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The Best Practices in CPR for Lifeguards

APHE7-08Every lifeguard is trained in cardiopulmonary resuscitation, or CPR, and has the certification—and very possibly the re-certification—to prove it.

But even with the most up-to-date training, the moment of actually treating a person in sudden cardiac or respiratory arrest can be unnerving. Complicating the matter is the public nature of a lifeguard's work: A victim may be poolside or at the beach, surrounded by distraught family or friends, and crowds of onlookers. The lifeguard must not only remain calm, but be able to control the crowd and initiate emergency aid—and do so in less than a minute.

Quick action in starting CPR is essential, perhaps more so than in other lifesaving measures. For each minute that defibrillation is delayed, according to the American Red Cross, the person's chance of survival diminishes by about 10 percent.

In other words, every minute counts, and you can measure by just how much with painful precision.

Here, then, are the best practices in performing CPR:

1. Initiate an Emergency Action Plan. Every lifeguard is part of a larger team, and no one should approach a life-threatening situation without alerting other members. Typically, this means giving a prearranged signal, such as a long whistle blast.  

Call for professional help, like emergency medical services (EMS).

2. Access the situation, and determine how best to begin resuscitation. The American Heart Association revised its guidelines in 2010 to make chest compressions the first of the three-part response that is CPR, and the process now goes by the acronym CAB, for Compression-Airway-Breathing.

Because the person needing a lifeguard's aid may be a victim of a near drowning or hypoxia (oxygen deprivation), however, giving two respirations before beginning compressions may be advised. A trained lifeguard will know to make the call.

3. Begin performing CPR. Lay the victim flat on a firm surface, and check for respiration and a pulse. This should take about 10 seconds, according to the ARC's lifeguarding manual. To check breathing, kneel alongside the victim and position your ear just above the mouth and nose, feeling for escaping air while looking for the chest to rise and fall. Check with two fingers for a carotid pulse at the side of the windpipe in adults (anyone 12 or older) and children (ages 1 to 12); use the brachial pulse of the inner arm for infants.

4. If a person is in cardiac arrest—unconscious, with no pulse and not breathing—begin with chest compressions, followed by ventilation. The standard is 30 compressions and two breaths, without interruption, until medical help arrives.

Follow these practices for a person in cardiac arrest:

•  Place one hand on the sternum, between the breasts, palm down. Place the other hand on top of the first and interlock your fingers. Keep your arms straight, with the shoulders over the hands. Press down, using the heel of your hand, at a steady rate of 100 compressions per minute (about the beat of the Bee Gees’ disco hit, "Stayin' Alive").

• Compression depth should be at least 2 inches for adults, about 2 inches for children and 1.5 inches for infants. Let the chest fully recoil after each compression.

• If an AED (defibrillator) is available, it should be used in combination with CPR until emergency personnel take over.

5. To assist a person who is not breathing:

• Tilt the head back (unless the victim is an infant) and lift the chin or, if spinal or neck injuries are suspected, use a jaw thrust to open the airway. Remove food or other objects from the mouth. Each lifeguard should be equipped with a resuscitation mask; effectively seal the mask over the mouth and nose using both hands, and blow into the valve. (If no mask is available, pinch the nose and seal your mouth over the victim's mouth, then breath out.)

• Each ventilation should last for about one second; watch for the victim's chest to rise and fall before the next is given.

• If the person has a pulse but has stopped breathing, ventilations should be given for two minutes. Pause for 10 seconds to check if breathing has resumed before continuing for another two minutes.

Two- or three-person CPR is the most effective—another good reason for alerting the lifeguard team—with one to two rescuers giving ventilations while the other does compressions. Rescuers should switch positions every two minutes to avoid fatigue and, the Red Cross notes, take less than five seconds to do so.

Remember, every minute counts.

GraceFrankGrace M Frank is a freelance editor and writer, and the owner of Frank Communications, She worked for many years as a reporter and staff editor at leading newspapers, including The New York Times, the International Herald Tribune, and The Tampa Tribune, where she covered education, government, and health issues. She holds a bachelor’s degree from Rutgers University in political science and a master’s from the University of Chicago in international relations. In her free time, she enjoys bike riding, books, good food, and blogging.

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