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:

  • If on land, the victim could be standing, sitting, on the ground in a supine, prone, or side position, or simply in the location of where the injury occurred.
  • If in the water, then victim’s body position is a factor: face up or face down, followed by depth: on the surface, submerged, or on the bottom.
  • Water depth: extreme shallow, shallow, mid-depth (3-5 foot) and deep (5 foot plus).
  • Location within the pool and pool architecture: lap lane, diving well, shallow recreation area, high lip gutters, elevated pool deck.
  • The number of lifeguards available during the incident.
  • The victim’s medical status: conscious or unconscious, followed by the possibility that the victim may need additional treatment for medical conditions or injuries.


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:

  • Sitting
  • Standing
  • Prone
  • Supine
  • Lateral (Coma)
  • Fetal

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.

  • Victim is located under a table, which is movable. (no time added)
  • Victim is located under a table, which is not movable. (no time added)
  • Victim is unconscious and a primary assessment must be performed, victim has a pulse is and breathing (add 5 seconds)
  • Victim is unconscious and a primary assessment must be performed, victim has a pulse  and is not breathing,  jaw-thrust maneuver must be used to provide adequate airway management, victim begins to breathe with assistance(add 10 seconds)
  • C-collar application (If trained to do so, and agency and county EMS protocols allow)

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:

  • Add one or two lifeguards to the team. Package victim, and provide care where victim is found.
  • Package and extricate victim to staging area to wait for advanced medical care and continue to treat and monitor victim’s injuries.

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:

  • Prone (surface, submerged, on the bottom)
  • Supine (surface, submerged, on the bottom)


TIMING GOAL: Up to 20 seconds for each position

Once proficient, move to these variations:

  • Shallow water (add 10 seconds)
  • Extreme shallow water (add 10 seconds)
  • Deep water (add 10 seconds)
  • 2-Rescuer team, primary lifeguard provides manual in-line stabilization, while the secondary lifeguard provides support, either to the victim or primary lifeguard. (no time limit)
  • 2-Rescuer team, variation above plus, once the victim is stabilized; proceed with extrication to the closest wall. (no time limit)
  • 2-Rescuer team, variation above exception  no verbal communication is allowed during the drill

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:

  • Deep water (add 5 seconds to transitions)
  • Deep water, add another lifeguard to provide additional secondary support (add 5 seconds to transitions)
  • No verbal communication allowed during the drill (no time change)

BACKBOARD PLACEMENT TRANSITION DRILL: Primary lifeguard provides manual in-line stabilization, head splint technique. OBJECTIVE: Complete the following sequence:

  • Secondary rescuer brings backboard and places it under the victim
  • Secondary provides head and chin support, and transitions in for primary lifeguard in providing in-line stabilization support
  • Primary lifeguard utilizes rescue tube under backboard for support
  • Primary lifeguard provides in-line stabilization
  • Secondary rescuer transitions out of providing in-line stabilization support

TIMING GOAL: 45-60 seconds to transition through all the entire sequence

Once proficient, add these variations:

  • Following the drill sequence, add strapping the victim to the backboard (add up to 60 seconds)
  • Following the strapping of the victim to the backboard, extricate the victim out of the pool (add up to 30 seconds)
  • No verbal communication allowed during the drill (no time added)
  • Add an additional lifeguard to the strapping and extrication component (reduce up to 20 seconds)
  • Add 2 additional lifeguards to the strapping and extrication component (reduce up to 30 seconds)

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.



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





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