APPENDIX I © 2011, 2016 The American National Red Cross. All rights reserved. PARTICIPANT’S MANUAL CHAPTER REVIEW ANSWER KEYS SECTION C 344 PARTICIPANT’S MANUAL CHAPTER REVIEW ANSWER KEYS Chapter 1 Review 1. What is the primary responsibility of a lifeguard? A | T o encourage patrons to participate in water safety educational programs C | To schedule and participate in frequent inservice trainings B | T o prevent drowning and other injuries from occurring at their aquatic facility D | To deliver patron safety orientations and administer swim tests 2. Provide three examples of how lifeguards fulfill their primary responsibility: Answers should include three of the following: Monitoring activities in and near the water through patron surveillance. ■■ Preventing injuries by minimizing or eliminating hazardous situations or behaviors. ■■ Enforcing facility rules and regulations and educating patrons about them. ■■ Recognizing and responding quickly and effectively to all emergencies. ■■ Administering first aid and CPR, including using an automated external defibrillator (AED) and, if trained, administering emergency oxygen when needed. ■■ Working as a team with other lifeguards, facility staff and management. ■■ 3. List five examples of secondary responsibilities that should never interfere with patron surveillance: 345 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include: ■■ Testing pool water chemistry. ■■ Assisting patrons, such as performing safety orientations, administering swim tests and fitting for life jackets. ■■ Cleaning or performing maintenance. ■■ Completing records and reports. ■■ Performing opening duties, closing duties or facility safety checks and inspections. Chapter 1 Review (continued) 4. List five characteristics of a professional lifeguard: Answers should include: ■■ Knowledgeable and Skilled ■■ Reliable ■■ Mature ■■ Courteous and Consistent ■■ Positive ■■ Professional ■■ Healthy and Fit 5. Lifeguards should: A | Keep a cell phone in their hip packs at all times, in case of emergency. C | Always be attentive and sit or stand upright when on surveillance duty. B | Stay alert by eating at the lifeguard stand. D | Assist patrons with swim testing when on surveillance duty. 6. A lifeguard is texting while on surveillance duty and fails to recognize a swimmer in distress. What legal principle could be a problem for this lifeguard? C | Refusal of care B | Abandonment D | Consent © 2011, 2016 The American National Red Cross. All rights reserved. A | Negligence SECTION C 346 Chapter 1 Review (continued) 7. List the five steps that a lifeguard should take when obtaining consent from an injured or ill person before providing first aid or emergency care: 1) State your name. 2) State your level of training. 3) Ask if you may help. 4) Explain that you would like to assess them to find out what you think may be wrong or what you can do to help. 5) Explain what you plan to do. 8. What is the validity period of an American Red Cross Lifeguarding certification? How does an American Red Cross certified lifeguard get recertified? The American Red Cross Lifeguarding/First Aid/CPR/AED Certification is valid for 2 years. Additional training may be required to meet state and local regulations or facility-specific policies. ■■ To re-certify, American Red Cross certified Lifeguards with a current certification may participate in a review course. ■■ Individuals with an expired American Red Cross Lifeguarding/First Aid/CPR/AED certification may participate in the full Lifeguarding course. A | T o ensure that lifeguards understand their responsibilities and know how to perform their job B | T o ensure that lifeguards get practice with their facility’s safety and rescue equipment and emergency action plans 347 Lifeguarding | Instructor’s Manual C | To ensure lifeguards understand codes, rules and regulations of the facility D | All of the above © 2011, 2016 The American National Red Cross. All rights reserved. 9. Why is it important to attend a pre-season orientation and training? Chapter 1 Review (continued) 10. What does EAP stand for? Emergency Action Plan 11. Why is it important for lifeguards and other team members to understand and practice the EAP? Answers include: ■■ Lifeguards and other staff members must practice the facility’s EAPs together until everyone knows their responsibilities and can perform them effectively. ■■ Conditions can change throughout the day, so the EAP may need to be adapted to particular situations (e.g., number of lifeguards on duty, availability of other safety team members on duty, types of activities occurring, etc.). 12. What is the best practice for the frequency of in-service training participation at well-managed aquatic facilities? A | A t least 1 hour of in-service training each month C | At least 1 hour of in-service training each day B | A t least 4 hours of in-service training each year D | At least 4 hours of in-service training each month 13. What are the benefits of regular, frequent in-service training? © 2011, 2016 The American National Red Cross. All rights reserved. Answer should include: ■■ Helps lifeguards maintain knowledge and skills as a professional rescuer. ■■ Skills degrade quickly and regular practice and feedback keeps skills fresh. ■■ Gives lifeguards a chance to practice with lifeguards at their facility. ■■ Helps lifeguards work with the safety team to efficiently respond in an emergency. SECTION C 348 Chapter 1 Review (continued) 14. List four topics that could be a discussed during in-service training: Answers should include four of the following: ■■ Address surveillance and recognition issues. ■■ Practice rescue skills. ■■ Understand and practice decision-making protocols. ■■ Review facility rules and regulations. ■■ Review facility protocols including records and reports. ■■ Practice customer service skills. ■■ Physical conditioning for lifeguards. QU E STION FOR FUTU R E G U I DE D DI SCUSS ION Being a professional lifeguard is about more than blowing a whistle and wearing a uniform. A lifeguard must be mentally, physically and emotionally prepared at all times to do their job. So, how should a lifeguard prepare for working at an aquatic facility? What personal lifestyle commitments should a lifeguard make? 349 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Responses should include: To fulfill the responsibilities of a professional lifeguard, you must be mentally, physically and emotionally prepared at all times to do your job. As a professional lifeguard you must: ■■ Have the appropriate knowledge and skills to help prevent and respond to emergencies. ■■ Be reliable; arrive to work on time and accept assignments willingly. ■■ Be mature, act responsible, take initiative and lead by example. ■■ Show a positive attitude in all job activities. ■■ Look professional and be prepared to respond appropriately to any situation. ■■ Stay healthy and fit, including regular exercise, good nutrition and a balanced diet, proper hydration, adequate rest and protection from sun exposure. Chapter 2 Review 1. What items are considered to be personal protective equipment for a lifeguard? Responses should include: ■■ Gloves ■■ Resuscitation masks ■■ Gowns ■■ Shields ■■ Protective Eyewear 2. What equipment should be worn or carried by a lifeguard at all times while on duty? List at least two and include the reason(s) why this equipment should be worn or carried. © 2011, 2016 The American National Red Cross. All rights reserved. Responses should include: ■■ A Rescue tube should be worn at all times when performing patron surveillance. Rescue tubes are capable of keeping multiple victims afloat and they are the primary pierce of equipment used to perform a water rescue. ■■ Hip-packs containing gloves and resuscitation mask(s) should be worn by lifeguards at all times, even when not on surveillance duty, so that equipment is instantly available in an emergency. ■■ Resuscitation mask(s) allow lifeguards to breathe air into a victim without making mouth-to-mouth contact. Resuscitation mask(s) should be carried in the Lifeguard’s hip pack at all times, even when not on surveillance duty, so that it is available instantly in an emergency. ■■ A Whistle is a signaling device for lifeguards used to activate the facility’s EAP and to get attention of other members of the safety team as well as patrons for policy enforcement. Whistles should be loud, made of material that will not rust and have breakaway lanyards. Lifeguards should wear whistles at all times. ■■ Disposable Gloves are used to protect lifeguards that may be exposed to blood or other potentially infectious material (OPIM). Gloves should be carried in the Lifeguard’s hip pack at all times, even when not on surveillance duty, so that they are available instantly in an emergency. SECTION C 350 Chapter 2 Review (continued) 3. What safety equipment/items should be easily accessible for a lifeguard while on duty? List at least two and describe how/when each item is used. Responses should include: ■■ Backboards are a standard piece of equipment used at aquatic facilities to remove victims from the water when they are unable to exit the water on their own or they have a possible head, neck or spinal injury. ■■ Automated External Defibrillators (AEDs) are used to analyze the hearts rhythm and deliver an electrical shock (when needed) to help re-established an effective heart rhythm. AEDs are used in conjunction with CPR. ■■ First aid kits include supplies used to treat common injuries at aquatic facilities including bleeding and wounds and help stabilize injuries to muscles, bones and joints. ■■ Bag-Valve-Mask (BVM) resuscitators are used to ventilate a victim in respiratory arrest or when performing CPR with more than one rescuer. ■■ Personal Protective Equipment (PPE) is used to prevent lifeguards from coming into direct contact with a victim’s body fluids. PPE includes gloves, resuscitation masks, gowns, masks, shields and protective eyewear. ■■ Rescue boards (for waterfront facilities) are used as standard equipment at waterfront facilities and are designed to accommodate a lifeguard plus one or more victims. Rescue boards may be used during rescues to quickly paddle out long distances or as a patrolling device for lifeguards. © 2011, 2016 The American National Red Cross. All rights reserved. 351 Lifeguarding | Instructor’s Manual Chapter 2 Review (continued) 4. As a lifeguard, you are responsible for: A | E nsuring that your facility is in compliance with local, state and federal regulations. C | Consistently enforcing your facility’s rules and regulations. B | C reating and reviewing your facility’s policies and procedures manual. D | Creating rules, regulations and emergency action plans. 5. List five common rules and regulations often posted at an aquatic facility. Answers should include five of the following: ■■ Swim only when a lifeguard is on duty. ■■ Swim diapers are required for small children or people with incontinence. ■■ No swimming with open or infected wounds. ■■ Obey lifeguard instructions at all times. ■■ No running, pushing or rough play. ■■ No hyperventilating before swimming underwater or breath-holding contests. ■■ No sitting or playing near or with drains or suction fittings. ■■ Dive only in designated areas. ■■ No glass containers in the pool area and locker rooms. ■■ No alcoholic beverages or drug use allowed. 6. Explain what it means to be “equipped and rescue-ready.” © 2011, 2016 The American National Red Cross. All rights reserved. Equipped and rescue-ready means that you are wearing or carrying the appropriate rescue equipment for your facility and ready to enter the water to perform a rescue. SECTION C 352 Chapter 2 Review (continued) 7. Identify at least two reasons why each lifeguard in the images below is not equipped and rescue-ready and indicate what can be done to improve each situation. ■■ ■■ ■■ ■■ ■■ ■■ Lifeguard does not have a rescue tube. Lifeguard has no sun protection (no hat, sunglasses or umbrella). Lifeguard is sitting with crossed legs. Lifeguard is wearing sneakers. Lifeguard in the chair is not wearing a hip pack. Lifeguard on the ground is not looking at the pool. © 2011, 2016 The American National Red Cross. All rights reserved. 353 Lifeguarding | Instructor’s Manual Chapter 2 Review (continued) QU E STION FOR FUTU R E G U I DE D DI SCUSS ION Effective surveillance includes several elements. What are these elements and why are they instrumental to keeping patrons safe? Responses should include: Elements of effective surveillance include: ■■ Recognition of dangerous behaviors ■■ Victim recognition ■■ Effective recognition ■■ Zone of surveillance responsibility ■■ Lifeguard stations © 2011, 2016 The American National Red Cross. All rights reserved. With effective surveillance, lifeguards can recognize behaviors or situations that might lead to life-threatening emergencies (such as drownings or injuries to the head, neck or spine) and act quickly to modify the behavior or control the situation. SECTION C 354 Chapter 2 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERFRONT LIFEGUARDS: 1. Which list of typical safety checklist items, along with others, applies to a lakefront swimming area? A | W ater chemistry, circulation system, drain covers, starting blocks B | B ottom conditions, pier attachments, buoys, safety lines C | Emergency shut offs, tubes, communication between ride dispatch and landing D | Wave height, tide charts, rip currents, beach flags 2. Which list of typical rules, along with others, applies to a lakefront swimming area? A | N o diving in shallow water, no running on pool deck, shower before entering the water B | R ide slides feet-first, stay on tubes, observe minimum height or weight requirements C | No swimming under piers, no fishing near swimming area D | Shower before entering, limit time in high temperature water, remove swim caps © 2011, 2016 The American National Red Cross. All rights reserved. 355 Lifeguarding | Instructor’s Manual Chapter 2 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS 1. In a waterpark setting, what additional items might be included in a safety checklist? Answers should include: ■■ Shoreline is clean and free of sharp objects ■■ Bottom conditions are free from hazards ■■ Water conditions are safe for swimming ■■ Piers are anchored, stable, free from trip or injury hazards ■■ Lifeguard stands and surrounding areas are clear of objects 2. Why should waterparks have signs posted at every attraction stating the water depth? Answer: ■■ To prevent patrons from finding themselves in what is deeper or shallower water than expected. 3. What rules are typically covered for waterpark attractions? © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include: ■■ The minimum or maximum number of people allowed on an attraction or a tube at a time. ■■ The maximum height or age requirements in areas designated for small children. ■■ The minimum height or weight requirements for patrons using an attraction. ■■ Life jacket requirements. ■■ Health restrictions. ■■ Proper riding position for a slide or ride vehicle. 4. What are some factors that make lifeguarding waterparks different than a typical pool? Answers should include: ■■ Various attractions (winding rivers, water slides, wave pools, splash castles, etc.) ■■ Ride vehicles ■■ Currents on attractions ■■ Potentially larger crowds ■■ Different rules and EAPs SECTION C 356 Chapter 3 Review 1. In general, there are three types of swimmers in distress or drowning victims. List each type with three observable characteristics for each. Answers should include: 1) Distressed Swimmer ■■ May be able to keep their face out of the water ■■ May be able to call or wave for help ■■ Horizontal, vertical or diagonal, depending on what they use to support themselves ■■ Floating, sculling or treading water 2) Drowning Victim—Active ■■ Not be able to call out for help because their efforts are focused on getting a breath ■■ Works to keep the face above water in an effort to breathe ■■ May be in a horizontal face-down position during the struggle because they are unable to lift their face out of the water (for example: a toddler) ■■ Has extended the arms to the side or front, pressing down for support ■■ Is positioned vertically in the water with an ineffective kick; a young child may tip into a horizontal face down position ■■ Might continue to struggle underwater once submerged ■■ Eventually will lose consciousness and stop moving Drowning Victim—Passive 3) ■■ Might float face-down at or near the surface or might sink to the bottom ■■ May be limp or have slight convulsive-type movements ■■ Has no defined arm or leg action, no locomotion and no breathing ■■ May appear to be floating, if at the surface of the water ■■ May be face-down, on one side or face-up, if at the bottom C Elevated Stations A Ground-Level Stations B. U sed in waterfront facilities to patrol the outer edge of a swimming area C. Ideal for a single guard facility B Floating Station D. G ood to use with a crowded zone 357 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 2. Match each station type with its general use: D A. Puts you close to the patrons to easily make assists Roving Stations Chapter 3 Review (continued) 3. A lifeguard on duty should be able to recognize and reach a drowning victim within: 30 seconds. 4. The size of a zone should allow for a lifeguard to recognize an emergency, reach the victim, extricate and provide ventilations within ______. Explain why. 1½ to 2 minutes In general, if you can provide ventilations within 1½ to 2 minutes, you might be able to resuscitate the victim. 5. What is the difference between total and zone coverage? Total coverage: Total coverage means that you are the only lifeguard conducting patron surveillance while on duty. Some facilities, such as a small pool, assign their lifeguards total coverage. When only one lifeguard is conducting patron surveillance, that lifeguard has to scan the entire area, control the activities of patrons in and out of the water and recognize and respond to emergencies. Zone coverage: Zone coverage means that the swimming area is divided into separate zones, with one zone for each lifeguard station. Zones can be designated by markers, such as ladders, lane lines, lifelines, buoys or the shape of the pool. © 2011, 2016 The American National Red Cross. All rights reserved. 6. Lifeguards should be actively ___________ their zones. A | Changing C | Creating B | Watching D | Searching Why? Lifeguards should search their assigned zones for behaviors that indicate a patron is in need of immediate assistance. Lifeguards should be searching for behaviors of a drowning victim or swimmer in distress. SECTION C 358 Chapter 3 Review (continued) 7. You are guarding a lap swim with only two patrons. All of the following will help you deal with the monotony EXCEPT for which? A | S tay fully engaged and do not let attention drift. C | Swing your whistle lanyard. D | Sit upright and slightly forward. B | Change body position and posture periodically. 8. It is very hot in your facility and you are starting to doze on the stand. All of the following can help you stay alert EXECPT for which? A | Stay in a cooler area during breaks. C | Rotate more frequently. B | S tay hydrated while drinking plenty of water. D | Jump in the pool while on surveillance duty to cool off. 9. You are distracted by the glare of the lights on the water and the water movements are making it hard to see all areas of your zone. Circle all acceptable options. A | Wear polarized sunglasses. B | Adjust your body position; stand up to look around and through the glare spots. C | Reposition the lifeguard station with the permission of your supervisor. D | Be aware of the normal appearance of the bottom of the pool; know the appearance of drains, colored tiles or painted depth markings. E | Do not change your position as the lifeguard stations are placed to be ascetically pleasing. 10. Why is it important for lifeguard managers to conduct drills to test zones? 359 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Lifeguard zones should be set up for success—the lifeguard must be able to clearly see all parts of the zone as well as be able to quickly respond in an emergency. Chapter 3 Review (continued) Voluntary hyperventilation 11. Fill in the blank: __________________________________________ , which can be described as rapid, deep breathing, is a dangerous technique used by some swimmers to try to swim long distances underwater or to hold their breath for an extended period while submerged in one place. If you see these dangerous activities, you must intervene. 12. RID stands for R: Recognition I: Intrusion D: Distraction 13. During rotation, both lifeguards must ensure there is no lapse in patron surveillance, even for a brief moment. To ensure this, what should each lifeguard do? The incoming lifeguard should: Search the zone and activity level of the zone that you will be guarding. Begin searching your zone as you are walking toward your station, checking all areas of the water from the bottom to the surface. The outgoing lifeguard should: © 2011, 2016 The American National Red Cross. All rights reserved. Inform the incoming lifeguard of any situations that need special attention. The exchange of information should be brief, and patron surveillance must be maintained throughout the entire rotation. Once in position, with the rescue tube strapped in place, the incoming lifeguard should make any adjustments needed, such as removing shoes or adjusting an umbrella before confirming to you that they own the zone. Confirm and signal that the zone is clear and transfer responsibility for the zone. You should continue scanning as you are walking toward the next station. SECTION C 360 Chapter 3 Review (continued) QU E STION FOR FUTU R E G U I DE D DI SCUSS ION What are some common injuries at a pool? How can a lifeguard treat and prevent them? Responses should include: ■■ Fractures ■■ Dislocations ■■ Abrasions (scrapes) ■■ Superficial burns (sunburns) ■■ Muscle cramps ■■ Heat exhaustion ■■ Dehydration ■■ Sprains and strains Lifeguards can help prevent these injuries by: ■■ Understanding how most injuries occur ■■ Increasing awareness of risks and hazards ■■ Helping patrons avoid risky behavior, including educating patrons about the consequences of risky behavior ■■ Developing a safety-conscious attitude Lifeguards can treat these injuries by providing appropriate emergency care according to their level of training. © 2011, 2016 The American National Red Cross. All rights reserved. 361 Lifeguarding | Instructor’s Manual Chapter 3 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERFRONT LIFEGUARDS: 1. Which scanning challenge often occurs at waterfronts but should not exist at pools? A | Distractions C | Murky water B | Heavy patron loads D | High air temperature 2. Who normally provides training for watercraft used at some waterfront facilities? C | Facility management B | The lifeguard figures it out D | The U.S. Coast Guard © 2011, 2016 The American National Red Cross. All rights reserved. A | The lifeguard’s training agency SECTION C 362 Chapter 3 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK LIFEGUARDS: 1. In a waterpark setting, which type of lifeguard stations might you encounter in a rotation? Answers should include: ■■ Elevated stations ■■ Ground-Level stations ■■ Roving stations ■■ Dispatch stations ■■ Landing zone stations 2. What are lifeguards guarding at dispatch stations responsible for? Assessing each potential rider to ensure that they meet all of the requirements for riding the attraction. Verifying that each rider wishing to ride the attraction is capable of holding themselves in the proper riding position. 3. What are some characteristics unique to waterpark features that may make it more difficult to see a drowning victim? Answers should include: Current, moving water or waves of an attraction ■■ Unexpected changes in depth ■■ Floating play structures ■■ Tubes or other ride vehicles from which patrons may fall ■■ Answers should include: ■■ Overcrowding. Be aware of your facility guidelines regarding the number of patrons allowed on the play structure and be prepared to restrict that number or summon additional help. ■■ Features such as towers, sprayers or climbing structures; be sure to move around your zone or change body position so you are able to see all areas of your assigned zone. 363 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 4. What are some scanning challenges that you may encounter when guarding a play structure? What tactics can you use to counteract them? Chapter 4 Review 1. List the three major strategies a lifeguard can use to help prevent injuries at an aquatic facility. Answers should include: ■■ Communicating with patrons ■■ Informing and educating patrons ■■ Enforcing rules 2. List three things that can help determine if a life jacket is appropriate for use. © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include: ■■ The life jacket is U.S. Coast Guard Approved. ■■ The life jacket is in good condition; no rips, tears, holes or shrinkage of the buoyant materials. ■■ The life jacket is appropriately sized for the patron; life jackets are sized by weight. Check the U.S. Coast Guard label to be sure the fit is matched to the weight range of the patron. ■■ The life jacket is properly worn. A properly fitted life jacket should feel snug, keep the person’s chin above the water and allow the person to breathe easily. The life jacket should not ride up on the patron’s body in the water. Completely secure any straps, buckles or ties associated with the life jacket. ■■ The patron(s) are properly using the life jacket. Correct any improper wearing or use of life jackets. Do not allow patrons to wear multiple life jackets or stack multiple life jackets on top of each other to be used as floats. SECTION C 364 Chapter 4 Review (continued) 3. Many facilities have unique challenges that demand different kinds of surveillance. For each situation listed below, list two guidelines you should keep in mind when providing surveillance for patrons. Guarding areas for young children: Answers include: ■■ Older children might be too large for some structures, or their play might be too rough for young children. ■■ Toddlers who are still learning to walk may fall easily. If they fall down in water, they usually cannot lift themselves to an upright position, even if the water is ankle or knee deep. ■■ Children often get lost. Remind adults to supervise their children at all times. ■■ You must watch out for young children using the pool as a toilet. The facility should have procedures for preventing and addressing the situation, including handling fecal incidents, which follow local health department guidelines. ■■ Children usually do not think about overexposure to the sun or hypothermia. If a child is becoming sunburned or overly cold, immediately inform the child’s parent or guardian. Play structures: 365 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include: ■■ Do not let a play structure become overcrowded. Be prepared to restrict the number of patrons using it at one time. ■■ Do not allow patrons to swim underneath structures. ■■ Watch that patrons return to the surface after dropping into the water from a floating feature. Swimmers can be surprised by the fall or become disoriented, especially if they do not realize they will be dropping into deep water. ■■ Pay close attention to children playing in and around sprays, fountains and interactive water-play structures. These attractions usually are in shallow water. Excited children may run and fall. A very young child who falls might not be able to get back up or may strike their head. ■■ Pay close attention to patrons in moving water. Moving water can surprise people. They might lose their balance and be unable to stand up again. ■■ Watch for overcrowding and horseplay on floating structures. These structures are tethered to the bottom of the pool; some allow patrons to walk from one floating structure to another while holding onto an overhead rope. ■■ Keep play safe and orderly. ■■ Patrons may climb onto floating toys and jump back into the water. They may not notice what is around them and jump onto other swimmers or into water that is over their heads. ■■ Patrons may throw balls and other toys and hit unsuspecting swimmers, resulting in injury. Chapter 4 Review (continued) 4. Identify three strategies for ensuring safe group visits. Answers include: ■■ Booking procedure. Before the visit, group leaders should provide the aquatic facility with information about how many group members and supervisors will be visiting, including swimmer characteristics such as percentage of swimmers and nonswimmers. ■■ Safety orientation. Conducted when the group first arrives at the facility. ■■ Classification of swimming abilities/Swim testing. Swim tests are administered to determine if a visitor has the minimum level of swimming ability required to participate safely in activities, such as swimming in water over their head or riding on certain slides. ■■ Designation of swimming areas. Swimming areas should be clearly marked and defined according to swimmers’ abilities and intended use. ■■ Identification of group leaders or adult chaperones. Your facility should use an identification system so that lifeguards and other facility staff can easily locate group leaders or adult chaperones. ■■ Buddy systems and buddy checks. Provide an additional layer of protection, specifically with larger groups including camps. 5. W hy is it important to educate your patrons about safety in, on and around the water? Answers should include: ■■ Patrons need to know about the risks that can cause injury. ■■ Patron education and instruction on how to use equipment and follow rules can prevent behaviors that lead to injury. ■■ Patrons may be unfamiliar with facility features, or be so excited that they do not read signs or pay attention to rules. © 2011, 2016 The American National Red Cross. All rights reserved. 6. You are in the lifeguard office taking a break from surveillance duty and a camp counselor requests a swim test for a new camper. You use the Red Cross water competency sequence to conduct a swim test. Describe these steps in order: 1) Enter the water and completely submerge. 2) Recover to the surface and remain there for at least one minute (floating or treading). 3) Rotate 360 degrees and orient to the exit. 4) Level off and propel yourself on the front or the back through the water for at least 25 yards. 5) Exit from the water. SECTION C 366 Chapter 4 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERFRONT LIFEGUARDS: 1. At waterfront facilities using swim tests for group visits, areas for nonswimmers should: A | B egin in shallow water and grade seamlessly into deep water appropriate for swimmers. C | Extend slightly into deep water for practice. D | Include designated deep water areas for diving. B | B e separated from the swimmer area with a continuous barrier, such as a pier or buoyed lifeline. © 2011, 2016 The American National Red Cross. All rights reserved. 367 Lifeguarding | Instructor’s Manual Chapter 4 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS: 1. Many facilities have unique challenges that require different guarding strategies. For each situation listed below, list two guidelines you should keep in mind when guarding patrons at the following attractions. Aquatic attractions: Answers should include two of the following: ■■ Watch patrons as they enter and exit an attraction. Dispatch patrons safely on a ride at set intervals. Dispatching is the method of informing patrons when it is safe for them to proceed on a ride. ■■ Carefully watch both the water below and the activities overhead. ■■ Keep patrons in view as long as possible. Keeping patrons in view can be a problem on some attractions. Structures, such as caves, enclosed tubes, bridges and buildings might prevent you from seeing patrons at all times. When a patron goes out of sight, watch to make sure that they emerge safely on the other side. ■■ Ensure that patrons who submerge return to the surface. The excitement may cause weak swimmers or non-swimmers to overestimate their abilities or underestimate the water’s depth. ■■ Be aware of special risks. Structures designed to have patrons sit or climb on them, or swim over or under them, pose hazards. Supervise patrons carefully. Someone who falls off of a mat, raft or tube might be injured or pose a hazard to another patron. Wave pools: © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include two of the following: ■■ Ensure that patrons enter only in the shallow end. ■■ When the waves are on, stand up to get a better view of patrons. ■■ Watch for swimmers who get knocked over by the waves or carried into deeper water by the undercurrent. Inexperienced swimmers may go to where the waves break because of the excitement. ■■ Do not let patrons dive into the waves or dive through inner tubes. ■■ Keep the areas around ladders and railings clear so that patrons can exit from the pool quickly. ■■ Keep other swimmers out of the pool during special activities like surfing. The surfboards or boogie boards in the wave pool can present a hazard to others. ■■ Before performing an emergency rescue, turn the waves off using the emergency stop (E-stop) button at the lifeguard chair. ■■ Rotate positions only when the waves are off. SECTION C 368 Chapter 4 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS: 2. What additional challenges might you face when enforcing rules in a waterpark? Answers include: ■■ Background music ■■ Loud patrons ■■ Large crowds ■■ Movement/current of a winding river 3. What are some responsibilities of a lifeguard assigned the landing zone of a slide? Answers should include: ■■ Helping riders exit the ride. ■■ Ensuring that the landing zone is clear. ■■ Communicating with the dispatching lifeguard. ■■ Moving ride vehicles onto a conveyor or stacking them to be used by other patrons. 4. What are some examples of rules or policies that might be found in a waterpark setting? 369 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include: ■■ Height or weight requirements for attractions ■■ Specific rules for ride vehicles ■■ Proper ride positions ■■ No forming chains on a winding river Chapter 5 Review 1. Why should an EAP be facility specific? So that all staff know their responsibilities as it relates to that facility. Factors such as the facility’s layout, number of staff on duty at a time, location of backup lifeguards and other safety team members, equipment used and typical response times of the local emergency medical services (EMS) system are included in the plan and depend on the facility. 2. Provide three examples of situation-based EAPs. Answers should include three of the following: Water emergency—Drowning victim—active ■■ Water emergency—Drowning victim—passive ■■ Water emergency—Spinal injury victim ■■ Water emergency—Missing person ■■ Land emergency—Injury or illness ■■ Evacuations ■■ Sheltering in place ■■ Severe weather ■■ Chemical spills or leaks ■■ Power failures ■■ Violence ■■ Thefts in progress ■■ © 2011, 2016 The American National Red Cross. All rights reserved. 3. P lace the following EAP actions in order for a situation where the victim is responsive and does not require additional care: 2 Rescue 4 Equipment check/corrective action 1 Signal 5 Return to duty 3 Report, advise, release SECTION C 370 Chapter 5 Review (continued) 4. Describe the actions of the additional safety team members listed below during a rescue where the victim is unresponsive and requires additional emergency care. Other lifeguards: 1) Assist with the rescue by providing emergency care. 2) Provide back-up zone coverage or clear the area. Additional safety team members: (Front desk staff, maintenance staff or others as designated by the EAP) 1) Summon EMS Personnel. 2) Bring additional equipment if necessary. 3) Clear the area or facility. 4) Control the crowd. 5) Meet EMS personnel. 6) Assist the lifeguards by providing emergency care (if trained and outlined in the EAP). 5. When completing a report, you should: A | Include all details about the incident, including your opinion about how the incident happened. 371 Lifeguarding | Instructor’s Manual D | Not allow the victim to leave until you have completed the report and your supervisor has signed it. © 2011, 2016 The American National Red Cross. All rights reserved. B | Allow witnesses to discuss their thoughts about the incident before compiling their statement onto one report. C | Collect all factual information about what was seen, heard and the actions taken. Chapter 5 Review (continued) 6. Who should deal with questions from the media after an incident? Select all that apply. A | The lifeguard who performed the rescue D | The company spokesperson B | The front desk attendant who called 9-1-1 E | EMS personnel C | The facility manager Why? Only management or a designated spokesperson should talk to the media or others about an incident. Sharing details about an incident could violate a victim’s privacy, which is protected by confidentiality laws. Failure to follow facility procedures for dealing with the media could lead to legal action. 7. Why might a supervisor chose NOT to re-open a facility that was closed during an emergency? Provide one example. Answers may include: ■■ Not enough lifeguards ready to return to surveillance duty. ■■ Missing or damaged equipment. ■■ Spills involving blood or other potentially infectious materials have been cleaned. ■■ Power failure. 8. Members of the safety team, including non-lifeguard personnel, should be: A | T rained and certified in first aid and CPR/AED at the same level of the lifeguard team (for professionals). © 2011, 2016 The American National Red Cross. All rights reserved. B | T rained in first aid and CPR for non-professionals. C | Trained in CPR if they are interested in receiving training. D | Trained to follow the other EAP duties that do not involve providing care. SECTION C 372 Chapter 5 Review (continued) 9. After an emergency has been resolved, there are still three important tasks to complete. Explain each task. Report: Fill out the appropriate incident report form as quickly as possible after providing care. Advise: Give the victim safety instructions to prevent a similar incident from recurring or recommend that the person follow-up with a health care provider. Release: In some cases, you will release the person under their own care or to a parent, guardian, camp counselor, group leader, instructor or other staff member. 10. Y ou must be prepared to respond to emergencies that are outside of the immediate aquatic environment and not part of your zone of responsibility. Describe three areas where these emergencies could occur. Answers should include three of the following: ■■ Locker rooms ■■ Concession areas ■■ Entrance and lobby areas ■■ Mechanical rooms ■■ Playgrounds and play areas ■■ Parking lots © 2011, 2016 The American National Red Cross. All rights reserved. 373 Lifeguarding | Instructor’s Manual Chapter 5 Review (continued) ADDITIONAL R EVI EW QU E STION S FOR WATE R FRONT LI FEG UAR DS: 1. An EAP for a missing person includes quickly checking if the person is in the water. Checking for a submerged victim is most difficult for which area? C | Underneath play structures in a swimming pool B | L ap swimming area in a pool with lane lines D | Underneath play structures at a waterfront with murky water © 2011, 2016 The American National Red Cross. All rights reserved. A | S pa with the bottom obscured by water jets SECTION C 374 Chapter 5 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS: 1. What additional steps might be included in the EAP for a wave pool, a winding river and the landing zone of a speed slide? Answers should include: ■■ Pressing the emergency stop (E-stop) button to turn off the waves in a wave pool. ■■ Shutting off the flow of water in a slide or winding river. ■■ Stopping the dispatch of riders at a speed slide. 2. What additional actions must be taken after signaling an emergency in the following attractions? Wave pool: Pushing the emergency stop (E-stop) button is required to stop the waves before attempting a rescue. Slides: The signal must alert the lifeguard stationed at the top to stop dispatching more riders. 3. What signals would you most likely use to activate the EAP in a waterpark setting? Answers should include: ■■ Whistle blast. ■■ Call box (pushing a button or dropping a phone). ■■ Pressing an e-stop button. © 2011, 2016 The American National Red Cross. All rights reserved. 375 Lifeguarding | Instructor’s Manual Chapter 6 Review 1. List the general procedures, in order, for situations involving a water rescue. 1) Activate the emergency action plan (EAP). 2) Enter the water, if necessary. 3) Perform an appropriate rescue. 4) Move the victim to a safe exit point. 5) Remove the victim from the water. 6) Provide emergency care as needed. 7) Report, advise and release. 2. What are some factors that should be considered when deciding how to enter the water? Select all that apply. A | Location of the victim E | Water temperature B | Location of other swimmers F | Your location C | Size of the victim G | Facility design/set-up D | Condition of the victim H | Type of equipment used © 2011, 2016 The American National Red Cross. All rights reserved. 3. In addition to the correct answer(s) above, what additional factors should be considered when deciding how to enter the water and why? Answers may include: ■■ Water depth and/or design of the lifeguard station; different entries are recommended for different water depths and various lifeguard stations/positions: • The slide-in entry is safest in most conditions, including shallow water. • The stride jump should only be used if the water is at least 5-feet deep and you are no more than 3-feet above water. • The compact jump should only be used when the water is at least 5-feet deep and can be used from the deck or from a height, such as on a lifeguard stand. • The run-and-swim entry should be used to enter the water from a zero-depth entry, gradual slope facility. ■■ Obstacles in the water (including people and lane lines); it may not be safe to enter the water using a compact jump or stride jump if your zone is crowded or contains obstacles. • The slide in-entry is useful in a crowded pool or in an area with obstacles. SECTION C 376 Chapter 6 Review (continued) 4. Identify the appropriate entry for each scenario listed below: SCENARIO ENTRY You are seated on an elevated lifeguard stand in the deep end during recreational swim and spot a passive-drowning victim. The area surrounding your station is clear of patrons and objects. Compact Jump You are searching your zone from an elevated station when you spot a patron who appears to have a head injury as a result of diving in shallow water. Slide-In Entry You spot an active drowning victim while searching your zone from a ground-level station located in the middle of the pool where the water is 4’ deep. Slide-In Entry You are searching your new zone as you walk toward the elevated lifeguard stand in the deep end before a rotation and you spot an active drowning victim. Stride Jump You have just rotated to a roving station during open swim at a crowded waterfront and spot a swimmer in distress. Run-and-Swim 5. What are the two most common assists and when should each be used? 1) Simple assist. A simple assist can be used in shallow water and may be merely helping a person to stand. The simple assist also may be used to rescue a victim who is submerged in shallow water and is within reach. 377 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 2) Reaching assist from the deck. To assist a distressed swimmer who is close to the side of the pool or a pier, use a reaching assist from the deck by extending a rescue tube within the victim’s grasp. Chapter 6 Review (continued) Select the appropriate rescue or extrication method for the scenarios below: 6. You are approaching a victim who is vertical in the water, near the surface in 4 feet of water. The victim is facing you and appears to be unconscious. A | Active Victim Front Rescue B | Passive Victim Front Rescue C | Passive Victim in Extreme Shallow Water–Face-Up D | Submerged Victim in Shallow Water 7. You are approaching a child who is facing away from you and struggling to keep their head above water. A | Active Victim Rear Rescue C | Passive Victim Rear Rescue B | Active Victim Front Rescue D | Passive Victim Front Rescue 8. You are approaching a victim from behind who appears to be unconscious. A | P assive Victim Front Rescue followed by Extrication Using a Backboard C | Passive Victim Front Rescue followed by a Walking Assist B | P assive Victim Rear Rescue followed by a Two-Person Extrication D | Passive Victim Rear Rescue followed by Extrication Using a Backboard 9. A victim in the water is not breathing. © 2011, 2016 The American National Red Cross. All rights reserved. A | Always remove a victim who is not breathing from the water as soon as possible to provide care. However, if doing so will delay care, then perform inwater ventilations until you can remove the victim. C | Give ventilations and CPR in the water for 1 minute, 30 seconds and then remove them from the water. D | W ait for additional assistance to remove the victim from the water. B | Give ventilations in the water, then remove the victim from the water. SECTION C 378 Chapter 6 Review (continued) 10. What are four core objectives in any rescue situation? Answers should include the following: ■■ Ensure the safety of the victim, yourself and others in the vicinity. This includes the entry, approach, rescue, removal and care provided. ■■ Use a rescue technique that is appropriate and effective for the situation. ■■ Provide an appropriate assessment, always treating life-threatening conditions first. ■■ Handle the rescue with a sense of urgency. © 2011, 2016 The American National Red Cross. All rights reserved. 379 Lifeguarding | Instructor’s Manual Chapter 6 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS 1. What should you consider when deciding what entry to use at a wave pool? Answers should include: ■■ The number of patrons. ■■ The height of your station. ■■ The depth of the water at your station. ■■ The mechanism of injury of the victim. ■■ The location of your station. 2. What attraction features might impact the removal of the victim from the water? © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include: ■■ Type of exit from attraction (stairs, high edges, ladder, zero entry, etc.). ■■ Ride vehicles. ■■ Water movement (current or waves). ■■ Shape of the attraction (e.g., walls of a speed slide). SECTION C 380 Chapter 7 Review 1. Touching soiled dressings that are contaminated with potentially infectious material is an example of: A | Indirect contact C | Droplet contact B | Direct contact D | Vector-borne contact 2. Examples of work practice controls include: A | D isposing of sharp items in puncture resistant, leak-proof, labeled container B | R emoval and proper disposal of soiled protective clothing as soon as possible C | Cleaning/disinfecting all equipment and work surfaces possibly soiled by blood or other potentially infectious material D | All of the above 3. The OSHA recommended solution to use for disinfecting contaminated or soiled equipment and surfaces is: A | 4 cups of bleach per gallon of water B | 1 cup of ammonia per gallon of water C | 1/4 cup of antibacterial soap per gallon of water D | 1 part bleach per 9 parts water 4. Place the following general procedures for injury or sudden illness on land in order: 2 Perform a primary assessment. Provide care for the conditions found. 3 Summon EMS, if needed and not already done. 1 Size up the scene. 6 Report, advise and release. 4 Perform a secondary assessment. Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 381 5 Chapter 7 Review (continued) 5. Describe six actions you should take or determinations that you should make while performing a scene size-up: 1) Use your senses to check for hazards that could present a danger to you or the victim. 2) Use appropriate PPE. 3) Determine the number of injured or ill victims. 4) Determine what caused the nature of the illness; look for clues to what may have caused the emergency and how the victim became injured or ill. 5) Form an initial impression that may indicate a life-threatening emergency. 6) Determine what additional resources may be needed. 6. Provide a situation and specific example of when you should move a victim who is on land. © 2011, 2016 The American National Red Cross. All rights reserved. Answers may include: ■■ You are faced with immediate danger. Examples include but are not limited to: • Fire or immediate risk of fire • Severe weather • Chemical spills ■■ You need to get to other victims who have more serious injuries or illnesses such as an unresponsive victim who is not breathing or has no pulse. ■■ It is necessary to provide appropriate care. Examples include but are not limited to: • Moving a victim to the top or bottom of a flight of stairs to perform CPR. SECTION C 382 Chapter 7 Review (continued) 7. If you are alone when responding to someone who is ill, you must decide whether to Call First or Care First. When should you Call First? Call 9-1-1 or the designated emergency number first, before providing care for: 1. Any adult or child about 12 years of age or older who is unresponsive. 2. A child or an infant who you witnessed suddenly collapse. 3. An unresponsive child or infant known to have heart problems. When should you Care First? Care First (provide 2 minutes of care, then call 9-1-1 or the designated emergency number) for: 1. An unresponsive child (younger than about age 12) who you did not see collapse. 2. Any victim suspected of drowning. 8. How do you tell the difference between an adult, a child and an infant? Adult: Puberty and older. Child: 1-year to puberty (development of breasts in girls and underarm hair in boys). Infant: Up to 1 year. For a drowning victim pulled from the water. 383 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 9. During the primary assessment, you find the victim is not breathing and has no pulse. When would you give 2 ventilations before starting CPR? Chapter 8 Review 1. Fill in the blanks: Lack of oxygen can eventually stop the heart (cardiac arrest) 3 and prevent blood from reaching the brain and other vital organs in as little as ____ minutes after submerging. Brain cell damage or death begins to occur within ____ 4 6 minutes. to____ 2. Describe the two types of respiratory emergencies: Respiratory distress: A condition in which breathing becomes difficult. Respiratory arrest: A condition in which breathing stops. 3. List five possible causes of respiratory distress. © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include five of the following: ■■ A partially obstructed airway ■■ Illness ■■ Chronic conditions, such as asthma and emphysema ■■ Congestive heart failure ■■ Electrocution, including lightning strikes ■■ Heart attack ■■ Injury to the head, chest, lungs or abdomen ■■ Allergic reactions ■■ Drug overdose ■■ Poisoning ■■ Emotional distress ■■ Anaphylactic shock 4. When caring for a person in respiratory distress: A | A sk the victim to stand and lean back to make breathing easier. C | Do not allow the victim to take their prescribed medication. B | D etermine the exact cause of respiratory distress before providing initial care. D | Maintain an open airway and summon EMS personnel. SECTION C 384 Chapter 8 Review (continued) 5. List five possible causes of respiratory arrest. Answers should include five of the following: ■■ Drowning ■■ Obstructed airway (choking) ■■ Injury to the head, chest, lungs or abdomen ■■ Illness, such as pneumonia ■■ Respiratory conditions, such as emphysema or asthma ■■ Congestive heart failure ■■ Heart attack ■■ Coronary heart disease (such as angina) ■■ Allergic reactions (food or insect stings) ■■ Electrocution, including lightning strikes ■■ Shock ■■ Poisoning ■■ Drug overdose ■■ Emotional distress 6. When checking to see if someone is breathing (circle all that apply): A | L ook to see if the victim’s chest clearly rises and falls. B | Check for breathing before checking for a pulse. D | Look away from the victim’s chest. E | Keep the victim’s mouth closed. F | Listen and feel for air against the side of your face. C | C heck for breathing and a pulse simultaneously. 8. What is a lifeguard’s objective when caring for a drowning victim who is not breathing? To get the victim’s mouth and nose out of the water, open the airway and give ventilations as quickly as possible. 385 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. 12 and ____ 20 7. Fill in the blanks. The normal breathing rate for an adult is between ____ breaths per minute. Chapter 8 Review (continued) 9. When giving ventilations to an adult who is not breathing but has a definitive pulse, you should give ventilations: A | 2 every 5 to 6 seconds C | 1 every 3 seconds B | 2 every 3 seconds D | 1 every 5 to 6 seconds 10. W hen giving ventilations to a child who is not breathing but has a definitive pulse, you should give ventilations: A | 2 every 5 to 6 seconds C | 1 every 3 seconds B | 2 every 3 seconds D | 1 every 5 to 6 seconds 11. What should you do if you are giving ventilations and the victim’s chest does not rise after the first breath? When giving ventilations, if the chest does not rise after the first breath, reopen the airway, make a seal and try a second breath. If the breath is not successful, move to compressions and check the airway for an obstruction before attempting subsequent ventilations. If an obstruction is found, remove it and attempt ventilations. However, never perform a blind finger sweep. © 2011, 2016 The American National Red Cross. All rights reserved. 12. A ll of the following describe appropriate care for a conscious person with an airway obstruction (choking) EXCEPT: A | C heck the victim for breathing and a pulse for no more than 10 seconds. C | Obtain consent; if the victim is a child, get consent from a parent or guardian. B | P erform a combination of 5 back blows followed by 5 abdominal thrusts. D | If the victim cannot cough, speak or breathe, activate the EAP and have someone summon EMS. SECTION C 386 Chapter 8 Review (continued) 13. If a conscious choking victim becomes unresponsive, what should you do? ■■ ■■ ■■ Carefully lower the victim to a firm, flat surface. Send someone to get an AED, and summon additional resources if appropriate and you have not already done so. Immediately begin CPR with chest compressions. © 2011, 2016 The American National Red Cross. All rights reserved. 387 Lifeguarding | Instructor’s Manual Chapter 9 Review 1. Describe the five links in the Cardiac Chain of Survival for adults: ■■ ■■ ■■ ■■ ■■ Recognition of cardiac arrest and activation of the emergency response system. Early CPR to keep oxygen-rich blood flowing and to help delay brain damage and death. Early defibrillation to help restore an effective heart rhythm and significantly increase the patient’s chance for survival. Advanced life support using advanced medical personnel who can provide the proper tools and medication needed to continue the lifesaving care. Integrated post-cardiac arrest care to optimize ventilation and oxygenation and treat hypotension immediately after the return of spontaneous circulation. 2. Fill in the blank: For each minute CPR and defibrillation are delayed, the victim’s chance for survival is reduced by about ____ percent. 3. What should you do if you think someone is having a heart attack? ■■ ■■ ■■ ■■ ■■ ■■ Take immediate action and summon EMS personnel. Have the victim stop any activity and rest in a comfortable position. Loosen tight or uncomfortable clothing. Closely monitor the victim until EMS personnel take over. Note any changes in the victim’s appearance or behavior. Comfort the victim. Be prepared to perform CPR and use an AED. © 2011, 2016 The American National Red Cross. All rights reserved. 4. Signs of cardiac arrest include (circle all that apply): A | Sudden collapse D | Unresponsiveness B | Vomiting E | Rapid pulse C | No pulse SECTION C 388 Chapter 9 Review (continued) 5. What is the objective of CPR? To perform a combination of effective chest compressions and ventilations to circulate blood that contains oxygen to the victim’s brain and other vital organs. 6. Fill in the blanks: Compressions given at the correct rate are at least ____ 100 per minute to a maximum of ____ per minute. 120 7. What is the appropriate compression depth when providing CPR on an adult? A | At least 2 inches but no more than 2.4 inches C | 2 inches D | 1½ inches B | A t least 2.4 inches but no more than 3 inches 8. When providing two-rescuer CPR, when should rescuers change positions? A | At least every 2 minutes C | During the analysis of the AED B | A fter 5 cycles of 30 compressions and 2 ventilations D | All of the above 9. You arrive on the scene when another lifeguard is performing CPR, what should you do first? Confirm that EMS personnel have been summoned. If EMS personnel have not been summoned, do so before getting the AED or assisting with care. © 2011, 2016 The American National Red Cross. All rights reserved. 389 Lifeguarding | Instructor’s Manual Chapter 9 Review (continued) 10. W hen performing two-rescuer CPR on an infant, describe how lifeguards should modify the following: Compression-to-ventilation ratio: Change from (30:2) to (15:2). This provides more frequent ventilations for infants. The compression technique: Use the encircling thumbs technique. 11. Provide three examples why a lifeguard could or should stop CPR: Answers should include three of the following: ■■ You see an obvious sign of life, such as normal breathing or victim movement. ■■ An AED is ready to analyze the victim’s heart rhythm. ■■ Other trained responders, such as a member of your safety team or EMS personnel, take over and relieve you from compression and ventilation responsibilities. ■■ You are presented with a valid do not resuscitate (DNR) order. ■■ You are alone and too exhausted to continue. ■■ The scene becomes unsafe. 12. True or False: It is not appropriate to use an AED on a victim who is pregnant? False Why? © 2011, 2016 The American National Red Cross. All rights reserved. Defibrillation shocks transfer no significant electrical current to the fetus. The mother’s survival is paramount to the infant’s survival. SECTION C 390 Chapter 10 Review 1. When completing a secondary assessment, lifeguards use SAMPLE to gather a brief history of the responsive victim. What does the mnemonic SAMPLE stand for? Signs and Symptoms S A Allergies M Medications P Pertinent past medical history L Last oral intake E Events leading up to the incident 2. List five symptoms of sudden illnesses: 391 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include five of the following: ■■ Changes in LOC, such as feeling light-headed, dizzy or becoming unconscious ■■ Nausea or vomiting ■■ Difficulty speaking or slurred speech ■■ Numbness or weakness ■■ Loss of vision or blurred vision ■■ Changes in breathing; the person may have trouble breathing or may not be breathing normally ■■ Changes in skin color (pale, ashen or flushed skin) ■■ Sweating ■■ Persistent pressure or pain ■■ Diarrhea ■■ Paralysis or an inability to move ■■ Severe headache Chapter 10 Review (continued) 3. List the general precautions for injury or sudden illness on land: 1) Care for any life-threatening conditions first. 2) Monitor the victim’s condition and watch for changes in LOC. 3) Keep the victim comfortable and reassure them. 4) Keep the victim from getting chilled or overheated. 5) Do not give the victim anything to eat or drink unless the victim is awake, able to swallow and follow simple commands and intake is indicated based on the treatment recommendations. 6) Care for any other problems that develop, such as vomiting. 4. How should you provide care for a victim experiencing a diabetic emergency? If it is available, give 15 to 20 grams of sugar in the form of glucose tablets to the victim. If not available, 15 to 20 grams of sugar from several sources can be given including glucoseand sucrose-containing candies, jelly beans, orange juice or whole milk. © 2011, 2016 The American National Red Cross. All rights reserved. 5. When would you summon EMS personnel for a victim of a diabetic emergency? Provide two examples. Answers should include two of the following: ■■ The person is unresponsive. ■■ The person is responsive but not fully awake and unable to swallow. ■■ The person does not feel better within about 10 to 15 minutes after taking sugar or gets worse. ■■ A form of sugar cannot be found immediately. Do not spend time looking for it. SECTION C 392 Chapter 10 Review (continued) 6. List three reasons why you should summon EMS personnel for a victim who is having, or had a seizure. Answers should include three of the following: ■■ The seizure occurs in the water. ■■ This is the person’s first seizure. ■■ The seizure lasts more than 5 minutes. ■■ The person has repeated seizures with no lucid period.. ■■ The person appears to be injured. ■■ The cause of the seizure is unknown. ■■ The person is pregnant. ■■ The person is known to have diabetes. ■■ The person fails to regain consciousness after the seizure. ■■ The person is elderly and may have suffered a stroke. 7. Y ou are lifeguarding at a crowded facility and recognize a patron in the water who appears to be having a seizure. Place the following response and care steps in order. Remove the person from the water. 3 Perform a primary assessment. 4 Support the person with their head above water until the seizure ends. 1 If breathing normally, position the victim on their side and monitor airway and breathing. 5 8. You are conducting a secondary assessment on an adult patron who lost their balance on the pool deck. The patron is slurring his speech while explaining that his arm is feeling numb. What sudden illness could this patron be experiencing? A | Cardiac arrest C | Seizure B | Diabetic emergency D | Stroke 393 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. Summon EMS personnel. 2 Chapter 10 Review (continued) 9. What does FAST stand for? F Face A Arms S Speech T Time When would you use it? Use this stroke screening scale to identify and care for a victim of stroke. 10. What are a lifeguard’s objectives while waiting for EMS personnel to arrive? 1) Care for any life-threatening conditions first. 2) Help the victim rest in a comfortable position and reassure them. If there are signs and symptoms of shock, lie the person flat. 3) Monitor the victim’s condition and watch for any changes in LOC. 4) Keep the victim from getting chilled or overheated (care for shock). © 2011, 2016 The American National Red Cross. All rights reserved. 5) Care for other problems that develop, such as vomiting. SECTION C 394 Chapter 10 Review (continued) 11. The following are signs and symptoms of shock, EXCLUDING: A | Altered level of consciousness C | Restlessness or irritability B | Warm or dry skin D | Nausea or vomiting Heat Stroke 12. F ill in the blank. _________________ is a life-threatening condition that occurs when the body’s systems are overwhelmed by heat and stop functioning. List three signs and symptoms of the condition described above: Answers should include three of the following: Changes in LOC ■■ Skin that is hot to the touch ■■ Skin that is wet or dry or appears red or pale ■■ Vision disturbances ■■ Seizures ■■ Vomiting ■■ Rapid and shallow breathing ■■ Rapid and weak pulse ■■ Lack of sweating ■■ © 2011, 2016 The American National Red Cross. All rights reserved. 395 Lifeguarding | Instructor’s Manual Chapter 11 Review 1. Head, neck or spinal injuries often are caused by high-impact/high-risk activities. List three examples of high-impact/high-risk activities in an aquatic environment. Answers should include three of the following: ■■ Entering head-first into shallow water ■■ Falling from greater than a standing height ■■ Entering the water from a height, such as a diving board, water slide, an embankment, cliff or tower ■■ Striking a submerged or floating object ■■ Receiving a blow to the head ■■ Colliding with another swimmer ■■ Striking the water with high impact, such as falling while water skiing or surfing 2. Place the general rescue procedures for caring for a head, neck or spinal injury in the water in order: © 2011, 2016 The American National Red Cross. All rights reserved. Check for responsiveness and breathing. 4 Activate the EAP. 1 Perform a rescue providing manual in-line stabilization. 3 Re-assess the victim’s condition and provide appropriate care. 6 Safely enter the water. 2 Remove the victim from the water using the appropriate spinal backboarding procedure. 5 SECTION C 396 Chapter 11 Review (continued) head splint 3. Fill in the blank. The ________________________ technique is used for performing manual in-line stabilization for victims in the water. 4. Backboards are a standard piece of rescue equipment used at aquatic facilities for immobilizing and removing the victim from the water. Backboards work best when they are equipped with: 1) A chest strap to secure the victim to the board 2) A head-immobilizer device that can be attached to the top, or head-end, of the board. 5. You enter the water to rescue a victim with a suspected spinal injury. You determine that the victim is not breathing. What should you do next? A | Remove the victim from the water using the Passive Victim Extrication technique. C | Remove the victim water using a Modified Spinal Backboarding procedure. B | Remove the victim from the water using the Spinal Backboarding procedure. D | Delay removal from the water and provide 2 minutes of in-water ventilations. 6. The following statements describe appropriate rescue techniques for a victim with a suspected spinal injury, EXCEPT: C | If the victim is small and is in shallow water, you do not need to use a backboard to extricate the victim. B | If the victim is submerged, you should not use the rescue tube when submerging and bringing the victim to the surface. D | If the victim is at the surface in deep water, you may need a rescue tube to support yourself and the victim. 397 Lifeguarding | Instructor’s Manual © 2011, 2016 The American National Red Cross. All rights reserved. A | If the victim is in shallow water, you do not need to use a rescue tube to support yourself. Chapter 11 Review (continued) 7. When rescuing a victim of a suspected head, neck or spinal injury using the spinal backboarding procedure, communication with the victim is important. What should lifeguards tell the victim? Answers include: ■■ Let the victim know what you are doing. ■■ Reassure the victim along the way. ■■ Tell the victim not to nod or shake their head but instead say “yes” or “no” to answer questions. 8. Describe four ways that additional lifeguards can help during spinal backboarding and extrication from the water. © 2011, 2016 The American National Red Cross. All rights reserved. Answers should include four of the following: ■■ Helping to submerge, position, and stabilize the backboard on deck ■■ Supporting the in-water rescuer in deep water ■■ Supporting the backboard while the chest strap and head-immobilizer are secured. ■■ Securing the chest strap or the head-immobilizer device ■■ Communicating with and reassuring the victim ■■ Guiding the backboard as it is being removed from the water ■■ Removing the backboard from the water ■■ Providing care after the victim has been removed from the water SECTION C 398 Chapter 11 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERFRONT LIFEGUARDS: 1. Special considerations for spinal injuries at a facility with a beach or other zero-depth entry may include: A | Injury from board diving and extrication from deep water onto a pier high above the water. C | Injury from plunging during a running entry, in-line stabilization and extrication from extremely shallow water. B | Injury from exiting a slide and dealing with current in a catch pool. D | Injury from fall from play structure, dealing with victim’s life jacket during stabilization and extrication. 2. How should lifeguards extricate a suspected spinal injury victim who is secured to a backboard from a zero-depth or sloping entry waterfront? After reaching the zero-depth entry, the lifeguards slightly lift the head-end of the backboard, carefully pulling the backboard and victim out of the water. Gently lower the backboard and victim to the ground once out of water using proper lifting techniques to prevent injury. © 2011, 2016 The American National Red Cross. All rights reserved. 399 Lifeguarding | Instructor’s Manual Chapter 11 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS: 1. How should lifeguards extricate a suspected spinal injury victim who is secured to a backboard from a zero-depth entry wave pool? After reaching the zero-depth entry, the lifeguards slightly lift the head-end of the backboard, carefully pulling the backboard and victim out of the water. Gently lower the backboard and victim to the ground once out of water using proper lifting techniques to prevent injury. 2. When rescuing a suspected head, neck or spinal injury victim from a winding river or other moving water attraction, moving water and objects in the water can pull or move the victim. What should be done to help minimize movement and protect the victim? © 2011, 2016 The American National Red Cross. All rights reserved. Answers include: ■■ Push the emergency stop button. ■■ Ask other lifeguards or patrons for help in keeping objects and people from floating into the rescuer while they are supporting the victim. ■■ Keep the victim’s head pointed upstream. ■■ Place the victim on a backboard by following the facility’s spinal backboarding procedure. SECTION C 400 Chapter 11 Review (continued) ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC ATTRACTION LIFEGUARDS: 3. What actions should lifeguards take when responding to a victim with a suspected head, neck or spinal injury in a catch pool? ■■ ■■ ■■ ■■ Immediately signal to other lifeguards or dispatchers to stop sending riders. If possible, stop the flow of water by pushing the emergency stop button. Once in-line stabilization is achieved and the victim is turned face-up, move the victim to the calmest water in the catch pool if water is still flowing. If several slides empty into the same catch pool, calmer water usually is between two slides. Place the victim on a backboard by following the facility’s spinal backboarding procedure. 4. What challenges might you encounter when responding to a head, neck or spinal injury in a waterpark? Consider different attractions such as a wave pool, winding river, speed slide, etc. Answers include: ■■ Water movement (current or waves) ■■ Ride vehicles ■■ Tight spaces such as steps on a tower or walls on a speed slide © 2011, 2016 The American National Red Cross. All rights reserved. 401 Lifeguarding | Instructor’s Manual
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