Training Day: 4 key cardiac care approaches for both ALS and BLS providers

Integrate cardiac monitors, waveform capnography, 12-lead ECG, training manikins and advanced airway devices to increase your EMS providers’ comfort level


Cardiac emergencies are the bread-and-butter calls that paramedics thrive on each day. They’re complex, present as high-acuity and make us think critically.

Training needs to extend past our biannual ACLS renewal or even BLS renewal (for all providers) and incorporate both psychomotor and cognitive skills in order to keep us attuned to updates, trends and best practices when it comes to cardiac care.

Looking into your training options, there’s a lot that you can do with minimal supplies and even more that you can do with maximum supplies. Let’s break down some cardiac care evolutions to review how we can incorporate them into your agency’s training repertoire.

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1. Static cardiology

Take a look back through your cardiac monitor’s records and print out some code summaries for your crews to review. It’s one thing to peruse the internet in search of a variety of cardiac rhythms – it’s another to simply use a couple extra rolls of monitor paper to print them off for yourself.

Using your own, in-house cardiac rhythm strips can help to put providers into their own comfort zone with the knowledge that the rhythm presented before them is from an actual patient (with protected health information removed, of course). Whether it’s a scanned printout or an actual rhythm strip in their hands, a few extra dollars in monitor paper can add a ton of value to static EKG rhythm strip interpretation.

2. Dynamic cardiology

Taking EKG interpretation one step further, your quality assurance or training staff can develop a few scenarios for your providers – a mini National Registry exam, if you will.

Adding training tools like a rhythm generator can turn your cardiac monitor into a dynamic rhythm-generating machine. Start with a bradycardia and transition into pacing, then onto a tachycardia that requires synchronized cardioversion.

Allow your providers to become intimately familiar and comfortable with your cardiac monitors by allowing them to practice, push buttons, verbalize (“charging ... shock on three ... one, two, three”), etc.

3. Capnography indicates ROSC

For BLS providers, integrate either a trainer AED or a rhythm generator into your cardiac arrest management scenarios and allow your crews to deliver an actual shock. Insert your supraglottic airway into your simulation manikin and obtain intravenous (IV) or intraosseous (IO) access. Then, continue with your compressions and ventilations until ALS providers “arrive.”

ALS crew members can take over by practicing the transition between AED operations and manual defibrillator operations. Two minutes are up, and a second (or third, fourth, etc.) shock is delivered. An automatic compression device is deployed, IV medications are delivered and your crews determine whether or not to continue airway management with their supraglottic device or transition toward an endotracheal tube.

End-tidal carbon dioxide numeric and waveform monitoring confirms airway placement and, in fact, indicates a return of spontaneous circulation (ROSC).

4. Post-resuscitation care

You continue to work your post-resuscitation patient “on scene” for another 10 minutes to maintain their hemodynamics. If you work in a critical care environment, or if your ALS system allows, transition your patient’s ventilations over to a portable ventilator. Suction units are standing by, and now you’re preparing to move your patient.

Using a scoop stretcher, lift your patient to your EMS cot and transport them to your ambulance. You’re not done yet! You still have another 10-15 minutes (or however shorter or longer) to manage your patient.

You acquire a 12-lead EKG (referring back to static cardiology), treat the patient’s current heart rhythm and condition (dynamic cardiology), and make a call to the receiving hospital to notify them of your patient’s status.

That’s cardiac care training for everyone.

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