Waterpark Option - AntonsSports.net

Transcription

Updated
For
2011
NLS
Waterpark
Precert Package
Created by:
RYAN RADFORD
THE
LIFEGUARDHOME
Ver 4.1
®
www.lifeguardhome.com
NLS Waterpark Precert Package 2011
NLS WATERPARK RECERTIFICATION INFO
While waterparks present even experienced lifeguards with new and unique challenges, the
basic concepts and principles of lifeguarding remain the same. You will be expected to
demonstrate these basic concepts and principles by adapting to the challenges presented by the
waterpark environment. You will be expected to demonstrate effective lifeguard supervision
and intervention principles while working with a team of other lifeguards on deck with you.
INSTRUCTOR: Ryan Radford
rradford@shaw.ca
TO BRING FOR RECERT:
 NLS Waterpark original wallet card within 7 YEARS of issue (no copies)
 CPR Level “C” original wallet card within 1 YEAR of issue (no copies)
 Fanny Pack with Pocket Mask and Goggles
 Whistle
 White T-shirt
READY FOR SOME WATERPARK??
Ryan Radford
-2-
EVALUATION
You will be evaluated based on the latest printing of the NLS Award Guide published by the Lifesaving
Society of Canada. A fail of any ONE of the following items will result in the failure of the recertification.
1. WRITTEN EXAM
50 Multiple Choice Questions
Pass: 65% (33-50/50)
Fail: Below 65% (0-32/50)
NOTE
Because the NLS Waterpark Option builds on the
skills taught and evaluated in the NLS Pool option,
it is expected that candidates be able to perform all
of these skills during the recertification. These may
include general lifeguard procedures and
techniques, first aid assessment and treatments, and
resuscitation skills.
2. SPECIALIZED RESCUES
a) Waterpark Spinals
Land spinals
Zero-depth spinals
Deep water spinals
Waterslide spinals
b) Wave/Water-feature Rescue
Emergency procedure with adaptation to facilities unique features (waves, lazy river, hot tub, stairs,
etc.)
A minimum of ONE of the above procedures will be evaluated. This may occur during simulations or as a
stand-alone procedure.
3. POOL PHYSICAL SKILLS
a) Carry
Approach 15 m head-up, pick up drowning non-swimmer in deep water and carry to nearest side of
pool (distance of 5 m) supporting the victim’s head AND shoulders out of the water.
b) Object Retrieval
Approach 15m, recover a 20lb (9kg) object located at the bottom of the pool and at a distance of
5 m from a dock or pool side; Surface and carry for a total distance of 5m. Rescuer’s head must be
above the water; the object may be below.
c) Spinal Carry
Perform a deep water spinal rollover and transport patient for a total distance of 15m, including ability
to change direction.
d) Submerged Patient Recovery
Performa 5m land on-deck approach and enter the water. Approach 15m to recover a submerged
victim. Carry the victim 15m using a control carry.
4. SIMULATIONS
The handling of each patient has to be performed realistically. Show exactly what you would do in
real life. In addition, when you are being a victim, please show every courtesy to your fellow
lifeguards by portraying the victim type as accurately and realistically as you can.
Please ask any questions necessary before your simulation to clear up any uncertainties you may have.
The simulations used to evaluate lifeguards during a recert are made up of any combination of the
following:
Public Relation Situations
Water Rescues (DNS, etc.)
Minor First Aids
Major Emergency
Candidates will demonstrate the leadership & communication skills necessary to effectively MANAGE a
team consisting between 4 and 8 lifeguards on deck at one time. You will be managing your team
using a Pivot-style of lifeguarding.
Ryan Radford
-3-
SIMULATION CRITERIA
The following is a list of common scenarios and/or errors that MAY constitute a “Failed” performance item during
simulations. Please note that this list is only a guideline to be used by students who may not have access to the Award
Guide. The author of this document takes no responsibility for failed candidates based on these criteria:
Resuscitation Techniques
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Patient Care / First Aid
Unconscious breathing patient removed from water to their back
Significant delay in removal from water
Pool airway management of unconscious patient
CPR Compressor not switched off every 2 minutes
Unecessary delay of compression during CPR (more than 10
seconds)
No roll for vomiting or regurgitating patient
Incorrect landmarking for chest compressions (adult, child, or
infant)
No abdominal thrust/back blows combo for conscous patient
with severe obstruction
No visual check of airway during unconscious obstruction
procedure
Excessive delay in activating EMS for any unconscious patient
Lifeguarding Techniques
 Scanning - no recognition within reasonable time of DNS/Major
Emergency
 Pool coverage not maintained for an unreasonable amount of
time
 Pool not cleared when unsupervised for extended period of time
 No effort made to backup other lifeguard during emergency
 No repositioning to cover other lifeguard if necessary
 Leaving deck area without signaling to other lifeguard
 No signaling for backup when responding to a major emergency
 Negative attitude towards patrons/public during public relation
incident
 Public relation incident completely unresolved
Lifeguarding Skills & Procedures
 Unsafe entry used (ie. Shallow dive)
 DNS approached unsafely (ie. guard directly in front of patient)
 No assessment or education/follow-up for a distressed or
drowning swimming
 Head and airway submerged for any patient
 ABC assessment not done at nearest point of safety
 Barrier devices (personal protective equipment) not used
 Airway not protected during recovery of submerged patient
 Rough handling and excessive movement of patient
 Missing person scenario not immediately communicated to
other lifeguard
 No immediate underwater search performed for missing person
 Inability to adapt to unique facility design (hot tub, sauna, deck
spinal, etc.)
Use of Equipment
 Patient not immobilized from stable to unstable on spineboard
 Poor lifting techniques causing uncessary movement to patient
on board
 Improper lifting techniques (using back for lifting)
 Sandbags or V-blocks not removed for victim roll on spine board
(vomit/regurgitation)
 Oxygen not used when necessary and available
 No oral airway used when necessary and available
 Unfamilar with oxygen unit
 Dangerous handling of oxygen unit
General
 No hazard check before entering scene
 ABC’s not assessed
 Failure to perform a systematic secondary survey/assessment of a
major patient
Spinal-Injured Patient
 Modified jaw-thurst not used when assessing or resuscitating
spinal-injured patient
 Full body immobilization not done for any spinal-injured patient
(cervical, thoracic, lumbar, etc.)
 Any loss of immobilization for spinal-injured patient
 No assessment of severity of spinal injuries
 Spine board strap done directly over injury site
Cardio-Respiratory Emergency
 Excessive movement of chest pain / shortness of breath patient
 Chest pain / S.O.B. patient not assisted into position of comfort
 No attempt to intervene in respiratory distress (medication,
pursed-lip breathing, assisted vents)
Soft Tissue Wounds/Burns

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No control of deadly bleeding
No cooling of any degree burn
Dry chemical burn not brushed off before flushing
Non-superficial embedded object removed
Needle prick not allowed to bleed for 10 minutes and/or not
washed with soap and water
Medical Emergencies
 Proper history not obtained regarding ASA for chest pain patient
(4As)
 No check for history of E.D. drug use prior to assisting with
nitroglycerine
 Auto-injector (EpiPen® or TwinJect®) not administed to
anaphylactic patient when patient cannot self-administer
 Auto-injector (EpiPen® or TwinJect®) not administered correctly
to anaphylaxis patient (safety cap not removed, not held for
correct time, no post-injection massage,etc.)
 TwinJect® second dose not administered correctly
 Medications not determined or assisted for patient experiencing
medical emergency
 Insulin assisted to diabetic patient with low blood sugar
(hypoglycemic)
 Sugar adminstered to unconscious patient
 Restraining of seizing patient
Environmental Conditions
 Improper re-warming of hypothermic patient (ie. placing in hot
tub, rubbing extremities)
 Improper cooling of heat-related patient depending on condition
Fracture/Joint Injury
 No assessment of fracture/joint injury (distal circulation and
point tenderness) to determine severity
 No immobilization of fracture/joint injury
 Ice applied to injury with decreased distal circulation
 Attempt to relocate a disclocation
Head/Facial Injury
 Does not assess head/facial injury for potential spinal injury
 Vital signs not recorded for severe head injury
Poisoning
 Poison Control Center not contacted for poisoning
Ryan Radford
-4-
NLS PROCEDURAL UPDATE
Over the years, many lifeguards were taught a specific procedure designed for the management of a lower
spinal cord injury. This procedure was referred to as a “Lumbar Procedure.” It typically involved
immobilization from the chest to the feet with specific attention to minimizing any movement of the legs.
Recent consensus amongst the Branch medical directors and
committees of the Lifesaving Society have concluded that this
specific procedure may not provide enough effective
immobilization for the patient. Therefore, all spinal injuries,
whether they be cervical, thoracic, lumbar, etc, are to be
immobilized fully from head to toe.
[Notice no head
restraints being used.
]
“The Spine is the Spine”
All spinal-injured patients should be immobilized head to toe
Trauma to the spine regardless of location (cervical, thoracic, or lumbar), is to be treated as a cervical spine
injury and he victim be fully packaged. On patient request, padding may still be applied under the legs.
Non-traumatic lower back injuries will continue to be addressed as a “lower systems injury.”
Spinal Injuries
Lower System Injuries
Mechanism of
Injury
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Diving
Falls from height
Direct blow/trauma to head/neck/back
Motor Vehicle Accidents

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Lifting or twisting
Repetitive movement
Previous back injury
Poor posture, muscle tone or physical conditioning
Signs &
Symptoms
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Pain and/or stiffness at the site of the injury
Tenderness or muscle rigidity along the spine
Bruising, deformity or swelling along the spine
Numbness, tingling or weakness in the
extremities (spinal nerve or cord injury)
Paralysis (spinal nerve or cord injury)

Pain limited to the injury site and worsened by
movement
Pain may radiate away from the injury site
Muscle spasms limit the range of motion
Patient may assume a stooped position and be
unable to stand up straight
Full Spine Immobilization: chest, head, lower
body (traditional “C-Spine” procedure)
May need to have legs supported in lower spine
injury if they cannot lower them
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Procedure
Adaptation

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Example
Padding if necessary to
maintain position found

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Load in position of comfort (lateral or supine)
Head does not need to be immobilzed
Use padding for comfort
2010 AHA CPR STANDARDS
Highlights from the new 2010 AHA CPR Standards:
C-A-B

In a non-aquatic history, the rescuer should immediately begin chest
compressions after discovering no breathing or abnormal breathing.
Note in an aquatic rescue, the traditional ABC protocol is still used.
Back Blows

For a conscious severely obstructed airway of an adult or child, a
combination of 5 abdominal thrusts (or chest thrusts) and 5 Back Blows
should be used to clear the airway.
Breathing Checks

Breathing checks in the unconscious patient should be a minimum of 5
and a maximum 10 seconds in length.
In-Water Resuscitation

Research has shown that it would not be unrealistic to provide rescue breaths not exceeding
20 seconds prior to starting CPR as victims with only respiratory arrest usually respond after
a few artificial breaths are given. Therefore, for any unresponsive, non-breathing patient
with an aquatic history, rescuers should give 2 breaths at the nearest point of safety. 3
additional breaths at 5 second intervals should follow. If breathing does not spontaneously
return after these 5 breaths, the patient should be removed immediately and CPR initiated.
EMS Call

EMS should not be sent for until the breathing check is complete
AED

An AED should be sent for in all unresponsive patients.
Hypothermic Assessment

In the past, hypothermic patients were to be assessed for upwards of one minute before
initiating CPR. This has been reduced to a 5-10 second check.
CPR Updates Reminders
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Compress at least 100 compressions/min
Adults: At least 2” compression depth
Children: At least 1/3 chest width (about 2”)depth
Infant: At least 1/3 chest width (about 1.5”) depth
Ensure proper chest recoil
Compressions should not be interrupted for more than 10 seconds
Only stop to reassess for a “sign of life”
Ryan Radford
-6-
PRIMARY SURVEY
PURPOSE: To discover and treat any immediately life-threatening conditions
Level of Consciousness
Send for EMS & AED
delicate Spine Precautions
Open Airway
Check Breathing (5 sec)
NO BREATHING/NO NORMAL BREATHING
Give 2 stacked Rescue
Breaths (in water)
Give 3 additional rescue
breaths (in water)
Initiate CPR & AED
Sequence
REMOVAL
If victim
shows signs of
life, reassess
breathing
Initiate CPR &
AED Sequence
AQUATIC HISTORY
NON- AQUATIC HISTORY
Scene Evaluation
Clear Pool
Call EMS
Carry Equip
Follow-Up Care
Ryan Radford
-7-
AUTOMATED EXTERNAL DEFIBRILLATOR
An AED should be sent for in all unconscious patients. Whereas CPR simply keeps basic body
functionality alive, an AED can actually “jump-start” the heart into a regular pattern
As soon as the AED arrives on scene,
the lifeguards should follow the
following basic steps:
1) Turn machine on
ON
2) Follow Prompts:
“Place Pads on Chest”
AED Reminders
3) Shock as Advised

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Ensure patient is not in a puddle or somewhat in water
Dry the chest before applying pads
Chest hair should be shaved; medical patches removed
Remove oxygen before shocking patient
Children should have pads placed front and back
SHOCK
Child Pad Placement
Ryan Radford
-8-
WHAT IS A WATERPARK?
Waterparks are defined by 3 unique characteristics:
MOVING
WATER
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Waves
Rivers
Currents
Standing Wave (“FlowRider”)
MOVING
RIDERS
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High Speed Slides
Moderate Speed Slides
Low Speed Slides
SPECIAL WATER
FEATURES
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Diving Boards
Diving Towers
Tarzan Swings
Zip lines
Spray Bars
Water Walkways
Jungle Gyms
Spray Guns
Special Spray Features
+ many more
Although not a defining characteristic, most waterparks have multiple bodies of water
Lifeguarding Considerations at a Waterpark
 Conceptual design incorporates more than “just a
pool”
 There is constant movement and activity
 The participant age range is wider
 The participant swimming ability range is wider
 Louder, busier, and more active than most pools
 There are more hazards (both natural and man-made)
 There may be more areas of sudden drop offs or depths
 Considerably more blind spots than a typical pool
A few additional things to watch for as a
waterpark lifeguard:
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Changes in slide spacing (more or less)
Confusion at bottom of attraction
Stoppage of water flow
Empty inner tubes
Patron entry point
Wave action- knock over
Wave action – patron trapped at edge
Trails of Blood
CONSTANT MOVEMENT IS ESSENTIAL TO ADEQUATELY PROVIDE
SURVEILLANCE OF A MODERN WATERPARK
Ryan Radford
-9-
WATERPARK SIMULATIONS: GUIDELINES, TIPS, AND RECOMMENDATIONS
During Waterpark simulations, you will be guarding in a team of 4-8 guards on deck. You will
need to demonstrate that you can not only work within a large team such as this, but that you can
also manage it. One technique of managing a large team of lifeguards on deck is using a “pivot”
guard or “deck supervisor.” This is essentially a position on deck that has all forms of
communication going through it.
The following are some general guidelines that you may want to think about when you are
controlling your team. Keep in mind these are only suggestions.
1. As the Pivot guard, you should be positioned somewhere where you can clearly see all of your other guards
and they can clearly see you. This position will be pre-established.
2. Before entering the water for a rescue, wait for acknowledgement from your pivot guard.
3. In a waterpark environment, small complicated hand signals are not efficient. Use LARGE, CLEAR signals
when communicating with your team.
4. Although hand signals are preferred for all non-majors, if you need to get a hold of another guard, a short
whistle blast may be used if necessary. Note: there should be a definitive difference between a short blast
indicating “attention” and a long whistle blast indicating a major emergency which calls for backup.
5. As pivot, you should be constantly ensuring that all bodies of water are being adequately covered. If they
are not, move guards appropriately or shut down the area.
6. As pivot, although you are watching your other guards to ensure proper placements and coverage, you
should still be scanning patrons in your general area. If you see an incident, you INTERVENE!! Don’t
waste valuable time trying to get someone else to respond when you are the closest guard.
7. If you have to leave your position for any reason (i.e. to do a rescue), ensure you cover it with an available
guard. The rest of the team may need to communicate with the pivot, so there always needs to be
someone at that position.
8. If an incident occurs, it is your job to make sure that:
i. Backup for the 1st guard is responding
ii. Remaining guards shift positions to cover unguarded areas
9. In a waterpark environment, pools can (and should) be shut down (“cleared”) independent of one another.
For example, if there is an unconscious victim in deep water, you may want to shut down the entire deep
tank and direct all patrons to the other pools while the incident is being dealt with.
10. Ultimately, it is the pivot’s responsibility to ensure EMS has been called for all necessary incidents, proper
pool coverage is constantly being maintained and all procedures/ treatments are going well. Although they
may not actually make the call, they ensure it has been taken care of.
11. The pivot is a position of leadership. Be confident in your skills and your team will follow your lead.
Ryan Radford
-10-
THE PIVOT GUARD SYSTEM
The pivot system is a means of organizing multiple lifeguards on the pool
deck.
In a pivot system, one guard (the pivot) monitors the number of lifeguards
responding to an incident (2 for a DNS in deep water, for example), as well
as the repositioning of the other guards. The pivot guard should direct the
other lifeguards as necessary.
The pivot guard system is recommended when the number of lifeguards on
deck at one time reaches or exceeds 4 (four) OR the lifeguards on deck
cannot maintain visual contact with one another because of physical
barriers.
The guard who controls this system is labeled the “pivot guard.” The pivot
has three key responsibilities.
1) To ensure that appropriate backup responds to any given
incident
2) To ensure that there is adequate coverage of all areas
3) To determine the need to close certain areas/pools if adequate
coverage cannot be maintained.
To illustrate the concept of pivot
lifeguarding, consider the following
example: imagine a little league hockey
game. At any given point when you look at
the puck, there will be ten little hockey
players all skating and swarming around it.
Compare this to a professional hockey
team. When you look at the puck, you
notice several players around it, however
you also notice some players playing back,
some changing position, and some
covering each other; they are looking at
where they need to be in the future, not
just where they are in the present. Not
every player can score the goal, but they all
need to work together as a team to get it.
The pivot system is very similar. Imagine 6
lifeguards on a waterpark pool deck. If one
guard blows the whistle for a DNS in the
deep tank, you do not want all 6 lifeguards
running over and jumping in. A pivot
system helps control this.
The following describes the guidelines typically associated with the pivot
system:
Guideline #1 – The pivot guard must be able to clearly see all the lifeguards on deck and all the lifeguards must be
able to clearly see the pivot guard whenever possible.
One of the problems with a large waterpark is the size and/or physical structures that can block sight lines. Because not
all lifeguards can see all other lifeguards (this includes guards at the top of slides), it is necessary for there to be one
lifeguard on deck that has a sight line with everyone. This is the pivot guard.
The following is an example of guard positions at a waterpark facility (6 guards on deck; 1 guard at top of slide):
Slide
Attendant
P
Ryan Radford
-11-
Guideline #2 – All communication must go through the pivot
All incidents, including PRs, minors and majors should always be relayed though the pivot. This allows the pivot to
reposition guards as necessary, assign necessary backup, and maintain an overall sense of what is happening at the
waterpark at any given time. This is especially important when delaying with a reported missing person.
A large area like a waterpark requires the use of large, clear hand signals to prevent any communication errors across
deck.
Guideline #3 – There always needs to be a pivot
Although the pivot guard is a team leader, they still must be a lifeguard as well. It is only reasonable to expect that in
an emergency, if the pivot guard is the nearest guard to respond, they should. In a situation where seconds can make a
difference, there should be a delay in which time is spent calling a guard from a further location simply so the pivot can
stay put. In the event that the pivot needs to enter the water to make a rescue, he/she must cover their position by
requesting another guard to act as pivot until the original pivot is able to return or the incident is resolved.
Guideline #4 – Ensure adequate pool coverage at all times
If a pool is not being watched effectively, there is the potential for a missed victim, therefore it is of critical importance
that the pool always has adequate coverage. As soon as one or more guards are busy and can no longer watch their
area (for example, during a major), if there are not enough available guards the pivot must decide what pool(s) to close.
In an example using an unconscious seizure in the deep tank (which requires 2 guards), the pivot may choose to do the
following (slashes indicate closed pool):
Slide
Attendant
(Calling EMS)
P
Ryan Radford
-12-
SOME GENERAL WATERPARK INFO
 Waterparks are generally defined as a facility made up of:
Moving Water (eg. Waves, currents, lazy rivers)
Moving Riders (eg. Slides, tube rides)
Water Features (eg. Spray features, water cannons)
They are not necessarily made up of multiple pools
The MAIN two are the moving water and moving riders
 Generally, everything in a waterpark is bigger than traditional lap pools… This
includes the amount of patrons that come swimming. More patrons directly results in
more PR situations, more first aids, and more rescues.
 In addition to provincial Pool Regulation standards for the pool, any facility with a
waterslide is also bound by the guidelines set forth in Appendix A of the CSA
Standard: “Safety Code for Amusement Rides and Devices.” (April 1, 2004).
 Although occasionally useful for temporary flume or pool checks, concave mirrors are
not a replacement for extra guards on the deck.
 There are several different types of waterslides: High-speed (Drop-off and free-fall),
moderate speed (serpents and twisters), low-speed (“kiddie” slides), and riders (tube
rides and mat rides). Each have their own hazards that lifeguards must take into
consideration when working.
 A slide should be checked each morning by walking up it in non-skid shoes.
 Patrons are often flipped upside down when they exit a slide flume into a catch pool.
This is because of hydrostatic braking (slowing down due to static water) which
causes the body to “somersault” and can cause distress in weak swimmers.
 One of the most important steps in a Waterpark rescue is to shut off the waves or the
slide using an emergency stop system.
 Because of the size, most Waterparks rely on using an intensive scanning system,
often times using one specific lifeguard as a communication point between all others
(may be known as a “pivot” or “deck supervisor” position).
 A waterpark/leisure pool requires a maximum turnover rate of 2 hours (compared to
the 6 hours of a standard pool) due to the warmer temperatures and higher patron
counts (2010 BC Pool Regulations).
Ryan Radford
-13-
WATERSLIDE TYPES
HIGH SPEED (FREE-FALL and DROP-OFF)
General Info
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30km/h +
Free-fall give the feeling
of a free-fall.
Free-fall ends in long
flume
Drop-off ends suddenly
in mid-air
Drop-off ends in a catch
pool
Common Rules



Strict age, height,
weight guidelines
Only one person in
flume at any one time
Supine riding only;
with rms and legs
crossed
MODERATE SPEED (TWISTERS)
General Info


Almost all ages welcome
Children may or may not
be allowed to ride with
parent
Common Rules
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
Several riders on slide
at one time allowed
with proper dispatch
timing
No stopping in slide
Supine or sitting
positions permitted
SLOW SPEED (KIDDIE SLIDES)
General Info
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Very gentle sloping
Some slides may allow
for parent with child
Children only
Common Rules


Parent waits for child
at bottom
Sitting positions only
TUBE/MAT/SLED (RIDES)
General Info


Uses apparatus to
transport rider down
flume
Can be considered high
speed, moderate or slow
speed ratings
Ryan Radford
Common Rules


Vary greatly
depending on ride
See manufacteur
specifications
-14-
THE PHYSICS OF A SLIDING RIDER
POTENTIAL ENERGY
KINETIC ENERGY
Ep = mgh
Ek=½mv2
Energy = (mass)(gravity)(height)
This is the total energy a rider has
stored at the top of the slide.
This is converted to kinetic energy.
Some riders may have too much stored
energy (ie. too much mass) and
therefore cannot safely go down a slide.
This is why we have max weight limits.
E
N
E
R
G
Y
Energy = ½ (mass)(velocity)(velocity)
This is the total energy resulting from a
rider’s motion. When velocity
increases, the energy increases
exponentially.
Depending on the mass and velocity,
there is a lot of energy that is traveling
in the flume.
Kinetic energy is lost through friction.
KINETIC ENERGY
FRICTION
For a moving rider to stop, all energy must be removed
SLIDING FRICTION
Occurs when one surface passes over
another.
Wearing a t-shirt will increase the
sliding friction and therefore slow down
the rider.
Riding a slide sitting up actually
increases the sliding friction and also
slows down a rider.
Ryan Radford
VISCOUS FRICTION
F
R
I
C
T
I
O
N
Occurs when an object passes through
a fluid.
A catch flume must have enough
water to fully stop a rider’s motion.
Increasing the water flow in the slide
will actually slow the rider’s velocity
and therefore decrease their energy.
More water means
more friction = slower
ride
-15-
WATERSLIDES (CONT)
Some general waterslide information:
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Entry is usually from a platform area (“dispatch zone”); may contain more than one slide
Riders finish in either a catch pool or slide flume (“exit zone”).
Waterslides typically have height and weight restrictions. These must be followed.
Rider position varies depending on the type of waterslide.
The slide manufactures may incorporate a mat, raft or tube into the slide design
Operators must follow both slide manufacturer guidelines as well as appropriate legislation
(ie. CSA Standards for Waterslides)
Each slider is different: you need to consider their size, age, and body position and sliding
attire when determining dispatching intervals
Watch for safe distance and time before the next rider is released
Waterslides utilize a variety of release methods including lifeguards, attendants, flag systems,
gate systems, and stoplight systems.
Some Waterslide Review Questions:
1.
2.
3.
4.
5.
6.
7.
Ryan Radford
If the flow of waters is increased will there be more or less sliding friction?
If the flow of water is decreased will there be more or less viscous friction?
What type of friction stabilizes a rider’s speed more, viscous or sliding friction?
What dangers does sliding friction have on a rider?
What dangers does the water flow have on a rider?
What may happen to a rider’s position in a slide as he accelerates into a curve?
What dangers does this position pose if the flow of water is low?
-16-
CSA STANDARDS FOR WATERSLIDES
As of April 1, 2004, The “Elevating Devices Safety Regulation” no longer contains waterslide
regulations for waterslides constructed after this date. Instead regulations are found in the Canadian
Standards Assocation (CSA) International Standard Z267-00 known as the “Safety Code for
Amusement Rides and Devices.” Appendix A of this code refers specifically to Waterslides. Note:
Any slides installed prior to April 1, 2004 must comply with the Elevating Devices Act in place at the
time of installation.
The following is some pertinent information found in these standards that lifeguards should be
aware of.
A1 - Design
A1.1g
A1.1k
A1.7
A1.8
A1.10
A1.11
The walking surface in and about the waterslide, including the entrance and exit to the waterslide are slipresistant and discourage retention of water
Crowd control at the point of entry to the dispatch area is facilitated
For each water slide designed and produced, the designed or manufacturer shall specify if the use of life jackets
shall be permitted
Every water slide shall include a system designed to provide reliable communications between attendants
supervising the dispatch and discharge areas, Must also include access to a communication device for
summoning emergency services.
The designer or manufacturer shall provide documentation stating the design capacity of each water slide and
the capacity of the dispatch area, and recommending the number of attendants required for the numbers of
riders using the water slide during any period of time.
The designer or manufacturer of every water slide shall provide documentation of factors that may limit the use
of the water, which may include, but not be limited to the : rider’s weight and size, rider’s physical ability, the
rider’s body position, the number or users, maximum and minimum water depth in the splashdown area.
A1 – Operation
A2.1
A2.2
A2.3
A2.4
A2.5
A2.6
A2.11
The area at the top of every water slide shall be supervised by at least one attendant who has been trained in
the
duties related to this position, who shall have continuous and direct supervision of that area.
The splashdown area of every water slide shall be supervised by at least one attendant who is trained and
certified in first aid and lifesaving techniques, who shall have continuous and direct supervision of that area
All components of the communications system referred to in Clause A1.8 shall be tested on a daily basis
Daily inspections shall be carried out on each waterslide, to ensure the safe operation of the water slide both
before the water is circulating and while the water is circulating.
A log book shall be maintained daily, reporting all inspections, tests, and records of operation, maintenance,
and incidents or accidents.
The owner/operator of every water slide shall post a sign at the entrance to the water slide, for the
information of patrons, that conveys information, rules and instructions of the use of the water slide.
The use of lifejackets shall be allowed on a water slide only if the manufacturer has specified that their use is
permitted.
Reference: CSA Standard Z267-00. Safety Code for Amusement Rides and Devices. March 2000.
Note: The above is a partial list of items contained within the safety code. This information should not be used in place
of actual documention. This is simply a list used for the instruction of lifeguards within British Columbia.
Ryan Radford
-17-
WAVES AND WAVE POOLS
There are 2 types of waves:
Oscillating
Solitary Transitional
 Stationary wave that goes up and down* like a “see-saw”
 Can trap weaker swimmers in deep water or against
walls
 Causes constructive (larger) and destructive (smaller)
waves caused by bounce back against walls
 Wave that moves down the length of the pool.
 Can toss swimmers into ground as it breaks.
 Can easily knock over weaker swimmers and small
children at shallow or water’s edge.
The Anatomy of a wave:
CREST
AMPLITUDE
WAVELENGTH
Still water level
TROUGH
Particle motion
in deep water
Particle motion
in shallow water.
Waves tilt to
form breakers.
It is important to test the amplitude and wavelength settings in a controlled manner
prior to letting public into the facility. Waves should be tested in this manner on a
regular basis.
Ryan Radford
-18-
LIFEGUARDING A WAVE POOL
Waves create a new and unique challenge for lifeguards who have only
experienced scanning and rescues in still water.
Every wave pool is unique in terms of wave size, wave frequency, resulting
currents, dead-zones (“nodes”), etc. It is only through regular practice and
training at a wave pool can the lifeguard become competent at performing
rescues in it.
All pools should have a visual and audible alarm sounding prior to waves being
turned on. This gives patrons not wanting to be in the waves a chance to exit the
wave pool.
Waves are run in cycles and not continuously for the following reasons:
i) Provides patrons with a rest period
ii) Provides guards with a rest period
iii) Provides wave generating machinery with a rest period
iv) Prevents excessive Cl2 dissipation into air
LIFEGUARD CONSIDERATIONS
LIFEGUARD CHALLENGES
 The Wave-Kill must be hit for all
rescues occurring in the wave
pool
 Waves do not stop immediately
after being shut off. Residual
waves make the initial part of the
rescue difficult
 Diving should never be permitted
while waves are on due to the
changing depth
 Lifeguards entering into a wave
pool must always enter into the
CREST of the wave
 Patrons should stay clear of the
wave generator at all times.
 Crowds increase dramatically
during periods when the waves
are on.
 Bottom scanning becomes
increasingly more difficult with
the higher patron density in the
pool and the constant moving
water.
 Rescue of a panicked patient in
waves introduces a new level of
danger to the rescuing lifeguard.
An aid of some form (immediate
backup lifeguard, rescue tube,
etc.) should always be used in
wave pool rescues
Ryan Radford
-19-
Waterpark Currents
i)
Hydraulic or Face “Hole”
“Hole”
Run Out
BOIL
Occurs when water flows over a barrier.
Rafts or tubes will often be overturned at the “hole.” Riders can also become trapped in the hole
ii)
Venturi Effect
ACCELERATION
Water flow slows before a construction and accelerates after it.
iii)
Vortex Current
Occurs when water changes direction as
it enters a basin or open zone in a slide.
The strength of a vortex is increased if a
barrier is present in the basin.
iv)
Acceleration through a curve
When water travels through a curve (for
example in a twisting slide), it accelerates.
Lifeguards must be aware of these areas as
patrons can start traveling faster than they
feel comfortable. This can result in friction
burns if the patron has enough energy to
travel past the water flow itself. This is one of the
reason it is so important to strictly
enforce the size and height guidelines set forth by the
slide manufactures.
Ryan Radford
-20-
POOL CHEMISTRY
Disinfection (Chlorine/Bromine)
Chlorine (or Bromine) is used to disinfect the pool water. It can be used in 3 different states: solid, liquid, or gas (most
effective). Once the chlorine is in the water, there are 3 forms of it. FAC (free available chlorine) is the amount of
chlorine molecules free to attack the nasty little ammonia products that were left by the bus load of preschoolers.
According to the 2010 BC Pool Regulations FAC levels should be maintained at:
0.5 ppm for a pool less than 30 degrees
1.5 ppm for a pool over 30 degrees
CAC (combined available chlorine) is the amount of chlorine molecules combined with an ammonia product – these
are also known as chloramines (chloramines are what can be smelt at many pools when you walk in).
CAC
Ammonia
“Baddies”
FAC
When CAC levels get too high or a pool fouling occurs, a superchlorination is done. TAC (total available chlorine) is
the total chlorine in the pool. This is obtained by adding FAC + CAC.
Ozone
Ozone (O3) is an alternate way of disinfection. In an Ozone pool, water is sent through an ozone generator in the
mechanical room where the “baddies” are destroyed. However, even in an ozone system, there is still a need for
chlorine in the main pool to deal with immediate contaminations. Ozone leaks can be very dangerous. As such, alarm
systems are installed and emergency procedures regarding a leak must be practiced.
Ultraviolet
Although still more expensive, many pools are using a UV system for disinfection. Advantages of a UV system include:
Much like ozone, because the disinfection happens outside of the pool, a residual chlorine level must be maintained in
the pool.
pH
acidic
1
neutral
2
3
4
5
6
7
8
basic
9
10
11
12
13
14
BC Pool Regulations: 7.2-7.8
pH measures the concentration of H+ ions in the water. This should be maintained between 7.4 and 7.8. Low pH is
acidic and can cause pipe corrosion. High pH is basic and can cause pipe scaling. Both can cause patron discomfort.
To lower the pH, use muriatic or hydrochloric acid. To raise the pH use Soda Ash or Sodium Bicarbonate (Baking
Soda).
Ryan Radford
-21-
BC POOL REGULATIONS (2010)
In October 2010, after 38 years, the BC Government replaced the 1972 Health Act with the 2010
Pool Regulations. The following is a highlight of what lifeguards need to be aware of:
Definition of a Lifeguard
A lifeguard must be 16 years old, hold certification(s) as outlined in the Pool Safety Plan and
receive training in the Pool Safety Plan prior to lifeguarding.
A lifeguard is responsible for the conduct and safety of all pool patrons, and is to perform no
duty other than pool surveillance.
Pool Safety Plan:
By Oct 2011, all public pools must have an approved written pool safety plan which is a detailed
written plan containing emergency, operating and cleaning/maintenance procedures in addition to
required first aid/lifesaving equipment.
The facility must:
a) prepare a written pool safety plan to ensure the health and safety of pool patrons,
b) make the plan readily available to pool employees,
c) train each pool employee in the procedures and in the use of the equipment described in the plan,
d) review and update the pool safety plan at least once each year.
The pool safety plan must include:
a) procedures to be followed in the event of a serious injury, emergency or incident,
b) the type of lifesaving, lifeguarding and first aid equipment to be kept within the immediate vicinity of the pool,
c) the number of lifeguards and other employees who are to be on duty while the pool is in use in order to ensure
adequate supervision of pool patrons,
d) operating procedures for the pool, and
e) the program of cleaning and maintenance of the pool, including the nature and frequency of the cleaning and
maintenance.
Staffing Levels


Must open with at least 1 lifeguard and 1 assistant
Max Ratio of Lifeguard to Patrons = As outlined in P.S.P.
Water Clarity and Chemical Standards





Pattern of the main drain OR a black disc (150mm in diameter) must be visible at the
deepest point of the pool
Water must be tested minimum twice a day
Maximum main pool temperature 37°C (98.6°F)
pH maintained between 7.2-7.8
FAC: 0.5ppm for a pool less than 30°C
1.5ppm for a pool over 30°C
Other

No diving in less than 2 meters of water
Ryan Radford
-22-
DROWNING PHYSIOLOGY
To drown is to suffocate in water or other fluid. A victim can drown in as little as 12-20 seconds.
Series of events in a drowning patient:
STRESS/
PANIC
HOLDING
BREATH
TERMINAL
GASP
DEATH
Our priority when dealing with any victim who is drowning is to quickly remove them from the
pool. If they are conscious this means supporting them with their head and shoulders above the
water while we transport to the nearest edge. If they are unconscious, this means protecting their
airway from having water enter it and transporting to the focal point.
DELAYED DROWNING EFFECTS DUE TO ASPIRATION
 Some individuals may be familiar with this as being called “secondary drowning”
however this is an outdated term which should no longer be used.
 As lifeguards, this is a major concern in every near-drowning person we rescue
 Is caused by as a fluid accumulation in the lungs which can begin to occur within
minutes to 72 hours after a drowning incident
 Fluid in lungs destroys the alveoli and causes problems with breathing and eventually
lack of air exchange.
 This can result in “Pulmonary Edema” or swelling of the lungs.
“SECONDARY
Signs and Symptoms: - Trouble breathing/Shortness of Breath
- Painful or persistent coughing
DROWNING”
- Chest Congestion
- Extreme Fatigue
- Strange and abnormal behavior (especially in children)
Any patient suffering from any of these symptoms should immediately seek medical attention.
In all drowning victims, we must assess for and educate each victim about the dangers of delayed drowning
symptoms.
Example of a follow-up for any rescue of distressed swimmer:
Assess: “Can you take 2 deep breaths for me? Did you breathe in any water?”
Educate: “You have just had a near-drowning episode. Over the next 72 hours if you experience any trouble breathing,
persistent coughing, chest congestion, or extreme fatigue, you need to contact a doctor or go to the hospital
immediately and tell them what happened. Please report back to me before leaving the pool today so I can
check on you again. ”
Follow-Up: Record all information in an incident report form.
Encourage the patron to stay in shallow water or wear a lifejacket.
Ryan Radford
-23-
ANAPHYLAXIS
Anaphylaxis is a severe allergic reaction that can affect multiple body systems.
An anaphylactic reaction can be caused by any number of known or unknown allergens. Some
common allergens include peanuts, bee stings, seafood, and latex.
Normal Appearance
Anaphylactic Reaction Appearance
Signs and Symptoms
 Generalized itching
 Blotchy, raised, red bumps
on the skin (hives)
 Wheezing; difficulty
breathing
 Swelling – including throat,
tongue, and face
 Dizziness, light headedness
 Unconsciousness
Treatment:





EMS
Monitor ABC’s
Medication (Auto-Injector)
Treat for Shock
Monitor Carefully
Lifeguards are trained in the administration
of Epinephrine to the anaphylactic patient
via a patient’s auto-injector (EpiPen® or
TwinJect®). You should be trained with
both trainers and consult with your facility
to determine their standpoint on this
procedure.
Ensure the following steps have been taken BEFORE ever administering a patient’s
Auto-Injector:





EMS has been called
Patient has history of anaphylaxis and contact with
known allergen
Only the patient’s TwinJect is used. DO NOT
administer another person’s Twinject
Victim is unable to self-administer (including unconsciousness)
Medication window is clear in colour
Window
s
*An expired auto-injector may still be administered provided the medication window shows a clear
fluid with no discoloration or precipitate.
Ryan Radford
-24-
AUTO-INJECTORS (TWINJECT® AND EPI-PEN®)
Lifeguards should be familiar with the administration protocol of both Twinject and EpiPen brand
auto-injectors. Although the principles of administration remain constant, there are slight variations
in the technique. Use this as a summary of the two devices.
TWINJECT
EPI-PEN
Cap 2
Cap
Cap 1
Active
Ingredient
Epinephrine
1. Remove BOTH Caps
2. Press red tip firmly into outer thigh
(should hear a click)
3. Hold for 10 seconds
4. Massage injection site for quick
dispersal
NOTE TIME OF ADMINISTRATION
a. Do not bend needle
b. Place used needle carefully into the
original case
1st DOSE
Protocol
Follow-Up
1. Remove safety cap
2. Press orange tip firmly into outer
thigh (should hear a click)
3. Hold for 10 seconds
4. Massage injection site for quick
dispersal
NOTE TIME OF ADMINISTRATION
c. Return used auto-injector to original
case or sharps container.
d. If no case is available, needle may be
bent back on a hard surface to avoid
an accidental prick.
Twinject
After 10 minutes from 1st dose, if patient
shows no signs of improvement, prepare
2nd dose:
Epinephrine
2nd DOSE
Protocol
No second dose available in EpiPen
1. Carefully unscrew base from red tip
2. Remove syringe from base unit by
gripping the blue plastic
3. Remove yellow safety collar
4. Inject needle into opposite leg of first
dose
5. Push plunger all the way down.
6. Massage injection site
Place used needle in original container
Ryan Radford
Follow-Up
-25-
WATERSLIDE COLLAPSES AT WATERWORLD, USA IN CALIFORNIA
One dead, 30 hurt in water slide collapse
June 3, 1997
CONCORD, California (CNN) -- A popular northern California
amusement park remained closed Tuesday, the day after a water slide
collapsed, killing a teen-age girl and critically injuring six of her high
school classmates.
At least 30 people were injured in Monday afternoon's accident at
Waterworld USA, about 30 miles northeast of San Francisco.
The students -- seniors on a pre-graduation outing -- ignored a
The twisted wreckage of the water-slide.
lifeguard's warning and tried to ride down the 75-foot-tall slide
together, according to Waterworld general manager Steve Mayer.
"Our guard couldn't control it," he said of the large gathering of teen-agers going down the water slide.
The accident occurred soon after the park announced that Napa High School students visiting Waterworld -about 120 in all, according to the school -- should return to their buses for the trip home.
At that point, some of them rushed to the top of the slide, according to
Rick McCurley, vice president of Premier Parks Inc., which owns
Waterworld.
Survivors said they were trying to break a school record for total
number on the slide when it gave way.
Witnesses said people on the winding slide, called the Banzai Pipeline,
crashed to the ground when it collapsed. The pool of water below
turned red with blood.
The injured teens were screaming and crying for help, witnesses said.
"It was a very chaotic scene at first," one police officer at the park said.
"It was pandemonium," another officer said.
One girl, a 17-year-old Napa student who was not identified, died 45 minutes later from a crushed chest.
Helicopters and ambulances transported the injured to nine hospitals.
In a statement issued late on Monday, Premier Parks defended its safety record. "Safety is our number one
priority. Based upon what we know at this point, we believe this slide was safe," the company said.
Concord police Lt. Jim Jennings said city officials would conduct an investigation at the site.
He said police were not aware before this incident of any safety problems at the park.
Ryan Radford
-26-
FREQUENTLY ASKED QUESTIONS
Q: What does the “initial 5 breaths” mean? I’ve never heard of this before.
When you take a normal first aid or CPR course, you are taught that if the patient is not breathing (or not breathing
normally), you contact EMS, send for an AED, and initiate CPR. This is the latest protocol for rescuers dealing with
sudden cardiac arrests. When we talk about an aquatic history, this is known as a hypoxic (low oxygen) event. There is
substantial research that shows that initiating rescue breathing as quickly as possible in such an event provides the best
possible patient outcome. Therefore, in the case of a drowning, we should initiate 5 breaths at the nearest point of
safety (typically shallow water). The actual delivery is as possible:
“Breathe” [chest rise, chest fall] “Breathe”
[5 seconds] “Breathe”
Following the 5th breath, if breathing has not spontaneously returned, we should immediately remove patient (if not
already done) and initiate CPR.
Q: How long should a “breath” take when ventilating?
According to the AHA 2010 Recommendations, a single breath of air should only take 1 second (enough to make
the chest rise). A child or infant will require a smaller amount
Q: Can we demonstrate 2 breaths in the water, then 3 breaths out of the water?
No. When we demonstrate this skill we want to have five quality rescue breaths in a row as soon as possible. If we are
in a depth were we can control complications, then we do this in the water. If we can't control complications, then we
do this out of the water. We should not demonstrate any unnecessary pauses in those five initial breaths or trying to do
other things. It needs to be high quality 5 breaths... not 2 here and 3 there. And it needs to be as soon as possible (as
soon as we are in a position to control complications).
Q: What is a “Sign of Life”
When performing CPR, a number of reactions from the patient can occur. Some of these are involuntary, while other
indicate a sign of life. It is important to only stop CPR to reassess a patient if a clear sign of life presents itself. This is
not an exhaustive list, but may help guide you as to what may happen during a resuscitation.





SIGN OF LIFE
Victim starts to breathe normally
Active vomiting
Coughing
Seizure
Coordinated movements





NOT A SIGN OF LIFE
Agonal breathing
Fluid buildup (regurgitation)
Loss of bowel/bladder control
Flickering eyes
Strange movements (posturing)
Q: What is the difference between vomit and regurgitation?
Ryan Radford
-27-
When performing CPR, especially in an aquatic related incident, it is to be expected that fluid will begin to accumulate
in the mouth and upper airway. This is considered a REGURGITATION (ie. a passive mechanism causing a backward
motion of gastric content to travel up the airway). This is caused by a rescuer's actions such as rescue breathing or chest
compressions. There is a common misconception from many lifeguards (and first aiders) that regurgitation and vomiting
are the same thing. VOMITING is an active mechanism caused by the muscular action of the stomach to "throw up" it's
contents. A patient actively vomiting may indicate something about this patient has changed and we need to be aware
of this change.
If the victim vomits while performing CPR:
• Roll the patient, and sweep to clear the airway
• Reassess ABC's
if there is a change in victim status, the victim's vital signs should re-assessed. If a victim takes a breath or actively
begins vomiting suddenly when CPR or ventilation of a victim is being performed, then the rescuer should stop and reassess the pulse (and breathing, if breaths are recurrent). THIS IS A CHANGE IN VICTIM STATUS suggesting revival.
If the victim regurgitates while performing CPR:
• Finish the 30 compressions
• Roll the patient, and sweep to clear the airway
• Give 2 breaths
• Position and Resume CPR
Regurgitation is not a change in victim status . Pausing to re-assess vital signs only delays critical circulation which, at
best, during CPR provides only one-fourth to one-third of the body's normal circulation. This more acceptable
management of regurgitation is confirmed in BCLS literature and has been supported by emergency physicians who
have queried why re-assessment was ever taught for regurgitation.
One of the underlying principles of the 2010 CPR Guidelines is to “Minimize interruptions in chest compressions.”
Reassessing every time you notice some fluid causes excessive interruptions and simply diminishes the patient's
prognosis.
Q: What are agonal respirations?
Agonal respirations are an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular
inspirations followed by irregular pauses. They may also be characterized as gasping, laboured breathing, perhaps
accompanied by strange vocalizations and myoclonus (a brief, involuntary twitching of a muscle ). In some cases,
agonal respirations can mirror normal breathing however become less frequest with time. The cause is due to cerebral
ischemia, due to extreme hypoxia or even anoxia which accompanies sudden cardiac arrest. Agonal breathing is an
extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to
complete apnea and heralds death.
Agonal respirations are commonly seen in cases of cardiac arrest , and may persist for several minutes after cessation of
heartbeat. The presence of agonal respirations in these cases indicates a more favourable prognosis than in cases of
cardiac arrest without agonal respirations.
Q: What is a “Guppy Breather” Spinal?
Imagine a patron were to dive into shallow water and come up floating. You would assume this patient to be
unconscious. However, upon rollover, the patron is wide awake but cannot speak. He is pale, appears scared, and
appears to be trying to “gulp” or suck air into his lungs. This patient has caused (possibly irreversible) damage to a high
level of the cervical region of the spinal cord. As a result, not only is his entire body paralyzed, but his diaphragm is
paralyzed as well. This patient is conscious, but unable to breath on his own. Your job as a lifeguard is to maintain
ventilations throughout your procedure. A “guppy breather” is essentially a conscious, non-breathing patient.
Q: What is the difference between “Lateral”, “3/4 Prone”, Recovery, Drainage, and
Semi-Prone Position?
Ryan Radford
-28-
LATERAL
¾ Prone / Recovery / Drainage / Semi-Prone
 Used for continuous monitoring of unc. victim
 Cannot leave the patient (they may vomit and
aspirate OR their airway may fall forward and
close)
 Used for unconscious, breathing victims
 Used for when a lifesaver must leave a patient
for some reason (to call 911, etc)
 Typically not used by lifeguards

Remember: Lateral is for lifeguards; Recovery is for rescuers.
Q: Can I administer sugar to an unconscious, diabetic patient?
NO. Regardless of prior training, the latest printing of the National Lifeguard Service Award Guide does not condone
this procedure. As lifeguards, sugar may only be assisted to a patient who can readily control their own airway.
Q: What are some simple tests to help check for signs of a stroke/TIA?
Besides a lowered LOC, confusion, poor coordination, and trouble speaking, a patient suffering from a TIA or Stroke
often displays numbness or weakness on one side of the body (this has to do with one side of the brain being affected).
Some simple bilateral symmetry tests can be used to help determine if the patient is suffering from this condition:
 Pupil Reactivity – Check to see if the pupils are equal and whether or not they both react appropriately to light.
 Tongue Test – Ask victim to stick their tongue straight out. The tongue may deviate to one side.
 Smile Test – Have patient smile for you. Check to ensure both sides of the mouth curl up equally.
 Squeeze Test – Have patient squeeze each of your hands as hard as they can. Check for equal strength as they
do so.
 Arm Lift – Have patient lift both arms up at the same time. Watch for one side raising an arm faster or higher
than the other.
Q: Can a patient who has taken Viagra or Cialis safely take nitroglycerine?
No. A patient who is on nitroglycerine should be directed by their Doctor not to take Viagra or Cialis as the two drugs
are contraindicated (see references below). A rescuer should consult with the EMS dispatcher prior to administering
nitroglycerine to a patient who has taken Viagra or Cialis. As per pharmaceutical guidelines, a patient can potentially
take nitroglycerine 1 full day (24 hours) after their last Viagra OR 4 full days (96 hours) after their last Cialis.
Q: Can a patient suffering from angina take both nitroglycerine and ASA? Which
should be taken first? How long between medications?
Yes. As per the CFAM (page 34) the nitroglycerine protocol for a patient suffering from chest pain is 1 dose every 3
minutes to a maximum of 3 doses in 10 minutes. If the first dose of nitroglycerine does not make the pain go away
within 3-5 minutes, have the patient take a second dose of nitroglycerine. Provided the patient has ASA and meets the
criteria of the 4A’s they can also chew a tablet.
Q: Is it true we’re doing Back Blows for obstructions now?
Yes. According to the 2010 AHA Guidelines, back blows should be used as part of the protocol for conscious severely
obstructed patients. The treatment protocol will include:
Ryan Radford
-29-
 Alternating 5 abdominal thrusts and 5 back blows for adults and children
 Alternating 5 chest thrusts and 5 back blows for obese or pregnant patients
 Alternating 5 back blows and 5 chest thrusts for infants (no change)
IMPORTANT:
 The patient’s airway is parallel to the ground during back blows.
 The rescuer can wrap one arm diagonally across the patient’s chest and have them bend forward.
 Deliver 5 firm back blows with the heel of their hand between the shoulder blades of the patient.
 The patient must have a good level of consciousness prior to attempting this procedure.
During Back Blows:
Ask victim to lean forward
with their airway parallel to
the ground.
Q: Can I administer an expired EpiPen or TwinJect?
Yes. If an anaphylactic patient requires their AutoInjector, but it is expired, it can still be administered provided the
window showing the drug appears clean and not discoloured.
Q: How do I remove a bee stinger?
A small sac attached to the end of a bee stinger can still be present after a patient is stung. We don’t want the contents
of the sac to be injected into the patient so DO NOT use your fingers, or even tweezers to remove the stinger. Instead,
use a plastic card or your hand to brush or “scrape” the stinger out. Rarely are they any more than superficial.
Q: What do I do if someone steps on a hypodermic needle?
The patient’s (and our) biggest concern will be that their may be a pathogen or disease –carrying agent on or in the
needle. Ensure the needle has been secured or safely disposed of first. The wound should be thoroughly washed with
soap and water and allowed to freely bleed for 10 minutes. The hope is that the pathogen will be flushed out f the
body. After 10 minutes, the wound should be bandaged and the patient sent to the hospital for exposure treatment. It is
not necessary to transport the needle to the hospital.
Ryan Radford
-30-
ADDITIONAL NOTES FROM THE PRECERT:
Ryan Radford
-31-

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