European Resuscitation Council Guidelines for Resuscitation 2010 ...
European Resuscitation Council Guidelines for Resuscitation 2010 ...
European Resuscitation Council Guidelines for Resuscitation 2010 ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
J. Soar et al. / <strong>Resuscitation</strong> 81 (<strong>2010</strong>) 1434–1444 1439<br />
Course <strong>for</strong>mat<br />
The ILS course is delivered over one day and comprises lectures,<br />
hands-on skills teaching and cardiac arrest simulation teaching<br />
(CASTeach) using manikins. The programme includes several<br />
options that enable instructors to tailor the course to their candidate<br />
group. The ILS course is designed to be straight<strong>for</strong>ward to run.<br />
Most courses are conducted in hospitals with small groups of candidates<br />
(average 12 candidates). Course centres should try as far as<br />
possible to train candidates to use the equipment (e.g., defibrillator<br />
type) that is available locally.<br />
Course content<br />
The course covers those skills that are most likely to result in<br />
successful resuscitation: causes and prevention of cardiac arrest<br />
including use of the ABCDE approach, starting CPR, basic airway<br />
skills and defibrillation (AED or manual). The course includes an<br />
optional session on issues relevant to the candidate group (e.g.,<br />
anaphylaxis, equipment checks). Once all the skills have been covered<br />
there is a cardiac arrest demonstration by the instructors<br />
that outlines the first responder role to the candidates. This is<br />
followed by the CASTeach station where candidates practice. ILS<br />
candidates are not usually expected to undertake the role of team<br />
leader. Candidates should be able to start a resuscitation attempt<br />
and continue until more experienced help arrives. When appropriate,<br />
the instructor takes over as resuscitation team leader. This<br />
is not always necessary because in some simulations resuscitation<br />
may be successful be<strong>for</strong>e more experienced help arrives. Standardised<br />
simulations are used that can be adapted to the workplace and<br />
clinical role of the candidate.<br />
Assessment<br />
Candidates are assessed continuously and must show their competence<br />
throughout the ILS course. There are no <strong>for</strong>mal testing<br />
stations at the end of the course. Candidates are sent assessment<br />
<strong>for</strong>ms with the pre-course materials. The <strong>for</strong>ms indicate clearly how<br />
their per<strong>for</strong>mance will be measured against pre-determined criteria.<br />
Assessment on the ILS course enables the candidate to see<br />
what is expected, and frame their learning around achievement<br />
of these outcomes. The following practical skills are assessed on<br />
the ILS course: airway management, CPR and defibrillation. With a<br />
supportive approach, most candidates achieve the course learning<br />
outcomes.<br />
The Advanced Life Support (ALS) Course<br />
The target candidates <strong>for</strong> this course are doctors and senior<br />
nurses working in acute areas of the hospital and those who may be<br />
resuscitation team leaders and members. 212,213 The course is also<br />
suitable <strong>for</strong> senior paramedics and some hospital technicians. The<br />
ILS course is more suitable <strong>for</strong> first responder nurses, doctors who<br />
rarely encounter cardiac arrest in their practice, and emergency<br />
medical technicians.<br />
Each instructor acts as a mentor <strong>for</strong> a small group of candidates.<br />
The course normally lasts <strong>for</strong> 2 or 2.5 days.<br />
Course <strong>for</strong>mat<br />
The course <strong>for</strong>mat has very few <strong>for</strong>mal lectures and teaching<br />
concentrates on hands-on skills, clinically-based simulations in<br />
small groups with emphasis on the team leader approach, and<br />
interactive group discussions. A <strong>for</strong>mal mentor/mentee session is<br />
included to enable candidates to give and receive feedback.<br />
Course content<br />
The course content is based on the current ERC <strong>Guidelines</strong> <strong>for</strong><br />
<strong>Resuscitation</strong>. Candidates are expected to have studied the ALS<br />
course materials carefully be<strong>for</strong>e the course.<br />
The course aims to train candidates to highlight the causes of<br />
cardiac arrest and identify sick patients in danger of deterioration<br />
and to manage cardiac arrest and the immediate peri-arrest problems<br />
encountered in and around the first hour or so of the event.<br />
It is not a course in advanced intensive care or cardiology. Competence<br />
in basic life support is expected be<strong>for</strong>e the candidate enrols<br />
<strong>for</strong> the course.<br />
Emphasis is placed on the techniques of safe defibrillation and<br />
ECG interpretation, the management of the airway and ventilation,<br />
the management of peri-arrest rhythms, simple acid-base<br />
balance, and of special circumstances relating to cardiac arrest.<br />
Post-resuscitation care, ethical aspects related to resuscitation and<br />
care of the bereaved are included in the course.<br />
Assessment and testing<br />
Each candidate is assessed continuously during the course and<br />
reviewed at the end of each day at a faculty meeting. Feedback<br />
is given as required. Candidates are expected to be able to use<br />
the ABCDE approach to assess and treat the sick patient, recognise<br />
cardiac arrest, provide good quality CPR and safe defibrillation<br />
throughout the course. There is a cardiac arrest simulation testing<br />
(CASTest) towards the end of the course. This tests the participant’s<br />
applied knowledge and skills during a simulated cardiac arrest.<br />
The reliability and measurement properties of the CASTest have<br />
been reported. 169,214,215 A multiple choice question (MCQ) paper<br />
taken at the end of the course tests core knowledge. Candidates are<br />
required to achieve 75% to pass this test. The measurement properties<br />
of the multiple choice papers have been assessed from over<br />
8000 candidates and found to have high internal consistency and<br />
discrimination properties (Data from <strong>Resuscitation</strong> <strong>Council</strong> (UK)<br />
and Dr Carl Gwinnutt).<br />
The <strong>European</strong> Paediatric Life Support (EPLS) Course<br />
The EPLS course is designed <strong>for</strong> healthcare workers who are<br />
involved in the resuscitation of a newborn, an infant or a child<br />
whether in or out-of-hospital. The course aims at providing caregivers<br />
with knowledge and skills <strong>for</strong> the management of the<br />
critically ill child during the first hour of illness and to prevent<br />
progression of diseases to cardiac arrest.<br />
EPLS is not a course in neonatal or paediatric intensive care<br />
aimed <strong>for</strong> advanced providers.<br />
Competence in paediatric basic life support is a prerequisite<br />
although refresher teaching in basic life support and relief of <strong>for</strong>eign<br />
body airway obstruction is included. The EPLS course is suitable<br />
<strong>for</strong> doctors, nurses, emergency medical technicians, paramedics etc<br />
who have a duty to respond to sick newborns, infants and children<br />
in their practice. 216,217<br />
Experience in paediatrics is necessary to keep simulations realistic<br />
and answer to candidates’ questions so a minimum of 50% of<br />
the faculty must have regular experience in neonatal or paediatric<br />
practice. The course lasts <strong>for</strong> 2–2.5 days.<br />
Course <strong>for</strong>mat<br />
The course <strong>for</strong>mat has few <strong>for</strong>mal lectures. Teaching of knowledge<br />
and skills is delivered in small groups using clinically<br />
based simulations (e.g., cardiac arrest, cardiac and respiratory failure,<br />
delivery room simulations). The emphasis is on assessment