Red Cross Lifeguarding: Responsibilities, Legalities, and Emergencies, Exams of Medicine

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primary responsibility - CORRECT ANS prevent drowning and other injuries from occurring at your aquatic facility by providing patron surveillance, inspecting the pool & lifeguard equipment before opening and at closing, enforcing pool rules & regulations. secondary responsibilities - CORRECT ANS Filling out records and reports, maintenance, and inspecting the facility, conducting swim tests, testing the water. must never interfere with your primary responsibility of patron surveillance. FIND (decision making acronym) - CORRECT ANS Figure out the problem Identify possible solutions Name the pros and cons for each Decide which solution is best and act on it legal considerations - CORRECT ANS To avoid liability, it is important to understand the following legal principles that apply to your role as a professional lifeguard: duty to act, standard of care, negligence, abandonment, confidentiality, documentation, consent and refusal of care DUTY TO ACT - CORRECT ANS While on the job, you have a legal responsibility to act in an emergency. Failure to adhere to this duty could result in legal action. STANDARD OF CARE - CORRECT ANS you are expected to meet a minimum standard of care. This standard requires you to: Communicate proper information and warnings to help prevent injuries, recognize someone in need of care, Attempt to rescue those needing assistance & provide emergency care according to your level of training.

NEGLIGENCE - CORRECT ANS When a person is injured or suffers additional harm because lifeguards failed to follow the standard of care or failed to act at all, the lifeguards may be considered negligent. Negligence includes: Failing to control or stop any behaviors that could result in further harm or injury, failing to provide care, providing inappropriate care, & providing care beyond the scope of practice or level of training. ABANDONMENT. - CORRECT ANS - once care is initiated, it must be continued until emergency medical services (EMS) personnel or someone with equal or greater training arrives and takes over. You can be held legally responsible for abandoning a person who requires ongoing care if you leave the scene or stop providing care CONFIDENTIALITY - CORRECT ANS While making a rescue or providing care, you may learn something about the injured or ill person, such as information about medical conditions, physical problems and medications taken. Laws that require you to keep their information confidential protect a person's right to privacy. This information should not be shared with anyone except EMS personnel directly associated with the person's care, facility management or the facility's legal counsel. DOCUMENTATION - CORRECT ANS Documenting injuries and incidents is very important. If legal action occurs later, your records and reports can provide legal documentation of what was seen, heard and done at the scene. Complete the required forms as soon as possible after the incident, preferably, immediately after the incident. As time passes, critical details may be forgotten. When completing a report, state the facts of the incident without including your opinion. Once the report is complete, sign and date it and have all responders read the report, then sign and date it as well. A copy of the report should be kept by the facility. CONSENT - CORRECT ANS - An injured or ill person must give permission before responders can provide first aid and emergency care. To obtain consent: State your name. State your level of training. Ask if you may help. Explain that you would like to assess him or her to find out what you think may be wrong or what you can do to help. Explain what you plan to do. With this information, an ill or injured person can grant his or her informed consent for care. Someone who is unconscious, confused or seriously injured or ill (such as in a nonfatal drowning) may not be able to grant consent. In these cases, the law assumes the victim would give consent if he or she were able to do so. This is called implied consent. Implied consent also applies to a minor who needs emergency medical assistance and whose parent or guardian is not present.

REFUSAL OF CARE- - CORRECT ANS Injured or ill people may refuse care, even if they desperately need it. Parents also may refuse care for children. Even though someone may be seriously injured, his or her wishes must be honored. In these situations, you should explain why he or she needs care. For significant injuries, you should call EMS personnel to evaluate the situation. For non-life-threatening emergencies, when care is refused and you are asked not to call EMS personnel, make it clear that you are neither denying nor withholding care and that you are not abandoning the victim. You must document any refusal of care. Someone else, such as another lifeguard, should witness the person's refusal of care and sign a report. Ask the person who refuses care to sign the report as well; if he or she refuses to sign, note that on the report. GOOD SAMARITAN LAWS-. - CORRECT ANS Protect people against claims of negligence after having provided emergency care in good faith without having accepted anything in return. These laws differ somewhat from state to state but generally help to protect people who act in good faith, within the scope of their training, and who are not negligent. Some Good Samaritan laws, however, do not provide coverage for individuals who have a legal duty to act, which includes professional lifeguards. Therefore, it is important that lifeguards consult a lawyer or the facility's legal counsel to determine the degree of protection provided by their state's Good Samaritan laws POLICIES AND PROCEDURES MANUAL - CORRECT ANS A policies and procedures manual should provide the information that you need to understand what is expected of you, to be able to work safely and to perform your duties effectively. This manual usually includes administrative policies and procedures, personnel policies and guidelines and standard operating procedures. IN-SERVICE TRAINING- - CORRECT ANS Lifeguards participate in a minimum of 4 hours of in-service training each month. The facility manager, lifeguard supervisor, a head lifeguard may conduct in-service trainings. Training sessions will address issues, such as surveillance and recognition, water and land rescue skills, emergency response drills, decision making protocols, facility rules and regulations, customer service, records and reports and physical conditioning. EMERGENCY ACTION PLAN- - CORRECT ANS The lifeguard team and other staff members must practice the facility's EAPs together until everyone knows their responsibilities and can perform them effectively. Because conditions can change throughout the day, you may need to adapt the EAP to a particular situation. Some facilities have created more than one EAP to cover specific situations or conditions. Factors that may affect the steps of an EAP include the number of lifeguards on duty. Every aquatic facility has its own specific set of EAPs based on the unique characteristics at each facility. Factors such as the facility's layout, number of staff on duty at a time, location of back-up lifeguards and other safety

team members, equipment used and typical response times of the local emergency medical services (EMS) system are included in the plan. EAPs should be practiced regularly and included in your facility's policies and procedures manual. SAFETY TEAM- - CORRECT ANS the lifeguard team is part of a larger group called a safety team—it's a network of people who prevent, prepare for, respond to and assist in an emergency at an aquatic facility. After your lifeguard team activates the facility's EAP, the safety team needs to back you up and provide assistance. The main objective of the safety team is to assist you in maintaining a safe environment and providing emergency care. The safety team includes lifeguards, other facility staff, EMS, police, and fire departments. PATRON SURVEILLANCE- - CORRECT ANS When performing patron surveillance, always keep the rescue tube ready to use immediately. Keep the strap of the rescue tube over the shoulder and neck. Hold the rescue tube across your thighs when sitting in a lifeguard chair or across your stomach when standing. Hold or gather the excess line to keep it from getting caught in the chair or other equipment when you move or start a rescue. You should also wear a fanny pack with an Adult pocket mask, and a pediatric pocket mask, & non-latex gloves, and your whistle. WEATHER CONDITIONS- - CORRECT ANS We close both indoor and outdoor pools for thunder and lightning. We follow the National lightning institutes guidelines, which state we should close the pool for 30 minutes. We would also close the pool whenever the bottom of the pool is not visible i.e. for heavy rain, hail, high winds, fog etc. Also if it's a safety issue i.e. chemicals too high/low, vomit or feces in the pool- tornados, power failure, fire etc. LIFEGUARD EQUIPMENT- - CORRECT ANS To respond quickly and appropriately to an emergency, a backboard & AED must be instantly available to you. A rescue tube, resuscitation mask and gloves must be on the lifeguard when on duty. PERSONAL PROTECTIVE EQUIPMENT- - CORRECT ANS Personal protective equipment (PPE) is the specialized clothing, equipment and supplies used to prevent you from coming into direct contact with a victim's body fluids. In addition to gloves and resuscitation masks, other PPE may be available at your facility, including gowns, masks, shields and protective eyewear. A blood spill kit should also be available to safely clean up blood. We also call this BSI (body substance isolation)

BAG-VALVE-MASK RESUSCITATOR- - CORRECT ANS A (BVM) is a handheld device attached to a resuscitation mask. It's used to ventilate a victim in respiratory arrest or when performing CPR. BVM's come in various sizes to fit adults, children and infants. The appropriately sized BVM should be used based on the size of the victim. Using a BVM requires two rescuers: one to maintain a tight seal for the mask, and one to squeeze the bag. SDS- - CORRECT ANS Employees must be trained about the chemicals stored and used in the workplace for jobs that involve handling such items. Each chemical has an information sheet called a Safety Data Sheet. Thus, SDS sheets contain information on hazardous chemicals. BLOODBORNE PATHOGENS STANDARD- - CORRECT ANS The Federal Occupational Safety and Health Administration developed the Bloodborne Pathogens Standard to reduce the risk of disease transmission while on the job. This standard helps to protect employees from contact with body fluids that may contain disease-causing bacteria and viruses, called Bloodborne pathogens. Your employer must provide an exposure control plan to help protect employees from being exposed to Bloodborne pathogens and let employees know what to do if an exposure occurs. OSHA- - CORRECT ANS is the federal Occupational Safety and Health Administration. Set required practices of infection control to protect employees who are at risk while on the job. They require employers to have an exposure control plan and offer the Hep B vaccination to employees for free. EFFECTIVE SCANNING- - CORRECT ANS Knowing what to look for to determine if a victim is in trouble in the water is a first step, but you also need to know how to look. Scanning is a visual technique for watching patrons in the water. When scanning, you should not just passively watch patrons in the water. Effective scanning requires you to deliberately and actively observe swimmers' behaviors and look for signals that someone in the water needs help. You must actively scan all patrons in the water, regardless of the type of activities taking place. THE RID FACTOR - CORRECT ANS - If an active victim drowns while lifeguards are on duty, it is probably due to one or more of the following causes: Lifeguards fail to recognize the victim's instinctive drowning response. Secondary duties intrude on lifeguards' primary responsibility of patron surveillance or lifeguards are distracted from surveillance.

ZONES OF SURVEILLANCE RESPONSIBILITY- - CORRECT ANS Your lifeguard supervisor or facility manager will establish each lifeguard's zone of surveillance responsibility—referred to as zones. These are the specific areas of the pool that are assigned to you while you are on duty. ZONE COVERAGE- - CORRECT ANS In zone coverage, the swimming area is divided into separate zones, with one zone for each lifeguard station. Zones can be designated by markers, such as ladders, lane lines, lifelines, buoys, or the shape of the pool, Zone coverage is effective for high-risk areas or activities, avoiding blind spots and reducing the number of patrons watched by each lifeguard. When zone coverage is being provided, each lifeguard needs to know the zone for each guarding position. If at any time you can no longer see some patrons while providing surveillance i.e. glare from the sun, adjust your position. TOTAL COVERAGE - CORRECT ANS - When you are assigned total coverage, you will be the only lifeguard conducting patron surveillance while you are on duty. Some facilities, such as a small pool, always assign their lifeguards total coverage. Other facilities use total coverage for specific situations, such as when there are a limited number of patrons present. When only one lifeguard is conducting patron surveillance, that lifeguard has to scan the entire area, control the activities of patrons in and out of the water and recognize and respond to emergencies. If adequate coverage cannot be provided for all patrons, inform a supervisor that help is needed. EMERGENCY BACK-UP COVERAGE- - CORRECT ANS In emergency situations when two or more lifeguards are on duty and one lifeguard must enter the water for a rescue, lifeguards who remain out of the water must now supervise a larger area. Additionally, a lifeguard manager may add additional lifeguards to a rotation when there are large groups of patrons, thus reducing the number of patrons each lifeguard watches. This is called back up coverage or added coverage. LIFEGUARD STATIONS- - CORRECT ANS Lifeguards perform patron surveillance from a variety of positions including elevated, ground level, roving (moving) and floating stations (dock, kayak, etc.) ROTATIONS- - CORRECT ANS Your supervisor will establish a plan for lifeguard rotations, usually based on: locations of stations, type of station (elevated, ground-level, roving or floating), The number of patrons using an attraction, The activity at the station, such as wave durations at a wave pool. The rotation begins with the incoming lifeguard. While rotating, each lifeguard should carry his or her own rescue tube, and both lifeguards must ensure there is no lapse in patron surveillance, even for a brief

moment. (new one stays while old getting off ladder and old waits for new one to get on stand before leaving) INFORMING AND EDUCATING PATRONS - CORRECT ANS Patrons need to know about risks that could cause injury. Signs communicate warnings & provide instructions on how to use equipment and list rules and regulations to prevent behaviors that can lead to injury. Part of your role, is to inform patrons about the potential for injury; therefore, you need to understand the rules and regulations of your facility and the rationale behind them. Get the patron's attention, for example by blowing a whistle, and saying, "Excuse me." Explain the hazard or danger, for example, "If you dive into shallow water, you might hit your head on the bottom and get injured." Explain a safe option. For example, say, "If you want to dive, please go to the deep end of the pool where it is safe." Extended underwater swimming/ breath holding is prohibited from all pools, swimmers who do this can hyperventilate under water and drown as a part of the body's response due to the lack of oxygen. RECREATIONAL SWIM GROUPS- - CORRECT ANS Sometimes, a group will reserve all or part of a facility for its own instructor to teach a class, lead a practice or conduct skill checks. These activities may include kayaking, SCUBA diving or swim team tryouts. In general, when guarding groups, you should: Ensure that swimming areas are divided according to swimmers' abilities and are clearly marked. Ensure that patrons stay in the sections appropriate for their swimming abilities. Be aware that weak or non- swimmers, excited to be together enjoying a recreational activity, may attempt to venture into areas that are beyond their swimming ability. Provide U.S. Coast Guard-approved life jackets for weak or non- swimmers. Know how to identify group leaders or chaperones. Ensure that chaperones are actively supervising the members of their group and that the appropriate swimmer-to-chaperone ratio is met. If it appears that they are not doing so, alert your facility's manager. Also giving swim test and tours of facility and make sure they know all the rules BUDDY CHECKS- - CORRECT ANS For groups using buddy checks such as, youth camps, you may need to signal the buddy check, confirm that everyone is accounted for and count the individuals or buddy pairs, depending on the system being followed. SWIM TESTS- - CORRECT ANS Swim tests are administered to determine if a swimmer has the minimum level of swimming ability required to participate safely in activities, or swim in certain areas of the pool, such as swimming in deep water or going off a diving board. Lifeguards should use the American Red Cross water competency sequence to give swim tests.

• have to (water competency sequence:) enter the water and completely submerge, tread or float for a min, rotate 360 deg, swim 25 yd and exit water on their own

AFR's (Accidental Fecal Response) - CORRECT ANS If fecal matter or vomit are found in your pool, the bacteria found in the AFR's can make swimmers sick. So, Lifeguards must immediately act; the pool must temporarily be closed, and chemically treated before it is safe to allow swimmers to return. Pools should follow state guidelines on how to treat the pool. SWIMMERS IN DISTRESS- - CORRECT ANS A swimmer can become distressed for several reasons, such as exhaustion, cramp or sudden illness. Quick recognition is key to preventing the distressed swimmer from becoming a drowning victim. A distressed swimmer makes little or no forward progress and may be unable to reach safety without assistance. Distressed swimmers may be: Able to keep their face out of the water. Able to call for help. Able to wave for help. Horizontal, vertical or diagonal, depending on what they use to support themselves. Floating, sculling or treading water. DROWNING VICTIM—ACTIVE- - CORRECT ANS a drowning victim who is struggling to remain at the surface of the water has distinctive arm and body positions. These are efforts to try to keep the mouth above the water's surface in order to breathe; this universal behavior is called the instinctive drowning response. A drowning victim who is struggling: Cannot call out for help because his or her efforts are focused on getting a breath. Works to keep the face above water in an effort to breathe. A young child may be in a horizontal facedown position during the struggle because he or she is unable to lift the face out of the water. Has extended the arms to the side or front, pressing down for support. Is positioned vertically in the water with no supporting kick. A young child may tip into a horizontal facedown position. Might continue to struggle underwater once submerged. Eventually will lose consciousness and stop moving. DROWNING VICTIM—PASSIVE- - CORRECT ANS some drowning victims do not struggle. They suddenly slip under water due to a medical condition or another cause. These drowning victims: Might float facedown at or near the surface or might sink to the bottom. May be limp or have slight convulsive-type movements. Have no defined arm or leg action, no locomotion and no breathing. May appear to be floating, if at the surface of the water. May be facedown, on one side or face-up, if at the bottom. Anyone who is exhibiting one or more of these signals for 30 seconds should be considered a drowning victim and responded to immediately. AT THE ONSET OF AN EMERGENCY- - CORRECT ANS Recognize the Emergency- The first step in any EAP is recognition that an emergency is taking place in the water or on land and determine that someone needs immediate help. Activate the EAP- Next, before leaving your station, activate the EAP by giving the prearranged signal, such as a 3 whistle blast, to alert other lifeguards and staff. Perform a Water

Rescue or Provide Emergency Care- Once you have given the signal, choose the appropriate rescue for the situation and provide care to the victim as necessary. Some rescues may require additional lifeguards to enter the water and assist with the water rescue. AFTER THE EMERGENCY-After the emergency has been resolved, you and other members of the safety team still have three important tasks to complete: report, advise and release. Report the Incident- Staff members involved in the incident need to complete the appropriate incident report form as quickly as possible after providing care. Advise the Victim- Depending on the nature of the incident, your next step may be to advise the victim. For example, you might give the victim safety instructions to prevent a similar incident from recurring or recommend that the person follow up with a health care provider. Release the Victim-A victim may be released only when the rescue and emergency care provided by you and your safety team is complete. In some cases, you will release the person under his or her own care or to a parent, guardian, camp counselor, group leader, instructor or other staff member. In other situations, you will release the victim to the care of advanced emergency care providers, such as EMS personnel. GENERAL PROCEDURE FOR WATER RESCUES - CORRECT ANS Activate the emergency action plan (EAP). Enter the water, if necessary. Perform an appropriate rescue. Move the victim to a safe exit point. Remove the victim from the water. Provide emergency care as needed. Report, advise and release. RESCUE APPROACHES- - CORRECT ANS The objective of a rescue approach is to safely, quickly and effectively move toward the victim in the water while maintaining control of the rescue tube, keeping the victim in your line of sight. The best way to swim to the victim using a rescue tube is with a modified front crawl or breaststroke. ENTRIES- - CORRECT ANS The objective of entries is to get in the water quickly and safely, with rescue equipment, and begin approaching the victim. Stride jump- Use the stride jump only if the water is at least 5 feet deep and you are no more than 3 feet above the water. Compact jump- you can use the compact jump to enter water from the deck or from a height, depending on the depth of the water. If jumping from a height (when you are more than 3 feet above the water, such as on a lifeguard stand or pier), the water must be at least 5 feet deep. Slide In Entry- Is used for head, neck, and spinal injuries.

ASSISTS- - CORRECT ANS Simple assist- a simple assist can be used in shallow water and may be merely helping a person to stand. The simple assist also may be used to rescue a victim who is submerged in shallow water and is within reach. Reaching assist-. To assist a distressed swimmer who is close to the side of the pool or a pier, use a reaching assist from the deck by extending a rescue tube within the victim's grasp. A swimmer in distress usually is able to reach for a rescue device. However, a victim who is struggling to keep his or her mouth above the water's surface in order to breathe may not be able to grab a rescue tube. In this case, you may need to enter the water to rescue the victim using a front or rear victim rescue. RESCUING A VICTIM AT OR NEAR THE SURFACE- - CORRECT ANS The objective of rescuing a victim at or near the surface of the water is to safely and confidently support the victim using the rescue tube before the victim submerges. The victim's airway should remain above the water while you move to a safe removal point. Active victim front rescue: for a drowning victim who is facing toward you. Active victim rear rescue: for a drowning victim who is facing away from you. Passive victim rear rescue: for a drowning victim is who is facedown at or near the surface in a vertical-to-horizontal position, seems unconscious and is not suspected of having a head, neck or spinal injury RESCUING A SUBMERGED VICTIM- - CORRECT ANS sometimes a drowning victim is below the surface. This could be in shallow water or in deep water beyond your reach. The objective in rescuing a submerged victim is to effectively and quickly go under water, make contact with the victim, bring him or her to the surface and support the victim on the rescue tube while maintaining an open airway, Continue to maintain an open airway while moving the victim to a safe exit point, remove the victim, assess the victim's condition and provide appropriate care. Use the following rescues, based on the victim's position in the water: Submerged victim in shallow water: for a victim who is passive, submerged in shallow water and beyond your reach, Submerged victim in deep water: for a victim who is submerged in deep water, In deep water, surface dives enable you to submerge to moderate depths to rescue or search for a submerged victim. When a victim is below the surface, you must be able to get under water or to the bottom using a Feet-first surface or headfirst surface dive. MULTIPLE-VICTIM RESCUE- - CORRECT ANS Sometimes two or more victims need to be rescued simultaneously. This may happen, for example, when a victim grabs a nearby swimmer to try to stay above the water or when a parent attempts to rescue a child but is overcome by the child's strength. The objective for this rescue is the same as for any other active victim. Several lifeguards should assist in a multiple victim rescue, if possible. At least one lifeguard should check the bottom for possible submerged victims while other lifeguards rescue the victims at the surface. Support them both while waiting for other lifeguard to help bring the other out of water

EXTRICATION/REMOVAL FROM WATER- - CORRECT ANS At this stage in the rescue, the objective is to safely and effectively remove the victim from the water, taking the victim's condition into account, and to provide the appropriate care. Any passive/unconscious person should be removed using the Two- person removal with a backboard at the side of a pool. IN-WATER VENTILATIONS- - CORRECT ANS Always remove a victim who is not breathing from the water as soon as possible to provide care. However, if you cannot immediately remove the victim or if doing so will delay care, then perform in-water ventilations. Once conditions allow you to remove the victim from the water, stop ventilations, remove the victim and then resume care immediately. QUICK REMOVAL FROM SHALLOW WATER FOR A SMALL VICTIM- - CORRECT ANS If you have rescued a passive or unconscious person who is smaller than you and a backboard is not immediately available, you may be able to lift the victim out of the water. Simply place the victim on the side, get yourself out of the water and begin providing care. Do not use this technique if you suspect a spinal injury RECOGNIZING AND CARING FOR BREATHING EMERGENCIES- - CORRECT ANS if a victim suffers a breathing emergency and is deprived of adequate oxygen, hypoxia will result. Hypoxia is a condition in which insufficient oxygen reaches the cells. Hypoxia may result from an obstructed airway, shock, inadequate breathing, drowning, strangulation, choking, suffocation, cardiac arrest, head trauma, carbon monoxide poisoning or anaphylactic shock. Signs and symptoms of hypoxia include increased breathing and heart rates, cyanosis (a condition that develops when tissues do not get enough oxygen and turn blue, particularly in the lips and nail beds), changes in level of consciousness (LOC) restlessness and chest pain. RESPIRATORY DISTRESS- - CORRECT ANS A victim who is having difficulty breathing is experiencing respiratory distress. Signs and Symptoms of Respiratory Distress - Slow or rapid breathing, Unusually deep or shallow breathing, Shortness of breath or noisy breathing, Dizziness, drowsiness or light- headedness, & Changes in LOC. Caring for Respiratory Distress- When you find a victim experiencing difficulty breathing, activate the emergency action plan (EAP) and: Maintain an open airway. Summon EMS. Help the victim to rest in a comfortable position that makes breathing easier. Reassure and comfort the victim. Assist the victim with any of his or her prescribed medication. Keep the victim from getting chilled or overheated.

RESPIRATORY ARREST- - CORRECT ANS a victim who has stopped breathing is in respiratory arrest. Respiratory arrest may develop from respiratory distress, respiratory failure or other causes including drowning; obstructed airway (choking); injury to the head, chest, lungs or abdomen; illness, such as pneumonia; respiratory conditions, such as emphysema or asthma; heart attack; coronary heart disease (such as angina); allergic reactions (food or insect stings); electrocution, including lightning strikes; shock; poisoning; drugs; and emotional distress. Caring for Respiratory Arrest- although respiratory arrest may have many causes, you do not need to know the exact cause to provide care. Begin by following the general procedures for injury or sudden illness on land. GENERAL PROCEDURES FOR INJURY OR SUDDEN ILLNESS ON LAND - CORRECT ANS 1. Size up the scene. (Move the victim only if necessary for his or her safety)

2. Perform a primary assessment. (Obtain consent if the victim is conscious)
3. Summon EMS, if needed.
4. Perform a secondary assessment, if no life-threatening conditions are found.
5. Provide care for the conditions found.
6. Report, advise and release. DROWNING VICTIMS - CORRECT ANS anyone who experiences respiratory impairment from submersion in water is a drowning victim. Drowning may or may not result in death. Victims who have been pulled from the water and are not breathing are in immediate need of ventilations. In general, if the victim is rescued quickly enough, giving ventilations may resuscitate the victim. Without oxygen, a victim's heart will stop and death will result. Your objective is to get the victim's mouth and nose out of the water, open the airway and give ventilations as quickly as possible. Always ensure that victims who have been involved in a drowning incident are taken to the hospital, even if you think the danger has passed. GIVING VENTILATIONS- (A person is not breathing but has a pulse) - CORRECT ANS Giving ventilations is a technique for breathing air into a victim to provide the oxygen necessary to survive. The air you exhale contains enough oxygen to keep a person alive. Each ventilation should last about 1 second and make the chest clearly rise. The chest should fall before you give the next ventilation. Give 1 ventilation every 5-6 seconds for an adult. (20-24 breaths 2 mins) Give 1 ventilation about every 3 seconds for a child or an infant. (40 breaths 2 mins) When giving ventilations to a victim: Maintain an open airway by keeping the head tilted back in the proper position. After you position the mask, seal the mask over the victim's

mouth and nose. Give ventilations for about 2 minutes, then reassess for breathing and a pulse. If the victim has a pulse but is not breathing, continue giving ventilations. Continue giving ventilations until: The victim begins to breathe on his or her own. Another trained rescuer takes over. More advanced medical personnel, such as EMS personnel, take over. You are too exhausted to continue. The victim has no pulse, in which case you should begin CPR or use an AED if one is available and ready to use. The scene becomes unsafe. When checking a victim for breathing do not confuse Agonal (sporadic breaths) with normal breathing. Continue to give the victim ventilations as if they are not breathing. *If you need to leave the victim to go call 911, place them in a recovery position. The H.A.I.N.E.S. position is a recovery position used for victims with a head, neck, or spinal injury. You roll the victim as a unit onto their side, to keep their head, neck, and back aligned. SUSPECTED HEAD, NECK OR SPINAL INJURY- - CORRECT ANS rarely happen in deep water. If you suspect that an unconscious victim has a head, neck or spinal injury, always take care of the airway and breathing first. Remove them from the water as soon as possible, care for the injury once you have removed them. Open the airway by using the jaw-thrust (without head extension) maneuver to check for breathing or to give ventilations. If the jaw-thrust (without head extension) maneuver does not open the airway, use the head-tilt/chin-lift AIRWAY OBSTRUCTION- - CORRECT ANS An airway obstruction is the most common cause of breathing emergencies. A victim whose airway is blocked can quickly stop breathing, lose consciousness and die. A partial airway obstruction can move some air to and from the lungs, often while wheezing. There are two types of airway obstruction: mechanical and anatomical. Any foreign body lodged in the airway is a mechanical obstruction and requires immediate attention. The body itself, most commonly the tongue, causes an anatomical airway obstruction. CONSCIOUS CHOKING- - CORRECT ANS (A person cannot speak, cough, cry, breathe) you must get consent before helping a conscious choking person. If the person is a child or infant, get consent from a parent or guardian, if present. If no parent or guardian is present, consent is implied. When caring for a conscious choking adult or child, perform a combination of 5 back blows followed by 5 abdominal thrusts. Each back blow and abdominal thrust should be a separate and distinct attempt to dislodge the object. For a conscious choking infant, perform a combination of 5 back blows and 5 Abdominal/chest thrusts. Use even less force when giving back blows and chest thrusts to an infant. UNCONSCIOUS CHOKING- - CORRECT ANS (A person is unconscious and an object is blocking the airway so ventilations do not go in) The objective is to clear the airway of the obstruction, allowing adequate ventilations. If an unconscious victim's chest does not clearly rise after giving a ventilation, assume the

airway is blocked by a foreign object and position yourself to give chest compressions as you would when performing CPR chest compressions. After compressions, look in the mouth for an object and, if you see one, remove it with a gloved finger. For an infant, use your little finger to remove the object. Reattempt 2 ventilations. Repeat cycles of 30 chest compressions, foreign object check/removal and 2 ventilations until the chest clearly rises. If the chest clearly rises, quickly check for breathing and a pulse for no more than 10 seconds. ADULT CARDIAC CHAIN OF SURVIVAL - CORRECT ANS - to effectively respond to cardiac emergencies, it is important to understand the Cardiac Chain of Survival. The links in the Cardiac Chain of Survival are: Early recognition and early access (911) to the emergency medical services (EMS) system. The sooner someone calls 9-1-1 or the local emergency number, the sooner EMS personnel will arrive and take over. Early CPR. CPR helps supply oxygen to the brain and other vital organs. This helps keep the victim alive until an AED is used or more advanced medical care is provided. Early defibrillation (AED). An electrical shock, called defibrillation, may help restore an effective heart rhythm. Defibrillation is delivered using an AED. Early advanced medical care. (EMS) personnel provide more advanced medical care and transport the victim to a hospital, and early advanced cardiac care (hospital). For each minute CPR and defibrillation are delayed, the victim's chance for survival is reduced by 10% per minute. Using the cardiac chain of survival helps to save more cardiac arrest victims. PEDIATRIC CARDIAC CHAIN OF SURVIVAL STEPS: - CORRECT ANS PREVENTION, CPR, 911, EMS, HOSPITAL. HEART ATTACK- - CORRECT ANS when the muscle of the heart suffers a loss of oxygenated blood; the result is a myocardial infarction (MI), or heart attack. Causes of a Heart Attack- Heart attacks usually result from cardiovascular disease. Other common causes of heart attack include respiratory distress, electrocution and traumatic injury. The most common conditions caused by cardiovascular disease include coronary heart disease (also known as coronary artery disease) and stroke. Recognizing a Heart Attack- The sooner you recognize the signs and symptoms of a heart attack and act, the better the victim's chance of survival. Signs & symptoms: Chest discomfort or pain that is severe, lasts longer than 3 to 5 minutes, goes away and comes back, or persists even during rest. Discomfort, pressure or pain that is persistent and ranges from discomfort to an unbearable crushing sensation in the center of the chest, possibly spreading to the shoulder, arm, neck, jaw, stomach or back. Difficulty breathing, such as at a faster rate than normal or noisy breathing. Pale or ashen skin, especially around the face. Sweating, especially on the face. Dizziness or light-headedness. Nausea or vomiting. Fatigue, lightheadedness or loss of consciousness

CARING FOR A HEART ATTACK- - CORRECT ANS Take immediate action and summon EMS personnel. Have the victim stop any activity and rest in a comfortable position. Loosen tight or uncomfortable clothing. Closely monitor the victim until EMS personnel take over. Note any changes in the victim's appearance or behavior. Comfort the victim. Assist the victim with prescribed medication, such as nitroglycerin or aspirin, and administer emergency oxygen, if is available and you are trained to do so. Be prepared to perform CPR and use an AED. Administering Aspirin for a Heart Attack- You may be able to help a conscious victim who is showing early signs of a heart attack by offering an appropriate dose of aspirin when the signs first begin. If the victim is conscious and able to take medicine by mouth, ask: Are you allergic to aspirin? Do you have a stomach ulcer or stomach disease? Are you taking any blood thinners, such as Coumadin® (warfarin)? Have you been told by a doctor not to take aspirin? If the victim answers "no" to all of these questions you can give them 2 baby aspirin or 1 adult aspirin. CARDIAC ARREST - CORRECT ANS - Cardiac arrest is a life-threatening emergency that may be caused by a heart attack, drowning, electrocution, respiratory arrest or other conditions. Cardiac arrest occurs when the heart stops beating, or beats too irregularly or weakly to circulate blood effectively. Cardiac arrest can occur suddenly and without warning. In many cases, the victim already may be experiencing the signs and symptoms of a heart attack. The signs of a cardiac arrest include sudden collapse, unconsciousness, no breathing and no pulse. CPR- - CORRECT ANS a victim who is unconscious, is not breathing and has no pulse is in cardiac arrest. The objective of CPR is to perform a combination of effective chest compressions and ventilations to circulate blood that contains oxygen to the victim's vital organs. CPR is performed in cycles of 30 chest compressions followed by 2 ventilations. Summoning EMS personnel immediately is critical for the victim's survival. If an AED is available, it should be used in combination with CPR and according to local protocols until EMS personnel take over. To most effectively perform compressions, place your hands in the center of the chest. Avoid pressing directly on the xiphoid process, the lowest point of the breastbone. Compressing the chest straight down provides the best blood flow and is also less tiring for you. Kneel at the victim's side, opposite the chest, with your hands in the correct position. Keep your arms as straight as possible, with your shoulders directly over your hands. The effectiveness of compressions can be increased if: The victim is on a firm flat surface, Compressions are the proper depth, Compression rate is appropriate, The chest fully recoils after each compression (letting the chest come all the way back up). & CPR is performed without interruption. Once you begin CPR, do not stop. Continue CPR until: You see an obvious sign of life, such as breathing. An AED is available and ready to use. Another trained rescuer takes over, such as a member of your safety team. EMS personnel take over. You are too exhausted to continue. The scene becomes unsafe. When performing CPR, it is not unusual for the victim's ribs to break or cartilage to separate. The victim may vomit, there may be frothing at the nose and mouth, and the scene may be chaotic. The victim also may produce agonal gasps. Remember that agonal gasps are not

TWO-RESCUER CPR - CORRECT ANS - when additional rescuers are available, you should provide two- rescuer CPR. One rescuer gives ventilations and the other gives chest compressions. Rescuers should change positions (alternate giving compressions and ventilations) about every 2 minutes to reduce the possibility of rescuer fatigue. Changing positions should take less than 5 seconds. When CPR is in progress by one rescuer and a second rescuer arrives, the second rescuer should confirm whether EMS personnel have been summoned. When performing two-rescuer CPR on a child or infant, rescuers should change the compression to-ventilation ratio from 30:2 to 15:2. The Adult ratio always stays 30:2. This provides more frequent respirations for children and infants. When providing two-rescuer CPR to an infant, rescuers should perform a different technique to give compressions, called the two-thumb- encircling-hands chest compression technique. AEDS- - CORRECT ANS AEDs are portable electronic devices that analyze the heart's rhythm and provide an electrical shock. Defibrillation is the delivery of an electrical shock that may help re-establish an effective rhythm. The two most common treatable abnormal rhythms that cause sudden cardiac arrest are ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach). In V-fib, the ventricles quiver, or fibrillate, without any organized rhythm. In V-tach, an abnormal electrical impulse controls the heart. This abnormal impulse fires so fast that the heart's chambers do not have time to fill. Using an AED on Adults- When cardiac arrest occurs, use an AED as soon as it is ready to use. First, apply the AED pads and allow the AED to analyze the heart rhythm. Then, follow the prompts of the AED. If CPR is in progress, do not interrupt chest compressions until the AED is turned on, the AED pads are applied and the AED is ready to analyze the heart rhythm. After a shock is delivered, or if no shock is advised, perform about 2 minutes of CPR before the AED analyzes the heart rhythm again. If at any time you notice an obvious sign of life, such as breathing, stop CPR and monitor the victim's condition. Administer emergency oxygen if available and you are trained to do so. USING AN AED ON CHILDREN AND INFANT'S- - CORRECT ANS while the incidence of cardiac arrest in children and infants is relatively low compared with that of adults, cardiac arrest does happen to young children. Causes of cardiac arrests in children include: Airway and breathing problems. Traumatic injuries or accidents (e.g., drowning, motor-vehicle collision, electrocution and poisoning). A hard blow to the chest. Congenital heart disease. Sudden infant death syndrome (SIDS). AEDs equipped with pediatric AED pads are capable of delivering the lower levels of energy considered appropriate for infants and children up to 8 years old or weighing less than 55 pounds. Use pediatric AED pads and/or equipment for a pediatric victim, if available. If pediatric-specific equipment is not available, an AED designed for adults can be used on children and infants. For a child or infant in cardiac arrest, follow the same general steps and precautions as when using an AED on an adult. If the pads risk touching each other because of the victim's smaller chest size, place one pad on the child or infant's chest and the other on the back.

AED PRECAUTIONS - CORRECT ANS - when operating an AED, follow these general precautions: Do not use alcohol to wipe the victim's chest dry; alcohol is flammable. Do not touch the victim while the AED is analyzing. Touching or moving the victim could affect the analysis. Before shocking a victim with an AED, make sure that no one is touching or is in contact with the victim or the resuscitation equipment. Do not touch the victim while the device is defibrillating. You or someone else could be shocked. Do not defibrillate a victim when around flammable or combustible materials, such as gasoline or free-flowing oxygen. Do not use an AED in a moving vehicle. Movement could affect the analysis. Do not use an AED on a victim wearing a nitroglycerin patch or other patch on the chest. With a gloved hand, remove any patches from the chest before attaching the device. Do not use a mobile phone or radio within 6 feet of the AED. Electromagnetic and infrared interference generated by radio signals can disrupt analysis. AEDS AROUND WATER- - CORRECT ANS a shock delivered in water could harm rescuers or bystanders; however, AEDs are safe to use on victims who have been removed from the water. If the victim is in water: Remove the victim from the water before defibrillation. A shock delivered in water could harm rescuers or bystanders. Be sure that there are no puddles of water around you, the victim or the AED. Remove the victim's wet clothing to place the AED pads properly, if necessary. Dry the victim's chest and attach the AED pads. If it is raining, take steps to make sure that the victim is as dry as possible and sheltered from the rain. Ensure that the victim's chest is wiped dry. PACEMAKERS AND ICD'S- - CORRECT ANS Pacemakers are small implantable devices sometimes located in the area below the right collarbone. There may be a small lump that can be felt under the skin if the implanted device is visible, or you know that the victim has one, do not place the AED pad directly over the device. This may interfere with the delivery of the shock. Adjust AED pad placement if necessary and continue to follow the AED instructions. If you are not sure whether the victim has an implanted device, use the AED as needed. It will not harm the victim or rescuer. JEWELRY AND BODY PIERCINGS- - CORRECT ANS you do not need to remove jewelry and body piercings when using an AED. Leaving them on the victim will do no harm. However, do not place the AED pad directly over metallic jewelry or body piercings. SECONDARY ASSESSMENT- - CORRECT ANS During the secondary assessment, you should take a brief history and perform a quick head-to-toe physical exam. If any life-threatening conditions develop during your secondary assessment, stop the assessment and provide appropriate care immediately.

USE SAMPLE TO TAKE A BRIEF HISTORY- - CORRECT ANS Use the SAMPLE mnemonic as an easy way to remember what you should ask. Signs and symptoms: What happened? Where do you feel any pain or discomfort? Do you have any numbness or loss of sensation? If so, where? Allergies: Do you have any allergies to medications or food? If so, what type of reactions have you experienced when you were exposed? Medications: Do you have any medical conditions or are you taking any medications? If so, what conditions do you have or what medications are you taking? Have you taken any medications in the past 12 hours? Pertinent past medical history: Have you recently been ill? Do you have any medical conditions? Have you experienced any recent falls, accidents or blows to the head? Have you had surgery, been in a traumatic accident or had a medical emergency? Last oral intake: When did you last eat or drink? What did you last eat or drink? Events leading up to the incident: What were you doing before the incident occurred?What were you doing when the incident occurred? CHECKING A CONSCIOUS PERSON- - CORRECT ANS Check the victim by performing a head-to-toe exam. Before beginning the exam, tell the person what you are going to do. Visually inspect the person's body, looking carefully for any bleeding, cuts, bruises and obvious deformities. Look for a medical identification (ID) tag, necklace or bracelet on the person's wrist, neck or ankle. LOC (Level of consciousness): neumonic - CORRECT ANS A- Alert V- Verbal P- Painful U- unresponsive SUDDEN ILLNESS- - CORRECT ANS Sudden illness can happen to anyone, anywhere. You may not be able to identify the illness, but you still can provide care. Victims of sudden illness usually look and feel ill. If you suspect something is wrong, check the victim. There are many types of sudden illness, including diabetic emergencies, fainting, seizures and stroke. Signs and Symptoms of Sudden Illness- Many sudden illnesses have similar signs and symptoms. These include: Changes in LOC, such as feeling light-headed, dizzy or becoming unconscious. Nausea or vomiting. Difficulty speaking or slurred speech. Numbness or weakness. Loss of vision or blurred vision. Changes in breathing; the person may have trouble breathing

or may not be breathing normally. Changes in skin color (pale, ashen or flushed skin). Sweating. Persistent pressure or pain. Diarrhea. Seizures. Paralysis & Severe headache. DIABETIC EMERGENCIES- - CORRECT ANS too much or too little sugar in a persons blood. If the person is conscious and can safely swallow fluids or food, give him or her sugar. If it is available, give glucose paste or tablets to the victim. If not available, sugar in liquid form is preferred. Most fruit juices (e.g., about 12 ounces of orange juice), milk and non-diet soft drinks have enough sugar to be effective. You also can give table sugar dissolved in a glass of water. If the person has hypoglycemia, sugar will help quickly. If the problem is high blood sugar (hyperglycemia), giving the sugar will not cause any further harm. FAINTING- - CORRECT ANS When a person suddenly loses consciousness and then reawakens, he or she may simply have fainted. Fainting is not usually harmful, and the person will usually quickly recover. Lower the person to the ground or other flat surface and position the person on his or her back. Loosen any tight clothing, such as a tie or collar. Make sure the victim is breathing. Do not give the victim anything to eat or drink. SEIZURES- - CORRECT ANS There are many different types of seizures. Generalized seizures usually last 1 to 3 minutes and can produce a wide range of signs and symptoms. When this type of seizure occurs, the person loses consciousness and can fall, causing injury. To provide care to a person having a seizure: Protect the person from injury by moving nearby objects away from the person. Position the person on his or her side, if possible, after the seizure passes so that fluids (saliva, blood, vomit) can drain from the mouth. When the seizure is over, the person usually begins to breathe normally. He or she may be drowsy and disoriented or unresponsive for a period of time. SEIZURES IN THE WATER - CORRECT ANS - if a person has a seizure in the water: 1. Summon EMS personnel. 2. Support the person with his or her head above water until the seizure ends 3. Remove the person from the water as soon as possible after the seizure (since he or she may have inhaled or swallowed water). 4. Once on land, position the person on his or her back and perform a primary assessment. Give ventilations or CPR if needed. STROKE - CORRECT ANS - As with other sudden illnesses, the signs and symptoms of a stroke or mini- stroke are a sudden change in how the body is working or feeling. This may include sudden weakness or numbness of the face, an arm or a leg. Usually, weakness or numbness occurs only on one side of the body. Other signs and symptoms include difficulty with speech (trouble speaking and being understood, and difficulty understanding others); blurred or dimmed vision; sudden, severe headache; dizziness or

confusion; loss of balance or coordination; trouble walking; and ringing in the ears. If the person shows any signs or symptoms of stroke, time is critical. The objective is to recognize a possible stroke and summon EMS personnel immediately. To identify and care for a victim of stroke, think FAST: Face—Weakness on one side of the face Ask the person to smile. This will show if there is drooping or weakness in the muscles on one side of the face. Does one side of the face droop? Arm—Weakness or numbness in one arm Ask the person to raise both arms to find out if there is weakness in the limbs. Does one arm drift downward? Speech—Slurred speech or trouble speaking Ask the person to speak a simple sentence to listen for slurred or distorted speech. Example: "The sky is blue." Can the victim repeat the sentence correctly? Time—Time to summon EMS personnel if any of these signs or symptoms are seen. SKIN AND SOFT TISSUE INJURIES- - CORRECT ANS Soft tissues are the layers of skin and the fat and muscle beneath the skin's outer layer. A physical injury to the body's soft tissue is called a wound. Soft tissue injuries typically are classified as either closed or open wounds. Closed wounds occur beneath the surface of the skin. The simplest closed wound is a bruise or contusion. In an open wound, the break in the skin can be as minor as a scrape of the surface layers (abrasion) or as severe as a deep penetration. The amount of external bleeding depends on the location and severity of the injury CARING FOR EXTERNAL BLEEDING- - CORRECT ANS to care for a minor wound, such as an abrasion, follow these general guidelines: Control any bleeding. Place a sterile dressing over the wound. Apply direct pressure until bleeding stops SHOCK - CORRECT ANS - any serious injury or illness can result in a condition known as shock. Shock is a natural reaction by the body. It usually means the victim's condition is serious. Signs and symptoms of shock include restlessness or irritability; altered LOC; pale or ashen, cool, moist skin; nausea or vomiting; rapid breathing and pulse; and excessive thirst. To minimize the effects of shock: Make sure that EMS personnel have been summoned. Monitor the victim's condition and watch for changes in LOC. Control any external bleeding. Keep the victim from getting chilled or overheated. Have the victim lie flat on his or her back. Cover the victim with a blanket to prevent loss of body heat. Do not overheat the victim— your goal is to maintain a normal body temperature. Comfort and reassure the victim until EMS personnel take over. Note: Do not give food or drink to a victim of shock, even if the victim asks for them.

NOSEBLEEDS- - CORRECT ANS to care for a nosebleed: Have the victim sit leaning slightly forward to prevent swallowing or choking on the blood. Pinch the nostrils together for about 5 to 10 minutes or until the bleeding stops. Other methods of controlling bleeding include applying an ice pack to the bridge of the nose or putting pressure on the upper lip just beneath the nose. Do not pack the victim's nose to stop. BURNS- - CORRECT ANS Burns are a special kind of soft tissue injury. Like other types of soft tissue injury, burns can damage the top layer of skin or the skin and the layers of fat, muscle and bone beneath. There are four sources of burns: heat, radiation, chemicals and electricity. Burns are classified by their depth. The deeper the burn, the more severe. Burns can be superficial (first degree), partial thickness (second degree) or full thickness (third degree). CARING FOR BURNS- Stop the burning by removing the victim from the source of the burn. Cool the burned area with large amounts of cold tap water at least until pain is relieved. Cover the burned area loosely with a sterile dressing. Take steps to minimize shock, such as by keeping the victim from getting chilled or overheated. Comfort and reassure the victim. POISONING- - CORRECT ANS a poison is any substance that can cause injury, illness or death when introduced into the body. Poisons can be in the form of solids, liquids, sprays or fumes (gases and vapors). If a person is showing signals of poisoning, call the Poison Control Center at 1-800-222-1222. If the person is unconscious or experiences a change in LOC, or if another life-threatening condition is present, summon EMS personnel. HEAT-RELATED ILLNESSES- - CORRECT ANS Heat-related illnesses are progressive conditions caused by overexposure to heat. If recognized in the early stages, heat-related emergencies usually can be reversed. If not recognized early, they may progress to heat stroke, a life-threatening condition. There are three types of heat-related illnesses: Heat cramps are painful muscle spasms that usually occur in the legs and abdomen. Heat cramps are the least severe of the heat-related illnesses. Heat exhaustion is an early indicator that the body's cooling system is becoming overwhelmed. Signs and symptoms of heat exhaustion include cool, moist, pale, ashen or flushed skin; headache, nausea and dizziness; weakness and exhaustion; and heavy sweating. Heat stroke occurs when the body's systems are overwhelmed by heat and stop functioning. Heat stroke is a life-threatening condition. Signs and symptoms of heat stroke include red, hot, dry skin; changes in LOC; and vomiting. Caring for Heat-Related Illnesses- Take the following steps: Move the victim to a cool place. Loosen tight clothing and remove perspiration-soaked clothing. Cool the victim by spraying with cool water or applying cool, wet towels to the skin. Fan the victim. Encourage the victim to drink small amounts of a commercial sports drink, milk or water if the victim is conscious and able to swallow.

COLD-RELATED EMERGENCIES - CORRECT ANS - Temperatures do not have to be extremely cold for someone to suffer a cold-related emergency, especially if the victim is wet or if it is windy. Hypothermia occurs when a victim's entire body cools because its ability to keep warm fails. A victim with hypothermia will die if care is not provided. The signs and symptoms of hypothermia include shivering; numbness; glassy stare; apathy, weakness or impaired judgment; and loss of consciousness. To care for hypothermia: Perform a primary assessment, including a pulse check for up to 30 to 45 seconds. Summon EMS personnel. Gently move the victim to a warm place. Sudden movements may cause a heart arrhythmia and possibly cardiac arrest. Remove any wet clothing. Warm the victim by wrapping all exposed body surfaces in blankets or by putting dry clothing on the victim. Be sure to cover the head since a significant amount of body heat is lost through the head. Do not warm the victim too quickly, such as by immersing him or her in warm water. If the victim is alert, have him or her drink liquids that are warm, but not hot, and do not contain alcohol or caffeine. If you are using hot water bottles or chemical hot packs, first wrap them in a towel or blanket before applying. Monitor the victim's condition and watch for changes in LOC. INJURIES TO MUSCLES, BONES AND JOINTS- - CORRECT ANS Accidents, such as falls, are a common cause of injuries to muscles, bones and joints. There are four types of muscle, bone and joint injuries: Fracture—A complete break, a chip or a crack in a bone. Factures can be open or closed. Closed fractures: The skin over the broken bone is intact. Open fractures: There is an open wound in the skin over the fracture. Dislocation—Displacement of a bone away from its normal position at a joint. These usually are more obvious than fractures. Sprain—Tearing ligaments at a joint. Strain—Stretching and tearing muscles or tendons. To care for injuries to muscles, bones and joints use Rice. Rest- Avoid any movements or activities that cause pain. Immobilize- Stabilize the injured area in the position in which it was found. Cold- Apply ice or a cold pack for periods of 20 minutes. Elevate- the injured area above the level of the heart helps slow the flow of blood, helping to reduce swelling. SPLINTS: - CORRECT ANS Anatomic splints: The person's body is the splint. For example, an arm can be splinted to the chest Soft splints: Soft materials, such as a folded blanket, towel, pillow or folded triangular bandage, can be used to form a splint. Rigid splints. Boards, folded magazines or newspapers, or metal strips that do not have sharp edges can serve as splints. The ground: The ground can be used to stabilize a leg injury.

ASTHMA- - CORRECT ANS Asthma is an ongoing illness in which the airways swell. An asthma attack happens when an asthma trigger, such as dust or exercise, affects the airways, causing them to suddenly swell and narrow. This makes breathing difficult, which can be frightening. You can often tell when a person is having an asthma attack by the hoarse whistling sound made when inhaling and/or exhaling. This sound, known as wheezing, occurs because airways have narrowed or become obstructed. You can assist with prescription- just obtain consent and follow directions. However, do not share medications from a bystander if the victim does not have their prescription call 911, and monitor them. ANAPHYLAXIS- - CORRECT ANS Anaphylactic shock, also known as anaphylaxis, is a severe allergic reaction that can cause air passages to swell and restrict breathing. In susceptible people, triggers can include insect bites or stings, certain food and food additives, medication and chemicals. Anaphylactic shock is a life-threatening condition and requires immediate care. Anyone at risk should wear a medical identification tag, bracelet or necklace. RECOGNIZING ANAPHYLAXIS- Some possible signs and symptoms of anaphylaxis include swelling of the face, neck, hands, throat, tongue or other body part; itching of the tongue, armpits, groin or any body part; rash or hives; weakness, dizziness or confusion; redness or welts on the skin; red watery eyes; nausea, abdominal pain or vomiting; rapid heart rate; wheezing, difficulty breathing or shortness of breath; difficulty swallowing; tight feeling in the chest and throat; low blood pressure; and shock. Caring for Anaphylaxis- If you suspect that someone is experiencing anaphylaxis, you should immediately: Summon EMS personnel. Provide emergency care. Remove the victim from the source of the allergy. Assist with the person's prescribed epinephrine auto-injector, if local protocols allow. CAUSES OF HEAD, NECK AND SPINAL INJURIES- - CORRECT ANS Head, neck and spinal injuries rarely happen during supervised diving into deep water. Head, neck or spinal injuries also happen out of the water, for example, when a person trips or falls on a pool deck or in a locker room. Head, neck or spinal injuries often are caused by high-impact/high-risk activities. In aquatic environments, examples of these activities include: Entering head-first into shallow water, Falling from greater than a standing height, Entering the water from a height, such as a diving board or water slide. Receiving a blow to the head, or Colliding with another swimmer. SIGNS AND SYMPTOMS- you should suspect a possible head, neck or spinal injury only if the activity was high-impact or high-risk and signs or symptoms of injury are present. The signs and symptoms of possible head, neck or spinal injury include: Unusual bumps, bruises or depressions on the head, neck or back. Heavy external bleeding of the head, neck or back. Bruising of the head, especially around the eyes and behind the ears. Blood or other fluids in the ears or nose, Seizures, Changes in level of consciousness, Impaired breathing or vision, Nausea or vomiting, Partial or complete loss of movement of any body area. Loss of balance, Victim holds his or her head, neck or back, Behavior resembling intoxication, severe pain or pressure in the head, neck or back. Back pain, weakness, tingling or loss of sensation in the hands, fingers, feet or toes. Persistent headache.

CARING FOR HEAD, NECK AND SPINAL INJURIES IN THE WATER

1. Activate the facility's emergency action plan (EAP). Facilities may have a distinct signal to begin a suspected head, neck or spine injury rescue.
2. Safely enter the water. If the victim is near a pool wall or pier, minimize water movement by using a slide-in entry rather than a compact or stride jump. If you use a SPINAL BACKBOARDING PROCEDURE- - CORRECT ANS after stabilizing the victim's head, neck and spine, you and at least one other lifeguard should place and secure the victim on a backboard. Using a backboard helps to immobilize the victim during the process of removing him or her from the water. A minimum of two lifeguards is needed to place and secure a victim on a backboard, but additional lifeguards or bystanders should also help, if available. To place a victim on a backboard, a 2nd lifeguard should submerge the board on an angle from the pool deck, the primary lifeguard should walk the victim on top of the board while maintaining the head splint technique. The second lifeguard will take over holding head splint so the primary can secure the victim to the board with 1 strap under the arms/across the chest. Then the primary will place one hand under the board and the other down the victims chest (like head and chin support) so that the 2nd lifeguard can lower the victims arms and immobilize the victims head to the board- once complete both lifeguards will remove the victim from the water and monitor until EMS arrive and take over. Remember we only do this for conscious victims and you need to remind them to not move.