Has the AHA made itself irrelevant to EMS?

[Veneficus]

All of the old timers I know like to complain/reminisce when an ACLS card really meant you knew what your were talking about before this idea of creating a curriculum to the lowest common denominator to serve as resuscitation training they might remember in a stressful situation.

I have noticed teaching over the years that participants often see the initial part of an algorythm as the definitive treatment for respective conditions and if it doesn't work, nothing is going to.

I have taught AHA classes so long I can sum up ACLS in 286 words. (my last attempt, but I will beat it I'm sure)

If you are not an instructor and have seen the pathetic excuse for the video training they put out that could have been done better by a highschool A/V group you might also join those old timers in complaining a little.

Making people who deal regularly with resuscitation sit through that crap every 2 years could probably be considered a crime against humanity.

Aside from hearing what the latest craze endorsed by the AHA is, nothing is really taught that is usable by resuscitation experts that for the most part hasn't been near standard or obsolete for some time.

Afterall, Even some parts of Canada I hear removed epi from the arrest algorythm in 2008.

Now anyone who knows anything about resuscitation knows that the key to it is finding whatever insult caused the body to fail in compensating and correct it with a specific treatment. (AHA likes to call it Hs&Ts or reversible causes)

Those insults have specific treatments. Ranging from what is in the ACLS guidlines to some very extreme surgical efforts.

EMS providers have even tried to extrapolate guidlines designed for medical pathologies to trauma patients. (even though the very AHA statement on its website says it is unlikely to work) A bunch of medical directors for EMS even enshrine these ideas in protocol. (seems sort of lazy to me signing a protocol for a recommendation that self describes as not really applicable or likely to work)

So is something new and better needed for resuscitation experts, both in hospital and out?

What topics should it include?

Should it be video driven or guided by expert instructors like every other area of healthcare?

Should it require a practical component?

Who should it be endorsed by?

Should it be required instead or in addition to AHA classes?

In PALS, rather than limit to cardiac pathologies, the course focuses on common emergencies.

Should there be an adult version of this to completely replace ACLS?

I have even been told by PALS students that the class was more useful for adults than ACLS.

Should this "new curriculum" include all common emergencies? Some? (which ones) or just cardiac?

What do you think?

 

[NYMedic828]

AHA is out of their mind.

I recently decided to get certified as a BLS instructor for AHA. I had no idea that they expect you to actually spend 4 hours teaching CPR, with nothing but their video.

I have only taught one class since being certified, but I only ran the video to show proper technique a couple of times and crack a few jokes to keep people awake.

There is honestly so much more that could learned in 4 hours, explaining to laypersons why certain things are or aren't done and whatnot vs showing someone how to place their hands and count to thirty literally 8 times over in the most bland manor possible

I took ACLS about a year ago now, and the only thing I learned from it was how to be a robot and run the same megacode over and over.

I did not learn anything about pathophsyiology or any innovations in the field of resuscitation. It was honestly disappointing. Thank god my employer pays for it.

I am truly convinced that AHA is just a big scam. They do everything for profit starting with the fact that they are a required certification to work in a vast majority of places. The fact that they endorse what they claim is "heart healthy" foods with their logo is an even bigger joke.

 

[Farmer2DO]

All of the old timers I know like to complain/reminisce when an ACLS card really meant you knew what your were talking about before this idea of creating a curriculum to the lowest common denominator to serve as resuscitation training they might remember in a stressful situation.

I have noticed teaching over the years that participants often see the initial part of an algorythm as the definitive treatment for respective conditions and if it doesn't work, nothing is going to.

I have taught AHA classes so long I can sum up ACLS in 286 words. (my last attempt, but I will beat it I'm sure)

If you are not an instructor and have seen the pathetic excuse for the video training they put out that could have been done better by a highschool A/V group you might also join those old timers in complaining a little.

Making people who deal regularly with resuscitation sit through that crap every 2 years could probably be considered a crime against humanity.

Aside from hearing what the latest craze endorsed by the AHA is, nothing is really taught that is usable by resuscitation experts that for the most part hasn't been near standard or obsolete for some time.

Afterall, Even some parts of Canada I hear removed epi from the arrest algorythm in 2008.

Now anyone who knows anything about resuscitation knows that the key to it is finding whatever insult caused the body to fail in compensating and correct it with a specific treatment. (AHA likes to call it Hs&Ts or reversible causes)

Those insults have specific treatments. Ranging from what is in the ACLS guidlines to some very extreme surgical efforts.

EMS providers have even tried to extrapolate guidlines designed for medical pathologies to trauma patients. (even though the very AHA statement on its website says it is unlikely to work) A bunch of medical directors for EMS even enshrine these ideas in protocol. (seems sort of lazy to me signing a protocol for a recommendation that self describes as not really applicable or likely to work)

So is something new and better needed for resuscitation experts, both in hospital and out?

What topics should it include?

Should it be video driven or guided by expert instructors like every other area of healthcare?

Should it require a practical component?

Who should it be endorsed by?

Should it be required instead or in addition to AHA classes?

In PALS, rather than limit to cardiac pathologies, the course focuses on common emergencies.

Should there be an adult version of this to completely replace ACLS?

I have even been told by PALS students that the class was more useful for adults than ACLS.

Should this "new curriculum" include all common emergencies? Some? (which ones) or just cardiac?

What do you think?

Excellent post. Definately agree.

I also was taught ACLS in the era that required real mastery of the content to get a card.

I think that having some basic class to standardize the response to cardiac arrest (and other cardiac emergencies) is a good idea. But there also needs to be a class where you REALLY need to know your $hit; the way ACLS used to be, for people like paramedics, physicians, many mid-levels and some nurses (depending on what area of medicine they practice). For God's sake, basic EMTs at my company are allowed to take the class if there is room, and have no problem passing it.

 

[Veneficus]

Excellent post. Definately agree.

I also was taught ACLS in the era that required real mastery of the content to get a card.

I think that having some basic class to standardize the response to cardiac arrest (and other cardiac emergencies) is a good idea. But there also needs to be a class where you REALLY need to know your $hit; the way ACLS used to be, for people like paramedics, physicians, many mid-levels and some nurses (depending on what area of medicine they practice). For God's sake, basic EMTs at my company are allowed to take the class if there is room, and have no problem passing it.

So what are your ideas to fix it?

 

[Farmer2DO]

So what are your ideas to fix it?

Have everyone get together and refuse to pay huge sums of money to AHA for a cookie cutter class that really isn't appropriate to teach to everyone? I mean, someone else could start a class that was appropriate for providers that make decisions, but with AHA there, I'm guessing that few would use it. Until people and organizations band together and demand something else, probably all they'll get is lip service from AHA. I mean, they've rather entrenched themselves as the only ones that offer the widely recognized, standarized class.

I've heard of an ACLS class for experienced providers. Anyone taken it?

 

[Veneficus]

Have everyone get together and refuse to pay huge sums of money to AHA for a cookie cutter class that really isn't appropriate to teach to everyone? I mean, someone else could start a class that was appropriate for providers that make decisions, but with AHA there, I'm guessing that few would use it. Until people and organizations band together and demand something else, probably all they'll get is lip service from AHA. I mean, they've rather entrenched themselves as the only ones that offer the widely recognized, standarized class.

I've heard of an ACLS class for experienced providers. Anyone taken it?

Taught it.

It is definately a better option for expert providers, but it doesn't work so well with mixed levels.

It definately requires eager participants who are willing to listen and participate in discussion.

The paramedics find it largely unsuited to prehospital as decision making is limited, so the ability to make use of the level of information does not exist.

It seems most suitable to nursing.

The specialist physicians we had seemed more interested than in the standard class, but still not happy to be there.

I cannot get the senior physicians to come to any of them.

 

[Farmer2DO]

Perhaps classes targeted to each group of providers would be best.

- A class for physicians and mid-levels that supervise resuscitation in hospital.

- A class for nurses that work in the hot zones: ICU, ED, PACU.

- A class for floor (and other non-critical areas) nurses.

- A class for paramedics.

- A class for anyone else that might be involved in resuscitation: non-paramedic EMS, PCT, LPN, CNA etc.

Having a cookie cutter class just isn't appropriate, but is a huge money maker.

 

[MS Medic]

Perhaps classes targeted to each group of providers would be best.

- A class for physicians and mid-levels that supervise resuscitation in hospital.

- A class for nurses that work in the hot zones: ICU, ED, PACU.

- A class for floor (and other non-critical areas) nurses.

- A class for paramedics.

- A class for anyone else that might be involved in resuscitation: non-paramedic EMS, PCT, LPN, CNA etc.

Having a cookie cutter class just isn't appropriate, but is a huge money maker.

I think this is probably the best idea. On a side note, does anyone know if writers of the AHA guildlines are actual practicing providers or are they research only.

 

[Veneficus]

I think this is probably the best idea. On a side note, does anyone know if writers of the AHA guildlines are actual practicing providers or are they research only.

Both

 

[MS Medic]

Well then, strictly looking at this from a prehospital perspective, I would say start with actual observation of codes worked in the field. I think this would need to include large urban areas with good response systems that work in an ideal text book way, urban areas where there is fire response but it just as likely as not have well intentioned but inadequately trained first responders, and rural areas where the only responders are likely to be the two people on the ambulance.
From there, the dynamics of working a code in these conditions needs to be examined and an appropriate ACLS program created.

 

[Veneficus]

Well then, strictly looking at this from a prehospital perspective, I would say start with actual observation of codes worked in the field. I think this would need to include large urban areas with good response systems that work in an ideal text book way, urban areas where there is fire response but it just as likely as not have well intentioned but inadequately trained first responders, and rural areas where the only responders are likely to be the two people on the ambulance.
From there, the dynamics of working a code in these conditions needs to be examined and an appropriate ACLS program created.

In theory, the individual provider is supposed to tailor the recommendations to their environment.

However, the class is geared towards strict adherence to the algorithm, which is drilling that it is the only right answer and without deviation.

I think the easy solution for field providers is for local medical direction to tailor guidlines in the form of protocols to the area served. The trouble is they don't.

 

[Arovetli]

One of my favorite parts of ACLS is how there exists the great fairy godmother who drops experienced providers from the sky so that you have plenty of people to rotate through CPR and sit there with a pen and paper and jot down times.

In the prehospital setting I find myself feeling extraordinarily lucky if I have at least one other person there who knows what the heck is going on and what to do about it.

 

[Veneficus]

One of my favorite parts of ACLS is how there exists the great fairy godmother who drops experienced providers from the sky so that you have plenty of people to rotate through CPR and sit there with a pen and paper and jot down times.

In the prehospital setting I find myself feeling extraordinarily lucky if I have at least one other person there who knows what the heck is going on and what to do about it.

That is why it is so important to be able to perform EJs, so you can go to the head, slap on the monitor, start the iv, tube the patient, and make everyone else do CPR while you don't move.

(I am an operations kind of guy can you tell?)

 

[WTEngel]

The real tragedy is the instructors in my opinion.

There are not very many instructors who do the job they should. Frankly, all the AHA requires to be an instructor is a commitment from that person that they will follow the material. They do not need to know anything at all about what they are saying...which is sad.

I have had to correct more previous instructor errors committed by the students than I could possibly count. Instructors cut corners, skimp on the material that is ALREADY bare bones, and then do a crap job of teaching what little material is left at the end of their instructor slaughter fest.

An excellent instructor (which I am fairly sure you are Vene) can fairly easily take the AHA material, present it in a way that is appropriate, and give the students a really great, relevant course.

I don't agree with everything AHA says either, and to be honest, some of their science is debatable, but using a bit of Socratic questioning and having a solid foundation of knowledge in order to be able to get your students to think outside of the box goes a long way.

I have enjoyed the last revision of ACLS to be honest. The videos are better than they used to be (still not great, but they never will be.)

If you really want to know where I think AHA missed the mark, it is PALS. The PALS material is horrible in my opinion.

 

[MS Medic]

In theory, the individual provider is supposed to tailor the recommendations to their environment.

However, the class is geared towards strict adherence to the algorithm, which is drilling that it is the only right answer and without deviation.

I think the easy solution for field providers is for local medical direction to tailor guidlines in the form of protocols to the area served. The trouble is they don't.

Your right but looking around my little fish bowl, it is A LOT more likely that AHA would retool the program than a medical director strike out on their own.

 

[MS Medic]

That is why it is so important to be able to perform EJs, so you can go to the head, slap on the monitor, start the iv, tube the patient, and make everyone else do CPR while you don't move.

(I am an operations kind of guy can you tell?)

I say pop an IO and roll.

 

[Arovetli]

I did the new online thing for my last ACLS. It was...interesting...

I lounged around on my couch one night and knocked it out, much better from the standpoint of getting it over with...much worse from the standpoint of education.

 

[usalsfyre]

Well then, strictly looking at this from a prehospital perspective, I would say start with actual observation of codes worked in the field. I think this would need to include large urban areas with good response systems that work in an ideal text book way, urban areas where there is fire response but it just as likely as not have well intentioned but inadequately trained first responders, and rural areas where the only responders are likely to be the two people on the ambulance.
From there, the dynamics of working a code in these conditions needs to be examined and an appropriate ACLS program created.

The dynamics of a code in these conditions should be simple. Response time over 5min=don't

 

[WTEngel]

Did the evaluator who did your skills check off actually do a sound job of running you through the mega code?

I am not totally against the online "HeartCode" version, but I think the students who use this method should be from a certain subset...

People who work in an ED, ICU, CCU, critical care environment, EMS, etc are usually fine doing online, because they are typically pretty sharp on this. The folks I have seen who have trouble are the floor staff, non critical care staff, and 20 year staff who have "taken ACLS 100 times before..."

I also think that any time there is a science update, they should suspend online courses for at least one year. It is important for people to go to a live course when a curriculum change has been made.

 

[Arovetli]

Did the evaluator who did your skills check off actually do a sound job of running you through the mega code?

Evaluator was a close friend....so um no...

But I agree with you, most codes are straightforward and no matter how many years you have been doing it you will find your skills in sharp decline when you get that one random (and actually fun) code that flipflops all over the place with/without pulses. Plus I don't think the online version made mention about the removal of atropine, but I didn't pay much attention to it. I pretty much watched tv, drank whiskey, and pushed random buttons until it let me pass.