jz 0 a American Heart Association. Basic Life Support INSTRUCTOR MANUAL Firs 1098765Acknowledgments ‘The American Heart Association thanks the following people for their contributions to Vv the development of this manual: Jose G. Cabafias, MD, MPH; Jeanette Previdi, MPH, RN; Matthew Douma, RN; Bryan Fischberg, NRP; Sonni Logan, MSN, RN, CEN, CVN, CPEN; Mary Elizabeth Mancini, RN, PhD, NE-BC; Randy Wax, MD, MEd: Sharon T. Wilson, PhD, RN, FCN; Brenda D. Schoolfield; and the AHA BLS Project Team, To find out about any updates or corrections to this text, visit w www.heart.org/courseupdates,5 Part1 General Concepts About This Instructor Manual Critical Role of the Instructor Course Planning and Support Materials Implementing Resuscitation Education Science in Training Testing for Course Completion After the Course Provider Renewal Instructor Training Part2 Preparing for the Course Course Overview Course Audience Course Planning and Support Materials Part3 Teaching the Course Instructor Teaching Materials Course Outlines and Agendas Part4 Testing Testing for Course Completion Basic Life Support Adult CPR and AED Skills Testing Checklist Basic Life Support Infant CPR Skills Testing Checklist 10 8 2 22 23 25 27 33 33 37 49 53 87Part 5 BLS Lesson Plans 1-33 —_ Part 5A BLS Renewal Lesson Plans 1-30 Part6 HeartCode® BLS Lesson Plans 1-30 ESD a cla CET ele ‘These resources are available on the AHA Instructor Network at, www.ahainstructornetwork.org, Precourse Materials Equipment List Sample Precourse Letter to Students (Classroom Course) Sample Precourse Letter to Students (HeartCode BLS) Sample BLS Course Agenda With Optional Lessons ‘Sample BLS Renewal Course Agenda Without Optional Lessons, ‘Sample HeartCode BLS Agenda With Optional Lessons ‘Sample HeartCode BLS Agenda Without Optional Lessons, Course Materials {Adult CPR and AED Skills Testing Checklist ‘Adult CPR and AED Skills Testing Critical Sklls Descriptors infant CPR Skils Testing Checklist Infant CPR Skils Testing Critical Skills Descriptors Team Dynamics Diagram ‘Summary of High-Quality CPR Components for BLS Providers“QM General Concepts PTT PUTS Ot a Sod ELT) We have reorganized our instructor manuals to provide an introductory section that discusses the science and educational principles of resuscitation training as well as the basic logistics for conducting any American Heart Association (AMA) course. For new instructors, Part 1 provides essential and practical tools to help launch them as AHA Instructors. For more seasoned instructors, Part 1 offers insights into the science and educational principles that go into the design of all AHA courses. Although some of this information applies mostly to the AHA advanced resuscitation courses, Basic Life Support (BLS) Instructors may find it useful. The remaining Parts of this instructor manual cover information.PoE CRUE tls Clg The ultimate goal of AHA courses is to improve outcomes for people with cardiovascular disease, especially those who need cardiopulmonary resuscitation (CPR) or emergency cardiovascular care (ECC). AHA Instructors have a unique opportunity to impact the survival of real people by helping to enhance student skills through learning and practice. Instructors, should use the educational design of ECC courses to simulate events that are as close to real emergencies as possible. In this way, AHA courses can prepare students to function optimally for their next emergency. ‘Asan AHA Instructor, your role is to help your students by + Demonstrating effective case management consistent with the current AHA Guidelines: for CPRand ECC ‘= Modeling high-quality principles of care ‘+ Facilitating discussions with a focus on desired outcome + Listening to students’ responses and providing feedback to ensure that they understand the learning concepts + Observing students’ actions and coaching them as necessary + Providing positive or corrective feedback + Managing discussions and simulations to optimize classroom time and maximize learning + Leading, modeling, and promoting prebriefing sessions before each simulation and structured debriefing sessions after each simulation ‘Some AHA Instructors will also teach blended-learning courses. These courses combine eLearning, in which a student completes part of the course online, with a hands-on instructor-led session. You'll learn more about blended-learning courses later in this manual, — Instructor Needs and Resources Science Update Information ‘Science and education updates occur periodically. The AHA provides the following resources so that you can access these updates as they are released: * The AHA Instructor Network, which nludes the EOC Beat fr instructions on how to access, visit www.ahainstructornetwork.org + The AHA website ea For full details ofall changes that were made to the resuscitation guidelines, the AHA strongly recommends that each instructor access the guidelines, available at eccguidelines.heart.org. Instructor Network ‘The AHA provides the Instructor Network as a resource to instructors. Here, instructors can access up-to-date resources and reference information about the AHA ECC programs and, science. AHA Instructor Registration www.ahainstructornetwork.org AILAHA Instructors are required to register with the AHA to be aligned with a Training Center. For instructions on how to register. visit www.ahainstructornetwork.org. Alignment must be approved by that Training Center before access to contents available. Acceptance of the user agreement is required during registration. -Once registered and approved, you will receive an instructor identification number. This number will be placed on your instructor card and is the same forall disciplines. This number stays the same if you change Training Centers. tis used on all course completions cards for classes that you teach. ‘The AHA reserves the right to delete or deny alignments on the Instructor Network.Pere EMU ee) ere) Before teaching a classroom course or hands-on session, please take the time to read and reviewin detail the instructor manual and lesson plans, provider manual and any additional student resources, and videos. Your preparation is key to a successful and rewarding teaching experience. [As you view the videos and the lesson plans (Parts 5 and 6), note how the course is organized and the expectations for you and the students. Make notes on your lesson plans asneeded This important preparation will enable you to teach the course more effectively and anticipate what you wil need to do as the course unfolds. This s especially true for those parts of the course that require you to organize the students for practice or testing, present the video to give information, facilitate discussions, distribute equipment, conduct debriefings, and give exams or hands-on tests. Notice of Courses iy For US-based instructors aligned with the AHA Instructor Network, the AHA offers the My Courses tool, where instructors can enter and maintain the classes they offer to the general public. These are displayed to customers searching for scheduled classes on the AHA's CPR and First Aid website, epr-heartorg. Before entering classes, check with your Training Center to determine what policies that center ‘may have about instructors entering their classes. As an instructor, you can still add your classes for display through My Courses even if your Training Center is not participating in listing through My Courses. For instructors based outside the United States, inform your International Training Center of | — courses open to the public so that they can send inquiries for classes to you. Ordering Materials Asan instructor, you can order books and other support materials through your Training Center or directly from the AHA at ShopCPR.Heart.org. There are also distributors available for AHA Instructors outside the United States (https://international.heart.org/en/how-to-buy). However, only 2 Training Center Coordinator can order course completion cards. Work with your Training Center Coordinator to ensure that your students receive their cards. Copyright of AHA Materials ‘The AHA owns the copyright to AHA books and other training materials. These materials may not be copied. in whole or in part, without the prior written consent of the AHA. For more information and to request permission to reprint, copy, or use portions of ECC textbooks or other materials, go to copyright.heart.org, Smoking Policy The Training Center must prohibit smoking in classrooms and training facilities during all AHA ECC training programs, Course Completion Cards Only a Training Center Coordinator, or another authorized Training Center representative designated by the Training Center Coordinator, can use the confidential security code to - order course completion cards (eCard or printed) for approved disciplines. The Training Center Coordinator should keep this code confidential Training Center Coordinators cannot order course completion cards without this code.(D) The Training Center Coordinator has final responsibilty to the AHA for the security code, The Training Center Coordinator must notify ECC Customer Support immediately ifthe security code is suspected as lost, stolen, disclosed, or used without authorization. ‘The AHA may change the code if deemed necessary to maintain the confidentiality of the code. Misuse of the confidential security code could result in termination of the Training Center Agreement. For more information on course completion cards, refer to the ECC Course Card Reference Guide on the Instructor Network and at epr:heart.org, Course Equipment AIIAHA ECC courses require that manikins and equipment allow demonstration of the core skills (eg, airway management, correct hand placement, compression depth, chest recoil) The AHA requires the use of an instrumented directive feedback device or manikin nll AHA courses that teach the skils of adult CPR ‘The AHA neither endorses nor recommends a particular brand of manikin or other equipment. The decision on which brand or model of equipment to use is the responsibilty of the Training Center, ‘You can find a detailed equipment list for your course or hands-on session in Part 2 of this instructor manual. High-Fidelity vs Low-Fidelity Simulation ‘Simulators have been used to teach BLS for decades. They give students the opportunity to Practice and improve the clinical skills needed for resuscitating real patients. Because of improvements in technology, healthcare professionals can more easily observe pathophysiologic signs. The variety of simulators has expanded considerably. Some are as simple and old-fashioned as using an orange to practice intramuscular injections. Others are more sophisticated, such as computer-guided mechanical devices that make practicing specific procedures look and fee! more real. Improved plastics have made task trainers (e9, airway practice models) more versatile and realistic, and many manikins have lifelike features and enhancements. While the term high fidelity has been used as a synonym for high technology, fidelity actually refers to the level of realism as this relates to specific learning objectives. Thus, high fidelity implies a very realistic simulation, while low fidelity implies that the student must use his ‘or her imagination to fillin the gaps. These definitions are based on the experience of the student rather than on the device itself. While advanced technology and high-fidelity simulation are appealing and may result in higher student satisfaction, they increase costs substantially without necessarily enhancing learning compared with more basic simulators. In fact, none of the available products are truly realistic compared with real human beings. ‘You may find high-fidelity manikins useful for teamwork and skills integration, but itis not certain which specific aspects of the scenario are improved by a higher degree of realism. Having a relevant case and setting for students—or matching the equipment to what the ‘students use in their practices—may be more important than a high-fidelity manikin for (D) translating the learning process to clinical practice. As an instructor, you can tailor your approach by using the resources available to create a high-fidelity environment that both satisfies students and achieves the desired learning objectives. Feedback devices can accurately measure rate, depth, and recoil of compressions and rate and volume of ventilation. This feedback should be used throughout the course and fortesting so that students are able to practice until they can do it without having to think about ite, automatically). Because you are trying to build automaticity, itis important for students to perform these skills correctly and consistently and for Team Leaders and team members to recognize correct performance by others. Infection Control Itis your responsibility as an instructor to ensure that a safe, clean environment is maintained in your class. Inform your students in advance that training sessions involve close physical contact with manikins and that they will be close to other students. In your welcome letter that is sent with course materials, tell students not to attend class. if they know they have an infectious disease, feel sick, or have open sores or cuts on their hands, mouth, of areas around their mouth. Participants and instructors should postpone CPR training if they are in the active stages of an infectious disease or have reason to believe they have been exposed to an infectious disease. Equipment and Manikin Cleaning ‘To reduce the risk of potential disease transmission, all manikins and training equipment need to be thoroughly cleaned after each class. Manikins used for CPR practice and testing require special actions to be taken between each student. The AHA strongly recommends, that you follow manufacturers’ recommendations for manikin use and maintenance. In the absence of manufacturers’ recommendations, the following guidelines may be used during andafter class: During Class '* Students and instructors should practice good hygiene with proper handwashing techniques. * When individual protective face shields are used, continue to follow all decontamination recommendations listed for cleaning manikins during and after a course. In addition, to reduce the risks to each user for exposure to contaminants, ensure that all students consistently place the same side of the face shield on the manikin during use. + Ifyouare not using face shields during the course, clean the manikins after use by each ‘student with a manikin wipe that has an antiseptic with 70% ethyl alcohol. = Open the packet, and take out and unfold the manikin wipe, = Rub the manikin’s mouth and nose vigorously with the wipe. Wrap the wipe snugly over the mouth and nose. Keep the wipe in place for 30 seconds. Dry the manikin’s face with a clean paper towel or something similar. = Continue with the ventilation practice. After Class «Take apart the manikins as directed by the manufacturer. Anyone taking apart and decontaminating manikins should wear protective gloves and wash their hands when finished. + As soonas possible after each class, clean any part of the manikin that comes into contact with potentially infectious body fluids during training to prevent contaminants from drying on manikin surfaces. + If manikins are stored for more than 24 hours before cleaning, follow these steps: — Wash all surfaces, reusable protective face shields, and pocket masks thoroughly with warm, soapy water and brushes. = Moisten all surfaces with a sodium hypochlorite solution having at least 500 ppm free available chiorine (one quarter cup of liquid household bleach per gallon of tap water) for 10 minutes, Make this solution fresh for each class and discard after each use. Using a concentration higher than one quarter cup has not been proven to be more effective and may discolor the manikins. ~ Rinse all surfaces with fresh water and air dry before storing.= Because some manufacturers have recommendations for cleaning manikin parts in a dishwasher, check with the manufacturer of the manikins being used to determine if this is an acceptable method, Some manikin materials could be damaged ina dishwasher. + Replace disposable airway equipment at the end of each class. + Clean manikin clothing and the manikin carrying case periodically or when soiled. ‘= Maintain other equipment used in class according to hospital policy. Wipe surfaces touched by students with antiseptic solution, Course Materials Templates Asa registered instructor, you can log in to your account to find templates for letters, forms, and other materials to help you prepare to teach the course. You will need to customize some of these materials, including the precourse letter, which tells students what they need to do to prepare for the course or hands-on session. Lesson Plans AIL AHA ECC instructor manuals include lesson plans that are intended to * Help you as an instructor to facilitate your courses + Ensure consistency from course to course * Help you focus on the main objectives for each lesson, + Explain your responsibilities during the course ‘Your lesson plans were created to be used before and during courses and during skills practice and testing sessions, as noted in Table 1. ‘Table 1. How to Use Lesson Plans Bofore the course Review your lesson plans, making notes of anything you want to ‘emphasize on the basis of your students roles and environment. + Identify objectives for each lesson + Define your role for each lesson plan + Gather the resources needed for each lesson. During the course + Follow each lesson plan as you conduct the course. Romind students what each video segment covers. ‘Make sure you have allthe resources, equipment, and supplies ready for each lesson, Help all students achieve the objectives identified for each lesson. + Encourage students to work in teams and to help each other. + Create an atmosphere that encourages peak performance and improvement that will carry over into clinical practice. During practice before | A student may have a question about a certain part of skills they wil askilistest be tested on. The lesson plans serve asa resource for youwhen answering those questions. Using the Provider Manual Students must have their own copy of the current provider manual to read before and to use ‘asa resource during and after the course. The lesson plans tell you when to refer students to specific sections of the provider manual during the course, ‘The provider manual is designed for individual use andis an integral part of the student's ‘education, Students may reuse their manuals during renewals or updates until new science ‘guidelines are published.‘Students taking a blended-learning course have access to the provider manual and other reference materials within the online portion. They may access the reference materials for — up to 2 years from the date they activate their online portion. Students should be allowed to bring electronic devices into the classroom to access these electronic materials. Tailoring to the Audience Determining Course Specifics Before you teach a course, determine the course specifics: + Student audience + Number of students, * Special needs or local protocols + Room requirements * Course equipment Details specific for the type of course or hands-on session that you will be conducting are locatedin Part 3. Course Flexibility ‘The AHA allows instructors to tallor their courses to meet audience-specific needs, One ‘example of this course flexibilty is local protocol discussions built into some of the lessons. For specific examples, refer to Part 2. ‘Any changes to the course are in addition to the basic course contents as outlined in this, manual and will dd to the length of the course. Instructors may not delete course lessons. or course components. Any additions or alterations to the course must be specifically Identified as non-AHA material (refer to the Non-AHA Content section). Some evidence suggests that adding content to the course may actually decrease learning and retention, se Although itis not considered a best practice to insert additional material into this course, instructors may add related topics, as long as none of the required lessons or course content is eliminated or shortened. Non-AHA Content Asan instructor, you can best serve your students when you can adapt to meet the needs of a specific audience. If you find that your students willbe better served by adding location- specific information, equipment, or specialty-specific content and you plan to discuss that non-AHA content in class or distribute handouts, follow these rules: * None of the required AHA lessons or course content can be eliminated or shortened, + Any changes to the course are in addition to the basic content as outlined in your instructor manual, * Adding additional content willadd time to the course. * Additional topics or information should be covered at the beginning or end of the course to avoid disrupting the flow of the requited lessons. * Any location-specific protocols or procedures that do not comply with AHA processes. {eg, substituting new medications, specialized techniques) should be identified to the ‘audience as location-specific. * Any non-AHA content must be identified as not approved or reviewed by the AHA, and the source of the information must be provided to the students. + Supplementary materials that you use need to be approved by the Lead Instructor ‘or the Course Director for advanced courses, as well as by your Training Center Coordinator. + Acopy of a revised agenda and any print material shared in class must be part of the permanent course file. + Your students cannot be tested on non-AHA content. If they complete the AHA-defined course completion requirements, they must be issued an AHA course completion card.(D> Students With Special Needs * The AHA does not provide advice to Training Centers on Americans With Disabilities Act requirements or any other laws, rules, or regulations. Training Centers must determine ‘accommodations necessary to comply with applicable lavs. The AHA recommends consultation with legal counsel + Astudent must be able to successfully complete all course completion requirements to receive a course completion card, Reasonable accommodations may be made, such as ‘manikin positioning, use of a text reader, or reading the exam to the student. * Ifa students unable to successfully complete skills testing because of a disabilty, he or she should be given written documentation of class attendance, with a listing of what testing was not successfully completed. * Advisor: BLS course completion cards accommodate students who pass the cognitive portion of the HeartCode* BLS Course but cannot perform the physical skills of CPR. By successfully advising others how to perform CPR and use an automated external defibrillator (AED), HeartCode BLS students with disabilities can receive an Advisor: BLS card. Students should check to make sure that their workplaces will accept these cards, ‘Advisor: BLS cards are available exclusively to authorized Training Centers for issuance inaccordance with AHA policy.0 eur cee curr uel in Training ‘According to research reviewed in the 2018 AHA Scientific Statement "Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest, providers’ skills can begin to decay only weeks after taking standardized resuscitation courses, which can lead to poor clinical care and survival outcomes for cardiac arrest patients. The Resuscitation Education Statement presented evidence supporting the following strategies to improve how well providers learn and retain these critical skills. + Mastery learning: To increase the likelihood that a student will truly learn key resuscitation skills, have students practice until they demonstrate mastery. AHA courses are designed to give students time to practice with video demonstration, scenarios, and group activities. As an AHA Instructor, your role is to provide the feedback and coaching to make students’ practice time meaningful and effective. + Perfect practice makes perfect: Use a mastery learning model that requires students to demonstrate key skills, and set a minimum passing standard for mastery. Video ‘demonstrations in AHA courses allow students to observe accurate and consistent resuscitation skills and to practice with the video and in group scenarios. Give students. time to practice until they are comfortable with the skills and feel ready to take the skills test + Measuring performance to motivate students: Set performance standards on the basis of observable behaviors, Determine the most important measures for patient outcomes ‘and process standards such as time, accuracy, and best practices. The skills testing ‘checklists in all AHA courses define the passing standard for critical skills and allow instructors to measure and document student performance. Deliberate practice: Use skill repetition paired with feedback and exercises, known {as deliberate practice, to teach behaviors that are difficult to master or should be performed automatically. “= Use of overlearning to improve retention: Train students beyond the minimum standard, known as overlearning, for behaviors that are likely to decay and would require effort to retrain someone to a level of mastery. + Spaced learning: Students who participate in more frequent, shorter learning sessions, have a better chance of retaining new knowledge and procedures. Strategies like eLearning, roling refresher events, and other ways to increase learning outside of scheduled training can reinforce training after the class. Resuscitation Quality Improvement® is an example of low-dose, high-frequency training that providers can use to regularly practice skills and reinforce learning at their workplace. Instructors may offer periodic skills refreshers between course events. Contextual learning: Training that applies directly to students’ scope of practice can engage students and make them eager to expand their expertise. Ensure that team composition, roles, and contexts are right for each group activity. and consider implementing appropriate levels of stress and cognitive load. Prebriefing, feedback, and debriefing: — Prebriefing: Briefing before a learning event creates a safe environment for students by setting their expectations. Prebriefing builds rapport between instructor and student, which can make students more receptive to feedback after the event, = Using data in feedback and debriefing: Students need performance data to improve, This includes data from instructors, other students, and devices. Debriefing tools: Debriefing tools or scripts improve instructors’ debriefing effectiveness by providing direction and content thats focused on improving learning outcomes. ‘Assessment: Assessment of student competence is a oritical part of developing tfficient resuscitation teams, Plan for various, high-quality assessments throughout each course to get a broader picture of each student's knowledge and skills,a * Innovative educational strategies: New methods of accessing up-to-date information can improve laypeople’s willingness to act, provider performance, and survival rates. For example, gamified learning can improve engagement, and social media delivers information quickly to large audiences. Faculty development: Initial instructor training s crucial, but empowering instructors to ‘commit to lifelong learning creates a culture of training excellence, inspires students, and enhances the classroom experience. Knowledge translation and implementation strategies: The best evidence evaluation won't improve patient survival if providers aren't able to apply the knowledge gained to clinical practice. According to the Resuscitation Education Statement, improving methods for translating scientific knowledge into clinical practice is an ongoing field of ‘study that could save more lives than a new breakthrough in managing cardiac arrest. AHA courses teach resuscitation skils as well as team skills and use tools like debriefing 0 that students learn not only how to perform the critical skills but how to assess and analyze behaviors in real resuscitation events to help their teams improve performance. Importance of High-Quality CPR High-quality CPR, comprising manual chest compressions and ventilation, is the foundation of lifesaving resuscitation for cardiac arrest victims. Maintaining blood flow to the heart and brainis the first priority, ahead of other interventions, such as administering medications. Individuals and teams should focus on maintaining cardiac output at all times during an ‘attempted resuscitation for cardiac arrest. ‘Too often, CPR either is not performed or is performed with too many interruptions during both out-of-hospital and in-hospital arrests. Studies of CPR skills retention have shown patterns of significant erosion of CPR skills in the days, weeks, and months after CPR training, CPR should be performed in real time with an audiovisual feedback device guiding each student's performance in all learning stations where CPR is required, This is critical for a high-performance team. In addition, chest compression fraction (CCF, the proportion of time that chest compressions are performed during a cardiac arrest, should drive increased performance in learning stations and cannot be measured unless compressions ‘are conducted in real time, Ventilation should also be timed or have real-time audiovisual feedback to help ensure optimal performance, This is true in practice, in testing, and in real- life emergencies. Allstudents will have the opportunity to practice high-quality CPR and then to demonstrate these lifesaving skills during the course assessment, ‘Components of high-quality CPR for adult cardiac arrest victims include the following: * Push hard (at least 2 inches [5 cml), using an automated feedback device to assist with performance improvement. * Push fast, compressing at a rate of 100 to 120 per minute. ‘* Minimize interruptions in compressions to less than 10 seconds. + Achieve a CCF thatis ideally greater than 80%, * Allow for complete chest recoil between compressions (ie, do not lean on the chest between compressions). * Avoid excessive ventilation, delivering breaths over 1 second that produce visible chestrrise. * Switch compressors about every 2 minutes or earlier iffatigued, High-Performance Teamwork With resuscitation teams, high-performance teamworkis a critical element of providing high-quality CPR and increasing survival rates, Resuscitation skills competency is most often verified on an individual basis despite the fact that successful patient outcome from cardiac arrest depends ona team. Students will earn about high-performance teamwork. and will practice It in the classroom, 1"2 High-performance teams effectively incorporate timing, quality, coordination, and ‘administration of the appropriate procedures during a cardiac arrest (Figure 1). These 4 key areas of focus include the following specifies: + Timing: time to first compression, time to first shock, CCF ideally greater than 80%, minimizing preshock pause, and early emergency medical services (EMS) response time = Quality: rate, depth, complete recoll; minimizing interruptions; switching compressors every 2 minutes or sooner if fatigued: avoiding excessive ventilation: and always using a feedback device + Coordination: team dynamics; team members working together, proficient in their roles + Administration: leadership, measurement, CQI, number of participating code team members ‘Teams function differently in different facilities and in all out-of-hospital settings. Knowing the policies and procedures and the local protocols of your classroom audience is essential toiinstructor preparation, Figure 1. Key areas of focus for high-performance teams to inerease survival rates, iming Quality Seca eee Beer ra at z parma High-Performance Teams Trou) ee The Role of a CPR Coach in a Resuscitation Team ‘When caring for a cardiac arrest victim, the resuscitation team must perform many important tasks. Efficiently coordinating these tasks is critical to improving patient ‘outcome. The Team Leader is typically responsible for monitoring the performance of BLS skills in addition to overseeing many other critical tasks, Coordinating so much at once is difficult and can lead to delays and errors in treatment. For these reasons, many resuscitation teams now include the role of CPR Coach. The CPR Coach supports performance of high-quality BLS skills, allowing the Team Leader to focus on other aspects of clinical care. Studies have shown that resuscitation teams with a CPR Coach perform higher-quality CPR with higher CCF and shorter pause durations compared with teams that don't use a CPR Coach. ‘The CPR Coach does not need to be a separate role; they can be blended into the current responsibilities of the Monitor/Defibrilator. The CPR Coach's responsibilities begin with the start of CPR. A primary focus is to coach team members in performing high-uality BLS skills and help them minimize pauses in chest compressions. Here is a brief summary of 7 specific responsibilities: Coordinate the start of CPR: As soon as the patient is identified as pulseless, the CPR Coach prompts action by saying, "lam the CPR Coach. There is no pulse, so let's starta compressions.” The CPR Coach then prepares the environment to optimize compressions. This may include lowering the bed and bed rails, getting a step stool, or rolling the victim to place the backboard and defibrillator pads. These actions help prevent Compressor fatigue and ensure high-quality compressions. Coach to improve the quality of chest compressions and ventilation: The CPR Coach does the following to help improve the quality of chest compressions and ventilation: * Convey objective data from a CPR feedback device to help the Compressor improve performance. Team members’ visual assessment of CPR quality is commonly inaccurate. * Coach performance of compressions (le, depth, rate, and chest recoil) and ventilation (ie, ventilation rate, volume and if needed, compression-to-ventilation ratio). + State the specific midrange targets to help team members perform compressions and ventilation within the recommended range (eg, tell them to compress at a rate of 110/min instead of a rate between 100 and 120/min). * Give corrective feedback and reinforce positive performance of CPR skills with specific acknowledgment (eg, good job with compression depth). Coordinate provider switches and defibrillation: The CPR Coach helps minimize the length of pauses during provider switches and defibrillation. The goal is to pause for less than § seconds. Here is an example of a CPR Coach's dialogue: “Team Leader, we have 30 seconds until the next pulse check. Next Compressor, please come stand by the current Compressor. !iprecharge the defibrillator, and then ll give a 5 second countdown. The Compressor will stop compressions at 1 second. Then, the Compressors will switch and hover over the chest. Well check a pulse, and the Team Leader will assess the rhythm. Ifit's a shockable rhythm, well shock immediately and then resume compressions.” Coordinate the placement of an advanced airway: The CPR Coach coordinates the placement of an advanced airway to minimize interruptions in compressions. First. the CPR Coach ensures that the Team Leader and Airway provider have a shared understanding, “My understanding is that we'll attempt intubation without stopping compressions. If that doesn't work, we can pause for up to 10 seconds for the intubation attempt. Is that correct?” Then, the CPR Coach announces the start of the intubation attempt and coordinates a pause if needed. Once the pause duration reaches 10 seconds, the CPR Coach directs the Compressor to start compressions again Instructor Tips * Any healthcare professional can be a CPR Coach. This person must have a current BLS Provider card, understand the responsibilities of a CPR Coach, and demonstrate the ability to coach Compressors and Airway providers effectively to improve performance. ‘+ The CPR Coach should be positioned next to the Defibrillator and in the direct line of sight of the Compressor. + Because the CPR Coach must continually talk to give ongoing coaching, they must modulate their voice's tone and volume so that they do net disrupt other aspects of patient care. ‘+ The CPR Coach should respect the Team Leader's ole and not be perceived as trying to take over leadership. They should keep the Team Leader informed, share their understanding with the Team Leader, and ask for verification of key tasks and decisions. Calculating CCF Healthcare providers can calculate CCF mechanically by using a feedback device or ‘manually by using 2 timers. One timer measures the total code time from code start until code stop or the return of spontaneous circulation, and a second timer measures the total chest compression time. To measure chest compression time, the second timer is 3“ started each time compressions begin or resume andis stopped during each pause in ‘compressions. The chest compression time is then divided by the total code time to equal CCF: CCF = actual chest compression time/total code time Prebriefing Effective briefing before a learning event, known as prebriefing, helps establish a safe environment for learning. Educators can build a sense of psychological safety by prebriefing to let students know that mistakes are expected and serve as sources of learning and that interpersonal risk-taking is encouraged. Effective prebriefing bullds rapport between students and instructors and ‘encourages feedback receptivity by clarifying performance targets and explicitly outlining aspects of performance feedback relevant for the session so that students know what to expect: timing, sources, purpose [training or assessment). for example. + Prebriefing should establish a supportive learning environment where itis safe to make mistakes and learn from them. + This includes highlighting key performance goals and performance expectations, ‘emphasizing the importance of ongoing practice, actively preparing students for the feedback they will receive, and describing when and how the debriefing will occur. + Setrules and realism for the simulation. = The high-performance team should establish goals and then discuss if those goals were met in the structured debriefing afterward. Feedback and Coaching Attimes, you will need to help a student master a skill This may require expertise in ‘communication and educational creativity. The fundamental principle of AHA courses is that students who are not able to master the required skills during the course can practice until they do. Instructors should be committed to finding and using the proper techniques that will be effective for a particular student. Adult learning principles coupled with debriefing techniques usually make for an effective combination. Here are some suggestions: + Review the objectives for a particular scenario or skils station with the student, * Give positive feedback when desired actions are observed; ask open-ended questions when nonpreferred actions are abserved to determine the student's thought process. + Use the same scenario repeatedly if necessary until the student accomplishes the objectives. Debriefing Debriefing is an organized, evidence-based, student focused process that takes place ina nonthreatening environment. tis a method of assisting students in thinking about what they «id, when they didit, why and how they didi, and how they can improve. Inan effective debriefing session, instructors ask questions and encourage students to analyze their own performance rather than offer only the instructor's perspective. Because this approach is focused on what the student thinks and does rather than on the instructor's viewpoint, students are more likely to remember and apply the lessons in their practice. Feedback vs Debriefing Simple feedback is typically geared toward correcting student actions the instructor has observed—an approach that can sometimes have the unintended consequence of fixing one mistake only to oreate others. Effective debriefing, on the other hand, focuses more on understanding why students acted a certain way, which allows correction of their thinking, 7 ‘Students typically do things for a reason that makes sense to them. Good debriefing helps students review their own performance and achieve a deeper understanding.a Although debriefing takes longer than simply giving feedback, reframing students’ understanding will make the lesson more applicable to real fe and will have a more lasting impact on future performance. Effective Debriefing Characteristics Effective debriefings must be ft for the purpose and focus on how to achieve performance standards. Specifically, instructors should attend to the established debriefing processes, tailor debriefings to context, use debriefing scripts to promote debriefing effectiveness, and view training as an opportunity to model debriefing practice and to prepare students for the process of a debriefing after actual clinical events, Students need performance data to improve; these data should be included in debriefings Whenever possible. Quantitative data provided during resuscitation education should come from several sources, including instructors, CPR devices, and data from simulators. Some data may be available in real time; other data, during debriefings, Feedback and debriefing should be part of a larger curriculum design and should not occur inisolation. These powerful educational interventions are integral elements to overarching curriculum design considerations. ‘The characteristics of an effective debriefing session include * Active participation * Student discussion * Self-analysis, = Application + Thorough processing of information With effective debriefing, students should * Analyze and evaluate what happened ‘+ Recognize how tools can help them manage situations + Develop the habit of self-critique We recommend using structured and supported debriefing, alearner-centered debriefing ‘model that focuses on what the student knows and thinks. This approach draws on evidence-based findings from behavioral science to focus on critical thinking and encourage students to analyze their motivations and performance. Itis an efficient and organized process to help students think about what they did—why, how, and when they did it and how they can improve. ‘Structured and supported debriefing follows a simple 3-step format to achieve a comprehensive and effective debriefing * Gather information about the events. + Analyze the information by using an accurate record. ‘+ Summarize the attainment of objectives for future improvement. Structured elements include the 3 specific phases described in Table 2, while supported elements include both interpersonal support and the use of protocols, algorithms, and best evidence. Be sure to allow enough time to conduct a debriefing session after each case. scenario. 15‘Table 2. Structured and Supported Debriefing Process fod Goal re ~ Gather | Askwhathappened | » Requestanarative from the Team Leader. duringthe case,to | « Request clarifying or supplementary information from developa shared the high-performance team. ‘mental model of the events. Listen to students to understand what they think and how they fee! ‘about the simulation. Analyze | Faciltate students’ | + Review an accurate record of events, reflection on and + Report observations (both correct and incorrect analysis of their Stepel actions. ‘Assist students in thoroughly effecting on and ‘examining their performance during the simulation {as well as in reflecting on their perceptions during the debriefing. Direct and redirect students during the debriefing to ‘ensure continuous focus on session objectives. ‘Summarize | Faciitateidentfication | + Summarize comments or statements from students andreview ofthe Have students identify positive aspects of theirhigh- ea pporformance team or individual behaviors. cal eis Hove students deny areas oftheir high- performance team or individual behaviors that require hange or correction. ‘You should view yourself as a facilitator whose goals are to enhance learning during the : training session and encourage students to critique themselves and reflect on future clinical encounters, This promotes continued self-improvement and will have a long-lasting effect well beyond any individual course. ‘A good facilitator effectively uses the key skills of listening, genuine inquiry, and open- tended questions to determine how the student understood the situation and what he or she \was thinking, Correcting a particular action will have an impact on only a single behavior; correcting an approach will affect the student's actions in a variety of situations, “Appropriate pauses and silence can give students the time they need to formulate their ‘thoughts. Demonstrating the usefulness of protocols and algorithms is also part of an effective facilitation, ‘Structured and supported debriefing can help facilitate learning the skills and techniques needed for clinical practice. Itis also important that you model and encourage good debriefing techniques because debriefing of actual resuscitation events can be a useful strategy to help healthcare providers improve future performance in clinical practice.) Contextual Learning ‘Another core concept for resuscitation training isto use training experiences that apply to students’ real-world scope of practice. + Consider that cifferent students find relevance indifferent things and tailor the learning ‘experience for the types of students, their settings, and the resources available in their environment. + When simulating resuscitation, acknowledge that manikin fidelity is not enough and use manikin features that matter. These features should engage students and be relevant to ‘the learning objectives. + Enhance realism for team training by ensuring that team composition, roles, and ‘contexts are right for your student groups. * Don't be afraid to stress your students (to a certain extent). The right amount of stress ‘can enhance experiential learning by maximizing student engagement. 718 ars PRCT ee Cay ‘The AHA requires successful completion of skills tests, as well as an exam in instructor led courses or successful completion of the online portion of HeartCode, for a student to receive a provider course completion card ‘The prompt and accurate delivery of provider skills and knowledge is critically important for patient survival, Accurate, objective, and uniform testing reinforces these lifesaving skills ‘and knowledge ands critical for the consistent delivery of content by all instructors. All AHA Instructors are expected to maintain high standards of performance for all skills tests, as discussed in the following sections. Skills Testing During skils testing, students must demonstrate competency in all skils without any assistance, hints, or prompting from the instructor. Instructors of the appropriate discipline will evaluate each student for his or her didactic knowledge and proficiency in all core psychomotor skills of the course. No AHA course completion cards issued without the required skills testing by either an AHA Instructor for that discipline or an AHA-approved computerized manikin in an AHA eLearning course. ‘Students in advanced life support courses are not required by the AHA to have a current BLS Provider card, but they are expected to demonstrate proficiency in BLS skills. Training Centers do have the option to require a current BLS Provider card, but requiring the card does not mean that BLS content and testing may be omitted from advanced courses. Skills Testing of Blended-Learning Students Instructors may need to conduct skills practice and testing during the hands-on session of ablended-learning course. The lesson plans in Part 6 will help facilitate these sessions, ‘The skills testing portion of the hands-on session should be conducted the same as in an instructor-led course. Some skills tests may require that additional students be present while the tests are being conducted (refer to Part 4 for further details). Exam ‘The exam measures the mastery of cognitive knowledge in ECC instructor-led healthcare courses Each student must score at least 84% on the exam to meet course completion requirements. ‘The AHA has adopted an open-resource policy for exams administered through an eLearning course or ina classroom-based course, Open resource means that students, may use resources as a reference while completing the exam. Resources could include the provider manual, either in printed form or as an eBook an personal devices, any notes the student took during the provider course, the 2020 Handbook of ECC for Healthcare Providers, the AHA Guidelines for CPR and ECC, posters, etc. Open resource does not mean open discussion with other students or the instructor, Students may not interact with each other during the exam, Inthe welcome letter you send to students with their course materials, emphasize the importance of bringing their books to class to use during the exam. Students using the ‘eBook version should download the manual to their device's eReader app and bring it with them in case there is no Internet connection. Exams are administered online, though there may be an occasional need to administer @ paper exam. More information about exams can be found on the Instructor Network. Ifyou use a paper exam, grade the exam, and answer any questions as soon as the student retursit. Students who score less than 84% will need to take a second exam or receive verbal remediation to confirm knowledge and understanding, If you give a student a secondexam, review the first exam with the student, allowing them time to study the questions they got wrong. If you provide verbal remediation, ask the student to verbally answer the uestions that he or she answered incorrectly, and document on the answer sheet whether the student correctly answered each question. You must document on the answer sheet that the remediation was successful, and that the student achieved a passing score. fa studenthas difficulty reading or understanding the written questions, you may read the exam to the student. You must read the exam as written and in a manner that does not indicate the correct answer. You may verbally translate the exam if needed, ECC blended-learning healthcare courses have a cognitive assessment incorporated into the online portion, so an exam does not need to be given to students when they attend the classroom portion. Exam Security Exam security is of the utmost importance: * Ensure that all exams are kept secure and not copied or distributed outside the classroom. + Exams are copyrighted: therefore, Training Centers or instructors may not alter them in ‘any way or post them to any learning management systems such as Internet or intranet sites. This includes precourse self-assessments* * When a paper exam must be used, always print the most current version from the online exam platform for the course you are teaching, * Each paper exam should be accounted for and returned to the instructor at the end of the testing period. “Exams are transiated into multiple languages. Ifa translated exam is needed for a course youre teaching, have your Training Center Coordinator contact ECC Customer Support to find outif the needed translation is available, Remediation Provider Course Student Remediation ‘Attimes, you will have to provide remediation to a student who is unable to perform satisfactorily in portions of the course, This is often resource-intensive and may require considerable expertise in communication and educational creativity. The fundamental principle is that every student who is not able to master the required skills during the course is still able to benefit from remediation, The instructor should be ‘committed to finding and using the proper techniques that will be effective for a student. ‘Aduit learning principles coupled with debriefing techniques usually make for an effective combination. Here are some suggestions: + Review the objectives for a scenario or skills station with the student. * Give positive feedback when desired actions are observed; ask open-ended questions when nonpreferred actions are observed to determine the student's thought process. * Use the same scenario repeatedly if necessary untl the student accomplishes the objectives. Consider using another instructor to provide remediation because that instructor might be able to offer an alternative approach that will be helpful for the student. : ‘At the time of the course, remediation for some students might not be successful within certain sections of the course (or exam or skills tests}. When this happens, the student may arrange for a separate remediation session. A student must meet all learning objectives to the satisfaction of the Course Director or Lead Instructor before receiving a course completion card. 9Students must complete all remediation sessions, including exams, skills tests, and skills stations, within 30 days after the last day of the original course. The remediation date will be listed as the issue date on the course completion card. fa student does not successfully complete all course requirements within 30 days, the ‘course is considered incomplete and a course completion card will not be issued. Remediation Concepts for Instructors Remediation is a learning process in which the instructor provides additional opportunities for the student to master the required skills of the course Informal remediation occurs throughout the course and is part of the learning process. When a student is having difficulty mastering a skill, he or she can be placed lastin line for performing skills for practice and/or testing. This gives the student additional time to ‘observe and learn from other students. Formal remediation occurs after a student has been formally tested ina skills or core case testing station and has been unable to demonstrate mastery. Have the student work one- ‘on-one with an instructor during breaks, lunchtime, or at the end of the day to assess areas {or improvement in performing a skill. hen, encourage the student to practice and, when ready, to indicate when he or she wishes to be tested. Itis important to communicate the need for formal remediation in a private, sensitive, and ‘objective debriefing immediately after the testing has taken place by using the scenario critical action objectives as a guide. Every student, with rare exceptions, should be able to benefit from remediation, Commit to providing remediation for students who have difficulties learning the skills and principles in the course the first time through, « Instructor styles of facilitating and student styles of learning may not match therefore, a ‘change of instructor may be necessary. Dor't assume that poor performance is associated with a lack of knowledge. There may be other factors (eg, personal or work-related issues) that are influencing the student's performance. « Ifa student is stil having difficulty after receiving remediation, you may need to examine the student's style of learning and make adjustments. «+ The role of the instructor isto facilitate learning. Always be respectful, courteous, positive, professional, and diplomatic when providing remediation to a student. ‘Additional materials to assist in remediation will be provided in a later section of the manual. Steps to Successful Remediation You may find these steps helpful when providing remediation: «+ Review the critical action steps that the student did not perform satisfactorily. «+ Using open-ended questions (debriefing tool), assess the student's thought process, and correct itif necessary. + Identify whether other factors might have affected the student's performance (eg, performance anxiety) «= Use the same or a similar scenario for retesting the student (eg, ifthe initial scenario was a respiratory case, use a respiratory case again for the retest) + Use other students who need remediation or other instructors to help forma high- performance team to manage the case scenario, «= Ifperformance anxiety or an instructor-student personality clash is a factor, ask another instructor to conduct the remediation. Instructors should make every effort to correct knowledge and skills deficits during the course, Doing so can help minimize the chances that students will require formal remediation at the end of the course.OO) BG TE Program Evaluation Ongoing evaluation and improvement of AHA materials and instructors are important to the ‘AHA, Each student should have an opportunity to evaluate the class. As an instructor, itis your responsibilty to provide that opportunity. There are several options for how a course evaluation can be provided. * Paper evaluation: A template for a written evaluation is available on the Instructor Network. Make enough copies so all your students can complete the evaluation at the end of the course and retur it to you. Review the feedback, and then send the Completed forms to your Training Center Coordinator, * eCard survey (United States): you are an instructor with a US Training Center and your Training Center is issuing eCards, your students will complete an online evaluation before they claim their course completion card. eCard surveys are another important ‘way to gain valuable feedback from your students on their overall satisfaction of the course. eCard Reports are available on the Instructor Network, * Online evaluation (international): f you are an instructor with an International Training Center, your students are encouraged to complete an evaluation online before they can ‘claim their CPRverify™ course completion card (eCard) in addition, instructors can have students complete the paper evaluation located on CPRverify. Issuing Provider Course Completion Cards Each student who successfully completes the course requirements will be issued an AHA. Course completion card (eCard or printed). More information can be found on the Instructor Network. No AHA course completion card is issued without hands-on manikin skills practice and testing by an AHA-approved computerized manikin as part of an AHA eLearning course or by an AHA Instructor for that discipline. Continuing Education/Continuing Medical Education Credit for Courses Most ECC online and blended courses offer continuing education (CE/continuing medical education (CME) credit and are designed to meet CE criteria. The CE/CME certificate is ‘automatically generated when students complete a course and claim their credit. This may not be the same as the certificate of completion, ‘Some classroom courses also offer credit for EMS professionals. The AHA is contracted to offer all EMS students CE hours through the Commission on Accreditation for Prehospital Continuing Education (CAPCE). Because there are contractual obligations to make CAPCE credit available to all EMS professionals completing a qualifying course, your Training Center and you. as an instructor, are required to collect and submit the information requested: first name, last name, and email address. The submission is done through the Instructor Network. Each students then sent an email invitation to provide the additional needed information and claim his or her credit. While the information for all EMS students must be submitted, students are not obligated to accept or claim their certificates, CAPCE accreditation does not represent that the content of a course conforms to any national, state, or local standard or best practice of any nature, If you would lke to offer CE credit to other professionals who attend your instructor-led (> 20u5es, you will need to work with your Training Center or employer to apply for credit through the appropriate authorizing body. Visit the Instructor Network to learn which courses offer CE/CME eredit and to find more information and updates. arovider Renewal Renewal Timeline The current recommended timeline for renewal of an AHA course completion cardis every 2 years. Although there is insufficient evidence to determine the optimal method and timing of retaking a course, research on skills retention and training show the following: «+ There is growing evidence that BLS knowledge and skills decay rapidly after initial training, + Studies have demonstrated the deterioration of BLS skills in as little as months after initial training, «+ Studies examining the effect of brief, more frequent training sessions demonstrated improvement in chest compression performance and shorter time to defibrillation. «+ Studies also found that students reported improved confidence and wilingness to perform CPR after additional or high-frequency training Given how fast BLS skills decay after training, and with the observed improvement in skills ‘and confidence among students who train more frequently, students should be encouraged to periodically review their provider manuals and practice skils whenever possible. In addition, instructors and Training Centers may offer opportunities for students to practice ‘and test their skills between course events,) GES en > Recruiting and Mentoring Instructors You may have students in your course who want to become AHA Instructors. The AHA encourages you, as a current AMA Instructor, to take a moment to pass along this information to all students who are interested in becoming an instructor after they successfully complete the provider course. ‘AN AHA Instructor course teaches the methods needed to effectively teach others. The ‘AHA requires that instructors be at least 18 years of age to attend an AHA Instructor course Instructor Candidate Selection The ideal instructor candidate * Is motivated to teach * Is motivated to facilitate learning * Is motivated to ensure that students acquire the skills necessary for successful course ‘completion * Views student assessment as a way to improve individual knowledge and skills Instructor Course Prerequisites Prospective participants in an AHA Instructor course must + Have current provider status in the discipline they wish to teach * Gave completed an Instructor Candidate Application (obtained from the Training Center Coordinator) Receiving an Instructor Card ‘Your instructor card for your discipline is issued by your primary Training Center. This may ot be the same Training Center where you took your training or monitoring Allinstructor cards are valid for 2 years. If you are a new instructor: * You must be monitored teaching your first course within 6 months after completing the classroom portion of your training. A current Training Faculty member for your discipline must monitor you while you teach an initial provider course or an update or renewal ourse. It's your responsibilty to schedule this monitoring, working withthe Training Faculty member who conducted your course or with the Training Center Coordinate; of your Training Center. * Youwillreceive your instructor card from your Primary Training Center once you have #uccesstully completed all monitoring requirements. The expiration date willbe 2 years from the month you completed all requirements, including monitoring * You must register on the Instructor Network with your Primary Training Center so that youreceive your instructor ID number. This number is placed on the back of your card, So youneed it before your card can be issued. Any questions about receiving your instructor card should be directed to your Training Center Coordinator Instructor Renewal Criteria: BLS four instructor status must be renewed by a Training Faculty member. You can renew your BLS instructor status by meeting all of the following criteria or by successfully completing all requirements for a new instructor. * Maintain current provider status. You can do this by maintaining a current provider card or by demonstrating exceptional provider skills toa Training Faculty member and by Successfully completing the provider exam. 23« Ir you choose the demonstration route, successful completion must be documented ons Instructor Training Faculty Renewal Checklist. Anew provider card may be issued Sth discretion of the Training Center or if ou request one, but itis not required by the AHA. «+ Earn 4 credits during each 2 years of your instructor recognition by doing any combination of the folowing: Teach an instructor-led BLS or Heartsaver® class. Each class counts as 1 crecit. ~ Conduct the hands-on skills session for a blended-learning course. Each day of oan Gade BLS hands-on sessions or Heartsaver hands-on sessions counts 2s ‘credit. — Conduct BLS and AED skils testing during a Pediatric Advanced Life Support PALS! Podiatric Emergency Assessment, Recognition, and Stabilization (PEARS oF Peeiiod Carciovaccular Life Support (ACLS) class. One credit is awarded per class. — Facilitate a Family & Friends® class. Each class counts as 1 credit. « Attend updates as required within the previous 2 years. Updates may address new aac ePatent or methodology and review Training Genter, regional, and national ECC information «+ Be monitored while teaching before instructor status expiration. The first monitoring efter the Instructor Essentials Course does not satisfy this requirement, Special Exceptions to Teaching Requirements ‘The requirement for instructors to teach a minimum of 4 courses in 2 years to renevi instructor status may be waived or extended under special circumstances. These circumstances include, but are not limited to, the following: « Callto active miltary duty for an instructor who isin the miltary reserve or National Guard), Monitoring during duty may be waived if Miltary Training Network Faculty members are not available « iliness or injury that has caused the instructor to take aleave from employment or teaching duties: « A imited number of courses offeredin an area because of lack of audience or delay of course materials ‘The Training Center Coordinator, in consultation with the assigned Training Faculty. may decide to waive the teaching requirements for the discipline in question. Consideration ‘Should be given to the amount of time an instructor is away from normal employment the length of delay in release of materials, and the number of courses taught in relation to the number of teaching opportunities. Documentation supporting the decision must be maintained in the instructors file. All other requirements for renewal must be met a5 stated previously.aD Preparing for the Course Re Tea Course Goal ‘The goal of the BLS Course is to train participants to save the lives of victims in cardiac arrest through high-quality CPR. The AHA designed the BLS Course to teach healthcare professionals how to perform high-quality CPR individually or as part of a team. BLS skills are applicable to any healthcare setting, BLS students will learn rescue techniques for adults, children, and infants. Learning Objectives At the end of the BLS Course, students willbe able to + Describe the importance of high-quality CPR andits impact on survival + Describe all the steps ofthe Chain of Survival + Apply the BLS concepts ofthe Chain of Survival + Recognize when someone needs CPR + Perform high-quality CPR for an adult a child, and an infant * Describe the importance of early use of an AED + Demonstrate the appropriate use of an AED + Provide effective ventilation by using a barrier device + Describe the importance of teams in muitrescuer resuscitation + Perform as an effective team member during multiescuer CPR * Describe how to relieve foreign-body airway obstruction for an adult, a child, and an infant Educational Design The AHA’s BLS Course is designed for healthcare providers caring for patients both in and ‘out of the hospital setting. Three different course formats are available to accommodate the learning needs of individual students and offer flexibility for instructors. All 3 course formats. include the same learning objectives and result in the same course completion card. A list of available formats is below. * Instructor-led training: This option is led by an instructor in a classroom setting, Instructors deliver courses designed to include both the cognitive portion of training and the psychomotor component of thorough skills practice and testing, * Blended learning: Blended learning uses oniine technology not only to supplement butalso to transform and improve the learning process. Successful blended learning can reach students with varying learning styles and in different environments, Iisa combination of eLearning, in which a student completes part of the course a self-directed manner, and a hands-on session with an instructor or a HeartCode- compatible manikin,268 «+ Resuscitation Quality Improvement® (RQI®): A unique ECC program designed specifically for training actively employed healthcare providers in clinical environments. Unlike the traditional instructor-led and blended courses, the RQI programis a — maintenance-of-competence platform designed for site-specific adoption. Benefits of Blended Learning ‘The online component of the blended-learning experience benefits both students and instructors, Online learning accommodates many different learning styles. For example, ‘some students prefer learning in a self-directed environment as opposed to @ group setting, {Also, online learning is time efficient for the following reasons: «+ Students have the flexibility to take the online instruction whenever their schedules permit. Time spent ata Training Center or other facility for supervised practice and testing is reduced. « Instructors have more time to focus on students’ learning needs, such as answering questions, coaching, and skills development. «+ Testing of core concepts is completed online, so students do not have to wait for other Students to finish taking the exam, and instructors have more time to focus on students’ learning needs. Preparing to Teach HeartCode BLS To be prepared to teach HeartCode BLS, the blended-learning program for BLS. we recommend that instructors take the online component of the course. This will help instructors understand what students learn there as well as answer questions students may have about the online course. As with instructor-led courses, all online courses are developed by using educational principles and best practices. Course materials are presented ina way that helps students learn and retain the information, Students are required to complete all online course activities, which are designed to teach and test core concepts. The online instruction is also designed to help students transfer and apply their knowledge to skills performance. Instructors should review all course materials, including the instructor manual, skills testing checklists, critical skills descriptions, and skils sections of the course video. Because some ‘students may require more in-depth information, instructors may want to review the high performance teams and CCF sections in the course video as well Understanding HeartCode BLS ‘The online component of HeartCode BLS uses 2 variety of learning assets—such as ramatizations, animations, self-directed learning, and interactive activities—to teach students the knowledge and skills of BLS. After completing the online portion, students will complete a hands-on skils session either with a HeartCode-compatible manikin or by attending an instructor-led session that focuses on meaningful skills practice, debriefing, team scenarios, discussions of local protocols, and skills testing. Validation of Online Course Certificates When a student has completed the online portion of any AHA course, a skills practice and testing session must be completed with an AHA Instructor or an approved HeartGode- compatible manikin ‘As a BLS Instructor, you may be asked to do a skills practice and testing session for HeartCode BLS or any of the Heartsaver online courses. You can confirm that the certificate a student brings you is vali. ‘To validate a student's online completion certificate, go to ning.heart.org/verify certificate, ~0 Es Who Can Take the Course ‘This course is designed for healthcare providers and trained first responders who provide Care to patients in a wide variety of settings or by those in a healthcare training program. Course Flexibility ‘The AHA allows instructors to tailor the BLS Course to meet audience-specific needs Consider these examples: * Ifyou are teaching this course to staff at a children's hospital, you might want to include extra practice time on infant and child manikins. + You may choose to adapt situations to the specific location. *+ You may eliminate “phone 9-1-1" for students who are EMS professionals and other emergency responders, ‘Any changes to the course are in addition to the basie course contents as outlined inthis ‘manual and will add to the length ofthe course. instructors may not delete course lessons ‘or course components. Any additions or alterations to the course must be specifically identified as non-AHA material. Please refer to the section titled Non-AHA Content inthis instructor manual for further detail Who Can Teach the Course AHA courses must be taught by AHA Instructors who have current instructor status in their specific discipline, An AHA Instructor in the appropriate discipline must also perform the D> _ formalassessment or testing of students, Lead Instructor 'f more than 1 instructors teaching in a BLS Course, a lead instructor needs to be designated. The lead instructor will oversee the communication among all instructors before and during the course, The lead instructor will also be responsible for issuing and ensuring that students receive course completion cards from the instructor's Training Center and that all course paperwork (eg, roster, skills testing checklists, course evaluations) is supplied for the training, ‘The following guidelines apply to lead instructors for provider courses: * Each BLS Course must have a lead instructor physically on-site throughout the course. + The lead instructor can also fil the role of instructor in the course. * The lead instructor is responsible for course logistics and quality assurance. * The lead instructor is assigned by the Training Center Coordinator, Instructor-to-Student Ratio The course size for the BLS Course is flexible, The course is designed fora ratio of 3 Students to 1 manikin, with no more than 2 manikins to 1 instructor (6 students to 2 ‘manikins to 1 instructor). With this ratio, 1 instructor observes 2 students during video-led manikin practice (practice while watching). The video for the course is designed to allow the ractice-while-watching sections to be repeated as many times as needed, Experienced instructors may monitor as many as 3 manikin stations at atime while the Students practice. This would change the ratio to 9 students to 3 manikins to 1 instructor. (OY For optimal practice time during the course, each student should have his or her own ‘manikin, if possible, However, using a 1:1 student-to-manikin ratio will not decrease overall Class time. One instructor cannot adequately monitor more than 3 manikin stations during & single practice-while-watching video segment. For skills evaluation, use a 1:1 instructor-to-student ratio. 27Course Planning and Support Materials Sample Precourse Letter to Students (Classroom Course) ‘The letter below is a sample you may modify and send to students attending the BLS Course. [ ate | Dear BLS Course Student Welcome tothe BLS Course. Enclosed are the agenda and your copy of the BLS provider Manualto help you prepare fr the program and the exam, Please bring our £39 Provider Manuato class: you vill beable to refer tot during class andthe exam. ove veing the eBook version, make sure your devices fly chargedane downoad tho manual to your device's eReader app in case there is nointemmet connection Review both the agendas andthe manual before coming to class so that youtearn more and are more comfortable with the course Date: | The classi scheduled for | a | vos ar toge confortable cating Youwilbe practcngsiithatrequre | trorking on yourhands and knees, bending standing, and iting. you have physical Te ae eu tam portaptinginte course loses one of conctons tat ight Preven yo0 tne arctrwitworkioeccommadatyour | esto en ptonrequrement inthe ever thet youre about the course, please call name) at [telephone number) Sincerely, (Name), Lead Instructor | tietook forward to weleoming youn Sy and date fas). youhave any questionsSample Precourse Letter to Students (HeartCode BLS) ‘The letter belowis a sample you may modify and send to students completing HeartCode BLS. (Date) Dear BLS Course Student: Welcome to the HeartCode® BLS Course, This course has 2 components: an online portion and an instructor-led classroom portion. You must complete the online portion first. You can access the online portion of the course by using this unique URL: [student's license URL). Important: You must print the certificate of completion at the end of the online portion You will need to give this to your instructor when you attend the classroom portion. It isnecessary to show that you completed the online portion. f you do not have your certificate of completion, you will not be able to complete the skills practice and testing ofthe course, The classroom portion is scheduled for Date: SS Time: — Location Please wear loose, comfortable clothing. You willbe practicing skills that require working on your hands and knees, bending, standing, and lifting If you have physical Conditions that might prevent you from participating in the course, please tell one of the instructors when you arrive for class. The instructor will work to accommodate your needs within the stated course completion requirements. In the event that you are il, please notify your instructor to reschedule your training, We look forward to welcoming you on (day and date of class). you have any questions ‘about the course, please call name) at (telephone number) Sincerely, (Name), Lead instructor (Room Requirements When selecting a location for a BLS Course, make sure the room has = + Good acoustics + Aclean and well-maintained environment Bright lighting that can be adjusted for video presentations + Aninstructor-controlled video player and a monitor or screen large enough to be viewed byall the students A chair for each student Ideally, a firm surface with adequate padding/protection for skills practice (eg, carpeted floors, sturdy table top, hospital bed, padded mats) * Atable for completing the exam Sample Floor Plan Figure 2 shows a sample floor plan. Arrange the room so that all students can see the video ‘screen and instructors can monitor student groups during practice. Figure 2. Sample oor pian. hal © =Menikin — @ =Student Core Curriculum Each AHA course must follow the guidelines and core curriculum in the most current ditions of the BLS Provider Manual and BLS Instructor Manual. Current editions of AHA. course materials must serve as the primary training resources during the course. Equipment List Equipment required for each class held is tsted inthe table below. All equipment used must be in proper working order and good repair.D>) Course Materials * Course roster: 1 perclass * Course agenda: 1 per instructor, 1 per student fifrequested) + Lesson plans: 1 per instructor * Course video: 1 per class Checklists and Exams * Skills testing checklists: 7 per student + Exam version 1: Paper copies as needed for backup for online exam {for classroom-based students) + Exam version 2: Enough copies for remediation, if needed * Blank exam answer sheet: 2 paper answer sheets per student as needed (for classroom-based students) + Exam answer key: 1 for each exam version + Course evaluation: 1 per student (for classroom-based students) + Pencil or pen: 1 per student Reference Material * BLS Instructor Manual: 1 per instructor * BLS Provider Manual: 1 per instructor, 1 per student Equipment * AED trainer with adult and pediatric pads: 1 per student group" + Manikins (adult/child, infant) (child manikin is optional): 1 per student group" + Pocket mask: 1 per student () + Disposable mouthpiece: 1 per student + Bag-mask device (appropriate sizes for each manikin used): 1 per student + Stopwatches: 2 stopwatches per instructor ideo player and monitor or screen large enough for all students to view: 1 per class *+ Manikin cleaning supplies (eg, alcohol pads): 1 setper class “Student group: 1 per group of3 students if 3:1 student-to-manikin ratio, except during the High= Performance Teams Activity 31Teaching the Course ‘The BLS Course is equipped to provide instruction to healthcare providers caring for Patients both in and out of the hospital. The course's abilty to serve both of these audiences is supported inthe instructor-led (classroom) course and HeartCode BLS by both instructor and student materials. Instructor- ‘The lessons featured on the video in the instructor-led BLS Course are based on real-world Scenarios that show skills being demonstrated in settings for each type of BLS provider. in-facilty provider or prehospital provider. To adapt to your classroom audience, as an instructor you have the option to choose between infaciity and prehospital lessons as you Navigate through the video during the course. Blended Learning Students participating in HeartCode BLS experience the same talioing to theirneeds by SelFidentitying as in-facity provider or prehospital provider. On the basis oftheir resporsse, Students navigate through the appropriate content of the online portion of the course. They view the same real-world scenarios featured in the instructor-led BLS video to prepare for skills practice and testing in the classroom. {The instructor manual. lesson plans, provider manuel, and testing are designed to support Poth the instructor-led training and blended-iearning formats ofthe course. Part 2 Preparing for the Course and Part 4: Testing will explain more about using each of these materials,Understanding Icons ‘The icone used in the lesson plans. inthis manual, andin the BLS Course videos are thereto \— remind you to take certain actions during the course, The lesson plans and videos contain the following con: Discussion Pray video oO Video pauses fo Stop video Students practice while watching video (instructors press Play to begin) ‘Students practice - S Repeat segment ieee eee ae Exam or skills test 2 In-faclity provider Prehospital provider ———————— Eee Understanding Lesson Plans 'AI|AHA ECC instructor manuals include lesson plans (Figure 3). The purposes of lesson plans are to «+ Help instructors facilitate ECC courses + Ensure consistency from course to course «+ Keep instructors focused on the main objectives for each lesson «+ Explain the instructor's responsibilities during the courseD> Tire. Somotetessonpian Using Lesson Plans Use lesson plans before the course, during the course, and during skills practice, O) Before the cours Review the lesson plans to understand + Objectives for each lesson * Yourrole for each lesson + Resources that you need for each lesson Make notes of things you want to remember or ad. During the cours + Follow each lesson plan as you conduct the course, + Remind students what they will see in each video segment, ‘+ Make sure you have all the resources, equipment, and supplies ready for each lesson, ‘+ Help the students achieve the objectives identified for each lesson, During practice before a skills test: ‘Astudent may have a question about a certain part of BLS. The lesson plans serve as the authoritative answer. Teaching With a Video ‘The BLS Course and classroom portion of HeartCode BLS are video based, Many of the lessons in the BLS Course use the practice-while-watching format. This means that students practice skills as the video guides them, To make sure that course material is taught consistently and that students benefit from the latest scientific research, show all of the course's video lessons completely. ) Practice While Watching The practice-while-watching method is used to teach skils in the BLS Course. Practice while watching isan effective approach for building skis mastery. 35Practice while watching aids the learning experience by organizing content into the following format: + Tell students what they will earn + Show them, * Allow them to practice * Provide coaching + Summarize what they learned Instructors should use the video to demonstrate correct performance of skills. Allow students time to practice while following the video demonstration. Observe students’ performance of the skills and provide corrective feedback. Finally, give students the option to practice without the video, if needed. Using the Provider Manual Each student must have the current BLS Provider Manual readily available for use before, during, and after the course. Students will need to do the following with the provider manual: + Read it before coming to class * Bringit to class to use as aresource during the exam + Refer to it after the course to maintain knowledge ‘The AHA designed this manual to correspond with the course video. The lesson plans tell you when to refer students to specific sections of the provider manual ‘The provider manual is designed for individual use and is an integral part of the student's education, Students may reuse thelr manuals during renewals or updates until new science guidelines are published, Students taking HeartCode BLS have access to the BLS Provider Manual and other reference materials within the eLearning course, They may access the reference materials, for up to 2 years after the date of key activation. Students should be allowed to bring electronic devices into the classroom to access these electronic materials.aD Course Outlines and Agendas Approximate course duration: 3 hours 40 minutes (forall required lessons); student-instructor ratio 6:1 BLS Course Outline student-manikin ratio 3:1; lesson times below are estimates and can vary from course to course ery Precourse Cy Precourse Preparation erat (in minutes) 1 Course Introduction ‘Rescuer Adult BLS. Part 1: Adult Chains of Survival Part 2: Scene Safety, Assessment, and ‘Adult Compression Part 3: Pocket Mask Part 4: 1-Rescuer Adult BLS AED and Bag-Mask Device Part 1:AED Part 2: Bag-Mask Device 2-Rescuer Adult BLS ‘Special Considerations Part 1: Mouth-to-Mouth Breaths, Part 2: Rescue Breathing Part 3: Breaths With an Advanced Airway Part 4: Opioid-Associated Life- Threatening Emergency Part 5: Maternal Cardiac Arrest High-Performance Teams Part 1:Team Dynamics Part 2: High-Performance Teams Part 3: High-Performance Teams Activity (Optional) ooo 6A (optional) Local Protocols Discussion Child BLS. Part 1: Pediatric Chains of Survival Port 2:Child BLS Part3: 2-Rescuer Child CPR au zs o0soG (continued) a738 fen Corer Infant BLS Part t:Infant BLS Part 2:Infant Compressions Part 3: Bag-Mask Device for Infants Part 4: 2-Rescuer Infant CPR art 5: AED for Infants and Children Less ‘Than 8 Years of Age ee (in minutes) Relief of Choking Part 1: Adult and Child Choking Part2:Infant Choking 0 Conclusion " Skills Tost Port 1: Adult CPR and AED Skills Test Part 2:Infant CPR Skills Test 2 Exam 13 Remediation Part 1: Skills Testing Remediation Part 2: Exam Remediation Postcourse Immediately After the CourseBLS Renewal Course Outline Approximate course duration: 3 hours (for all required lessons); student-instructor ratio 6:1 student-manikin ratio 3:1; esson times below are estimates and can vary from course to course Lesson Corer’ eee ee i) Precourse | Precourse Preparation 1 Course Introduction 2 Adult BLS Part 1: Adult Chains of Survival Part: 1-Rescuer Adult LS Part 3: AED Practice Part 4: Bag-Mask Device 3 ‘Special Considerations Part 1: Mouth-to-Mouth Breaths Part 2: Rescue Breathing Part 3: Breaths With an Advanced Airway Part 4: Opioid-Associated Life-Threatening Emergency Part §:Maternal Cardiac Arrest 4 High-Performance Teams Part 1:Team Dynamics Part 2: High-Performance Teams Part 3: High-Performance Teams Activity (Optional) 4A | Local Protocols Discussion (optional) 5 child BLS. Part 1: Pediatric Chains of Survival Part 2:2-Rescuer Child CPR Part 3: Adult CPR and AED Skills Test (Optional) 6 Infant BLS Part: Infant Compression Part 2:2-Rescuer Infant CPR. Part 3: AED for Infants and Children Less Than BYears of Age Part 4 Infant CPR Skis Test (Optional) 7 Relief of Choking Part 1: Adult and Child Choking Part2: Infant Choking (continued) 3940 er Cee’ Conclusion ee {in minutes) | skis Test Part 1: Adult CPRand AED Skills Test Part2: Infant CPR Skills Test 10 " Remediation Part 1: Skills Testing Remediation Part 2: Exam Remediation Postcourse Immediately After the Courseeal HeartCode® BLS Outline Approximate course duration: 2 hours (for all required lessons}; student-instructor ratio 6:1; student-manikin ratio 3:1 lesson times below are estimates and can vary from course to course Corer’ Cee ets Constr) Precourse Precourse Preparation 1 Course introduction 2 ‘Adult BLS. Part 1: Scene Safety, Assessment, and Adult Compressions Part 2: Pocket Mask Part 3: 1-Rescuer Adult LS Part 4: Bag-Mask Device Part §:2-Rescuer Adult LS 3 ‘AED for Adults, Children, and Infants Part 1: AED Review Part 2: AED 4 Special Considerations: Rescue Breathing 5 High-Performance Teams Activity (optional) 5A Local Protocols Discussion (optional) 6 2-Rescuer Child CPR aD Infant BLS Part 1: Infant Compressions Part 2: Bag-Mask Device for Infants Part 3:2-Rescuer infant CPR 8 Relief of Choking Part 1: Adult and Child Choking Part 2:Infant Choking, (continued) aa2 ks ral oer’ (ease 9 Conclusion 10 | Skis Test Part 1: Adult CPR and AED Skills Test Part2:Infant CPR Skills Test u Remediation* Postcourse | Immediately After the Course “Remeciation me wil vary depending on need and numberof students,a ‘Sample BLS Course Agenda With Optional Lessons 12 students, 2 BLS Instructors; student-instructor ratio 6:1; student-manikin ratio 3:1; total time: approximately 4 hours and 15 minutes (with breaks) 8:00-8:05 Lesson 1: Course Introduction 8:05-8:35 Lesson2: 1-Rescuer Adult BLS Part 1: Adult Chains of Survival Part 2: Scene Safety, Assessment, and Adult Compressions Part 3:Pocket Mask Part 4: 1-Rescuer Adult LS 8:35-8:55 Lesson Part 1: AED Part 2: Bag-Mask Device {ED and Bag-Mask Device 855-904 Lesson 4: 2-Rescuer Adult BLS. 9104-914 Lesson 5: Special Considerations Part 1:Mouth-to-Mouth Breaths Part 2: Rescue Breathing Prt 3: Breaths With an Advanced Airway Part 4: Opioid-Associated Life-Threatening Emergency Part S: Matornal Cardiac Avrest 4-840 | Lesson :High-Performance Teams ad Part: Team Dynamics Part 2:High-Pertormance Teams Part 3 High-Performance Teams Activity (Optional) 9:40-10:00 Lesson 6A: Local Protocols Discussion (Optional) 10:00-10:10 Break 10:10-10:20 Lesson 7: Child BLS Part 1: Pediatric Chains of Survival Part2:Child BLS Part 3:2-Rescuer Child CPR 1020-10-40 Lesson 8: Infant BLS Part t:Infant BLS, Part2:Infant Compressions Part 3: Bag-Mask Device for Infants Part 4: 2-Rescuer Infant CPR Part S: AED for Infants and Children Less Than 8 Years of Age 1040-1047 Lesson 9: Relief of Choking Part 1: Adult and Child Choking Part 2:Infant Choking 1047-1052 1052-112 Lesson 11: kills Test a Part 1: Adult CPR and AED Skills Test Part 2:Infant CPR Skills Test (continued) 43119241157 Lesson 12: Exam asta Lesson 13: Remediation Part 1: Skills Testing Remediation Pact 2:Exam Remediationa ‘Sample BLS Renewal Course Agenda Without Optional Lessons 6 students, 1 BLS Instructor: student-instructor ratio 6:1; student-manikin ratio 3:1 total time: approximately 3 hours (with breaks) 8:00-805 1: Course Introduction 805-827 Lesson 2: Adult BLS Port 1: Adult Chains of Survival Part2:1-Rescuer Adult BLS. Part 3: AED Practice Part 4: Bag-Mask Device 827-837 Lesson 3: Special Considerations Part 1: Mouth-to-Mouth Breaths Part 2: Rescue Breathing Part 3: Breaths With an Advanced Airway Port 4: Opioid-Associatod Life-Threatening Emergency Part 5; Maternal Cardiac Arrest 8:37-8:46 Lesson 4: High-Performance Teams Part 1: Team Dynamics Part 2: High-Performance Teams 846-256 Break 8:56-9:05, Lesson§:Child Bis. Part 1: Pediatric Chains of Survival Part 2: 2-Rescuer Child CPR 9:08-9:23 Lesson 6: Infant BLS. Part 1:Infant Compressions Part 2:2-Rescuer infant CPR Part 3: AED for infants and Children Less Than 8 Years of Age 9:23-8:30, Lesson 7: Relief of Choking Part 1: Adult and Child Choking Part2:Infant Choking 9:30-9:35 Lesson8:Conclusion 2935-1018 Lesson 9:Skills Test Part 1: Adult CPR and AED Skills Test Part 2: Infant CPR Skis Test 10:18-10:40 Lesson 10: Exam 1040-105 Lesson 11: Remediation Part 1: Skil Testing Remediation Pert 2: Exam Remediation 45