# [Didn't Expect to Come Back, but...] First Save



## Cory (Sep 3, 2009)

So, I didn't expect to return to this forum, but after my latest experience I have learned some things, and I wanted to come back because I want to have this forum as a resource. So I want to apologize to every member of this forum now for what has happened in the past, and hopefully you can accept my apology.

First Save:

   So, as some of you know, I worked as a lifeguard at a pool this summer. (yes, I'm only a wannabe EMT/medic) And it was a slow summer for the most part. I felt more like a cop than someone guarding any lives. I treated a nosebleed, and two bee stings. But then on my second last day of the year I had a real situation. [I have written this so many times from incident reports to school essays, that I really am just going to give a cut and dry explanation.)

   We had ten day camps come to the pool, making somewhere around 90-120 kids in the pool at any given time of the day. It was madness from the minute we opened.

Anyway, at around 2:20 I happened to look up from my area and notice a crowd forming around the steps at the three foot entrance. I spotted the lifeguard from that area in the crowd, and seconds later I saw her sprint off inside. I knew immediately she was going to call 911. So, frantically I signaled my senior lifeguard, and we cleared the pool. I took off for the crowd. My expectation was a broken leg or arm (a common topic regarding the safety risks of the steps)

   When I got there, I realized the situation was much worse. On my approach I saw a boy and a woman at the middle of the crowd. There was a three year old boy laying unconscious just outside the pool. His eyes were rolled back, and vomit was spewing from him. So, noticing the vomit, I immediately grabbed a CPR mask off of one of the lifeguards chairs. There was a woman giving him chest compressions, she was not a lifeguard but I ignored that and continued. 

   So when I got there, I was berrated with insults and jeers from the crowd. I walked up to the two, got down just in front of the boy's head, and immediately told the woman who I was and that she needed to continue chest compressions (he most likely had a pulse, but he had gone unconscious under water[still wet, wet drag lines coming from the waters edge] so I deduced that he was in essence a choking victim, which would require chest compressions anyway) 

   Sparing many details that you all would most likely already know (traumatc things for me, but most of you have all seen it before) we did five sets on him, each time watching him fade in and then back out, until on the fifth set, instead of making a struggling noise and clenching his teeth, he just started crying. So we rolled him into a recovery position. 

   Now, being it my first time, and a bunch of lifeguards at a pool that has never in it's 50 years having had a bad emergency situation (or even transport), a lot of emtional stuff came after all of this. But basically, after we rolled him, I looked up to see tw EMT's three cops and the chief of police and the fire chief all staring back at me. The boy was released hours later with no complications.

   It was an elightening, ensuring and yet disturbing experience for me. It both confirmed and made me question my choice of EMS. But later I realized that this had in fact definately confrimed it. So I am taking an explorers course at a local hospital just for a starting place ( I still don't know if EMS is an option, and even if i is it will most likely be the hospital's ambulance service)

   Now, I figure a lot of those details about how the procedure went and how his body reacted and what I was feeling wouldn't be as interesting to a bunch of EMTs as it would be to my English teacher or a jaded pool manager. But I do have very detailed stroies re-telling it written if you want to read them (let me know, don't really expect anyone to, but you're more than welcome to PM me about it) But keep in mind this was a VERY cut and dry telling.


-Cory-


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## medic417 (Sep 3, 2009)

Congrats on your efforts. If you decide on EMS be advised if you claim saves you must accept blame for the failures.  Best advise is do your best for every patient and move on.


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## Cory (Sep 3, 2009)

Yeah, we did a lot wrong in all reality, it was a miracle he had no broken ribs or depleted alveoli from the force of the CPR we were giving to him. Basically my uncle (the fire chief) told me to just not worry about the quality of our care because the boy survived and was 100% in just a few hours, but I still do worry and I took some time to critique everything we did (mainly the fact that a bystander initiated CPR while a lifeguard left, but I couldn't have helped that)


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## exodus (Sep 3, 2009)

So exactly why was CPR initiated? Where was it indicated? Did the boy have a pulse? Did the AED shock him? Do you have ANY idea what CPR is for? Do you know what it does... I'm sorry, but you may have hurt the boy more than helped. He's CHOKING. Abdominal thrusts help that, not chest compressions...


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## Cory (Sep 3, 2009)

exodus said:


> So exactly why was CPR initiated? Where was it indicated? Did the boy have a pulse? Did the AED shock him? Do you have ANY idea what CPR is for? Do you know what it does... I'm sorry, but you may have hurt the boy more than helped. He's CHOKING. Abdominal thrusts help that, not chest compressions...



He was an unconscious choking victim, which requires chest compressions. Plus, he was not breathing, so rescue breathing was a must. The AED was not necesarry, the pool is next door to the city FD. The woman said she didn't "feel" a pulse, but my guess is it was faint and she couldn't tell (she apparently put her ear on his chest to get a pulse)

Yes, I am fully aware what CPR is for. And again, the boy was released and perfectly okay. I got a letter from the Red Cross, the FD, and the hospital all confirming my actions to be correct, and a successful resusitation.

I am going to just guess that you missed the part about him being unconscious, but hopefully you weren't suggesting I give abdominal thrusts to an unconscious victim.


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## Akulahawk (Sep 3, 2009)

If you do decide to continue to educate yourself in EMS, do your best to learn what is being taught to you. Do your best for every patient, know you've done your best, and move on. You must learn to accept both sides of things: the glory for the saves and the blame for the failures. The biggest failure, however, is to not learn from your mistakes. 

Oh, and stick around! The people here might occasionally get a little grumpy about stuff, but if you're willing to keep your eyes and ears (and mind) open to things, you can learn a lot.


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## ffemt8978 (Sep 3, 2009)

exodus said:


> So exactly why was CPR initiated? Where was it indicated? Did the boy have a pulse? Did the AED shock him? Do you have ANY idea what CPR is for? Do you know what it does... I'm sorry, but you may have hurt the boy more than helped. He's CHOKING. Abdominal thrusts help that, not chest compressions...



Actually, it depends upon to what level of CPR a person is trained to.  While I fully expect a lifeguard to be trained to the Healthcare Provider level, I am not sure that it is required in ALL areas.

The Healthcare provider level is what teaches the abdominal thrusts for an unresponsive victim, along with things like pulse checks and AED application.  The lay rescuer course teaches CPR only for an unresponsive choking victim, and from the sounds of the original post, CPR was initiated by a bystander prior to his arrival.


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## Lifeguards For Life (Sep 3, 2009)

exodus said:


> So exactly why was CPR initiated? Where was it indicated? Did the boy have a pulse? Did the AED shock him? Do you have ANY idea what CPR is for? Do you know what it does... I'm sorry, but you may have hurt the boy more than helped. He's CHOKING. Abdominal thrusts help that, not chest compressions...



that was just being discussed elsewhere. i had thought the same thing. this story doesnt seem to flow quite right


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## Lifeguards For Life (Sep 3, 2009)

yeah on a second read this story doesnt flow at all
1. you state you happened to look up and notice this event. how do you miss any submersion or emergency where the water is 3 feet deep and clear

2.If the pt was vomiting why was there no attempt to clear the airway or even assess to see if the pt. was breathing or not?

3.why do you think you were greeted with insults and jeers from the crowd?

4. you state the pt. most likely had a pulse, shouldnt you find out if the pt. has a pulse or not? 

5.from what parameters do you gather that the pt. was indeed a choking victim? did you ask the crowd of people that obviously wittnessed said event before you?

6. EMt's showed up on scene and just watched?


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## Cory (Sep 3, 2009)

Lifeguards For Life said:


> that was just being discussed elsewhere. i had thought the same thing. this story doesnt seem to flow quite right



I don't see why you say that. If you are implying that it did not happen then I am sorry, but it did.



> Actually, it depends upon to what level of CPR a person is trained to. While I fully expect a lifeguard to be trained to the Healthcare Provider level, I am not sure that it is required in ALL areas.
> 
> The Healthcare provider level is what teaches the abdominal thrusts for an unresponsive victim, along with things like pulse checks and AED application. The lay rescuer course teaches CPR only for an unresponsive choking victim, and from the sounds of the original post, CPR was initiated by a bystander prior to his arrival.



Well, my certification says CPR/AED professional, but it is a Red Cross course. Although we were taught to give compressionas to an unconscious choking victim.

Again, I am trained in AED, but we are next door to the FD. And I never checked for a pulse, what the woman told me when I got to her was 1.) she had cleared his airway, attempted to give mouth to mouth but his chest didn't rise, and 2.) she felt for a pulse (later learned she out her ear to his head) heard nothing and immediately went into chest compressions. 

I would have told her to stop, but again it was clear that he had been dragged out of the pool already unresponsive. So, again, in essence he was a choking vinctim. Following my training we continued CPR. I have no doubt in my mind that the rescue breathing is what saved him ultimately.

She was the one who initiated CPR before I even knew anything had happened. She was a day camp supervisor, and trained in basic CPR (she didn't even know what a CPR mask was) She had apparently insisted the lifeguard call 911 while she began CPR, and being the scared 17 year old girl that the lifeguard was, she just took off running.


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## medic417 (Sep 3, 2009)

http://www.americanheart.org/presenter.jhtml?identifier=3025002

"If the choking is not relieved, the child will become unresponsive.  When the child becomes unresponsive, shout for help, lower the child to the ground, and *start CPR*.  If someone else is present, send that person to phone 9-1-1 while you start CPR."

Looks like he did what AHA says to do.  Leave the kid along.


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## Lifeguards For Life (Sep 3, 2009)

Cory said:


> I don't see why you say that. If you are implying that it did not happen then I am sorry, but it did.
> 
> 
> 
> ...


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## Lifeguards For Life (Sep 3, 2009)

medic417 said:


> http://www.americanheart.org/presenter.jhtml?identifier=3025002
> 
> "If the choking is not relieved, the child will become unresponsive.  When the child becomes unresponsive, shout for help, lower the child to the ground, and *start CPR*.  If someone else is present, send that person to phone 9-1-1 while you start CPR."
> 
> Looks like he did what AHA says to do.  Leave the kid along.



true, i will stop picking


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## hottrotter18 (Sep 3, 2009)

Cory said:


> I would have told her to stop, but again it was clear that he had been dragged out of the pool already unresponsive...
> She was the one who initiated CPR before I even knew anything had happened. She was a day camp supervisor, and trained in basic CPR (she didn't even know what a CPR mask was)



First of all, im glad that everything worked out for the better!
now...

Its obvious that you have more training in this situation than the woman who was giving chest compressions. 
You need to take control of the scene. I would have told her to stop doing compressions, and immediately begin with checking breathing rate, and if he did in fact have a pulse. 

You say it was obvious he was unresponsive when pulled out of the water... who's to say that the woman giving the victim compressions didnt make him pass out from doing so?


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## Cory (Sep 3, 2009)

Lifeguards For Life said:


> yeah on a second read this story doesnt flow at all
> 1. you state you happened to look up and notice this event. how do you miss any submersion or emergency where the water is 3 feet deep and clear
> 
> 2.If the pt was vomiting why was there no attempt to clear the airway or even assess to see if the pt. was breathing or not?
> ...




I am not lying. I made it clear in the OP that it was a cut and cry version.

1. I was at the other end of the pool, this was not in my area, I would have never been able to see it. The pool was shoulder to shoulder, and the majority of people were already flocked around the stairs. Even people who were right next to the boy said they hadn't seen it happen.

2. Please read my latest post. The airway was cleared immediately, and no breathing was heard.

3. Are you kidding me? I "think" I was greeted with insults and jeers? Are you implying that I made that up? When I ran up, three ladies from a day camp stood right in front of me and said, 'You're a bunch of lifeguards and you don't know CPR?" Too which I replied that we did. One of the women found me afterwards and gave me a formal apology for it.

4. AGAIN, I didn't initiate CPR. The woman doing CPR when I arrived told me she was certified, and that he had no pulse, was not breathing, had a cleared airway, and from there I went to work. He had already been in resparitory arrest for almost a minute, I didn't want to waste time.

5. AGAIN, there was a trail of water leading from his feet to the water's edge. He was soaked. I had guessed that the vomit was most likely due to the pressure change. The lifeguard who had pulled him out and ran for the phone was soaked when I saw her, she hadn't been soaked just 20 minuted before this occured. PLUS, even though she had cleared his airway, vomit was still coming out. That is why I had the mask in the first place.

6. When I saw the EMT's for the first time, I had the boy in a recovery position for almost a minute, trying to get his attention and comfort him. When I looked up, EMS were waiting for us to move. We looked at them, got up and they wrapped him up in a blanket and put him on the stretcher.


Good enough?


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## Cory (Sep 3, 2009)

Lifeguards For Life said:


> Cory said:
> 
> 
> > I don't see why you say that. If you are implying that it did not happen then I am sorry, but it did.
> ...


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## ffemt8978 (Sep 3, 2009)

Knock it off.


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## Cory (Sep 3, 2009)

hottrotter18 said:


> First of all, im glad that everything worked out for the better!
> now...
> 
> Its obvious that you have more training in this situation than the woman who was giving chest compressions.
> ...



Yes, well I will admit it wasn't until afterwards that I learned for sure that the lifeguard saw him passively floating the surface, she pulled him out, rolled him over (that is when the pressure change enduced vomiting) and then the woman immediately snatched him. A testament to why the guard should've stayed.

And yes, her CPR was a total mess at first, and I am still upset that another lifguard didn't relieve her (my intention was to do two person CPR and monitor her compressions) but when I got there, I stopped things, she went on to tell me about her assessment, and from there I told her to continue and I would do rescue breathing. I went by what she said. Might have been a mistake, but by her calm nature towards what had happened she seemed professional, and NO ONE else was doing a damn thing. I HAD to react. You all have to understand the staff, the crowd, and the situation better. That woman was alnoe in a sea of gawking faces. Both shocked patrons and frozen life guards, me and her were the only ones doing anything other than yelling.


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## hottrotter18 (Sep 3, 2009)

Cory said:


> And yes, her CPR was a total mess at first, and I am still upset that another lifguard didn't relieve her (my intention was to do two person CPR and monitor her compressions) but when I got there, I stopped things, she went on to tell me about her assessment, and from there I told her to continue and I would do rescue breathing.



All im trying to do is pass more ideas onto you of what else you could have done better, which im sure you've thought about alot. 

While she was stopped and telling you her assessment, check that pulse.
make someone get an AED. 



Cory said:


> I went by what she said. Might have been a mistake, but by her calm nature towards what had happened she seemed professional, and NO ONE else was doing a damn thing. I HAD to react. You all have to understand the staff, the crowd, and the situation better. That woman was alnoe in a sea of gawking faces. Both shocked patrons and frozen life guards, me and her were the only ones doing anything other than yelling.



Its your job to react. you did what you did, because thats what your trained to do. Emergency situations test test peoples ability to think under pressure. 
The lady lifeguard, from what i've read, was definitely in the wrong to run away from the child, and pass off care to a bystander. She should have had someone else call 911. 

Only thing to do is to learn from it.


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## Akulahawk (Sep 3, 2009)

hottrotter18 said:


> All im trying to do is pass more ideas onto you of what else you could have done better, which im sure you've thought about alot.
> 
> While she was stopped and telling you her assessment, check that pulse.
> make someone get an AED.
> ...


And if you fail to do so... is the true failure.


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## Cory (Sep 3, 2009)

hottrotter18 said:


> All im trying to do is pass more ideas onto you of what else you could have done better, which im sure you've thought about alot.
> 
> While she was stopped and telling you her assessment, check that pulse.
> make someone get an AED.
> ...




Agreed, at this pool there is a general feeling that AED's aren't necessary. And the one time I asked where it was, I don't even remember getting a straight answer (leads me to believe we eriously don't have one)

Now, we are next door to the FD. But it only has two ambulances, and while the city is tiny, they do mutual aid for a huge area of large population, so it is not uncommon for them both to be out.

No doubt this incident will make a lot of changes at the pool. Like I said, in 50something years it has been open there has never been a medical emergency (besides a life guard who hurt her back once, but someone drove her home to rest) and no one has ever been transported out ny EMS until this day. And the EAP has suffered due to lack of actual experience. As a testament to that, the entire city was pretty much gathered around the fence while this happened (city is small, 1 square mile and low population)


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## Shishkabob (Sep 3, 2009)

Now, before I continue, I want to say good job.



> I walked up to the two, got down just in front of the boy's head, and immediately told the woman who I was and that she needed to continue chest compressions (he most likely had a pulse, but he had gone unconscious under water



What made you think he was a choking victim?  Or was it just an assumption because he wasn't breathing?


You didn't check a pulse and just assumed they needed CPR.  Just because someone isn't breathing doesn't mean they don't have a pulse, as it could have simply been a case of respiratory arrest, which is dealt with by rescue breaths and not chest compressions. 

Don't just take someones word for something just because they say it's so.  If a bystander tells me they don't have pulse, I'm going to say thanks and check it anyways.   

Always check a pulse.  It takes 5 seconds, which in the grand scheme of things is not that much time.  That is why the AHA, and everyone else for that matter, stresses ABC's, and in that order.





Take it as constructive criticism, and not just criticism.


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## Cory (Sep 3, 2009)

Linuss said:


> Now, before I continue, I want to say good job.
> 
> 
> 
> ...



Again, he was clearly a passive drowning victim. Drowning is essentially choking, or at least treated the same when the victim is unresponsive. I was taught to give chest compressions to an unrepsonsive choking victim(Red Cross) And I was taught to treat a passive drowning victim as a choking victim. And I know what you mean about taking a pulse, and I should have taken one no doubt, but I was confident that he had a pulse and she hadn't been able to feel it. It was totaly obvious he wasn't breathing, so rescue breathing was clearly needed.

Next time, if there is one, I will not just brush it off if another lifeguard doesn't help. And I will not make the same mistakes. All in experience I guess. Hopefully it is things like this now that will make me stronger when I get into EMS later.

What I told my manager was the woman probably wouldn't have been too willing to get off of him, but I guess next time I will have to do it anyway.

So anyway, the thing I remember most was how after every cycle, I would remove the mask and his teeth would clench, his eyes would rattle and he would make this distinct struggling sound, and then nothing, he would be totaly out again. Every time I noticed this I stopped her for a second, then had her continue as soon as he went out again. On the fifth time this struggle turned into an outbreak of crying. Can anyone explain?


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## kittaypie (Sep 4, 2009)

Cory said:


> So anyway, the thing I remember most was how after every cycle, I would remove the mask and his teeth would clench, his eyes would rattle and he would make this distinct struggling sound, and then nothing, he would be totaly out again. Every time I noticed this I stopped her for a second, then had her continue as soon as he went out again. On the fifth time this struggle turned into an outbreak of crying. Can anyone explain?



from what you're saying, it sounds like he probably had a pulse (which would explain the struggling sound) and all he really needed was rescue breathing. you mentioned he was actively vomiting when you approached him. was he still supine when he was vomiting? that would've been a good time to roll him on his side (while maintaining c-spine precautions since no one saw the incident) and help clear the airway. after vomiting had ceased, you should start rescue breathing.

and by "totally out" did you mean pulseless and apneic? did you ever check a pulse?

besides that, i think you did a really good job of handling the situation. ped arrests are horrific things to experience. i commend you for maintaining a clear head and doing what was needed. 

my advice is to remain open to constructive criticism and learn from this experience so that next time things will run better. keep an open mind and keep learning!


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## rescue99 (Sep 4, 2009)

medic417 said:


> http://www.americanheart.org/presenter.jhtml?identifier=3025002
> 
> "If the choking is not relieved, the child will become unresponsive.  When the child becomes unresponsive, shout for help, lower the child to the ground, and *start CPR*.  If someone else is present, send that person to phone 9-1-1 while you start CPR."
> 
> Looks like he did what AHA says to do.  Leave the kid along.



I agree. What was needed, was accomplished. It turned out okay and all is well with the world. A bit of tweaking on training days, run some scenarios where everyone does a job, do it often...and poof...a more organized cluster the next time ^_^


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## thatSPIKYflip (Sep 4, 2009)

As a fellow lifeguard, I can understand your situation.  At my pool, there hasn't been any serious emergency in at least 5 years, possibly longer.  Personally, I have never experienced a serious emergency.

A couple things I'd like to say:

1. Good job!  You were in a difficult situation and there was a positive outcome.
2. About the woman performing chest compressions: I am also ARC CPR/AED Professional Rescuer certified, and this is correct procedure for an unconscious choking victim.
3. About the first lifeguard who left the scene to call 911: was she punished for leaving the scene? I can understand freezing up, but she should have at least signaled for another lifeguard to aid her and begin an initial assessment.
4. If the woman performing chest compressions was the one who performed the initial assessment, I believe that you should have instructed her to stop and perform an initial assessment of your own, seeing as you are higher in terms of level of care, and provided care as needed.

Overall, I believe that you did a good job, and I'm glad that everything turned out okay.


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## HotelCo (Sep 4, 2009)

Cory said:


> Again, he was clearly a passive drowning victim. Drowning is essentially choking, or at least treated the same when the victim is unresponsive. I was taught to give chest compressions to an unrepsonsive choking victim(Red Cross) And I was taught to treat a passive drowning victim as a choking victim. And I know what you mean about taking a pulse, and I should have taken one no doubt, but I was confident that he had a pulse and she hadn't been able to feel it. It was totaly obvious he wasn't breathing, so rescue breathing was clearly needed.
> 
> Next time, if there is one, I will not just brush it off if another lifeguard doesn't help. And I will not make the same mistakes. All in experience I guess. Hopefully it is things like this now that will make me stronger when I get into EMS later.
> 
> ...



You can tell when someone doesn't a pulse just by looking at them?
The sounds didn't give away that he might have a pulse?
You should have checked, confident or not, regardless if someone else checked it. 
What exactly was her level training? Just CPR? The same as yours?

I don't want to rip into you here, I want to help you. We all do. But if you are so sure you didn't need to check a pulse... I can't help but think you need to take the class again, perhaps a better one.

On a positive note... good job in acting quickly. You made mistakes, we all do... but you didn't freeze, you didn't let the crowd keep you away.. you helped. Good job.


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## medic417 (Sep 4, 2009)

HotelCo said:


> You can tell when someone doesn't a pulse just by looking at them?
> The sounds didn't give away that he might have a pulse?
> You should have checked, confident or not, regardless if someone else checked it.
> What exactly was her level training? Just CPR? The same as yours?
> ...



Hotel for non healthcare they skip the check pulse step.  The OP is non healthcare.  Check link I posted earlier.  They actually did what it says.


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## HotelCo (Sep 4, 2009)

> Lower the victim to the ground, faceup.  If you are alone with the child victim, *start the steps of CPR.*



Don't the steps of CPR include checking the ABCs?


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## medic417 (Sep 4, 2009)

HotelCo said:


> Don't the steps of CPR include checking the ABCs?



"Quote:
Originally Posted by medic417  
http://www.americanheart.org/present...tifier=3025002

"If the choking is not relieved, the child will become unresponsive. When the child becomes unresponsive, shout for help, lower the child to the ground, and start CPR. If someone else is present, send that person to phone 9-1-1 while you start CPR."

Looks like he did what AHA says to do. Leave the kid along. "

Says start CPR not steps of CPR.


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## Mountain Res-Q (Sep 4, 2009)

medic417 said:


> Hotel for non healthcare they skip the check pulse step.  The OP is non healthcare.  Check link I posted earlier.  They actually did what it says.



True, however, according to the OP, his cert is labeled as "CPR/AED Professional" from the ARC...  also known as CPRO (CPR for the Professional Rescuer)... which is the equivalent of what all healthcare Proveders must maintain... there are differences between Lay CPR and Professional CPR, and according the OPs understanding on how to perform CPR, he appears to be trained to a Lay Standard, despite the fact that his cert says professional... as evidenced by the lack of a pulse check, which is not longer taught in Lay...  For Lay, ABCs are Airway, Breathing, Signs of Life (no pulse check)...

As I understand it, at least in CA, Lifegaurds are required to maintain certification in Public Safety First Aid (~16 hours that includes O2, backboarding, and few other BLS skills) and Professional CPR/AED (~8 Hours)...  so my only confussion is whether or not they are properly instructing Lifeguards in OH to a predetermined BLS standard similar to CA (as if using CA as a measuring board is a good idea ).

Otherwise, regardless of what we feel as far as proper technique... we are talking Lifegaurd/First Aid stuff, in which the outcome was all good...  GOOD JOB, Cory...  I would just recommend checking into whether or not your cert is actually CPRO or Lay... and (if your goal is actually to be in EMS one day) learn from this and increase your knowledge so that the next time this happens you can do it even better...


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## HotelCo (Sep 4, 2009)

> If the choking is not relieved, the child will become unresponsive.  When the child becomes unresponsive, shout for help, lower the child to the ground, and start CPR.  If someone else is present, send that person to phone 9-1-1 while you start CPR.
> 
> The steps of CPR of the child who has become unresponsive after choking are the same, with one addition.
> 
> ...



The way I learned it, the steps of CPR included checking the ABCs.


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## Cory (Sep 4, 2009)

Mountain Res-Q said:


> True, however, according to the OP, his cert is labeled as "CPR/AED Professional" from the ARC...  also known as CPRO (CPR for the Professional Rescuer)... which is the equivalent of what all healthcare Proveders must maintain... there are differences between Lay CPR and Professional CPR, and according the OPs understanding on how to perform CPR, he appears to be trained to a Lay Standard, despite the fact that his cert says professional... as evidenced by the lack of a pulse check, which is not longer taught in Lay...  For Lay, ABCs are Airway, Breathing, Signs of Life (no pulse check)...
> 
> As I understand it, at least in CA, Lifegaurds are required to maintain certification in Public Safety First Aid (~16 hours that includes O2, backboarding, and few other BLS skills) and Professional CPR/AED (~8 Hours)...  so my only confussion is whether or not they are properly instructing Lifeguards in OH to a predetermined BLS standard similar to CA (as if using CA as a measuring board is a good idea ).
> 
> Otherwise, regardless of what we feel as far as proper technique... we are talking Lifegaurd/First Aid stuff, in which the outcome was all good...  GOOD JOB, Cory...  I would just recommend checking into whether or not your cert is actually CPRO or Lay... and (if your goal is actually to be in EMS one day) learn from this and increase your knowledge so that the next time this happens you can do it even better...




My certs: 1. "CPR/AED Professional Rescuer/LG"  2. "Lifeguard/First Aid"


Now, backboarding WAS a huge part in my class, but definitely no O2, no C-Collar, no intubation. We have all of those materials at the pool from the local FD, but we are not allowed to use them. I was definitely taught everthing about assesmnt (including pulse check) and here is where my mistake was: I took the womans word for it when she said he had no pulse(again, I figuered it was faint, but he was essentially a choking victim) it was obvious there was no breathing. When the struggling sounds would happen, I would stop CPR until they ceased, it was obvious he had gone back out (yes, would have been a good time to re-check pulse, but I was taught to check every 2 minutes or 5 cycles, but at exactly 2 minutes and 5 cycles he came back)

Anyway, it was successful, I made crucial mistakes, I'm a little ashamed for not taking over and for letting her run the scene a little. But our training is not bad, my instructor has worked with ARC for 50 years (although only gave CPR once when she was 18 to a woman that had been dead for 3 hours) and she is fully capable. She has been head lifeguard at some of the big water parks around here, and is involved in numerous water safety council things. The problem was, this incident tested everyone for the first time. 

She told me afterwards that she was trained in basic ARC CPR (day camp supervisor required) and that she had done it at a large MVA once.



Someone mentioned backboarding him, and I have to be honest and hopefully someone can help me, but I have NO idea how to even go about putting a backboard on a three year old boy (a very small one at that)


I talked to my cousin who is an EMT (the one responding on the scene that day) afterwards, and asked him a lot of questions. Basically, I was sure that she had broken multiple ribs (she compressed WAY too much, but I was so focused that when I was going to mention it, I just forgot and went back to rescue breathing) and that I had caused lung issues from over-inflation. Luckily, this was not the case.


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## Akulahawk (Sep 4, 2009)

CPR on a 3 year old won't likely break any ribs... their ribs are mostly cartilage still. They flex really well. As to the c-spine skills, it's possible to do it with a regular board, but they do make pedi boards too. If the pool is going to host lots of kids day camp events, you might want to do in-service training on everyone about how to properly put a child on the board. It might be beneficial to the staff there to do regular drills for the likely rescues and incidents that will be seen there. 

Yes, I was a lifeguard...


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## Cory (Sep 4, 2009)

Akulahawk said:


> CPR on a 3 year old won't likely break any ribs... their ribs are mostly cartilage still. They flex really well. As to the c-spine skills, it's possible to do it with a regular board, but they do make pedi boards too. If the pool is going to host lots of kids day camp events, you might want to do in-service training on everyone about how to properly put a child on the board. It might be beneficial to the staff there to do regular drills for the likely rescues and incidents that will be seen there.
> 
> Yes, I was a lifeguard...



Agreed. We are for starters going to start wearing equiptment on our persons(fanny packs most likely). And we are going to have a mandatory CPR class every month, not attending could result in termination. And we are going to do safety drills SPECIFICALLY related to our pool and it's structures.

This will be a big change. Some guards have worked here for almost ten years and never seen anything bad. Getting people to comply could be a problem, but if this boy wouldn't have lived or would've had substantial injury, we would have been sued out of business most likely. Thankfully the family never asked any questions and gave us best wishes, we were lucky. But some areas in neighboring cities have pretty large amounts of low income citizens, ones who are most likely not insured and would be more than happy to get us to pay for them.

This terrible accident both helped me(experience wise) and the pool in general, although I was pretty disturbed by it for a while (hence the part about questionaing my choice in EMS, but that has subsided, I literally have to strain to remember what he even looked like)


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## EMSLaw (Sep 4, 2009)

The ARC CPR for Professional Rescuer class also teaches chest compressions for unconscious choking in adults - 100 per minute, the same as CPR.  They formerly taught abdominal thrusts, but that changed at some point (my first responder's class video showed the old way, the CPR video the new).  

Of course, as others have mentioned, you do the "shake and shout" first and then do your ABCs.  You only move on to the chest compressions if the rescue breaths don't make the chest rise.  (You probably all know this a lot better than me, so I'll shut up now).  I believe that pulse checks are not in the Lay CPR course, nor is rescue breathing.   

Still, any CPR the patient walks away from, right...?


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## Cory (Sep 4, 2009)

Well, she did know how to check for a pulse by listening to his chest (not reliable, but another mistake of mine was not considering her level of CPR and her ability to efficiently check for a pulse)


The courses are great for telling you HOW to do CPR and WHEN to do CPR, but they say nothing about how to handle a situation wih an arrest patient, or how the pt. will react, or what to expect on a scene. It is unfortunate, and hopefully I will be able tp speak to the other lifeguards about what I have learned.


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## Mountain Res-Q (Sep 4, 2009)

EMSLaw said:


> The ARC CPR for Professional Rescuer class also teaches chest compressions for unconscious choking in adults - 100 per minute, the same as CPR.  They formerly taught abdominal thrusts, but that changed at some point (my first responder's class video showed the old way, the CPR video the new).
> 
> Of course, as others have mentioned, you do the "shake and shout" first and then do your ABCs.  You only move on to the chest compressions if the rescue breaths don't make the chest rise.  (You probably all know this a lot better than me, so I'll shut up now).  I believe that pulse checks are not in the Lay CPR course, nor is rescue breathing.
> 
> Still, any CPR the patient walks away from, right...?



A few points of order:

"shake and shout" (at least by ARC standards) is a NO NO...  it is now "tap and shout".

You move on to compressions (in CPRO) if there is no pulse or if (after repossioning) the airway is obstructed.  For Lay, you move on to compressions if there is are no signs of life (afte the two initial rescue breaths) in adults, if there is no pulse in pedi/infant, or if (after repossioning) the airway is obstructed in adults (instead of abdominal thrusts).

Pulse checks are no more in Lay for adults... they still exist for children and infants.  Likewise, rescue breathing is no more in adults... but is still taught for child and infant.


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## rescue99 (Sep 4, 2009)

Cory said:


> Well, she did know how to check for a pulse by listening to his chest (not reliable, but another mistake of mine was not considering her level of CPR and her ability to efficiently check for a pulse)
> 
> 
> The courses are great for telling you HOW to do CPR and WHEN to do CPR, but they say nothing about how to handle a situation wih an arrest patient, or how the pt. will react, or what to expect on a scene. It is unfortunate, and hopefully I will be able tp speak to the other lifeguards about what I have learned.



Cory...stop defending yourself. I've seen a lot worse scene management out of long timers on occasion.


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## EMSLaw (Sep 4, 2009)

Mountain Res-Q said:


> A few points of order:
> 
> "shake and shout" (at least by ARC standards) is a NO NO...  it is now "tap and shout".



Yes, you're absolutely right, now that I look at the official course materials.  Is AHA different in this respect?



> You move on to compressions (in CPRO) if there is no pulse or if (after repossioning) the airway is obstructed.



Okay, I agree, but isn't the sign that the airway is obstructed the lack of a rising chest during the rescue breaths?  That's what leads to your 100 distinct attempts to dislodge the object per minute.


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## Cory (Sep 4, 2009)

EMSLaw said:


> Yes, you're absolutely right, now that I look at the official course materials.  Is AHA different in this respect?
> 
> 
> 
> Okay, I agree, but isn't the sign that the airway is obstructed the lack of a rising chest during the rescue breaths?  That's what leads to your 100 distinct attempts to dislodge the object per minute.



Well, I was also taught to use your thumb yo remove any VISIBLE obstructions. But if you can't get it out that way, and they are unresponsive, then you start compressions (and in a drowning case, rescue breathing)

One thing I always found odd about Lifeguard training: they don't really say how to specifically treat a drowning victim or what most drowning victims will require, they just say to remove from water, and start assesment/ABC's. It wasn't until after this that my instructor happened to mention that I should treat an unresponive drowning victim the same way as an unresponsive choking victim if they are not breathing, but this failed to be mentioned in my class.


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## Mountain Res-Q (Sep 4, 2009)

EMSLaw said:


> Yes, you're absolutely right, now that I look at the official course materials.  Is AHA different in this respect?
> 
> Okay, I agree, but isn't the sign that the airway is obstructed the lack of a rising chest during the rescue breaths?  That's what leads to your 100 distinct attempts to dislodge the object per minute.



1.  I don't know what AHA says on that (or don't remember)... the only reason I know what ARC says is because I am working on becoming an instructor for ARC Wilderness First Aid (something that my area lacks despite an interest in by the community) and "had to get" Instructors Cert in Lay FA/CPR/AED (as of 3 weeks ago - but I have no intention of teaching this level - CPRO, Public Safety, and Wilderness is more my style).

2.  Possibly... but that obstruction could be due to the possitioning of the neck... which is why you reposition first, try two more breaths, and then move on.  My point was that an obstucted airway on an unconscious person is one of several reasons why Lay folks are taught to do compressions.  And the rules change depending on Adult/Child/Infant as to pulse check and the use of rescue breathing...


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## Akulahawk (Sep 5, 2009)

Cory said:


> Well, I was also taught to use your thumb yo remove any VISIBLE obstructions. But if you can't get it out that way, and they are unresponsive, then you start compressions (and in a drowning case, rescue breathing)
> 
> One thing I always found odd about Lifeguard training: they don't really say how to specifically treat a drowning victim or what most drowning victims will require, they just say to remove from water, and start assesment/ABC's. It wasn't until after this that my instructor happened to mention that I should treat an unresponive drowning victim the same way as an unresponsive choking victim if they are not breathing, but this failed to be mentioned in my class.


I suppose I was fortunate... I _was_ taught that stuff. It's actually very simple, and it's the reason why lifeguard training doesn't get into it very much. You want to be certain that the airway is open. A drowning victim doesn't need suctioning... except to clear the pharynx. There will be other issues down the road for the wet drowning victim, but for the immediate rescue... they'll need air. Now if you're seeing vomit coming up... suction/remove that stuff ASAP. That stuff will cause some really nasty problems if it gets into the lungs. Your First Aid/CPR coursework should have taught you how to deal with unconscious vomiting victims...

Once the victim is removed from the water (lifeguard skills), you then must use other skills to further assess the problems... (First Aid and CPR skills). The idea is to transition from one activity to another.


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## Brandon O (Sep 8, 2009)

EMSLaw said:


> The ARC CPR for Professional Rescuer class also teaches chest compressions for unconscious choking in adults - 100 per minute, the same as CPR.  They formerly taught abdominal thrusts, but that changed at some point (my first responder's class video showed the old way, the CPR video the new).
> 
> Of course, as others have mentioned, you do the "shake and shout" first and then do your ABCs.  You only move on to the chest compressions if the rescue breaths don't make the chest rise.)



This is completely correct and I'm a little upset that some people are tearing into the OP based on CORRECT application of the recommendations (maybe an imperfect assessment, but that's a separate issue). No chest rise, reposition and try again, still nothing, you go straight into CPR, checking for visible objects each time you do your breaths. The chest thrusts are your attempt to dislodge the obstruction. Abdominal thrusts are used on the CONSCIOUS patient only.


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