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

Introduction: Decision-making in emergencies is a multifactorial process based on the rescuer, patient, setting and resources. The eye-tracking system is a proven method for assessing decision-making process that has been used in different fields of science. Our aim was to evaluate the lifeguards9 capacity to perform the ABCDE (Airway-Breathing-Circulation-Dissability-Exposure) approach when facing a simulated critically ill-drowned victim. Methods: A cross sectional simulation study was designed to assess the skills and sequence of the ABCDE approach by 20 professional lifeguards. They had to assess a victim and act according to his/her clinical status following the ABCDE primary assessment approach. Two kind of variables were recorder: those related to quality of each step of the ABCDE approach; visual behaviour using a portable eye-movement system. The eye-tracking system was the Mobile Eye system (Bedford, USA). Results: None of the study participants was able to complete correctly the ABCDE approach. Lifeguards spent more time in the Circulation step: Airway (15.5±11.1 s), Breathing (25.1±21.1 s), Circulation (44.6±29.5 s), Disability (38.5±0.7 s). Participants spent more time in viewpoints considered as important (65.5±17.4 s) compared with secondary ones (34.6±17.4 s, p = 0.008). This also was represented in the percentage of visual fixations (fixations in important viewpoints: 63.36±15.06; fixation in secondary viewpoints: 36.64±15.06). Conclusion: Professional lifeguards failed to fully perform the ABCDE sequence. Evaluation by experts with the help of eye-tracking technology detected lifeguards9 limitations in the assessment and treatment of an eventual critically ill victim. Such deficits should be considered in the design and implementation of lifeguards’ training programmes.