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Friday, 20 January 2012
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The Canadian Red Cross is the leading provider of a number of water safety, first aid and CPR programs. Candidates have a number of options when registering for first aid and CPR which include learning CPR on infants, children and adults. This page will focus on other preventative and safety measures including water safety and assistant water safety courses.

AWSI-Learning

Objectives:

• Identify the learning characteristics for the age categories and identify appropriate teaching strategies for the age categories.
• Identify the four learning styles (visual, auditory, tactile, and kinaesthetic).
• Demonstrate an understanding of why and how people learn (learning process, domains of learning).

Evaluation Criteria:
• Identifies effective communication (verbal and nonverbal) tips for working with all age groups
• Identifies effective strategies for solving problems and resolving issues

Time: 1.5 hours (classroom)

Materials:
• Origami paper
• Flip chart paper and markers
• Interactive age characteristic chart

Activities:
Classroom session (1.5 hours)
Factors that affect communication: Choose an activity that the candidates are unfamiliar with (ex. Origami). Provide the class with verbal instructions only. Give the candidates time to try the activity. Ask the candidates how much success they had. As a group discuss what factors affected their ability to learn the task the first time:

> Unsure of what the task was
> Unfamiliar with the task—no previous experience to draw from
> Anxiety caused by lack of direction and feedback
> Limited practice time

Go over the same activity again but this time provide a brief explanation, a demo, break it into manageable steps. Provide the candidates with constructive feedback and provide practise time. As a a group discuss how much success the group achieved and what affected the outcome.

> Motivational Factors—was the goal easily understood and achievable?
> Is the learner able to tell when the goal has been achieved?
> Is the challenge degree appropriate?
> Was the use of manageable chunks beneficial to the learners?
> Satisfaction or reward is anticipated
> Experience is enjoyable

Key points:
• Importance of recognizing different learning styles
• Ways to ensure all learning types are being reached
• Factors that affect communication: Lack of communication, lack of experience, lack of direction and feedback, limited practise feedback.
• Learning requires feedback
• Inclusion is linked to to learner readiness

Dinosaur: Split the candidates into 4 groups. Provide each group with a piece of flip chart paper and markers. Each group will receive instructions on what they are to draw. But the groups can not communicate with each other.

Group 1 “Paint a brontosaurus”
Group 2 “Paint a dinosaur”
Group 3 “Paint an animal”
Group 4 “Paint hebtzyqnp”

Group 4 will have no idea what it is they are being asked to paint, as the word they are provided will not make any sense to them. Group 3 will paint whichever animal the group agrees on. Group 1 and 2 will have little or no difficulty painting their pictures. Give the groups a few minutes to complete their drawings. Hang the posters and let everyone know that the goal of the activity was to paint a brontosaurus (input). Depending on how the group perceived the instructions, they processed a different message (Storage). The actual painting was retrieval. Discuss with the group the purpose of the activity: to show that when learners are at different levels of cognitive development, they may hear messages differently than intended.

Ask group 4 how they felt when they didn’t understand the goal.

Ask group 3 how they handled with directions that they understood but were not very specific enough to clearly identify the goal.

Ask group 1 and 2 how they felt about the directions. How easy was it to perform the task when they understood the directions and knew what the goal was. Relate this back to a 3-5 year old preschool class. Will all the children understand the verbal instructions you give them? Because the main way awe can influence learning is input. It is important to demonstrate (visual) as well as verbal.

Key points:
• Understanding the process of input, storage and retrieval. Age characteristics: Create and interactive chart with the age characteristics from page 4.5 and 4.6 of the AWSI manual using recipe cards. Allow candidates a few minutes to put them in order. Make sure the entire group is in consensus on the order. Go over the chart with the candidates and the manual and have them correct the chart to make sure its in the correct order. Relate some of the characteristics back to how this will affect their teaching.

Key points:
• Age characteristics and how they apply to activities in our lessons
• Meeting the needs

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Friday, 13 January 2012
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AWSI – Red Cross Swim

Objectives:
• Know the Red Cross history in Canada, programs and services, and Seven Fundamental Principles. Identify the various components of the Red Cross Swim program..
• Identify the components of the Haddon Matrix Injury Prevention Model (PEE [personal, environment, and
• equipment; PSSS. Prepare! Stay Safe! Survive!.
• Identify the difference between an “accident” and an “incident” and that “accidents” are predictable and preventable (injury prevention).

Evaluation Criteria:
• Identifies the components of the RC swimming and water safety program
• Identifies how to incorporate inclusion with lessons
• Identifies the link between injury prevention and the RC swim program
• Identifies the components of the Haddon Matrix Approach to Injury Prevention
• Identifies the difference between “accident”and “incident”
Time: 1.5 hours classroom

Materials
• Appendix C (Facilitators guide) handouts
• Appendix B (Facilitator guide) handouts
• Flip chart paper and markers
• Appendix D (Facilitator guide) handouts Activities

Classroom Session (1.5 hours)
**There is no activity that entirely covers objective 1 watch for it in practicum. Seven fundamental principles (15 min): Divide the class into groups of 2 or 3. distribute Appendix B ( facilitator guide) handouts. Have candidates complete and review the answer with the class. Give each group a piece of flip chart paper with a fundamental value on it. Ask candidates to relate it back to being AWSI`s

Key points:

• 7 fundamental principles
• RC history (when RC was established, what year)
Water Safety Program (15 min) : Divide class into groups of 2 or 3. Distribute
Appendix C (Facilitators guide) handouts. Have candidates complete it. Review the answers afterwards with the class.

Key points:
• The different programs RC has offered Injury prevention (20 min): Break class into small groups. Introduce the Haddon matrix (example on board). Ask candidates to share a scar/injury story. Ask them to
create a time line for the incident and then to fill in the Haddon matrix for it. Ask them to identify the factors that caused the incident and what could have been done differently to avoid the incident. Start a discussion with the class. Go over everyone’s posters and have the class talk about why the RC has based their program on injury prevention. Have candidates read p. 2.7 of the AWSI manual.

Key points:
• Understanding the Haddon matrix
• Definition and understanding of injury prevention (developing water safe behaviours, by affecting attitudes through the use of personal experience)
• How the program incorporates injury prevention
• It is the instructors role to ensure injury prevention is encorporated
• Accident Vs Incident
• 5 strategies for incorporating injury prevention. (language, small chunks, ask why, wise choices, simulate choices) and how these strategies for developing your water safety activities and evaluating current activities to identify whether they identify injury prevention or not.

Drowning Statistics (15 min): Split the class into groups and distribute current copies of the 10 year drowning report. Give each candidate a piece of flip chart paper and have them identify the components of a typical victim profile. Each group will present their victim profile and identify how RC swim could have made a difference.

Summary of information: Divide class into two groups Have one group for an inner circle facing out. Have the over group stand facing the inner circle. Give each person a RC question card appendix D. The inner circle begins by reading the information to the outer circle member. They discuss the answer together. The person keeps notes to present at the end. After a few minutes call rotate. The outer circle moves 1 space clock wise. Repeat until everyone have been at each question. Have the candidates read the questions out loud and record the answers. Provide extra information from ch. 2 when needed.

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Monday, 09 January 2012
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When registering for Red Cross safety and education programs candidates have a variety of options. These options include water safety training, first aid aid training and a variety of CPR courses to choose from. This article will focus on Red Cross water skills and water safety.

Skills and Water Safety

OBJECTIVES

1. Identify the importance of skills and water safety content in the Red Cross Swim program and the placement of

the skills and water safety content items in the Haddon Matrix Injury Prevention Model.

2. Accurately demonstrate the skills and water safety items to the performance criteria of the Red Cross Swim

program (Red Cross Swim Preschool, Red Cross Swim Kids, and Red Cross Swim Programs for Adults &

Teens).

3. Identify the progressions of all skills and water safety content items.

Activity: Modelling – Classroom (Dry)

Materials: Flipchart, felts

Time: 20 minutes

Materials: Flipchart, felts

Activity: Place candidates into groups of 3. Have candidates go through the AWSI manual and go over items in the manual that may have a safety concern and write them down on a flipchart. Have them present to the class and explain why the feel it could be a safety concern

Key Examples:

Dives,

Entries into pool,

etc.

Key points: Go over the the progressions of water safety in skills (aka, siting dive first, kneeling dive second, standing dive last).

Go over the areas of water safety.

Activity: Haddon Matrix - Classroom (Dry)

Time 20 minutes

Materials: Accident/incident stories written on a paper to handout. Flipchart. Felts

Activity: Hand out a accident / incident story to three different groups into the class. Have them read about the Haddon Matrix and place the story into the haddon matrix and fill in the Haddon Matrix to there story as much as possible. Discuss there results one at a time and discuss how the students will use the haddon Matrix to prevent injuries and incidents from happening while they teach there lessons.

Goal: Identify the importance of skills and water safety content in the Red Cross Swim program and the placement of the skills and water safety content items in the Haddon Matrix Injury Prevention Model.

Activity: Safety Presentations

(5 hours)

This is the wet portion of Skills and water safety. Throughout these activities you will be modelling a AWSI instructor and will follow that up with a discussion being a WSIT and the students being AWSI students.  Modelling during the activity and WSIT during discussion after activity. You are a AWSI instructor unless otherwise posted.

Site Safety, Importance of Supervision, When and Where to swim

Time: 1 Hour

Materials: Swimming pool and Regular aquatics toys / materials

Activity: Pool Tour / Safari (make sure you stop and read the rules)

(15 minutes)

-Have all the students hold onto a noodle and as the awsi instructor walk backwards around the pool and throughout the aquatics area giving an introduction to the deep end, shallow end, hot tub, sauna, steam room, lifeguard, etc. Make sure you stop and ask the students if they see any fishy’s in the water along the way. Make sure you ask.

Why do we have rules?

Where’s the lifeguard?

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Entry Intro

(5 minutes)

-Have all the students sitting on the edge. Ask them. Is everybody sitting on the edge? Who gets in First? Why? (make sure everything is safe). Give the students a quick discussion on why teacher goes into the water first and we should always wait for an adult (mommy or daddy) before we go into the water.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Listening Game

(5 minutes)

-Have the students sitting on the ledge talking to each other. Ask the students who’s listening? Whoever’s listening say “Everybody look at Julia, she’s got her listening ears on and she’s quiet and ready to listen. Who else is listening?” Try to get everybody in the class involved.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Pop Quiz!

(5 minutes)

-Ask the students the following questions

Can we ever go swimming alone? Do we go with a buddy?

Who knows the perfect weather for swimming outside? What’s bad weather for swimming outside?

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Whirlpool

(5 minutes)

Make a whirlpool with your arm. Have the kids try to make a whirlpool. Would it be tough to swim in a whirlpool? Where can we find a whirlpool?

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Class creativity

(20 minutes)

As a WSIT: Divide the class into 3 groups and have them come up with a game / activity for Site Safety, Importance of Supervision, When and where to swim. Give the class 5 – 10 minutes to come up with a activity that meets the goals, memorable and fun and tell that class what learner type you are reaching.

Goals: Try to reach all learner types. Make it memorable and make it fun.

Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Entries and Exits

Time: 1 hour

Materials: Pool and normal pool equipment, Shaving cream.

Activity: Lumberjack game!

(5 minutes)

-What kind of tree are you? Chop chop chop. Fall in (assist if needed)

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: I’m being eaten by a boa constrictor

Sing the following song with the students sitting on the ledge. Have them enter through the progressions of the song.

Chorus: “I’m being eaten by a boa constrictor,

a boa constrictor, a boa constrictor,

I’m being eaten by a boa constrictor,

And I don’t like it very much!”

Oh no’s! He’s got my toes! (toes go into water)

Chorus

Oh jeez! He’s got my knee’s (knees go into water)

Chorus

Oh glum! He’s got my bum (Bum goes into water)

Chorus

Oh mommy! He’s got my tummy (tummy goes into water)

Chorus

Oh Darn! He’s got my arms (Arms go into water)

Chorus

Oh heck! He’s got my neck (Neck goes into water)

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Humpty Dumpty

(5 minutes)

-Sing humpty dumpty one at a time and help students into the water.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Go over the progressions of entries (from first entry to deep water jumps)

(10 minutes)

-with aids, without aids, with instructor, without instructor, etc.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Dives and Strides

(20 minutes)

As a WSIT: divide class into four groups. Give each group one of the following items to teach and to discuss safety concerns and where it lies in the progression of entries. Also have them explain what type of learner their activity is catering too.

1. Sitting Dive

2. Kneeling Dive

3. Disoreinting Entries

4. Front Dive

5 minute prep time.

Presentations

As a WSI: Stride Entries.

-you will present stride entries. Show them an example and have them try doing one themselves going one at a time from a single file. After a practice run place some shaving cream on the top of their heads and see if they can keep it on. Discuss safety concerns of stride entries and the discussion that can follow.

Discussion

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Go Go Gopher

(10 minutes)

-play go go gopher with the students. Have them line up along the wall arms reach apart by deep water. Tell them only to jump in when you say go. Say ready set go….pher! Then try go..lf, go…ld, go…at, go…dzilla!

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

PFD’s and Lifejackets

Time: 20 minutes

Materials: Lifejackets

Activity: Introduction to Lifejackets.

(10 minutes)

-Go over how to wear a PFD and how to check quality , zippers, buckles and straps

-show a poor quality lifejacket and a new lifejacket and ask the students if they can tell the difference.

-Jumps and movement in the water with life-jackets.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: PFD Train

(10 minutes)

-Have all the students put on lifejackets and hold onto one persons strap, while on back, and be pulled by instructor. Instructor chants “choo choo” as the students get pulled around the pool.

-Students also gain experience putting on the lifejackets and taking them off.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Cold Water Survival

Time: 1 Hour

Materials: Mats, hose, kickboards, pool, whiteboard, felts

Activity: Cold water huddle

(20 minutes)

-Have class jump into the water and get out as fast as possible. They will be cold and wet. Have them describe how they feel. Hopefully they will explain how they are cold. Have them each put on a lifejacket and get into a huddle position in a circle with the smallest people in the middle. Have them explain the difference in terms of heat loss. Have the students then try it again as a group in the pool.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity:  Ice Safety

(20 minutes)

-Place a bunch of mats, kickboards, and other floating things into a deep end corner of the pool. Run a hose over the students as they try to swim to and climb on and away from the mats. This activity simulates ice safety. Promote them to distribute their body weight as much as possible and to roll away from the unfrozen water. Have each student try it once.

Activity: Hypothermia Presentation

(20 minutes)

-Have all the students sit down and use the whiteboard to go over hypothermia. What it is. How to prevent it. How to treat it. How to provide basic care

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Boating

Time: 30 minutes

Materials: Boat, whiteboard, felts

Activity: Boating Pictionary

(10 minutes)

-Using whiteboard and felts go over boating safety playing pictionary. Draw scenarios on the board and have the students guess what’s needed for a boating trip as you draw. Go over and include: float plans and what things are needed on a boat before leaving.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Go on Boating trip

(20 minutes)

-With one boat taped on deck practise entering and exiting while others practice on a boat in the water. Follow this with a controlled capsize on the water. Mention boating regulations and go over materials needed a the importance of a float plan.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Rescues 

Time: 40 minutes

Materials: Pool, normal pool equipment, cards with one part of rescue breathing written on them (2x)

Activity: Identify buoyant objects

(5 minutes)

-Have the class collect as many buoyant objects that they can find within a safe distance from you. Have them bring it back and put it in a pile next to the pool. Select items one at a time and ask the class if they think it floats. Toss it into the pool and show the class whether it does or does not.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: What time is Mr. Shark (progression: change direction and return to edge)

(5 minutes)

-Face the class and have the entire class holding onto the ledge in the shallow end. Ask them to ask you “what time is it Mr.Shark?”. Respond with a time and have them take that many steps towards you.  At one point shout “Lunch time” and have them return to the edge as fast as they can.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Ring Race

(5 minutes)

-Through numerous different coloured rings in various depths and divide the class into two different groups. Have the students race to get as many different rings using head first and feet first surface dives. The team with the most points (each colour ring is given a value) wins the game. Emphasis is on doing head first and feet first surface dives with hand above head while coming up.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Rescue Race

(15 minutes)

-Divide the class into two different groups lined up on the deep end side. Place each of the rescue breathing cards upside down on the entire side of the pool (approximately 25 meters away). Have the students race to the other side of the pool, one at a time, a uncover the first step (or the following form the previous) and leave right side up and return to the other side to tag another race. Continue relay until the proper order of rescue breathing is complete on other side of pool. Make sure the students go one at a time and only leave one card in the proper order left right side up at a time.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Ladder Approach

(10 minutes)

-Have the class sit down in front of a whiteboard and draw a drowning person in a lake and someone on the dock not far from the drowning victim. Draw a ladder off to the side of the drawing. Ask the students what would be the safest thing they could do in that situations to save the victim, reminding them that entering the water is dangerous and the risks of what could happen if a victim were to grab onto a rescuer. Go through all the steps and fill them in on the ladder off to the side. Explain to the class why its called the ladder approach and the importance of keeping as safe as possible when rescuing a victim. Do not go further than reach.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Wise choices

Time: 30 minutes

Materials: Whiteboard, felts, kickboards, hose, life-jackets

Activity: Make a current

(5 minutes)

Have the class get into the water and get into a circle and start going counter-clockwise. Make them go as fast as they can and then tell them to let go and relax. The current will take them away. Explain to the students the dangers of currents.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Make a wave

(5 minutes)

-Have the class in a line, backs against the wall, each with a kickboard making waves. Have one person swim, one at a time along the waves. Explain to the students the dangers and difficulties of swimming in waves.

As a WSIT Ask: Why is this a good activity? Where is this in the progression of things? What are some safety concerns?

Activity: Drowning Discussion

(5 minutes)

-Have the class sit down next to a whiteboard and go over there swimming limitations, alcohol and personal choices and the responsibilities.

As a WSIT: Identify the importance of skills and water safety content in the Red Cross Swim program and the placement of

the skills and water safety content items in the Haddon Matrix Injury Prevention Model.

Activity: Deep water Survival

(15 minutes)

-Divide class into two different teams. Throw as many lifejackets as there are students into the middle of your swimming lane. Get one team to start on one end of the lane and the other team to start on the other end of the lane. Have everybody swim to a lifejacket, put it on in deep water with no assistance, and get there team into a position for

Remainder of Dry Time

Identify the importance of skills and water safety content in the Red Cross Swim program and the placement of

the skills and water safety content items in the Haddon Matrix Injury Prevention Model.

Activity: Prepare, Stay Safe, Survive (Dry): Do this last!!!

 (20 minutes)

Post flip-charts around the room. Label the flipcharts Prepare! Stay Safe! Survive! And Personal, Equipment, Environment.

a. Have candidates place the activities and demonstrations that were done in the water under the

appropriate headings. Share as a group.

b. Relate the activities to the five strategies for incorporating injury prevention. What strategy did each of the

activities relate to? What safety supervision items do we need to be aware of?

Looking back on the activities done in the water, decide which activities incorporated injury prevention, and

which of the five strategies were covered. Divide into pairs to discuss, and then share as a whole group.

Look at the progressions and activities that were not done in the water. Where would they fit on the flip-charts?

 

 

 

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Thursday, 05 January 2012
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The Red Cross is the foremost leader in safety training. The Red Cross is not only popular in CPR and first aid training courses but it also is the Canadian leader in water safety programs. This page is dedicated to the assistant water safety instructor (AWSI) communication lesson plan. These topics are covered in the AWSI instructor course provided through the Canadian Red Cross.

AWSI communication

Objectives to complete:

1. Identifies how communication affects learning

2. Domonstrate ability to communicate verbally and non-verbally with all age groups

3. identify effective strategies for solving problems and resolving issues in an aquatic environment

4. Identify how to create and maintain a safe environment for children and how to proceed appropriately should a situation arise

Evaluation critiria (C3)

1. Identifies effective communication (verbal / non-verbal) tips for working with all age groups

2. Identifies effective strategies for solving problems and resolving issues

Time: 1 Hour (dry)

Materials: Aladdin Video, audio / visual equipment, flipchart, paper/ pens, headband cards

Activity: Characteristics of Communication (20 minutes)

  • -Brainstorm what makes communication effective
  • -Ensure the following is highlighted:
  • -talk to not at
  • -eye level
  • -assertive
  • -specific
  • -body language match’s verbal
  • -use names
  • -Create brainstorm ideas in a chart format

Effective Communication                                   Strategy

-Eye Level                                             -Shoulders in water

-In the water always for feedback

Review communication concerns when teaching in an aquatic Environment

Concern                                                Solution

-language barrier                                   -visual cues (thumbs up)

-child with ear plugs                               -bring closer, ensure that they are getting the message

-learning challenges                               -adapt progressions

Activity: Tone, Volume, Voices, Direction (15 minutes)

  • -Play the Aladdin Video (song: “You ain’t Never had a friend like me”)
  • -Brainstorm as a group all the different types of communication that occurred (tone, volume, body language, facial expression, etc.)
  • -record answers on a flip-chart
  • -How do we use that communication as instructors?
  • -What was the main message of this video?
  • -point out how Aladdin used several ways to teach one message and how it relates to instructing
  • -examples: visual, auditory, volume (loud, quiet, small / big voice), assertive tone, specific (ain’t never had a friend like me), characters, non-verbal communication, eye contact at level, entertaining, fun, fast paced, colors
  • -kept reemphasizing the same method.

Key points to cover

  • -communication key to being a good instructor
  • -instruct with enthusiasm
  • -verbal vs non verbal (matching)
  • -keep it short / simple / specific

Activity: Headband Game (being specific, key points / perception checks)

  • -Round one
  • -give guesser a familiar object to place on forehead
  • -have class only give vague answers to the guesser (ex:maybe, i guess so…) – five minute limit
  • -guesser may or may not get the answer
  • -Round two
  • -second guesser given a familiar object
  • -class to give specific answers (yes, clear answers and details)
  • -Round three
  • -guesser get a non-familiar object
  • -class directed to give specific answers

Summary

  • -Review each round: How did the guesser feel in Round 1?2? Why?
  • -What happened to communication in Round 3 when no one knew the object?

Key points

  • -being specific
  • -process of communication
  • -using key points / perception checks
  • -good instructor link

Building Healthy Relationships (10 minutes)

  • -Read the section on healthy relationships on pg. 3.3 to the end of the chapter
  • -Quickly review the key points list on 3.3

Activity: Break into 3 groups:

  • Group 1: identifies what they need as swimmers in a lesson
  • Group 2: identify what they need as parents
  • Group 3: identify what they need as fellow instructors

Have them present while acting in the role of who they are talking about (swimmer, parent, instructor)

Review with the gorup what to do if a swimmer wants to speak confidentially.

 

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Monday, 02 January 2012
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The information posted on this page about the affects of altitude is supplemental material to first aid and CPR training. This information will not be covered in this immense detail in any of the comprehensive first aid courses. This material is provided to give candidates an understanding on the demands of the body as altitude increases and the body’s responses. This data can then be used to help in any cardiopulmonary or first aid scenario at increased altitudes. Additional topics such as pulmonary edema and high altitude cerebral edema are not covered in any significant detail in Red Cross first aid training.

ALTITUDE AND PERFORMANCE

I. PHYSICS OF ALTITUDE
Medium altitude – 5000 – 10,000 feet – in relation to athletics, we are concerned with this altitude range
High altitude – greater than 10,000 feet. More than 40 million people live and work between 10,000 ft. (3048 meters) and 18,000 ft. (5486 meters).
Barometric (air) pressure decreases as altitude increases (ie) as the weight of the column of air above the point of measurement decreases. However, the chemical composition of the atmosphere is uniform up to 20,000 meters.
PO2 in dry ambient air at sea level = .209 X 760 mm Hg = 160 mmHg
PO2 in dry ambient air at 3048 meters (10,000 ft.) = .209 X 510 mm Hg = 107 mm Hg.
PO2 in dry ambient air at summit of Mt Everest – 8848 meters (29,028 ft.) = .209 X 250 mm
Hg = 52 mm Hg.
Oxyhemoglobin dissociation curve – only a small change in percent saturation of hemoglobin is observed with decreasing PO2 until an altitude of about 10,000 ft. Measurable negative effects on VO2 max. have been noted at altitudes as low as 4000 ft. The critical alveolar PO2 at which an unacclimatized person loses consciousness within a few minutes during acute exposure to hypoxia occurs at an altitude of 23,000 ft.

Decreased density of air –> decreased external air resistance –> external work is decreased ataltitude in sprint type activities where high velocities are involved. There will also be less air resistance encountered by projectiles. Air temperature decreases linearly by 6.5o C per 1000 meters of altitude or 2oC (3o F) per 1000 ft. Air becomes increasingly dry with increasing altitude –> water loss via respiratory tract is
higher at high altitude.

Solar radiation – UV radiation is more intense at high altitude –> sunburn, snow blindness. Force of gravity is decreased with distance from the earth’s center –> higher altitudes should have a favourable effect on jumping and throwing events.

II. IMMEDIATE AND LONGER ADJUSTMENTS TO ALTITUDE HYPOXIA
A. Cardiovascular System
VO2 = (HR X SV) X (CaO2 – CvO2)
With increasing altitude, CaO2 progressively decreases. To compensate, cardiac output initially increases during rest and submaximum exercise due to an increase in heart rate. Over the first week at altitude, cardiac output falls to or below sea level values for the same VO2 and there is a progressive increase in O2 extraction –> more efficient method of delivering O2. The most important long-term adaptation to altitude is an increase in the blood’s oxygen carrying capacity. Hemoglobin concentration starts to increase during the first two days at altitude due to a decrease in plasma volume and an increase in RBC production by bone marrow. These hematological changes during acclimatization are dependent on an adequate iron intake. In some high altitude natives and well-acclimatized sojourners, hemoglobin concentration may be increased 40 – 50% above normal.

Concentration of 2,3 DPG within RBC increases –> shift O2 dissociation curve to right –> unload more O2 at the tissues for a given capillary PO2. Even after several months of acclimatization, VO2 max. still remains significantly below sea level values.

B. Pulmonary System
Decreased alveolar PO2 –> decreased arterial PO2 –> stimulation of aortic and carotid
chemoreceptors –> increase in ventilation –> increase in PAO2 and PaO2
Hyperventilation –> decreased PACO2 and PaCO2 –> increase in blood pH (respiratory alkalosis) –> plasma bicarbonate levels decrease during first two days because the kidneys excrete excess HCO3 to compensate pH.
After the acid-base balance is corrected, hyperventilation persists during acclimatization. Within a week at high altitude, a new level for VE is attained – 40 to 100% above sea level values.

C. Sensory and Mental Function
Research studies have shown the following decrements in performance at altitude:
• At 3048 meters (10,000 ft.) – a 30% decrease in visual acuity, a 25% decrease in light sensitivity, and a 25% decrease in attention span.
• At 4500-5500 meters (14,800-18,000 ft.) – a 15-20% decrease in cognition and recall. A 25% decrease in pursuit tracking ability
• At 6100 meters (20,000 ft.) – a 25% decrease in reaction time.

D. Responses To Exercise
VO2 max. decreases 3 – 3.5% per 1000 ft. above 5000 ft. At 14,000 ft. VO2 max. is decreased approximately 30%. This is due to:
a) decreased oxygen content of arterial blood –> decreased a-vO2 difference in maximal exercise
b) after acclimatization – decrease in maximal cardiac output due to a decrease in maximum heart rate and stroke volume. The decrease in maximal stroke volume is most likely due to the reduction in venous return which is caused by the decreased blood volume – Starling mechanism
The percentage reduction in VO2 max. is equal in both trained and untrained individuals. Oxygen uptake is the same at altitude as at sea level for the same submaximal workload. However, heart rate and minute ventilation will be greater. During heavy exercise, muscle and blood lactate levels are higher at altitude for any given workload for two reasons:

a) Since the VO2 max. is reduced, any given workload now requires a higher percentage of the VO2 max. to perform.
b) There is a reduced blood buffering capacity due excretion of certain amount of bicarbonate via the kidneys. Higher level of perceived exertion for any workload.

E. Acclimatization Limits
The highest permanent settlement is located at 17,000 ft. in the Andes. It has generally been observed that acclimatization stops and physical condition & mental function begin to deteriorate at altitudes above 17,000 ft. (5200 meters).

F. Time Required for Acclimatization
The longer you stay at altitude, the better you perform in aerobic events but it never reaches sea level values. The number of days needed to acclimatize depends on the altitude:
9000 ft. –> 7 – 10 days
12,000 ft. –> 15 – 21 days
15,000 ft. –> 21 – 25 days
The length of time required depends to a large extent on the individual. A few people will never acclimatize and will continue to suffer mountain sickness. Acclimatization to one altitude ensures only partial acclimatization to a higher altitude. High altitude exposure for periods longer than two weeks results in a significant reduction is both body fat and lean body mass due mostly to appetite depression. The benefits of acclimatization are probably lost within 2 or 3 weeks after returning to sea level.

III. ALTITUDE TRAINING AND SEA LEVEL PERFORMANCE

A. Altitude Training

In order to attain top achievement at altitudes of 6500 feet or higher, endurance athletes should acclimatize for 2-3 weeks before their major competition. Non-endurance athletes may arrive close to the time of competition.
During the first few days at altitude, athletes may experience acute mountain sickness, which may hinder their training. Since VO2 max. is decreased at altitude, intensity of training must be decreased. However, this problem can be solved by living at altitude, but going down to lower altitudes for few hours per day to train – “sleep high, train low”. It is not necessary to train at a higher altitude than the actual place of competition. Some athletes consistently fail at altitude –> complicates team selection.

B. Performance After Return To Sea Level

It is clear that altitude acclimatization improves one’s capacity to work at altitude. Several studies have reported no increase in VO2 max. or performance in running events at seal level after several weeks of training at altitudes ranging from 7500 to 13,000ft. compared with pre-altitude performance. There is no consistent scientific evidence to support training at altitude to improve sea level performance.

Adaptations to altitude which should increase VO2 max. on return to sea level:
a) increased hemoglobin concentration
b) local muscle adaptations – increased number of mitochondria, oxidative enzymes, etc.

Adaptations which hinder performance on return to sea level:
a) decreased maximum stroke volume and maximum heart rate which persists for a few weeks
b) increased VE at a given workload –> extra oxygen goes to respiratory muscles during exercise
c) decreased buffering capacity of blood for lactic acid
d) specificity of training – while at altitude, the athlete isn’t able to train at close to sea level race pace. One must lower the absolute workload to perform aerobic exercise at the same relative intensity at altitude as at sea level.

C. Live High – Train Low Altitude Training

Athletes who use this method of training live and/or sleep at moderate altitude (6500-9000 feet), while going to a lower elevation (less than 4000 feet), in reasonable proximity, for a few hours daily to train. The purpose of this procedure is to get the beneficial physiological altitude adaptations, while maintaining sea level training intensity. This method of training results in better sea level performance than is obtained by living and training at altitude for a number of weeks and then returning to sea level to perform.

IV. ALTITUDE ILLNESSES

Altitude illnesses are on a continuum and are not separate illnesses. Most altitude illness is preventable. Proper management requires early diagnosis and prompt intervention.

A. Prevention of Altitude Illnesses
The following measures will reduce the incidence and severity of high altitude illness.
1. Staged ascent – slow ascent to altitude while climbing. Once travellers reach 8000 ft., they should not ascend more than 1000 to 2000 ft. per day.
– if possible, don’t fly or drive to high altitude. Start below 10,000 feet (3048 meters) and walk up. If you do fly or drive don’t over-exert yourself or move higher for the first 24 hours.
– acclimatize to lower altitudes before going to high altitudes
– “work high but sleep low”
– if you begin to show symptoms of moderate altitude illness, don’t go higher until symptoms decrease. Don’t go up until symptoms go down! If symptoms increase, go down, down, down!
– in the presence of extreme cold or heat, or severe exertion, it may be necessary to ascend even more slowly than the above recommendations.

2. Avoid alcohol and other depressant drugs including barbituates, tranquilizers and sleeping pills. These depressants further decrease the respiratory drive during sleep resulting in a worsening of the symptoms.

3. High carbohydrate diet – a diet of at least 70% carbohydrates reduces symptoms of acute mountain sickness by about 30% and can be started one to two days prior to ascent.

4. Appropriate exercise level – until acclimatized, it is best to exercise moderately, avoiding excessive breathlessness and fatigue.

5. Drug prophylaxis – there are several drugs that can lessen the symptoms of high altitude illness. However their use is not recommended as a routine measure. The drug of choice is acetazolamide (Diamox).

6. Fluid ingestion – drink lots of water (but not much alcohol), enough to produce a very diluted urine. Dehydration is a common cause of headache at altitude.

7. Keep in mind that different will acclimatize at different rates. Make sure that everyone in your party is properly acclimatized before going higher.

B. Acute Mountain Sickness

Most common form of altitude illness. It can occur at altitudes over 6500 ft., but more common over 10,000 ft.

AMS occurs 12 – 36 hours after arriving at altitude and usually lasts 2 to 3 days.

The occurrence of AMS is dependent on the elevation, the rate of ascent, and individual susceptibility. Many people will experience mild AMS during the acclimatization process. This condition is exacerbated by exercise during the first few hours of altitude exposure.
Symptoms – headache, fatigue, irritability, loss of appetite, nausea, vomiting, dizziness, insomnia, generalized weakness. The syndrome resembles an alcohol hangover.
Treatment – the only cure is either acclimatization or descent. Symptoms of mild AMS can be treated with pain medications for headache and Diamox. Moderate or severe AMS requires descent to lower altitudes.

C. High-Altitude Pulmonary Edema (HAPE)

Pulmonary edema – accumulation of fluid in the alveoli –> decreased diffusing capacity for oxygen
Occurs above 10,000 ft. and takes 36 – 72 hrs. to become obvious. It can strike individuals of any age, particularly those who ascend rapidly. The occurence rate is 1% to 2% of trekkers at altitudes over 10,000 ft. Risk factors for HAPE include the altitude above sea level, the rate of ascent to that altitude, and individual susceptibility. The direct effect of hypoxia on systemic arterioles is vasodilation. In contrast, hypoxia in the
lung causes vasoconstriction –> increased pulmonary vascular resistance –> right ventricle must generate a higher pressure –> pulmonary hypertension –> greatly elevated pulmonary capillary pressure –> movement of fluid from the circulatory system to the pulmonary interstitial spaces and alveoli.

Symptoms – shortness of breath, severe fatigue, cough which sometimes produces a frothy and/or bloody sputum, tachycardia, severe headache, insomnia, chest tightness or congestion, blue or gray fingernails or lips, often a slight fever; may rapidly go on to unconsciousness and death. The symptoms often begin at night when shortness of breath at rest may occur.

The hypoventilation and associated hypoxemia that occur during sleep may further predispose persons to HAPE –> avoid sleeping medications, alcohol, and sedatives that further depress ventilation.

Treatment – descend to lower altitude immediately with or without oxygen
– diuretics are quite effective if and only if fluids are replaced as rapidly as they are excreted.
– Diamox is effective for prevention and treatment
– Dexamethasone will improve symptoms

D. High-Altitude Cerebral Edema (HACE)

Accumulation of excess fluid in the brain

Rare below 12,000 ft.

Symptoms – loss of coordination, confusion, hallucinations, severe headache, severe weakness and fatigue, coma
Treatment – same as for HAPE
Treatment of altitude illness is based on four principles:

(1) stop ascent in presence ofsymptoms;

(2) descend if no improvement or if condition worsens;

(3) descend immediately if HAPE, loss of coordination, or changes in consciousness are present;

(4) ill persons must not be left behind alone or sent down alone.

E. Other Medical Problems at Altitude

Retinal hemorrhage – occurs in 50% of people going above 17,500 ft. – reversible after return to sea level. However, irreversible visual defects can occur.
Low temperatures –> hypothermia, frostbite; Sunburn

The material posted in this blog on first aid and medical conditions in levels of high altitude is for information purposes only. To learn to recognize and treat major first aid emergencies take a first aid course near you. Certifications can last as long as 3 years and successful candidates receive certification cards upon completion of the course.

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