Surprise! Now Save My Life

During the summer of 2005, six of us drove from Lexington, KY to the tiny town of Mexican Hat, Utah (pop. 88) to begin a self-supported, multi-day river trip down the San Juan River. We drove through the night and arrived at our outfitter’s store at 4pm the following day. The thermometer on the store’s front porch read 110 degrees.

We walked into the store, passing an elderly couple who had just finished eating a late lunch at the small diner inside. As the couple drove away in their van, we secured our river permit and discussed driving to see the rock formations that are common in the area. As we stepped outside, the same van that had just left pulled back in front of the store. The man hopped out and told us that he needed help, that his wife had passed out.

We carried the woman inside and laid her on the floor. She was not breathing and had no pulse. An ambulance was called and I began CPR. About 20 minutes later, the ambulance arrived with an AED. They shocked her a few times and then loaded her into the ambulance for the 20 minute drive to the hospital. I knew that her survival was unlikely, and later found out from the outfitter that she had died. Though the ending wasn’t what we wanted, I was glad that we were able to provide the best care possible under the circumstances, especially for her husband’s sake.

At the time of this incident I had been a CPR instructor for almost 20 years. During part of this time I managed a city pool where I was responsible for lifeguard training. I made my lifeguards practice their CPR skills every day. Additionally, we ran “surprise” drills five times per week where the guards had to activate the emergency action plan, clear the pool, and perform a backboarding or near drowning scenario. I critiqued CPR skills hundreds of times each summer, and could recite the steps and perform the skills myself perfectly, every time.

That is why I was so surprised when I missed the most important step with the lady at Mexican Hat. I forgot to check for signs of life. I had assumed that she had passed out from the heat, and went to ask the outfitter for some damp towels. Luckily, one of my companions (who had taken one of my CPR classes) thought to check for breathing, and found there were no signs of life. There was really no break in appropriate care for the woman, but I should have known better. 

With all of my perfect CPR practice, I had never actually participated in a “surprise” drill where my brain had to go from “What rock formations should we see?” to “You have an unconscious victim. Go!” All of my practice was planned. That is why, to this day, I continue to have my student recreation center staff participate in surprise drills. Nothing prepares you for the real thing like the next best thing to the real thing. There is no warning, no pre-practice, no hint that something is going to happen. The surprise scenario begins and the staff members involved have to rely on their previous training to respond correctly.

Overall, staff members react very well to surprise drills. Sometimes we discover large-scale training deficiencies that we are able to correct. For example, when we practice skills during our monthly skills checks, the employee is in a controlled environment where they have the manikin, CPR mask, and AED readily available. When employees are stationed out in the facility, they carry first aid supplies, including their CPR mask, in a shoulder pouch. The CPR mask fits better in the pouch if the mask is compressed. During one of our surprise drills, a number of our staff did not realize that they needed to pop the mask out before using it. Now, when we do our monthly skills checks, we always give the employees a compressed mask so they can practice popping it out before performing CPR.

Here are the things we’ve found that help to make surprise drills more effective for our staff:

  • Always have the staff practice their skills in a controlled environment before running any surprise drills. It’s better to correct basic errors before expecting the staff to perform well in an unexpected setting. Staff should be able to perform CPR/AED skills flawlessly in a controlled setting. Be sure that you maintain high expectations and don’t be satisfied with “only a few mistakes.” Mistakes will be magnified many times over during a real emergency.
  • Recreate as many steps as possible during controlled practice. If employees are expected to communicate emergencies using a radio, have them practice using a radio during skills practice. Make sure they speak clearly and provide all important details, such as location of the emergency, condition of the victim, and as much additional information as possible that would help staff and paramedics better deal with the situation. Have them locate the needed equipment in their shoulder pouch or fanny pack if that is where their equipment is usually stored when they’re on duty. Have them put on protective gloves before practicing their skills. Set the stage as best you can to recreate a real situation.
  • We use manikins for our surprise drills, placing them in various areas around the facility. You can put an old lost-and-found t-shirt on the manikin so that employees can practice cutting away clothing in order to place the AED pads on the chest correctly.
  • Try your best to surprise the employees, but make sure they know it’s a drill BEFORE they actually call EMS. On the initial radio call, the person who is caring for the victim will preface their emergency communication by repeating: “This is a drill. This is a drill.”
  • We formed a Risk Management Team, composed of student supervisors who were interested in helping to train our staff. The team helps during surprise drills by watching different areas of the facility and reporting how employees perform during the drills.
  • Always provide immediate feedback, and take the time to correct any significant errors after the drill concludes. Record the results of the drill, including who participated, effectiveness of communication and skills, and any other pertinent information. We created a Google Doc to capture this information. This way you won’t always be “surprising” the same employees over and over.

Giving employees the opportunity to react in situations that closely resemble the “real thing” gives them confidence and increases the chance that they will act appropriately in a true emergency.

How do you prepare your staff to handle emergencies?

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