Gerald Dworkin "Standard of Care"- NDPA Symposium 2012

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Gerald Dworkin "Standard of Care"- NDPA Symposium 2012

  1. 1. 2/11/12$ GeraldM.Dworkin Consultant, AquaticsSafety&WaterRescue LifesavingResources,LLC www.lifesaving.com Developed(for( NationalDrowningPreventionSymposium (2012) !! THE!POWER!OF!WATER!!THE!POWER!OF!WATER!SHOULD!NEVER!BE!UNDERESTIMATED+ 2!ITS!BEAUTY,!STRENGTH+OR!FORCE.!!LIFE!CANNOT!EXIST!WITHOUT!WATER.!IT!EMPOWERS+US!AND!COMMANDS!RESPECT.!!! BE!READY+FOR!IT!! ! ! www.lifesaving.com! 1$
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  9. 9. 2/11/12$ 26 GeraldM.Dworkin Consultant, AquaticsSafety&WaterRescue LifesavingResources,LLC www.lifesaving.com Developed(for(NationalDrowningPreventionSymposium (2012) 9$
  10. 10. 2/11/12$PRINCIPLES$!  RuleofNumbers !  EmergencyActionPlans(EAPs)!  PRMFactors !  EmergencyResponsePlans(ERPs)!  RIDFactors !  IncidentCommand(IC)&Incident!  ThreatAssessment&HRDFactors ActionPlans(IAPs)!  SuctionEntrapment&VGBAct !  SpinalInjuryManagement&!  LegalResponsibility&Liability MechanismofInjury(MOI) Factors !  BodySubstanceIsolation(BSI)!  Rules,Regulations&EECFactors Protocols!  LayersofProtection(LOP) !  RescuePriorities !  ManagementofHypoxia(MOH)!  SurveillanceProtocols!  StandardOperatingProcedures !  PositivePressureVentilation(PPV) Protocols (SOPs)!  FacilityUUseGuidelines(FUG) !  CPRProtocols !  AEDProtocols 28MURPHY’S$LAWS$1.  Anythingthatcanhappen–willhappen.2.  Whenitdoes,itwillhappenattheleastopportunetime.3.  MotherNatureisaBitch! 291.Anythingthatcanhappen–willhappen. 30 10$
  11. 11. 2/11/12$2.  Whenitdoes,itwillhappenattheleastopportunetime. 313.MotherNatureisaBitch! 32EMERGENCY$RESPONSE$PLAN$THUNDER$&$LIGHTNING$STORMS$!  Recognize(theDanger!  Evacuate(allPatrons&Staff!  Return(Procedures PolicyDevelopment 33 11$
  12. 12. 2/11/12$ 34RULE$OF$NUMBERS$ Frequency!:Probability! Themorepatronswhouseyourfacilityincreasesthe probabilityofasignificantincident.Eachdayyouoperatewithoutasignificantincidentbrings youonedayclosertowhentheincidentwilloccur. 35 36 12$
  13. 13. 2/11/12$ 37 38DROWNING$101$!  7thleadingcauseofunintentionalinjurydeaths.!  2ndleadingcauseofunintentionalinjurydeathsforchildren(1(–( 14(years(of(age.!  3rd(leading(cause(of(death(for(children(0(–(4(years(of(age.(!  6–10timesmorepeoplesufferbraindamagethandeathfrom submersionincidents.!  Minoritiesdrownatarate2xgreaterthan whites.!  Malesdrownatarate4xgreaterthanfemales. 39 13$
  14. 14. 2/11/12$ 40!  6,000–7,000drowningsannually.!  3,500duringrecreationalswimmingactivities.!  90%inopenwater.!  50%U67%arealcoholordrugUrelated.!  100+in“guarded”facilities. 41 42 14$
  15. 15. 2/11/12$PEDIATRIC$SUBMERSIONS$!  Secondleadingcauseofunintentionaldeathnationwide.!  Leadingcontributingfactor: Lack(orlapse(inadult(supervision( !  Youngchildrenareattracted(towaterandhave littleconceptofthedangers(associatedwithwater. Theactionofchildrenaroundwateris unpredictable. 43!  BIGHEAD/LITTLEBODYSYNDROME.!  Nearlyhalfofthevictimswereoutofsight lessthan5minutespriortotheincident.!  Drowningisasilent(death.!  64%ofthevictimswerenotexpectedtobe inorneartheswimmingpoolpriortothe incident. 44WATER$CRISES$DistressSwimmer DrowningVictim!  Cansupport(selfinwaterby !  Cannotsupport(selfinwater swimmingorfloating. byswimmingorfloating.!  Cankeepheadoutofwater !  Cannotkeepheadoutof tobreathe. watertobreathe.!  Cancall(outforhelp. !  Cannotcall(outforhelp.!  Canwave(forhelp. !  Cannotwave(forhelp. 45 15$
  16. 16. 2/11/12$INSTINCTIVE$DROWNING$RESPONSE$!  Head(istilted(back(inattempttobreathe.!  Vertical(positioninthewater.!  Arms(areextendedlaterally.!  Victimsdon’t(call(outforhelp.!  Victimsdon’t(wave(forhelp.!  Appear(to(be(playing(in(the(water.(!  Strugglefor20–60seconds. 46THE$DROWNING$PROCESS$!  Struggle((20–60seconds)!  Ingest&aspiratewaterintostomach&airway!  Laryngospasm(!  Hypoxia(!  Unconsciousness!  (Aspiratewaterintolungs)!  Respiratory(arrest(!  Cardiac(arrest( 47TYPES$OF$DROWNING$!  Wetdrowning!  Drydrowning!  Laryngeal(drowning(!  Mammaliandivingreflex!  Shallowwaterblackout(hyperventilation)!  Silent(passive)drowning!  LongQTSyndrome!  TorsoReflex 48 16$
  17. 17. 2/11/12$SECONDARY$DROWNING$INCIDENT$ 49 50CHERRY$HILLS$WATERPARK$INCIDENT$ 51 17$
  18. 18. 2/11/12$P$R$M$FACTORS$ Prevention( Recognition( Management( 52PREVENTION$!  Establish&enforcerules(&regulations(!  Strategicpositioningoflifeguard(stations(!  Removeorwarnofhazards(!  Prohibitorsafeguardrisks(!  Vigilantsurveillance(&supervision( 53RECOGNITION$!  Incidents(!  Potential(forIncidents !  Hazards !  Risks 54 18$
  19. 19. 2/11/12$MANAGEMENT$!  Potential(forincidents !  Hazards !  Risks!  Incidents( !  Rescue !  Emergencypatientcare!  Rescueequipment!  Personalprotectiveequipment(PPE) 55 56LOUISIANA$SUBMERSION$INCIDENT$ 57 19$
  20. 20. 2/11/12$R$I$D$FACTORS$ Recognition( Intrusion( Distraction( 58A$SERIES$OF$EVENTS$ 59THREAT$ASSESSMENT$&$HRD$FACTORS$ Hazard+Risk=Danger Hazards !  Remove !  WarnRisks !  Prohibit !  Safeguard 60 20$
  21. 21. 2/11/12$ 61 62VIRGINIA$GRAHAM$BAKER$(VGB)$ACT$ 63 21$
  22. 22. 2/11/12$ 64 http://www.lifesaving.com 65LEGAL$RESPONSIBILITY$&$LIABILITY$!  Duty(to(Act(!  GoodSamaritanLaws!  Consent(!  Abandonment!  Records(&(Reports(!  Negligence 66 22$
  23. 23. 2/11/12$NEGLIGENCE$1.  Duty(toPlaintiff2.  Breach(Duty3.  Injury(orLoss(4.  DirectCorrelation(ofBreachtoInjury/Loss( 67COEUR$D’ALENE$INCIDENT$ 68 www.yonigottesman.com 69 23$
  24. 24. 2/11/12$RULES,$REGULATIONS$&$EEC$FACTORS$ Establish( Enforce( Consequences( 70 71LAYERS$OF$PROTECTION$!  Supervision(!  Isolation(fencing(!  SelfSclosing,(selfSlatching(&(selfSlocking(gates(!  Gatesopenoutward,awayfromthepool!  Poolcover!  Poolalarm!  Passivemonitoring!  Lifeline(!  Depth(line(!  Depthmarkers!  Telephone( 72 24$
  25. 25. 2/11/12$GOFF$V.$HAMLET$APARTMENTS$INCIDENT$ 73 http://www.lifesaving.com/poolUsafelyUdigitalUassets 74 75 25$
  26. 26. 2/11/12$PERSONAL$FLOTATION$DEVICES$(PFDS)$ 76WEAR$IT!$ 77PFD$TYPES$ 78 26$
  27. 27. 2/11/12$ 79SURVEILLANCE$PROTOCOLS$!  30Ssecond(Rule(!  10/20(Rule(!  10x10ReactionRule!  Rotation(!  Zone(of(Responsibility((ZOR)(!  Sunglasses 80SUNGLASSES$!  Protection(fromultraviolet(rays(duringsunlight.!  Protection(frompowerful(light(becausewheneyesreceive extralight,itclosestheiriscausingthelifeguardtosquint.!  Protection(fromglare(becausewatercanreflectagreat dealoflightandconcealobjects.!  Eradicatelightfrequenciesthatcanblur( (((((((((((((( visionorreduce(contrast. 81 27$
  28. 28. 2/11/12$POLARIZED$SUNGLASSES$!  Fromthemomentofreflection,lightbecomespolarized andformsvisualnoise–blinding(glare(thatinterfereswith therealimage.!  Polarizedlensesenhance(visual(acuity,(color,(contrast(and( comfort.!  Tinted(lenses(onlyreducelighttransmittance– theydo(not(block(blinding(glare. 82USLA$POSITION$ON$PATRON$SURVEILLANCE$Lifeguardsassignedtosuperviseanaquaticareashall(not(be( subject(to(dutiesthatwoulddistract(orintrude(their attentionfromproperobservationofpersonsinthe waterfrontarea,orthatprevent(immediate(assistance(to personsinthewater.Specifically,lifeguards(assignedtowater surveillanceshall(not(be(assigned(to(any( (((((((((((((( duties(other(than(public(safety! 83 84 28$
  29. 29. 2/11/12$OPERATIONAL$PROTOCOLS$!  StandardOperatingProcedures(SOPs)!  EmergencyActionPlans(EAPs)!  EmergencyResponsePlans(ERPs)!  IncidentCommand(IC)&IncidentActionPlans(IAPs)!  MissingPersonvs.MissingBather!  CredibleWitness 85LIFEGUARD$QUALIFICATIONS$ Certificationvs.(Qualification !  Screening!  PreUServiceTraining!  StandardOperatingProcedures(SOPs)!  SurveillanceProtocols,VictimRecognition&ZonesofResponsibility!  EmergencyActionPlans(EAPs)!  EmergencyResponsePlans(ERPs)& EmergencyDrills!  IncidentCommand(IC)&IncidentAction Plans(IAPs)!  Rescue&PPEEquipmentRESPONSIBILITY$OF$AUTHORITY$HAVING$JURISDICTION$(AHJ)$!  ConductThreatAssessment!  DetermineLevelofOperationalCapabilityRequired!  Plan(fortheIncident!  Train(fortheIncident!  AcquiretheResources(Requiredto Safety&EffectivelyManage(theIncident 87 29$
  30. 30. 2/11/12$JAMIE$KENNEDY$EXPERIMENT$ 88A$B$C$RESCUE$ (Primary(Response ( (CoverSup(Response ( ( (Secondary(Response 89FACILITYNUSE$GUIDELINES$!  Accountability!  Supervision!  WithinArm’sReach!  Lifejackets 90 30$
  31. 31. 2/11/12$ 91COMPETITION$DIVING$INCIDENT$ 92WATER$ENTRIES$ 93 31$
  32. 32. 2/11/12$SPINAL$IMMOBILIZATION$PROTOCOLS$Thelackofneurologicaldeficitdoesnotruleoutinjury.Itjust meanstheinjuryisnotyetapparent.IftheMechanismofInjury(MOI)issufficienttohavecauseda spinalinjury,thenassumetheinjuryexists.EmergencyCareProtocols !  StandingtakeUdown !  Shallowwater !  Deepwater !  Land 94DIVING$INCIDENT$ 95 96 32$
  33. 33. 2/11/12$PATIENT$ASSESSMENT$A=AirwayB=BreathingC=CirculationD=DisabilityE=ExaminationM=MechanismofInjury 97BSI$PROTOCOLS$!  UniversalPrecautions!  PersonalProtectiveEquipment(PPE)!  VaccinePreventableHepatitis !  HepatitisBVaccine !  HepatitisAVaccine !  HapatitisA/BVaccine 98MANAGEMENT$OF$HYPOXIA$PositivePressureVentilation(PPV) !  Personalresuscitationmask(PRM) !  Personalresuscitationshield(PRS) !  BagUValveUMask(BVM)resuscitatorOxygenAdministrationAirwayManagement !  Suction 99 33$
  34. 34. 2/11/12$MASSACHUSETTS$INCIDENT$ 100BASIC$LIFE$SUPPORT$ChainofSurvival !  Access !  CPR !  AED !  AdvancedLifeSupport(ALS)CPR:LifeSavingorLifeSustaining? !  30:2ratioAEDProtocols 101AED$PROTOCOLS$ AutomatedExternalDefibrillator !  High&Dry!  VerbalCommands !  I’mClear! !  You’reClear! !  Everyone’sClear! 102 34$
  35. 35. 2/11/12$HUNTINGTON$BEACH$AED$RESCUE$ 103PRINCIPLES$!  RuleofNumbers !  EmergencyActionPlans(EAPs)!  PRMFactors !  EmergencyResponsePlans(ERPs)!  RIDFactors !  IncidentCommand(IC)&Incident!  ThreatAssessment&HRDFactors ActionPlans(IAPs)!  SuctionEntrapment&VGBAct !  SpinalInjuryManagement&!  LegalResponsibility&Liability MechanismofInjury(MOI) Factors !  BodySubstanceIsolation(BSI)!  Rules,Regulations&EECFactors Protocols!  LayersofProtection(LOP) !  RescuePriorities !  ManagementofHypoxia(MOH)!  SurveillanceProtocols!  StandardOperatingProcedures !  PositivePressureVentilation(PPV) Protocols (SOPs)!  FacilityUUseGuidelines(FUG) !  CPRProtocols !  AEDProtocols 104SAN$JOSE$NEARNDROWNING$INCIDENT$ 105 35$
  36. 36. 2/11/12$106107108 36$
  37. 37. 2/11/12$TOMORROW’S$LIFEGUARD$ 109Lifesaving!Resources,!LLC! www.lifesaving.com! Gerald!M.!Dworkin! gerald@lifesaving.com 110 37$

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