Assessing the efficacy of rescue equipment in lifeguard resuscitation efforts for drowning

doi:10.1016/j.ajem.2015.12.006

The American Journal of Emergency Medicine

Volume 34, Issue 3, March 2016, Pages 480-485

https://doi.org/10.1016/j.ajem.2015.12.006 Get rights and content

Abstract

Purpose

The whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance.

Method

A controlled trial was conducted to study the time effect of 4 different rescue techniques and assess CPR quality, along with the physiological effects of each rescue technique (blood lactate and subjective Borg's scale effort perception) on 35 lifeguards.

Results

Among the final sample subjects (n = 23), a total of 92 rescues were completed. Total water rescue time was longer without equipment (NE). The total rescue time was significantly lower using RB (P < .001). Similar good quality of CPR before and after water rescue was observed in all trials (P > .05), although correct ventilations represented less than 50% of total in all trials. Blood lactate increased after all rescues. The subjective effort Borg's scale showed significantly less effort using RB vs without equipment, fins, and fins and rescue tube.

Conclusion

The use of propelling and/or floating equipment saves precious time with repercussions in the reduction of drowning mortality and morbidity. The RB offers a significant advantage. Lifeguards need more CPR training, especially considering the importance of efficient ventilations for drowning victims.

Introduction

Drowning is a leading global killer, particularly among children and young adults. Worldwide, there are approximately 42 drowning deaths every hour, every day [1]. This number highly underestimates the real figures, even for high-income countries [2].

The whole drowning process, from immersion to cardiac arrest, usually occurs within seconds to a few minutes [3]. Therefore, an early and effective rescue may stop the drowning process and prevent the majority of initial and subsequent water aspiration, the respiratory distress, the need to resuscitation, and the medical complications.

Drowning involves principles and interventions that are rarely or not found in any other medical situations. That is stated in the “drowning chain of survival” [4], which refers to a series of water safety interventions. Its third ring refers specifically to the benefits and the importance of providing flotation to the victim stopping the drowning process as early as possible.

It is worldwide accepted that lifeguards would do a fastest, safest, and harmless rescue, both to himself and to the victim, if using rescue equipment [5]. Currently, several water rescue equipment are available providing safety for the rescuer and may impact positively the time to rescue and consequently the victim's outcome. Its choice and use are based on lifeguard's expert opinions and local practices. Based on nonscientific but best practice concepts, many different pieces of rescue equipment have been used to speed up the rescue. The most common water rescue equipment in use are fins (F), rescue tube (T), and rescue board (RB), used by lifeguard services as a personal floatation device to provide to the victim during a water rescue [6], [7], [8] but not much is known about the specific efficiency of each equipment. Scientific evidence is needed to fill those knowledge gaps [5].

Our objective was to compare in a quasiexperimental trial, a water rescue performed by surf lifeguards with and without equipment, to evaluate the most efficient—the safest equipment with lower rescue time—as well as to assess the effects of each rescue technique on lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance—tireless.

Section snippets

Materials and methods

A controlled trial was conducted to study the effect of 4 different rescue techniques with and without lifesaving equipment and to assess CPR quality, along with the physiological effects of each rescue technique on lifeguards.

Demographic data

From the 35 lifeguards recruited, 11 were excluded because of not having completed 1 of the 4 rescues or 1 of the 5 CPR trials. The final study sample (n = 23) consisted of 21 men (91%). Mean age was 30 ± 6.77 years; height, 177 ± 10.0 cm; weight, 76 ± 7.72 kg; and BMI, 24.12 ± 2.02 kg/m². There was no significant age difference between men and women, only in height (P < .001) and weight (P = .02) (Table 1).

Cardiopulmonary resuscitation quality

Results of CPR quality variables at baseline and after each water rescue trial are shown

Discussion

In drowning, the safer and faster a rescue is accomplished, the better to prevent the asphyxia and decrease the severity of outcomes. To achieve this goal, several pieces of equipment that improve floating and/or reduce rescue times have been recommended and are available for use by surf lifeguards [5], [17], [22]. Rescue material can support floating (RT), provide propulsive (F), or have mixed functions (such as RB).

Our study, conducted under controlled and simulated conditions, using 4

Conclusions

The use of propelling and/or floating equipment saves time during water rescue, entailing saving more lives. The use of any equipment is better than no use. Among the use of rescue equipment, the RB offers a significant advantage when compared with F or FT under studied conditions. Water rescue is a demanding effort even for trained surf lifeguards, regardless of the rescue technique applied. However, this is not a handicap to perform good-quality CPR after rescue. Still, lifeguards need more

Conflict of interest statement

No conflicts of interest to be declared.

Acknowledgments

We would like to thank all lifeguards and instructors involved in this trial and Ana Catarina Queiroga, Manuela Sestayo Fernandez, and Violeta González Salvado for helping in the review.

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A technique called in-water resuscitation (IWR) was devised on a surfboard to ventilate persons who seemingly did not breathe upon a water rescue. Despite IWR still raises uncertainties regarding its applicability, this technique is recommended by the International Liaison Committee for Resuscitation (ILCOR). Thus, this study aimed to evaluate the feasibility of IWR with a rescue board before and during towing and, to compare rescue times and rescue-associated fatigue levels between rescues with rescue breath attempts and without (SR).
A randomized crossover pilot test was conducted: 1) IWR test with pocket mask and, 2) Conventional SR test. IWR tests were conducted using a Laerdal ResusciAnne manikin (Stavanger, Norway). Three groups of variables were recorded: a) rescue time (in s), b) effective ventilations during rescue, and c) rating of perceived effort (RPE).
Focusing on the rescue time, the performance SR was significantly faster than IWR rescue which took 61 s longer to complete the rescue (Z = −2.805; p = 0.005). No significant differences were found between techniques for the RPE (T = −1.890; p = 0.095). In the IWR analysis, lifeguards performed an average of 27 ± 12 rescue breaths.
The application of IWR on a rescue board is feasible both at the time of rescue and during towing. It shortens the reoxygenation time but delays the arrival time to shore. Both IWR and SR result in similar levels of perceived fatigue.
Surfers as aquatics rescuers in Portugal and Spain: Characteristics of rescues and resuscitation knowledge
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The aim of this study was to analyze the rescues carried out by surfers from Portugal and Spain, their knowledge of rescue and resuscitation and their perception and risk behavior while surfing. An online survey was conducted in 2048 surfers from Portugal and Spain, with questions regarding the demographic characteristics, experience, perception and risk behavior of the surfers; rescues attended by the surfers and surfer's knowledge and experience in rescue and resuscitation. Concerning the number of rescues carried out by surfers, 78.5% of the participants had to carry out at least one rescue in their lifetime. A significant association was found between the years of surfing experience, the surfing level and the number of rescues carried out (p < 0.05). Thirty-five-point eight percent of the surfers never attended a cardiopulmonary resuscitation (CPR) course and 76.2% had no work experience as a lifeguard. Correspondingly, the vast majority of the surfers analyzed did not have the essential knowledge about rescue and resuscitation. This study provides evidence of the important role that surfers play in saving lives on Portuguese and Spanish beaches. The results suggest that the number of rescues conducted by surfers each year in Portugal and Spain is relevant to reducing the number of fatalities that occur along coasts.
Does a short intervention with vibration foam roller recover lifeguards better after a water rescue? A pilot study
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The aim of this study was to analyze the effects of a recovery program based on foam roller with and without vibration on blood lactate clearance and perceived fatigue after a water rescue.
A quasi-experimental crossover design was carried out to compare passive (PR) recovery and a short protocol of foam roller (FR) and vibration foam roller (VFR) recovery after a 100 m water rescue in 7 volunteer lifeguards. Blood lactate and perceived exertion were measured before and after the rescue, and also after the 5-min recovery intervention.
Blood lactate levels decrease significantly with foam roller (p = 0.013; effect size = 0.97) and vibration foam roller recovery (p < 0.001; effect size = 1.62). Passive recovery did not show significant differences clearing out blood lactate. Fatigue perceived decrease significantly with all the recovery methods, but foam roller has higher effects on the global fatigue and VFR on the legs.
FR and VFR clear out more blood lactate and decrease fatigue more than PR, with the subsequently increase of the physical conditioning to perform another effort.
Lay-rescuers in drowning incidents: A scoping review
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Many victims of drowning fatalities are lay-people attempting to rescue another. This review aims to identify the safest techniques and equipment (improved or purpose made) for an untrained bystander to use when attempting a water rescue.
A sample of 249 papers were included after the bibliographic search, in which 19 were finally selected following PRISMA methodology and 3 peer review proceeding presented at international conferences. A total of 22 documents were added to qualitative synthesis.
Geographical location, economic level, physical fitness, or experience may vary the profile of the lay-rescuers and how to safely perform a water rescue. Four lay-rescuers profiles were identified: 1) Children rescuing children in low- and middle-income countries (LMICs), 2) Adults rescuing adults or children, 3) Lay-people with some experience and rescue training, 4) Lay-people with cultural or professional motivations. Three types of techniques used by those lay-rescuers profiles: a) non-contact techniques for rescues from land: throw and reach, b) non-contact techniques for rescue using a flotation device and, c) contact techniques for rescue into the water: swim and tow with or without fins.
The expert recommendation of the safest technique for a lay-rescuer is to attempt rescue using a pole, rope, or flotation equipment without entering the water.
However, despite the recommendations of non-contact rescues from land, there is a global tendency to attempt contact rescues in the water, despite a lack of evidence on which technique, procedure or equipment contributes to a safer rescue. Training strategies for lay-people should be considered.
Measuring the physiological impact of extreme heat on lifeguards during cardiopulmonary resuscitation. Randomized simulation study
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Citation Excerpt :
Following the values of Foster et al. [25], in the hyperthermic environment, they perceived CPR as “hard”, while in the thermoneutral environment it was “somewhat hard”. RPE using perceived stress scales is a widely used tool with high validity to quantify exercise intensity [37] and is commonly used in resuscitation studies with rescuers [13,30,38,39]. During exercise, numerous physiological mechanisms of heat loss are activated to prevent excessive core temperature increases, but in hot and humid environments this can be a challenge in body thermoregulation [40].
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A randomized quasi-experimental cross-over design was used to test physiological lifesaving demands (50 min acclimatization +10 min CPR) in two different thermal environments: Thermo-neutral environment (25 °C) vs Hyperthermic environment (37 °C).
The data obtained from 21 lifeguards were included, this covers a total of 420 min of resuscitation. The CPR performance was constantly maintained during the 10 min. The Oxygen uptake (VO 2) ranged from 17 to 18 ml/min/kg for chest compressions (CC) and between 13 and 14 ml/min/kg for ventilations (V) at both 25 °C and 37 °C, with no significant difference between environments (p > 0.05). The percentage of maximum heart rate (%HR max) increased between 7% and 8% at 37 °C (p < 0.001), ranging between 75% and 82% of HR max. The loss of body fluids (LBF) was higher in the hyperthermic environment; LBF: (37 °C: 400 ± 187 g vs 25 °C: 148 ± 81 g, p < 0.001). Body temperature was 1 °C higher at the end of the test (p < 0.001). The perceived fatigue (RPE) increased by 37° an average of 2 points on a scale of 10 (p = 0.001).
Extreme heat is not a limiting factor in CPR performance with two lifeguards. Metabolic consumption is sustained, with an increase in CC, so V can serve as active rest. Nevertheless, resuscitation at 37 °C results in a higher HR, is more exhausting and causes significant loss of fluids due to sweating.
Is it feasible “scoop and run while playing” resuscitation on a rescue water craft? A randomized simulation study with lifeguards
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Citation Excerpt :
Contrary to our initial hypothesis and the expected results, on the RWC the CCs were not greatly affected by the speed, and we obtained values higher tan 86% in all tests. It has been accepted that a mínimum score of 70% [5–7,13] is an appropriate indicator of resuscitation quality; however, there have been different interpretations of this value, usually based on the limitations of the measuring instruments. Trained lifeguards exceed 70% (E-CPR and Q-CPR) in almost all the study situations, while non-trained lifeguards never reach this percentage.
Response time is a predictive factor for survival of drowning victims and lifesaving. Rescue Water Craft (RWC) are lifeboats very common in lifeguards operations. The aim of this study was to analyze the feasibility of providing effective mouth-to-mouth ventilations and/or cardiopulmonary resuscitation (CPR) on the RWC while sailing at different speeds.
A quasi-experimental cross-over block design was used to test during one minute efforts the effectiveness of Mouth to Mouth ventilation (MM-only) and CRP, at the beach and sailing at two diferents speeds 5 knots(kn) and 10 kn with calm sea. Quality CPR reference were 2015 ERC guidelines.
The data obtained from 13 lifeguards were included, that means that 78 resuscitation test were completed. The MM-only performance skills reached 69.7% ± 40.4 for 5 kn and 60.0% ± 41.8 for 10 kn (p = .59). For full CPR, performance was 74.4% ± 24.2 and 68.5% ± 23.9 respectively. Quality of MM and CPR decreased, not significantly, while sailing at 5 kn and 10 kn [(Q-MM; 5 kn: 59.9% ± 37.8 vs. 10 kn: 43.2% ± 41.4, p = .42)(Q-CPR; 5 kn: 64.8% ± 21.2 and 10 kn: 60.6% ± 21.0, p = .44)]. MM-only and CC variables were significantly worse on RJS when compared with resuscitation at the beach (p < .05). A trend for better results by lifeguards previously training on RJS was observed.
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Original ContributionAssessing the efficacy of rescue equipment in lifeguard resuscitation efforts for drowning

Abstract

Purpose

Method

Results

Conclusion

Introduction

Section snippets

Materials and methods

Demographic data

Cardiopulmonary resuscitation quality

Discussion

Conclusions

Conflict of interest statement

Acknowledgments

Resuscitation

Am J Emerg Med

Resuscitation

Resuscitation

Resuscitation

Am J Emerg Med

Wilderness Environ Med

Resuscitation

Global report on drowning: preventing a leading killer

Australian Policy Online

Quality of cause-of-death reporting using ICD-10 drowning codes: a descriptive study of 69 countries

BMC Med Res Methodol

Drowning

N Engl J Med

Original Contribution
Assessing the efficacy of rescue equipment in lifeguard resuscitation efforts for drowning