In the water resuscitation
The current Red Cross method of in-water ventilations in the Lifeguarding book (page 102/129) instructs you to "always remove a victim who is not breathing from the water as soon as possible to provide care. However, if you cannot immediately remove the victim or if doing so will delay care, then perform in-water ventilations. Once conditions allow you to remove the victim from the water, stop ventilations, remove the victim and then resume care immediately."
This may be the policy where you go to work, in which case do what the policy says. Also follow any local EMS protocols.
Some other lifeguard programs put a priority on rescue breathing in the water and wait slightly longer to remove the victim from the water.
The International Life Saving Federation (see links at the bottom of this page) looks at in-the-water-resuscitation from this point of view:
"Whenever an apparently non-breathing victim is found in the water, the rescuer is confronted with a difficult
choice. Should the rescuer attempt resuscitation procedures in the water or should the rescuer bring the victim to
shore first, then attempt resuscitation?"
They also say "When respiratory arrest is corrected prior to onset of cardiac arrest, the death rate is less (0% to
44%) than in those cases where full CPR (including chest compressions) is needed (33% to 93%). For these
reasons, in cases of respiratory arrest without cardiac arrest while the victim is still in the water, the time involved
in rescue will be enough, in the majority of cases, to result in cardiac arrest. This will lead to an increase in the
likelihood of death. If hypoxia can be corrected in the water, before cardiac arrest takes place, the victim's chance
of survival increases significantly. "
In other words, if the victim is not breathing and it takes too long to get them
out of the water and start rescue breathing, their heart may also stop beating and then they have a much smaller
chance of survival.
ILSF continues: "What if the victim is actually breathing and the rescuer mistakenly gives ventilations?
It can be difficult to determine whether an unconscious victim is breathing spontaneously while the rescuer and
victim are still in the water. Even so, if the rescuer ventilates a breathing victim, it is very unlikely to have a
negative impact. On the other hand, ventilating a victim who is not breathing may revive the victim, or at least
maintain circulation."
"If the victim is in cardiac arrest, won't the time involved in giving ventilations in the water delay CPR, early
defibrillation, and other critical interventions?
There will indeed be a delay, but the brief time involved in trying to immediately restart breathing is the best
approach. The higher death rate resulting from cardiac arrest (33% to 93%) versus respiratory arrest alone (0% to
44%) justifies the risk of attempting in-water resuscitation immediately. In the majority of these cases, breathing is
usually restored by mouth-to-mouth ventilation in the first minute."
The ILSF says: "If breathing is not restored after one minute of
ventilation, the rescuer should rescue the victim.... Attempt to prevent unnecessary neck movement if there is a
suspicion of head or neck trauma."
Some other notes:
A well managed pool would have a rule that any patron who wants to float motionlessly and stare at the bottom of
the pool, feel the sunshine on their back or let their kids climb on them, will do so with thumbs-up so the guards
know they are okay. If your pool does not have that rule, then you might want to partially determine consciousness
before grabbing a 'victim' who turns out to not be a victim after all.
If the victim is at the surface, without taking any extra time, splash and yell at them as you swim up as part of
determining consciousness (or determining they're just playing games with you or staring idly at the bottom of the
pool).
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CPR compressions need to be given on a firm, flat surface and you can't attempt them in the water.
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Getting the defibrillator should have been
practiced as a part of your emergency action plan so you shouldn't have to tell someone, but be sure it was done;
people have forgotten they had an AED around.
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When practicing on people in the water in class don't try to open the victim's mouth (they don't want to have to
choke on water that might get in). Don't breathe into anybody's mouth even as a joke. Instead, fake it with a
pocket mask.
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When you are being the victim, critique your rescuer, including silently counting seconds on checks and breaths.
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Do not continuously correct your rescuer; they won't learn if you keep doing it for them.
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The ILSF material on this page was taken from a page linked to from the American Red Cross Lifeguard Management website that is out of operation.
To read all of the International Life Saving Federation Medical Commission
STATEMENTS ON IN-WATER RESUSCITATION
Go to http://www.ilsf.org/
and on the left hand side click on Medical, then medical position statements, then scroll down to Statements on In Water Resuscitation
or sometimes this link functions:
http://www.ilsf.org/sites/ilsf.org/files/filefield/medical_policy_07_in-water_resuscitation.pdf
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