Participant Reports Chest Tightness During Cool-Down
During the cool-down of a 60-minute shallow-water class (water 29 °C, 16 participants), a 58-year-old woman tells you she has 'tightness' in her chest that started a few minutes ago and 'a bit of heartburn.' She is conscious, talking in full sentences, and her skin looks pale and slightly clammy. She has no known cardiac history on her screening form but takes medication for high blood pressure. She wants to 'just sit on the deck a minute and then drive home.' The lifeguard is on the far side of the pool with another group.
1. What is your immediate assessment and action sequence?
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Treat chest tightness with pallor and clamminess as a possible cardiac event until proven otherwise, even with 'heartburn.' Sequence: stop her activity, assist her out of the water to a seated or resting position on the deck, stay with her, and summon the lifeguard and call emergency services (or direct a bystander to call) - do not wait to see if it passes. Keep her calm and still, monitor breathing and responsiveness, and be ready with the facility's AED and emergency action plan. Do not let her drive herself.
2. How do you respond to her request to 'sit a minute and drive home,' and why?
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Decline clearly and kindly: 'I can't let you drive with chest symptoms; we're getting you checked.' Symptoms plus pale, clammy skin in a hypertensive adult warrant EMS evaluation; a delay to 'see if it passes' is the classic failure mode. Offer to call a family member, but EMS transport is the default. Document her refusal if she declines care, and continue monitoring until handoff.
3. What follow-up documentation and review should occur, and what should you avoid saying?
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Record time of onset, symptoms as she described them, observed signs, actions taken, who was notified, EMS arrival/handoff, and outcome if known. Debrief with the lifeguard and manager, and review why the lifeguard was out of position relative to the class. Avoid diagnosing ('it's just heartburn') or reassuring her that it's nothing; describe and refer. Also avoid discussing her condition with other participants.