Updated For NLS Waterpark Precert Packagelifeguard/downloads/resources/wp_precert...NLS Waterpark...

NLS

Waterpark

Precert Package

Created by:

RYAN RADFORD

Updated For

2011

THE

LIFEGUARDHOME® www.lifeguardhome.com

Ver 4.1

NLS Waterpark Precert Package 2011

Ryan Radford www.lifeguardhome.com -2-

NLS WATERPARK RECERTIFICATION INFO

While waterparks present even experienced lifeguards with new and unique challenges, the basic concepts and principles of lifeguarding remain the same. You will be expected to demonstrate these basic concepts and principles by adapting to the challenges presented by the waterpark environment. You will be expected to demonstrate effective lifeguard supervision and intervention principles while working with a team of other lifeguards on deck with you.

INSTRUCTOR: Ryan Radford [email protected] TO BRING FOR RECERT:

NLS Waterpark original wallet card within 7 YEARS of issue (no copies) CPR Level “C” original wallet card within 1 YEAR of issue (no copies)

Fanny Pack with Pocket Mask and Goggles

Whistle

White T-shirt

READY FOR SOME WATERPARK??

mailto:[email protected]



EVALUATION You will be evaluated based on the latest printing of the NLS Award Guide published by the Lifesaving Society of Canada. A fail of any ONE of the following items will result in the failure of the recertification.

1. WRITTEN EXAM 50 Multiple Choice Questions Pass: 65% (33-50/50) Fail: Below 65% (0-32/50)

2. SPECIALIZED RESCUES a) Waterpark Spinals

Land spinals Zero-depth spinals Deep water spinals Waterslide spinals

b) Wave/Water-feature Rescue Emergency procedure with adaptation to facilities unique features (waves, lazy river, hot tub, stairs,

etc.) A minimum of ONE of the above procedures will be evaluated. This may occur during simulations or as a stand-alone procedure.

3. POOL PHYSICAL SKILLS a) Carry

Approach 15 m head-up, pick up drowning non-swimmer in deep water and carry to nearest side of

pool (distance of 5 m) supporting the victim’s head AND shoulders out of the water.

b) Object Retrieval Approach 15m, recover a 20lb (9kg) object located at the bottom of the pool and at a distance of

5 m from a dock or pool side; Surface and carry for a total distance of 5m. Rescuer’s head must be above the water; the object may be below.

c) Spinal Carry Perform a deep water spinal rollover and transport patient for a total distance of 15m, including ability to change direction.

d) Submerged Patient Recovery Performa 5m land on-deck approach and enter the water. Approach 15m to recover a submerged victim. Carry the victim 15m using a control carry.

4. SIMULATIONS The handling of each patient has to be performed realistically. Show exactly what you would do in real life. In addition, when you are being a victim, please show every courtesy to your fellow lifeguards by portraying the victim type as accurately and realistically as you can.

Please ask any questions necessary before your simulation to clear up any uncertainties you may have.

The simulations used to evaluate lifeguards during a recert are made up of any combination of the following:

Public Relation Situations Water Rescues (DNS, etc.) Minor First Aids Major Emergency

Candidates will demonstrate the leadership & communication skills necessary to effectively MANAGE a team consisting between 4 and 8 lifeguards on deck at one time. You will be managing your team using a Pivot-style of lifeguarding.

NOTE Because the NLS Waterpark Option builds on the skills taught and evaluated in the NLS Pool option, it is expected that candidates be able to perform all of these skills during the recertification. These may include general lifeguard procedures and techniques, first aid assessment and treatments, and resuscitation skills.



SIMULATION CRITERIA The following is a list of common scenarios and/or errors that MAY constitute a “Failed” performance item during simulations. Please note that this list is only a guideline to be used by students who may not have access to the Award Guide. The author of this document takes no responsibility for failed candidates based on these criteria:

Resuscitation Techniques Unconscious breathing patient removed from water to their back Significant delay in removal from water Pool airway management of unconscious patient CPR Compressor not switched off every 2 minutes Unecessary delay of compression during CPR (more than 10

seconds) No roll for vomiting or regurgitating patient Incorrect landmarking for chest compressions (adult, child, or

infant) No abdominal thrust/back blows combo for conscous patient

with severe obstruction No visual check of airway during unconscious obstruction

procedure Excessive delay in activating EMS for any unconscious patient

Lifeguarding Techniques Scanning - no recognition within reasonable time of DNS/Major

Emergency Pool coverage not maintained for an unreasonable amount of

time Pool not cleared when unsupervised for extended period of time No effort made to backup other lifeguard during emergency No repositioning to cover other lifeguard if necessary Leaving deck area without signaling to other lifeguard No signaling for backup when responding to a major emergency Negative attitude towards patrons/public during public relation

incident Public relation incident completely unresolved

Lifeguarding Skills & Procedures Unsafe entry used (ie. Shallow dive) DNS approached unsafely (ie. guard directly in front of patient) No assessment or education/follow-up for a distressed or

drowning swimming Head and airway submerged for any patient ABC assessment not done at nearest point of safety Barrier devices (personal protective equipment) not used Airway not protected during recovery of submerged patient Rough handling and excessive movement of patient Missing person scenario not immediately communicated to

other lifeguard No immediate underwater search performed for missing person Inability to adapt to unique facility design (hot tub, sauna, deck

spinal, etc.)

Use of Equipment Patient not immobilized from stable to unstable on spineboard Poor lifting techniques causing uncessary movement to patient

on board Improper lifting techniques (using back for lifting) Sandbags or V-blocks not removed for victim roll on spine board

(vomit/regurgitation) Oxygen not used when necessary and available No oral airway used when necessary and available Unfamilar with oxygen unit Dangerous handling of oxygen unit

Patient Care / First Aid

General No hazard check before entering scene ABC’s not assessed Failure to perform a systematic secondary survey/assessment of a

major patient

Spinal-Injured Patient Modified jaw-thurst not used when assessing or resuscitating

spinal-injured patient Full body immobilization not done for any spinal-injured patient

(cervical, thoracic, lumbar, etc.) Any loss of immobilization for spinal-injured patient No assessment of severity of spinal injuries Spine board strap done directly over injury site

Cardio-Respiratory Emergency Excessive movement of chest pain / shortness of breath patient Chest pain / S.O.B. patient not assisted into position of comfort No attempt to intervene in respiratory distress (medication,

pursed-lip breathing, assisted vents)

Soft Tissue Wounds/Burns No control of deadly bleeding No cooling of any degree burn Dry chemical burn not brushed off before flushing Non-superficial embedded object removed Needle prick not allowed to bleed for 10 minutes and/or not

washed with soap and water

Medical Emergencies Proper history not obtained regarding ASA for chest pain patient

(4As) No check for history of E.D. drug use prior to assisting with

nitroglycerine Auto-injector (EpiPen® or TwinJect®) not administed to

anaphylactic patient when patient cannot self-administer Auto-injector (EpiPen® or TwinJect®) not administered correctly

to anaphylaxis patient (safety cap not removed, not held for correct time, no post-injection massage,etc.)

TwinJect® second dose not administered correctly Medications not determined or assisted for patient experiencing

medical emergency Insulin assisted to diabetic patient with low blood sugar

(hypoglycemic) Sugar adminstered to unconscious patient Restraining of seizing patient

Environmental Conditions Improper re-warming of hypothermic patient (ie. placing in hot

tub, rubbing extremities) Improper cooling of heat-related patient depending on condition

Fracture/Joint Injury No assessment of fracture/joint injury (distal circulation and

point tenderness) to determine severity No immobilization of fracture/joint injury Ice applied to injury with decreased distal circulation Attempt to relocate a disclocation

Head/Facial Injury Does not assess head/facial injury for potential spinal injury Vital signs not recorded for severe head injury

Poisoning Poison Control Center not contacted for poisoning

NLS PROCEDURAL UPDATE Over the years, many lifeguards were taught a specific procedure designed for the management of a lower spinal cord injury. This procedure was referred to as a “Lumbar Procedure.” It typically involved immobilization from the chest to the feet with specific attention to minimizing any movement of the legs.

Recent consensus amongst the Branch medical directors and committees of the Lifesaving Society have concluded that this specific procedure may not provide enough effective immobilization for the patient. Therefore, all spinal injuries, whether they be cervical, thoracic, lumbar, etc, are to be immobilized fully from head to toe.

Trauma to the spine regardless of location (cervical, thoracic, or lumbar), is to be treated as a cervical spine injury and he victim be fully packaged. On patient request, padding may still be applied under the legs. Non-traumatic lower back injuries will continue to be addressed as a “lower systems injury.”

Spinal Injuries Lower System Injuries Mechanism of Injury

Diving

Falls from height

Direct blow/trauma to head/neck/back

Motor Vehicle Accidents

Lifting or twisting

Repetitive movement

Previous back injury

Poor posture, muscle tone or physical conditioning

Signs & Symptoms

Pain and/or stiffness at the site of the injury

Tenderness or muscle rigidity along the spine

Bruising, deformity or swelling along the spine

Numbness, tingling or weakness in the extremities (spinal nerve or cord injury)

Paralysis (spinal nerve or cord injury)

Pain limited to the injury site and worsened by movement

Pain may radiate away from the injury site

Muscle spasms limit the range of motion

Patient may assume a stooped position and be unable to stand up straight

Procedure Adaptation

Full Spine Immobilization: chest, head, lower body (traditional “C-Spine” procedure)

May need to have legs supported in lower spine injury if they cannot lower them

Load in position of comfort (lateral or supine)

Head does not need to be immobilzed

Use padding for comfort

Example

[Notice no head

restraints being used. ]

“The Spine is the Spine” All spinal-injured patients should be immobilized head to toe

Padding if necessary to maintain position found



2010 AHA CPR STANDARDS

Highlights from the new 2010 AHA CPR Standards:

C-A-B In a non-aquatic history, the rescuer should immediately begin chest

compressions after discovering no breathing or abnormal breathing. Note in an aquatic rescue, the traditional ABC protocol is still used.

Back Blows

For a conscious severely obstructed airway of an adult or child, a combination of 5 abdominal thrusts (or chest thrusts) and 5 Back Blows should be used to clear the airway.

Breathing Checks Breathing checks in the unconscious patient should be a minimum of 5

and a maximum 10 seconds in length.

In-Water Resuscitation

Research has shown that it would not be unrealistic to provide rescue breaths not exceeding 20 seconds prior to starting CPR as victims with only respiratory arrest usually respond after a few artificial breaths are given. Therefore, for any unresponsive, non-breathing patient with an aquatic history, rescuers should give 2 breaths at the nearest point of safety. 3 additional breaths at 5 second intervals should follow. If breathing does not spontaneously return after these 5 breaths, the patient should be removed immediately and CPR initiated.

EMS Call EMS should not be sent for until the breathing check is complete

AED An AED should be sent for in all unresponsive patients.

Hypothermic Assessment In the past, hypothermic patients were to be assessed for upwards of one minute before

initiating CPR. This has been reduced to a 5-10 second check.

CPR Updates Reminders

Compress at least 100 compressions/min

Adults: At least 2” compression depth

Children: At least 1/3 chest width (about 2”)depth

Infant: At least 1/3 chest width (about 1.5”) depth

Ensure proper chest recoil

Compressions should not be interrupted for more than 10 seconds

Only stop to reassess for a “sign of life”



Scene Evaluation

Level of Consciousness

Open Airway

Send for EMS & AED

Give 2 stacked Rescue

Breaths (in water)

Give 3 additional rescue

breaths (in water) Initiate CPR & AED

Sequence

REMOVAL

Initiate CPR &

AED Sequence

NO BREATHING/NO NORMAL BREATHING

Follow-Up Care

Clear Pool Call EMS

Carry Equip

delicate Spine Precautions

Check Breathing (5 sec)

PRIMARY SURVEY

PURPOSE: To discover and treat any immediately life-threatening conditions

NO

N-

AQ

UA

TIC

HIS

TO

RY

A

QU

AT

IC H

IST

OR

Y

If victim shows signs of life, reassess

breathing



AUTOMATED EXTERNAL DEFIBRILLATOR

An AED should be sent for in all unconscious patients. Whereas CPR simply keeps basic body functionality alive, an AED can actually “jump-start” the heart into a regular pattern As soon as the AED arrives on scene, the lifeguards should follow the following basic steps: 1) Turn machine on 2) Follow Prompts:

“Place Pads on Chest”

3) Shock as Advised

ON

SHOCK

AED Reminders Ensure patient is not in a puddle or somewhat in water

Dry the chest before applying pads

Chest hair should be shaved; medical patches removed

Remove oxygen before shocking patient

Children should have pads placed front and back

Child Pad Placement



WHAT IS A WATERPARK? Waterparks are defined by 3 unique characteristics:

MOVING MOVING SPECIAL WATER WATER RIDERS FEATURES

Waves

Rivers

Currents

Standing Wave (“FlowRider”)

High Speed Slides

Moderate Speed Slides

Low Speed Slides

Diving Boards

Diving Towers

Tarzan Swings

Zip lines

Spray Bars

Water Walkways

Jungle Gyms

Spray Guns

Special Spray Features + many more

Although not a defining characteristic, most waterparks have multiple bodies of water

Lifeguarding Considerations at a Waterpark A few additional things to watch for as a waterpark lifeguard:

Conceptual design incorporates more than “just a pool”

There is constant movement and activity

The participant age range is wider

The participant swimming ability range is wider

Louder, busier, and more active than most pools

There are more hazards (both natural and man-made)

There may be more areas of sudden drop offs or depths

Considerably more blind spots than a typical pool

Changes in slide spacing (more or less)

Confusion at bottom of attraction

Stoppage of water flow

Empty inner tubes

Patron entry point

Wave action- knock over

Wave action – patron trapped at edge

Trails of Blood

CONSTANT MOVEMENT IS ESSENTIAL TO ADEQUATELY PROVIDE

SURVEILLANCE OF A MODERN WATERPARK



WATERPARK SIMULATIONS: GUIDELINES, TIPS, AND RECOMMENDATIONS

During Waterpark simulations, you will be guarding in a team of 4-8 guards on deck. You will need to demonstrate that you can not only work within a large team such as this, but that you can also manage it. One technique of managing a large team of lifeguards on deck is using a “pivot” guard or “deck supervisor.” This is essentially a position on deck that has all forms of communication going through it. The following are some general guidelines that you may want to think about when you are controlling your team. Keep in mind these are only suggestions.

1. As the Pivot guard, you should be positioned somewhere where you can clearly see all of your other guards and they can clearly see you. This position will be pre-established.

2. Before entering the water for a rescue, wait for acknowledgement from your pivot guard.

3. In a waterpark environment, small complicated hand signals are not efficient. Use LARGE, CLEAR signals when communicating with your team.

4. Although hand signals are preferred for all non-majors, if you need to get a hold of another guard, a short whistle blast may be used if necessary. Note: there should be a definitive difference between a short blast indicating “attention” and a long whistle blast indicating a major emergency which calls for backup.

5. As pivot, you should be constantly ensuring that all bodies of water are being adequately covered. If they are not, move guards appropriately or shut down the area.

6. As pivot, although you are watching your other guards to ensure proper placements and coverage, you

should still be scanning patrons in your general area. If you see an incident, you INTERVENE!! Don’t waste valuable time trying to get someone else to respond when you are the closest guard.

7. If you have to leave your position for any reason (i.e. to do a rescue), ensure you cover it with an available guard. The rest of the team may need to communicate with the pivot, so there always needs to be someone at that position.

8. If an incident occurs, it is your job to make sure that:

i. Backup for the 1st guard is responding

ii. Remaining guards shift positions to cover unguarded areas

9. In a waterpark environment, pools can (and should) be shut down (“cleared”) independent of one another. For example, if there is an unconscious victim in deep water, you may want to shut down the entire deep tank and direct all patrons to the other pools while the incident is being dealt with.

10. Ultimately, it is the pivot’s responsibility to ensure EMS has been called for all necessary incidents, proper pool coverage is constantly being maintained and all procedures/ treatments are going well. Although they may not actually make the call, they ensure it has been taken care of.

11. The pivot is a position of leadership. Be confident in your skills and your team will follow your lead.



To illustrate the concept of pivot lifeguarding, consider the following example: imagine a little league hockey game. At any given point when you look at the puck, there will be ten little hockey players all skating and swarming around it. Compare this to a professional hockey team. When you look at the puck, you notice several players around it, however you also notice some players playing back, some changing position, and some covering each other; they are looking at where they need to be in the future, not just where they are in the present. Not every player can score the goal, but they all need to work together as a team to get it. The pivot system is very similar. Imagine 6 lifeguards on a waterpark pool deck. If one guard blows the whistle for a DNS in the deep tank, you do not want all 6 lifeguards running over and jumping in. A pivot system helps control this.

THE PIVOT GUARD SYSTEM The pivot system is a means of organizing multiple lifeguards on the pool deck. In a pivot system, one guard (the pivot) monitors the number of lifeguards responding to an incident (2 for a DNS in deep water, for example), as well as the repositioning of the other guards. The pivot guard should direct the other lifeguards as necessary. The pivot guard system is recommended when the number of lifeguards on deck at one time reaches or exceeds 4 (four) OR the lifeguards on deck cannot maintain visual contact with one another because of physical barriers. The guard who controls this system is labeled the “pivot guard.” The pivot has three key responsibilities.

1) To ensure that appropriate backup responds to any given incident

2) To ensure that there is adequate coverage of all areas 3) To determine the need to close certain areas/pools if adequate

coverage cannot be maintained. The following describes the guidelines typically associated with the pivot system: Guideline #1 – The pivot guard must be able to clearly see all the lifeguards on deck and all the lifeguards must be able to clearly see the pivot guard whenever possible. One of the problems with a large waterpark is the size and/or physical structures that can block sight lines. Because not all lifeguards can see all other lifeguards (this includes guards at the top of slides), it is necessary for there to be one lifeguard on deck that has a sight line with everyone. This is the pivot guard. The following is an example of guard positions at a waterpark facility (6 guards on deck; 1 guard at top of slide):

P

Slide Attendant



Guideline #2 – All communication must go through the pivot All incidents, including PRs, minors and majors should always be relayed though the pivot. This allows the pivot to reposition guards as necessary, assign necessary backup, and maintain an overall sense of what is happening at the waterpark at any given time. This is especially important when delaying with a reported missing person. A large area like a waterpark requires the use of large, clear hand signals to prevent any communication errors across deck. Guideline #3 – There always needs to be a pivot Although the pivot guard is a team leader, they still must be a lifeguard as well. It is only reasonable to expect that in an emergency, if the pivot guard is the nearest guard to respond, they should. In a situation where seconds can make a difference, there should be a delay in which time is spent calling a guard from a further location simply so the pivot can stay put. In the event that the pivot needs to enter the water to make a rescue, he/she must cover their position by requesting another guard to act as pivot until the original pivot is able to return or the incident is resolved. Guideline #4 – Ensure adequate pool coverage at all times If a pool is not being watched effectively, there is the potential for a missed victim, therefore it is of critical importance that the pool always has adequate coverage. As soon as one or more guards are busy and can no longer watch their area (for example, during a major), if there are not enough available guards the pivot must decide what pool(s) to close. In an example using an unconscious seizure in the deep tank (which requires 2 guards), the pivot may choose to do the following (slashes indicate closed pool):

P

Slide Attendant

(Calling EMS)



SOME GENERAL WATERPARK INFO Waterparks are generally defined as a facility made up of:

Moving Water (eg. Waves, currents, lazy rivers) Moving Riders (eg. Slides, tube rides) Water Features (eg. Spray features, water cannons) They are not necessarily made up of multiple pools The MAIN two are the moving water and moving riders

Generally, everything in a waterpark is bigger than traditional lap pools… This

includes the amount of patrons that come swimming. More patrons directly results in more PR situations, more first aids, and more rescues.

In addition to provincial Pool Regulation standards for the pool, any facility with a

waterslide is also bound by the guidelines set forth in Appendix A of the CSA Standard: “Safety Code for Amusement Rides and Devices.” (April 1, 2004).

Although occasionally useful for temporary flume or pool checks, concave mirrors are

not a replacement for extra guards on the deck. There are several different types of waterslides: High-speed (Drop-off and free-fall),

moderate speed (serpents and twisters), low-speed (“kiddie” slides), and riders (tube rides and mat rides). Each have their own hazards that lifeguards must take into consideration when working.

A slide should be checked each morning by walking up it in non-skid shoes.

Patrons are often flipped upside down when they exit a slide flume into a catch pool.

This is because of hydrostatic braking (slowing down due to static water) which causes the body to “somersault” and can cause distress in weak swimmers.

One of the most important steps in a Waterpark rescue is to shut off the waves or the

slide using an emergency stop system. Because of the size, most Waterparks rely on using an intensive scanning system,

often times using one specific lifeguard as a communication point between all others (may be known as a “pivot” or “deck supervisor” position).

A waterpark/leisure pool requires a maximum turnover rate of 2 hours (compared to

the 6 hours of a standard pool) due to the warmer temperatures and higher patron counts (2010 BC Pool Regulations).



WATERSLIDE TYPES HIGH SPEED (FREE-FALL and DROP-OFF) General Info Common Rules

30km/h +

Free-fall give the feeling of a free-fall.

Free-fall ends in long flume

Drop-off ends suddenly in mid-air

Drop-off ends in a catch pool

Strict age, height, weight guidelines

Only one person in flume at any one time

Supine riding only; with rms and legs crossed

MODERATE SPEED (TWISTERS)

General Info Common Rules Almost all ages welcome

Children may or may not be allowed to ride with parent

Several riders on slide at one time allowed with proper dispatch timing

No stopping in slide

Supine or sitting positions permitted

SLOW SPEED (KIDDIE SLIDES)

General Info Common Rules

Very gentle sloping

Some slides may allow for parent with child

Children only

Parent waits for child at bottom

Sitting positions only

TUBE/MAT/SLED (RIDES) General Info Common Rules

Uses apparatus to transport rider down flume

Can be considered high speed, moderate or slow speed ratings

Vary greatly depending on ride

See manufacteur specifications



THE PHYSICS OF A SLIDING RIDER

POTENTIAL ENERGY

Ep = mgh Energy = (mass)(gravity)(height)

This is the total energy a rider has stored at the top of the slide. This is converted to kinetic energy. Some riders may have too much stored energy (ie. too much mass) and therefore cannot safely go down a slide. This is why we have max weight limits.

E

N

E

R

G

Y

KINETIC ENERGY

Ek=½mv2

Energy = ½ (mass)(velocity)(velocity)

This is the total energy resulting from a

rider’s motion. When velocity increases, the energy increases exponentially.

Depending on the mass and velocity, there is a lot of energy that is traveling in the flume.

Kinetic energy is lost through friction.

For a moving rider to stop, all energy must be removed

SLIDING FRICTION

Occurs when one surface passes over another. Wearing a t-shirt will increase the sliding friction and therefore slow down the rider. Riding a slide sitting up actually increases the sliding friction and also slows down a rider.

F R I C T I O N

VISCOUS FRICTION

Occurs when an object passes through a fluid. A catch flume must have enough water to fully stop a rider’s motion. Increasing the water flow in the slide will actually slow the rider’s velocity and therefore decrease their energy.

pool

KINETIC ENERGYKINETIC ENERGY

FRICTIONFRICTION

More water means more friction = slower

ride



WATERSLIDES (CONT) Some general waterslide information:

Entry is usually from a platform area (“dispatch zone”); may contain more than one slide

Riders finish in either a catch pool or slide flume (“exit zone”).

Waterslides typically have height and weight restrictions. These must be followed.

Rider position varies depending on the type of waterslide.

The slide manufactures may incorporate a mat, raft or tube into the slide design

Operators must follow both slide manufacturer guidelines as well as appropriate legislation (ie. CSA Standards for Waterslides)

Each slider is different: you need to consider their size, age, and body position and sliding attire when determining dispatching intervals

Watch for safe distance and time before the next rider is released

Waterslides utilize a variety of release methods including lifeguards, attendants, flag systems, gate systems, and stoplight systems.

Some Waterslide Review Questions: 1. If the flow of waters is increased will there be more or less sliding friction? 2. If the flow of water is decreased will there be more or less viscous friction? 3. What type of friction stabilizes a rider’s speed more, viscous or sliding friction? 4. What dangers does sliding friction have on a rider? 5. What dangers does the water flow have on a rider? 6. What may happen to a rider’s position in a slide as he accelerates into a curve? 7. What dangers does this position pose if the flow of water is low?



CSA STANDARDS FOR WATERSLIDES

As of April 1, 2004, The “Elevating Devices Safety Regulation” no longer contains waterslide regulations for waterslides constructed after this date. Instead regulations are found in the Canadian Standards Assocation (CSA) International Standard Z267-00 known as the “Safety Code for Amusement Rides and Devices.” Appendix A of this code refers specifically to Waterslides. Note: Any slides installed prior to April 1, 2004 must comply with the Elevating Devices Act in place at the time of installation. The following is some pertinent information found in these standards that lifeguards should be aware of.

A1 - Design

A1.1g

The walking surface in and about the waterslide, including the entrance and exit to the waterslide are slip-resistant and discourage retention of water

A1.1k Crowd control at the point of entry to the dispatch area is facilitated A1.7 For each water slide designed and produced, the designed or manufacturer shall specify if the use of life jackets

shall be permitted A1.8 Every water slide shall include a system designed to provide reliable communications between attendants

supervising the dispatch and discharge areas, Must also include access to a communication device for summoning emergency services.

A1.10 The designer or manufacturer shall provide documentation stating the design capacity of each water slide and the capacity of the dispatch area, and recommending the number of attendants required for the numbers of riders using the water slide during any period of time.

A1.11 The designer or manufacturer of every water slide shall provide documentation of factors that may limit the use

of the water, which may include, but not be limited to the : rider’s weight and size, rider’s physical ability, the

rider’s body position, the number or users, maximum and minimum water depth in the splashdown area.

A1 – Operation

A2.1 The area at the top of every water slide shall be supervised by at least one attendant who has been trained in the duties related to this position, who shall have continuous and direct supervision of that area.

A2.2 The splashdown area of every water slide shall be supervised by at least one attendant who is trained and certified in first aid and lifesaving techniques, who shall have continuous and direct supervision of that area

A2.3 All components of the communications system referred to in Clause A1.8 shall be tested on a daily basis A2.4 Daily inspections shall be carried out on each waterslide, to ensure the safe operation of the water slide both

before the water is circulating and while the water is circulating. A2.5 A log book shall be maintained daily, reporting all inspections, tests, and records of operation, maintenance,

and incidents or accidents. A2.6 The owner/operator of every water slide shall post a sign at the entrance to the water slide, for the

information of patrons, that conveys information, rules and instructions of the use of the water slide.

A2.11 The use of lifejackets shall be allowed on a water slide only if the manufacturer has specified that their use is permitted.

Reference: CSA Standard Z267-00. Safety Code for Amusement Rides and Devices. March 2000. Note: The above is a partial list of items contained within the safety code. This information should not be used in place of actual documention. This is simply a list used for the instruction of lifeguards within British Columbia.



WAVES AND WAVE POOLS

There are 2 types of waves:

Oscillating Stationary wave that goes up and down* like a “see-saw”

Can trap weaker swimmers in deep water or against walls

Causes constructive (larger) and destructive (smaller) waves caused by bounce back against walls

Solitary Transitional Wave that moves down the length of the pool.

Can toss swimmers into ground as it breaks.

Can easily knock over weaker swimmers and small children at shallow or water’s edge.

The Anatomy of a wave:

It is important to test the amplitude and wavelength settings in a controlled manner prior to letting public into the facility. Waves should be tested in this manner on a regular basis.

CREST

TROUGH

WAVELENGTH

AMPLITUDE

Particle motion in deep water

Particle motion in shallow water. Waves tilt to form breakers.

Still water level



LIFEGUARDING A WAVE POOL Waves create a new and unique challenge for lifeguards who have only experienced scanning and rescues in still water. Every wave pool is unique in terms of wave size, wave frequency, resulting currents, dead-zones (“nodes”), etc. It is only through regular practice and training at a wave pool can the lifeguard become competent at performing rescues in it. All pools should have a visual and audible alarm sounding prior to waves being turned on. This gives patrons not wanting to be in the waves a chance to exit the wave pool. Waves are run in cycles and not continuously for the following reasons:

i) Provides patrons with a rest period ii) Provides guards with a rest period iii) Provides wave generating machinery with a rest period iv) Prevents excessive Cl2 dissipation into air

LIFEGUARD CONSIDERATIONS LIFEGUARD CHALLENGES

The Wave-Kill must be hit for all rescues occurring in the wave pool

Waves do not stop immediately after being shut off. Residual waves make the initial part of the rescue difficult

Diving should never be permitted while waves are on due to the changing depth

Lifeguards entering into a wave pool must always enter into the CREST of the wave

Patrons should stay clear of the wave generator at all times.

Crowds increase dramatically during periods when the waves are on.

Bottom scanning becomes increasingly more difficult with the higher patron density in the pool and the constant moving water.

Rescue of a panicked patient in waves introduces a new level of danger to the rescuing lifeguard. An aid of some form (immediate backup lifeguard, rescue tube, etc.) should always be used in wave pool rescues



Waterpark Currents

i) Hydraulic or Face “Hole”

Occurs when water flows over a barrier. Rafts or tubes will often be overturned at the “hole.” Riders can also become trapped in the hole

ii) Venturi Effect

Water flow slows before a construction and accelerates after it.

iii) Vortex Current

iv) Acceleration through a curve When water travels through a curve (for example in a twisting slide), it accelerates. Lifeguards must be aware of these areas as patrons can start traveling faster than they feel comfortable. This can result in friction burns if the patron has enough energy to travel past the water flow itself. This is one of the reason it is so important to strictly enforce the size and height guidelines set forth by the slide manufactures.

BOIL

ACCELERATION

Occurs when water changes direction as it enters a basin or open zone in a slide. The strength of a vortex is increased if a barrier is present in the basin.

“Hole”

Run Out



POOL CHEMISTRY

Disinfection (Chlorine/Bromine)

Chlorine (or Bromine) is used to disinfect the pool water. It can be used in 3 different states: solid, liquid, or gas (most effective). Once the chlorine is in the water, there are 3 forms of it. FAC (free available chlorine) is the amount of chlorine molecules free to attack the nasty little ammonia products that were left by the bus load of preschoolers. According to the 2010 BC Pool Regulations FAC levels should be maintained at:

0.5 ppm for a pool less than 30 degrees

1.5 ppm for a pool over 30 degrees CAC (combined available chlorine) is the amount of chlorine molecules combined with an ammonia product – these are also known as chloramines (chloramines are what can be smelt at many pools when you walk in).

When CAC levels get too high or a pool fouling occurs, a superchlorination is done. TAC (total available chlorine) is the total chlorine in the pool. This is obtained by adding FAC + CAC.

Ozone Ozone (O3) is an alternate way of disinfection. In an Ozone pool, water is sent through an ozone generator in the mechanical room where the “baddies” are destroyed. However, even in an ozone system, there is still a need for chlorine in the main pool to deal with immediate contaminations. Ozone leaks can be very dangerous. As such, alarm systems are installed and emergency procedures regarding a leak must be practiced.

Ultraviolet Although still more expensive, many pools are using a UV system for disinfection. Advantages of a UV system include:

Much like ozone, because the disinfection happens outside of the pool, a residual chlorine level must be maintained in the pool.

pH

acidic neutral basic

1 2 3 4 5 6 7 8 9 10 11 12 13 14

pH measures the concentration of H+ ions in the water. This should be maintained between 7.4 and 7.8. Low pH is acidic and can cause pipe corrosion. High pH is basic and can cause pipe scaling. Both can cause patron discomfort. To lower the pH, use muriatic or hydrochloric acid. To raise the pH use Soda Ash or Sodium Bicarbonate (Baking Soda).

BC Pool Regulations: 7.2-7.8

FAC Ammonia “Baddies”

CAC



BC POOL REGULATIONS (2010) In October 2010, after 38 years, the BC Government replaced the 1972 Health Act with the 2010 Pool Regulations. The following is a highlight of what lifeguards need to be aware of:

Definition of a Lifeguard

A lifeguard must be 16 years old, hold certification(s) as outlined in the Pool Safety Plan and receive training in the Pool Safety Plan prior to lifeguarding.

A lifeguard is responsible for the conduct and safety of all pool patrons, and is to perform no duty other than pool surveillance.

Pool Safety Plan:

By Oct 2011, all public pools must have an approved written pool safety plan which is a detailed written plan containing emergency, operating and cleaning/maintenance procedures in addition to required first aid/lifesaving equipment. The facility must:

a) prepare a written pool safety plan to ensure the health and safety of pool patrons, b) make the plan readily available to pool employees, c) train each pool employee in the procedures and in the use of the equipment described in the plan, d) review and update the pool safety plan at least once each year.

The pool safety plan must include:

a) procedures to be followed in the event of a serious injury, emergency or incident, b) the type of lifesaving, lifeguarding and first aid equipment to be kept within the immediate vicinity of the pool, c) the number of lifeguards and other employees who are to be on duty while the pool is in use in order to ensure

adequate supervision of pool patrons, d) operating procedures for the pool, and e) the program of cleaning and maintenance of the pool, including the nature and frequency of the cleaning and

maintenance.

Staffing Levels

Must open with at least 1 lifeguard and 1 assistant

Max Ratio of Lifeguard to Patrons = As outlined in P.S.P.

Water Clarity and Chemical Standards

Pattern of the main drain OR a black disc (150mm in diameter) must be visible at the deepest point of the pool

Water must be tested minimum twice a day

Maximum main pool temperature 37°C (98.6°F)

pH maintained between 7.2-7.8

FAC: 0.5ppm for a pool less than 30°C 1.5ppm for a pool over 30°C

Other

No diving in less than 2 meters of water



DROWNING PHYSIOLOGY

To drown is to suffocate in water or other fluid. A victim can drown in as little as 12-20 seconds.

Series of events in a drowning patient:

Our priority when dealing with any victim who is drowning is to quickly remove them from the pool. If they are conscious this means supporting them with their head and shoulders above the water while we transport to the nearest edge. If they are unconscious, this means protecting their airway from having water enter it and transporting to the focal point.

DELAYED DROWNING EFFECTS DUE TO ASPIRATION

Some individuals may be familiar with this as being called “secondary drowning” however this is an outdated term which should no longer be used.

As lifeguards, this is a major concern in every near-drowning person we rescue

Is caused by as a fluid accumulation in the lungs which can begin to occur within minutes to 72 hours after a drowning incident

Fluid in lungs destroys the alveoli and causes problems with breathing and eventually lack of air exchange.

This can result in “Pulmonary Edema” or swelling of the lungs. Signs and Symptoms: - Trouble breathing/Shortness of Breath

- Painful or persistent coughing - Chest Congestion - Extreme Fatigue

- Strange and abnormal behavior (especially in children)

Any patient suffering from any of these symptoms should immediately seek medical attention.

In all drowning victims, we must assess for and educate each victim about the dangers of delayed drowning symptoms.

Example of a follow-up for any rescue of distressed swimmer: Assess: “Can you take 2 deep breaths for me? Did you breathe in any water?”

Educate: “You have just had a near-drowning episode. Over the next 72 hours if you experience any trouble breathing, persistent coughing, chest congestion, or extreme fatigue, you need to contact a doctor or go to the hospital immediately and tell them what happened. Please report back to me before leaving the pool today so I can check on you again. ”

Follow-Up: Record all information in an incident report form.

Encourage the patron to stay in shallow water or wear a lifejacket.

STRESS/ PANIC

HOLDING BREATH

TERMINAL GASP

DEATH

“SECONDARY

DROWNING”



ANAPHYLAXIS

Anaphylaxis is a severe allergic reaction that can affect multiple body systems. An anaphylactic reaction can be caused by any number of known or unknown allergens. Some common allergens include peanuts, bee stings, seafood, and latex.

Normal Appearance Anaphylactic Reaction Appearance

Signs and Symptoms Generalized itching Blotchy, raised, red bumps

on the skin (hives) Wheezing; difficulty

breathing Swelling – including throat,

tongue, and face Dizziness, light headedness Unconsciousness

Treatment:

EMS Monitor ABC’s Medication (Auto-Injector) Treat for Shock Monitor Carefully

Ensure the following steps have been taken BEFORE ever administering a patient’s Auto-Injector:

EMS has been called Patient has history of anaphylaxis and contact with

known allergen Only the patient’s TwinJect is used. DO NOT

administer another person’s Twinject Victim is unable to self-administer (including unconsciousness) Medication window is clear in colour

*An expired auto-injector may still be administered provided the medication window shows a clear fluid with no discoloration or precipitate.

Lifeguards are trained in the administration of Epinephrine to the anaphylactic patient

via a patient’s auto-injector (EpiPen® or TwinJect®). You should be trained with

both trainers and consult with your facility to determine their standpoint on this

procedure.

Window

s



AUTO-INJECTORS (TWINJECT® AND EPI-PEN®)

Lifeguards should be familiar with the administration protocol of both Twinject and EpiPen brand auto-injectors. Although the principles of administration remain constant, there are slight variations in the technique. Use this as a summary of the two devices.

TWINJECT EPI-PEN

Epinephrine

Active Ingredient

Epinephrine

1. Remove BOTH Caps 2. Press red tip firmly into outer thigh

(should hear a click) 3. Hold for 10 seconds 4. Massage injection site for quick

dispersal NOTE TIME OF ADMINISTRATION

1st DOSE Protocol

1. Remove safety cap 2. Press orange tip firmly into outer

thigh (should hear a click) 3. Hold for 10 seconds 4. Massage injection site for quick

dispersal NOTE TIME OF ADMINISTRATION

a. Do not bend needle

b. Place used needle carefully into the original case

Follow-Up

c. Return used auto-injector to original case or sharps container.

d. If no case is available, needle may be bent back on a hard surface to avoid an accidental prick.

After 10 minutes from 1st dose, if patient shows no signs of improvement, prepare 2nd dose: 1. Carefully unscrew base from red tip 2. Remove syringe from base unit by

gripping the blue plastic 3. Remove yellow safety collar 4. Inject needle into opposite leg of first

dose 5. Push plunger all the way down. 6. Massage injection site

2nd DOSE Protocol

No second dose available in EpiPen

Place used needle in original container Follow-Up

Cap 2 Cap

Cap 1

Twinject



WATERSLIDE COLLAPSES AT WATERWORLD, USA IN CALIFORNIA

One dead, 30 hurt in water slide collapse June 3, 1997

CONCORD, California (CNN) -- A popular northern California amusement park remained closed Tuesday, the day after a water slide collapsed, killing a teen-age girl and critically injuring six of her high school classmates. At least 30 people were injured in Monday afternoon's accident at Waterworld USA, about 30 miles northeast of San Francisco. The students -- seniors on a pre-graduation outing -- ignored a lifeguard's warning and tried to ride down the 75-foot-tall slide together, according to Waterworld general manager Steve Mayer. "Our guard couldn't control it," he said of the large gathering of teen-agers going down the water slide. The accident occurred soon after the park announced that Napa High School students visiting Waterworld -- about 120 in all, according to the school -- should return to their buses for the trip home. At that point, some of them rushed to the top of the slide, according to Rick McCurley, vice president of Premier Parks Inc., which owns Waterworld. Survivors said they were trying to break a school record for total number on the slide when it gave way. Witnesses said people on the winding slide, called the Banzai Pipeline, crashed to the ground when it collapsed. The pool of water below turned red with blood. The injured teens were screaming and crying for help, witnesses said. "It was a very chaotic scene at first," one police officer at the park said. "It was pandemonium," another officer said. One girl, a 17-year-old Napa student who was not identified, died 45 minutes later from a crushed chest. Helicopters and ambulances transported the injured to nine hospitals. In a statement issued late on Monday, Premier Parks defended its safety record. "Safety is our number one priority. Based upon what we know at this point, we believe this slide was safe," the company said. Concord police Lt. Jim Jennings said city officials would conduct an investigation at the site. He said police were not aware before this incident of any safety problems at the park.

The twisted wreckage of the water-slide.



FREQUENTLY ASKED QUESTIONS

Q: What does the “initial 5 breaths” mean? I’ve never heard of this before. When you take a normal first aid or CPR course, you are taught that if the patient is not breathing (or not breathing normally), you contact EMS, send for an AED, and initiate CPR. This is the latest protocol for rescuers dealing with sudden cardiac arrests. When we talk about an aquatic history, this is known as a hypoxic (low oxygen) event. There is substantial research that shows that initiating rescue breathing as quickly as possible in such an event provides the best possible patient outcome. Therefore, in the case of a drowning, we should initiate 5 breaths at the nearest point of safety (typically shallow water). The actual delivery is as possible:

“Breathe” [chest rise, chest fall] “Breathe” [5 seconds] “Breathe” [5 seconds] “Breathe” [5 seconds] “Breathe”

Following the 5th breath, if breathing has not spontaneously returned, we should immediately remove patient (if not already done) and initiate CPR.

Q: How long should a “breath” take when ventilating? According to the AHA 2010 Recommendations, a single breath of air should only take 1 second (enough to make the chest rise). A child or infant will require a smaller amount

Q: Can we demonstrate 2 breaths in the water, then 3 breaths out of the water? No. When we demonstrate this skill we want to have five quality rescue breaths in a row as soon as possible. If we are in a depth were we can control complications, then we do this in the water. If we can't control complications, then we do this out of the water. We should not demonstrate any unnecessary pauses in those five initial breaths or trying to do other things. It needs to be high quality 5 breaths... not 2 here and 3 there. And it needs to be as soon as possible (as soon as we are in a position to control complications).

Q: What is a “Sign of Life” When performing CPR, a number of reactions from the patient can occur. Some of these are involuntary, while other indicate a sign of life. It is important to only stop CPR to reassess a patient if a clear sign of life presents itself. This is not an exhaustive list, but may help guide you as to what may happen during a resuscitation.

SIGN OF LIFE NOT A SIGN OF LIFE

Victim starts to breathe normally

Active vomiting

Coughing

Seizure

Coordinated movements

Agonal breathing

Fluid buildup (regurgitation)

Loss of bowel/bladder control

Flickering eyes

Strange movements (posturing)

Q: What is the difference between vomit and regurgitation?



When performing CPR, especially in an aquatic related incident, it is to be expected that fluid will begin to accumulate in the mouth and upper airway. This is considered a REGURGITATION (ie. a passive mechanism causing a backward motion of gastric content to travel up the airway). This is caused by a rescuer's actions such as rescue breathing or chest compressions. There is a common misconception from many lifeguards (and first aiders) that regurgitation and vomiting are the same thing. VOMITING is an active mechanism caused by the muscular action of the stomach to "throw up" it's contents. A patient actively vomiting may indicate something about this patient has changed and we need to be aware of this change.

If the victim vomits while performing CPR: • Roll the patient, and sweep to clear the airway • Reassess ABC's

if there is a change in victim status, the victim's vital signs should re-assessed. If a victim takes a breath or actively begins vomiting suddenly when CPR or ventilation of a victim is being performed, then the rescuer should stop and re-assess the pulse (and breathing, if breaths are recurrent). THIS IS A CHANGE IN VICTIM STATUS suggesting revival.

If the victim regurgitates while performing CPR:

• Finish the 30 compressions

• Roll the patient, and sweep to clear the airway

• Give 2 breaths

• Position and Resume CPR

Regurgitation is not a change in victim status . Pausing to re-assess vital signs only delays critical circulation which, at best, during CPR provides only one-fourth to one-third of the body's normal circulation. This more acceptable management of regurgitation is confirmed in BCLS literature and has been supported by emergency physicians who have queried why re-assessment was ever taught for regurgitation. One of the underlying principles of the 2010 CPR Guidelines is to “Minimize interruptions in chest compressions.” Reassessing every time you notice some fluid causes excessive interruptions and simply diminishes the patient's prognosis.

Q: What are agonal respirations? Agonal respirations are an abnormal pattern of breathing characterized by shallow, slow (3-4 per minute), irregular inspirations followed by irregular pauses. They may also be characterized as gasping, laboured breathing, perhaps accompanied by strange vocalizations and myoclonus (a brief, involuntary twitching of a muscle ). In some cases, agonal respirations can mirror normal breathing however become less frequest with time. The cause is due to cerebral ischemia, due to extreme hypoxia or even anoxia which accompanies sudden cardiac arrest. Agonal breathing is an extremely serious medical sign requiring immediate medical attention, as the condition generally progresses to complete apnea and heralds death. Agonal respirations are commonly seen in cases of cardiac arrest , and may persist for several minutes after cessation of heartbeat. The presence of agonal respirations in these cases indicates a more favourable prognosis than in cases of cardiac arrest without agonal respirations.

Q: What is a “Guppy Breather” Spinal? Imagine a patron were to dive into shallow water and come up floating. You would assume this patient to be unconscious. However, upon rollover, the patron is wide awake but cannot speak. He is pale, appears scared, and appears to be trying to “gulp” or suck air into his lungs. This patient has caused (possibly irreversible) damage to a high level of the cervical region of the spinal cord. As a result, not only is his entire body paralyzed, but his diaphragm is paralyzed as well. This patient is conscious, but unable to breath on his own. Your job as a lifeguard is to maintain ventilations throughout your procedure. A “guppy breather” is essentially a conscious, non-breathing patient.

Q: What is the difference between “Lateral”, “3/4 Prone”, Recovery, Drainage, and Semi-Prone Position?



LATERAL ¾ Prone / Recovery / Drainage / Semi-Prone

Used for continuous monitoring of unc. victim

Cannot leave the patient (they may vomit and aspirate OR their airway may fall forward and close)

Used for unconscious, breathing victims

Used for when a lifesaver must leave a patient for some reason (to call 911, etc)

Typically not used by lifeguards

Remember: Lateral is for lifeguards; Recovery is for rescuers.

Q: Can I administer sugar to an unconscious, diabetic patient? NO. Regardless of prior training, the latest printing of the National Lifeguard Service Award Guide does not condone this procedure. As lifeguards, sugar may only be assisted to a patient who can readily control their own airway.

Q: What are some simple tests to help check for signs of a stroke/TIA? Besides a lowered LOC, confusion, poor coordination, and trouble speaking, a patient suffering from a TIA or Stroke often displays numbness or weakness on one side of the body (this has to do with one side of the brain being affected).

Some simple bilateral symmetry tests can be used to help determine if the patient is suffering from this condition:

Pupil Reactivity – Check to see if the pupils are equal and whether or not they both react appropriately to light.

Tongue Test – Ask victim to stick their tongue straight out. The tongue may deviate to one side.

Smile Test – Have patient smile for you. Check to ensure both sides of the mouth curl up equally.

Squeeze Test – Have patient squeeze each of your hands as hard as they can. Check for equal strength as they do so.

Arm Lift – Have patient lift both arms up at the same time. Watch for one side raising an arm faster or higher than the other.

Q: Can a patient who has taken Viagra or Cialis safely take nitroglycerine? No. A patient who is on nitroglycerine should be directed by their Doctor not to take Viagra or Cialis as the two drugs are contraindicated (see references below). A rescuer should consult with the EMS dispatcher prior to administering nitroglycerine to a patient who has taken Viagra or Cialis. As per pharmaceutical guidelines, a patient can potentially take nitroglycerine 1 full day (24 hours) after their last Viagra OR 4 full days (96 hours) after their last Cialis.

Q: Can a patient suffering from angina take both nitroglycerine and ASA? Which should be taken first? How long between medications? Yes. As per the CFAM (page 34) the nitroglycerine protocol for a patient suffering from chest pain is 1 dose every 3 minutes to a maximum of 3 doses in 10 minutes. If the first dose of nitroglycerine does not make the pain go away within 3-5 minutes, have the patient take a second dose of nitroglycerine. Provided the patient has ASA and meets the criteria of the 4A’s they can also chew a tablet.

Q: Is it true we’re doing Back Blows for obstructions now? Yes. According to the 2010 AHA Guidelines, back blows should be used as part of the protocol for conscious severely

obstructed patients. The treatment protocol will include:



Alternating 5 abdominal thrusts and 5 back blows for adults and children

Alternating 5 chest thrusts and 5 back blows for obese or pregnant patients

Alternating 5 back blows and 5 chest thrusts for infants (no change)

IMPORTANT: The patient’s airway is parallel to the ground during back blows. The rescuer can wrap one arm diagonally across the patient’s chest and have them bend forward.

Deliver 5 firm back blows with the heel of their hand between the shoulder blades of the patient.

The patient must have a good level of consciousness prior to attempting this procedure.

Q: Can I administer an expired EpiPen or TwinJect? Yes. If an anaphylactic patient requires their AutoInjector, but it is expired, it can still be administered provided the window showing the drug appears clean and not discoloured.

Q: How do I remove a bee stinger? A small sac attached to the end of a bee stinger can still be present after a patient is stung. We don’t want the contents of the sac to be injected into the patient so DO NOT use your fingers, or even tweezers to remove the stinger. Instead, use a plastic card or your hand to brush or “scrape” the stinger out. Rarely are they any more than superficial.

Q: What do I do if someone steps on a hypodermic needle? The patient’s (and our) biggest concern will be that their may be a pathogen or disease –carrying agent on or in the needle. Ensure the needle has been secured or safely disposed of first. The wound should be thoroughly washed with soap and water and allowed to freely bleed for 10 minutes. The hope is that the pathogen will be flushed out f the body. After 10 minutes, the wound should be bandaged and the patient sent to the hospital for exposure treatment. It is not necessary to transport the needle to the hospital.

During Back Blows: Ask victim to lean forward with their airway parallel to the ground.



ADDITIONAL NOTES FROM THE PRECERT:

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