National Lifeguard

National Lifeguard Pool & Waterpark

Candidate Workbook

June 2015 Edition July 2018 Edition BC & Yukon Branch

A Supplemental Resource for NL Candidates

National Lifeguard Candidate Workbook

Published by the Lifesaving Society, BC & Yukon Branch 112 – 3989 Henning Drive Burnaby, BC, Canada V5C 6N5 Phone 604.299.5450; Fax 604.299.5795 Email: [email protected]; Website: www.lifesaving.bc.ca Fifth edition: June 2015 Copyright 2009 by the Royal Life Saving Society Canada. Reproduction, by any means, of materials contained in this book is prohibited unless authorized by the publisher. Direct inquiries can be made to the Lifesaving Society office. ________________________________________________________________________ The Lifesaving Society is Canada’s lifeguarding expert. The Society works to prevent drowning and water-related injury through its training programs, Water Smart® public education initiatives and aquatic safety management services.

Annually, the Society certifies over a million Canadians in its swimming, lifesaving, lifeguarding, and first aid training programs − including Canada’s lifeguards.

The Society is an independent, charitable organization educating Canadian lifesavers since the first Lifesaving Society Bronze Medallion Award was earned in 1896.

The Society represents Canada internationally as an active member of the Royal Life Saving Society and the International Life Saving Federation, and is the governing body for lifesaving sport − a sport recognized by the International Olympic Committee.

_________________________________________________________________________

Registered Charity No. 119129039 RR0001 Lifesaving Society®, Swim to Survive®, and Water Smart® are registered trademarks of the Royal Life Saving Society Canada. Trademarks other than those owned by the Lifesaving Society used in this document belong to their registered owners.

Lifesaving Society BC & Yukon: NL Candidate Workbook 1

TABLE OF CONTENTS

Lifeguarding Techniques………………………….………………………………….……..... 3 Scanning & Observation………………………………………................................. 3 Scanning Zones………………………………………………………………... 3 Systematic Scan Pattern……………………………………….……….……… 3 The 10:30 Scanning Window….…………………………………………….. 4 Scanning the Bottom…..…………………………………...…………….…… 4 Positioning………………………………………………………..……………………. 4 Movement…………………………………………………………….….…………….. 5

Principles of Public Relations………………..…………………......................................... 6 Basic Public Relations……….............................................................................. 6 Complex Public Relations……………….............................................................. 6

Lifeguards & Rescue Aids……………………………………………………........................ 8 Use of rescue aids……….................................................................................... 8 Carrying the rescue aid……………….................................................................. Entries with a rescue aid……………………………………………………………… Placement of the rescue aid – conscious victim……………………………………. Placement of the rescue aid – unconscious victim………………………………….

8 9 9 10

2015 Resuscitation Standards………………………......................................................... 11 The 2015 CPR Standards…………………………………….................................... 11 Effective CPR……………………………………………………………….………….. 11 Spinals & Airway Management……………………………..................................... 12 Conscious Obstructed Airway Procedures……………………………………..……. 12 First Aid Updates…………………………………………………………………..….. 12 Victim Positioning…………………………………………………………….. 12 Treatment of Severe Bleeding……………………...…………………………. 12 Heat-Related Injury……………………………………………………………. 12 Vomit versus Regurgitation…………………………………………………… 12

Automated External Defibrillators……………………….………………………………….. 13 Components of an AED……………..…………….................................................. 13 AED Operation Principles……………..……………………………………………… 13

Drowning Physiology…………………………………………………………………………. 14 Progression……………………............................................................................. 14 Signs & Symptoms……………….……………………………………………………. 15 Treatment – Responsive Victim……………………............................................... 15 Treatment – Unresponsive Victim ……………….…………………………………. 15

Management of a Drowning Non-Swimmer………………………………………………... 16 Management of a Responsive Drowning Non-Swimmer Flowchart....................... 16

First Aid – Chest Pain………………………………........................................................... 17 Signs & Symptoms………….................................................................................. 17 Treatment……………........................................................................................... 17 Medication……………….…………………………………………………………….. 18


First Aid - Anaphylaxis………………………..……………………………………………….

19

Signs & Symptoms………….................................................................................. 19 Treatment……………........................................................................................... 19 Medication……………………………………………………………………………... 20 The EpiPen…....................................................................................................... 20 The Allerject…..................................................................................................... 21

First Aid – Oxygen Therapy………………………..…………………………………………

22 Oxygen Therapy………….................................................................................... 22 Oral Airways………............................................................................................. 23 The Oxygen Unit………………………………………………………………………. 24

Lifeguard & the Law…………………..……………………………………………..………... 25

2010 BC Pool Regulation…………………………………………………………..…………. 27

WHMIS – What Lifeguards Need to Know…………………………………..…..………….

29 Three Key Elements…………................................................................................ 29 Responsibilities………………………………………………………………………… 30

Swimming Pool Disinfection………………………..………………………………………...

31 Recreational Water Illnesses…………................................................................... 31 Disinfection……………........................................................................................ 31 pH…………………………………..…………………………………………………... 32

Simulation First Aid Form………………………………………..………………..………….

33

Legend

SFA Standard First Aid

CFAM Canadian First Aid Manual

CLM Canadian Lifesaving Manual

Feedback

To ensure quality control of NL programs, the Lifesaving Society uses course feedback forms as an evaluation tool for the NL program and its Instructors. To submit feedback on your NL course, visit the website at www.lifesaving.bc.ca (click Training Programs – Course Feedback).

Join us on facebook through the website at www.lifesaving.bc.ca

References training videos on the Lifesaving Society YouTube site

References approved on-line resources

http://www.lifesaving.bc.ca/

http://www.lifesaving.bc.ca/


Starburst Scan Pattern

Arcing Scan Pattern

Zig-Zag Scan Pattern

EXTENSIVE Lifeguards share the entire area

equally, scanning globally

INTENSIVE Lifeguards are responsible for a

specific area or “zone”

LIFEGUARDING TECHNIQUES SCANNING & OBSERVATION (Alert: Lifeguarding in Action, Chapter 2/Alert Insert)

Scanning is the systematic visual observation of the facility, its patrons and their activities. Effective scanning is the foundation of the lifeguard surveillance system and must be continuous to be effective. Effective scanning includes:

• The ability to recognize hazardous behaviours, activities and victim types.

• Having a predetermined scanning zone, pivot position and movement zone.

• Having a systematic scan pattern to ensure complete coverage.

• The application of the 10-30 Scanning Window.

• Scanning the bottom.

Lifeguards must ensure that other duties do not distract or interfere with pool surveillance (such as moving lane ropes, talking to other guards or patrons, etc).

• Lifeguards should use all of their senses including direct vision that includes head movement, peripheral vision and hearing.

Scanning Zones Predetermined scanning zones are selected based on:

• The number of patrons, their age and activities.

• The number of lifeguards and their locations.

• Facility design and layout.

• The supervision zone shape and size.

• Blind spots, glare, lighting conditions, etc.

A lifeguard can be responsible for a designated section (or zone) or for the whole pool space.

Systematic Scan Pattern Lifeguards must use a systematic scan pattern in order to effectively supervise their designated zone and to ensure complete coverage.


• Areas of bather congestion

• Fixed and portable equipment

• Hot tubs, saunas and steam rooms

The 10-30 Scanning Window According to the NL standard, a lifeguard should be able to effectively scan an assigned zone within a window of 10 to 30 seconds.

If a lifeguard is unable to effectively scan their whole zone in less than 30 seconds, then the size of the zone would need to be adjusted and another lifeguard would be required in the rotation. This is done to ensure public safety as most drownings occur in less than 30 seconds.

A 30 second scan must take in:

• The surface, middle and bottom of the pool basins

• Hazards, blind spots, pool basin edges and corners

• Other lifeguards on duty

Scanning the Bottom The slightest disturbance on the surface of the water will distort the view of the bottom. Swimmers often find bodies on the bottom before lifeguards because they have their faces just below the surface (Tom Griffiths/Aquatic Safety Research Group – From the Bottom Up/2006). It is for this reason that:

• The bottom of the pool, not the surface, must be prioritized during visual scanning.

• An immediate in-water search with mask or goggles must be performed by a minimum of one lifeguard for any missing person (regardless of age) last seen in or around the pool area. A water search may be initiated by a member of the lifeguard team before the pool is cleared.

• Lifeguards must be taught to respond immediately to any unusual shadows, smudges or dark objects below the surface, without hesitation. When in doubt, fish it out.

POSITIONING (Alert: Lifeguarding in Action, Chapter 2/Alert Insert)

Positioning – General

The pivot point is a stationary position often located where a lifeguard can see the majority of their designated zone or in high traffic or hazardous areas.

• Locate pivot points where majority of zone can be seen, thus reducing the amount of movement required to achieve the 10-30 scanning window.

• This spot should be used as a set position from which the lifeguard would start and finish a scanning and movement cycle.

Stationary guards (in towers or chairs) need to be complemented with roving lifeguards who can deal with prevention (public relations) and move to cover high traffic or hazardous areas and blind spots.


Positioning – Waterparks The pivot guard system is one method of organizing lifeguards on deck. The system is useful when there are four or more lifeguards on duty or when guards cannot maintain visual contact with one another because of blind spots (details in the “Insert” section at the front of the Alert: Lifeguarding in Action manual). The pivot guard – the person who plays a central role in coordinating the team – has three key responsibilities:

• To ensure that there is adequate supervision (scanning coverage) of all areas.

• To ensure that appropriate back-up responds to any given incident.

• To close certain areas/pools if adequate supervision cannot be maintained.

MOVEMENT (Alert: Lifeguarding in Action, Chapter 2/Alert Insert)

Movement While Lifeguarding Movement is required to observe blind spots, hazard areas and hot areas not seen in the systematic scan pattern from the pivot point. Movement must occur often in order to effectively scan a designated lifeguarding zone.

• Lifeguards should alternate stationary scans (from the pivot) and moving scans.

• Movement and scanning should occur together.

• Lifeguards need to adjust their body position while moving around the deck to ensure that their back is not facing the water.

Movement & On-deck Rotation When multiple lifeguards are required, they will often rotate between positions to provide relief.

• These rotations can occur every 15-30 minutes.

• Start with the hardest position (entering the rotation) and end with the easiest position (just before leaving the deck).

• “Bumping” lifeguard conversation should be limited to 10 seconds with both lifeguards simultaneously observing the scanning zone.

Movement & Off-deck Rotation When a lifeguard is relieved of supervision duties, they should walk the perimeter of all pool basins (checking the edges and bottom) before leaving the pool deck.

• Hot areas should be checked during each rotation.

• Lifeguards should be rotated off the deck within reasonable time frames to allow for recovery and assist in maintaining vigilance when on the pool deck.


PRINCIPLES OF PUBLIC RELATIONS Lifeguards have a responsibility to educate patrons and in turn the community about the hazards and risks associated with water-related activities. Their goal should be to help patrons to be safe in, on and around the water.

It is important to note that lifeguards may have to address more complex ‘Public Relation’ or ‘PR’ concerns that go beyond the scope of pool-related safety issues. As such, it is important that lifeguards apply the principles of handling a PR when addressing patron questions, complaints or behaviour. Lifeguards must use their judgement and experience to differentiate between basic and complex PR situations.

BASIC PUBLIC RELATIONS These would include situations that deal with pool safety issues or a patron’s ability to follow pool guidelines and facility rules. Such activities might include running on the pool deck, diving into shallow water, spitting into pool gutters or shaving in the sauna.

When dealing with basic PRs, lifeguards should use the principle of Stop, Educate and Redirect:

• Stop the unsafe or inappropriate behaviour,

• Educate the patron about why that behaviour is unsafe, unsanitary, etc.

• Redirect the patron to an alternate activity that is safer or more appropriate.

COMPLEX PUBLIC RELATIONS These could include religious, sexual or legal issues such as a patron swimming with a Kirpan (religious or ceremonial dagger), a topless swimmer, or breastfeeding on the deck.

It is important to note that lifeguards are not experts in law, and may experience PRs that challenge their own views and beliefs. Lifeguards must follow employer policies, procedures and expectations when dealing with complex situations. Working as a lifeguard requires exceptional communication skills. Utilizing the following skills can be helpful when dealing with complex PRs or if a patron is upset.

• Listen to what the patron is saying and periodically put the speaker's message into your own words (don’t interrupt – let them finish speaking first). This shows the patron that you are listening and gives them an opportunity to correct any misunderstandings. For example, "I just want to make sure that I'm following you correctly. When you first spoke you said...and then this happened, and then so-and-so did such-and-such, and you felt...and now you want...have I got it right?"

• Empathize/Reflect by looking at the situation from the patron’s point of view (try to understand where they are coming from). Reflecting acknowledges and validates the speaker’s feelings and lets the speaker know that their feelings are normal and understandable (e.g. “It sounds like that frightened you.” or “You seem to be feeling angry towards that person.”).


• Redirect/Problem Solve can include redirecting patrons to another staff member or other source of information (front desk, supervisor, website etc.) or problem solving on the spot if supervision is not compromised. If dealing with the situation while lifeguarding: o Be quick, clear and polite. o Remember to signal a ‘PR’ to your other guard(s) before addressing patrons. o Ensure that the facility is under proper supervision at all times. Constant scanning and

movement to check blind spots will aid in keeping conversations short and relevant. BARRIERS TO COMMUNICATION

To be an effective lifeguard, not only must you have great speaking skills but you also must be an excellent listener. Often when PR’s escalate, it is due to poor communication techniques such as:

1. Advising- Being an advice giver or saying, “I’m telling you…”

2. Comparing- “That’s not what you just said…”

3. Sparring- Picking a fight or “pushing buttons”

4. Mind Reading- Jumping to conclusions or finishing a person’s sentence.

5. Being Right- Avoid being defensive. It’s not who is right or wrong – seek understanding.

6. Rehearsing- Rehearsing your response before the person has finished speaking.

7. Derailing- Obstructing progress or changing the subject.

8. Filtering- Hearing what you want to hear.

9. Placating- Pacifying, appeasing – “Calm down!!”

10. Dreaming- Disengaging from the speaker or discussion – stay focused.

ACTIVE LISTENING EXERCISES

1. Real Life Peer Listening

With a partner, take turns telling a difficult or complicated event from your life. As you listen to your partner, sum up their experience and feelings in brief responses during the telling (integrate listening skills and emphasize/reflect from above).

2. Lifeguard PR Scenarios

While lifeguarding, a patron tells you the following situations. How do you deal with it?

• A patron can’t believe how dirty the change room is and that it’s unacceptable for it to be in such a state of disorder.

• A swimmer is frustrated with the ‘slow’ swimmers in the ‘fast’ lane and that he is NOT enjoying his swim with so many people getting in his way.

Deal with the problem, not the person. Shift from the complaint to an action plan that will resolve the situation.


LIFEGUARDS & RESCUE AIDS USE OF RESCUE AIDS As per the NL Award Guide), lifeguards must be trained on how to rescue a victim both with and without an aid. Lifeguards should carry a rescue aid when lifeguarding as:

• Trained back-up may not always be available.

• The rescuer versus victim size ratio may require additional support.

• The swimming and support ability of the rescuer may be an issue.

• Using a rescue aid effectively is a safety precaution for lifeguards.

The Lifesaving Society recommends the use of the rescue tube, rescue can, ring buoy or adult pfd as they provide sufficient newtons of buoyancy to support a large adult and often the rescuer as well. Lifeguards should not carry flutter boards or child size PFDs as a rescue aid as they have relatively low newtons of buoyancy and would not support an adult in distress.

Carrying the rescue aid Lifeguards must carry the rescue aid in such a way that they can easily access the aid in the event of an emergency.

• An adult lifejacket may be worn over one shoulder through an armhole, a strap may be clipped and slung over one shoulder, or the lifejacket can be held in one hand.

• A ring buoy may be carried rope in one hand, ring in the other, OR, ring over one shoulder and line in hand.

• A rescue can or tube may be worn with the shoulder strap over one shoulder or across the chest. The excess line is held in hand.

o Tube held around the waist for quick access and maneuverability.

o Excess rope held in hand, not crossing in front of the legs (trip hazard).

o Tube carried over the shoulder for quick access and maneuverability.

o Excess rope held in hand, not crossing in front of the legs (trip hazard).


Entries with a buoyant rescue aid Entries may be feet first or head first depending on the facility design, location around the pool, obstructions, water conditions, depth and victim’s condition. Lifeguards must enter the pool with caution and concern for their safety and the safety of the victim and other patrons. The buoyant rescue aid can be held (foot first entry) or let down to the deck (dive entry) before entry. The rescue aid should not be thrown into the water (loss of control) or tossed off to the side (get caught on fixed or portable deck equipment) before entry. If holding the rescue aid, be aware of the impact of the water and control the aid to allow a quick approach to your victim.

Placement of the rescue aid – conscious victim If the buoyant aid is trailing behind you on your approach, time your contact with the victim so you can retrieve the aid and extend it to the victim in a timely manner. Always approach the victim in such a way that they are unlikely to grasp you.

Option 1

If the victim is able to grasp the aid (e.g. a distressed swimmer) the lifeguard can extend the rescue aid to the victim (in-water reaching assist).

Option 2

From behind, grasp the victim around the waist with one arm and use your free hand to bring the rescue aid to the front of the victim.

Option 3

From behind, the rescuer will slip their arms under the victim’s armpits while keeping the aid between the rescuer and the victim.


Placement of the rescue aid – unconscious victim Using an adult lifejacket, the rescuer will put both arms through the lifejacket arm holes so that the lifejacket is inside out. If you have larger/longer arms, keep elbows out of the arm holes. Approach the victim so that your shoulders are aligned with theirs and grasp them in a modified carry. Using a pendulum maneuver, return in the direction you came from bringing the victim into a face-up position. You can remain in a modified carry or switch into another control carry if needed.

With the rescue tube across your chest and under your arms, approach the face-down victim so that your shoulders are aligned. Grasp the victim in a modified carry and using a pendulum maneuver, return in the direction you came from bringing the victim into a face-up position. The victim will now be floating on the rescue tube. You can then switch into another control carry if needed (ensure that the rescue tube ends remain under the victims armpits).

Lifeguards are encouraged to watch the Rescue Tube Demonstration videos on the Lifesaving Society YouTube site.

Once the victim is on the rescue tube, the lifeguard can provide rescue breaths in shallow water provided they can manage complications.


2015 RESUSCITATION STANDARDS

THE 2015 CPR STANDARDS

• Candidates will check for breathing, if a person is not breathing or not breathing normally, they will immediately start CPR with chest compressions.

• If there is a history of submersion, the rescuer will start with 2 rescue breaths due to the hypoxic nature of the incident.

• Lifeguards are encouraged to watch the Resuscitation video series on the Lifesaving Society YouTube site.

.

EFFECTIVE CPR Effective compressions are essential for providing blood flow and can significantly increase survival rates. The following changes have been implemented to ensure high quality, effective CPR:

Depth Landmarking Notes Adult (8 years +)

5-6 cms or 2-2.4 inches

The centre of the chest between the nipples.

100-120 compressions per minute for all age groups. The rescuer must allow the chest to fully recoil (fully rise) after each compression. The maximum delay in CPR should be about 10 seconds (AED analysis or to switch compressors).

Child (1-8 years)

1/3 the anterior-posterior diameter of the chest (about 5cm or 2 inches)

Infant (0 to 1 year)

1/3 the anterior-posterior diameter of the chest (about 4cm or 1.5 inches)

Two fingers on the lower half of the sternum (one finger width below the nipple line).


SPINALS & AIRWAY MANAGEMENT As per the national standard, a jaw thrust will be used to open the airway on a spinal-injured victim.

• Lifeguards can initially attempt the jaw thrust (no head extension) to open the airway of an unresponsive trauma victim with suspected cervical spine injury.

• If a jaw thrust without head extension does not open the airway, reposition to the jaw thrust/head extension or head tilt/chin lift technique as opening the airway remains a priority.

Lifeguards are encouraged to watch the breathing/non-breathing flatboard/slantboard Spinal Rescue video series on the Lifesaving Society YouTube site.

CONSCIOUS OBSTRUCTED AIRWAY PROCEDURE Each province and major training agency has different procedures to deal with a conscious victim with a severe airway obstruction. The BC & Yukon Branch has adopted the following procedures:

• Alternating 5 abdominal thrusts and 5 back blows for adults and children

• Alternating 5 chest thrusts and 5 back blows (if possible) for obese or pregnant victims

• Alternating 5 back blows and 5 chest thrusts and for infants

FIRST AID UPDATES Victim Positioning When a victim is left unattended or is breathing on their own, they should be placed in the recovery position in order to maintain a patent airway.

• Victims with a suspected spinal injury should be left in the position found unless normal breathing can not be assessed. If breathing can not be assessed, the victim should be rolled supine.

Treatment of Severe Bleeding Bleeding is controlled by applying firm and direct pressure - elevation is no longer recommended as it reduces the amount of pressure applied and can aggravate other injuries (fractures).

Heat-Related Injury Electrolyte drinks (sport drinks) can be used in the treatment of heat exhaustion. For alert victims of suspected heat stroke, immersion in cold water is the initial recommended treatment. If the victim is not alert the application of wet towels, dousing with water, sponging, etc. would be appropriate.

Vomit versus Regurgitation Research has shown that lay rescuers are unable to accurately tell the difference between vomiting and regurgitation, as such, rescuers are encouraged to reassess the victim only if they are starting to show more obvious life signs (e.g. consciousness, adequate breathing or purposeful movement).

• If there is fluid (saliva and/or foam) coming out of the mouth during compressions, continue CPR and clear the airway prior to giving the 2 rescue breaths. Do not reassess ABCs!

• If there is a large amount of vomitus (fluid containing particulate), rescuers will stop compressions, clear the airway then resume CPR. Do not reassess ABCs!

Lifeguards are encouraged to watch the Vomit versus Regurgitation video on the Lifesaving Society YouTube site.


AUTOMATED EXTERNAL DEFIBRILLATORS To give the victim the best chance of survival, activation of EMS, provision of CPR and operation of an AED must occur within the first moments of a cardiac arrest. For every minute that passes between collapse and defibrillation, survival rates decrease by 7% to 10%. Even minimal AED training has been shown to improve survival rates.

COMPONENTS OF AN AED All AED models have the same basic operating components to include:

• A POWER button • A SHOCK button • A set of ELECTRODE pads • PROMPT screen or symbols

AED OPERATION PRINCIPLES

• The first thing a rescuer should do is turn on the POWER button. The unit will prompt the rescuer on how to use that particular model of AED, so listen carefully to the instructions.

• The electrode pads must be properly positioned as they can only be applied once. o All clothing on the upper body must be removed for landmarking and pad application. o Shave chest so pads stick to the skin not the hair. o Wipe off water or sweat before putting on the pads.

• Water and/or wet environment o Remove the victim from freestanding or still water. o If removing a victim from a swimming pool, clear the victim from the water completely

(do not leave the victims feet in the water). o Ensure that the victim’s chest is dry and that your hands are dry.

Adult Pad Placement Infant/Child Pad Placement

Unless the victim shows signs of life, the rescuer will always perform 2 minutes of CPR after a “shock” or “no shock” sequence.

The pad that attaches to the upper right hand side of the chest should not go over top of the sternum, clavicle or nipple.

The pad that attaches to the lower left hand side of the chest should wrap around the rib cage (do not place on the abdomen). This pad often has a heart symbol on it to help you identify the left side pad.

One pad attaches to the anterior chest and the other pad attaches to the back or posterior chest.


DROWNING PHYSIOLOGY

Almost 500 Canadians die every year in water-related incidents. Drowning remains the third leading cause of accidental death among Canadians under 60 years of age and the second leading cause of accidental death for children under the age of 10 (2009).

The World Health Organization (WHO) adopted new drowning definitions in 2002 to include both cases of fatal and nonfatal drowning as per the Utstein Report.

• Drowning is the process of experiencing respiratory impairment from immersion in liquid. o No Morbidity occurs when the victim has survived the immersion episode with good cerebral

performance. o Morbidity occurs when the victim has survived the immersion episode with poor cerebral

performance (to include moderately disabled, severely disabled, vegetative state/coma and brain death).

• Death by Drowning occurs when the victim has succumbed to a submersion/immersion episode.

PROGRESSION Panic Stage • The victim has entered water and realizes that they are in trouble – fear and panic sets in. • The victim is struggling to keep their head above the water and may be able to provide minimal

support to initially call for help (a distressed swimmer). • Breathing and heart rate increases thus further reducing oxygen levels in the blood. • Fatigue sets in quickly and the victim can no longer call for help as they are unable to keep their

mouth/head above the surface of the water (drowning victim).

Breath Holding Stage • The victim can no longer support themselves above the water spending the majority of the time

submerged, swallowing a lot of water and attempting to hold their breath. • During the submersion episode, all of the major body systems slow down including the heart

(diving bradycardia) and peripheral blood flow is stopped (mammalian diving reflex), minimizing the need for oxygen.

• Hypoxia (a decrease in oxygen levels in the body) sets in and acidosis (a decrease in pH) can occur due to the failure to reduce carbon dioxide levels in the blood.

Terminal Gasp Stage • A final desperate attempt to get air results in aspiration (inhalation of water into the lungs).

o In the event of a laryngospasm (spasm of the vocal cords) only a very small amount of water will enter the lungs (most common in children).

o If a larger amount of water enters the lungs, the surfactant (a soapy film that prevents the alveoli from sticking together or collapsing) gets washed off of the alveoli and pulmonary edema (excessive fluid in the alveoli and resulting swelling of the lung tissue) will set in further reducing the oxygen levels in the body.

o The victim asphyxiates (suffocates) and anoxia (total lack of oxygen in the body) sets in.

Unresponsiveness • If rescue is not initiated, unconsciousness can occur in as little as/or less than 45 seconds.


SIGNS & SYMPTOMS It is important to note that a history of submersion needs to be determined and that the symptoms can present immediately OR be delayed by several hours or days.

• Signs and symptoms of drowning can include: o Shortness of breath and/or difficulty breathing o Coughing or wheezing o Nausea and/or vomiting o Shock symptoms (weak/rapid pulse and pale/cool/clammy skin) o Coughing up a whitish or pink frothy sputum (this is a severe symptom; the victim is

generally unresponsive and requires resuscitation) o An altered level of consciousness and/or a significant change in behaviour o Extreme tiredness and/or weakness

TREATMENT – RESPONSIVE VICTIM • Get the victim’s head and shoulders out of the water as soon as possible

• Determine the mechanism of injury/history of the incident o Did you breathe in any water or did water “go down the wrong way”? o Can you take a deep breath (does the victim start to cough/breath sound raspy)?

• Call EMS if the victim has any of the above listed signs and symptoms

• Complete the Primary Survey (to include ABCs and bleeding check)

• Semi-sitting or position of comfort

• Reassurance, blanket and oxygen

• The victim and/or a child’s parent/guardian must be educated to seek medical care if any of the above signs and symptoms appear within 72 hours of the submersion incident.

TREATMENT – UNRESPONSIVE VICTIM • Get the victim’s airway out of the water as soon as possible • Calling EMS • Check breathing for 5 seconds • If breathing is absent or ineffective, the rescuer will provide 2 rescue breaths, if no return of

spontaneous breathing, the rescuer will start compressions (CPR) • If the victim is breathing normally, the rescuer will roll them into the recovery position and

complete the primary survey.


MANAGEMENT OF A DROWNING NON-SWIMMER


FIRST AID - CHEST PAIN In Canada, thousands of people die every year from coronary artery disease and stroke; half of these deaths occur before the victim reaches the hospital. Some of the preventable causes of heart disease are smoking, high blood pressure and high cholesterol.

● Angina is caused by a temporary or partial blockage of the coronary arteries that supply blood (which contains nutrients and oxygen) to the heart muscle. These blockages can occur when a fatty deposit (plaque) builds between the layers of the artery (atherosclerosis) and reduces blood flow to the heart muscle. A victim with an angina attack could still be having a heart attack.

● A Heart Attack is caused by a complete blockage of the coronary arteries that supply blood (food and oxygen) to the heart muscle. Without oxygen, the heart muscle begins to die (necrosis) resulting in reduced heart contractions or cardiac arrest (heart stops beating).

SIGN & SYMPTOMS

Angina Attack Heart Attack

Pain can last up to 20 minutes Pain persists for more than 20 minutes

Rest, oxygen and medication can relieve the pain

Rest and oxygen can reduce the pain, but it does not solve the problem and requires

immediate medical attention

Pain presents in shoulders, arms, jaw, neck and on the back. The pain is often described

as a discomfort.

Pain presents in shoulders, arms, jaw, neck and on the back. Pain is typically described as

“crushing” or “squeezing” and is severe.

LOC – Ranges from alert to confused

Breathing – Ranges from normal to shortness of breath

Circulation – weak and rapid pulse (difficulty finding a radial pulse)

Skin – pale, cool and clammy/sweaty (can also be grey or cyanotic)

Nausea and/or vomiting – can feel like an upset stomach or indigestion

Weakness, dizziness and fatigue

TREATMENT Treatment of non-traumatic chest pain should include:

● Scene assessment and determine victim history/mechanism of injury o What brought on the pain/what were you doing?


o Have you had this pain before? If so, how does this compare to last time? What did you do to make it feel better?

o Do you have any medication? o Is this pain normal for you?

● Assist victim into position of comfort (or semi-sitting) and loosen tight clothing ● Call EMS and complete the primary survey (to include ABCs, bleeding and/or injury) ● Assist victim with their medication ● Reassure victim and monitor vital signs (including pain level)

MEDICATION

NITROGLYCERIN ASA (Aspirin/acetylsalicylic acid) A conscious victim should be assisted in taking their own medication in the treatment of non-

traumatic chest pain. Nitroglycerin is a drug that causes the vessels to dilate (“open up”) allowing blood flow around a blockage.

ASA is an antiplatelet and can be beneficial in the treatment of chest pain by reducing further clotting.

Nitroglycerin can come in a tablet, spray or medication patch. A tablet or spray should be placed under the tongue.

Assist a victim in taking their own ASA provided that: A – they are not Allergic to ASA or

ibuprofen A – they have not been told to Avoid ASA

Assist with the administration of nitroglycerin up to a maximum of 3 doses in a 10-minute period (one dose every 5 minutes). Administration of the first dose is when timing begins.

Do not assist a victim with taking a medication if they are not alert (cannot take it themselves). Nitroglycerin should not be used in victims who have taken sexual enhancement drugs within a certain time frame: sildenafil (Viagra) and vardenafil (Levitra) within 24 hours, or tadalafil (Cialis) within 96 hours unless directed otherwise by EMS.

Have the victim chew (2) low dose (81 mg) ASA tablets or (1) high dose (325 mg) ASA tablet. The victim may take 2 additional low dose ASA tablets if directed by EMS.

A victim with an angina attack can still have a heart attack. If the victim’s pain is not reduced to 0 out of 10 within 3 – 5 minutes of their first nitroglycerin dose, call EMS immediately and continue nitroglycerin doses as needed. If the victim has pain despite wearing a nitroglycerin patch, they can still receive their nitroglycerin dose. Call EMS immediately if they do not have their medications.

DO NOT substitute acetaminophen (Tylenol) or ibuprofen (Advil/Motrin) as they can block the platelet aggregating effect of ASA.

A victim who has been prescribed nitroglycerin should also take ASA.


FIRST AID - ANAPHYLAXIS Anaphylaxis is a severe, often life-threatening, allergic reaction that affects multiple body systems. The most dangerous symptoms are breathing difficulties and a drop in blood pressure (shock).

• An anaphylactic reaction can be caused by any number of allergens to include peanuts, tree nuts, seafood, egg and milk products. Over 3 million people in North America suffer from a nut or peanut allergy.

• People with uncontrolled asthma and a food allergy seem to have an increased risk of developing a more severe allergic reaction.

SIGNS & SYMPTOMS Anaphylactic signs and symptoms do not appear in any particular order and no two reactions are the same (although each successive reaction can get worse). General Signs and symptoms include:

• Generalized itching

• Blotchy, raised, red bumps on the skin (hives)

• Wheezing, difficulty breathing

• Swelling – including throat, tongue and face

TREATMENT Epinephrine – alternately named adrenaline – is a hormone produced naturally in the body and is released in times of stress. An injection of epinephrine, given when symptoms begin, helps to reverse the effects of an anaphylactic reaction. It can increase the heart rate, constrict blood vessels (increase blood pressure), and open airways, making breathing easier.

• Determine the history to ensure that the victim is having an anaphylactic reaction.

• Activate EMS. o The effects of epinephrine wear off 10 to 20 minutes after injection. ALL individuals

receiving epinephrine must immediately be transported to hospital.

• Only use the victim’s epinephrine auto-injector to treat the anaphylactic reaction.

• Follow the directions on the epinephrine auto-injector. o DO NOT use the auto-injector regardless of the expiry date if the epinephrine solution is

discoloured and/or has a precipitate. o Remove any protective caps or covers. o DO NOT touch the end of the auto-injector once the protective cap is removed. o Firmly press (do not stab) the auto-injector into the thigh and hold for 10 seconds. o Do not inject epinephrine into any

other muscle group (e.g. buttocks). o Place the used auto-injector into a

Sharps container. o Do not apply ice to the injection site

as it can inhibit the dispersal of epinephrine into the blood stream.

Stuck by a Needle? In the event that a rescuer has been “stuck by a needle”… • Allow the wound to bleed freely • Obtain the name, contact info and medical history of the victim • Notify the supervisor and follow workplace exposure procedures • Wash wound with soap and water • Get to a hospital within 2 hours For more information, contact WorkSafeBC at 1-888-621-7233

• Dizziness, light headedness

• Stomach cramps, vomiting, diarrhea

• Decreased LOC or unconsciousness


• Monitor ABCs closely as the victim can experience tachycardia (rapid heart rate), palpitations (pounding heartbeat), pallor (paleness), dizziness, weakness, tremors (trembling), headache, throbbing, restlessness, anxiety and fear.

• There are no contraindications to using epinephrine when treating a life-threatening reaction. Epinephrine must be administered as early as possible after the onset of symptoms of severe allergic response in conjunction with a known or suspected allergy contact.

• Often a victim will be directed by their doctor to take Benadryl (or another antihistamine) after their epinephrine injection. You can assist the victim in taking additional medication as directed by their physician.

MEDICATION There are three brands of epinephrine auto-injectors on the market, the EpiPen, the Twinject and the Allerject. All epinephrine auto-injectors come in two different dosage strengths.

• The smaller dose delivers 0.15 mg of epinephrine and is intended for victims who weigh 15 to 30 kg (33-66 pounds).

• The larger dose delivers 0.3 mg of epinephrine and is intended for victims who weigh 30 kg (66 pounds) or more.

Although the NL program trains candidates in epinephrine administration, rescuers must consult, and comply with, their employer’s policies and procedures with respect to medication administration.

The EpiPen The EpiPen is the most common epinephrine auto-injector on the market. Once it has been determined that the victim requires a dose of epinephrine, the user will:

1. Check the condition of the solution in the window.

2. Remove the blue safety cap from the EpiPen.

3. Do not place thumb on either end of the EpiPen.

4. Press the orange tip of the pen into outer thigh until there is a "click".

5. Hold the pen in place for 10 seconds

6. Massage injection site for quick dispersal of medication.

7. The orance tip will click down on cover the exposed needle. Put the needle into a sharps container.

More information and training videos are available at www.epipen.ca

Blue safety cap

Orange injector

http://www.epipen.ca/


The Allerject The Allerject™ contains an electronic voice instruction system to help guide users through each step of the injection and is available in either English or French. Once it has been determined that the victim requires a dose of epinephrine, the user will:

1. Pull the Allerject™ from the outer case and check the condition of the solution in the window. • If you are not ready to use the Allerject, put it back in the outer case.

2. Pull off the red safety guard • To reduce the chance of an accidental injection, do not touch the black base of the auto-

injector. • The red safety guard is meant to be tight. Pull firmly to remove.

3. Place black end against the middle of the outer thigh and press firmly. • Hold in place for five seconds. • The Allerject™ makes a distinct sound (click and hiss) when you press it against the leg.

This is normal and indicates that the AllerjectTM is working correctly. • Massage injection site for quick dispersal of medication.

More information and training videos are available at www.allerject.ca

STEP 1 STEP 2 STEP 3

http://www.allerject.ca/


FIRST AID – OXYGEN THERAPY Respiration is the exchange of gases between the atmosphere and the living cells of the body. Hypoxia is an inadequate supply of oxygen to the body tissues, whereas, anoxia is when the body tissues are getting no oxygen at all. This can be caused by an inadequate airway (e.g. choking), breathing complications (e.g. no breathing) or circulatory problems (e.g. a heart attack results in the poor circulation of oxygen).

Lifeguards should note that while giving the victim oxygen is beneficial, the victim’s airway must continually be monitored. Effective victim care without oxygen is better than oxygen without artificial respiration. Oxygen is NOT a substitute for artificial ventilation.

OXYGEN CYLINDER • A “D” size cylinder contains 2000-2200 psi of O2 when full (or 350-420 liters)

• The tank should be changed at 500 psi

• Only open the cylinder a 1/4 turn (90 degrees counter-clockwise)

• Oxygen use dangers (FORT): o Fire (open flame/smoking can cause the oxygen to explode) o Oil and grease are explosive when exposed to oxygen o Rough handling (dropping the tank or breaking the medical post can turn the cylinder

into a missile - do not use/store in an upright position) o Tunnel vision by the lifeguards (focusing on trying to use the equipment and forgetting

about victim care)

REGULATOR • Reduces the high pressure within the cylinder to a safe working pressure

• One gauge measures liter flow per minute (lpm) and the other measures the pounds per square inch (psi) in the tank

• The regulator must be bled off, lpm knob turned off and the tank turned off after every use

INHALATOR • An inhalator is also known as a standard or simple face mask and can be used on all

breathing victims

• 10 lpm flow is used (delivers 60% oxygen)

VENTILATOR • Can be a pocket mask or a bag, valve and mask (BVM) and is used on all non-breathing

victims or victims who are not breathing effectively

• A 15 lpm flow is used

• A pocket mask delivers 50-60% oxygen and a BVM delivers 90% oxygen


OXYGEN FORMULA • At 10 lpm: multiply the first two of the four digits by 2

o 2000 psi x 2 = 40 mins o 1500 psi x 2 = 30 mins o 0800 psi x 2 = 16 mins

• At 15 lpm: multiply the first two of the four digits by 1 o 2000 psi x 1 = 20 mins o 1500 psi x 1 = 15 mins o 0800 psi x 1 = 8 mins

ORAL AIRWAYS • An Oropharyngeal Airway (OPA) is a hollow plastic device that will prevent the tongue from

blocking the airway and assist in maintaining a patent airway.

• Should be used on all unconscious victims unless they refuse it (gag reflex), have active vomiting, have ongoing bleeding in the airway or have an obstructed airway.

• Recommended with a pocket mask on an unconscious victim. Measurement 1. To measure an OPA, use only the curved portion of the airway; do

not include the straight part (colored) and the wide flange. 2. Measure from the angle of the jaw (below the ear) to the corner of

the mouth. 3. If the measurement falls between sizes, the larger of the two should

be used to prevent an airway obstruction. Inserting the OPA 1. Grasp the lower jaw and tongue firmly. 2. Visually inspect the airway for any foreign objects or fluid before

inserting OPA. 3. Hold the OPA in the happy face position (so it looks like a smile). 4. Slide it along the roof of the mouth. When it reaches the back,

rotate it 180° so that it slips into position behind the tongue. 5. The flange remains outside of the lips. 6. Assess for a clear airway.

Cautions 1. If the victim gags or vomits, remove the OPA immediately. 2. An OPA will prevent the tongue from blocking the throat because there is a hollow space down

the centre of the throat for the air passage. 3. If there is any fluid (vomit, saliva, blood, water, etc.) in the victim’s throat, the hollow space in the

OPA may be blocked by the fluid. An OPA will NOT prevent fluid from causing an obstructed airway. If fluid is present, roll the victim to a drainage position.


THE OXYGEN UNIT

Pocket Mask or Ventilator

Simple Face Mask or Inhalator


LIFEGUARD & THE LAW OVERVIEW Canadian lifeguards are affected by a variety of regulations and legislation. These documents may regulate the environment in which the lifeguard works, establish safety requirements, set legal obligations and define certain working conditions. These regulations will differ from one province or territory to another. Lifeguards should consult with their employers and familiarize themselves with the relevant regulations for their facility. Lifeguards should also familiarize themselves with Chapter 8 of the Alert Manual. STATUTES Statutes are written laws made by federal, provincial or municipal government. Statutes set regulations that must be adhered to (with criminal or quasi-criminal punishment for those who fail to comply). Some statutes that affect lifeguards include:

• Occupier's Liability Act Anyone who owns or operates a premise such as a swimming pool owes a "duty of care" to any person present in the facility. This duty of care requires that all reasonable steps be taken to protect persons in the facility.

• Employment Standards Act The Employment Standards Act defines the minimum rights and obligations of employers and employees. These rights and obligations include things such as wages, hours of work, overtime, vacations, holidays, and termination of employment.

• Good Samaritan Act This law is designed to encourage professional rescuers and lay rescuers alike to respond to emergencies that they might encounter outside of their professional work responsibilities. The Act provides protection to lifeguards who respond to an emergency when it is not part of their job as a lifeguard. If the rescuer acts reasonably and within the scope of their training, the Act will provide protection from legal actions by the injured person or parties. The only exception to this protection is if the rescuer acts in a grossly negligent fashion. When a lifeguard performs a rescue or provides first aid treatment while lifeguarding a facility (whether paid or volunteer), they are not covered by the Act.

• BC Pool Regulation (2010) The 2010 BC Pool Regulation outlines operating conditions which directly affect the health and safety of bathers such as water treatment chemical levels, minimum water clarity standards, facility cleanliness and supervision requirements (reference page -30).

• WHMIS 2015 The Workplace Hazardous Materials lnformation System (WHMIS) is a national information system, coordinated by the federal government, to improve worker protection and to reduce the incidence of illnesses and injuries resulting from the use of hazardous materials in the workplace (reference page 29-30).


• Occupational Health and Safety Act The Occupational Health and Safety Act establishes the minimum standards for safety in the workplace. These standards address requirements for safety equipment, worker training, safety practices and control of exposure to hazardous materials and environments. WorkSafeBC provides workplace liability and disability insurance to protect workers and employers from work-related injuries and illness. For instance, WSBC may cover the cost of health care and/or compensate injured workers for lost employment income.

• Canadian Public Pool Safety Standards There are often references made to Industry Standard or trends that are common throughout a specific industry. Often these trends or standards are built on the foundation of federal requirements, other provincial/territorial legislation, coroner recommendations and training agency standards based on research.

To help establish basic standards, the Lifesaving Society Canada has researched and published the first edition of the Canadian Public Pool Safety Standards which can be found on the National website at www.lifesaving.ca

STATUTES Contracts are agreements between individuals which give rise to legal rights and obligations. Lifeguards are affected by contracts, often without realizing it. Some examples can include contracts of employment, admission tickets, facility rentals, etc.

LIABILITY Liability is the state of being legally obliged and responsible. There are different types of liability as it applies to a lifeguard.

• Statutory Liability Statutory liability is a direct violation of a written law or statute.

• Occupier Liability Owners/occupiers must exercise reasonable care for a person's safety. The owner/occupier could be liable if the person was injured or not warned of a dangerous condition in or around the facility.

• Vicarious Liability (also known as Master-Servant) The employer is responsible for the acts or omissions of the employee.

• Negligence Negligence means carelessness, or the failure to behave in a reasonable manner. The standard dictated by a statute may be evidence of a minimum standard of reasonable care. Negligence exists only if all of the following conditions occur: o Duty of Care: the first responder owed a duty of care to the victim o Standard of Care: the first responder, through a careless act or omission, fell below the

standard of care which should be expected of a reasonable person under the circumstances.

o Causation: the first responder’s act or omission caused injury or death to the victim.

http://www.lifesaving.ca/


2010 BC POOL REGULATION

On October 8, 2010 the Ministry of Healthy Living and Sport announced the new BC Pool Regulation, BC Reg. 296/2010 that replaces the Swimming Pool, Spray Pool and Wading Pool Regulation, B.C. Reg. 289/72, and the Pool Exemption Regulation, B.C. Reg. 256/98. The regulation modernizes the requirements for the design, construction, alterations to, and operation of swimming and bathing facilities offered for use by the public.

In addition to the new Pool Regulation, the Design Guidelines and Operation Guidelines have been developed to assist operators in interpreting the Regulation. Where there is a discrepancy between the Regulation and the Guidelines, the BC Pool Regulation shall prevail.

This section summarizes the highlights of the 2010 Pool Regulation (and the August 7, 2012 amendments); all lifeguards trained and/or working in the BC & Yukon Branch should be familiar with the 2010 BC Pool Regulation. Candidates can reference the full document at:

http://www.qp.gov.bc.ca or http://www.bclaws.ca

2010 BC Pool Regulation

Lifeguard Definition and/or

Qualifications

Section 17(1) A lifeguard is a person who: • Is at least 16 years old • Holds certification(s) as outlined in the Pool Safety Plan • Receives training in the Pool Safety Plan (amended August 7, 2012)

Industry Standard in BC/Yukon for lifeguard training is a current National Lifeguard Service (NL) award.

Minimum Staffing

Section 17(2) Pool supervision is provided by at least 1 lifeguard and any additional lifeguards as required by the Pool Safety Plan (amended August 7, 2012) A pool must open with at least 1 lifeguard and 1 additional person who is on duty within the swimming facility, is trained in the Pool Safety Plan and is designated by the operator for the purpose of back-up (amended August 7, 2012). The Operating Guidelines go on to state that the additional person: • Is not a lifeguard and is not responsible for supervision • Is to provide back-up to a lifeguard in the event of an emergency • Must be conversant with the Pool Safety Plan and attend regular in-service training • Hold a current CPR or SFA

A pool should open with at least 2 NL trained lifeguards as per Industry Standard.

Lifeguard Duties Section 17(1c/1d) A lifeguard is responsible for the conduct and safety of all pool patrons, and is to perform no duty other than pool surveillance.

Lifeguard to Patron Ratio

Section 13(2c) The number of lifeguards required to ensure adequate supervision of pool, must be specified in the Pool Safety Plan. The Operating Guidelines state that moveable equipment (e.g. swing ropes, inflatable’s) and waterslides are to be directly supervised by aquatic staff (not necessarily lifeguards). Industry Standard in BC/Yukon is a maximum of 1 lifeguard for every 40 persons.

http://www.qp.gov.bc.ca/

http://www.bclaws.ca/


2010 BC Pool Regulation

Pool Rules

Section 8 (reference the Operating Guidelines) • Pool rules must be posted • The rules posted under subsection must prohibit the following behaviour:

o Entering the pool with an illness, including open sores, bandages, head colds, discharging ears or noses or infected eyes, or without having first taken a cleansing shower

o Running, fighting or engaging in other conduct likely to cause an injury while in the pool enclosure

o Contaminating or fouling the pool o Failing to immediately report to the operator or lifeguard an injury suffered

while in the pool enclosure, or contamination or fouling of the pool o Failing to supervise children for whom one is responsible while in the pool

enclosure o Diving into the pool, except in designated areas (amended August 7, 2012)

Pool Safety Plan

Section 13 (reference the Operating Guidelines) A detailed written plan containing emergency, operating and cleaning/maintenance procedures in addition to required first aid/lifesaving equipment. The employer must train each employee in the Pool Safety Plan and ensure that each employee complies with the Pool Safety Plan (amended August 7, 2012)

Required Equipment

Section 13/Section 17(3c)/Section 18(2) Can include a reaching pole and throwing line (to be specified in the Pool Safety Plan). The Operating Guidelines go on to state that additional equipment should include: • Rescue aids around deck for quick/easy access • Emergency telephone • Minimum of a #2 first aid kit as per WorkSafeBC • Pocket mask and gloves • A spine board • Oxygen kit (400 litres or greater) • Full set of airways • A.E.D. (defibrillator)

Pool Clarity Section 10 (2a) Pattern of the main drain OR a black disc 150mm in diameter must be visible at the deepest point of the pool.

pH level

Section 10 (2d) pH must be tested at least twice daily and maintained between 7.2-7.8 The health officer may impose more stringent testing requirements to prevent a health hazard (amended August 7, 2012)

Minimum Free Available Chlorine

Section 10 (2f) • 0.5ppm for a pool less than 30 degrees • 1.5ppm for a pool over 30 degrees

The health officer may impose more stringent testing requirements to prevent a health hazard (amended August 7, 2012)


WHMIS – WHAT LIFEGUARDS NEED TO KNOW WHMIS stands for the Workplace Hazardous Materials Information System. It is a comprehensive system for providing health and safety information on the safe use of hazardous products used in Canadian workplaces.

WHMIS 1988 has aligned with the worldwide hazard communication system known as GHS - the Globally Harmonized System of Classification and Labelling of Chemicals. The newly aligned system will be called WHMIS 2015 in Canada. From now until May 31, 2017, suppliers (manufacturers and importers) can use WHMIS 1988 or WHMIS 2015 to classify and communicate the hazards of their products. Lifeguards will be trained on the system in use by their employer.

THREE KEY ELEMENTS The main components of WHMIS 2015 are hazard identification and product classification to include labelling, safety data sheets, and worker education and training.

1. Labels Hazardous materials must be labeled using a specific label format. A WHMIS label is any mark, stamp, sign, device, sticker or wrapper that alerts workers to particular hazards and basic information regarding safety precautions.


2. Safety Data Sheets (SDS) Hazardous materials must have Safety Data Sheets which detail the hazards associated with the product. Known as an SDS, it is a technical document providing comprehensive data on a product related to:

• Health effects of the product

• Hazards associated with the product

• Precautionary measures

• Emergency procedures

3. Education All employees must be educated to understand WHMIS 1988 or WHMIS 2015 and its functions. The level of training depends on the possibility of exposure to a hazardous material.

Employee should be able to understand how to apply their knowledge of the material to protect their own health and safety. It is not enough to simply give the workers the SDS Sheet. For instance, Lifeguards may receive specific instruction on a product such as gas chlorine.

RESPONSIBILITIES While WHMIS 2015 includes new criteria for hazard classification and requirements for labels/SDSs the roles and responsibilities for suppliers, employers and workers have not changed.

Suppliers, who sell or import a hazardous product, will: • Identify whether their products are hazardous as outlined in the Hazardous Products

Regulations. • Prepare and provide labels and SDSs to purchasers of hazardous products intended for use in a

workplace.

Employers will: • Educate and train workers on the hazards and safe use of products. • Ensure that hazardous products are properly labelled and prepare labels, as needed. • Provide access to current SDSs to workers and prepare SDSs, as necessary (e.g., a hazardous

product made onsite such as ozone). • Ensure appropriate control measures are in place to protect the health and safety of workers.

Workers will: • Participate in WHMIS and chemical safety training programs. • Take necessary steps to protect themselves and their co-workers. • Inform the employer if there is inadequate adequate protection or information on a controlled

product to ensure health and safety (by law an employee cannot be penalized for doing so). • Work with the employer to develop programs and procedures that will help ensure worker

safety when using controlled products.

A well-managed Workplace Hazardous Material Information System will result in workers being able to avoid personal injury.

An employee must understand that the system is in place for their benefit and should make any effort to participate in the programs that are designed to protect them.


SWIMMING POOL DISINFECTION

RECREATIONAL WATER ILLNESSES Illnesses that are spread by swallowing, inhaling or coming in contact with contaminated water are called recreational water illnesses (RWIs).

Pseudomonas is the bacteria that causes skin rashes and ‘swimmers ear’. Pseudomonas can multiply quickly when water disinfectant levels drop. Gastroenteritis is a stomach ailment that causes diarrhea, nausea, vomiting and abdominal pain. It happens when fecal matter is swallowed by a swimmer before having been killed by a disinfectant. Most RWIs can be prevented by maintaining a proper disinfection concentration.

Cryptosporidium is the parasite that causes gastroenteritis and is very difficult to kill once it has entered the filtration system. ‘Crypto’ is the one parasite that is not easily controlled by consistent chlorination over 1.0ppms. If a fecal incident is noted, lifeguards must clear the pool and follow the Pool Safety Plan for fecal incidents in order to prevent cryptosporidium.

DISINFECTION Disinfectant is a chemical capable of destroying infectious agents. Regardless of the disinfection method used in a pool, Section 10 of the 2010 BC Pool Regulation requires a minimum of 0.5 ppm (parts per million) of free available chlorine (FAC) to prevent recreational water illness (RWI).

Water Parameter Range Testing Frequency

in Regulation Recommendation

Frequency

Free available Chlorine 0.5ppm (under 30 degrees) 1.5ppm (over 30 degrees)

At least twice daily

Every 4 hours or before and after periods of heavy use

Combined Chlorine Not to exceed 1.0ppm

Bromine 1.5ppm (under 30 degrees) 2.5ppm (over 30 degrees)

Chlorine (Cl2) Chlorine is the least expensive and most common disinfectant used in pools. It comes in three forms:

Chlorine Gas (Cl2) Dry Chlorine (Cl) Liquid Chlorine (bleach)

• 100% available chlorine content

• Lowers pH • Sodium carbonate (soda

ash) used to raise pH levels

• 65% to 95% available chlorine content

• Raises pH (has a pH of 11) • Muriatic acid used to lower

pH levels

• 11% available chlorine content

• Raises pH (has a pH of 13)

• Muriatic acid used to lower pH levels

All of these forms of chlorine will kill organic materials in the water, but must have a system of continuous feed. Effectiveness and rate of chlorine depletion are affected by bather load, sunlight, evaporation and water turbulence. Chlorine is extremely toxic therefore one must be familiar with site-specific emergency procedures and the WHMIS/SDS sheets before handling chlorine.


Salt (NaCl) Electrical devices (chlorine generators) have been developed that produce chlorine from salt dissolved in the water or within a separate salt solution (brine) chamber. A pool salt reading of approximately 2500 ppm is required to maintain adequate chlorine generation.

Advantages Disadvantages

• Decreases leak & toxicity concerns • Chlorine generated as needed • By-products assist in pH maintenance

• Capital & on-going costs • Slight salty taste to water • Changes pool reading procedures

Bromine (Br) Some pools will use bromine instead of chlorine. In most cases the higher cost and bromines inability to kill some bacteria deters most facilities from using it.

Ozone (O3) When injected into water, ozone oxidizes organic material to disinfect the water. Ozone is a powerful oxidizer that acts thousands of times faster than chlorine. As there is no ozone in the pool itself, a residual disinfectant (i.e. chlorine) is still needed. Ozone is produced by the corona discharge method using high voltage electricity (most common) or the ultraviolet method. Although toxic in high concentration, ozone has a half life of 18 minutes reverting to oxygen in a short time.


• Chloramines destroyed, thus better air and water quality

• Less super-chlorination required • Quickly reverts to oxygen, less toxic

• No residual in pool to kill pathogens • Requires separate room as with chlorine • Highly corrosive in gaseous form

Ultraviolet Light (UV) Most new municipal pools are including UV as part of their disinfection system. As with ozone, chlorine residual in the pool is still required.


• Chloramines destroyed, thus better air and water quality

• No super-chlorination required • No toxic by-products or risk of leak • Limited annual maintenance, long service life • Small footprint compared to ozone

• No residual in pool to kill pathogens • No effect on TDS • Highly corrosive in gaseous form

pH is a scale that measure the acidity of water. Pure water has a pH of 7.0 (neutral), acids have a pH less than 7. Section 10 (2d) of the 2010 BC Swimming Pool Regulation states that pH must be maintained between 7.2-7.8. The ideal range for pH in swimming pools is 7.4-7.6. There are a variety of factors that can affect pH to include the types of disinfectants used and total alkalinity.

Note!

VICTIM INFORMATION Victim Name: Victim Age: Gender: M F Address: Phone# Date of Incident: Time of Incident: Time EMS Arrival:

HISTORY Chief Complaint (CC)? What hurts? History of CC? What happened? Medical History? Happened before? Medical conditions?

Medications? Including Tylenol, etc.

Allergies? To medication and foods

Last Meal? What and how long ago?

VITAL SIGNS Time: Time: Time: LOC Alert Voice Response

Pain Response Unresponsive

Alert Voice Response

Pain Response Unresponsive Alert Voice Response

Pain Response Unresponsive

Resp. Laboured Shallow Wheezing Other________ Rate (10sec x 6) _____________

Laboured Shallow Wheezing Other________ Rate (10sec x 6) _____________

Laboured Shallow Wheezing Other________ Rate (10sec x 6) _____________

Pulse Weak Strong Irregular Other________________________ Rate (10sec x 6) ______________

Weak Strong Irregular Other________________________ Rate (10sec x 6) ______________

Weak Strong Irregular Other________________________ Rate (10sec x 6) ______________

Skin Normal Pale Flushed Normal Pale Flushed Normal Pale Flushed

Cool Warm Hot Cool Warm Hot Cool Warm Hot

Sweaty Dry ________ Sweaty Dry ________ Sweaty Dry ________

Eyes Equal Unequal Equal Unequal Equal Unequal Dilated Constricted Dilated Constricted Dilated Constricted

React Slow React No React React Slow React No React React Slow React No React

HEAD TO TOE PAIN ASSESSMENT

Head Neck Back Chest Abdomen Pelvis Arms/Hands Legs/Feet

Position (Where is the pain?)

Quality Sharp Dull Squeezing Other______________________

Radiating Yes No (Where?)_____________________

Severity 1 2 3 4 5 6 7 8 9 10

Timing (Constant? How Long?)

TREATMENT

Spinal Immobilization Obstructed Airway Procedure Assisted Vents CPR Direct pressure / Bandaging Immobilization/Splinting Cooling Blanket Victim Position___________________________________________ Oxygen_______ lpm OPA size ____________ Assist with Medication_______________________________________________________________________________________ Other______________________________________________________________________________________________________

Lifeguard Signature: Lifeguard Signature:

SIMULATION FIRST AID FORM

Documents

National Lifeguard