In an aquatics incident, giving effective ventilations to the victim is the priority. With rescue breathing, now termed ventilations, it is recommended that each breath is delivered over 1 second and that there is sufficient tidal volume to cause the chest to visibly rise. It takes practice to deliver air through a pocket mask or bag-valve-mask ventilation (BVM) to get a steady, gentle rise of the victim’s chest . Ventilations are not rapid or forceful. To be successful, some skills that should be routinely trained include:
• Proper placement of the rescuer around the victim to deliver ventilations
• Proficiency in opening the airway from the lateral and cephalic (top of the head) positions
• Proper sealing of the pocket mask or BVM from the lateral and cephalic positions
• Tactile proficiency in delivering effective ventilations for an adult, child, and infant using a pocket mask
• A synchronized proficiency with your rescue partner in delivering effective ventilations with a BVM for an adult, child, and infant
• Changing out rescuers, pocket masks or BVMs due to fatigue, safety or equipment failure without interrupting ventilations
• Incorporating emergency oxygen (if trained to do so)
In the lifeguard industry, it is common to see rescuers train vigorously to deliver two effective ventilations combined with chest compressions for CPR. Unfortunately, this is often the only time that lifeguards train in providing ventilations. I encourage reprioritizing and training, just as vigorously, to provide adequate, uninterrupted ventilations for victims who have a pulse but are not breathing. If you encounter a passive victim in the water who is not breathing and has no visible trauma to the head and neck, then hypoxia or a lack of oxygen within their system is the likely culprit.
Here are a series of drills that your team can practice:
GLOVING-UP PROGRESSION DRILLS 1-5
All lifeguards lined up holding a pair of gloves. Have several boxes of gloves available. OBJECTIVE: Each lifeguard must get gloves on, with hands in the air. TIMING GOAL: 10-15 seconds to complete the objective.
Go through the drill until all lifeguards have passed within the allotted time. Strive to reduce the allotted time to 10 seconds. If gloves become compromised (too much sweating or tearing) get another set. Gloves are not expensive and should be used. Utilize large and extra-large gloves for this drill.
Here is the progression:
• Drill 1: Stationary position with gloves in hand
• Drill 2: Stationary position with gloves pulled from hip pack
• Drill 3: Walking from points A to B, gloves pulled from hip pack
• Drill 4: Running from points A to B, gloves pulled from hip pack
• Drill 5:Same as 4, except rescuers expected to be properly placed around the victim
AIRWAY MANEUVER DRILL
Pair up lifeguards — one rescuer, one victim. Primary rescuer is 10 feet away from the victim, who is in the supine position. OBJECTIVE: Move quickly into position and open the airway. Victim is non-spinal. TIMING GOAL: 3-7 seconds for each maneuver.
Go through each maneuver:
• Lateral: Head tilt/chin lift
• Cephalic: Jaw thrust with head extension
POCKET MASK ROTATION DRILL
For four or more lifeguards: Lifeguard (A) will be at the lateral position of the manikin and begin providing ventilations for an adult. Lifeguard (B) will start at the chest of the manikin with hand on the chest, monitoring the effectiveness of the ventilations. OBJECTIVE: Provide steady, uninterrupted victim care while rotating through rescuers.
Ventilations should be steady and uninterrupted, causing the chest to visibly rise. After performing three successful ventilations, lifeguard (C) will step into the open position at the top of the victim (cephalic) and begin to provide ventilations. Lifeguard (A) will take over for lifeguard (B) at the chest. Rescuers will continue rotating through the lateral and cephalic ventilation positions for at least three rotations, going through all the positions. Once proficient, rescuers should progress to pulling gloves from a hip pack and gloving up before stepping in and providing ventilations. The rescuer “on deck” will be queued to start gloving up once ventilations begin (up to 15 seconds to glove up). Rescuers rotating off from monitoring the victim’s chest should de-glove and get back into the lineup. VARIATION: Same drill, providing ventilations to a child.
BVM ROTATION DRILL
For four or more lifeguards: Lifeguard (A) will be squeezing the BVM bag, and lifeguard (B) will be opening the airway from the cephalic position and sealing the mask. Lifeguard (C) will be at the manikin with hand on the chest, monitoring the effectiveness of the ventilations. OBJECTIVE: Provide steady, uninterrupted victim care while rotating through rescuers.
Lifeguards (A) and (B) will provide ventilations for an adult with lifeguard (C) at the chest monitoring the effectiveness. After three successful ventilations, lifeguard (D) will step in and take over for lifeguard (A). Lifeguard (A) takes over for lifeguard (B) and (B) to (C), monitoring for effective ventilations. Lifeguard (C) will rotate out and go back into the lineup. Again, ventilations should be steady and uninterrupted, causing the chest to visibly rise. Rescuers will go through at least three rotations, going through all the positions. Once proficient, rescuers should progress to pulling gloves from a hip pack and gloving up prior to stepping in and providing ventilations. The rescuer on deck will be queued to start gloving up once ventilations begin (up to 15 seconds to glove up). Rescuers rotating off from monitoring the victim’s chest should de-glove and get back into the lineup. VARIATIONS: Same drill, (1) providing ventilations to a child, (2) replacing BVM mask with a pocket mask because of equipment failure, and (3) moving the victim to a new location due to the scene becoming unsafe and resuming care.
THREE-RESCUER REPLACEMENT DRILL
A three-person rescue team (two rescuers ventilating the victim, one rescuer monitoring ventilations) will move into position and completely replace an existing rescue team that is ventilating a victim. The replacement team will continue to provide steady, uninterrupted care. OBJECTIVE: Quickly replace the existing rescue team. TIMING GOAL: No more than 15 seconds.
DRILL SEQUENCE
Gloving-up Progression Drills 1-4 (8 min)
• Airway Maneuver Drills, Lateral and Cephalic (4 min)
• Rescuer Placement Drill (4 min)
• Gloving-up Progression Drill 5 (2 min)
• Pocket Mask Rotation Drill, Adult and Child (Infant if time is available) (5 min)
• Gloving-up, hip packs (5 min)
• BVM Rotation Drill, Adult and Child (Infant if time is available) (7 min)
• Alternate between pocket mask and BVM, due to equipment failure (5 min)
• Moving the victim, scene unsafe (5 min)
• Three-Rescuer Replacement Drill (5 min)
Remember: Providing excellent airway management and ventilations can save a life. Good luck, and keep training.
