Lifeguards and C-spining

[WuLabsWuTecH]

I have a friend who is a lifeguard, who informed me today that next year they are thinking of getting rid of the c-collar from their training. She understand how it is useful, but complains that they are hard to size and difficult to use.

For those of you with water rescue experience--please comment!

I understand that there a unique challenges in immobilizing a pt in the water but some aspects seem easier. For one, you don't have to roll the pt to get the backboard under him, and no going up and down is necessary. Challenges I can see are keeping him immobilized until the board is in place (no hard ground for him to lie on), and that you never get to assess his spine or back for injuries since you never roll him.

One other thing that gets to me is that in one instance, I heard of the lifeguard insisting on backboarding the pt before he come out of the water but defib was needed. No I can't imagine needed both cspine and defib in the same case out of the water that often, but why cspine? Now you've wasted a few minutes, and when he's out of the water, he's securly fastened to a wet board! Now we need to undo all you just did to get the defib on him!

I understand that for a 16 yo in lifeguarding class, learning to use a c-collar may be hard and they don't go over cspine injuries enough for them to understand why all of this is important, but it seems like rather than educate more we're just going to ignore it? The American EMS way, just leave out important stuff b/c its too hard and teach it to the book?

Should Lifeguards be given this additional education or should they just wait for us to show up?

 

[usafmedic45]

Challenges I can see are keeping him immobilized until the board is in place (no hard ground for him to lie on)

If you have enough people (at least four, preferably six), a cooperative patient and calm water, it's not that difficult to keep them immobilized

Now we need to undo all you just did to get the defib on him!

Dry the front of his chest off and just stay clear of the water on the deck. I would not worry about the back of the patient being wet. The concerns with a wet patient and defib are arcing across the surface of the chest (hence drying) and provider safety.

Of course, in an arrest scenario I would only do c-spine precautions (immobilization with people to get him out of the water) if I really thought there was a high risk of spinal injury (head first dive into shallow water, obvious trauma to the head, etc).

 

[EMT11KDL]

Wow i have never really thought of this.

But as a lifeguard, we use the bored as a tool to get the pt out of the water. We don't always strap them down to get them out.
If there is no chance of C-spine injury we don't strap them in the water. we look at the MOI, the exact same way EMS does in the field.

For the past 4 years we have never had a c-collar at my pool. due to the fact that when we are placing the pt on the bored in the water
our hands are where the collar would be! for us to put a collar on the pt, the pt would already have to be on the bored.

As an EMT I have to step back from what I would do in the Field and remember my training as a guard.

Hope that helps answer your question. If you need more clarification on something ill try and help the best i can!

 

[zappa26]

American Red Cross Lifeguarding doesn't include use of a collar. It does teach long backboarding in the water, but it only makes use of the board with three or four straps and a pair of head blocks ... no collar.

 

[Shishkabob]

My question is "Why"?


Vast majority of trauma calls a lifeguard does is on the sand, and as such the c-collar is still viable.

 

[mycrofft]

Even if the standard is lowered, your employer can exceed it if they do it right.

For starters, they can hire EMT's and train them as lifeguards or vice versa.
They can get an instructor to teach a valid C spine protocol, have this signed off by their medical consultant, and m aintain a training record for each employee who has such trainings.
HOWEVER, beware if they just go out and "buy some stuff", then don't replace or maintain it.

 

[Seaglass]

But as a lifeguard, we use the bored as a tool to get the pt out of the water. We don't always strap them down to get them out.
If there is no chance of C-spine injury we don't strap them in the water. we look at the MOI, the exact same way EMS does in the field.

This. As I recall, we were trained to have someone hold c-spine for likely spinal/head trauma, or if nobody had seen it happen, but not to strap them down. C-spine was secondary to the ABC's.

Then again, we were also taught to attempt CPR in the water, so maybe my training should be taken with a grain of salt. Even the instructors recognized how crazy that was, but it was in the official curriculum. It's also been awhile since I was a lifeguard, and I never held a formal job as one.

 

[WuLabsWuTecH]

How did they teach you guys to do CPR in the water?

Did it start with sometihng like place your hand under the neck of the victim...?

Perhaps have another lifeguard swin under the pt and have you guys time your compressions so one guy pumps on the chest at the same rate and time that the other pushes up on the patient?

I guess the lifeguards at the camp this girl works at get taught c-collar but when they redo their training curriculum next year they are taking it out.

 

[EMT11KDL]

I have never heard of CPR in the water. The only thing close that I have ever done was Ventilation of the PT while still in the water, never started compressions tell we got out of the water.

Being in the water there is so many different variables, like are we in open water, pool, or a water park? How Deep is the water? How many guards are available to help?
Was the pt floating on the top of the water or at the bottom? Active or passive drowning?

 

[Mountain Res-Q]

I can understand that c-collars might be confusing for 16 y/o pool lifeguards (we are talking pools right?), but that is no excuse to remove something from training at any level; you train to a standard that makes sense and if someone can't meet that standard than say bye bye. From a swiftwater rescue standpoint (a little more intense than a pool)...

We all know that Backboarding may be way overdone in real life. The reality is that we backboard everything with a "suspected" spinal injury becasue we don't have x-ray vision and are following protocol to reduce the risk of the injury. In reality, how many pts. that we backboard have the injury? Is it possible that the boarding is unnessesary and may contribute to injury? I liken this to a pt in a MVC. The car is on fire. We should be boarding them. What do you do? Yank them out fast! Burning to death trumps the unlikelyhood of a spinal injury. In a water rescue, drowning outweighs spinal injury as well. If they had a spinal injury in the water, we need to get them to the surface ASAP, with little regard for the spine. Any damage has already been done. Should we board them at this point? Sure... unless something else trumps this... i.e. CPR. You can not effectively do CPR in water. Anyone who says otherwise is not providing decent compressions. While in the water, throw a board under them, lift them out, and start CPR. Worry about collars and straps latter or now if you have enough people.

As far as collars being confusing goes? There are other ways to "immbolize" a neck. A rolled town works great and are readily available at a pool. And lets. be serious, the only time a spinal injury should/could be suspected in a pool would be diving related: 1. person complaining of back/neck pain after a dive/jump or 2. person unconscious after a jump/dive. Consider the need for boarding, and do so accordingly, but realize that starting CPR, controlling that gusher on the head, etc... takes prioity over spinal care, which is difficult enough to properly provide in the water.... the damage is done already and all you can do in mitiagate further damage. You are not going to be using a bollar, head bed, or straps in water. The board goes under them and you lift them out as best you can while maintaining some mesaure of c-spine care... then you can continue boarding them. IMHO...

 

[Seaglass]

How did they teach you guys to do CPR in the water?

Did it start with sometihng like place your hand under the neck of the victim...?

The book we used said to place a backboard under them, have two people support it, then start compressions. All of the diagrams seemed to assume that drowning would take place in a conveniently shallow pool, with lots of trained lifeguards just standing around. The instructors and common sense said to just ignore all that and get out of the water...

Come to think of it, I've come across the same instructions more recently somewhere. I'll post when I find the reference--it's bothering me now. (Edit: never mind. Some of the Brady EMT-B textbook diagrams just look a lot like them.)

 

[zappa26]

I should clarify. At the waterpark where I've been lifeguarding for a year and a half, we require American Red Cross certification, and that doesn't include use of a collar. For suspected spinal injury in the water, we board the patient using straps and head blocks. We have one EMT-I manager, and myself and one other lifeguard are First Responders, so it's possible we could apply a collar at that time, but most of our staff can't do that.

 

[WuLabsWuTecH]

The book we used said to place a backboard under them, have two people support it, then start compressions. All of the diagrams seemed to assume that drowning would take place in a conveniently shallow pool, with lots of trained lifeguards just standing around. The instructors and common sense said to just ignore all that and get out of the water...

Come to think of it, I've come across the same instructions more recently somewhere. I'll post when I find the reference--it's bothering me now. (Edit: never mind. Some of the Brady EMT-B textbook diagrams just look a lot like them.)

Yeah, well in a pool there is usually a shallow end, but floating them down that way should take the same amount of time as putting them on the edge.

Even with 2 ppl supporting the board you can't hold it firmly enough to do compressions? And how does the third guy do compressions while afloat or standing on the bottom and at the pt is at chest level? You have no leverage at that level.

Although it makes sense that head injuries would be in the shallow end more often. People diving into shallow water etc...

 

[mycrofft]

In my limited lifeguard experience...

More neck injuries from being jumped upon by cannonballers while standing in the pool than diving. Or running and falling or getting "clotheslined" horsing around outide the pool proper.

 

[rescue99]

This is a great thread, thanks! So happens that I've arraigned for 2 lifeguard trainers to help do a shallow water (peds) drowning / rescue CE on July 30th for a local FD. I thought it would be a good way to bring several responding levels together.

 

[guardian528]

well i'm an ocean guard, and we still use the collar... we don't do any boarding or anything in the water, since there are waves and stuff that make it such a bad environment, the goal is to get them out of the water quickly, then cspine them