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Lifeguard Primary Assessment
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The lifeguard primary assessment answers one question: is anything about to kill this casualty in the next few minutes? Nothing else happens until it is complete.
Lifeguard Primary Assessment in Order
1. Scene safety. Is it safe for you? A rescuer who becomes a casualty has made the situation worse. Check for the hazard that caused the incident and whether it is still present.
2. Responsiveness. Tap and shout. A casualty who responds has an airway and is breathing, which answers the next two questions immediately.
3. Call for help. Before assessing further, not after. Send someone specific for the AED and to phone emergency services.
4. Airway. Open it. Head tilt and chin lift, or a jaw thrust without head tilt where spinal injury is suspected.
5. Breathing. Look, listen and feel for no more than 10 seconds. Agonal gasping is not breathing and is a common reason CPR is delayed.
6. Severe bleeding. A rapid sweep for catastrophic haemorrhage, controlled with direct pressure.
What comes next depends on the answers
Not breathing means CPR begins immediately. Breathing but unresponsive means the recovery position and continuous monitoring. Responsive means you move on to a secondary assessment.
The mistake that cannot be recovered from
Starting a detailed head-to-toe examination on a casualty who is not breathing. It happens because a visible injury draws attention, and a bleeding scalp is more obvious than absent respiration. The lifeguard primary assessment exists to impose an order that instinct does not supply.
Agonal breathing
Occasional irregular gasps in the first minutes of a cardiac arrest. It looks like breathing to an untrained observer and is a sign of arrest, not of life. Anyone who is not breathing normally is treated as not breathing.
Reassess
A primary assessment is not done once. A casualty who was breathing when you found them may not be two minutes later, so monitoring continues until handover.
Lifeguard primary assessment: frequently asked questions
What is the lifeguard primary assessment?
The lifeguard primary assessment checks scene safety, responsiveness, then calls for help, then airway, breathing and severe bleeding. It identifies anything immediately life threatening before any detailed examination starts.
What is agonal breathing?
Occasional irregular gasps in the early minutes of cardiac arrest. It looks like breathing but is a sign of arrest, so anyone not breathing normally is treated as not breathing.
What is the most serious mistake in assessment?
Beginning a detailed head-to-toe examination on a casualty who is not breathing, usually because a visible injury drew attention away from the airway.
Reviewed by Jackie Stern, Lifeguard Instructor, Firefighter and EMT. Jackie Stern has taught lifeguarding for more than 20 years and works as a firefighter, EMT and swim instructor. She reviews course content, prerequisites and rescue standards against current certification requirements.
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