Magazine article Parks & Recreation

CPR Training for Lifeguards: New Research, New Thinking

Magazine article Parks & Recreation

CPR Training for Lifeguards: New Research, New Thinking

Article excerpt

Our lifeguards call it "Baywatch CPR." It's the miracle of television and films. To a tense musical soundtrack, a lifeguard checks the victim's neck and dramatically shouts out, "No pulse!" The heroic lifeguards complete an average of three cycles of chest compressions and breathes when the victim suddenly sits up and coughs. "You'll be all right," the lifeguards say. In the next scene the victim is sharing a romantic dinner with one of the lifeguards.

Of course we recognize these scenes for what they are, fiction. In real life, people who require CPR don't get up and walk around a few minutes later. In fact, most don't get up at all. Extensive research into survival rates for cardiac arrest victims indicates that the survivor rate is surprisingly small, maybe less than five percent.

Most of these studies focused on adult victims whose cardiac arrest was brought on by non-traumatic factors. There is no extensive research into survivor rates for children who experience cardiac arrest or for drowning victims who experience cardiac arrest as a result of respiratory failure. Still, there is no reason to believe that the survivor rates for such circumstances would be significantly different.

Yet, research into CPR has recently produced a development with implications for lifeguarding. A three-year study in New York City examined 662 cases of individuals who received CPR from a bystander. The survivor rate for these victims was found to be 4.6%. Yet, in cases when CPR was performed ineffectively, the survivor rate dropped to only 1.4%. From this study we can infer that doing CPR poorly is only marginally better than not doing it all.

The implication of this study is that we cannot tolerate lifeguards having poor CPR skills. The contemporary expectation of our profession is that lifeguards are professional rescuers, as capable of performing effective CPR skills as any police officer or emergency medical technician (EMT). Unfortunately, this is not always the case. The most common reason lifeguards fail audits or examinations by outside firms like the American Red Cross or Ellis and Associates is not lack of skill in the water, but mistakes in CPR skills.

The Catch-22 in lifeguard CPR skills is that, while these skills are critical, they are also very unlikely to be needed. EMTs in highly populated areas may perform CPR several times a month. Yet, most lifeguards will never need to administer CPR in a real situation.

Without the experience of real emergencies, lifeguards must rely on simulations to maintain effective CPR skills. Since CPR skills are more complex than other lifeguard skills, they require more training and more reinforcement to maintain. Evidence of this can be seen in the amount of time devoted to CPR in current lifeguard certification courses. In Red Cross Lifeguard Training, for example, nine hours is spent on CPR training: this accounts for one third of the course.

However, even with the amount of time spent on CPR skills in lifeguard courses, we would be fooling ourselves to believe that all lifeguards will come to work for us with excellent skills right from the start. CPR skills are a lot like driving skills. We may hand our car keys to a 16-year-old with a brand new license, but only with a great deal of trepidation. The license only says the teenager knows how to drive, not that they are a skilled driver. With a couple months of practice, the average teenager will be able to eat a hamburger, tune the radio and change lanes all at one time. We have to give the same attention to practicing CPR skills for lifeguards.

Skills Need Reinforcement

New lifeguards and lifeguards returning from a long winter season off should have CPR skills reinforced several times a week in the early part of the season. Lifeguard trainers should also watch for guards who experience trouble remembering skills or performing them consistently. These guards should be assigned additional practice, possibly even on a daily basis. …

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