BLS Instructor Course Module

Mastering the Art of Teaching Basic Life Support

Module Overview: Teaching BLS Provider Courses

As a BLS Instructor, you are responsible for training healthcare providers and other professional rescuers to recognize life-threatening emergencies, provide high-quality chest compressions, deliver appropriate ventilations, and ensure early use of an AED. This module will equip you with the specific knowledge and skills to effectively teach the BLS Provider course, emphasizing adherence to current AHA guidelines, effective team dynamics, and precise skills assessment using official checklists.

Key Learning Objectives for This Module:

Effectively teach and assess the systematic approach to BLS, including scene safety and patient assessment for all age groups.
Demonstrate, teach, and accurately assess high-quality CPR techniques for adults, children, and infants, including 1- and 2-rescuer scenarios.
Teach and assess the correct use of an Automated External Defibrillator (AED) for adults, children, and infants.
Facilitate understanding and practice of effective team dynamics during multi-rescuer resuscitation attempts.
Demonstrate, teach, and assess techniques for relief of foreign-body airway obstruction (choking) in adults, children, and infants.
Identify key updates in BLS guidelines and effectively integrate them into teaching.
Utilize the BLS Instructor Manual and official AHA skills testing checklists to ensure course consistency and accurate student evaluation.

Understanding the Chain of Survival:

Emphasize the links in the In-Hospital Cardiac Arrest (IHCA) and Out-of-Hospital Cardiac Arrest (OHCA) Chains of Survival. For BLS providers, early recognition and activation of emergency response, early high-quality CPR, and rapid defibrillation are key.

Key BLS Guideline Updates (Instructors must stay current):

[Placeholder: Insert specific details on the latest BLS guideline changes regarding compression rate, depth, ventilation, AED use, team dynamics, etc. This section MUST be updated regularly by the instructor/organization based on current AHA publications.]
Example of a past update: Emphasis on minimizing interruptions in chest compressions.
Example of a past update: Changes to ventilation rates with an advanced airway.

Instructor Responsibility:

It is the BLS Instructor's responsibility to be thoroughly familiar with the most current AHA Guidelines for CPR and ECC and to teach these accurately. Regularly review updates published by the AHA and your Training Center.

The BLS systematic approach ensures rescuer safety and rapid identification of life-threatening conditions.

Teaching Scene Safety and Initial Steps:

Verify Scene Safety: Ensure the environment is safe for rescuers and the victim.
Check for Responsiveness: Tap and shout. For infants, tap the foot.
Shout for Nearby Help / Activate Emergency Response System: Direct someone to call 911/activate facility code and get an AED and emergency equipment. If alone, activate EMS via mobile device (if adult/child) or provide ~2 mins of CPR first if alone with an unwitnessed child/infant collapse before leaving to call.
Check for Breathing and Pulse Simultaneously (Healthcare Providers):
- Scan chest for rise and fall (no more than 10 seconds). Note agonal gasps are NOT normal breathing.
- For adults/children: Check carotid pulse (no more than 10 seconds).
- For infants: Check brachial pulse (no more than 10 seconds).
If no breathing/only gasping AND no definite pulse within 10 seconds: Start high-quality CPR, beginning with chest compressions.

Instructor Focus for Assessment:

Students must verbalize scene safety. The sequence of checking responsiveness, activating ERS (including AED retrieval), and simultaneously checking breathing and pulse (within 10 seconds) is critical. Correct identification of agonal gasps and prompt initiation of CPR are key assessment points.

Teaching and assessing high-quality adult CPR is a primary focus of the BLS course.

Key Components of High-Quality Adult CPR:

Victim Position: Supine on a firm, flat surface.
Hand Placement: Heel of one hand on the lower half of the sternum (center of the chest); other hand on top.
Compression Rate: 100 to 120 per minute.
Compression Depth: At least 2 inches (5 cm), but not more than 2.4 inches (6 cm).
Chest Recoil: Allow full recoil of the chest after each compression; do not lean on the chest.
Minimize Interruptions: Limit pauses in chest compressions to less than 10 seconds (e.g., for breaths, AED analysis).
Airway: Open airway using head-tilt/chin-lift (or jaw thrust if trauma suspected and trained).
Ventilations (with barrier device): Deliver each breath over 1 second, ensuring visible chest rise.
- 1-Rescuer CPR Ratio: 30 compressions to 2 breaths.
- 2-Rescuer CPR Ratio: 30 compressions to 2 breaths.
Switching Compressors (2-Rescuer): Switch compressors approximately every 2 minutes (or 5 cycles), or sooner if fatigued, with minimal interruption (ideally <5 seconds).

Instructor Focus for Assessment (AHA BLS Adult CPR Skills Checklist):

Assess all critical criteria: scene safety, responsiveness check, ERS activation, pulse/breathing check, correct hand placement, compression rate, depth, full recoil, minimizing interruptions, adequate ventilations, correct 30:2 ratio, and effective compressor switches in 2-rescuer scenarios. Use of CPR feedback devices is strongly recommended.

Child CPR techniques are adapted for anatomical and physiological differences.

Key Components of High-Quality Child CPR (Age 1 to Puberty):

Hand Placement: One or two hands (depending on child's size and rescuer's strength) on the lower half of the sternum.
Compression Rate: 100 to 120 per minute.
Compression Depth: At least 1/3 the anterior-posterior diameter of the chest, approximately 2 inches (5 cm).
Chest Recoil: Allow full recoil.
Minimize Interruptions.
Airway: Head-tilt/chin-lift.
Ventilations (with barrier device): Deliver each breath over 1 second, ensuring visible chest rise.
- 1-Rescuer CPR Ratio: 30 compressions to 2 breaths.
- 2-Rescuer CPR Ratio: 15 compressions to 2 breaths.
Switching Compressors (2-Rescuer): Approximately every 2 minutes or 10 cycles (for 15:2 ratio).

Instructor Focus for Assessment (AHA BLS Child CPR Skills Checklist):

Key differences from adult include potential for one-handed compressions, depth of approx. 2 inches (1/3 AP diameter), and the 15:2 compression-to-ventilation ratio for 2-rescuer CPR. All other quality metrics (rate, recoil, interruptions) are similar.

Infant CPR requires specific techniques due to their small size and delicate anatomy.

Key Components of High-Quality Infant CPR (Under 1 Year, excluding newborns):

Hand Placement (1-Rescuer): Two fingers (or two thumbs side-by-side if rescuer's hands are small) in the center of the chest, just below the nipple line on the lower half of the sternum.
Hand Placement (2-Rescuer - Preferred): Two thumb-encircling hands technique around the infant's chest.
Compression Rate: 100 to 120 per minute.
Compression Depth: At least 1/3 the anterior-posterior diameter of the chest, approximately 1.5 inches (4 cm).
Chest Recoil: Allow full recoil.
Minimize Interruptions.
Airway: Head-tilt/chin-lift to a neutral or "sniffing" position. Avoid overextending the neck.
Ventilations (with barrier device): Rescuer's mouth covers infant's mouth AND nose. Deliver each breath over 1 second, ensuring visible chest rise.
- 1-Rescuer CPR Ratio: 30 compressions to 2 breaths.
- 2-Rescuer CPR Ratio: 15 compressions to 2 breaths.
Switching Compressors (2-Rescuer): Approximately every 2 minutes or 10 cycles (for 15:2 ratio).

Instructor Focus for Assessment (AHA BLS Infant CPR Skills Checklist):

Critical differences include hand placement (2-finger vs. 2-thumb technique), compression depth (approx. 1.5 inches/4 cm), neutral airway position, mouth-to-mouth-AND-nose seal for breaths, and the 15:2 ratio for 2-rescuer CPR. Brachial pulse check is also key.

Early defibrillation with an AED is a critical link in the chain of survival for victims of sudden cardiac arrest.

Universal AED Operating Steps:

Power ON the AED.
Attach AED pads to the victim's bare chest according to the diagrams on the pads.
Clear the victim and allow the AED to ANALYZE the rhythm. Ensure no one is touching the victim.
If a shock is advised: Clear the victim again (verbalize "Clear!") and press the SHOCK button.
Immediately resume CPR (starting with chest compressions) after the shock is delivered, or if no shock is advised.
Follow AED prompts.

AED Use for Children (1 to 8 years) and Infants (Under 1 Year):

Use child pads and an attenuated dose if available. Most AEDs have pediatric pads or a key/switch for pediatric mode.
If child pads/attenuator are NOT available, use adult pads. Ensure pads do not touch each other. An anterior-posterior placement may be necessary.
For infants, a manual defibrillator is preferred if available and by trained providers. If not, an AED with pediatric dose attenuation is preferred. If neither is available, an AED with adult pads/dose may be considered, with pads placed so they don't touch (often anterior-posterior).

Instructor Focus for Assessment:

Students must demonstrate correct AED operation sequence, including safe pad placement, clearing the victim during analysis and shock, and immediate resumption of CPR. For child/infant, appropriate pad/dose selection (or adaptation if pediatric options are unavailable) is critical.

Effective teamwork is crucial during multi-rescuer resuscitation attempts. BLS courses introduce foundational concepts of team dynamics.

Key Elements of Effective Team Dynamics:

Clear Roles and Responsibilities: Each team member should know their role (e.g., compressor, airway, AED operator, team leader if designated) and responsibilities.
Knowing Your Limitations: Team members should be aware of their own skill level and limitations and ask for help or guidance when needed.
Constructive Intervention: If a team member observes an incorrect action or a critical step being missed, they should respectfully and clearly intervene.
Knowledge Sharing: Team members should share critical information with each other.
Closed-Loop Communication: The team leader gives a clear message/order. The team member confirms the message was heard and understood, and reports back when the task is complete. (Example: Leader: "Give 1 mg epinephrine." Responder: "Giving 1 mg epinephrine." Later: "Epinephrine given.")
Clear Messages: Speak clearly and calmly. Use concise language.
Mutual Respect: Treat all team members respectfully, regardless of experience level.
Summarizing and Re-evaluating: The team leader should periodically summarize the patient's status, interventions performed, and reassess the situation, adapting the plan as needed.

Instructor Focus:

During 2-rescuer CPR scenarios, observe and coach students on these team dynamics principles. Emphasize clear communication, defined roles, and mutual support. This lays the groundwork for more advanced team-based care in courses like ACLS and PALS.

Recognizing and managing foreign-body airway obstruction (FBAO) is a critical BLS skill.

Responsive Adult/Child (Age 1+) with Severe Airway Obstruction (Cannot Speak, Cough Forcefully, or Breathe):

Ask, "Are you choking?" If the person nods yes:
Perform abdominal thrusts (Heimlich maneuver) until the object is expelled or the person becomes unresponsive.
- Stand or kneel behind the person. Make a fist with one hand.
- Place the thumb side of your fist against the person's abdomen, in the midline, slightly above the navel and well below the breastbone.
- Grasp your fist with your other hand and press your fist into the person's abdomen with a quick, forceful upward thrust.
- Repeat thrusts until effective or person becomes unresponsive.
For pregnant women or very obese individuals, perform chest thrusts instead of abdominal thrusts.

Unresponsive Adult/Child (Age 1+) with Airway Obstruction:

Gently lower to the floor. Activate ERS (if not already done).
Begin CPR, starting with chest compressions (do not check for pulse).
Each time you open the airway to give breaths, look for the obstructing object in the back of the throat. If you see an object that can be easily removed, remove it with your fingers. Do NOT perform blind finger sweeps.
Continue CPR until the object is removed and normal breathing resumes, or until advanced help arrives.

Responsive Infant (Under 1 Year) with Severe Airway Obstruction:

Deliver cycles of 5 back slaps and 5 chest thrusts.
- Hold the infant face down (head lower than chest) along your forearm, supporting the head and jaw with your hand. Deliver 5 firm back slaps between the shoulder blades with the heel of your hand.
- Turn the infant face up (head lower than chest) on your other forearm. Deliver 5 quick chest thrusts in the same location as CPR compressions (center of chest, just below nipple line) using two fingers.
Repeat cycles of 5 back slaps and 5 chest thrusts until the object is expelled or the infant becomes unresponsive.

Unresponsive Infant with Airway Obstruction:

Gently place on a firm, flat surface. Activate ERS (if not already done).
Begin CPR, starting with chest compressions.
Each time you open the airway to give breaths, look for an object. If seen and easily removable, remove it. Do NOT perform blind finger sweeps.

Instructor Focus for Assessment:

Students must correctly identify signs of mild vs. severe obstruction. For severe obstruction, they must demonstrate the correct technique (abdominal thrusts for adult/child, back slaps/chest thrusts for infant). For unresponsive victims, the critical action is to start CPR and look for the object before attempting breaths.

BLS Instructor Module Completion

Mastery of BLS skills and the ability to effectively teach them are paramount for a BLS Instructor. Continue to practice and refine your understanding of these techniques and the associated assessment criteria. Your role is vital in training providers who can make a difference in a cardiac emergency.