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Rescue Theory

08 Jan Chief's Column, GIBP News | Comments Off on Rescue Theory
Rescue Theory
 

A swimmer’s head sits low in the water and his arms flap out to the sides while trying to keep his head up. The lifeguard sees the telltale signs of a swimmer in distress. She immediately kicks into a whole pre-determined plan. She radios for backup, grabs her fins and rescue tube, chooses the proper entry (from sand or rocks), and dolphins through shallow water while unwrapping her tube. Swimming with her head intermittently up to keep sight of the victim, she pauses on the approach, and talks to him as she keeps her buoy between them while extending it. Upon contact, she moves to his rear and buckles the buoy around him, assesses him, signals to shore what his condition is and if she needs help, swims him to the beach while checking intermittently, re-checks him more thoroughly at the shore and renders whatever medical aid is needed. While doing this she prepares to pass all this info on to her supervisor or other first responders.

Making an ocean rescue is a complicated process which requires a great deal of preparation to effect safely. There are a lot of ways this could potentially go sideways, so we spend a large percentage of precious training time on this topic. Obviously there is a lot of physical training required in advance so the body is prepared, but the real keys are the mental aspects. These we break into two general categories, elimination of variables and cognitive flexibility under stress.

Elimination of variables encompasses a whole range of physical, mental, and psychological components. The overarching concept is when you start the rescue process there are a lot of things that need to happen, so you want to make sure you take care of as many of these variables as you can in advance and have fewer unknowns as you enter the rescue scenario. In addition to the areas that are consistent between most rescues, each event is unique and so things will be encountered that that could not be planned for.

When you go into action your body instinctively kicks in a whole range of physiological responses so you can do things you wouldn’t normally be able to do. Time seems to slow down as chemicals are dumped into your blood stream. Depending on your training and history, you can experience a diminished mental capacity while at the same time have an enhanced physical capability. Taking care of as many things as possible in advance is crucial since you may not be at your best mentally during the rescue process. The key components in the concept of elimination of variables are: level of fitness, skills, equipment preparation, and state of readiness.

Level of fitness involves a great deal of physical training that is specific to the actual environment that rescues will be made in. Our guards work out before every shift so they’re intimately familiar with the bottom contour, waves, and currents of that particular day. We also use competition as a means to motivate the entire staff to be at their physical peak during the beach season.

Rescue skills atrophy if not used regularly. Incorporated into our daily pre-shift workouts is a skill component. They may practice CPR, hand signals, components of a rescue, public relations, or handling a lost child. Sports enthusiasts and public safety professionals regularly use the term “muscle memory” to signify repeating something over and over again until you don’t have to consciously think about it. For example you may practice a modification to your swim stroke so many times that you start doing it automatically when you swim. They may be using the term incorrectly in this context, but it makes sense in that it’s almost like your body remembers how to do something without your brain having to tell it. If these skills are kept current through repeated training and practice, they happen almost subconsciously during the rescue process so the rescuers consciousness isn’t spread too thin. He/she can then focus on the weird stuff that inevitably happens, instead of on things that need to happen for every rescue.

Equipment preparedness is integral in the process. There’s nothing worse than having equipment malfunction when trying to save another person. A fairly routine rescue can go horribly wrong when a fin strap breaks or a buoy is wrapped up improperly so the strap doesn’t play out smoothly. There’s a reason fire departments insist that each piece of equipment is maintained and put up the same way each time. When you need that hose or pump, it needs to be easy to get and needs to work. One of the first things the lifeguards learn is how to properly wrap their rescue buoy. Once this is committed to “muscle memory” it’s automatically done the same way each time. Each guard uses the same technique so the buoys are interchangeable if they have to use someone else’s equipment. The same principle applies to oxygen units, personal water craft, rescue vehicles, automatic external defibrillators and any other piece of equipment. If you get in a rescue truck at any point of the day or night the equipment is stored the same way, every piece of equipment works, it’s full of gas, and ready to go. Fewer variables stand between the rescuer and successfully saving a life.

State of readiness is a general concept that basically means the lifeguards come to the job each day prepared mentally, physically, and psychologically. They are able to maintain a state of alertness for their entire shift because they are well rested, hydrated, and wearing the proper gear for sun protection or temperature control. It also implies that they leave their personal problems at home and don’t let any issues they may be having interfere with their work or concentration on duties. It’s better to have an empty tower than a lifeguard who is there physically but who is not focused. The only person who truly can monitor this is the lifeguards themselves, so the expectation is that they will remove themselves from duty if there’s some reason that they can’t focus on the job. Finally, before a lifeguard is able to work a stand, he/she needs to have developed a certain level of confidence in his/her ability to save someone. This is accomplished by all the aforementioned skills and through a belief that they can handle unusual situations on the fly because they are proficient in their ability think creatively under the gun.

Cognitive flexibility under stress, the ability to demonstrate flexibility and creative problem solving strategies under duress, is a little harder concept for the guards to grasp at first. Through repetition neural pathways become more “worn”, much like a foot path that has been traveled more often and therefore becomes easier to use. This is a good thing in that response to a given stimuli becomes automatic, but with the obvious benefits come inherent risks. The potential issue lies in the environment itself. The ocean and beach are in a constant state of flux, as are the beach patrons themselves.  No rescue is routine, as there are a multitude of factors that can affect the process. When in a stressful situation we all have a tendency to default to what we know. That’s good if it means we perform CPR the way we were trained. But you also hear stories about police officers who, in the midst of a shootout, start collecting their empty magazines off of the street because that’s the way they did it when practicing at the range. The goal of teaching people to show “cognitive flexibility” during a rescue or crisis is for them to default to their training while at the same time being able to expand their awareness and come up with creative solutions to problems that pop up while dealing with a multitude of issues.

Understanding this principle helps in the teaching process. In ocean lifeguarding we teach from the top down. Our instructors focus on the overarching principles and teach to trouble shoot application of these principles to a variety of real life scenarios. For example, instead of teaching exactly how to make contact with a victim in the water, we focus on basic principles such as keeping floatation between the rescuer and victims’ bodies, pausing and assessing a safe distance from a victim. That way the concept works when you use other types of floatation and/or in a myriad of specific rescue techniques. Or we may talk about tone of voice as opposed to specific words to say to a victim. Once these general concepts are internalized through training and repetition (muscle memory), the guards become more confident and comfortable in their ability handle anything that is thrown at them.

These concepts and a respect for the power and variability of the ocean are the beginnings of forging competent and professional lifeguards.