When it comes to saving a life in the water, in-service trainers have many components that they need to train their lifeguards on: Identifying the victim, making the appropriate entry and rescue, extricating the victim in water and onto land, and providing the appropriate care that can include rescue breaths, CPR, use of an AED, and administration of emergency oxygen.
Let’s focus on rescue breathing — specifically, opening the airway using the triple airway maneuver for a victim. The triple airway maneuver can be performed both on land and in the water. Being proficient at this technique requires consistent practice and focus.
As an in-service trainer, break the triple airway maneuver into manageable parts: Lifeguard’s body position and hand placement on the person; performing the maneuver; effective sealing of the rescue mask; and effective rescue breaths that cause the chest to rise.
Note: Only perform these drills if authorized through your agency.
BODY POSITION AND HAND PLACEMENT
Body Position Drill 1: Two-person teams (one will be the rescuer; the other, the victim). The victim takes a supine position (on their back) on the ground.
Objective: Move to the victim and get into position with hand placement to perform the triple airway maneuver.
Timing Goal: 15 seconds.
Once the rescuer has demonstrated proficiency, reduce the time down to 5 seconds to get into proper position. Once the rescuer has demonstrated their proficiency within the new timing goal, switch roles so both participants can practice.
Body Position Drill 2: Three-person teams (two will be the rescuers; one, the victim). The victim goes on the ground in a supine position.
Objective: Move to the victim. One rescuer gets into position with hand placement to perform the triple airway maneuver. One rescuer gets into position to provide chest compression/assistance with a BVM.
Timing Goal: 15 seconds.
Once both rescuers have demonstrated proficiency, reduce the time down to 5 to 7 seconds to get into proper position. Once the rescuers are proficient within the new timing goal, switch out the victim so all participants can practice the rescuer positions.
PERFORMING THE MANEUVER
Tilt, Thrust, And Open Drill: Two-person teams (one will be the rescuer; the other, the observer/proctor; and a manikin with jaw thrust capabilities will be used as the victim).
Objective: Open victim’s airway by tilting the head back with both hands, thrust the jaw up and forward, and use the thumbs to open the airway.
Timing Goal: 3 to 5 seconds.
Once the rescuer has demonstrated proficiency, reduce the time down to 5 seconds to get into proper position. Once the rescuer has demonstrated their proficiency, switch roles so both participants can practice. Once both rescuers are comfortable with their skills, move to Sealing the Mask Drill.
SEALING THE MASK
Sealing the Mask Drill: Two-person teams (one will be rescuer; one, the observer/proctor; and a manikin with jaw thrust capabilities will be used as the victim). Resuscitation mask and BVM will be used.
Objective: Open the victim’s airway and seal the resuscitation mask by using one of the three methods:
• Jaw Thrust
• E-C Technique with head fully extended
• E-C Technique with head in neutral position
Timing Goal: 3 to 5 seconds.
Once the rescuer has demonstrated proficiency in one method, switch rescuers. Move through and become proficient in all three methods. Once both rescuers are comfortable, transition to sealing the mask attached to the BVM. Practice all three methods.
Variation on the Drill: Imagine that the mask on the BVM is compromised. Switch it out with your issued resuscitation mask and practice the three methods.
RESCUE BREATHS
Make the Chest Rise Drills: Two-person teams (one will be rescuer; one, the observer/proctor; and manikin(s) with jaw thrust capabilities will be used as the victim(s)). Resuscitation mask and BVM will be used.
Objective: Open the airway of the victim, seal the mask, and provide rescue breaths that make the chest rise. Provide five effective breaths.
Timing Goal: 10 to 15 seconds.
Once the rescuer has demonstrated proficiency in one method, switch rescuers. Move through and become proficient in all three methods. Once both rescuers are comfortable, transition to sealing the mask attached to the BVM and provide rescue breaths. Practice all three methods.
Variations On the Drill: Imagine the victim is a child or infant and provide the appropriate rescue breaths using the appropriate manikin.
SCENARIOS
Land Scenarios: Two-person teams, and a manikin with jaw thrust capabilities, resuscitation mask and BVM.
Scenario 1: Rescuers arrive on the scene to an unresponsive adult. Assess scene safety, do a primary assessment, activate EMS, and provide the appropriate care for an unresponsive adult who has a pulse but is not breathing. Provide five effective breaths.
Timing Goal: 30 seconds.
Scenario 2: One rescuer arrives on the scene to an unresponsive child. Assess scene safety, do a primary assessment, activate EMS, and provide the appropriate care for an unresponsive child who has a pulse but is not breathing. Provide five effective breaths.
Secondary rescuer arrives on the scene after 30 seconds. Rescuers transition to providing rescue breaths with a BVM. Provide five effective breaths with the BVM.
Timing Goal: 60 seconds.
Scenario 3: Rescuer One is handed an unresponsive infant. Assess scene safety, do a primary assessment, activate EMS, and provide the appropriate care for an unresponsive infant who has a pulse but is not breathing. Provide five effective breaths. Rescuer Two arrives and takes over. Patient care is uninterrupted and smooth. Rescue Two provides five effective breaths.
Timing Goal: 60 seconds
MISTAKES TO LOOK FOR
As the trainer, your critical eye is needed so lifeguards don’t make mistakes that could delay or compromise care. Here are some errors you might see:
• Improper body position to provide rescue breaths
• Ineffective mask seal
• Over- or under-inflation with the resuscitation mask/BVM
• Failure to maintain an open airway when providing breaths
- Failure to make the chest clearly rise during rescue breaths
As the trainer, your job is to make sure lifeguard safety is the priority, especially when working with a real victim. Keep your lifeguards focused, proficient, and rescue ready.
Good luck and keep training.