# BAD ACLS Instructor??



## pinetree (Sep 25, 2007)

I've never had a course so poorly taught, and so poorly tested.  Please advise if this is how ACLS is currently taught.  This is a letter I sent to the facility director:

Dear J.......,

From advisement of the ECC, I would like your feedback
on the ACLS class offered last Saturday.  As you are
the program director, I am to bring it to your
attention first.  I believe the instructor for the
course was Jason, who might be related to yourself.  

In my opinion, the course was grossly deficient and
not up to AHA standard in the following manners:

1. Megacode testing was not carried out individually. 
Each individual student must be tested on 2 rhythms in
addition to VF/Vtach and PEA.  Instead, the students
were tested as a group, and were allowed to use their
cards and notes.

2. Written examination was to be close book.  Instead,
open book, open note, and open discussion was allowed,
and encourage.  Multiple individuals loudly
communicated with each other on the answers to
difficult problems.  Needless to say, every one
passed.

3. The course was truncated from 4 hours to 2, at the
expense of NO INDIVIDUAL megacode testing.  The group
was tested together as a group, and we discussed the
procedures and methods of running the code during the
testing.  AHA standard require individual testing with
no coaching, no prompting, and no discussion.

4. Individual's previous ACLS cards were not check to
assure that they are current, and are qualified to
take the recertification course.

5. One individual, who arrived 1 hour late, attended
only about 10 minutes of the discussion, was allowed
to complete the course, and was told "go read the
book".  This is contrary to AHA standard that all
individuals must attend the entire training program to
pass the course.

6. Individual skill testing for BLS skill, and
individual written testing for BLS were not carried
out.  Individuals who desired the BLS card simply had
to pay a fee for their card.  This is done inspite of
significant change in the BLS instruction since 2005.

7. The instructor knowingly passed students who many
by their own admission, have never studied the new
guidelines, and one did not even have her book removed
from the cellophane wrapper.

Based on what I have observed in this class, and
comparing to the many ACLS, BLS, and ATLS courses I
have taken since 1989 - this program was completely
sub-par by any testing organizations' standard. 
Individuals who passed and received their ACLS and BLS
certification can not be assured of competency based
on the teaching and testing protocol of this class.

As there might be conflict of interest in the facility
director, and the instructor in this case, I would
like a feedback from your organization on this matter
within 1 week before advancing the concerns to ECC.

Thank you,


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## BossyCow (Sep 25, 2007)

All I can say is ... Wow!


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## reaper (Sep 25, 2007)

ACLS is a joke now. Instructors are not required to have megacodes and there is no failing the course. As long as you sit through the class, you get a card.
They need to go back to the old days where it was pass or fail!!


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## pinetree (Sep 25, 2007)

The sad part is, the class really didn't exist.  We barely touched the tip of the iceberg in the changes since 2005.


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## bstone (Sep 25, 2007)

pinetree said:


> The sad part is, the class really didn't exist.  We barely touched the tip of the iceberg in the changes since 2005.



So, wait...did the class actually happen? Confused.


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## DT4EMS (Sep 25, 2007)

pinetree said:


> 1. Megacode testing was not carried out individually.
> Each individual student must be tested on 2 rhythms in
> addition to VF/Vtach and PEA.  Instead, the students
> were tested as a group, and were allowed to use their
> ...



I put little ** where I made my responses during your post.

Man, no wonder why people are giving ACLS a bad rap lately. I have nothing but hundreds of positive evals from ACLS and PALS classes here. We have had great success with the new guidelines.

I have had ACLS since 1991. I happen to like the way it is taught now. People actually get it. Sorry you had such a crappy deal. Come see us! We have a blast but work hard too!

Kip


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## pinetree (Sep 25, 2007)

The class didn't really happened, as it was simply a group discussion of 6 cases on a two sheet (4 page) of 6 rhythm that was handed out to each student.  

No overhead projection, no kodachrome, no going through the guidelines.  We simply discussed 6 cases, then go to the "group" megacode testing.  I can't call it a class.  It was a one hour group discussion of 6 cases using our little cards.


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## Ridryder911 (Sep 25, 2007)

As one of the first non-physician ACLS instructors; I can attest the now course outline is a joke and there is no longer any credibility in having it. I look for the NREMT to remove it from re-registration requirements soon. 

Clarity, first NO one is certified in ACLS per AHA. It is * only* an educational course, describing you have successfully attended and completed their recommended standards. * THAT'S IT! * 

It is up to the Instructors discretion on how to conduct the course. It is highly recommended to follow their guidelines and suggestions as set forth from the ACLS Task Committee. For as passing the test or not.. who cares? One can re-test after counseling.. so take it & pass somehow. 

Megacode testing is no longer evaluating your knowledge and emphasis on per say of cardiac arrest, rather as much as performance as a team leader. Prompts are suggested and can be used, in fact encouraged especially for hospital providers to prevent medication errors. 


Pretest is nice. I recommended it since it much harder than the current written forms. However; it again is suggested. 

Because of poor course, the availability to recert on line, computer base testing with no skills (except team leader) has led this once accountable course to be nothing and a waste of time. I teach it because we are required to have it... and that's it! 

I now see that AHA has invented an "advanced airway" class (that used to be in ACLS) for an optional fee of course $$$$. What is next and IV course, arrhythmia course, defib course... think of the possibility $$$$

R/r 911


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## pinetree (Sep 25, 2007)

Actually, I like the 2005 protocols.  I like the format of the book, and the comments on effectiveness of the meds that we once memorized so faithfully.

The pretest was good, and I learned so much from zipping through it till I exhausted all the questions it had.  The supplemental information was good reading, once you printed it out, about 100 pages.

I think the 2005 book is a big improvement over the last one.   Too bad, comments I've gleaned from 2 physician sites similarly commented about the deterioration of ACLS and ATLS programs alike.


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## Arkymedic (Sep 26, 2007)

DT4EMS said:


> I put little ** where I made my responses during your post.
> 
> Man, no wonder why people are giving ACLS a bad rap lately. I have nothing but hundreds of positive evals from ACLS and PALS classes here. We have had great success with the new guidelines.
> 
> ...



Hey Kip you working at TCAD?


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## DT4EMS (Sep 26, 2007)

Arkymedic said:


> Hey Kip you working at TCAD?



Nope. Richard Cotter is the EMS educator there. I am the EMS Educator at Ozarks Medical Center in West Plains 

I run at least 2 PALS and ACLS refreshers a month and an Initial of each every other month. If I ran a class like what was described earlier in this thread I would be out of a job.

We are really strict with ours and follow the AHA guidelines and have great results.

I am lucky though. I have some great instructors to work with including on of the best respiratory/airway guys in the country. He is a respiratory therapist who loves sharing with EMS. For every Medic refresher he brings in pig lungs and vents. 

You can't imagine 300,000,000 alveoli until you "see" 300,000,000 alveoli


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## Arkymedic (Sep 26, 2007)

DT4EMS said:


> Nope. Richard Cotter is the EMS educator there. I am the EMS Educator at Ozarks Medical Center in West Plains
> 
> I run at least 2 PALS and ACLS refreshers a month and an Initial of each every other month. If I ran a class like what was described earlier in this thread I would be out of a job.
> 
> ...



I still thought he was but was just curious since I know you do a lot of dt classes in that part of SW MO.


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## disassociative (Sep 26, 2007)

Oh, it gets even better. 

In alot of the ACLS courses around my area--the ACLS card does not reflect the ability of the provider, rather it merely reflects that they have attended the class.


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## pinetree (Sep 26, 2007)

I took the eACLS just to be different 2 years ago, didn't quite like it, as it might not be as vigorously proctored as I would like.  But the megacode still had to be done in person to get the eACLS card - which, depending on your testing center, can be very vigorous.

Based on what I've read here and elsewhere, ACLS instructors are not following the AHA's guideline on testing.  OR that it is the fault of AHA not to make the guideline clear enough on the requirement of testing.

The ECC folks read me the testing standard, and it seems quite clear that Megacode testing is still required.  They probably need to make it much more clear on how individuals should be tested.

I agree, a certificate is not an indication of competency, but neither is an MD, DO, DDS, or any other certifications..  But a minimum standard must be made at the point of certification to assure that the instruction is adequate, and that the student preparation is adequate.


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## disassociative (Sep 26, 2007)

Yes, I agree. Insructors like the ones mentioned above; not following the proper guidelines, are going to slowly but surely detriment the certification process. I think ACLS should be tested at Pearson Vue centers just like the NREMT, in a controlled environment. This information is critical, and it can mean the difference between life and death in some situations.


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## pinetree (Sep 26, 2007)

An example of what I've seen in both a recent BLS class I took, and this pseudo-ACLS class is that not enough emphasis is made on the use of AED's in this transition.

As many AED's in the public are pre-2005 protocols (made before DEC 2006), we will encounter many AED's that will direct the rescuer on the old method.

I believe the current guideline is that for all rescuer to follow the prompts of their AED and follow the format of the AED irregardless of your current BLS/ACLS training.

That means, you can't do CPR immediately after defibrillation if your AED if made in the pre-2005 AHA protocols.  Which might mean up to 1/2 of the AEDs found in the community.

This point was not emphasized in my ACLS nor my BLS class.


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## DT4EMS (Sep 27, 2007)

pinetree said:


> An example of what I've seen in both a recent BLS class I took, and this pseudo-ACLS class is that not enough emphasis is made on the use of AED's in this transition.
> 
> As many AED's in the public are pre-2005 protocols (made before DEC 2006), we will encounter many AED's that will direct the rescuer on the old method.
> 
> ...



You are correct. The main reason we found behind that practice is under stress people would forget to turn the AED back on. Plus it takes a lot of time (increases hands-off time). 

I am glad you take enough pride to want to do it right. I get sick of earing people whine becuase we expect them to do it right. Like I said............ no pre-test.......... you can't stay here.

In our medic refreshers I caught flack for making them pick up a packet and complete about 70 pages of homework prior to the start of the refresher.

After the first one, most quit griping. It made the class easier for everyone.


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## pinetree (Oct 2, 2007)

Here is the facility's response, essentially saying that the AHA is blessing their new method of teaching,  VERY SAD :sad:

Dear D,

I want to thank you for bringing this issue to my attention and allowing me to respond to each of your concerns. 

It is the policy of Life Support Services, Inc. to provide a high quality educational program, consistent with the guidelines of the American Heart Association. When an issue is identified either through the instructor monitoring the program evaluations, or through an email such as yours, it is the policy of Life Support Services, Inc. to take corrective action. 

The instructor for this class has been reprimanded and is being reeducated to the AHA testing and evaluation guidelines. His future classes will be monitored closely for adherence to both AHA guidelines and the educational policies and procedures of Life Support Services, Inc. 

You had also brought to my attention that the cards were issued with the wrong instructor name on them. This was a clerical error, and new cards with the correct instructor name are being sent to the individual students. 

As per your email regarding the class, we can offer a response by referencing the American Heart Association’s Advanced Cardiovascular Life Support Instructor Manual, dated 2006. 

1.	“Megacode testing was not carried out individually. Each individual student must be tested on 2 rhythms in addition to VF/V-tach and PEA. Instead, the students were tested as a group, and were allowed to use their cards and notes.”
a.	Pages 41-42
i.	Students are to be tested in groups, and demonstrate competency as the team leader in a cardiac arrest situation.
b.	Page 10
i.	The Handbook of Emergency Cardiovascular Care may be used during all learning stations and at the Megacode testing station within limits. 
2.	“Written examination was to be close book. Instead, open book, open note, and open discussion were allowed, and encouraged. Multiple individuals loudly communicated with each other on the answers to difficult problems. Needless to say, everyone passed.”
a.	Page 29
i.	There are to be no resources used, and any displayed algorithms are to be covered up. The students are not allowed to cooperate with each other. The instructor has been reprimanded.
3.	“The course was truncated from 4 hours to 2, at the expense of NO INDIVIDUAL Megacode testing. The group was tested together as a group, and we discussed the procedures and methods of running the code during the testing. The AHA standard requires individual testing with no coaching, no prompting, and no discussion.”
a.	Page 42
i.	The student is allowed to rely on his/her team for help, but not to over rely or manage most/all of the case
ii.	Students should play roles during the test.
b.	Page 10
i.	The Handbook of Emergency Cardiovascular Care may be used during all learning stations and at the Megacode testing station within limits. 
4.	“Individual’s previous ACLS cards were not checked to assure that they are current, and are qualified to take the recertification course.” 
a.	Page 8
i.	The “what to bring and what” to wear section simply states to bring the ACLS manual to class. Students are able to use the Handbook of Emergency Cardiovascular Care for Healthcare Providers (which is optional to bring to class) and are also able to use it as a reference guide at some of the stations.
ii.	The AHA does not require students to bring their current ACLS card with them to class.
5.	“One individual, who arrived 1 hour late, attended only about 10 minutes of the discussion, was allowed to complete the course, and was told “go read the book”. This is contrary to AHA standard that all individuals must attend the entire training program to pass the course.”
a.	While it is the intent that students attend every minute of the course, I would hate to think that the door should be closed once the instructor starts talking. 
i.	Tardy students should be proficient in the knowledge and skills necessary to pass the ACLS course before the exam is taken.
6.	“Individual skill testing for BLS skill and individual written testing for BLS were not carried out. Individuals who desired the BLS card simply had to pay a fee for their card. This is done in spite of significant change in the BLS instruction since 2005.”
a.	The 2005 changes necessary for BLS competency were covered in the lecture. 
b.	BLS hands-on was evaluated for competency during ACLS scenarios.
c.	Each of the students will be given a BLS written test at their convenience. Life Support Services, Inc. will be contacting each of the individuals in need of the written exam to set this up. The cards have been recalled, and will not be re-issued until the process is completed. 
7.	“The instructor knowingly passed students who many by their own admission, have never studied the new guidelines, and one did not even have her book removed from the cellophane wrapper.”
a.	The students were passed because they demonstrated the knowledge and skills which are required to pass the class. 
b.	It is necessary to be familiar with the information in the book. It is understood that this is a renewal course, so the students in the class, in fact, already have an understanding of the materials. The instructor does go over the materials, and any questions may be asked during/after the lecture, so long as it is not during the skills testing. 



Respectfully,



R.
President, Lif Services, Inc.








 CC: J, CEO


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## crash_cart (Oct 2, 2007)

Is the lack of seriousness regarding this training a reflection of the possibility that if it isn't watered down, that no one would take those courses?  I've run across some documents online about training requirements being a reason why many choose to leave EMS, especially in my state.  

Not saying it's right or wrong, just wondering why it would be structured the way it is.


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## reaper (Oct 2, 2007)

Crash,

If people can't handle the training, then they need to leave EMS.  I left NE because the state won't bring EMS into the 21st century.


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## Ridryder911 (Oct 2, 2007)

I believe this points out the general opinion on why ACLS is no longer regarded as a recognized training program. It *DOES NOT* certify nor does it demonstrate one has knowledge in emergency cardiac care. Rather one has met the standards as set forth per AHA as under ECC recommendations. 

Unfortunately, AHA ACLS has been on a slippery slope and the courses of past quality is hard to find. I am sure Chip's is one of fine quality as some others. I know myself and a few others attempt to continue bring a quality program. With the ease of obtaining ACLS cards, albeit per computer, online, video, what ever the means the credibility has been lost. 

I agree it is a shame. It was once was thought as a nice measure to judge and view if one really knew ECC and resuscitation measures. As demonstrated in the letter, AHA no longer emphasizes the need of exact knowledge, rather the general implication of where, how to manage the team approach and obtain information if needed. Which is great.. if there is even a team. 

This is why I wished there were another respectable agency that would take the lead in certifying and testing those that work in emergency cardiac care. I do doubt, that there will be. With increasing litigation's, responsibilities, and studies demonstrating that retention being poor, it may be a long time if ever see an organization step up. 

Well, until then we will have to honor the request of our license and certifying agencies, and continue to "play the game"...

R/r 911


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## skyemt (Oct 2, 2007)

Hello all... this is my first post...
i find that most of the CPR courses being taught now are lacking in theory, and heavy in mechanics... they don't stress the importance of compressing almost 2 inches... if you compress 1 inch, even at the correct rate, you might as well save your energy... they also don't stress that over ventilaing a patient increases the intrathoracic pressure to the point where you are fighting against your own perfusion attempts... to say that overventiating will make a patient vomit just doesn't give the whole picture, and clearly leaves students short on some very important reasons as to why we do what we do.

i have heard that the courses taught now are not nearly as good as older days, but i'm not really sure why that should be the case...


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## VentMedic (Oct 2, 2007)

Very true Skyemt.  
My pet peeve now is the AHA advocating mechanical assist devices without a clear definition of these devices or elaborating on the basics.


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## pinetree (Oct 3, 2007)

I think I will forward my concern to the AHA ECC.   I found during the so called "GROUP" megacode testing, one of the ER nurses was doing the ventilation about 40 breaths per minute...  In real life, that would get you vomitus pretty quickly.

Of course, the letter said that through the group effort (which only about 1/3 of the group participated), any one who desired a BLS card can get one...

The whole thing is a joke, BLS, ACLS, and likely PALS and other programs directed by the AHA.


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## Ridryder911 (Oct 3, 2007)

I understand your concerns and being disgruntled; however I highly suggest leaving the matters alone. You have written and received an response. 

Continuation of the matter may only actually bring problems to you later on. Although, I totally agree with your frustration, there is a time not to make career suicide. Remember, your only venting your side of the story. As well, since ACLS is NOT really a certifying body or even a required course for many, some may not see the continuation of "nit picking" an educational course. 

Again, I am NOT condoning what occurred, but there is a time and place to pick your battle. Continuation upwards, after this has been already handled (placed instructor on probation) may only lead to more problems, please evaluate your actions before taking any further stance. 


R?r 911


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## skyemt (Oct 3, 2007)

Pinetree, Rid makes a very good point in that ACLS is not a "certification", but rather a continuation in education... As such, and as you obviously feel strongly about the matter, why not put the effort instead into your own agency, to improve the quality of CPR there? It all starts at home, and i think you might be surprised at the results you get... At least, in your district, you will be sure you have done your part to get the outcome you want, which in the end is better quality CPR...


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## pinetree (Oct 3, 2007)

I think you might be right.  Let the ones who want to take the low road take the low road.


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## Ridryder911 (Oct 3, 2007)

pinetree said:


> I ...
> 
> The whole thing is a joke, BLS, ACLS, and likely PALS and other programs directed by the AHA.



Let me redirect this to a hypothesis. Again, I agree with your frustration, and yes some courses and over all I am thoroughly frustrated with AHA content and presentation of ACLS and some other courses, but *NOT ALL* is a joke. 

I teach ACLS at the least twice a year to my Paramedic service, There is not one Paramedic in the service that has not been re certified at the least twice to three times. Hence, the same material, the same video, the same test is presented to them over and over... The same as CPR... 

Do you believe I should present "respiratory adjuncts" such a NPA, OPA, or even simple face masks and test over them to active field Paramedics that have been performing the procedures correctly for 10 years on a daily basis, and is observed by other credentialed instructors? Again, the mundanes of some of the program is why some of the instruction is curtailed. Really, do I need  to spend 5 minutes to teach on how to place a NPA in a dummy to a Paramedic with 25 years experience? If I do so, he/she needs to be terminated. 

I do have different programs, they all follow AHA outline however are different. The one I teach in the hospital is much different than the field. You have a group of OB and orthopedic nurses versus those of ICU/ER and then Paramedics. So yes, alterations are performed sometimes. Yes, they all are tested over the same material, but again I spend more time on megacodes and ACS in EMS type ACLS class than for say the orthopedic nurses. Chances of the OB nurses ever working a cardiac arrest and definitely being the team leader are near to never, however; having them recognizing and calling a code, taking actions for the code team as well as preparing the patient, establishing an large bore IV (to OB nurse this is larger than a 20g) and being able to perform BVM is essential. They will NEVER establish an advanced airway such as LMA, Combitube, or Intubation but may direct the code until the team arrives. Which is the intent of the course. In which AHA is attempting to describe... the intent in which, the course is offered. 

These supplemental courses are meant to re-enforce material, one should already possess or to inform a participant of maybe a different methodology or approach of the current standards per specialty organization. The same as PHTLS/ITLS even ATLS does for EMS practitioners and physicians. One does not become any more a trauma expert after attending such courses as they were prior, nor a pediatric specialist after attending a PALS course.  

If one wanted to become an expert or specialist in these prescribed areas, then one would have to attend graduate and post graduate degree studies and then have sucessfully completed a specialty license or board certifications such as an M.D., D.O., Nurse Practitioner, Nurse Clinician, that actually have residencies (years) of studies. 

That is why most EMS does not place any more emphasis on alphabet courses. There important to maintain and keep us abreast of the current recognized methods, as well as demonstrating that we are efficient in the skills required as well. Really, nothing more than that. 

R/r 911


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## Markhk (Oct 7, 2007)

I remember a while back that AHA was really emphasizing the statement, "Certification does not mean Competency" and that the ACLS card should not be waved around like a Boy Scout merit badge. 

Has anyone tried the Laerdal ACLS self-directed program that includes the skills assessment? In many ways, I felt this program really helped overcome inconsistencies in training due to the "human" equation. I enjoyed playing with the simulations-- it helped me learn quite a bit. Previously, the Laerdal program required you to do intubation on an actual manikin with sensors, but it has now changed to two skills (a) ventilation drill and (b) 2-minutes CPR drill. 

I think AHA is trying hard to emphasize more and more than strong BLS, rather than meds, is what makes the difference in a code situation.


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