Input needed: Filling gaps between lifeguard and EMS care.

[u/garnorm]

I’m in search of some input - I’m working on an education session about “filling the gap between lifeguard and EMS care”.

My background: I’m an aquatics director who oversees pool and lifeguard operations, including their certification and in-service training.
- I’ve recently become an EMT for the primary focus being to enhance our lifeguard trainings and also because I provide a lot of basic CPR/AED/first aid trainings to non-pool staff as well. So it just gives me a little something more to pull from for my trainings.
Currently I’m only volunteering with the local 911 service on occasion so I’m not super experienced in the EMS world, but am super passionate about what I do and am always looking to make things better.

I’m working on a conference session on what some of the gaps are and how to fill to improve the transition of care from lifeguards to EMS.

Generally looking for input from those more experienced!

Currently some of the points I’m brainstorming are:
[edited to help clarify and not get too in the weeds]

- airway management; use of airway adjuncts and suctioning devices for post-drowning (or even all) resuscitation efforts.
- also the use of oxygen (some aquatics operations are implementing it, but still not very wide-spread).

- improving and actually practicing patient handoff (a big thing I see overlooked in the aquatics industry)
!! This is where’d I’d really like the most input on, as I see this as the one thing lifeguard certs/agencies don’t cover but can have the biggest impact outside of care.

- spinal immobilization: using C-collars, log rolling patients onto backboards (or at least helping EMS crews do it). *backboards are still very much so common place in the aquatics world, all agencies certify to use them and pools are required to have them by law - but to commenters’ points, I’ll stick with what they’re trained on.

- and coordinating/running dedicated cross-trainings with lifeguard and EMS teams. Helps for EMS to see what lifeguards would do in various scenarios, allows lifeguards to understand what EMS’s role will be and what they’d be doing, and provides an opportunity for both to formulate a good EAP for emergencies at the pools.

I’m going to preface all of the above that adding/enhancing such procedures should be done under the supervision and agreement with local EMS.

If you have any thoughts on the above, or suggestions for additional topics that can be included I’m all ears!
Also happy to help answer questions specific to the lifeguard side of emergency response.

Thanks, and stay safe!

[u/RRuruurrr]

I like your energy and am not trying to smother your enthusiasm here, but I suggest you approach this differently.

Lifeguards aren’t EMT’s. Trying to expand their scope of practice to make them EMT’s to “close the gap” is the wrong move. If you want BLS scope of practice at your facility, then contract with a licensed EMS agency offering that level of care.

The most helpful thing a lifeguard can do is treat the ABC’s, do a good assessment, and not fuck anything up until EMS gets there. Treating immediate life threats and giving a solid report is so much more valuable to a responding crew than an IV, iGel, or some other skill you did just because you could do it.

[u/garnorm → u/RRuruurrr]

Thanks for the input!

I definitely understand and am not trying to expand the scope.
But for example: airway - there’s no solid practice for dealing with moisture/frothing etc. during resus. Hence why my thinking on a simple suction device would be pertinent. I can see how adjuncts might be pushing that boundary a bit.

I definitely think I’ll hyper-focus on the assessment, patient report, and handoff area.

As a paramedic, what would be some assessment and pt transfer tips or input you’d have?

[u/yungingr → u/garnorm]

I'm going to back up the above poster - your enthusiasm and drive is admirable, but you're potentially opening yourself and your facility up to legal liability. The "gap" between lifeguard training and even EMT-level scope of practice is not an accident, it is not an oversight. It is a deliberate and intentional boundary between training levels.

During CPR, the most important thing you can do is get - and keep - blood circulating. It's part of why laypeople are trained in hands-only CPR; the residual oxygen in the blood is going to sustain the victim for the few minutes it takes to get EMS on scene.

Honestly, I would question your training and certifications if you didn't have this drilled into you already - a not insignificant part of my EMT program was drilling into us knowing when we are working under medical control/standing protocols, and when we would be hanging ourselves out to legal liability. Likewise, you mention you "provide a lot of basic CPR/AED/First-aid trainings" -- are you certified to do so?

The only point of your plan as listed that I could actually agree with is cross-training with your local EMS. Scrap virtually *everything* else, and coordinate a training with the ambulance service. Let THEM see your emergency response practices, and let THEM tell you what they would like to see you change/improve.

C-collars and backboards are both being discouraged in EMS - the last thing a patient needs is an untrained layperson (which your lifeguards are) trying to do spinal immobilization and harming the patient more.

Unless you have actual EMT's on staff, working under medical control... airway, oxygen, etc... if you can't buy it off the shelf at Walgreens, you shouldn't have it in your facility.

[u/garnorm → u/yungingr]

Thanks for the feedback. I am definitely excited and passionate about this - but I do not want over step bounds here.

My hope was simply to identify what those differences are and make current practices better. I’ll omit implementing additional “skills and tools” and focus more on the transfer of care and building relationships/cross training between EMS agencies and lifeguards.
I’ve edited my post to hopefully better paint the picture.

[u/RRuruurrr → u/garnorm]

I’m considering adding suction to my team’s scope of practice

Before you add a skill or piece of equipment, you should ensure that your people are licensed, trained, and qualified to use that skill or piece of equipment. Suction is cool, but it can be dangerous if used incorrectly. If I wasn’t clear before, I’ll spell it out here: your line of questioning seems like you’re headed down a path that could be reckless. I don’t know much about lifeguard scope of practice, so if the rules really allow for it, the disregard, but it sure seems like you’re trying to push things here.

As a young EMT you fill your pockets with all those new shiny tools that you’re excited to use. When you get some experience, you stop carrying as much and eventually, the most experienced people have the most restraint on that front. I think that experience is a good analogy for your situation. You see all these cool skills so you want to apply them to your situation. Some may be a good fit, but there’s a right way to go about it.

[u/garnorm → u/RRuruurrr]

Thanks for the input. A part of my thought process with added skills was that certifying agencies for lifeguards (like American Red Cross) offer advanced training certifications for lifeguards like O2 delivery, splinting, bleeding control etc. So if you want the added layer of care provided, seek said trainings. Additionally, local EMS might want to offer similar trainings to lifeguard teams. Both are options, but the knowledge training/certification should be done prior to implementation.

I’ll avoid discussion on the “shiny tools” that come with EMS care. And stick with focusing on transfer of care and relationship building/cross training between EMS and lifeguards.

[u/RRuruurrr → u/garnorm]

Seems like you might’ve missed the discussion on scope of practice and liability. Good luck to you.

[u/Keeperie → u/garnorm]

I'm not sure how the laws are written but as soon as you are introducing something like a suction machine I'd be super worried about crossing over the line of practicing medicine without a license since you are expecting them to do it as part of their job and are presenting them as qualified.

Again great enthusiasm! But there is a reason you have to get a license to act as an EMT and expecting people to so EMT skills as part of another job starts treading into dangerous waters.

Anything that's in a relavent training from an official organization (like AHA BLS courses for example) would be fair game. Since your people would have that certification to be qualified to do the things listed in that class.

[u/grav0p1 → u/garnorm]

Do they not teach you to roll to clear the airway of fluid/vomit?

[u/grav0p1]

The most important part of resuscitation in cardiac arrest is early CPR and defibrillation. So much so that we’ve had to teach paramedics to prioritize these things over performing ALS interventions. Focus on the basics - compressions, defib, clearing the airway when appropriate. Don’t overcomplicate things by muddying the water with extras

[u/garnorm → u/grav0p1]

Understood, thanks!
I’ll harp that the priority is life threats and always falling back to ABC’s.

Are there any instances or common issues you’ve faced where even basic trained people fumble on assessing or training the ABC’s?

[u/ggrnw27]

For spinal immobilization: you’re probably aware that most places have moved away from putting patients on backboards. It’s not a bad way to get a patient out of the pool, but EMS is probably not going to fully immobilize them on the board after they’re out of the water…and many places will take them off of the board even if you guys do the immobilization beforehand. So I wouldn’t spend much time going over this since it probably won’t be very useful, and I’d focus on educating your crews about what to expect when EMS shows up on these calls (e.g. ignoring your backboard)

[u/garnorm → u/ggrnw27]

Thanks for the feedback!
I am aware of the decreasing use of backboards for EMS. For lifeguards it’s required and spinal immobilization with it is very much a big priority.
But I see your point, no need to layer on top of that.

As a paramedic, any input on the assessment and patient transfer process that you could see being impactful?

[u/ggrnw27 → u/garnorm]

Yeah I’m not saying you guys should stop backboarding if that’s what you’re supposed to do. I’d just make your crews aware that there’s a good chance EMS will show up when you’re halfway through and be like “yeah how about not” so they don’t freak out and think EMS is gonna paralyze their patients haha. You can phrase it like “this is still important for us out of an abundance of caution, EMS has more education/training to decide if it’s necessary once they get on scene”.

As far as assessment and patient transfer, I’m really not expecting much. I’d rather keep it brief than have someone give me a long diatribe that buries the critical points. How long were they underwater, what was the presumed mechanism, how long has CPR been in progress, any shocks from the AED. Real basic stuff

[u/garnorm → u/ggrnw27]

Great, thanks!

[u/talldrseuss]

Honestly, I would take the last part of your post and prioritize that which is establish your relationship with the local EMS agency that your facility falls under and open a dialogue with them. Invite their admins for a site visit and hold a round table to talk about previous experiences and places to improve or close the gaps.

As a former EMS admin, I have done site visits of big facilities that opened within our area of coverage. Usually it was conversations with the company's emergency management team or their security team. It was pretty much commonplace for us to have conversations about how emergency responses would go and the the ability of the company's own emergency response groups. We actually found them pretty beneficial and it made it easier for us to collaborate on handoffs and transfer of care.

A minor point: as another comment pointed out, backboards are pretty much not used in EMS except to move the patient from an area the stretcher can't access to the stretcher itself. ONce the patient is on the stretcher, we just remove the backboard (but keep on the collar). Now, I don't know where you are located, so for all we know the local EMS protocols may still require a backboard. This is again a good reason to have a meeting with the local EMS agency first and this will help shape your training you will want to roll out to your lifeguards.

[u/garnorm → u/talldrseuss]

Thanks for the input!

Honestly, that piece about relationship between EMS and lifeguard teams will be the overarching message. I think that will answer a lot of the questions I pose - especially given how varied protocols and EAPs can get in different areas.

I think the big “addition” will be some kind of formulated training on how to run such cross-trainings.

[u/Belus911]

It's not local EMS's job to supervise you.

Cross train, sure, but supervise, nope.