Deep water backboarding

This is the order in which you rescue a spinal injury victim in deep water using a head splint or head and chin support. The head splint is the main method used in Red Cross lifeguard training. The head and chin support is an alternate method that can be used on a victim with tight muscles or in a lifejacket that keeps a guard from applying a head splint tightly, or on a victim with only one arm.

For most of our practices we will use the CJ spineboards, but you can adapt these instructions to any of the styles of boards we have. Much of this also applies to shallow water backboarding.

For testing in our class, to be sure we see all the skills from each person, we will have the primary rescuer stuff the rescue tube(s) under the end of the board before lifting it from the water and have the primary rescuer get out of the pool first. You could easily end up doing things differently in real life.

First make certain that the backboard is ready to go, with the velcro rolled up. (But when the boards are put away wet into storage the velcro should be unrolled so it does not mildew.) It is a mistake to think you can save time by having the velcro unrolled before you start, straps will stick to each other as they move around in the water.

To do this easily, you will need three or four rescue tubes, but you can get by with only two.

C.J. spineboards and longer tubes are easier to use, but we will practice with all kinds.

Make a mental note that out on a lake the head immobilizer WILL float far away and should be stored in a net bag you can attach to the backboard until it is needed.

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Treat these practices as if they were real.

It is crucial

that if the rescue is taking place in moving water you move to a sheltered area if possible;

that you maintain in-line stabilization;

that no one swims under the board;

that the person holding head/neck never lets go to do anything else;

if things get messed up, you go back in steps carefully instead of giving up;

that you have calm communication during problems (the victim is hearing everything you say!);

and, (once they get to the surface), that the victim's face (mouth and nose) is out of the water all the time.

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The first lifeguard activates the emergency action plan. Don't give a big, long speech to the other guard(s) about getting various pieces of equipment and calling 911. The victim may well be sinking and needs your attention. (The other guard(s) have been trained to do what is needed and you will have in-service training to practice your skills with each other, right?)

Enter the water carefully using a slide-in entry. Don't make any big waves, either on your first entrance, or when going back to get equipment, or approaching the board.

If the victim is submerged, the first lifeguard leaves their rescue tube at the surface and brings the victim to the surface using the head splint or head and chin technique. They should bring the victim up diagonally face down until they are almost at or at the surface, then rotate the victim face up. NOTE: when you practice with a head chin support it is really awkward, or sometimes nearly impossible, to complete backboarding if the victim's arm is not put down by their side before a head-chin is applied. See page 260 of your text.

The second lifeguard retrieves the first lifeguard's rescue tube, hustles to the first guard and carefully stuffs it between the first rescuer and the victim under the first lifeguard's armpits. See step 1, page 265. (During initial practices sometimes the tube gets under one armpit of the lifeguard, but not the other, and ends up under the victim instead, which is not acceptable.)

It is crucial that the second guard initially stuffs the tube carefully and looks to see if it is in place properly. The first guard should be concentrating on the victim, not the placement of the tube. You may find that it is easier to stuff if you come from the head end of the lifeguard/victim, instead of approaching from the feet end where the lifeguard is kicking.

Confirm that the victim is conscious and breathing. The video says: "Remember your priority is to care for life-threatening conditions. If at any time during the procedure if the victim is not breathing or shows life-threatening conditions immediately remove the victim from the water and provide appropriate care."

If the tube between the first rescuer and the victim now has a loose strap, and it gets tangled in your legs as you tread, speak up to the other guard and have them fix it before you go on. OR .. we have tried having the second rescuer put the strap over the first rescuer's head at this point. The text and videos do not talk about this, but it seems to be what we see in the photos at steps 3 and 4 on page 265.

The first guard moves towards the wall or corner.

The second lifeguard (rescuer 2) places a tube under the victim's knees (step 2 on page 265 of your text). Wrap the strap around the tube first. You might not be able to get it under both legs at once. It can help if the primary guard carefully spins the victim in a circle to get their legs up a little, but you must keep the victim's neck straight and some victims will not become horizontal until the tube is under their legs.

Getting the backboard under the victim:

The second lifeguard retrieves the backboard, removes the head immobilizer and goes to meet rescuer 1 and the victim. If they have extra tubes and use a tube for support it should be high on their chest with the tube under their armpits. Do not sit on the tube. The second lifeguard should take a good look at the board and figure out which way to point the board so that the head end ends up at the victim's head instead of at their feet.

The second lifeguard submerges the board under the victim then controls how fast it rises under the victim. (step 3 page 265) There is no one completely correct method of holding the board to get it under the victim. As you experiment with the various styles of boards we have at De Anza, you will see that each handles differently; all the more reason to be sure you get in-service training at the pool where you eventually work.

If you didn't deal with the free end of the rescue tube strap, it's best to keep track of where it is, don't get it caught between the victim and board, but you can correct it without moving the victim if you notice it too late.

If the board is in the wrong place, lower and move the board, do not try to move the victim forward and back. Do not tug or push on the victim's legs.

With a Miller board, the top pins must be at the victim's shoulders.

When using a C.J. Spineboard, it is crucial that the second guard make sure the top roll of velcro is in the correct place at the armpit before continuing through the strapping. To be really certain the board is in the right place the second guard can partially unroll the wad of velcro (on their side only).

For the head chin support the text says to move your lower arm under the board as it is being raised into place. The first guard, who's doing the head-chin, carefully yet quickly moves their lower arm from under the victim to under the backboard, while keeping the upper arm and hand in place on the victim. The second guard needs to make sure the board stays under the victim, supporting the victim enough that the victim's face does not go under water.

Getting the arm under the board as the board is raised under the victim is great if it gets in the right place on the first try, but that does not always happen.

If the board is not in the right place you will need to be sure it is. If it is not, you can go back carefully in steps.

If you are using a head splint support, when the backboard is in the right place, rescuer 1 can move their elbow out of the way as the board is raised into place. They should carefully (the video says 'gently') swing their lower elbow towards the top of the victim's head (while still squeezing the two arms to keep the head in line with the body and without moving the neck).

It is not crucial that the backboard be properly in place under the victim on the first try, but it is crucial that the backboard be properly in place without bumping the victim, moving the victim's neck or letting loose of the in-line stabilization.

When you have confirmed that the backboard is properly in place

(head splint) (see photo on page 265 at step 4) The second guard uses a head chin support to the victim with their upper arm straight along the victim's sternum, hand at the chin and with the other arm under the board applying upward pressure, to stabilize the victim. The lower arm under the board does not necessarily need to be straight along the victim's backbone. When they feel secure they must tell the primary rescuer that they have full control of the board.

The primary rescuer moves the victim's arms down towards their sides.

(head chin) When the first guard tells the second guard that they have successfully moved their arm under the board and have full control of it, the steps in the text would have the second lifeguard remove the tube under the knees and go to the head of the board. Especially if you are using a backboard that is quite bouyant and tends to tip easily, you will find that the victim will stay more stable if you go to the head of the board and get the chest strap secure before sliding the knee area tube out. This requires a third tube if the guard doing the strapping is not strong enough to tread water high in the water.

Both the head chin and head splint method finish in the same way. The guard going to the head of the board should look to make certain that the board has not slipped in relation to the victim. They wrap the strap on their rescue tube so it is out of the way. They double check that their rescue tube is centered. They let the guard stablizing the neck know that they are about to put their tube under, and they put their rescue tube under the board, (use both hands to push down on the rescue tube and let it up) about as far along the board as they can get it without bumping the arm of the guard who has control of the victim.

Your text says "the primary rescuer" (at the head end of the board when using the head splint) "balances the the board on the rescue tube with with his or her forearms." As you will find during practice, this can't be accomplished by resting your forearms on the board. You should place the end of the board at your chest, (not up as high as your throat), squeeze the side edges of the backboard with your arms and hold the victim's head in place with your hands on either side of the victim's head. The lifeguard's arms should not be resting on top of the board, as they will not be able to support the victim and hold the board in place if it is bumped.

Once the guard at the head has taken over stabilzation, if they realize they did not center the rescue tube and it might slip out, they should not have the other guard try to push it into place. You can't properly maintain in-line stabilization while you try this. Instead, go back carefully in steps. (Or better yet, be certain the rescue tube is centered before taking over immobilization at the head of the board.)

Did you move away from the wall? These next steps will be easier at the wall, so move back.

At this point the stabilization is precarious. Only the victim's head is being held. If the board is bumped the victim's body can slide off the board, causing considerable movement of the neck. Take extreme care at this point.

Again, especially if you are using a backboard that is quite bouyant and tends to tip easily, you will find that the victim will stay more stable if you go to the head of the board and get the chest strap secure before sliding the knee area tube out. This requires a third tube if the guard doing the strapping is not strong enough to tread water high in the water.

Removing the tube under the victim's knees:

The first guard warns the guard holding the victim in stabilization that they are about to remove the knee area tube and confirms that the guard is ready for movement of the board. The backboard really should be at the wall or in a corner now, the guard holding the victim should have their back to the wall. The first guard then carefully slides the tube that is under the victim's legs out towards the feet. The best way to do this is to push down in it with both arms and pull it out past the foot end of the board. You might want to do it in two parts, first slide it as far as the ankles, pause and then finish. Do not jeck it out quickly and move the victim. Do not slide it out towards the side. Again, warn the other guard before you do this to be sure the other guard is ready for potential movement.

Always strap the chest first, then other straps. Strap it from the side you are on, do not take the time to go around the board while the victim is in this precarious position. Get the chest strapped right away, do not take time to unroll all the straps first. When using a C.J. Spineboard, the first strap must go above the victim's bosom at the armpits.

Do not lean on the board as you strap. You can have a tube at your armpits as you strap or not if you find it easier and still safe.

The chest strap should be tight but not so tight as to inhibit the victim's breathing. The video says: "tighten the straps until it is difficult to slide a finger between the strap and the victim."

If the victim is wearing a rash guard, wetsuit or other swim outfit with sleeves, you may have trouble getting the chest strap right up at the armpits.

We used to tell guards that in deep water you might find it easier to strap the chest first, then the thighs, then the hips, then the legs/feet, instead of going from head to toe, so that the legs won't slide off the board as easily. But the current instructor's manual says that strapping in an order other than chest, then hips, then thighs is "not proficient," so we no longer recommend a different order.

In deep water the guard doing the strapping can't always see across the victim as they strap. If you strap from the sticky velcro side, the far end of the sticky velcro strap can be wadded up where you can't see it. If you end up strapping from the sticky velcro side, check the strapping from the soft velcro side before you lift from the water. Especially look at the strap at the armpits for snugness.

Your text mentions strapping at chest, hips and thighs (making the strap at the legs/feet optional) but you will find you have less movement of the victim if you use all the straps.

It is crucial that the head immobilizer go on after the strapping is done. Don't velcro hair under the immobilizer or through the board hand grips.

At all times, in deep or shallow water, at the gutter or not, one of the two guards must be holding on to the board/victim; never let the board and victim float free.

It might be tempting to put a tube under the foot end of the board early, but it could make it difficult to keep the victim's face out of the water, so we advise against it.

Once the straps are all on, the guard who did the strapping puts on the head immobilizer. Do not try to do both sides of the immobilizer from the same side of the board by reaching way across. The video says to "secure the head immobilizer device by placing a strap low across the victim's forehead." It should be low enough to cover the eyebrows, but not down on the eyes.

Before moving the board to the gutter, check the placement and tightness of the straps. Recheck to see that long hair is not hanging over the board.

If you put rescue tubes under the foot end of the board (and you should even though they are optional), be sure to wrap the strap up and to communicate with the guard at the head end as they need to prepare themselves for movement of the board. The guard at the head end should have one hand on the board and one hand on the gutter. The effort to get the tubes under the foot end can cause considerable movement of the board and it should not come off the gutter/wall as the one guard holding it will not be able to control it if it leaves the gutter/wall. The tube(s) must be centered under the board or they can come flying out at a really bad time.

Your text says "if available, an assisting lifeguard remains in the water to help push the board." During all our practices/testing we require that an extra guard be found to stay at the foot end of the board during the lifts/removal in case the board starts to fall back into the pool. They should let the guards practicing/testing do the removal by themsleves, but be ready to grab the board if needed.

The board is moved to the gutter so the head end is resting on, supported by the gutter. One guard holds the end at the gutter while the other guard climbs out of the pool. That guard then holds the board while the other climbs out (page 267).

It is crucial that guards communicate with each other before one climbs out and that they communicate before/during lifting.

After you have climbed out of the pool if you suddenly realize that the straps do not look right (one was not strapped, the strap at the chest is below the bosom or a strap is obviously loose, for example), go back in carefully. Slide back in, do not jump in.

Lift the board from the gutter up to the side, then finish pulling the board all the way out. (Watch out that your fingers don't get pinched between the gutter/side and the board!)

During practice we put the head immobilizer strap on tightly, then loosen it, so that the victim will be able to lift their head up slightly in case the board is dropped.

During the lift from the pool communicate with each other. Do not try to lift the board all the way up in the air, slide it along the edge of the pool. Do not jerk the board.

The video says: "Both lifeguards slide the backboard up and over the edge of the pool and out of the water by stepping backward while keeping their knees bent. The board will be angled somewhat based on the height of the deck above the water and the type of gutter system. However try to keep the board as horizontal as practical. They gently lower the backboard to the ground and reassess the victim, providing appropriate care."

see also: shallow water backboarding