High-Performance PALS

The complexity of advanced resuscitation requires a systematic and highly organized set of assessments and treatments that:

1. Take place simultaneously and
2. Are performed efficiently and effectively in as little time as possible.

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.

High-Performing Resuscitation Team Roles

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.

Team Leader

The team leader is required to have a big-picture mindset. This includes the following duties:

• Keep the resuscitation team organized and on track
• Monitor the team's overall performance and accuracy
• Back up any other team member when appropriate
• Train and coach other team members when needed and provide feedback
• Facilitate all actions and understanding during the code
• Focus on the comprehensive care of the patient
• Assign remaining roles to the other team members
• Make appropriate treatment decisions based on proper diagnosis

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.

Compressor

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.

Airway Manager

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.

AED/Monitor/Defibrillator

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.

IV/IO/Medications Provider

This team member is in charge of all vascular duties, including:

• Initiating vascular access using whatever technique is appropriate
• Administering medications with accuracy and timeliness as directed by the team leader
• Providing feedback or advice when appropriate

Time Recorder

The time recorder is responsible for keeping a rolling record of time for:

• All specific resuscitation interventions
• All medications or treatments administered
• The frequency and duration of any CPR interruptions

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.