I have been teaching ACLS / EP for years now. Both nurses and paramedics. Hell, I have even recert'd MD's. You would be surprised how MD's are in regard to ACLS. They can cut your chest apart but when you ask the dose of 1,10,000 Epi or make push does Epi, they shit the bed but in reality, they have the guides to look at when working a code in the SICU of something.
ACLS, frankly, all of the canned courses are just that, canned and that is why student that have taken it more than twice, say fuck it, same info, lets get it over with. I attempt to make it more colorful for nurse and medic students. For example. I will take 2 medics to start the code, drop in front of the family (family being the nurses, pick 3 or 4 of them and make them yell and cry). Then I will add 2 more medics and 2 medics acting as fire dept. They will work the code, low light maybe, all of the crying and yelling to simulate family freaking. Make them work the code with NO MD over site. See, for those that don't know what paramedics do in codes, we do the first 45 mins. working in the home, get code back and start ROSC care or pronounce pt. I have had, myself, 7 codes since this year started, not counting OD's.
We are expected to know every code drug, dose, every code protocol, we have no guides. Then, know AND understand the reason for ROSC care, which is actually where paramedics come into play because frankly, codes are BLS, CPR and shock. I have had myself in 2 years, 5 codes, walk out of the hospital, neuro. intact.
So, with that said, these students work the code to show the nurses the difference we go through, the thought process, the operations on how to work in an "austere environment" because anything NOT in hospital is not controlled. I don't have the docs, 10 nurses to help. Then operations on how to get pt. down 4 flight walk up apartment building while still ventilating, checking pules and ECG every flight of stairs, making sure CPR device is working correctly, checking tube placement. As a senior medic, I am responsible for all of this and called on the carpet for good or bad during QA.
Then, I have the nurses attempt a code, using the class MD (our medical director) act as the doc on call and they are permitted to use guides. Having the doc give orders, preform tasks to standards. They understand now, what we as medics go through, and the medics understand the difference between in and out of hospital codes. More importantly, nurses not familiar with paramedics get an understanding of how we do things and when we show up at the E.D. and the line looks ugly with the tape job or there is vomit on the pt.'s chest, they get that things are not pretty in a home.
I have seen in recent years, a disconnect with younger students, that believe that ACLS is actually helpful but in reality, nothing, including cardiac meds have been proven to work, ever. It is shocking and fucking awesome CPR. When I get the attaboy for a code well done, I pass the info back to the medical director that says, my team worked it. They broke sweat and bad knees doing the job. They carried the 350 pound pt. down 3 flight walk up's, sweating for that cat to walk out of the ICU neuro. intact. I just happened to be crew chief.
M.
