Lifeguard teams practicing standing in-line stabilization and spinal management (Photo credit: Kyle Maxwell, East Bay Regional Park District)
Spinal management is one of the three core skills of lifeguarding, the other two being rescues and CPR/AED. Good spinal management focuses on in-line stabilization that protects the neck and spine while allowing effective airway management. Because lifeguards are required to have proficiency with these skills both on land and in the water, the necessary skill set for spinal management is doubled. Listed below are a variety of complicating variables that should be considered and incorporated into in-service training:
LAND IN-LINE STABILIZATION PROGRESSION DRILL: 2-person lifeguard teams will move into position to provide manual in-line stabilization and airway management for the victim on land. “Airway management” means assisting the victim in having a patent airway. OBJECTIVE: Quickly move into the proper position to provide care. Have the lifeguards start 10 feet from the victim. Go through each position:
TIMING GOAL: Up to 10 seconds for each position
Push your lifeguards to develop their spinal management skills by changing up the workspace.
Once proficient, add a variation(s) to the position.
Spinal management progression should follow this sequence: maintain in-line and provide airway management until more advanced medical care takes over, or move victim into neutral position and package on to a backboard. If the latter; additional lifeguards should assist with packaging and extrication. Go through all the positions and variables listed above, adding:
There is no time limit on these additions due to the importance of maintaining in-line stabilization throughout the whole drill. A good goal would be to complete packaging and extrication before advance medical care arrives.
Working in creative spaces strengthens their teamwork skills.
WATER IN-LINE STABILIZATION PROGRESSION DRILL: Starting in mid-depth water, lifeguard will move into position to provide manual in-line stabilization, either a head splint or head and chin support to the victim. OBJECTIVE: Move quickly without causing unnecessary disturbance in the water, reach the victim, provide manual in-line stabilization and provide care. Have the lifeguards start 10 feet from the victim. Go through these victim positions:
TIMING GOAL: Up to 20 seconds for each position
Once proficient, move to these variations:
Your underwater work is just as important as your surface work
When it comes to underwater skills, get proficieny first, then incorporate the rescue tube and work towards proficiency again.
IN-LINE STABILIZATION TRANSITION DRILL: (6+ lifeguards preferred) Starting at mid-depth, 2-Rescuer team with the primary lifeguard holding in-line stabilization and the secondary lifeguard providing support on victim who is face-up on the surface. OBJECTIVE: A single lifeguard will enter and transition into the primary role, the lifeguard from the primary role will transition into the secondary role, the lifeguard in the secondary role will rotate out. Drill ends when lifeguard in the original secondary role finishes in the primary role and all lifeguards have rotated through all positions. TIMING GOAL: 15 seconds for the lifeguard to transition into the primary role or into the secondary role
Once proficient, move to the variations:
BACKBOARD PLACEMENT TRANSITION DRILL: Primary lifeguard provides manual in-line stabilization, head splint technique. OBJECTIVE: Complete the following sequence:
TIMING GOAL: 45-60 seconds to transition through all the entire sequence
Once proficient, add these variations:
Practice your spinal management land skills just as much as your water skills
Make it a priority to break spinal management into digestible components for your lifeguards. Since there is the potential for many variables, keep the training objectives simple and clear. Provide enough time and opportunities for your staff to reach proficiency and strive for mastery of each skill. Effective training is consistent training.
ALL IN THE TIMING
Spinal Management drills 1-Hour Curriculum (12 lifeguards, 3 backboards with spinal gear)
Briefing 5 minutes
Land In-line Stabilization Progression 5 minutes
Land In-line Stabilization Progression variations 5 minutes
Land In-line Stabilization Progression variations with patient packaging 15 minutes
Water In-line Stabilization Progression with variations 10 minutes
In-line Stabilization Transition 5 minutes
Backboard Placement Transition 10 minutes
Debrief/Breakdown with clean-up 5 minutes