ALS is a component of national standards in most countries. For example, in Australia, NSQHS standard 9.6 requires all acute care hospitals to have a clinical workforce that is able to respond appropriately to a deteriorating patient, including having a system in place to ensure access at all times to clinicians who can practice advanced life support.
Furthermore, it is a clear community expectation that hospital staff are prepared and able to resuscitate the victims of cardiac arrest.
In practice though, this standard is variably interpreted. The Australian standards provide little or no guidance on what “appropriately trained” to provide ALS means.
Nonetheless, the default position is to complete an ALS course provided / sanctioned by the Australian Resuscitation Council (ARC). This two day course combines pre-reading, lectures and seminars, part-task training, simulations and assessment (usually fact recall and a simple, unrealistic simulation).
While there is no mention of refreshment of skills and knowledge in the NSQHS standards, the ARC will allow you to undertake a 1 day refresher if you do so within 2 years of your last certification, or a repeat 2-day course every 4 years.
In essence, they forget about you for 4 years, and assume that you can execute on day 1460 as you did on day 1.
No account is taken of :
- local policy
- your clinical exposure
- the equipment you use in your own environment
There is a better way.
We all learn best when we build on our past experience and knowledge. Spaced learning is an evidence based strategy that allows learners to process the information they have been presented, and build on it over time. Cramming all learning into a 2 day period flies directly in the face of this approach.
A far more appropriate way to impart knowledge is to build a curriculum for continuous learning, teaching the basics, reinforcing them after a short period, and building further awareness.
Well constructed online learning platforms enable users to tailor their learning to their needs, accelerating through sections they are familiar with, while allowing them to explore areas they want to know more about.
Traditional ALS management does not take local context into account. Recognition that awareness of local policies and procedures, and familiarity with the equipment that healthcare staff are expected to use in the heat of resuscitation is critical to forming a well prepared service.
Exposure to clinical activity is also essential. There is no doubt that the capacity we would expect from someone who has not been involved in a resuscitation event for 2 years would be vastly different from someone who does it weekly, yet traditional models do not recognise this.
Healthcare professionals who use the logbook functionality to record their participation in real-world ALS events can monitor their activity and outcomes. Using this data, Osler helps the user identify when they are lacking in exposure to clinical resuscitation.
Smart, technology based approaches to ensuring fitness-for-practice can be implemented to fill these gaps.
Simulation is a strategy used to help students learn to apply factual knowledge. It includes interpretation of data, prioritisation, anticipation and planning and decision making.
Osler has developed a real world simulation online, allowing the learner to experience what it’s really like to run an ALS scenario.
These two strategies to preparation to participate in an ALS event could not be more polarised. Who would you want looking after you if your heart stops?
Furthermore, by training in this way, real time completion data is maintained, ensuring that hospitals comply with national regulations.
Finally, the lack of portability of training acquired in healthcare environments leads to duplication of training (and enormous expense and waste), while in contrast assumptions are made regarding the capability of our staff based on where they have worked in the past. Osler believes our credentials must be portable, visible, and above all, useful to individuals and managers alike.