Water Rescues

A. Active Drowning Victim

A good way for a lifeguard to prepare themselves for an active drowning victim rescue is to put themselves in the mindset of the victim. In many cases of active drowning victims, much of their basic reasoning skills no longer exist. They have one main motive, to get air to stay alive. A lifeguard should be prepared to deal with these survival instincts.

STEP 1: Activate the facility's Emergency Plan. Make sure your tube is securely at your side and always approach the victim from behind to avoid a struggle.

STEP 2: Position your arms in a hooking motion under the victim’s armpits. Make sure to secure the victim by holding on to their shoulders. Do not ball your hands up by closing your fists. Also, make sure to tell the victim that you are a lifeguard and you are there to help them, so that they may calm down.

STEP 3: Position the victim on the rescue tube by slightly leaning their body back over the tube for flotation. This will allow for easier movement of the victim in the waterand less dead weight.

STEP 4: Using strong circular kicking motions,move the victim to safety. If the victim can kick, they may assist you in reaching the edge.

STEP 5: If the victim seems to be fully conscious, do a spinning rotation so that once you reach the side of the pool, the victim may grasp onto the edge for support. Make sure to not release the victim until they are secure, especially in deepwater.

Often in the case of an active drowning victim, once the lifeguard brings the victim to the edge, they will quickly recover. In cases of a sudden cramp or simply a sudden moment of panic, their body will soon begin to recover. Assist the victim in their exit from either ladders or stairs located in the shallow end of the pool area. Stay with the victim and pay close attention to any signs or signals of illness or injury that may have been missed in your initial assessment.

B. Passive Drowning Victim

Approach on a passive drowning victim has many of the same maneuvers but in this case, we have to make sure to secure the victim's head and neck. Unlike the active drowning victim, passive drowning victims will possess no muscular strength or control in their neck and therefore will not pull their head out of the water. In securing a passive drowning victim, follow the same steps highlighted above, but make sure to slightly lean the victim's head back to one side sothat it may rest on the opposite side of the lifeguard.

It is best to remove the victim from the water by a backboard. However, when dealing with a passive victim who is not breathing and a backboard is not immediately available and waiting to remove them to the deck will delay vital care, then performing in-water ventilation with the use of an airway mask is recommended. In addition, if you have rescued a victim who is passive and is smaller than you, and a backboard is not immediately available, you may lift them directly onto the deck without the use of the backboard. However, you cannot use this method if you suspect a spinal injury, and the victim is breathing.

C. Removal from the Water

Unlike the case of an active victim who is conscious and can usually be able to remove themselves with assistance after a few minutes of rest, passive victims that remain unconscious need further attention and assistance. Although time is always important in all rescue scenarios, it is always better to do things right the first time than rush and make mistakes. As with many rescues, it is often good to have two lifeguards. This allows for the proper execution of the rescue as well as shared knowledge to ensure that it is done correctly. In these rescues, communication is key. The steps outlined below will take off where our passive/active drowning rescues left off with the victims securely at the edge of the pool deck.

STEP 1: Rescuer number 2 will come to the edge of the pool deck and grasp the wrist of the victim. Make sure to grasp the wrists, not the hands. Grasp the victim’s right wrist with your right hand, your left hand to the victim's left wrist. Make sure to have a low center of gravity so that you do not fall into the pool under the victim’s weight.

STEP 2: As rescuer number 2 secures the victim's arms, rescuer number 1 will exit the pool to retrieve the backboard. Note that since we do not suspect a spinal injury, use of straps and head immobilizers are not needed.

STEP 3: Rescuer number 2 will slide the backboard into the water on the side of the victim that matches up with whichever hand rescuer number 1 has on top of his crossed hands. If rescuer number two has their left hand on top, the board goes to the left; if their right hand is on top, the board goes to the right. It is up to rescuer number 1 to indicate which side the board should go by clearly saying “Left Side” or “Right Side.”

STEP 4: Make sure to put the board in the water feet first (narrow side) straight up and down. Rescuer number 1 will ease the board into the water until the top of the board matches up with the victim’s head (there should be about 2-3 inches of space between the top of the victim's head and the top portion of the backboard).

STEP 5: Once the board is secured in the water, rescuer number 2 will carefully rotate the victim by uncrossing his arms. Again, if the rescuer's right hand is on top, the victim is rotated (spun) to the right side. If the left hand is on top, the victim is rotated (spun) to the left side.

STEP 6: Once the victim is on the board, each rescuer will grab the wrist of the victim that is closest to them and their side of the board. Slightly pull the victim out of the water so that their body rests on the board.

STEP 7: Once the victim is evenly on the board, and both rescuers have indicated they are ready (saying I’ve got it or go) slowly pull them out to the pool deck. Make sure to gradually ease them down. NOTE: Pull any hair to the side so that it doesn’t get caught in between the board and the side of the pool. Leaving the victim on the board, the lifeguard will then conduct their primary survey assessing breathing and circulation.

Section 11

A. Passive Submerged: Deepwater

Surface Dives

Often if left unnoticed, a victim will quickly slip under the water and become submerged. Lifeguards must therefore approach the victim underwater by using a pencil surface dive. The lifeguard will simply press their legs together to perform a pencil-like figure while using their arms to force themselves underwater. Make sure to still approach the victim from behind so thattheir back is to the lifeguard’s chest.

B. Passive Submerged

If the victim is not quickly rescued, they will often slip under the water. The lifeguard must completely submerge under the water using the submerged approach technique highlighted above.

STEP 1: The lifeguard should approach the victim on the surface until there are about two feet from the victim's back.

STEP 2: Leaving your rescue tube at the surface either to the left or right side, and submerge using a surface pencil dive, submerge so that the lifeguard is at the victim’s level in the water, the victim’s back to the lifeguard’s chest. In waters less than 8 feet it is best to keep the rescue tube attached during the rescue

STEP 3: Secure the victim by reaching across the victim’s chest, under their arms with one arm. You should reach across the victim using the opposite arm opposite the side that you left the tube at the surface. (Tube to the left—grab with the right. Tube to the right grab with the left.) Make sure to secure the victim by reaching across their chest, not hooking under their armpit.

STEP 4: Once the victim is secure, kick up to the surface while pulling on the excess like of your tube with your free hand.

STEP 5: Once you hit the surface and have located your tube, grasp it about midway and force it underwater so that it floats up under the armpit of the arm that is still holding the victim. The tube will now be in between you and the victim.

STEP 6: Place your other arm over the tube so that the tube rests under both of your armpits. Reach back under the victim with a hooking motion so that you are in your rescue starting position.

NOTE: Forcing the tube underwater is often difficult. You will have to use the weight of your body to force it under your armpit between the victim and yourself. If the tube slips out of your hand, simply retry but make sure to keep the victim’s mouth above water at all times. Also, before submerging, make sure to have your excess line to one side so it does not tangle around your neck or the victims.

C. Submerged Spinal

As with all rescues, there is the fear that the victim may have ensured their head, neck, or back either from a fall or contact with the pool floor. Greater care must always be taken in these situations to ensure no further damage is done. In the case of a submerged victim with a possible spinal injury, the lifeguard must not only bring the victim to the surface but also approach and secure them with the greatest amount of care.

STEP 1: Making as little motion as possible while approaching the victim. The lifeguard should use a side stair or deck entry into the water so that they don’t make waves that may come in contact with the victim.

STEP 2: If the victim is face down, do a pencil dive down to the victim’s side and secure them using the head chin support. If you come from the right of the victim, your right hand will be on their chest. If you come from the left side of the victim, your left hand will be on their chest and your right hand on their back.

STEP 3: Once you have secured the victim, slowly kick up to the surface at an angle, rotating under the victim as you do this. The rotation under the victim and angular assent should be completed so that once you hit the surface, the victim has been fully rotated to your opposite side, face up.

STEP 4: Kick to the shallow end, supporting the victim to start backboarding for removal.

A. Shallow Water

Although the dangers of shallow water diving are well known, many times individuals do not take the warnings of No Diving. If you see anyone diving into the pool area, whether it is an adult or a child, make sure to correct this behavior immediately. If it is left untouched, other individuals may assume that it is okay for them todo the same. This will continue until someone ultimately gets injured. Although spinal injuries can occur in the deepwater due to jumping off a diving board the wrong way or slipping on the side of the pool and falling into the water, a greater hazard exists in the shallow end. Below are the rescue techniques used to secure the inline stabilization of the head and neck of the victim to ensure that no further damage is done. Keep in mind, during these rescues, the victim should have a pulse and should be breathing. If the victim does not show signs of life, advanced medical care needs to be administered immediately.

STEP 1: Approach the victim from the front so that their head is pointed toward your check making as little movement as possible.

STEP 2: Grasp the victim’s arms in between the elbow joint and the armpit. Position your hands so that the palms are facing up.

STEP 3: Once you have grasped the victim’s arms, slowly rotate the shoulders so that the arms clamp inward. Making a smaller and smaller angle (V position). Make sure to duck under the arms while clamping them inward so as not to make contact.

STEP 4: Securely clamp the victim’s arms so that they are touching the sides of the head. Slightly bring the victim to one side so that their head is directly above your elbow joint. Make sure they are not loose otherwise movement still can occur and further damage might be done.

STEP 1: Approach the victim from the side making as little movement as possible.

STEP 2: Grasp the victim’s arms in between the elbow joint and the armpit. Position your hand so that the palms are facing down this time. You should be reaching over the victim with one arm (right to right left to left).

STEP 3: Slowly close the arms so that they clamp the sides of the victim’s head and neck.

STEP 4: In a fluid forward motion, rotate the victim 180 degrees on their axis, pressing the arm closest to you underwater to rotate the victim face up. Note: Rescuers should not go underwater or change their standing position.

STEP 5: Make sure to be level with the victim in the water, continue a forward motion to keep the victim as horizontal as possible until help arrives.

NOTE: This Technique can also be used for a submerged victim in shallow water. The lifeguard will simply perform steps 2-4 underwater before bringing the victim to the surface.

STEP 1: Approach the victim from the sidemaking as little movement as possible.

STEP 2: Place the victim’s arms to their sides. Try to not push the victim underwater while doing so.

STEP 3: Place one arm underwater on the victim's back. Your forearm should be resting straight down the center of the victim’s spine. Your hand should be on the back of the victim’s head. Make sure not to place the hand on the victim’s neck.

STEP 4: Place the opposite arm straight down the victim’s chest with the hand on the victim’s chin, just below their mouth so that they may breathe. Make sure not to place the hand on thevictim’s mouth.

STEP 5: Make sure to be level with the victim in the water, their shoulder should be pressing on the center of your chest. Continue a forward motion to keep the victim as horizontal as possible until help arrives.

Head Chin Splint Face Down

STEP 1: Approach the victim from the side making as little movement as possible.

STEP 2: Place the victim’s arms to their sides. Make sure not to push the victim underwater while doing so. Step 3. Place one arm underwater on the victim’s chest. Place your hand on the victim’s chin, just below their mouth.

STEP 3: Place the opposite arm on the victim's back. Your forearm should be resting straight down the center of the victim’s spine with a hand on the back of the head.

STEP 4: Make sure the victim is secure. Rotate under the victim dunking underwater. Make sure to keep a tight splint during the rotation. When you surface, you should be on the opposite side of the victim and the victim should now be face up. It is key to maintain stabilization during the rotation so that rotation of the head or neck does not occur.

STEP 5: Make sure to be level with the victim in the water, their shoulder should be pressing on the center of your chest. Continue a forward motion to keep the victim as horizontal as possible until help arrives.

Backboarding

The above are rescue techniques used to secure the victim while in the water. What is equally important is how to safely remove the victim from the water. Since we suspect that a spinal injury may have occurred, more care must also be given in the removal. Remember, during these rescue techniques, the victim should be breathing and should have a pulse.

Communication is key. Rescuers should take their time to make sure they do not rush and make mistakes or further injure the victim.

STEP 1: Rescuer #1 should secure the victim using the head chin support. Rescuer #1 should enter the water with the backboard in hand making as little water disturbance as possible. Rescuer #2 should position themselves on the opposite side of the victim compared torescuer #1.

STEP 2: Rescuer #1 should continue a forward motion so that the victim remains as horizontal as possible. Rescuer #2 should press the board underwater using a wide grip forcing it under the victim. Rescuer #2 may move the board underwater to better position it so that the victim’s head is level with the top of the board.

STEP 3: As the board begins to rise toward the victim, Rescuer #1 must cautiously remove their head from the back of the victim and place it on the back of the board, almost a mirror image of where it once was. It is important to be very gentle during this process due to possible movement of the head and neck.

STEP 4: Supporting the victim and the board, both rescuers should move toward the edge of the pool, leaving enough space for rescuer #2 to position themselves on the edge of the pool with the head end of the board resting on their chest just above the collar bone. Keep in mind rescuer #2 should still be stabilizing the victim while moving.

STEP 5: Once the board has been positioned, rescuer #2 will take over stabilization of the head and neck by placing their forearms on the edge of the board and hands on each side ofthe head. This will allow rescuer #1 to secure the victim’s body. Rescuer #2 must also support the board by balancing the bottom with their legs. A tube can also be placed on either side of the board to help with floatation.

STEP 6: Rescuer #1 will drape the straps across the victim’s body starting from the top. The first strap will go across the victim’s chest, under their arms. The second strap goes across the victim’s waist securing the victim’s hands. The third strap goes across the victim’s thighs.

STEP 7: Rescuer # 1 will then slowly move to the opposite side of the board and click the straps starting from the bottom and working their way to the top. Keep in mind that some of the straps may be under the victim. Extreme care should be taken when extracting these straps.

STEP 8: Rescuer # 1 will now locate the two head immobilizers. Each head immobilizer will have a straight side, slanted side, and an ear hole. Make sure to use the straight side against the victim’s face. Rescuer #1 will force rescuer #2 hands out of the way to place the head immobilizers on the Velcro pads. The position may need to be adjusted depending on the position of the victim’s head in relation to the board.

STEP 9: Rescuer #1 will finally secure the head using the head and chin strap. They would be tightly secured to minimize movement of the head and neck.

STEP 1: Both rescuers should lift the head end of the board so that it rests on the side of the pool.

STEP 2: Rescuer #1 will exit the pool making as little movement as possible and position themselves at the head of the victim on the pool deck. Rescuer #2 will position themselves at the foot end of the board.

STEP 3: Slightly lifting the board, rescuer #1 will slowly pull the board out of the water withthe help of rescuer #2 pushing.

STEP 4: Once the victim’s upper body has been removed past the hips, the rescuers shouldswing the board so that it rotates to the side of the pool.

STEP 5: Begin continued assessment of the ABC until emergency assistance arrives.

Section 13

A. Escapes

Lifeguards should never enter the water without their rescue tubes. But sometimes this is not enough. The panicking and blurred mental state of overactive drowning victims can often cause them to grab onto the closest thing for floatation, whether that be a rescue tube or a lifeguard. If a lifeguard finds themselves in a situation where a victim has grabbed on to them for flotation, it is key to stay calm. If possible, give the victim the rescue tube and tow them to the nearest edge or shallow area. If it is not possible to simply give them the rescue tube and they are actively latched onto you, follow these steps:

STEP 1: Keep calm and take a deep breath. Submerge underwater. Often once air is taken out of the equation, the victim will quickly let go and return to the surface. If this does not occur, grab closest to the victims elbows as possible and try and force them up and over

STEP 2: Swim a safe distance from the victim, regain your rescue tube, and reassess the situation. If it is possibly to simply use a tube extension, do so and tow the victim to the edge. If this is not possible, retry the rescue, always coming from behind the victim and

B. Taking it to Land

Introduction to Rescue Breathing and CPR

Once the victim has been brought to safety, their vital signs should be continuously monitored until EMS assistance arrives. This includes monitoring breathing and circulation through assessing the Airway, Breathing and Circulation. If an individual stops breathing or loses their pulse, rescue breathing and CPR should be initiated to ensure that they receive adequate oxygen and blood circulation until help arrives.

We ask that you visit the Mayo Clinic First Aid website at http://www.mayoclinic.org/first-aid for further information on first aid topics and treatments.