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The complexity of advanced resuscitation requires a systematic and highly organized set of assessments and treatments which will take place simultaneously and in as efficient and effective a time-frame as possible. Now, in order for all of this to happen correctly, it often requires a high-performance team of highly trained and experienced healthcare professionals to act in an organized and communicative manner. When the advanced life support code happens in this manner, the successful resuscitation rate increases while improving the chances of a successful long term patient outcome. Successful high-performance teams do not happen by chance, they are created. Not only do these teams have medical expertise and a high level of mastery of resuscitation skills, they are actually able to demonstrate effective treatments while utilizing effective communication. In a high-performance resuscitation team, there are no members that are better than another. Whether one team member is filling the role of a team leader or is operating as a supportive team member, all are extremely important and all play a special role in successful resuscitation efforts. So whether you’re a team leader or a team member during a resuscitation attempt, all members should understand their particular role but they should also understand and be comfortable with other team members' roles as well. This will help each team member anticipate what may be expected next and will help them perform their role with efficiency and communicate well as a vital member of a high-performance resuscitation team. So now let’s take a look at what each role is and what the most common requirements are for that role. Let's take a look at the role of team leader. This role requires a “Big Picture” mindset and has many different moving parts. The team leader keeps the resuscitation team organized and on track, monitors the team’s performance and accuracy, backs up team members when needed, and trains and coaches, while facilitating an understanding during the code while focusing also on that comprehensive patient care that's so important. It’s important to remember that every symphony needs a conductor and every high performance resuscitation team needs a person to fill the role of team leader if the group is going to operate efficiently and effectively. It's the responsibility of the team leader to ensure that all team members are doing everything that should be done in the right way and at the right time. A team leader should be able to explain to a team member why during CPR, pushing hard and fast in the center of the chest is so important, why ensuring that complete chest recoil happens after each compression, why minimizing interruptions in chest compressions increases the effectiveness of basic life support and why to avoid excessive or forceful ventilation that is so detrimental during manual ventilation delivery. Now let’s look closer at the other high performance team members. The roles of PALS team members must be carried out in a proficient manner based on the acquired skills and retained skills that those team members are authorized to perform because of their scope of practice. It’s vitally important that the resuscitation team understand and are clear about each of their role assignments, are prepared to fulfill their role responsibilities effectively, have a good working knowledge of PALS algorithms, have had sufficient practice in the different resuscitation skills and that they are truly committed to success! There are many team member roles and each of these roles is critical to the successful delivery of high performance resuscitation techniques. There are large in-facility teams and there are smaller out of hospital teams. For the duration of this PALS course, we're going to be utilizing the small team approach but each of the roles could expand to encompass the size team that is available to you. The large team would include a Team Leader, a Compressor, an Airway Manager, an AED/Monitor and Defibrillator and a Timer/Recorder. The small team is going to include Team Leader/Airway, an IV/IO Medication and Compressor, and an AED/Monitor Defibrillator and Compressor. Recording can be done by any team member but may be done by the team leader in the small team approach. This is often found in small offices or prehospital settings. Now let’s break each of these roles out and speak briefly about what each role is expected to do. The team leader. The team leader is the one who when necessary, assigns the remaining needed roles to appropriate team members. They must make appropriate treatment decisions based on proper diagnosis and interpretation of the patient’s signs and symptoms including advanced assessment like 12 lead EKG’s, laboratory reports and overall appearance of the patient. It’s the team leader who has the responsibility to give feedback to the team and must assume the roles of those who are not available or assigned. The Compressor. This team member is assigned a compressor type role so that the patient gets the CPR that they need in order to survive this event. They're going to also follow the latest recommendations and resuscitation guidelines in order to maximize that basic life support role. This person may alternate with the AED/Monitor/Defibrillator every 5 cycles or every two minutes. This can occur sooner if the compressor suffers from fatigue. The airway person is in charge of all patient airway aspects. They will not only work diligently to open and maintain the patient’s airway but will provide bag-mask ventilation with the appropriate basic and advanced airway adjuncts as needed. The AED/Monitor and Defibrillator person will be the person who brings and operates the AED/Monitor/Defibrillator. In certain cases, a monitor/defibrillator will be already present and therefore would be moved or slanted in such a way that the Team Leader along with most of the team are able to see it clearly. The AED/Monitor/Defibrillator person can and will change positions with the compressor every 5 cycles or every 2 minutes or at which time the compressor, that's actively giving CPR compressions, is showing signs of fatigue which, you know as well as I do, that that affects the quality of the CPR being delivered and therefore affects the potential outcome of the patient. The IV/IO/Medication person is the one whose gonna be in charge of the vascular access and medication role. This is a Pediatric Advanced Cardiac Life Support role. It not only initiates vascular access using whatever technique required for successful and patent access, but it also administers medications with accuracy upon team leader direction and gives advice when appropriate. The Timer/Recorder is a role of a member that keeps a rolling record of the time interventions, medications and treatments that were performed and then announces when the next treatment is due. They record the frequency and duration of interruptions in compressions and communicate these to the team leader and the entire team. In the absence of a timer or recorder role, another team member will be assigned these responsibilities.
The complexity of advanced resuscitation requires a systematic and highly organized set of assessments and treatments that:
In this lesson, you'll learn about how these high-functioning teams operate, including a break down of the individual roles and responsibilities for each.
As successful resuscitation rates increase, so do the chances that the patient receives the best chance for a positive, long-term outcome. And for a resuscitation attempt to be successful, all parts must be performed correctly by a high-performing team of highly trained, organized, and communicative healthcare professionals.
Successful high-performance teams take a lot of work and don't just happen by chance. Each individual in a team must have the expertise to perform his or her job and a high-level mastery of their resuscitation skills. And they have to function as one cohesive unit, which requires a focus on communication within the team dynamic.
It doesn't matter if you're a team leader or a supportive team member. All members of a resuscitation team are equal, and each plays a vital role in any team resuscitation scenario.
Pro Tip #1: What does matter is your ability to not only understand your role, but also the roles of others on your team. When you know the roles and responsibilities of each team member, you can anticipate what's coming next, which will increase the ability of the team to communicate, improve the efficiency and performance of the resuscitation, and the chances for the patient to have a positive outcome.
Now that you understand the importance of understanding the roles and responsibilities of each team member, let's look at some common duties and requirements for each.
The team leader is required to have a big-picture mindset. This includes the following duties:
Every symphony needs a conductor, just as every successful resuscitation team needs a team leader for the group to operate effectively and efficiently.
The team leader has a responsibility to ensure that all team members are playing their individual role to the best of their abilities, and this includes doing things the right way at the right times. But perhaps the biggest responsibility of the team leader centers on his or her ability to communicate clearly and effectively and explain to team members the specifics of resuscitation care.
A Typical Resuscitation team is dependent on the environment, as teams in hospital settings can be quite large, while those in pre-hospital settings (EMS and first responders) might include just two or three healthcare providers.
A typical large team simply means a more precise division of duties, while smaller teams will be required to share duties.
Typical Large Team – will include a team leader, a compressor, an airway manager, an AED/monitor/defibrillator, an IV/IO/medications provider, and a time recorder.
Typical Small Team – will include a team leader and airway manager, a compressor and IV/IO/medications provider, and an AED/monitor/defibrillator and compressor. (In a small team, recording can be done by any team member but is often handled by the team leader.)
In this ProPALS course, our emphasis will be on the small team approach. However, it's important to understand that roles can always expand based on need and the number of healthcare providers present.
Pro Tip #2: You likely noticed that compressor was listed twice in the small team example. And the reason for this is simple: As you fatigue, the quality of CPR diminishes. As the quality of CPR diminishes, so does the patient's chance for a positive outcome.
The team member in charge of compressions should know and follow all the latest recommendations and resuscitation guidelines to maximize their role in basic life support.
Chest compressions are vital when performing CPR. So vital, in fact, that this team member often rotates with another team member (usually the AED/monitor/defibrillator) to combat fatigue.
The best time to switch positions is after five cycles of CPR, or roughly two minutes. However, if you're feeling fatigued, it's better to not wait if the quality of chest compressions has diminished.
The airway manager is in charge of all aspects concerning the patient's airway. This includes opening the airway and maintaining it. And using equipment like a bag valve mask or more advanced airway adjuncts as needed.
As you might have guessed, this team member is in charge of bringing an AED to the scene (unless one is already present) and operating the AED. This team member is also the most likely candidate to share chest compression duties with the compressor.
This team member is in charge of all vascular duties, including:
The time recorder is responsible for keeping a rolling record of time for:
The time recorder also announces to the team when/if a next treatment or more medication is due. If no one person is available to fill the role of time recorder, the team leader will assign these duties to another team member or handle them herself/himself.
Every successful resuscitation team includes members who understand his or her individual role, as well as the roles of other team members, and is prepared to effectively do their part. This includes having a good working knowledge of PALS algorithms along with acquiring sufficient skills practice.
And wouldn't you know it, that's exactly what you'll be learning in this course.