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

[Cory]

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.



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.

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)

 

[Shishkabob]

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.

 

[Cory]

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



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.

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?

 

[kittaypie]

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!

 

[rescue99]

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 ^_^

 

[thatSPIKYflip]

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.

 

[HotelCo]

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?

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.

 

[medic417]

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.

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.

 

[HotelCo]

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?

 

[medic417]

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.

 

[Mountain Res-Q]

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...

 

[HotelCo]

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.

1.
Yell for help. If someone comes, send that person to phone your emergency response number (or 911) and get the AED if available.
2. Lower the victim to the ground, faceup. If you are alone with the child victim, start the steps of CPR.
3.
Every time you open the airway to give breaths, open the victim's mouth wide and look for the object. If you see an object, remove it with your fingers. If you do not see an object, keep giving sets of 30 compressions and two breaths until an AED arrives, the victim starts to move, or trained help takes over.
4.
After about five cycles or two minutes, if you are alone, leave the child victim to call your emergency response number (or 911) and get the AED if available.

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

 

[Cory]

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.

 

[Akulahawk]

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...

 

[Cory]

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)

 

[EMSLaw]

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...?

 

[Cory]

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.

 

[Mountain Res-Q]

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.

 

[rescue99]

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.

 

[EMSLaw]

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.