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 an 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 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.