1. BLS for Prehospital Providers Course

2. BLS PHP Workshop Objectives
Discuss how historical feedback from the EMS community shaped the development of the course
Describe the new format: “flipping the classroom”
Describe the most critical roles of the resuscitation team, and secondary roles as responders increase: the “pit crew approach”
Identify the importance of chest compression fraction (CCF) for survival rates
Demonstrate the high-performance teams concept
Identify procedure for how Training Centers and Instructors administer course keys to students

3. Overview
History and Purpose of New BLS Course
Specific EMS Scenarios
EMS Field Application
Local Protocols
High-Quality CPR
The American Heart Association (AHA) determined the need for a more strategic partnership with the prehospital community because of specific feedback from that group of professionals.
Research indicated the prehospital market needed a course designed to address what the EMS professionals encountered on the job. Typical BLS courses did not always reflect the environment or the demands of that profession.
In the prehospital arena, training has evolved into primarily scenario-based training. This allows for more than testing for acquisition of cognitive information; it adds variables in decision making that are based on other factors. By addressing issues such as environment, staffing levels, and tiered response, this new course helps students understand and implement learning objectives more effectively.
This course addresses concepts encountered outside the hospital that aren’t currently in the BLS for Healthcare Providers Course (BLS HCP). These concepts include, but are not limited to, patient positioning and environment before initiating resuscitation, caring for the arrest patient on scene versus enroute to a medical facility, discontinuing efforts in the field, and identifying roles and responsibilities of team members during administration of high-quality CPR.
The AHA heard from many prehospital providers, administrators, and medical directors that the BLS HCP Course does not address how resuscitation is performed in the field: “This isn’t what we do.” In the BLS for Prephospital Providers Course (BLS PHP), there is discussion about local protocols, response strategies, destination determination, and differences with the AHA BLS algorithm. This reduces confusion and helps implement the strongest scientific guidelines into the workplace. This also allows for more explanation to the question Why is this the right thing to do? and expands the discussion on current science.
High-quality CPR can only be performed when a team is in sync and there is constant evaluation of the overall effort by the Team Leader. Improved performance and outcomes are the goals. This will be achieved primarily by increasing team communications and debriefing after cases so the team does better the next time.

4. Why BLS PHP?
In 2012, the AHA assembled an EMS Advisory Panel consisting of field providers from around the country. That group made the following recommendations:
Design a specific BLS curriculum for prehospital providers that includes EMS-specific tests
Make the scenarios entirely EMS oriented and realistic to the prehospital environment
Include high-performance teams concept to increase the level of competence
Create a curriculum that teaches how to set up the scene for high-quality CPR
The AHA is continuously working on improving relations with strategic partners. The EMS Advisory Panel consisted of a diverse group of EMS professionals to develop recommendations for the BLS PHP Course. The panel clearly communicated the need for a course to specifically meet the needs of EMS and prehospital providers. As a result, the AHA designed this course with EMS scenarios to facilitate the practical application and learning styles of EMS providers.
The first responder community is considered a strategic partner because they are the backbone of BLS and are often begin treatment for patients if no bystanders began CPR. The survival rate for out-of-hospital cardiac arrests can be achieved by strengthening the prehospital BLS skills and building more effective teams.
The course introduces the pit crew approach to teach how to work codes with teams of 2 to 6 people by using high-performance team concept.
High-quality CPR can only be performed when a team is in sync and there is constant evaluation of the overall effort by the Team Leader.

5. Flipping the Classroom
Course Flexibility:
Flipping the Classroom
BLS PHP is a new customizable learning experience, combining online and classroom-based training into one high-performance program created specifically for prehospital professionals.
The course is the first of its kind (hybrid) for the AHA.
The total experience combines what is learned and verified in the online portion with the implementation strategies practiced in the classroom.
BLS PHP is not a one-size-fits-all course. It is designed to be customizable, allowing for the inclusion of local treatments and protocols, which can vary greatly in each prehospital environment.
It is very important to not separate the components of this training, but rather keep them together as a complete course. Neither component can stand alone. The online portion and the classroom portion must work together for the best educational outcome and to provide students with the greatest chance of saving lives.

6. BLS PHP Course―An Inside Look
This begins the second section.

7. Increase Survival Rates
Course Strategies to
Increase Survival Rates
Use the pit crew approach to teach how to conduct a code with teams varying from 2 to 6 people
Introduce BLS Instructors to the concept of structured and supported debriefing
Create scenario-based training that may represent a student’s next call in the field
Develop core course segments that provide the opportunity for medical directors to tailor the course to local response protocols
The pit crew approach isn’t a prescribed method but a mindset of performing multiple tasks simultaneously. All team members know their specific tasks and concentrate on doing that task as perfectly as possible. The idea is that there are critical roles that need to be performed, and as the number of team members increase, the highest priority tasks can be completed with more ease. Ultimately, a Team Leader needs to constantly evaluate team performance and make adjustments where necessary. He or she must communicate the needed changes in a closed-loop fashion so there is no misunderstanding.
Professionals perform better only when they realize where tasks and issues currently exist. Debriefing cases during training will provide students information on how to do better in a real case. This debriefing should be peer-to-peer rather than Instructor-led, thus allowing the individual team members to discuss why things went the way they did and what they were thinking when it happened.
By practicing team performance in the classroom, students should find that real cases flow more smoothly when there are predetermined roles, responsibilities, and expectations for each team member. Tiered response systems with multiple agencies should also find the course helpful in promoting cohesive approaches to actual calls and allowing different agencies to determine treatment plans or actions beforehand.
The AHA understands that local response protocols rarely mirror AHA treatment algorithms. Neither is completely right or wrong. What is crucial is to understand the importance of both and how to shape information into improved performance while achieving better patient outcomes.

8. BLS PHP Course Components: Online Portion

9. Interactive Online Content
Same course objectives as BLS HCP
Written exam with the same foundational learning objectives but with prehospital terminology.
See the Science buttons so students can drill deeper into the Why?
To ensure students have an adequate grasp of key concepts, there are questions throughout the online portion asking, “What would you do next?” These questions don’t count toward whether the student passes the cognitive part of the course, but rather these questions make the student think about the situation and what is the right thing to do for the patient.
The student still needs to score 84% or higher on the written exam and successfully perform the skills of BLS the same as they would for the BLS HCP course. The BLS PHP Course is designed to be a practical application for the prehospital environment, but the skills are the same as for BLS HCP, as determined by the testing and exit criteria based on the 2010 AHA Guidelines for CPR and ECC.

10. Scenario-Based Training
EMS-oriented scenarios and realistic settings for the prehospital environment
Termination of resuscitative efforts
Drowning
Pit crew approach
Several concepts are unveiled in this course, such as
Determining if the cause is medical or trauma and determining whether restriction of spinal motion is a priority
When and how to terminate resuscitation in the field
Encountering a patient in a space that is not conducive to a team of more than 2 people performing high-quality BLS and deciding when and how to move the patient
Asphyxial cause of arrest and management priorities
The essence of all the points above is that you can incorporate this information into how your agency responds to and cares for the victim of cardiac arrest.

11. EMS-Themed Training Medical cause of victim driving off the road
Moving patient for better access and improved resuscitation
Practice like you play
The essence of all of the points above is that you can incorporate this information into how your agency responds to and cares for the victim of cardiac arrest. There are narrated lessons on the specific BLS skills associated with each scenario.

12. BLS PHP Course Components: Classroom Portion

13. Customization Components Role of Ventilation Medical vs Trauma
Local Protocols
Customization
Components
Role of Ventilation
Medical vs Trauma
Interagency Roles
Termination Criteria
Use of AED
Because many local treatment protocols differ from the AHA BLS algorithms, the course offers the opportunity to discuss team member roles, ventilation management, use of airway adjuncts, how different departments (fire, police, and EMS) can work better together, and, if a resuscitation attempt is unsuccessful, how and when to terminate efforts in the field. These will prove to be healthy, yet challenging, discussions. The instructor’s knowledge of local protocols and the available science will prove very beneficial during the course and allow the instructor to tailor each course to the needs of the prehospital providers in attendance and discuss how these teams function together.
Compression Protocols
Pit Crew

14. Local Protocols AHA guidelines: Resource Provide guidance
Lend supportive information
Substantiate―they are based upon available science
Many agencies use AHA guidelines to devise local treatment protocols
Protocols and guidelines not always parallel
The AHA produces scientific guidelines for treatment that are based upon current published scientific studies. Each recommendation is assigned a class (I, IIa, IIb, or III) for level of probable benefit versus harm and a level of evidence (A, B, or C) that is based upon the strength of the scientific evidence available. Many administrators and medical directors use these published guidelines when considering what goes into their local treatment protocols. In most cases, the protocols do not mirror AHA algorithms.
Neither is completely right or wrong. Both local protocols and guidelines try to balance what is best for patients and healthcare personnel. It is important for Instructors to glean the positives from both and bring them into the discussion.

15. Helps individuals and teams reflect on and improve performance
BLS Debriefing
Peer to peer
Nonthreatening
Helps individuals and teams reflect on and improve performance
In a follow-up to a scenario presented to a resuscitation team, it is critical to allow time (at least half as much time as the scenario) to digest the situation―what occurred and what could have been performed better. It is highly important to debrief in a training scenario so that performance on the next real case is improved over past performance (CQI or continuous quality improvement).
The instructor should introduce the concept by saying, “Let’s discuss what we just performed.” Beginning with the Team Leader, instructors should ask (sample questions):
What did you find?
What tasks did you do or assign? In what order?
Did the situation go as planned?
What could have gone better?
Debriefing allows students to hear what was done well and to be encouraged. The things that could have been better can be discussed while developing a game plan for the future. This should not be a penalizing session, but rather an encouraging and enlightening one.

16. Pit Crew Approach―Instructor
Capturing and optimizing the percentage of arrest time that high-quality chest compressions are performed has a predictable improvement in survival.
The term chest compression fraction, or CCF, is just that―trying to achieve the 80% threshold, which increases survival by 200% to 300%.
It’s hard to improve a process if you don’t know how you are currently performing. Some agencies have devices that give constant feedback on compression performance, but most don’t. In an effort to improve outcomes for sudden cardiac arrest patients and to address the findings in the AHA Consensus Statement on CPR Quality, we need to work diligently to increase CCF to >80%. To measure CCF, we have 3 options for the instructor, each with its merits and levels of simplicity and cost:
The 2-stopwatch technique: The team scenarios are timed for 10 minutes each. The instructor has 2 stopwatches in hand and starts from 0 stopwatch number 1 after reading the scenario and lets it run to the end (10-minute mark) and stops the case. The instructor starts stopwatch number 2 when compressions begin and stops it during each pause between compressions, repeating this for all active compressions during the case. At the end of the scenario, the instructor stops stopwatch number 2 and looks at the cumulative time compressions were performed. For example, a total time of compressions of 6 minutes and 30 seconds would equate to a CCF of 65%, and 8 minutes and 15 seconds would equate to a CCF of 83%.
Full Code Pro App: This is a free app for Apple devices only (currently). It is a very useful tool that helps capture events during a cardiac arrest. At the end of the resuscitation attempt, the app assembles a report of the data into a file that can be sent to the staff who are responsible for quality control and decision making to record the team’s performance. The app will allow the collection of CPR data at the end of the case. There is a tutorial video available on YouTube that will help users learn the app and its functions at To use this app in the BLS PHP Course with a group of at least 5 to 6 rescuers, the Observer/Recorder would operate the app.
Instrumented manikins: There are numerous manikins on the market that capture CPR performance data, many in real time. The AHA does not endorse any single manikin, its manufacturer, or vendors. These are available in wired and wireless models, and many display performance on a remote computer screen for instructor’s ease of use.
Any of these 3 options can be used by the instructor. What is truly important with this part of the BLS PHP Course is to bring performance improvement to the forefront to save more lives.

17. Team Dynamics Suggested roles for a 6-member team:
1. Compressor: Does 5 cycles of chest compressions
2. Airway: Opens the airway; provides bag-mask ventilation (and uses airway adjuncts as appropriate)
3. Monitor/Defibrillator: Brings and operates an AED (ACLS and PALS providers bring a manual monitor/defibrillator); may alternate with Compressor every 5 cycles. If a monitor is present, it should be placed in a position where it can be seen by everyone
4. Team Leader: Assigns roles and makes treatment decisions; provides feedback (when needed) to the rest of the team
5. Observer/Recorder: Records the time of interventions (and frequency and duration of interruptions in compressions); communicates these to the Team Leader
6. IV/IO/Medications (ACLS provider role): Initiates IV/IO access; administers medications
This diagrams the different team members that make up the high performance team. Note that the critical roles are those in the triangle.
The Team Leader is also a vital role and is needed to keep the team on track. If the Team Leader doesn’t have enough extra team members to delegate to, then the Team Leader should be responsible for assuring the task is done.

18. High-Performance Team Activity
Equipment needs:
For each group of 6-9 participants: 1 each manikin, BVM, and AED trainer; and 2 stopwatches.
Break into groups of at least 6. AHA staff or Faculty will be the Team Leader in each group. Each group will complete the remaining scenarios, including debriefing and local protocol discussion. This activity should last approximately 15 minutes.
The scenario should allow for the following times:
10 minutes for the case
5 minutes to debrief
15 minutes for local protocol discussion and wrap-up
Demonstrate high-performance team dynamics, detailing roles of each member on the team, by using effective team leadership:
For high-performance team roles, review Lessons 5 and 6 in the BLS PHP Instructor Supplement, pages 7 to 13 of Lesson Plans.
For Team Diagram, review Team Dynamics on slide 29; the Team Diagram handout is also available on the BLS PHP Instructor DVD.
Demonstrate the use of the 2-stopwatch technique.
Demonstrate an effective debrief session. (Use debriefing questions from Instructor Supplement and also on the next slide.)
Demonstrate a discussion of local protocol application.
Describe different techniques for measuring CCF using a stopwatch, the Full Code Pro App, and instrumented manikins.

19. Questions for Discussion:
Team Performance
How could you improve the actions of the teams you observed (for the cardiac arrest in vehicle, child drowning, and cardiac arrest in bathroom scenarios)?
Do your teams do anything different from what you observed in the scenarios that you think improves patient outcomes?
Are there observational or clinical data you could share to help improve team performance?
Would you like clarification on any actions or components of the video?
Use these questions after the end of each scenario activity.

20. BLS PHP Course: New Materials
This begins the third section.

21. Availability and Distribution
Unlike other AHA eLearning courses, this course isn’t as simple to divide into Parts 1, 2, and 3. This course requires regulation and prearrangement regarding who can attend and how students enroll for the course.
Not all AHA Training Centers will offer this course. Only Training Centers that have the experience and expertise to teach this course and that have the targeted student population to attend it will offer the course.
Think of this course as a classroom course with preparatory work to be completed by the student before coming to class rather than as an online course where a student schedules a Skills Practice and Testing Session after completing the online portion. To avoid the scenario where a student purchases a key to the online portion but is unable to find a Training Center that offers the classroom portion, the AHA requires students to enroll at a Training Center that offers both the online key and the classroom portion of the course.
The code for ordering the course is available on the Instructor Network for AHA Training Center Coordinators, who can provide it to Instructors or directly to students.

22. New Course Materials Instructor Supplement:
Contains the tools needed to teach the classroom portion
Includes agenda, outlines, and Lesson Plans
Use with the BLS for Healthcare Provider Instructor Manual
The Instructor Supplement contains the tools Instructors need to teach the classroom portion of the BLS PHP Course.
These tools include the agenda, outlines, and Lesson Plans for organizing the classroom portion of the course.
The Instructor Supplement is 3-hole drilled so that it can be stored in the same binder with the instructor’s BLS for Healthcare Providers Instructor Manual, which contains the details about conducting the BLS skills testing, providing remediation, and issuing course completion cards.

23. Instructor Package Instructor Supplement and CD Classroom DVD
Instructors must obtain and use the Instructor Supplement in conjunction with their current BLS HCP Instructor Manual. There is an Instructor Supplement CD that contains course materials and a BLS PHP classroom DVD.
If needed, here is purchasing information:
Product #
SRP: $75

24. New Course Materials Lesson Plans: New concept
Response to Training Network feedback
The BLS PHP Course introduces a new concept aid to assist instructors in course management. The decision to introduce Lesson Plans was made because of feedback from AHA Instructors. Most Instructors who are formal educators use Lesson Plans. Feedback that the Lesson Maps weren’t as useful was taken into consideration when developing Lesson Plans.
The Lesson Plans that are included in the Instructor Supplement are the next generation of Lesson Maps. The Lesson Plans contain the same valuable information to help you organize class time, prepare for skills practice and testing, and lead group discussions on high-quality CPR, team resuscitation, and local protocols.

25. Note the design differences for the BLS PHP Lesson Plans and the information they contain. As with all new courses, Instructors should review all materials before teaching their first course.

26. Other BLS PHP Resources on the Instructor Network
Equipment List
Team Diagram
Questions for Discussion
FAQ
Course Requirements Training Memo
The BLS PHP Instructor Supplement DVD contains the resources needed by Instructors to teach the course. For convenience, the AHA has placed these key resource documents and others on the Instructor Network:
Equipment List
Team Diagram
Questions for Discussion
ALL AHA course FAQ documents are considered “living documents,” meaning that FAQs are updated with new information as needed. Instructors should make a regular habit of referring to the FAQ document before teaching any course to obtain useful information for responding to questions. Each time the FAQ is updated, there is a corresponding date for the update to assist Instructors with determining if new information has been added.
The BLS PHP FAQs have been updated to reflect questions received from AHA Faculty training and webinars.
The BLS PHP Training Memo outlines specific information for both Training Centers and Instructors.

27. Post-Workshop Evaluation
Please use this link to complete a short survey on the workshop you have attended:
Instructors are encouraged to complete the survey as soon as possible and provide constructive feedback. Each survey will be short and should take approximately 10 minutes or less to complete. This will enable the AHA to have additional insight on improvements for future workshops.