Scan for bleeding drill incorporates a primary and secondary rescuer (photo credit: Pete DeQuincy, city of American Canyon)

 

In February 2013, I briefly touched on one primary assessment drill in my “Back to Basics” article. This article breaks primary assessment into 5 drills utilizing a single rescuer.

Primary assessment can lead to caring for and monitoring an unconscious victim, dealing with severe bleeding, providing rescue breathing, or preforming CPR. Your primary assessment should include:

  • Check for Responsiveness/ Summons EMS (body rolling the victim when necessary)
  • Look, listen, and feel for breathing with a pulse check
  • Check for severe bleeding and provide care

Sound easy? It’s not! Primary assessment with a progression to the appropriate patient care should be done in under a minute. Additionally, most training on primary assessment is done in a quiet, non-disruptive environment, where several steps are skimmed over verbally rather than physically training on them.

Speed and proficiency are mandatory for an effective primary assessment. Train with these drills to get your lifeguard team ready for the challenges that await them.

The personal safety of the rescuer is paramount and a scene size-up with gloving up is the prequel to every primary assessment.

GLOVING UP DURING SCENE SIZE-UP DRILL:  Have your lifeguard team line up with gloves in hand.  OBJECTIVE: Each lifeguard must have their gloves on by the time it takes to verbalize all the components of a scene size-up. A scene size-up should be a scan that includes:

  • Checking the scene for environmental dangers
  • Determining the number of victims
  • Assessing whether additional resources needed
  • Determining the mechanism of injury to the victim
    • Assessing whether there is a need for extrication of the victim

Depending on your agency and local protocols and your level of training, scene size-up could also include:

  • Whether spinal precautions needed

This is all completed before entering the scene and making contact with patient while simultaneously pulling gloves from a fanny pack and getting them on. TIMING GOAL: 10-12 seconds to complete the objective with a trainer reciting the components. 

Here is a video link of the drill: http://www.youtube.com/watch?v=6b-vleXEH40&list=PLmuuhapccrBdx_...

Once proficient in the drill, move to these variations:

  • Lifeguards start with gloves in their fanny pack (no change)
  • Lifeguards, in verbal unison, recite the components of scene size-up while gloving up (15 seconds then reduce to 10-12 seconds once proficient)
  • Combine the two variations above: Lifeguards verbalize scene size-up starting with gloves in fanny pack (15 seconds then reduce to 10-12 seconds)

 

Body rolling the victim should be done quickly and safely. Primary and secondary rescuers should work in unison.

 

BODY ROLL DRILL: Group your lifeguards in teams of three: one primary rescuer, one secondary rescuer, and one victim. Victim is on their side with the rescuer(s) 5-10 feet away. OBJECTIVE: Primary rescuer must check responsiveness of victim, state, “No response,” body roll the victim to a supine position. Care should be taken on head, neck and back while rolling the victim. A secondary rescuer arrives. The primary rescuer tells the secondary rescuer “to activate EMS.” TIMING GOAL: 5-7 seconds to complete the objective.

Here is a video link of the drill: http://www.youtube.com/watch?v=Zzv29hAgfUE&list=PLmuuhapccrBdx_...

Once proficient, move to the variations:

  • Victim is in the prone position (10 seconds)
  • Rescuers start with gloves on (no change)
  • Once victim is in the supine position, rescuer takes a lateral or cephalic position on the victim (no change)
  • Victim is in the prone position with both rescuers assisting to body roll the victim. Once the victim is in the supine position, secondary rescuer leaves to activate EMS, while the primary moves to lateral or cephalic position on the victim (5-7 seconds)

 

AIRWAY MANEUVER PROGRESSION DRILL: (Note: This drill was mentioned in Aquatics International, Nov/Dec 2013, and is an integral part of primary assessment.  Several variations have been modified to include quickly checking for breathing and a pulse for no more than 10 seconds.) Pair up your lifeguards: one rescuer, one victim. Victim is in the supine position on the ground with the rescuer 5-10 feet away. OBJECTIVE: Rescuer moves to the lateral side of the victim and opens the airway with head-tilt/ chin-lift technique. The rescuer is in position to look, listen, and feel for breathing. TIMING GOAL: 5 seconds to complete the objective.

Here is the video link: http://www.youtube.com/watch?v=uyU1QyNNF00&list=PLmuuhapccrBdx_...

 

Once proficient, move to these variations:

  • Rescuer moves to the cephalic position and preforms the jaw-thrust with head extension maneuver (5 seconds)
  • Rescuer performs a pulse check after opening the airway in the lateral position (no change)           
  • Rescuer performs a pulse check after opening the airway in the cephalic position (no change)
  • Rescuer opens the airway in the lateral position, and checks for breathing  and a pulse  for no more than 10 seconds (up to 15 seconds)
  • Rescuer opens the airway in the cephalic position, checks for breathing and a pulse for no more than 10 seconds (up to 15 seconds)

 

With a non-spinal victim, open the airway in the cephalic position, then slide one hand down to do the pulse check during the "look, listen, and feel" phase.

 

SCAN FOR BLEEDING (SC4B) DRILL: Lifeguards are paired: one rescuer, one victim. Victim is on the ground in the supine position, with the rescuer checks for breathing and a pulse. Rescuer states, “Scanning for severe bleeding,” and awaits trainer’s cue for what type of care to provide. OBJECTIVE: Rescuer needs to provide the appropriate care as dictated from the trainer’s cue within the timeframe allowed. TIMING GOAL: Vary depending on the medical condition of the victim.

Trainer states that the victim has:

 

  • “Severe bleeding from (L or R) leg.” Rescuer needs to request additional assistance, and provide direct pressure to control the bleeding. (10 seconds)
  • “No severe bleeding, no breathing, but there is a pulse.” Rescuer provides adult rescue breathing with a pocket mask for three successful breaths, making the chest rise. (18 seconds.)
  • “No severe bleeding, no breathing, no pulse.” Rescuer provides CPR for one cycle, 30 compressions with 2 breaths (30 seconds. Once proficient, reduce to 24 seconds.)

 Once proficient, add an additional rescuer and modify care that supports two rescuers.

  • “No severe bleeding, victim is breathing.” Rescuers maintain an open airway on the victim. (5 seconds.)
  • “Severe bleeding from (L or R) leg.” Primary rescuer provides direct pressure to control the bleeding, secondary rescuer retrieves the first aid kit, and both rescuers use bandages and gauze to control the bleeding. (20 seconds.)
  • “No severe bleeding, no breathing, but there is a pulse.” Primary rescuer provides adult rescue breathing with a pocket mask, while secondary rescuer retrieves BVM and assembles it by the time the primary rescuer performs three successful breaths, making the chest rise. Once assembled, rescuers utilize BVM for one breath (25 seconds)
  • “No severe bleeding, no breathing, no pulse.” Rescuers provide two-person CPR for one cycle, 30 compressions with 2 breaths (30 seconds. Once proficient, reduce to 24 seconds.)

 

Once your lifeguard team has become proficient in all the drills listed above, link them together with the PRIMARY ASSESSMENT COMBINATION DRILL: This drill combines the drills with an end goal of doing a sequence that connects all 4 drills into one fluid drill. Start by combining only two drills then incorporate additional drills once your lifeguard team shows proficiency. OBJECTIVE: Rescuer(s) complete the combined drills within the timing goals. To achieve success, it is very likely that several in-service trainings will need to be dedicated to this topic.  TIMING GOAL: The Timing Goal from each drill and variation should be added together which will vary depending on the drill combination (45-90 seconds).

Remember practice builds skill proficiency, and skill proficiency builds personal empowerment, which elevates the rescuer to an aquatic professional.  Train often, and with a passion.

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Tags: assessment, challenge, drills, in-service, lifeguard, lifeguarding, passive, primary, training, victim

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