Fourth Edition StarGuard Best Practices for Lifeguards Fourth Edition StarGuard Best Practices for Lifeguards Jill E. White Human Kinetics Library of Congress Cataloging-in-Publication Data White, Jill E., 1955- Starguard : best practices for lifeguards / Jill E. White. -- 4th ed. p. cm. Includes bibliographical references. ISBN-13: 978-0-7360-9835-9 (soft cover) ISBN-10: 0-7360-9835-6 (soft cover) 1. Lifeguards--Training of--Handbooks, manuals, etc. I. Title. GV838.74.W45 2012 797.2’00289--dc23 2011042383 ISBN-10: 0-7360-9835-6 (print) ISBN-13: 978-0-7360-9835-9 (print) Copyright © 2012, 2006 by Jill E. White and Starfish Aquatics Institute Copyright © 2002, 1999 by Starfish Aquatics Institute and American Safety & Health Institute All rights reserved. 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Box 80, Torrens Park, South Australia 5062 0800 222 062 e-mail: [email protected] E5241 ContEntS Preface  ix  ◾  Acknowledgments  xiii Part I Prevention Strategy 1 ChAPter 1  Foundation of Best Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Identifying What Is Important in Saving Lives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 Misconceptions About Lifeguarding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 The Need for Best Practices in Lifeguarding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 The Need for Best Practices From Management and Patrons . . . . . . . . . . . . . . . . . . . . .5 ChAPter 2  reducing the risk at an Aquatic Facility . . . . . . . . . . . . . . . . . . . 7 StarGuard Risk Management Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Prevention Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Layers of Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Controlling High-Risk Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Minimizing the Risk of Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Enforcing Rules and Policies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Identifying Threatening Behaviors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18 Performing Lifeguard Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 ChAPter 3  Managing Bloodborne and recreational Water Illness  . . . . . . . . 21 Disease Transmission and Swimming Pools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Bloodborne Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22 Reducing Exposure to Bloodborne Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23 Recreational Water Illness and Waterborne Pathogens . . . . . . . . . . . . . . . . . . . . . . . .27 Reducing Exposure to Waterborne Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28 Part II Surveillance 33 ChAPter 4  recognizing Distress and Drowning . . . . . . . . . . . . . . . . . . . . . 35 Distress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36 Drowning Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 Victim Recognition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38 How the Water Hides Drowning Victims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41 ◾ v vi ◾ Contents ChAPter 5  Looking for Distress and Drowning  . . . . . . . . . . . . . . . . . . . . . 45 Observation Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .46 The RID Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 Zones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 The StarGuard Scanning Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .50 Strategies for Improving Vigilance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51 Proactive Rotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 Drowning Detection Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56 Part III response and rescue 59 ChAPter 6  Deciding to Act and emergency response  . . . . . . . . . . . . . . . . 61 Legal Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .62 Legal Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Responder Chain of Command . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .64 Emergency Action Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 STAAR Aquatic Rescue Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66 Early Activation of Emergency Medical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68 When to Call EMS for Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Deciding to Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70 What to Expect When You Call 9-1-1 in the United States . . . . . . . . . . . . . . . . . . . . . .70 Crowd and Bystander Management in an Emergency Situation . . . . . . . . . . . . . . . . . .71 Activating the Emergency Action Plan for a Water Rescue . . . . . . . . . . . . . . . . . . . . . .72 ChAPter 7  Performing Assists and rescues for responsive Victims  . . . . . . 75 Rescue Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .76 Land-Based Assists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77 Water Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .78 Approach Strokes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .80 Water Rescue on the Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .81 Water Rescue Under the Surface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 Special-Situation Rescues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86 After the Rescue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88 Part IV Emergency Care 91 ChAPter 8  Managing Aquatic Spinal Injuries  . . . . . . . . . . . . . . . . . . . . . . 93 Mechanisms of Injury and Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94 Managing a Spinal Injury on Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95 Managing a Spinal Injury in the Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .95 In-Line Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .98 Backboarding Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 Contents ◾ vii Preparing to Backboard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 Backboarding and Extrication Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .104 ChAPter 9  Performing Basic First Aid  . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Primary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Secondary Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Recovery Positions and Protecting the Airway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112 Control of Bleeding and Managing Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .114 Wounds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .116 Facial Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .117 Bone, Joint, and Muscle Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118 Illness and Altered Mental Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .120 Breathing Difficulty or Shortness of Breath . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 Severe Abdominal Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .126 Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .128 Bites and Stings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .129 Exposure to Heat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 Exposure to Cold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .132 Triage for Catastrophic Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .133 Emergency Moves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .134 ChAPter 10  Performing CPr and Using an AeD  for Professional rescuers  . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Basic Life Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 Treatment for Sudden Cardiac Arrest (SCA) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 CPR and AED for Multiple Rescuers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .150 Rescue Breathing for a Person With a Pulse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .153 Special Conditions for CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 Choking (Foreign-Body Airway Obstruction) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .160 ChAPter 11  Performing rescues and Lifeguard CPr  for Unresponsive Drowning Victims . . . . . . . . . . . . . . . . . . . . 165 Rescue of an Unresponsive Drowning Victim . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .166 Extrication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .169 Special Considerations for Drowning Victims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171 Integrating Adjunct Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .172 Transferring to EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .173 Coping With Emotional Distress After the Incident . . . . . . . . . . . . . . . . . . . . . . . . . . .175 Part V Workplace Environment 177 ChAPter 12  Facilitating Workplace Safety  . . . . . . . . . . . . . . . . . . . . . . . . 179 Minimizing the Risk of Workplace Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .180 Health Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .183 viii ◾ Contents ChAPter 13  Meeting Workplace expectations . . . . . . . . . . . . . . . . . . . . . . 189 Projecting a Professional Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .190 In-Service Training and Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191 Accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .192 Judgment Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .193 What to Expect From Your Employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194 What Your Employer Will Expect From You . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .195 ChAPter 14  Considering Site- and Situation-Specific Circumstances . . . . . . 197 Single-Lifeguard Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 Lifeguarding People With Disabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .200 Lifeguarding Special Events and Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .201 Lifeguarding Outside the Workplace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 Lifeguarding in Wilderness Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .205 ChAPter 15  Lifeguarding at Water Parks and Similar Spaces . . . . . . . . . . . 207 Water-Park Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .208 Facilities Similar to Water Parks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209 Prevention Strategy at Water Parks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .210 Surveillance Strategy at Water Parks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .211 Response, Rescue, and Emergency Care at Water Parks . . . . . . . . . . . . . . . . . . . . . .216 Water-Park Workplace Expectations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .219 ChAPter 16  Lifeguarding at Nonsurf Waterfronts  . . . . . . . . . . . . . . . . . . . 221 Waterfront Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .222 Prevention Strategy at Waterfronts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .223 Surveillance Strategy at Waterfronts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .224 Response, Rescue, and Emergency Care at Waterfronts . . . . . . . . . . . . . . . . . . . . . .227 Waterfront Workplace Expectations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .233   Appendix: emergency Oxygen  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .235 Oxygen in Emergency Care Versus Medical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . .235 Components of an Emergency Oxygen System . . . . . . . . . . . . . . . . . . . . . . . . . . . . .236 Assembly of Emergency Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239 Oxygen Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .239 Maintenance of Emergency Oxygen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .241 Considerations for Oxygen in an Emergency Action Plan . . . . . . . . . . . . . . . . . . . . . .242   Bibliography and resources  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .243   About the Author  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .247 PrEfaCE Water hides and water suffocates. This inherent danger of water is the essence of the StarGuard training program. This text is designed to prepare you to earn a StarGuard course completion certificate and will help you recognize the important role you play in keeping patrons safe. The information is concise, clear, and designed to develop your confidence and competence. The text and supplemental online resources, when combined with the training sessions taught by authorized StarGuard instructors, will teach you the essentials of lifeguarding by focusing on what is important. In this edition, we continue to focus on the StarGuard Risk Management Model, updated to help you understand the factors that contribute to saving lives. The model includes five components: 1. prevention strategy, 2. surveillance, 3. response and rescue, 4. emergency care, and 5. workplace environment with one part of this text devoted to each. Once you understand the model, learning best practices for applying that knowledge are the next step. The training program continues to be unique in its experiential methodology and integrated approach, combined with a team and leadership development foundation. What’s New in the Fourth Edition? The fourth edition of StarGuard: Best Practices for Lifeguards and its online resource bring an increased emphasis on evidence-based practices and how those apply in the real world. The text has an expanded international focus to reflect the growth of the StarGuard program beyond the United States. The content in the fourth edition has been updated to include new research. The reference list is now organized by chapter to increase its usefulness. The CPR, AED, and first aid content has been provided by the Health and Safety Institute (HSI) through its American Safety and Health Institute (ASHI) brand and is based on 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascu- lar Care, and 2010 American Heart Association and American Red Cross International Consensus on First Aid Science With Treatment Recommendations. The consensus on science process occurs every five years, with the purpose of identifying and reviewing international science and knowledge relevant to emergency care. At the suggestion of instructors who used previous editions, first aid and CPR have been consolidated and included in the StarGuard text. Complementing the HSI/AHSI content is an expanded chapter specific to adapt- ing CPR and rescue skills for an unresponsive drowning victim. A new chapter explores the important step of deciding to act and a systematic method of emergency ◾ ix x ◾ Preface response. Other new or expanded content can be found for victim recognition, work- place safety, workplace culture, and site- and situation-specific considerations. The goal is to emphasize reducing risk at an aquatic facility by using a team approach that includes parents or caregivers, users, facility managers or supervisors, and your employer. This approach will help us return to reasonable expectations for the role of a lifeguard without diluting high performance mandates. In contrast, some detail has been removed from the fourth edition and is available within other resources. The content specific to lifeguarding in a wilderness setting more than one hour from medical care is available through Landmark Learning, our education partner for that specialty training. Visit www.landmarklearning.org for more information. The most significant addition to the fourth edition is the web resource, which you can access using the key code instructions at the front of the book. More than 95 highly interactive and multimedia learning activities will help you apply the material in the text and prepare you to successfully complete the course. If you are enrolled in a StarGuard lifeguard certification course delivered through blended learning (part online, part face-to-face),  the online activities, chapter quizzes, and the online test are required and designed to help you prepare for the certification exams.  Features of the Book The fourth edition of StarGuard: Best Practices for Lifeguards includes several new or revised features designed to streamline your learning experience: ◾ Chapter objectives. Each chapter’s learning objectives appear at the begin- ning of the chapter rather than at the beginning of each part, as in the previ- ous edition. ◾ Skill guides. Chapters that describe physical skills that you will practice during the in-person part of your training include concise charts with descrip- tions and photos of how to perform the skill. ◾ Best practices. Key points appear as best practices periodically throughout the book and can be found in the margins of the text. ◾ Knowledge into practice. At the end of each chapter is a section that helps you integrate the concepts you’ve learned throughout the chapter. ◾ Visit the web resource. This element encourages you to visit the website and lists the learning exercises you’ll find there. ◾ On the job. This final section helps you understand how you will be expected to perform on the job by listing key competency requirements found in most international qualification standards. Assistance in Meeting National and International Standards The fourth edition continues to assist lifeguard candidates in meeting standards. The content is consistent with the guidelines for supporting the development of minimum competencies as outlined in numerous guidance documents, including but not limited to the Model Aquatic Health Code sponsored by the U.S. Centers for Disease Control and Prevention (CDC), the UK National Pool Lifeguard Qualifi- cation, the minimum competencies recommended by the International Life Saving Federation, and Australian NTIS training package qualifications. As mentioned