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Lifeguard Academy
Day Four
Inspection
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Line up at attention in ascending
order according to cadet number
Have notebooks on the floor in front
of you, face up with binding facing
out
Know is your chance to ask
instructors questions you may have
Sudden Injury or Illness
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Steps are the same for any sudden
emergency. So far you’ve learned
to:
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Size Up Scene (ENAME)
Initial Assessment (ABCs)
Summon EMS (Control 1 or 9-1-1)
Treat Life Threatening Conditions
What's Next?
•
After life threatening conditions are cared
for, first responders should perform a
secondary assessment to gather
additional information about injuries or
conditions that may need to care for.
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Conditions are not initially life
threatening, but could become life
threatening if left untreated.
Secondary Assessment
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Composed of two parts:
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SAMPLE History
Head to Toe Examination
SAMPLE History
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Interview the victim and bystanders to
get information about the victim’s
problem and any known conditions that
could relate to the problem. Doing so
may provide helpful information for you
and more advanced medical personnel.
Look for any medical identification tags.
Obtaining a victim history can be done
by following the mnemonic SAMPLE.
SAMPLE History
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S- Signs and Symptoms
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Signs- What you observe/learn
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Symptoms- What the victim tells you
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Are you allergic to food, medications, etc.? What happens when
exposed to allergens?
A- Allergies
M- Medications
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Ask what happened? Where do you feel pain? Do you feel numbness?
Are you taking any medications? When did you last take your
medications? Did you miss any doses?
P- Pertinent Medical History
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Do you have any medical conditions?
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When did you last eat or drink? What did you last eat or drink?
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What were you doing before the incident? What happened?
L- Last Oral Intake
E- Events Preceding
Gathering SAMPLE History
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When talking to children, get down
at eye level, talk slowly and in a
friendly manner, use simple words
and ask questions the child can
answer
Also, remember that all information
gathered is confidential and can
legally only be told to individuals
providing care to patient.
Physical Exam
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Once the initial assessment is complete
and any life threatening emergencies
corrected, begin the physical exam.
The purpose of the physical exam is to:
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Gather information about the victim’s
problem.
Identify the signs and symptoms of the injury
or illness.
Begin to care for what you see.
Physical Exam
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Check the patient’s body in the
following order
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Head
Neck
Collarbone and Shoulders
Chest
Abdomen
Extremities (Arms then Legs)
Back
Physical Exam
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Inspect (look) and palpate (feel) for the
following signs of injury (use the
mnemonic DOTS):
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Deformity
Open Injuries
Tenderness
Swelling
Ask whether the victim has any pain.
Not any areas that the victim states are
painful.
Head to Toe- Head
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Look for blood or clear fluid in or
around the ears, nose and mouth
Recheck LOC
Look closely at the pupils and
determine if each pupil is equal,
round, reactive, and light
accommodating (PERRLA)
Palpate head and hair looking for
injuries.
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Head to Toe- Neck
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Look for DOTS
If no abnormalities present and you
don’t suspect the victim suffers
from a head, neck, or back injury,
move on to the shoulders
If you suspect a head, neck or back
injury though, immobilize the head
and spine.
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Head to Toe- Collarbone and
Shoulders
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Check the collarbone and shoulders
for DOTS
Ask the victim to shrug their
shoulders
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Head to Toe- Chest
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Check the chest by asking the
person to take a deep breath and
then blow the air out.
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While person is doing this, watch for
signs of difficulty breathing or pain
Palpate the ribs, feeling for DOTS
Ask if they are experiencing any
pain.
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Head to Toe- Abdomen
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Ask if person has pain in their
abdomen
Apply slight pressure to the four
quadrants of the abdomen
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The abdomen should be soft, not rigid
Check the hips by asking if the
person has pain
Place hands on both sides of the
pelvis and push down and in.
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Head to Toe- Arms
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Palpate the arms for DOTS,
checking only one arm at a time
Ask the person to move their
fingers, hands and arms
Check both hands for cap refill,
motion, sensation, temperature,
and pulse.
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Head to Toe- Legs
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Lastly, check each leg
Check the feet for cap refill,
motion, sensation, temperature,
and pulse.
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Head to Toe Back
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Check the victims back for DOTS.
If the victim is lying down, gently
reach your hands under the victim
to palpate the back
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Make sure to check your gloves
afterwards for signs of blood or injury
Alternatively, if the victim does not
complain of back pain, you could
ask them to sit up to check their
back.
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Head to Toe Examination
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When checking a child, begin at the
toes to allow the child to watch
what is happening
Care for conditions as you find them
Avoid touching painful areas
Physical Exam
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The following conditions do not require a
complete head to toe physical exam:
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Injury related problems, such as an injured
hand or food.
Illness related problems, such as difficulty
breathing or chest pain.
Medical complaints
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Generally, victims with medical complaints do
not require the same level of physical exam
as those with injuries.
Ongoing Assessment
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Continue to assess the victim’s vital signs while
awaiting the arrival of more advanced medical
personnel. Vital signs include consciousness,
breathing and circulation, including pulse and
skin characteristics.
Repeat the initial assessment every 5 minutes
for a victim who has a serious problem
(unstable) and every 15 minute for a victim who
does not have a serious problem (stable).
Repeat physical exam, if needed.
Continue to record all findings.
Turn over your findings to more advanced
medical personnel when they arrive.
Secondary Assessment Video
6:27
Skill: Secondary Assessment
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Cadets form pairs
First cadet is rescuer, second cadet
is victim
Perform secondary assessment on
victim, making sure to include
physical exam and SAMPLE history
Once instructor checks off skills,
switch positions
Circulatory System
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The circulatory system consists of the
heart, blood and blood vessels.
Escape of blood from the arteries, veins
or capillaries is called bleeding.
Blood is made up of liquid (plasma) and
solid components (white and red blood
cells and platelets)
Blood:
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Protects against disease.
Maintains constant body temperature.
Transports oxygen, nutrients and wastes.
Three major types of blood vessels are
arteries, capillaries and veins.
Circulatory System
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Blood in the arteries travels faster
and under greater pressure than
blood in the capillaries or veins.
Blood in the arteries pulses with
each contraction of the heart;
blood in the veins flows more
slowly and evenly.
Bleeding
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Bleeding is either internal or external. External
bleeding is generally obvious.
When bleeding occurs, the normal response of
the body is to constrict blood vessels and begin
clotting the blood at the wound site.
Uncontrolled bleeding, whether internal or
external is a life threatening emergency.
When bleeding occurs, blood volume is affected.
Significant loss in blood volume is life
threatening. Therefore, severe bleeding should
be controlled immediately.
Signs and Symptoms of External
Bleeding
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Each type of blood vessel bleeds differently because
blood pressure within the vessels varies.
Arterial bleeding is bright red and oxygen rich. It is
often rapid and profuse. Because the blood is under
more pressure, it spurts from the wound. Arterial
bleeding is harder to control than other types of
bleeding. As blood pressure drops, the amount of
spurting may also drop.
Venous blood is under less pressure and flows from
the wound at a steady rate. It is dark, unoxygenated
blood.
Capillary blood is dark red in color. It is under low
pressure, oozes from the wound, and usually clots
spontaneously.
Caring for External Bleeding
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External bleeding is usually easy to control.
Complete the initial assessment, checking airway,
breathing, and pulse before focusing on bleeding.
Follow body substance isolation (BSI) precautions
whenever bleeding is present.
Placing a clean object, such as sterile gauze pad, on a
wound minimizes infection.
Applying direct pressure with the fingers or hand
stops most bleeding, allowing clots to form.
Pressure on a wound can be maintained by snugly
applying a pressure bandage.
Summon more advanced medical personnel if
bleeding cannot be controlled or if pressure points
must be used to control it.
Signs and Symptoms of Internal
Bleeding
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Internal bleeding is the escape of blood from arteries, veins
or capillaries into spaces within the body.
Injured internal organs often result in extensive bleeding
that is concealed.
Internal bleeding is not directly visible, and it may take
time for signs and symptoms to appear.
Suspect internal bleeding in any serious injury.
Signs and Symptoms include:
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Discoloration of the skin (bruising)
Tissues, such as those in the abdomen, that are tender, swollen
or hard.
Anxiety or restlessness.
Rapid breathing.
Skin that feels cool or moist and looks pale, ashen or bluish
Nausea and vomiting.
Excessive thirst.
Declining level of consciousness.
Care for Internal Bleeding
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Care depends on the severity and site of
the injury.
If there is minor internal bleeding, such
as isolated bruising on the arm, apply
ice to the injured area to reduce pain
and swelling.
If you suspect that internal bleeding is
likely because of the seriousness of an
injury, call advanced medical personnel
immediately. Since shock may result,
your care for this victim would be the
same as for any shock victim.
Wounds Video
8:38
Skill: Control Bleeding
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Cadets form pairs
One cadet is victim while other is
rescuer.
Practice controlling bleeding on
forearm or leg wound and eye or
scalp wound
Once two different scenarios are
checked off switch positions
Shock
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Shock is also called Hypoperfusion.
Shock is a life threatening condition in which the
circulatory system fails to circulate oxygen rich
blood to all parts of the body.
Shock is the inevitable result of any serious
injury or illness.
When the body is healthy, three conditions must
be present to maintain normal blood flow so that
tissue is adequately oxygenated.
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The heart must function properly.
An adequate amount of blood must be circulating.
The blood vessels must be intact and able to
regulate blood flow.
Shock is a result of the body’s failure to
maintain adequate blood flow to
vital organs, preventing their failure.
Causes of Shock
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Shock (Hypoperfusion) can be
caused by inadequate blood
volume, resulting from conditions
such as dehydration, excessive
vomiting, diarrhea, or internal or
external blood loss.
Shock Domino Effect
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Injury causes severe bleeding
Heart attempts to compensate for the disruption of blood by beating faster
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Rapid pulse increases rate of blood lose
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As blood volume drops, pulse is weaker and harder to find
Increased workload on heart increases oxygen demand
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Breathing rate increases
To maintain circulation of blood to vital organs, blood vessels in extremities
constrict
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Skin appears pale and feels cold
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In response to stress, body perspires heavily making skin feel moist
Since cells in extremities are without oxygen, they start to die
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Body dilates extreme vessels to return blood flow, leaving vital organs
without oxygen
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Heart compensates for lack of oxygen by beating faster, which
increases rate of blood lose
Vital organs begin to fail due to lack of oxygen
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Person becomes restless and drowsy and ultimately looses
consciousness
Once heart is affected, it begins to beat erratically, resulting in irregular
pulse
Ultimately, heart will stop due to lack of oxygen
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Once heart stops, breathing stops
Signs and Symptoms of Shock
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Restlessness and irritability.
Rapid and weak pulse.
Rapid breathing.
Pale, ashen, or bluish, cool, moist, skin.
Excessive thirst.
Nausea and vomiting.
Changes in level of consciousness.
Signs and symptoms of shock may be present
immediately, become evident during the
physical exam, or may appear later, such as
during the ongoing assessment.
Caring for Shock
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Perform an initial assessment. If there are no
immediate life threatening conditions, perform a
physical exam and SAMPLE history.
Do not wait for signals of shock to appear before
providing care. Provide care in the following manner:
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Monitor breathing and pulse.
Control any external bleeding.
Help the victim rest comfortably. Unless the victim is
having great difficulty breathing, he or she should be
placed flat on the back. If you do not suspect head or
spine injuries or possible broken bones, elevate the
legs.
Keep the victim from getting chilled or overheated.
Do not give anything by mouth (food or drink).
Administer supplemental oxygen, if it is available and
you are trained to do so.
Sudden Illness Video
8:50
Heat Exposure
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When the body gets too hot, heat moves
from the body core to the skin surface.
Excessive heat is removed when the
blood vessels near the skin dilate.
Heat emergencies can occur as a result
of loss of fluid and salt from heavy
sweating. This can begin to produce
painful spasms of skeletal muscles.
Heat Exposure
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As the exposure becomes more serious,
the body’s temperature regulating
mechanism can be overwhelmed.
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Sweating stops as a result of low body fluid
levels.
Body temperature rises rapidly because of
the lack of sweating.
The brain and other vital organs cannot
function properly.
Unconsciousness and seizures can occur.
Death can follow if the situation is not
corrected.
Stages of Heat Related Emergencies
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Heat cramps
 Painful muscle spasm
 Treat with rest, fluid if conscious, light stretching, massage
Heat exhaustion
 Early sign that body’s cooling system is getting overwhelmed
 Signs and Symptoms
 Cool, Moist skin
 Headache, nausea, dizziness
 Weakness, exhaustion
 Heavy Sweating
Heat stroke
 Least common
 Body systems overwhelmed by heat and begins to stop
functioning
 Life threatening condition
 Signs and Symptoms
 Red, hot dry skin
 Changes in LOC
 Vomiting
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Heat Exposure
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Those at greatest risk of illness caused
by heat exposure include:
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Young children and the elderly.
Those involved in strenuous activity in a hot
environment.
Those with health problems, such as
respiratory and cardiac problems.
Those using specific drugs or medications.
Those who have had heat related illnesses in
the past.
Signs and Symptoms of Heat Exposure
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Headache.
Cool, moist, pale or ashen skin (early
stages).
Dry, red, hot skin (later stages).
Nausea.
Exhaustion.
Progressive loss of consciousness (later
stages).
Rapid, weak pulse (later stages).
Rapid, shallow breathing (later stages).
High body temperature.
Care for Heat Exposure
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To care for a heat related emergency, cool the victim’s body
and summon more advanced medical personnel.
Cooling the body can be done by:
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Removing the victim from the hot environment.
Giving small amounts of cool water to a conscious victim.
Having the victim lie down in a cool or shady area and elevate
the legs slightly if possible.
Loosening or removing clothing.
Applying cool, wet towels or sheets or cold packs to the body.
Fanning the victim.
Placing cold packs or ice packs on the victim’s wrist, arms,
armpits, legs and groin.
Summon more advanced medical personnel and monitor
breathing and pulse.
Heat Related Emergencies Video
3:20
Cold Exposure
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The body generates heat by converting food to
energy and through muscle contractions, in an
effort to maintain a body temperature of about
99 degrees Fahrenheit.
When the body is cold, blood vessels near the
skin constrict, keeping warm blood in the center
of the body.
Sometimes constriction of blood vessels is not
enough to keep the body warm. In this case,
the body starts to shiver. Shivering produces
heat through muscle action.
Factors Affecting Cold Exposure
Severity
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Air temperature.
Humidity.
Wind.
Clothing.
Intensity of activity.
The body’s ability to adapt
Cold Exposure
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Those at greatest risk of the problems
associate with cold exposure include:
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Young children and the elderly.
Those without adequate clothing, equipment
or training for a cold environment.
Those with health problems.
Those using specific drugs or certain
medications, such as alcohol and diuretics.
Cold related emergencies can be
generalized (hypothermia) or
localized (frostbite).
Cold Related Emergencies
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Frostbite
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Localized freezing of body
tissue exposed to cold
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Superficial
Deep
Signs and Symptoms of Frostbite
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Superficial
 Most common form of frostbite
 Skin is frozen, underlying tissues are not
 Skin is soft, but blanches when palpated
 Involves loss of feeling and sensation
 Person feels tingling sensation when rewarmed
Deep
 Skin is white and waxy
 Skin is firm when palpated
 Swelling and blisters may be present
 When rewarmed, skin appears red with areas of purple and
blue
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Factors affecting the extent of localized
damage include:
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Air temperature.
Wind speed.
Length of exposure.
Amount of expose area.
Care for Frostbite
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Handle the affected area gently.
Remove wet clothing and any
jewelry from the affected area.
Cover the affected area with dry
dressings and bandage loosely.
Do not rub the area or break any
blisters.
Do not re-expose the injury to
cold.
Do not apply heat.
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Cold Related Emergencies
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Hypothermia
 Generalized cooling of body when body can no longer
generate sufficient heat to maintain normal body temperature
 Temperature drops below 95 degrees
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Signs and Symptoms of Hypothermia
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Cool skin
Shivering
Numbness
Decreased level of consciousness
Poor coordination
Difficulty speaking
Rigid posture
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Care for Hypothermia
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Summon more advanced medical
personnel.
Reassure the victim.
Handle the victim gently.
Remove the victim from the cold
environment.
Have the victim stop all activity and rest.
Remove wet clothing.
Place the victim in dry blankets or
clothing.
Protect from any further heat loss.
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Cold Related Emergencies
3:41
Prevent Heat and Cold Emergencies
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Emergencies resulting from
overexposure to extreme temperatures
are preventable:
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Do not work in the hottest or coldest parts of
the day, if possible.
Take frequent breaks to rewarm or cool the
body.
Take breaks to replenish eh body with food
and fluids.
Reduce the intensity of the work.
Wear clothing appropriate to the tasks and
the environment.
Behavioral Emergencies
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Behavior refers to the manner in
which a person acts or performs.
A behavioral emergency is a
situation in which a person exhibits
abnormal behaviors that is
unacceptable or intolerable.
Causes of Behavioral Emergencies
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Situational stress.
Illness or injury resulting in lack of
oxygen or low blood sugar.
Substance abuse.
Mental illness, including crises
involving panic, agitation, self
destructive behavior, and/or
violence
Actions that Suggest Behavioral
Emergency
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Threatening posture—fists
clenched, fighting stance, etc.
Possession of weapons.
Threatening harm to others or self.
Verbal abuse.
Speaking in a nonsensical manner.
Extremely withdrawn.
Hallucinations.
To Calm a Victim with a Behavioral
Emergency
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Assume a non-threatening posture.
Acknowledge that the person appears upset and
that you would like to help.
Get in front of the victim and at eye level.
Avoid unnecessary contact. Maintain a
comfortable (and safe) distance from the victim.
Do not threaten, challenge, or argue with a
victim.
Involve others that the victim trusts.
Encourage the victim to discuss whatever is
troubling him or her.
Behavioral Emergencies
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Assess the scene for potential violence before
approaching the victim. Check with family
friends or other bystanders to determine the
victim’s history and actions before your arrival.
Stay away from the victim and the scene if it is
not safe.
Document the victim’s behavior and have
witnesses in attendance to verify actions. Use
same sex attendants whenever possible, to
minimize the accusations of sexual misconduct
commonly alleged by emotionally disturbed
victims.
If the victim refuses to provide consent, but you
feel that the victim is a threat to self or others,
have law enforcement personnel and more
advanced medical personnel intervene.
Break
10 mins
Impact Training
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In Review:
The 2:00 minute window
Using two or more rescuers
Impact Training
How the eye works:
Field of view
Outer Field
Middle Field
Inner Field
Activity: Mask, and Megabat
Impact Training
Scanning: A dissection
Questions to ask:
The interval of each scan
There should be a beginning and an end to each
scan
Sit/Stands (Changing body posture) are required
Assessing facial expressions, location in swim area,
body position
Mentally anticipate group or individuals
movement/activity
Impact Training
Utilize a specific type of scan:
Arc
Parallel lines
Spoke
Group
Impact Training
Polarized glasses: How they work
Activity: Using two pairs of
sunglasses
Impact Training
“ A Series of Events”
Breakout Session