The Red Cross PHSS Course Delivery Dilemma

The American Red Cross has a problem. Preparedness Health & Safety Services (PHSS) courses are inconsistent. Well-intentioned instructors throughout the United States are adding to or subtracting from or otherwise changing the structure of these courses. Some instructors/ITs are completing the course requirements sooner than the recommended hours while others are taking on more participants in a class than the “sacred” 10 to 1 participant/instructor ratio. There are even some instructors/ITs in California that are stacking course sessions together to make weekend courses (like a mini Aquatic School) that attract participants as far away as Alaska and Texas who fly in for this instruction.

All these courses are different from each other and the generic outline found in Red Cross Instructor Manuals and Guides for Training Instructors. This means that someone in Georgia who takes a Lifeguarding course may have a different experience from someone in Utah or in Arizona. The American Red Cross wants its courses delivered in a consistent manner.

The answer to the Red Cross’s problem lies in understanding what exactly is consistent course delivery. Ironically, this understanding is changing along with the Red Cross. In 2011, to streamline its processes and to better manage its immense organization, the Red Cross restructured itself from a collection of some 800 to 1200 local chapters, each with its own CEO and Board of Directors, to a National Organization run from Washington DC (or Virginia). This restructuring took away any local presence of Red Cross support in favor of a strong, centralized entity. Current Red Cross PHSS policies, contained in the Manual of Administrative Policies and Procedures (MAPP), which was based on the old organization, had to be removed from circulation. Unfortunately, no one thought to rewrite them first, so Red Cross policies have had to be recalled from memory since 2011, at least for those of us on the outside looking in.

Just as the organization is left without its written policies, the issue of inconsistency in instruction comes to the forefront. A new department is created called Quality Assurance and Instructor Engagement with the mission to make PHSS courses and instruction consistent again. New factions in charge of this inconsistency problem define it in harsh, rigid ways, the way doctors define a cancer-like something to be rooted out and cut away to save what is left of the body.

I remember a time when the Red Cross had this kind of rigid policy of conformity. I can recall participants in tears on the floor of a gymnasium attempting to produce a perfect CPR tape. I can recall tribunals held because a 30-hour WSI course was finished in 25, the instructor-trainer choosing not to fill in the time with extra drills and activities. (A Health & Safety Director even once told me that I could not use a 10-lb dumbbell for Lifeguard Training because the Instructor Manual used the term “10-lb brick.”) In a bizarre attempt to ensure consistency, the Red Cross of those days, while generous and ethical in its other programs and services, was petty, pedestrian, and prescriptive in its Health & Safety operation.

Things got better in the 1990’s. By then, the Red Cross realized that it was putting so much pressure on students in CPR classes that they were too paralyzed with fear to perform skills like CPR when called upon out in the world. The Americans with Disabilities Act also had become an issue because Red Cross Instructors were not trained to modify and accommodate. This led to the brilliant concept known as “Teaching to the Standard and Testing to the Objective.” This concept not only opened the door for people with disabilities to take and succeed in Red Cross courses, but it led to the creation of critical course components and requirements which became the new basis for course consistency.

The Red Cross finally began to relax its inflexibility and empower its instructors to use guidelines to make decisions about modifications, course structure, etc.

In 1995, I was selected to be a member of a 10-person National Faculty for the Red Cross Lifeguard Training program that introduced equipment-based rescues. In preparation for my appointment, I was invited to go to National Headquarters to be trained. There, sitting in meetings with my 9 peers and high-level National Program Managers and other National Representatives, I was taught that consistency in course delivery was a matter of completing course requirements and not, for example, making the class last a certain amount of hours. We were taught how to look past inevitable differences and diversity in classes we taught so that we could measure and assess the critical components that course participants had to complete to earn certification.

I remember the specific meeting when we talked about the recommended hours and how they might fluctuate due to the many variables present in any course. This was to be expected and we were to decide consistency by making sure that all critical components of the course were taught—nothing added or subtracted—as determined by assessment guidelines. I have followed these concepts in my teaching and in mentoring other instructors/ITs since 1995 until things began to change in 2015.

The “players” have all changed at National since 1995 and there is a certain lack of understanding of what I was taught in the mid 90’s. The most frustrating part is that the QA and Instructor Engagement Department acts as though their rigid interpretation of course delivery was always the policy. I know first-hand that that is not true. As a matter of fact, the new First Aid/CPR/AED Instructor Manual released in 2016 is the first textbook with policy statements that reflect current QA & IE directives.

To understand course delivery before 2015-2016, look in an old Fundamentals of Instructor Training (FIT) textbook, if you can find a copy. The FIT book talks about applying various teaching methods, introducing flexibility in delivering subjects, handling course management under the instructor’s control (remember BASIC), and course consistency through educating and empowering instructors. And it also talks about ethics and commitments that instructors make to customers, self, task, organization, and people. The Red Cross of the 1990s did not threaten its instructors with investigation and suspension of their certification; it taught about ethics and commitment. (Sure there were Inquiry Committees to review complaints and reports of problem instructors, but remediation and reclamation of the instructor was the objective; investigation and suspension were meted out when warranted as last resorts, not first resorts and certainly not before all facts had been gathered.) I grew up believing in ethics and commitments and doing my best to follow policies, keep promises, tell the truth, be fair, and promote the success of others.

Where have these concepts gone in the new organization of the Red Cross? They seem to have gotten lost with the disappearance of MAPP and the mothballing of the FIT course. Sadly, they have been replaced in this new Red Cross organization by rigidity, conformity, and recitation. Instead of focusing on inflexibility and rote, the QA & IE group should be working on re-establishing ethics and commitment within the organization.

Consistent does not mean identical. Instruction is not recitation. This new direction by the Red Cross will not resolve the inconsistency issue except in the most artificial way while negatively impacting the quality of instruction. It will return the Red Cross to those days when “No” was the default answer to any question, when instructors knew nothing except what was on the page, when participants left frustrated from classes and afraid to use the skills they had been taught because they lacked a perfect remembrance of what they should do.

Well, at least all the courses will be uniform in length.

Lifeguard Red-Shirt Drills Can Give False Results

silhouettes
Silhouettes for lifeguard testing

The infamous “red-shirt drill” is a test of a lifeguard’s vigilance. It works like this: The aquatic facility manager or head lifeguard hands a swimmer a red shirt (i.e., red cap, red ball, or dark silhouette of a submerged victim, sometimes collectively known as VATs-vigilance awareness tests) who brings the thing into the water close to the lifeguard about to be tested and, upon receiving a signal from the office puts on the red shirt/cap, releases the red ball, or drops the silhouette on the bottom of the pool. Inside the office, the stop watch is clicked on. The test has begun. Only this is not a fair test of a lifeguard’s surveillance capacity; it is biased test that can lead the tester to draw a false conclusion.

I have long been an advocate against these types of drills and tests. I was subjected to them in the 1970s when I began lifeguarding, and I learned very soon that they were not an accurate indicator of surveillance effectiveness.

Putting this issue aside for a second, there are other reasons why this type of drill or test is ill-advised. First and foremost, conducting this drill is a violation of the RID factor, specifically the intrusion of a secondary duty (a supervisor-imposed drill or test) while the lifeguard being tested is involved in a primary duty (supervising the public and looking for real victims to rescue). Second, this drill puts the public at risk because the lifeguard leaves the station without a real victim to rescue, and the drill is conducted with the public in the way where they can be jumped on, swam over, struck with a rescue tube, etc. In the case of the red-shirt drills I remember, the participant wearing the shirt had to be rescued, subjecting the “victim” to more risk.

The red shirt drill and all of its variations are an old-school method of testing lifeguard efficiency. In more modern times, it was revived by organizations like Ellis and Associates, Poseidon Technologies, and others as a way of proving something is wrong with lifeguarding that must be improved. For example, here is an article written by Joshua L. Brener of Poseidon Technologies in 2002: “Your Lifeguards Watch, but Do They See?”.

Manikin dropped by Ellis
A Manikin Similar to Those Dropped by Ellis & Associates for Their Tests

This article mentions a test conducted by Ellis and Associates who dropped manikins in 500 manikins in pools across the United States without telling the lifeguards what they were beforehand and then timed each lifeguard’s response. The problem with a test like this is that the results are far from scientific, and they do not take into account that operation of each lifeguard’s thought process with regard to situational awareness, principles of attention capture, sensorimotor response, etc.

On the very surface of the issue (no pun intended), a lifeguard actively looking for real hazards and victims, and unaware that a test was being conducted, might react with confusion at the sudden appearance of a manikin in the water or he/she might overlook it entirely because of honed situational awareness and sensorimotor skills might discount an object detected that is not part of the set of targets being sought. And, this decision to overlook or discount the manikin may initially occur at less than a conscious level. To testers and observers, it simply looks like the lifeguard is not focused and “really looking.”

(Ironically, Mr. Brener’s company, Poseidon Technologies, which uses cameras and sensors to detect unmoving victim and to signal the lifeguards, has had the opposite problems. In an article in 2005, it was reported that Poseidon was reacting to the shadows cast into a pool by birds and clouds and sounding the alarm when no one was in danger. Despite that devices like Poseidon can work tirelessly, they do not have the capacity to be situationally aware—to make a judgment and throw out false stimuli that resemble a drowning victim but is not a drowning victim.)

This means that a lifeguard who is focused and doing his/her job may not have scored well on the Ellis and Associates test. Obviously, lifeguards who are not focused and watching would do poorly as well. The trouble with this test is that you cannot know why a lifeguard scored poorly or even why a lifeguard scored well.

For example, if lifeguard know beforehand of the possibility of being tested, and a lifeguard scores well, that may mean the lifeguard was tipped off about the test or he/she may be looking for the test to the exclusion of looking for real victims and hazards. At the very least these tests, when announced beforehand, compete with the lifeguard’s focus on real emergencies.

In my first experience with a red shirt drill, I was accidentally tipped off by the 12-year-old they sent in with the red shirt. I remember that I was scanning the pool when I saw her. She was looking at me with a devilish smile; the only person in the water looking at me and smiling. It seemed strange but I didn’t think much of it until I looked toward the office. There, I saw the pool manager’s silhouette in the window, staring out and holding an object in his hand. Others in the office were standing and looking on the window as well.

When my visual sweep came around again, I saw the little girl underwater wearing a red shirt. It still took a few seconds for me to process this and switch from scanning mode to “this is a test” mode. Realizing I was being tested, I blew my whistle and rescued my “victim.” I got a really great time, which was included in my personnel file. If the girl hadn’t starred at me with her big smile, I might have never noticed her in that red shirt!

Some of my fellow guards scored poorly in later tests, and a few were even warned that they had to improve. All this time, I was thinking how unfair and biased such a test was.

Today, I still think of these tests as unfair, biased, and hazardous to the surveillance process (as an intrusion of a secondary duty). Every now and then, I read something about a supervisor dropping a silhouette or a manikin on the bottom of the pool to test lifeguard awareness. “Back to the stone age” I think, and I worry about all the ways these tests, designed to improve lifeguard attentiveness, do the opposite and may even cause good lifeguards to be falsely evaluated.

 

Equipment-Based Rescues: More than 20 Years of Effectiveness

OFFUTT AIR FORCE BASE, Neb. -- Kate Eaton, a lifeguard representing Offutt pools, simulates rescuing Emily Thayer while competing during the 2009 Nebraska State Lifeguard Competition held at Hitchcock Pool in Omaha July 10. Twenty-nine teams of lifeguards from Offutt and pools throughout the state competed in events that include timed rescues, first-aid scenarios and general knowledge. U.S. Air Force Photo by Jeff W. Gates.
OFFUTT AIR FORCE BASE, Neb. — Kate Eaton, a lifeguard representing Offutt pools, simulates rescuing Emily Thayer while competing during the 2009 Nebraska State Lifeguard Competition held at Hitchcock Pool in Omaha July 10. Twenty-nine teams of lifeguards from Offutt and pools throughout the state competed in events that include timed rescues, first-aid scenarios and general knowledge. U.S. Air Force Photo by Jeff W. Gates.

More than 20 years ago, in 1995, the American Red Cross launched its landmark equipment-based Lifeguarding program. Years earlier, Ellis and Associates and the YMCA had begun training their swimming pool and waterpark lifeguards in equipment-based rescues, but the impact of this change what not really felt throughout the lifeguarding community until the American Red Cross unveiled its program. Suddenly, once the ARC committed to equipment-based rescues, lifeguards at swimming pools and waterparks everywhere could be seen with rescue tubes.

Most lifeguards today were hardly born when this transformation took place. Only one year earlier, Red-Cross–trained lifeguards had a completely different skill set: the cross-chest carry, the armpit tow, the underwater approach, the double-grip-on-one-wrist escape, etc. These skills are almost unknown to today’s swimming pool lifeguard who, with rescue tube in hand, use the active victim front and rear rescues, the submerged victim rescue, the deep-water lift with backboard. The lifeguarding world completely changed in 1995.

I was right in the middle of this change. Selected by the Red Cross as 1 of 10 National Faculty for this new program, I helped to train Instructor Trainers on the East Coast and throughout California in this new program.

But this change did not come easy. Many resisted, especially in my home state of California. At almost every training in California in 1995, someone would step-up and preach doom and gloom about using the rescue tube. In fact, a couple large Southern California organizations have even chosen to ignore equipment-based rescues to this day while still certifying their staff in American Red Cross Lifeguarding (how do they do that?). More than resisting this change, they predicted that lifeguards who use equipment would become weak and lose the ability to be effective. They were talking the demise of lifeguarding, where the rescue tube was not seen as a tool, but as a crutch.

Fast-forward to 2016. Taking a look around, I am happy to report that, over 20 years later, equipment-based lifeguarding is still going strong. The predictions of the nay-sayers about how lifeguards and lifeguarding would suffer because of the rescue tube have, thankfully, not come true. Instead of diminishing the capacity of lifeguards, equipment-based rescues have made lifeguarding safer and more effective.

Lifeguarding, first aid, and CPR skills will continue to evolve over the coming years as new generations attempt to make life-saving easier and more effective. While we should hold fast to what is working now while testing what is on the horizon, we must always do so with an open mind and a teachable heart. Otherwise, like those organizations mentioned before, we may miss the next important, life-changing innovation in our field and become something of relics because we refused to listen and adapt.

Remembering My First and Last Rescues

Lifeguard on duty in swimming pool

My career as a swimming pool lifeguard began in the summer of 1973. I was hired by a local municipality and paid $3.00 with the promise of a $0.25 per hour raise each year (minimum wage was $1.65). I got a “real job” in 1984 but continued lifeguarding here and there until 1995. In all these years, I helped a lot of people, made some rescues, and even revived a few. I remember every rescue and first aid situation I was involved in and I can look back on my lifeguard years with pride and a sense of accomplishment. You could say that I’ve stayed active with training lifeguards and swimming instructors in part as a way of connecting to my past and as a way of helping others to be ready to experience what I did when I was younger.

In particular, I have a strong recollection of my first and last rescues. Like every rescue in between them, they were each unique, as different as people are different, and at the same time, in a subtle way, familiar. The most remarkable thing to me is that I learned so much about being a lifeguard from each incident and, even as I compare my first rescue to my last, despite my many years as a lifeguard and a trainer of lifeguards, that I still could learn from the experience.

My First Rescue

My first rescue happened on my first day as a working lifeguard (my baptism of fire). The city where I worked had scheduled a preseason excursion by a local preschool that bordered the park and pool. The pool was “Z” shaped with a diving area extending in one direction off the main pool and a 2-foot deep “tot pool” extending off the main pool in the other direction. The only part of the pool open was the tot pool. Four lifeguards, myself included, were stationed around this tiny pool, one on each side and another lifeguard stated in the water just outside the safety line that marked the slope down to the 3.5-foot area of the main pool. About 25 children were in the water and parents and teachers stood on deck alongside the lifeguards on each side, creating a crowded feeling, at least to me.

All of a sudden, a parent was screaming “save my baby, save my baby.” I looked around but couldn’t see anything amiss. The other lifeguards were looking also, but they didn’t see any struggling child. The pool manager was talking in my ear. “Make the rescue,” he said. “Where?” I answered. He just answered: “get in there!” I came to realize later that he didn’t see the victim either!

As I looked around again, I saw a small girl “swimming” directly toward the deck where I was standing. She was about in the middle of the pool, stroking arm-over-arm, but not breathing. Suddenly, that seemed unusual to me. I reacted, entering the water and picking up the child. Instantly, I could tell she was out of breath and scared. I verified she was breathing and passed her to her mother. Apparently, she had fallen forward in the water and could not recover back to a standing position. To the casual observer, it looked like swimming. What an unusual first rescue!

drowning-handsMy Last Rescue (So Far)

The last time I made a rescue, I was not working as a lifeguard. It was 2002 and I had been snorkeling by myself at Wood’s Cove in Laguna Beach, CA. There were two lifeguards stationed at the cove and others on the beach sunbathing and enjoying the beach. Wood’s Cove is nice for scuba and snorkeling because there is a sudden drop at one entry/exit point close to shore that makes putting on and taking off equipment easy. I was exiting at that point and had my mask and fins in hand when I noticed a boy about 7 or 8 years old who appeared to be treading water in a part of the water a foot or so over his head and no more than a few feet away from safety. I would have walked right past him except that his eyes were wide open like saucers and he was staring toward Catalina Island, struggling hard to stay afloat. “Do you need help?” I asked the boy. He immediately shook his head in the affirmative. So I scooped him up and placed him on the sand. I found out his name was Jason and that he was at the beach with his mother. Looking around, I observed that the two Laguna Beach lifeguards were talking to each other; they had not observed my rescue. I looked over where Jason said his mother was, and I saw that she was reading a magazine, unaware of my interaction with her son. I said goodbye to Jason and stopped briefly to ask Jason’s mother to watch him more closely. She appeared mildly perturbed by my comments, but she did not answer. I said nothing to the two lifeguards (though I should have).

Conclusion

I started this blog by saying that I found it remarkable to learn so much from every rescue, especially this last one. In this last rescue, I wasn’t looking for victims as I exited the water at Wood’s Cove that day, and it was only Jason’s eyes, such a small signal, that led me to believe he needed help. It is astounding and troubling to me that there were three people on the beach that day that should have seen him before I did. That has taught me to be an advocate for water safety and never to assume that someone else is probably watching.

And, as for my first rescue, even I had no experience, somehow, I was equal to the challenge. I analyzed a situation and acted. I believe that this began a pattern for me that served me well as a lifeguard. Keeping focus, following one’s instincts, and being decisive builds confidence to act in the future. My first rescue, and the others in between, prepared me for my last rescue. And because I am still upon the earth, I am prepared to help in my next, if another situation should present itself.

Resilience: The Quality Lifeguard Training Forgot

resilience

Reliability, maturity, consistency, courtesy, positivity, professionalism, leadership, health and fitness, etc. All great qualities recommended by lifeguarding courses and textbooks. Each important in its own way; in fact, so important that I cannot imagine any lifeguard being successful on the job who is not reliable, mature, consistent, courteous, professional, etc. And yet, these characteristics not withstanding, I would like to suggest the addition of one of the most essential (yet most often overlooked or forgotten) qualities of any lifeguard: RESILIENCE.

According to Psychology Today, “resilience is that ineffable quality that allows some people to be knocked down by life and come back stronger than ever. Rather than letting failure overcome them and drain their resolve, they find a way to rise from the ashes.” From the Latin resilire, it literally means to recoil or bounce back. Why is this such as important quality for lifeguards to develop?

Even though the bulk of a lifeguard’s job is a mixture of fun in the sun with daily prevention, supervision, and maintenance, lifeguards, like other professional rescuers, must be ready at any moment to step in to rescue and administer care when it matters most. When this happens, lifeguards may have to deal with unpleasantness of severe bleeding, vomiting, disfiguring injuries or baffling sudden illnesses, and even life and death. This aspect of the job is highly stressful and fraught with emotion. If a lifeguard is resilient, he or she can face these challenges, see them through with courage and determination, regardless of the outcome. Without the capacity to be resilient, lifeguards and others in these roles may succumb to debilitating stress, obsess about their problems and failures, and feel overwhelmed or victimized. They may even develop mental problems or turn to unhealthy coping mechanisms such as isolation, denial, and drug or alcohol abuse.

Illustration depicting an illuminated roadsign with a motivational concept. Dark dusk sky background.

Fortunately, resilience, like other traits and characteristics, can be developed. It begins by taking personal responsibility for your physical, mental, and psychological health and preparation for the job. This means that we must:

  1. Understand and accept that the job of a lifeguard may have unpleasant, stressful, and difficult challenges. We want to prevent them if we can but these challenges are not insurmountable; they can be faced and managed.
  2. Get the training and knowledge we need. As a lifeguard, your goal should be to get smarter; more skillful; and more confident every day.
  3. Come to work prepared (i.e., well rested, energized, positive, and ready to work) and stay focused.
  4. Adopt a healthy lifestyle that includes exercise, a well-balanced diet, and a positive outlook.
  5. Build healthy relationships at home and at work. Make and maintain connections with family, friends, and coworkers. Train with our lifeguard team and have a good working relationship with our supervisors. Help and cooperate with each other on the job, and, when appropriate, have some fun together.
  6. Remember our training when facing an emergency. We know what to do. We can be decisive and follow through until relieved. We will give assistance to teammates and accept their help as well.
  7. Despite the outcome of the emergency, accept that we have done our best and keep a realistic perspective. We will participate in staff debriefings, including critical incident stress debriefings, if necessary and appropriate.