ABCDE approach to victims by lifeguards: how do they manage a critical patient? A cross sectional simulation study

Abstract

6Introduction: Decision-making in emergencies is a multifactorial process based on the 7 rescuer, patient, setting and resources. The eye-tracking system is a proven method for 8 assessing decision-making process that has been used in different fields of science. Our 9 aim was to evaluate the lifeguards' capacity to perform the ABCDE (Airway-Breathing-10 Circulation-Dissability-Exposure) approach when facing a simulated critically ill-11 drowned victim. 12 Methods:A cross sectional simulation study was designed to assess the skills and 13 sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a 14 victim and act according to his/her clinical status following the ABCDE primary 15 assessment approach. Two kind of variables were recorder: those related to quality of 16 each step of the ABCDE approach; visual behaviour using a portable eye-movement 17 system. The eye-tracking system was the Mobile Eye system (Bedford, USA). 18Results: None of the study participants was able to complete correctly the ABCDE 19 approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), 20 Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants 21 spent more time in viewpoints considered as important (65.5±17.4 s) compared with 22 secondary ones (34.6±17.4 s, p = 0.008). This also was represented in the percentage of 3 23 visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary 24 viewpoints: 36.64±15.06). 25 Conclusion: Professional lifeguards failed to fully perform the ABCDE sequence. 26 Evaluation by experts with the help of eye-tracking technology detected lifeguards' 27 limitations in the assessment and treatment of an eventual critically ill victim. Such 28 deficits should be considered in the design and implementation of lifeguards' training 29 programmes.30