IHCA Preparedness: 3 Essential Trainings For Hospital Staff

In terms of pace, complexity, intensity, and stakes, Code Blues are one of the most challenging medical emergencies to respond to in the hospital setting. But at many hospitals, they also occur irregularly and sometimes unpredictably. While some patients display signs of deterioration before going into cardiac arrest, the signs can be easy to miss or may escalate rapidly and with little warning, catching even the most attentive clinicians off guard. From a preparedness perspective, it poses a challenge: How can hospitals ensure that clinicians’ skills, training, and readiness don’t lapse in between infrequent, unpredictable events?

In short, it comes down to this: While cardiac arrest events themselves may occur relatively infrequently, preparation and training must be constant. It’s the only way to ensure that clinicians have the support and experience they need to perform at their best when a cardiac arrest occurs, no matter how much time has elapsed since they last responded to a similar emergency.

In this article, we’ll look at how a layered, comprehensive training strategy can help fill gaps and prevent deterioration in skills, knowledge, and preparation between emergency events. Keep reading to learn more!

Cover the basics: BLS, ACLS, and PALS Training

As a starting point, all hospital staff should receive regular basic life support (BLS) training that emphasizes high-quality cardiopulmonary resuscitation (HQCPR), including chest compressions and rescue breathing.¹ BLS training is the foundation of effective sudden cardiac arrest response. It helps all staff members — regardless of their role or typical level of involvement in codes — feel more prepared to initiate lifesaving interventions when needed.

A subset of clinicians who are directly involved in Code Blue care should take that  training up a notch with Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) courses, which delve deeper into the management of cardiac arrest scenarios. Compared to BLS, for example, ACLS training covers more specific cardiac arrest topics, including advanced airway management, intravenous access, medication administration, and post-resuscitation care.

Tip: For maximum effectiveness, avoid the “one and done” mentality when it comes to BLS, ACLS, and PALS courses. Most certification courses are good for two years, but studies show that’s not enough for optimal performance. Unless the knowledge gained in those courses is put into practice right away, those skills are likely to fall by the wayside after 1 to 6 months, leaving practitioners unprepared in the event of an emergency.¹ Use that information to your hospital’s advantage and encourage staff to take refresher courses regularly.

Lay the foundation: High-quality CPR

HQCPR will be covered in BLS/ACLS training, but it’s important enough for optimal Code Blue care to deserve some additional emphasis as well. HQCPR is one of the few interventions that has been consistently shown to improve cardiac arrest outcomes.² And while it’s not difficult to understand its  individual components, execution can be challenging for practitioners, particularly when you take into account the numerous distractions and simultaneous background activities that occur during an actual event. The more practice and muscle memory clinicians bank prior to the onset of an event, the easier it will be for them to tune out the noise and focus on execution.

To reinforce the training on HQCPR that clinicians will receive with BLS and ACLS courses, consider the following:

• Incorporating CPR feedback devices during training sessions
• Emphasizing lesser known (but equally important) aspects of CPR quality, like chest recoil
• Training clinicians to use end-tidal carbon dioxide monitoring to guide compression quality

Note: If your hospital regularly uses mechanical CPR (mCPR), that takes some of the pressure off the performance of HQCPR — but not entirely. Mechanical CPR isn’t available or appropriate for all patients, so hospital staff still need to be prepared to perform CPR manually in certain situations. Plus, mCPR requires its own training and preparation too. It’s crucial to have a well-rehearsed process for device application in place prior to an actual event to avoid delays, and that takes significant practice to master.

Level up: Simulation training

BLS, ACLS, and HQCPR are instrumental components of staff preparedness for IHCA, but they all share one crucial drawback: They are unable to mimic the complexity of an actual event. Put another way, it’s one thing to ace a BLS or ACLS course, and something else entirely to translate that knowledge into practice during a rapidly changing, emergent situation with no shortage of other variables to contend with: changes to the patient’s status, communication with the rest of the team, etc.

That’s where simulation trainings and mock codes come in. They help put clinicians in more realistic scenarios and give them an opportunity to practice aspects of the code that won’t be covered in standalone BLS or ACLS courses: things like interdisciplinary collaboration, teamwork, and ensuring all members of the team know and can execute their role.^3,4

Here are some of our top tips to make the most of simulation training exercises at your hospital:

• Collaborate with stakeholders across departments. Simulation training is interdisciplinary and requires a lot more coordination and logistics than standalone training courses. Having buy-in across departments will play a key role in maintaining consistency in the programming.
• Add the element of surprise. Simulations take place in controlled environments, but they’re still your best bet to mimic some of the stakes and unpredictability seen in real events. Holding occasional “surprise” simulations, rather than pre-scheduled, will give you the most accurate information about how prepared your staff members are to respond to a cardiac arrest on a moment’s notice.
• Don’t neglect the data. It’s just as important to collect and analyze data during mock codes as it is during real-life events. (Good news for electronic Code Blue documentation adopters: Tools like CoDirector® Resuscitation Software already have this functionality built-in, with a Training Mode feature designed for this exact purpose.) During a training exercise, clinicians may actually have more time and bandwidth to evaluate data and feedback, reflect on it, and incorporate it going forward.