Perhaps not!
Most hospitals and other healthcare facilities require their
nursing staff, allied health staff, and anyone else with direct patient contact
(i.e. portering staff, technicians, PSWs, etc.) to have current Basic Life Support (BLS) - Cardiopulmonary
Resuscitation (CPR), and renew it annually.
Clinical staff who work in critical care areas such as the
Intensive Care (ICU), Cardiac Care Unit (CCU), Emergency Department (ED), and
Pediatric Intensive Care Unit (PICU) are also required to maintain current
certification in the appropriate advance life support courses – i.e. Advanced
Cardiac Life Support (ACLS) and/or Pediatric Advanced Life Support (PALS).
There is however a dangerous and shameful trend that a small
number of hospitals are following. These
few hospitals have decided, in an effort to save money, that they will not
require any of their hospital staff to have BLS-CPR training, nor any of their
critical care staff to also have the applicable advanced life support training.
Why is this a
dangerous trend?
Both the (Canadian) Heart & Stroke Foundation and the
American Heart Association research demonstrates that immediate and
high-quality BLS-CPR is the first and most important step in the chain of
survival in patients experiencing a sudden cardiac arrest. That fact does not change based on the
patient’s location (i.e. in a hospital setting or in the community).
According to the Canadian Association of Emergency
Physicians (CAEP), victims of out-of-hospital sudden cardiac arrest are 3 to 4
times more likely to survive if immediate high-quality bystander CPR is
administered. Why would we not also want
to ensure that patients in a hospital setting also received immediate and
high-quality CPR?
Both the Heart & Stoke Foundation and the American Heart
Association also note the success of advanced life support therapy is dependant
on immediate and high-quality BLS-CPR.
Outside of a busy Emergency Department environment, nurses can go many years without having to
ever perform CPR – even in acute care hospitals. This is why annual recertification is vital.
(All Emergency Department staff still need annual recertification as well.)
Annual recertification provides the knowledge and
muscle-memory to make the correct actions instinctual. It also provides staff with up-to-date
knowledge as well as changes in techniques and protocols.
As for clinical staff in critical care areas, advanced life
support training is essential for early detection and management of life
threatening emergencies. This is
arguably even more important in teaching hospitals where a cardiac arrest may
be managed by a “Resident” physician who is still learning the ropes. In this case, nurses with current advanced
life support certification are a vital check and balance for the resident
physician and can provided valuable input and suggestions if they have and
maintain current advanced life support training. Support for this is available in current
literature and research – and it contributes to an increase in the possibility
of the patient’s survival.
-
Allied health staff such as Registered Respiratory Therapists (RRT or
RT) also need to maintain current certification in ACLS, PALS, and Neonatal
Resuscitation Program (NRP).
-
ED & PACU nurses need BLS-CPR, ACLS and PALS.
-
ICU & CCU nurses need BLS-CPR and ACLS.
-
PICU nurses need BLS-CPR and PALS
-
NICU (and Nursery) nurses need BLS-CPR and NRP.
As an aside, CPR in an Emergency Department or elsewhere in the
hospital setting (once a cardiac arrest team has arrived) is much different
that it is in the community. The head of
the cardiac arrest team instructs the person doing chest compressions when to
start and stop, and if they need to push harder or faster. Expecting someone who has only performed CPR
(and likely only chest compressions) in this type of setting to competently
perform CPR alone in the community is unreasonable.
Also, without current BLS-CPR training, it is unlikely that
staff would have the knowledge or skills to quickly deploy and use the
automatic external defibrillators (AEDs) that are becoming for readily
available in the community. (The use of
AEDs is now taught in most CPR courses.)
What can we do?
1) Find out if your local hospital(s) requires
their nursing staff, allied health staff, and anyone else with direct patient
contact (i.e. portering staff) to have current BLS-CPR and renew it annually.
- If not, insist that they do. Create
a petition. Inform the media. It may be your life or the life of a loved
one who may not be getting the optimal care they need and deserve
otherwise. Lives may depend on it!
2) Find out if your local hospital(s) requires
clinical staff who work in critical care areas to have and maintain current advanced life support certification. (These
must be renewed every 2 years.)
- If not, insist that they do. Create
a petition. Inform the media. It may be your life or the life of a loved
one who may not be getting the optimal care they need and deserve
otherwise. Lives may depend on it!
3) Get
trained in First Aid and CPR (preferably CPR for adults, children, and
infants – with AED training). Everyone should be trained!
-
Reputable agencies such as the Heart
& Stroke Foundation, the Canadian
Red Cross, and St. John Ambulance all provide CPR training. All three agencies also provide additional
First Aid courses. “Standard First Aid
and CPR” courses are the most comprehensive.
(Links will be provided at the end
of this blog post.)
-
“Level C with AED” includes
adult, child and infant CPR. Ensure that your course includes this.
4) If nurses and other staff at your local
hospital(s) are not trained in current BLS-CPR with AED, hopefully someone else
whose profession requires them to maintain current certification (i.e.
Lifeguards, teachers, etc.) will be around if you need them.
5) If you are nursing staff, allied health
staff, and anyone else with direct patient contact (i.e. portering staff, technicians, PSWs, etc.) to
whom this blog post refers – get trained – and maintain your certification. You should have current BLS-CPR Level C/Healthcare Provider with AED
certification.
-
If you are licensed clinical staff, you should consider this a professional responsibility!
6) If
you are a nurse working in a critical care area (i.e. ICU, CCU, PACU, ER, PICU,
NICU, etc.) – get trained – and maintain current certification in the
appropriate advance life support courses.
- You should consider this
a professional responsibility!
7) If
you are a Registered Respiratory Therapists (RRT or RT), you need to
maintain current certification in ACLS, PALS, and Neonatal Resuscitation
Program (NRP).
- You should consider this
a professional responsibility!
8) If
you are a student about to start your studies to become a healthcare
professional, as a good baseline you should take Standard First Aid with BLS-CPR Level C/Healthcare Provider with AED
certification - prior to starting to your program.
Links:
Heart & Stroke Foundation – CPR & First Aid: http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.3581673/k.DDB4/First_aid_CPR_and_AEDs_Learn_to_save_a_life.htm
(The Heart & Stroke Foundation, together with the
American Heart Association, set the standards for CPR, ACLS, PALS, and NRP in
North America.)- Information for Healthcare Providers on current guidelines, ACLS, PALS, and NRP: https://resuscitation.heartandstroke.ca/
Canadian Red Cross – CPR & First Aid: http://www.redcross.ca/what-we-do/first-aid-and-cpr
(Opportunities also exist for humanitarian relief and
disaster response and relief in Canada and around the world.) http://www.redcross.ca/
St John Ambulance – CPR & First Aid: http://www.sja.ca/English/courses-and-training/Pages/default.aspx
Other useful links for healthcare professionals:
American Heart Association (AHA) Consensus Statement - “Cardiopulmonary
Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and
Outside the Hospital” - http://circ.ahajournals.org/content/128/4/417
Heart & Stroke Foundation - Current Canadian guidelines for
resuscitation including BLS-CPR, ACLS, PALS, and NRP - http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.6301495/k.940B/CPRguidelines.htm and
https://resuscitation.heartandstroke.ca/guidelines/overview/resuscitationguidelines
Heart & Stroke Foundation – Information for Healthcare Professionals
- http://www.heartandstroke.on.ca/site/c.pvI3IeNWJwE/b.4331833/k.B6A5/For_Professionals.htm
American Heart Association – Current guidelines for resuscitation
including BLS-CPR, ACLS, PALS, and NRP - http://circ.ahajournals.org/content/122/18_suppl_3.toc
Canadian Association of Emergency Physicians (CAEP) – “Position
Statement on Bystander Cardiopulmonary Resuscitation” - http://cjem-online.ca/v13/n5/p339
American College of Emergency Physicians (ACEP) – “Policy
Statement on Public Training in Cardiopulmonary Resuscitation and Public Access
Defibrillation” - http://www.acep.org/Clinical---Practice-Management/Public-Training-in-Cardiopulmonary-Resuscitation-and-Public-Access-Defibrillation/?__taxonomyid=117952
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