Drowning and aquatic injuries dictionary.

BACKGROUND: Drowning is a significant public health issue with more than 320,000 deaths globally every year. These numbers are greatly underestimated, however, due to factors such as inadequate data collection, inconsistent categorization and failure to report in certain regions and cultures.The objective of this study was to develop a standardised drowning dictionary using a consensus-based approach. Through creation of this resource, improved clarity amongst stakeholders will be achieved and, as a result, so will our understanding of the drowning issue. METHODOLOGY: A list of terms and their definitions were created and sent to 16 drowning experts with a broad range of backgrounds across four continents and six languages. A review was conducted using a modified Delphi process over five rounds. A sixth round was done by an external panel evaluating the terms' content validity. RESULTS: The drowning dictionary included more than 350 terms. Of these, less than 10% had been previously published in peer review literature. On average, the external expert validity endorsing the dictionary shows a Scale Content Validity Index (S-CVI/Ave) of 0.91, exceeding the scientific recommended value. Ninety one percent of the items present an I-CVI (Level Content Validity Index) value considered acceptable (>0.78). The endorsement was not a universal agreement (S-CVI/UA: 0.44). CONCLUSION: The drowning dictionary provides a common language, and the authors envisage that its use will facilitate collaboration and comparison across prevention sectors, education, research, policy and treatment. The dictionary will be open to readers for discussion and further review at www.idra.world.

Relationship between the Performance in a Maximum Effort Test for Lifeguards and the Time Spent in a Water Rescue.

The main objective of this study was to analyse the relationship between the performance in a maximum incremental test for lifeguards, the IPTL, and the effectiveness of a 200 m water rescue on the beach. Initially, 20 professional lifeguards carried out the IPTL in the pool and then they performed a 200 m water rescue on the beach. The maximum oxygen uptake (VO2max) in the IPTL was estimated. In both tests, heart rate (HR), blood lactate (La) and time achieved were measured. The VO2max estimated in the IPTL (VO2IPTL) was 44.2 ± 4.7 mL·kg·min-1, the time reached in the IPTL (TimeIPTL) was 726 ± 72 s and the time spent in the rescue (TimeRescue) was 222 ± 14 s. The results showed that the time reached in the pool (TimeIPTL) was the best predictor variable of the performance in water rescue (TimeRescue) (R2 = 0.59; p < 0.01). A significant correlation was also observed between the estimated maximum oxygen uptake and the beach rescue performance (R2 = 0.37; p = 0.05). These results reveal that the IPTL, a maximum incremental test specific to lifeguards, allows the estimation of the effectiveness of a 200 m rescue on the beach.

Plastic blanket drowning kit: A protection barrier to immediate resuscitation at the beach in the Covid-19 era. A pilot study.

OBJECTIVE: Introducing a new, simple and inexpensive portable equipment for lifeguards, consisting of a pre-assembled full-size plastic blanket with a mask and HEPA filter, which could offer significant time-saving advantages to reduce COVID-19 risk transmission in the first few minutes of CPR after water rescue, avoiding the negative impact of delayed ventilation. METHOD: A pilot study was carried out to determine the feasibility of the pre-assembled kit of face-mask and HEPA filter adapted on a pre-set plastic-blanket. The first step consisted of washing hands, putting on safety glasses and gloves as the first personal protection equipment (PPE) and then covering the victim with an assembled plastic blanket. The second step consisted of 10 min of cardiopulmonary resuscitation (CPR) with PPE and plastic blanket, following the technical recommendations for ventilation during COVID-19. RESULTS: Ten rescuers took part in the pilot study. The average time to wear PPE and place the pre-assembly kit on the victim was 82 s [IC 58-105]. After 10 min the quality of the resuscitation (QCPR) was 91% [87-94]. Quality chest compressions (CC) were 22% better than ventilations (V). Most of the rescuers (60%) thought that placing the plastic blanket on the victim on the beach was somewhat simple or very simple. CONCLUSIONS: Resuscitation techniques in COVID-19 era at the beach have added complexities for the correct use of PPE. Plastic blanket plus basic ventilations equipment resource could be a new alternative to be considered for lifeguards to keep ventilation on use while reducing risk transmission.

[Occupational health recommendations for lifeguards in aquatic emergencies in the Covid-19 era: prevention, rescue and resuscitation.] / Recomendaciones de salud laboral para socorristas ante emergencias acuáticas en la era Covid-19: prevención, rescate y reanimación.

Severe acute respiratory syndrome (SARS-CoV-2), which causes coronavirus disease 2019 (Covid-19), is highly contagious. Lifeguards are the first line of response in aquatic emergencies and they will suffer a strong exposure to risk this first summer of the Covid-19 era, so their occupational health must be rethought in their professional practice during the new normal. The main public health measure to prevent drowning is prevention, but when this fails and assistance or rescue is required, in most interventions, distancing will not be possible. The limitation of personal protective equipment (PPE) for rescue is a reality that must be known and that can affect the health of the lifeguard. A review of the current literature aimed at avoiding or minimizing the risk of contagion in the interventions carried out by rescuers in the Covid-19 era was performed. This article provides structured information on the prevention of contagion in lifeguards, the potential risks, the available PPE, and the recommendations for its proper use during rescue or prehospital care in aquatic settings.

El síndrome respiratorio agudo severo (SARS-CoV-2), que causa la enfermedad por coronavirus 2019 (Covid-19), es altamente contagioso. Los socorristas son la primera línea de respuesta en las emergencias acuáticas y van a sufrir una fuerte exposición al riesgo este primer verano de la era Covid-19, por lo que su salud laboral debe ser replanteada en su práctica profesional durante la nueva normalidad. La principal medida de salud pública para evitar ahogamientos es la prevención, pero cuando esta falla y se requiere la asistencia o el rescate, en la mayor parte de las intervenciones el distanciamiento no será posible. La limitación de los equipos de protección personal (EPI) para el rescate es una realidad que debe conocerse y que puede afectar a la salud del socorrista. Se realizó una revisión de la literatura actual orientada a evitar o minimizar el riesgo de contagio en las intervenciones realizadas por rescatadores en la era Covid-19. Este artículo ofrece una información estructurada sobre la prevención del contagio en los socorristas, los riesgos potenciales, los EPI disponibles y las recomendaciones para su adecuado uso durante los rescates o la atención prehospitalaria en los entornos acuáticos.

Is it feasible "scoop and run while playing" resuscitation on a rescue water craft? A randomized simulation study with lifeguards.

OBJECTIVE: Response time is a predictive factor for survival of drowning victims and lifesaving. Rescue Water Craft (RWC) are lifeboats very common in lifeguards operations. The aim of this study was to analyze the feasibility of providing effective mouth-to-mouth ventilations and/or cardiopulmonary resuscitation (CPR) on the RWC while sailing at different speeds. METHOD: A quasi-experimental cross-over block design was used to test during one minute efforts the effectiveness of Mouth to Mouth ventilation (MM-only) and CRP, at the beach and sailing at two diferents speeds 5 knots(kn) and 10 kn with calm sea. Quality CPR reference were 2015 ERC guidelines. RESULTS: The data obtained from 13 lifeguards were included, that means that 78 resuscitation test were completed. The MM-only performance skills reached 69.7% ± 40.4 for 5 kn and 60.0% ± 41.8 for 10 kn (p = .59). For full CPR, performance was 74.4% ± 24.2 and 68.5% ± 23.9 respectively. Quality of MM and CPR decreased, not significantly, while sailing at 5 kn and 10 kn [(Q-MM; 5 kn: 59.9% ± 37.8 vs. 10 kn: 43.2% ± 41.4, p = .42)(Q-CPR; 5 kn: 64.8% ± 21.2 and 10 kn: 60.6% ± 21.0, p = .44)]. MM-only and CC variables were significantly worse on RJS when compared with resuscitation at the beach (p < .05). A trend for better results by lifeguards previously training on RJS was observed. CONCLUSIONS: Resuscitation techniques on board of a RWC are feasible and therefore they could be an option for lifeguards when their training, sea conditions, distance and the victim's characteristics allow it. CPR maneuvers may be highly effective at 10 kn, both for MM-only and CPR, however, the quality of the ventilations dramatically worsen with increasing speed.

Recomendaciones de salud laboral para socorristas ante emergencias acuáticas en la era Covid-19: prevención, rescate y reanimación / Occupational health recommendations for lifeguards in aquatic emergencies in the Covid-19 era: prevention, rescue and resuscitation

El síndrome respiratorio agudo severo (SARS-CoV-2), que causa la enfermedad por coronavirus 2019 (Covid-19), es altamente contagioso. Los socorristas son la primera línea de respuesta en las emergencias acuáticas y van a sufrir una fuerte exposición al riesgo este primer verano de la era Covid-19, por lo que su salud laboral debe ser replanteada en su práctica profesional durante la nueva normalidad. La principal medida de salud pública para evitar ahogamientos es la prevención, pero cuando esta falla y se requiere la asistencia o el rescate, en la mayor parte de las intervenciones el distanciamiento no será posible. La limitación de los equipos de protección personal (EPI) para el rescate es una realidad que debe conocerse y que puede afectar a la salud del socorrista. Se realizó una revisión de la literatura actual orientada a evitar o minimizar el riesgo de contagio en las intervenciones realizadas por rescatadores en la era Covid-19. Este artículo ofrece una información estructurada sobre la prevención del contagio en los socorristas, los riesgos potenciales, los EPI disponibles y las recomendaciones para su adecuado uso durante los rescates o la atención prehospitalaria en los entornos acuáticos

Severe acute respiratory syndrome (SARS-CoV-2), which causes coronavirus disease 2019 (Covid-19), is highly contagious. Lifeguards are the first line of response in aquatic emergencies and they will suffer a strong exposure to risk this first summer of the Covid-19 era, so their occupational health must be rethought in their professional practice during the new normal. The main public health measure to prevent drowning is prevention, but when this fails and assistance or rescue is required, in most interventions, distancing will not be possible. The limitation of personal protective equipment (PPE) for rescue is a reality that must be known and that can affect the health of the lifeguard. A review of the current literature aimed at avoiding or minimizing the risk of contagion in the interventions carried out by rescuers in the Covid-19 era was performed. This article provides structured information on the prevention of contagion in lifeguards, the potential risks, the available PPE, and the recommendations for its proper use during rescue or prehospital care in aquatic settings

Prehospital Emergency Medicine at the Beach: What Is the Effect of Fins and Rescue Tubes in Lifesaving and Cardiopulmonary Resuscitation After Rescue?

OBJECTIVE: To analyze the influence of fins and rescue tube use in a water rescue, assessed by time and distance to salvage position, physiological parameters, and cardiopulmonary resuscitation (CPR). METHODS: Twenty professional lifeguards (10 men, 10 women) conducted 3 tests: a baseline test of 5 minutes of CPR and 2 water rescues, 1 without rescue equipment (NRE), and the other with fins and rescue tube (FRT). They also had to perform 5 minutes of CPR after each rescue. Time and distance of the rescues, physiological parameters (blood lactate concentration and heart rate), and quality of CPR were analyzed. RESULTS: CPR quality worsened by 26 to 28% (P < .001) after rescue. However, there were no differences using FRT. The use of rescue equipment reduced the time (FRT: 216±57 seconds; NRE: 319±127 seconds; P < .001) and distance covered (FRT: 265±52 m; NRE: 326±41 m; P < .001). No differences were found in lactate levels between FRT and NRE just after the rescues, but there were some after 5 minutes of subsequent CPR (FRT: 10.7±2.2 mmol/L; NRE: 12.6±1.8 mmol/L; P < .001). Comparing women with men, we found significant differences in lactate concentrations only in FRT (women: 9.6±1.4 mmol/L; men: 8.1±1.2 mmol/L; P = .031). CONCLUSIONS: The use of fins and rescue tube provides a comprehensive benefit in an aquatic emergency. However, FRT did not have any effect on the quality of the postrescue CPR.

Can surf-lifeguards perform a quality cardiopulmonary resuscitation sailing on a lifeboat? A quasi-experimental study.

PURPOSE: Drowning is a high-priority public health problem around the world. The European Resuscitation Council Guidelines for Resuscitation 2015 put special emphasis on special environments like open waters. Stopping the drowning process as soon as possible and starting an early cardiopulmonary resuscitation (CPR) improve survival. Inflatable rescue boats (IRBs) are used around the world in the water rescue of drowning victims. Our objective was to test the quality of CPR performed by surf-lifeguards while sailing on an IRB. METHODS: A quasi-experimental simulation trial was conducted in Tenerife (Canary Islands-Spain) on September 2015. Ten surf-lifeguards were asked to perform a 2 min CPR on manikins in four different scenarios: (1) onshore, (2) on adrift boat, (3) on a boat sailing at 5 knots and (4) on a boat sailing at 10 knots. CPR was performed individually and was measured by means of CPRmeter (Laerdal, Norway) located on the standard manikin. Repeated measures analysis of variance was used in order to analyse the differences between scenarios. RESULTS: The composite of all CPR variables was over 84% in all conditions, but it was lower when CPR was performed on board: onshore (96.49±3.58%) versus adrift (91.80±3.56, p=0.04), sailing at 5 knots (88.65±5.54, p=0.03) and sailing at 10 knots (84.74±5.56, p=0.001). CONCLUSION: Surf-lifeguards are able to deliver good-quality CPR even on a moving IRB, but their performance is lower than onshore. This fact should be considered in real cases to balance the risk and benefits of CPR on board.

Cardiopulmonary Resuscitation Quality by Helicopter Rescue Swimmers While Flying.

OBJECTIVE: Our objective was to assess the cardiopulmonary resuscitation (CPR) quality by helicopter rescue swimmers (HRSs) while flying. METHODS: Twenty HRSs from the Spanish Maritime Safety took part in this study. The research protocol included 2 phases: a baseline test (5 minutes of CPR on land) and a challenge test (5 minutes of CPR on a Sikorsky S-61N helicopter in-flight). A Laerdal Resusci Anne mannequin with Laerdal PC Skill Reporting (Stavanger, Norway) was used to register CPR variables. RESULTS: CPR quality on land versus in-flight was not significantly different. The mean chest compression (CC) depth (52.6 mm on land vs. 51.9 mm in-flight) was inside the recommended range, but mean CC rate (133 vs. 132 per minute), tidal volume (752 vs. 888 mL), and hands-off time (9 per cycle in both tests) were above the 2015 recommended goal. Incomplete chest re-expansion was observed in 19% of on land and 26% in-flight CCs. CPR quality was maintained throughout the 5-minute challenges. CONCLUSION: HRSs are able to perform CPR in a flying helicopter with similar quality to CPR on land. They need additional training to avoid excessive CC rates, tidal volumes, and hands-off times and to permit chest re-expansion.

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

PURPOSE: The whole drowning process usually occurs within seconds to a few minutes. An early rescue may stop and/or prevent most medical complications. Fins, rescue tube, and rescue board (RB) are the equipment most frequently used by lifeguards. Our objective was to compare, in a water rescue quasiexperimental trial, these different pieces of rescue equipment to define the safest and with the lower rescue time as well as to assess their effects on the lifeguards' physiological state and cardiopulmonary resuscitation (CPR) performance. METHOD: A controlled trial was conducted to study the time effect of 4 different rescue techniques and assess CPR quality, along with the physiological effects of each rescue technique (blood lactate and subjective Borg's scale effort perception) on 35 lifeguards. RESULTS: Among the final sample subjects (n = 23), a total of 92 rescues were completed. Total water rescue time was longer without equipment (NE). The total rescue time was significantly lower using RB (P < .001). Similar good quality of CPR before and after water rescue was observed in all trials (P > .05), although correct ventilations represented less than 50% of total in all trials. Blood lactate increased after all rescues. The subjective effort Borg's scale showed significantly less effort using RB vs without equipment, fins, and fins and rescue tube. CONCLUSION: The use of propelling and/or floating equipment saves precious time with repercussions in the reduction of drowning mortality and morbidity. The RB offers a significant advantage. Lifeguards need more CPR training, especially considering the importance of efficient ventilations for drowning victims.

Costumbres lúdicas en España: el juego de bolos en la etapa final del camino de Santiago / Playful customs in Spain: the game of the skittles in the final stage of the Way of Santiago / Hábitos de lazer em Espanha: o jogo de bolos na fase final do caminho de Santiago

El estudio buscó identificar y analizar las prácticas lúdicas de los habitantes del noroeste de España y la relación que se establece con las diferentes vías marítimo-terrestres del Camino de Santiago que penetran en Galicia. Los datos se obtuvieron a través de una metodología cualitativa, utilizando la entrevista semiestructurada y la revisión bibliográfica. Se constató un gran paralelismo entre las vías de entrada del Camino de Santiago en Galicia y los municipios donde sigue vigente el juego de bolos, verificando las influencias de los peregrinos en su camino a Santiago con fines espirituales, trasladando sus costumbres y tradiciones

The study sought to identify and analyze the playful practices of residents of northwestern Spain and their relation to the distinct sea-land routes of the Way of Santiago that enter Galicia. Data were obtained through a qualitative methodology, using semistructured interview and literature review. A relevant relationship was found between the routes to enter the Way of Santiago in Galicia and the towns where the game of skittles is still played, indicating the influence of pilgrims on their way to Santiago with spiritual ends, who transfer their customs and traditions

O estudo procurou identificar e analisar as práticas lúdicas dos habitantes do noroeste da Espanha e a relação que se estabelece com as diferentes vias marítimo-terrestres do Caminho de Santiago que penetram a Galícia. Os dados foram obtidos através de uma metodologia qualitativa, utilizando a entrevista semiestruturada e a revisão da literatura. Constatou-se um grande paralelo entre rotas de entrada do Caminho de Santiago na Galícia e os municípios onde atualmente ainda se joga bolos, indicando as influências de peregrinos no seu caminho a Santiago para fins espirituais, transferindo seus costumes e tradições

Effect of physical fatigue on the quality CPR: a water rescue study of lifeguards: physical fatigue and quality CPR in a water rescue.

PURPOSE: The purpose of the study is to analyze the influence of the fatigue caused by a water rescue on the cardiopulmonary resuscitation (CPR) performance. METHODS: The sample of our research is composed of a group of 60 lifeguards (30 men and 30 women) who have been trained at the Universities of A Coruña and Vigo. Two tests were conducted: the first test involved the execution of 5 min of CPR (rested), and the second one in performing water rescue and subsequent CPR (exhausted) for 5 minutes. The quality of the CPR at rest and at fatigue condition was compared. The recording instrument was the Laerdal Resusci Anne manikin. The time of the water rescue was also registered. RESULTS: Gender does not significantly influence CPR, either at rest or at fatigue condition. However, the fatigue caused by rescue has a significant influence on the total quantity of chest compressions: rested (380 ± 38.64); exhausted (411 ± 56.09; P < .001) and ventilations: rested (24 ± 2.97); exhausted (26 ± 3.92; P < .001). Also in correct chest compressions: rested (285 ± 82.67); exhausted (246 ± 122.08; P = .02) and ventilations: rested (14 ± 7.09); exhausted (9 ± 6.67; P < .001). As far as the water rescue is concerned, men are faster (261 ± 34.58 s) when compared to women (326 ± 99.87 seconds; P = .001). CONCLUSION: The accumulated fatigue during a water rescue performed by lifeguards reduces the quality of chest compressions and ventilations on the CPR.