Fall From a Wet Pool Deck: Incident Judgement
At 07:40 a lone lifeguard is on duty at an indoor 25 m pool. A bather slips on a wet tiled area near the shallow-end steps, striking their head on the deck edge. The bather is conscious but confused, with a scalp laceration bleeding moderately. The lifeguard is certified in first aid and CPR. The facility's emergency action plan (EAP) requires calling emergency services for any head injury with altered consciousness and completing an incident report within 24 hours. There is one other staff member on site, a receptionist with no first-aid training. The pool is open and three other swimmers are in the water. The nearest ambulance response is estimated at 12 minutes.
1. List the immediate priorities in order and explain how the lifeguard should manage the pool while treating the casualty.
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Priority order (ABCs before admin):
- Scene safety and summon help. Confirm the deck is safe; the wet area is a slip hazard to rescuers too. Call to the receptionist to phone emergency services immediately (do not wait) and to bring the first-aid kit and AED.
- Care for the casualty. The bather is conscious but confused after a head strike - treat as a potential spinal/head injury. Keep them still, do not move them unnecessarily, control the bleeding with direct pressure using gloves, and monitor consciousness, breathing, and pupils continuously. Confusion after head injury is a red flag for concussion or worse.
- Manage the pool. The lifeguard cannot leave the casualty. The receptionist (untrained) must clear the pool - ask the three swimmers to exit and close the pool to entry. The lifeguard should not attempt to supervise swimmers and treat a casualty simultaneously; the pool must be closed until cover is restored.
- Handover. When paramedics arrive, give a clear handover: mechanism (slip, head strike), time, conscious state changes, bleeding control, and any relevant history.
- Documentation. Complete the incident report within the EAP's 24-hour window, but only after the casualty is handed over - never at the expense of care.
2. The receptionist has no first-aid training. What tasks can and cannot be delegated, and what does this reveal about the facility's staffing risk?
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Can be delegated (non-clinical, procedural):
- Calling emergency services and giving location and nature of incident.
- Fetching the first-aid kit and AED.
- Clearing the pool and locking the gate / posting 'pool closed'.
- Keeping bystanders back and directing the ambulance to the correct entrance.
- Taking names and contact details of witnesses for the report.
Cannot be delegated:
- Any first aid, bleeding control, spinal precautions, or casualty monitoring.
- Supervising the pool (the receptionist is not a lifeguard).
- Deciding whether the casualty can be moved or whether to call an ambulance - that is the lifeguard's clinical judgement.
Risk revealed: The facility is operating with a single lifeguard and no backup - a lone-guard model. One casualty instantly removes all pool supervision, forcing closure. This is a systemic staffing gap: the EAP assumes a second trained responder who does not exist. Recommendations: require a minimum of two trained staff on duty during open hours, cross-train the receptionist in basic first aid and emergency calling, and add a written lone-guard protocol that mandates pool closure the moment the guard must leave the chair.