shallow water backboarding

This is the order in which you rescue and backboard a spinal injury victim in shallow water using a head splint for our practices in class. (A lot of this also applies when using a head and chin support.) 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. C.J. spineboards and longer tubes are easier to use, but we will practice with all kinds.

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.

_______________________________

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 face up at the surface), that the victim's face (mouth and nose) is out of the water all the time.

_______________________________

The first lifeguard (or rescuer 1) 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. Don't make the huge mistake of taking a flying leap into the pool while gripping the backboard.

Approach a face down victim from the side. (See page 259 in your text.) Grasp the victim's arms midway between the elbow and the shoulder. Put your right hand on their right arm, your left hand on their left arm. Gently squeeze the victim's arms to their head and keep them squeezed so their head stays in line with their body. Victims arms will cross at the wrists when you have a tight squeeze and the head is really trapped by the arms. The head must stay squeezed.

Lower yourself down to water level (shoulder depth) so you won't lift the victim up out of the water on the next step. Walk and glide the victim slowly forward, so their legs might come up to the surface and their body might be in a straighter line.

While still moving the victim forward, roll them towards you until they are face up and their face is out of the water. Their head should be close to the crook of your arm and their arms must remain squeezed against their head so that their head stays in line with the rest of their body. Keep their face out of the water from now on.

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."

Move the victim towards the side of the pool. If your victim has legs that sink, you might find it easier to get them on the backboard if the primary rescuer moves them slowly in a wide circle while the other guard places the backboard. Don't make the secondary rescuer chase you and the victim. If you can't get the victim's legs up parallel to the surface, then you will have to get the backboard under anyway, without moving the victim's neck or otherwise losing in-line stabilization.

The second guard gets the backboard, removes the head immobilizer and 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, then submerges the board under the victim, then controls how fast it rises under the victim. (Page 263, picture at step 2.)

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.

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).

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.

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.

When the backboard is in the right place, the primary rescuer can slide the arm that is under the victim slightly towards the top of the victim's head. 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).

The rescuer 2 then applies a head and chin support to the victim with their upper arm straight along the victim's sternum, hand at the chin and the other arm under the board, applying upward pressure. 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 first guard then slides their arm out from under the victim and lets the secondary rescuer take over in-line stabilization.

Shorter people should insist that they and their partner stay in shallower water where they can stand flatfooted if possible instead of standing on tiptoes. Taller people should bend their knees or spread their legs wide apart to be low enough in the water.

The primary rescuer then lowers the victim's arms, goes to the head of the board, and submerges as needed to shoulder depth.

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. (See page 263, photo at step 5.)

Your text says that the guard at the head of the board should "support the backboard 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.)

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.

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. 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.

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.

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.

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.

At all times, whether out in the water or at the gutter, one of the two guards must be holding on to the board/victim; never let the board and victim float free.

Keeping the rescue tube at the head end centered and in place, the two guards get the head end to the side of the pool and with one of them at each side of the board, lift it up to the gutter so it is resting on, supported by the gutter. The guard at the head end should have one hand on the board and one hand on the gutter.

One guard uses both hands to get a tube under the foot end of the board. The tube should centered under the board or it can come flying out atr a really bad time. (In real life this would be optional and either guard could do this, but for testing purposes, so each guard can be tested on all parts of each role, we will have the first guard do it.)

It is crucial that guards communicate with each other before one climbs out and that they communicate before/during lifting. Be carefull to not get your fingers pinched between the board and the gutter/pool deck edge.

For purposes of testing, to be sure each lifeguard candidate does all of each skill, the first guard climbs out while the other holds the board and side/gutter. Then the first guard holds the board while the second guard climbs out.

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 top is not above the bosom, or a strap is obviously loose, for example), go back in carefully using a slide-in entry. Do not jump in.

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.

Both guards lift the board 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 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:

Deep water backboarding