Monday, January 7, 2013

Lifeguard Fatigue and CPR

Effect of physical fatigue on the quality cardiopulmonary resuscitation: a water rescue study of lifeguards
Authors: Roberto Barcala-Furelos, et al.

This study, out of Spain, provided some evidence to support the idea that fatigue from an in-water rescue leads to sub-optimal CPR.  A study of this nature has been done before, but this one was performed after the updated 2010 CPR protocols.  As you can imagine, it doesn't provide any mind-blowing information, and pretty much serves to tell us what we already know, but this type of evidence may come in handy when designing training programs or lobbying for increased resources.

The basic design of the study:

  • Had lifeguards perform CPR on mannequins both during a resting phase and after enacting a simulated/standardized rescue
  • Used feedback mannequins to monitor quality of CPR
  • Compared CPR quality between genders and between resting and post-rescue 
Important results:
  • Gender did not effect quality of CPR
  • Overall, CPR quality was poor compared to standard
    • Low number of correct ventilations (very important in drowning)
    • Although in increase in compressions after rescue, there were less correct compressions performed
    • Fatigue worsened overall CPR
With high quality CPR, especially ventilations, playing such an important role in survival after drowning, this study should be taken into consideration when designing lifeguard training programs and drafting standard operating procedures.  Steps should be taken to maximize "real-world" scenarios with an emphasis on maintaing high quality skills despite the adrenaline rush and to account for this rescuer fatigue when establishing on-scene protocols and the roles of auxillary responders.



  1. Although we train our people to work a patient for up to 40 minutes if alone, we also get them in the habit of changing over every 10 minutes if not alone. Yes I have found issues with compressions, but at least we keep the ventilation on track.

  2. The majority of CPR protocols I'm aware of state if alone you should continue CPR until physically exhausted, or until another trained responder arrives and takes over. In my experience, it is unlikely you could continue CPR for 40 minutes while alone.

  3. the future of CPR after water rescue are mechanical compression (LUCAS) or EMS immediate assistance. A water rescue is very hard. In 75 m. can take 3-4 min. and cause lactic acid 14 millimoles. With this amount of lactic acid (aerobic power) to do CPR, but not quality CPR. We will publish more studies clarifying these concepts.
    Roberto Barcala-Furelos
    (author of the paper)