimmers off at a safe distance (20 yards or more) from the emergency scene, allowing swimmers to swim with the waves to the victim. In the Water Operations Minimum of two rescue swimmers needed for an Offshore Spinal. Minimum equipment needed is a spinal board with straps, two lifeguard tubes, and C-Spine blocks if available. The first rescuer in water to arrive at the victim places the victim into inline stabilization and keeps the victim afloat. ○ If the victim is face down, roll the victim onto their back while maintaining in-line stabilization. Rescuers shall continue inline stabilization until C-Spine blocks are in place. ○ Determine if the victim is conscious and if so, their level of consciousness. Make them feel safe by staying calm and consistently communicating with them. As soon as possible, turn the victim’s head into the waves to relieve lateral movement that waves  can cause on the victim’s spine. The rescuer holding C-Spine should slide their rescue tube under the victim’s center back, placing the victim’s head on their own chest, and the rescuer should hold C-Spine with their forearms. ○ This will allow the rescuer to hold C-Spine, float the victim, and break any possible crashing waves with their own body before they crash onto the victim’s face and mouth. Any additional rescue swimmers should help provide flotation until the spinal board arrives. Once the spinal board arrives, all rescuers (aside from the one holding C-Spine) should slide the spinal board under the victim and secure the victim to the board. First strap at the chest under victim’s arms, second strap at the waist, place victim’s lower arms into the straps, and then strap across the legs. The rescuer holding C-Spine should adjust grip as necessary while continuing to hold in-line stabilization. ○ The rescuer holding C-Spine was the first rescuer on scene and has been in the water the longest. There is a chance that they will be fatigued from their efforts. Throughout the operation, Marine 21 (or water craft overseeing rescue operations) should continue to check in with them to see if they need to switch out at any time. While the victim is being secured to the spinal board, rescuers should slide rescue tubes perpendicularly under the spinal board to assist with flotation of the victim. ○ One rescue tube should be placed under the board at victim’s shoulders, the other under the board at the thighs. Add more rescue tubes as needed and adjust as necessary to keep victim’s head out of the water. If water conditions and the victim’s condition allows it, place C-Spine blocks on spinal board while in the water. If not, do so once on board Marine 21. Extrication from the water/Rescue Craft Operations Remove the dive door on Marine 21, swimmers shall swim the spinal board to the boat. ○ The boat should be positioned so that waves carry those in the water into the boat. A rescuer on Marine 21 should take over inline stabilization while other rescuers on the boat help pull the spinal board onto the boat. Marine 21 operator shall ensure all rescue swimmers are clear and take the victim to Church Street Boat Ramp. In the event Marine 21 is not in the water, once the victim is strapped to the spinal board and ready for extrication, a Whaler 17 shall be used to transport the victim ○ Lift the victim carefully onto the bow of the boat. This will take a number of rescuers both in the water and on the boat. Two or more rescuers shall stay with the victim and support and hold them on the bow of the boat. ○ Maintain a slow, safe speed so as not to cause further injury to the victim, or injure any rescuers on the bow of the boat Aquatic Camp Information In the instance where the victim is a camper, once there is another rescue craft on scene and all available staff from the primary boat is in the water assisting, the boat operator should immediately return to Dempster to drop off any campers on the boat and pick up any available Lifeguard or FD personnel and return them to the scene. ○ If the victim is unconscious, not breathing, does not have a pulse, or is severely injured, the primary responding boat (most likely the boat the incident occurred on) should not wait for Marine 21 to transport. Life over limb.. 3.5 Diver Rescue In many beach areas, people skin dive (diving with mask, fins, and snorkel) and scuba dive (using  compressed air tanks). Lifeguards are encouraged to become scuba certified. This training provides insight into the sport and helps greatly in understanding scuba rescue techniques, as well as the pathophysiology of diving injuries. In the event that a Lifeguard sees a SCUBA diver in need of assistance or rescue, EFD and the EFD dive team should be requested immediately. Signs of distress of a diver may include: Waving toward shore Blowing a whistle Surfacing alone with no sign of the buddy Surfacing and remaining motionless Breaking the surface very suddenly or even explosively Hurriedly ripping off a mask or other equipment Mask on the forehead or off the face Swimming toward shore, but making no progress Retrieval of a conscious, distressed diver is essentially the same as for any victim, but complicated by the equipment and relative lack of mobility of the diver. Surf rescues of divers can be hazardous because the tank and regulator can strike the lifeguard, causing serious injury including loss of consciousness. 3.6 Suicide Attempts Response to a suspected suicide attempt should automatically trigger a call for both an Evanston Fire Department and Evanston Police Department response. It’s not uncommon for people to try to take their own lives in or near the water. People may jump from piers, cliffs, or bridges. They may swim offshore. They may even attach themselves to weights. They may drive cars into the water. While many suicide attempts will occur at more remote areas or at times when lifeguards are not present, lifeguards may be called to respond. The most difficult aspect of a suicide presentation is the fact that those attempting suicide may not want to be rescued. They may swim away from approaching rescuers and refuse to grasp extended RFDs. Suicide incidents can be incredibly stressful for lifeguards. Any rescuers needing help or consultation following the incident should please reach out to any of their supervisors or can find resources in Chapter 1. 3.7 Sand Collapse Beachgoers of all ages love to dig in the sand, but each year in unusual cases, this leads to death and injury. Like any trench in the soil, the walls of sand holes can collapse, causing entrapment and possible suffocation, as well as crushing injuries. Sand though is even less stable than the trenches dug by construction workers in soil. Beachgoers should not be permitted to dig holes deeper than their waist due to collapse concerns. When a sand hole collapses over a person or persons, it is an immediate, life-threatening emergency. The weight of sand can cause crushing injuries and sand granules can fill every void, preventing breathing. Depending on the size of the hole, it may be exceedingly difficult to determine where the victim is to begin digging and to avoid worsening the situation. When lifeguards become aware of a sand hole collapse that has covered a beach goer, an immediate emergency should be declared, and EFD should be contacted. Section 4 - First Aid/Injury The most common emergency situations on the lakefront are basic first aid injuries. No matter how small or seemingly menial, they should be treated with the same attention and seriousness as any other emergency. 4.1 First Aid/Injury Emergency Action Plan PRIMARY RESCUER SECONDARY MANAGER OTHER RIPPER ROVING LC GUARD GUARDS SUPERVISOR Identify Injured 1 Person Notify Manager, Follow Red Cross 2 procedures to treat injury Continue treatment Assist in Ensure proper Bring First Aid treatment if treatment is being Box, and AED to necessary, provided and Primary Rescuer. 3 perform proper equipment secondary is being used. survey. Continue treatment Assist if Radio Roving Assist If Assist If Respond to scene. If Monitor Radio. necessary Supervisor if injury necessary necessary, if not EFD has not been Determine severity of is not minor in go back to Ripper notified, upon arrival to injury, decide what 4 nature. If needed, position scene determine further actions or notify Dispatch for whether EFD response resources are needed EFD is needed. Ensure and provide them. safety of all staff Respond if needed. Complete treatment Assist if Perform patient Assist if Wait for Oversee interviews and If EFD was contacted, necessary interview and necessary Supervisors and paperwork. If EFD was confirms that they complete EFD and provide dispatched, be received emergency 5 paperwork. them any prepared to provide on EFD Main pertinent them a full report and information any vitals taken. 4.2 First Aid/CPR Guidelines CPR is designed to provide oxygenated blood to the cardiovascular system in the event of a cardiovascular failure such as a heart attack or drowning incident. The process of CPR has been modified throughout the years by the agencies that set CPR standards, however the fundamentals of CPR remain switching between chest compressions to pump blood through the body and assisted breaths to give oxygen to the lungs. By this process oxygen is supplied to the bloodstream and the body's organs are prevented from shutting down. Compressions Chest compressions are designed to pump the heart in the event it stops pumping itself. Chest compressions are modified for different victims based on the size of the victim's chest cavity however with each victim it is important to allow the chest to fully recoil after each compression. This allows for more effective compressions as the chest is pumped up and down as opposed to being compressed down. Breaths Assisted breaths are designed to provide oxygen to the victim’s lungs to be absorbed into the bloodstream. Assisted breaths involve using either your lungs or a device such as a bag valve to push air into the lungs. Using your lungs is less effective than a bag valve because it is more difficult to achieve a good seal around the patient’s mouth and air from your lungs contains less oxygen than fresh air. In addition, the bag valve mask can be attached to an oxygen tank to provide 100% oxygen to the victim. Whenever giving breaths you must ensure the breath device is firmly placed on the victim’s face to ensure the air enters the victims’ lungs. In addition, as breaths are given it is important to watch the victim's chest for a rise and fall to ensure the air enters the victim's lungs. With smaller victims such as children, breaths must be modified to be softer to prevent internal damage to the victims’ lungs from over inflation. 4.2a Caring for the victim Always follow your American Red Cross training and Emergency Action Plans. Always wear gloves and other personal protective equipment. Don’t move an injured victim unless absolutely necessary. Keep non-essential onlookers away from the scene. Get info on medical history and how the injury/illness occurred. If the victim is unconscious, get backboard in case CPR is needed. 4.2b Post Incident Any equipment that has been contaminated after an incident should be placed in a marked “Biohazard Bag” for disposal. Wash hands thoroughly after the event, even if gloves were worn. If it is believed that an exposure has occurred, clean the area of contact thoroughly, write down what happened on an incident report, and contact supervisory staff immediately. Fill out all necessary paperwork and alert Supervisors of the incident if they were not already aware. For incidents involving campers: In addition to following the First Aid/Injury Emergency Action Plan if a camper is injured in any way, you MUST alert the Director and/or Assistant Director of the camp and fill in an incident or first aid report. 4.3 First Aid Quick Reference Guide Condition Recognition/Signs and Symptoms Providing Care/First Aid -Coughing or wheezing that may occur after exercise -Obtain consent and assist a person with their -Difficulty breathing or shortness of breath (Rapid, shallow prescribed inhaler if they have it. Asthma breathing) -Maintain an open airway -Tightness in chest -Help the person sit up and rest in a position of May require -Inability to talk without stopping frequently for a breath comfort (e.g.: sitting in a chair with hands on head) EFD -Crying -Monitor patients ABC’s, calm patient, and keep -Pulse will be rapid them warm -Skin, lips and nail beds may have discoloration from lack of oxygen -Swelling/rash/hives on the face, neck, hands, throat, tongue -Maintain an open airway Anaphylactic or other body part -Remove the victim from the source of the allergy Shock -Difficulty breathing or shortness of breath -Assist with the person’s prescribed epinephrine (Allergic -Difficulty swallowing auto-injector (Remember to determine whether the reaction) -Tight feeling in the chest and throat person already has taken epinephrine or -Change in level of consciousness antihistamine) Contact EFD -Signs and Symptoms of Shock. Shock -If they have an antihistamine medication in their anaphylaxis kit, help them take it -Stay with them and monitor ABC until EFD arrives -Do not give fluids or food -Convulsive movements/severe muscle twitching -Maintain an open airway Seizure -Clenched teeth/drooling -Provide a safe private environment (Epileptic -Cyanosis -Lie patient down and protect head Grand Mal) -Change in levels of consciousness -After seizure passes turn on side to drain fluids -Abnormal breathing from the mouth Contact EFD -Loss of bowel & bladder control -Loosen restrictive clothing -Abnormal vocalizations. Staring. -If in water support head above water -Monitor patients ABC’s -Do not put anything in patients mouth -Rapid, deep breathing -Summon EFD if necessary Hyper- -Tingling in arms and mouth -Monitor patients ABC’s Ventilation -Cramps in fingers -Be prepared to perform rescue breathing if -Sharp chest pains conditions worsen May require -Unconsciousness EFD -Shortness of breath -Be prepared to perform CPR and use an AED -Chest pain or discomfort that may radiate to another area -Have the patient stop any activity and rest in a Heart Attack -Profuse sweating position of comfort in the shade -Pale, sweaty skin. Nausea/Vomiting -Loosen tight or uncomfortable clothing Contact EFD -Tight feeling in the chest -Monitor patients ABC’s -Extreme fatigue, unresponsiveness -Assist the patient with prescribed medication, aspirin or nitroglycerin -Hypoglycemia-Insufficient amount of glucose in the blood. -If they are unresponsive or not fully alert, place in -Hyperglycemia-Excessively high blood glucose levels recovery positions, maintain open airway and Diabetic -History of diabetes, often seen with a medical ID tag monitor ABCs Emergency -Confused, agitated, and verbally abusive -Use oral glucose gel tube only if patient is able to -They will appear ill. Sweaty. take it themselves Contact EFD -Changes in levels of consciousness -If they can tolerate it, give orange juice, milk and -Numbness in mouth and tongue non-diet soft drinks or candy (15 G sugar for child, -Unconscious, seizures, unresponsive 20 G sugar for adult) Condition Recognition/Signs and Symptoms Providing Care/First Aid  -Painful muscle spasms that usually occur in the legs and -Move patient to a cool place abdomen -Loosen tight clothing and remove Heat Cramps -Sweating perspiration-soaked clothing -Increased heart rate -Cool the victim by spraying with cool water or May require -Exhaustion and dizziness applying cool, wet towels to skin EFD -Encourage the patient to drink small sips of fluids, preferably an electrolyte sports drink or water. -Monitor patients ABC’s -Profuse sweating -Move patient to a cool place -Cool, moist, pale, ashen or flushed skin -Loosen tight clothing and remove -Headache, nausea, dizziness, weakness and exhaustion perspiration-soaked clothing Heat -Thirst -Cool the victim by spraying with cool water or Exhaustion -Fainting applying cool, wet towels to skin -Dilated pupils -Encourage the patient to drink small sips of fluids, Contact EFD -Note: Heat exhaustion is an early indicator that the body’s preferably an electrolyte sports drink or water. cooling system is becoming overwhelmed. -Monitor patients ABC’s -Red, hot, dry skin -Move patient to a cool place -Changes in levels of consciousness -Perform rapid cooling measures. Immerse in cold Heatstroke -Vomiting water or provide cold wet towels and ice packs on -Constricted pupils neck, underarms, and in groin area Contact EFD -Disorientation -Loosen tight clothing and remove -Seizure perspiration-soaked clothing -Note: Heat stroke occurs when the body’s systems are -Monitor patients ABC’s overwhelmed by heat and stop functioning. Heat stroke is a life-threatening condition. -Shivering -Move the patient to a warm place and remove any -Numbness wet clothing Hypothermia -Glassy stare -Dry the patient and warm the victim slowly, be -Apathy sure to cover the head. Contact EFD -Weakness or impaired judgment -Put them in dry clothing and apply heat packs -Change in levels of consciousness -If the patient is alert, have the patient drink liquids -Note: If cold water drowning, start CPR and do not re-warm. that are warm, not hot. -Monitor patients ABC’s Opioid -Presence of items associated with drug use -Provide care for the conditions found including Overdose -Decreased breathing effort and rate ventilations or CPR if necessary -Gasping, gurgling, snoring -Administer Naloxone (Narcan) if available Contact EFD -Blue or gray skin, decreased level of consciousness and EPD -Pinpoint Pupils -Trouble with speaking, slurring, unable to understand FAST: directions -Face. Ask them to smile, is there weakness or Stroke -Drooling or difficulty swallowing drooping present? -Drooping of the features on one side of the face -Arm. Instruct the person to close their eyes and Contact EFD -Loss of consciousness, confusion hold both arms straight out, palms up, for 10 -Headache, dizziness seconds. Is there weakness or drooping? -Speech. Ask them to say “You can’t teach an old dog new tricks.” Are they slurring or having trouble speaking? -Time. If there were any issues with the above tasks, note the time that these symptoms started. If possible, ask family/friend that are with them when they first noticed any issues or symptoms. Section 5 - Lakefront Water Response Team/EFD Search & Rescue EFD’s Water Rescue Team, including Marine 21 and the Personal Watercrafts (PWC/Jetski), are to be notified and requested in any emergency or rescue situation involving a watercraft/vessel or involving a swimmer not directly off of one of the swimming beaches. EFD may request the assistance of Lifeguard and Lakefront staff during water emergencies. 5.1 Emergency Notification If a member of the Lakefront staff witnesses an emergency situation on the water, or is interviewing a witness to an emergency either in person or on the radio, the following key information should be gathered to help pinpoint the location of the rescue. Nature of emergency Where is the vessel or swimmer located, or where were they last seen What kind and color of vessel/was the swimmer wearing a PFD How many people were on board the vessel Last known coordinates What is the Cell phone # for a person on board the vessel in distress Do they have an anchor and are there personal floatation devices on board? (If yes, put them on) Any possible illuminating signal devices or sound making devices Section 6 - Active Threat Procedure Run, Hide, Fight – Active Shooter Protocol An Active Shooter is an individual actively engaged in killing or attempting to kill people in an open and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims. Active shooter situations are unpredictable and evolve quickly. Typically, the immediate deployment of law enforcement is required to stop the shooting and mitigate harm to victims. Because active shooter situations are often over within 10 to 15 minutes, before law enforcement arrives on the scene, individuals must be prepared both mentally and physically to deal with an active shooter situation. If you hear shots fired on the lakefront or if you witness an armed person shooting or threatening people (active shooter): Immediately choose the best way to protect your life. Very quickly, make your best determination of what is occurring and which of the options below will provide the greatest degree of security for you employing the “RUN, HIDE, or FIGHT” protocol. If possible, notify individuals on the beachfront to evacuate immediately. The call out of “Active shooter, EVACUATE” will cause a panic, but will get people moving off the beachfront. RUN: Evacuate If Possible If there is considerable distance between you and the gunfire/armed person, quickly move away from the sound of the gunfire/armed person. If the gunfire/armed person is in your area, run as fast as possible, far away until you are in a secure place to hide. Leave your belongings behind. Take others with you, but do not stay behind because others will not go. Call 911 when it is safe to do so. Do not assume that someone else has reported the incident. The information that you are able to provide law enforcement may be critical, e.g. number of shooters, physical description and identification,number and type(s) of weapons, and location of the shooter. However, your safety is priority; only try to ascertain the information listed above if it does not put you in immediate danger.  If you choose to run, understand you are in an open area. A gunman may see you. If possible, run in a serpentine pattern, or use cover to move away. Do not attempt to move wounded individuals. It is imperative to create as much distance as possible between yourself and an active shooter while in an open area. If there are any snow fences between you and a possible escape route, do not hesitate to either jump over, or knock down any snow fences. Knocking them down may help others gain distance from the shooter. HIDE: Hide silently in as safe a place as possible If the shooter is in close proximity and you cannot evacuate safely, hide in an area out of the armed person’s view. Silence phones and turn off other electronics. If you are outdoors and cannot RUN safely, find a place to hide that will provide protection from gunfire such as a brick wall, large trees, cars or buildings. The bathroom facilities are concrete and block construction. If you choose to hide inside, bring as many bystanders as you can inside, lock the door behind you and get as low to the ground as you can, lay down if possible. Hide behind vehicles, keep low, keep moving to remain out of the shooters line of sight. FIGHT: Take action to disrupt or incapacitate the shooter As a last resort, fight. If you cannot evacuate or hide safely and only when your life is in imminent danger, take action. Attempt to incapacitate or disrupt the actions of the shooter. Act with physical aggression toward the shooter. Use items in your area such as fire extinguishers or chairs. Throw items at the shooter if possible. Call 911 when it is safe to do so. Immediately after an incident: Wait for Local Law Enforcement officers to assist you out of the area. When law enforcement arrives, keep hands up, with palms open, and obey commands. Note: Understand that gunfire may sound artificial. Assume that any popping sound in rapid succession is gunfire. Be mindful that violent attacks can involve any type of weapon, not just a gun. Knives, blunt objects, physical force or explosives can be just as deadly as a gun. The suggested actions provided here are applicable in any violent encounter. Plan ahead: Visualize possible escape routes, including possible places to hide or shelter safely. Bathroom facilities, nearby buildings, cars, and boat houses are all places to flee too, if necessary. Early warning signs of an active shooter event may take place days, or even weeks prior. Paying attention to signs and patterns may help you identify threats before they become violent. Potential warning signs may include: increasingly erratic, unsafe, or aggressive behavior. Hostile behavior based on claims of injustice, or perceived wrongdoing. Drug or alcohol abuse  Claims of marginalization or distancing from friends and co workers Changes in performance at work, to include increasing aggression towards coworkers, and erratic behavior. You can help ensure the safety of others and those around you. Be aware of these sudden changes. Take note of these escalations and immediately report to a supervisor. Provide any information that may help facilitate intervention and mitigate potential risks Never hesitate to report an erratic or suspicious person to a supervisor