Advanced Cardiac Life Support Instructors Research Articles

Questionnaire survey on medical futility and termination of resuscitation in cardiac arrest patients among emergency physicians in Hong Kong.

The perceptions of medical futility and decisions about termination of resuscitation (TOR) for out-of-hospital cardiac arrest (OHCA) are highly heterogeneous and dependent on the practice of the attending emergency physicians. The objective of this study was to report and investigate the knowledge, attitudes, and practices regarding medical futility and TOR during management of OHCA in Hong Kong. A cross-sectional survey was conducted among emergency medicine physicians in Hong Kong. The questionnaire assessed participants' background, knowledge, attitudes, and behaviours concerning medical futility and TOR in management of OHCA. Composite scores were calculated to reflect knowledge, attitudes, and practices of OHCA treatment. Subgroup analysis and multiple regression analysis were used to explore the relationship between participants' background, knowledge, attitudes, and behaviours. The response rate to this survey was 57% (140/247). Independent predictors of less aggressive resuscitation in OHCA patients included status as a Fellow of the Hong Kong College of Emergency Medicine (β= -0.314, P=0.028) and being an Advanced Cardiac Life Support instructor (β= -0.217, P=0.032). There was no difference in aggressiveness of resuscitation in terms of years of clinical experience (β=0.015, P=0.921), knowledge of TOR (β=0.057, P=0.509), or attitudes about TOR (β= -0.103, P=0.214). The correlation between knowledge and attitudes was low (Spearman's coefficient=0.02, P=0.795). Clinical practice and behaviour of TOR was not demonstrated to have associations with knowledge or attitude. Status as a Fellow of the Hong Kong College of Emergency Medicine or Advanced Cardiac Life Support instructor were the only two parameters identified that had significant relationships with earlier TOR in medically futile patients with OHCA.

Looking Back on Advanced Cardiovascular Life Support Education in Korea through Narratives of Instructors

Purpose: The Advanced Cardiac Life Support (ACLS) course has been spreading since its introduction to Korea by the American Heart Association (AHA) in 2007. The scale of the program increases yearly. We assessed the significance of the ACLS courses conducted so far and evaluated problems that arose in an effort to improve ACLS education. Methods: Qualitative study. We conducted narrative interviews with twelve ACLS instructors from the AHA and the Korean Association for Cardiopulmonary Resuscitation (KACPR), selected in the order of frequency of instruction, using open- ended questions. Results: The total interview time of 16.7 hours was recorded on 402 transcript pages. We identified eight categories of comments including course objectives, obstacles, difficulties, teaching strategies, qualifications and competency, experience, conditions, and directions for optimal education, and from these, we formulated a proposal to the community. Conclusion: Calling on the experiences of these instructors, we identified opportunities for improving the educational environment of ACLS.

Validation of a detailed scoring checklist for use during advanced cardiac life support certification.

Defining valid, reliable, defensible, and generalizable standards for the evaluation of learner performance is a key issue in assessing both baseline competence and mastery in medical education. However, before setting these standards of performance, the reliability of the scores yielding from a grading tool must be assessed. Accordingly, the purpose of this study was to assess the reliability of scores generated from a set of grading checklists used by nonexpert raters during simulations of American Heart Association (AHA) Megacodes. The reliability of scores generated from a detailed set of checklists, when used by 4 nonexpert raters, was tested by grading team leader performance in 8 Megacode scenarios. Videos of the scenarios were reviewed and rated by trained faculty facilitators and a group of nonexpert raters. The videos were reviewed "continuously" and "with pauses." The grading made by 2 content experts served as the reference standard, and 4 nonexpert raters were used to test the reliability of the checklists. Our results demonstrate that nonexpert raters are able to produce reliable grades when using the checklists under consideration, demonstrating excellent intrarater reliability and agreement with a reference standard. The results also demonstrate that nonexpert raters can be trained in the proper use of the checklist in a short amount of time, with no discernible learning curve thereafter. Finally, our results show that a single trained rater can achieve reliable scores of team leader performance during AHA Megacodes when using our checklist in a continuous mode because measures of agreement in total scoring were very strong [Lin's (Biometrics 1989;45:255-268) concordance correlation coefficient, 0.96; intraclass correlation coefficient, 0.97]. We have shown that our checklists can yield reliable scores, are appropriate for use by nonexpert raters, and are able to be used during continuous assessment of team leader performance during the review of a simulated Megacode. This checklist may be more appropriate for use by advanced cardiac life support instructors during Megacode assessments than the current tools provided by the AHA.

Mark Ambler, BSN, MBA, RN, CCRN, CNML

Mark Ambler, BSN, MBA, RN, CCRN, CNML

OTC At-Home Defibrillator Pros and Cons

ABOUT THE AUTHOR Denise Drummond Hayes, RN, CRNP, MSN is a Basic Life Support and Advanced Cardiac Life Support Instructor and a Clinical Editor at Lippincott Williams and Wilkins.

T EACHING ACLS S TROKE O BJECTIVES TO P REHOSPITAL P ROVIDERS : A C ASE-BASED A PPROACH

Objectives. To determine whether a case-based educational module would increase prehospital care providers' short-term and long-term knowledge about stroke and to compare the educational impact when the module was moderated by a physician versus an advanced cardiac life support (ACLS) instructor. Methods. A stroke module consisting of two case-based scenarios was administered to emergency medical services (EMS) personnel by either an ACLS instructor or a physician. Identical 25-question tests (based on 1997 ACLS prehospital stroke objectives) were administered before and after the module. Descriptive statistics were calculated by groups, and Wilcoxon tests were used to assess the significance of improvement in scores based on the paired data. Results. Two hundred six EMS personnel [112 (54%) emergency medical technician (EMT)-P, 91 (44%) EMT-B/EMT-I, and three (2%) other training levels] participated in the module, of whom 74 [30 (41%) EMT-P, 42 (57%) EMT-B/EMT-I, and two (2%) other training levels] participated in follow-up testing between six and seven months. Overall, there was a 32% improvement in test scores immediately after completion of the module (p < 0.001) and an 18% improvement at six months (p < 0.001). No significant difference in pretest scores existed between the physician-led and ACLS instructor-led groups (mean EMT-P pretest scores 69% versus 70% and EMT-B/EMT-I scores 55% versus 54%, respectively). There was no significant difference in short-term (p = 0.36) or long-term (p = 0.074) score improvements between the two groups. Conclusion. This case-based approach to EMS stroke education is effective and can achieve equal benefit when administered by a physician or an ACLS instructor.

A profile of BLS and ACLS instructors

To examine factors that motivate people to become and remain basic life support (BLS) and advanced cardiac life support (ACLS) instructors. A questionnaire was mailed to 967 BLS and ACLS instructors. The study was performed in the San Francisco Bay Area. All BLS and ACLS instructors whose names were registered with the Santa Clara County Affiliate of the American Heart Association. Although there is room for improvement, 81% of the instructors were satisfied with their jobs. "Satisfaction in performing a valuable service" was the predominant reason they became instructors. "Lack of time" was the main factor causing people to stop teaching. The majority of BLS and ACLS instructors surveyed were quite happy. The current system appears to be working in that the teachers themselves are satisfied. An accurate portrait of BLS and ACLS instructors is crucial for organizations such as the American Heart Association if they wish to attract and retain instructors.

Problem-based ACLS instruction: a model approach for undergraduate emergency medical education.

The optimal format for teaching advanced cardiac life support (ACLS) to medical students and other groups with little emergency medicine experience has not been studied extensively. We report an ACLS provider course that was taught to sophomore medical students using a self-directed, problem-based learning model. The traditional two-day provider course format was replaced by a series of clinical problems that emphasized various aspects of the ACLS curriculum. Students then met weekly with an ACLS instructor who served as a tutor to discuss the problem. A specific set of learning objectives for the entire ACLS curriculum was developed into a study unit index and given to students at the beginning of the course. Enhanced practice time was offered to students in the form of traditional teaching stations and skills laboratories. Students were tested using standard ACLS criteria. The students in the problem-based course achieved a higher pass rate on the written test and skills stations than senior medical students did in a standard two-day course during the same time period. The problem-based format with enhanced practice time would appear to be an effective alternative for groups that need to acquire the basic skills needed in a resuscitation attempt but have little previous experience in this area.

Methods of Examination

To the Editor.— During a recent advanced cardiac life support (ACLS) class we experienced an unusually high failure ratio in one of the work-shops. Part of the American Heart Association's (AHA) criteria for an ACLS instructor's class is for each participant to complete successfully eight workshops (performance stations) covering various skill areas of resuscitation. On the first day of the two-day class 15 students went through the static dysrhythmia work-shop. The workshop is followed with an examination on 13 dysrhythmias. For students to complete this section they must score 100%. The examination can be given by showing ECGs on an overhead projector, slide projector, or ECG recording paper. Twelve (80%) of 15 failed the examination when it was given via an overhead projector. Of the 15 students, eight were physicians, three were registered nurses, three were registered respiratory therapists, and one was a registered cardiopulmonary technologist. As a prerequisite to