Module: PALS Instructor Training

1.1 Target Audience

The Pediatric Advanced Life Support (PALS) program is specifically designed for healthcare providers who are involved in the management of respiratory and/or cardiovascular emergencies and cardiopulmonary arrest in pediatric patients. This includes, but is not limited to, physicians, nurses, paramedics, and other allied healthcare professionals who regularly care for children.

1.2 Core Curriculum

The core curriculum builds upon foundational BLS skills, placing significant emphasis on high-quality CPR according to BLS recommendations. Key areas of instruction include:

• Systematic approach to pediatric assessment.
• Early recognition and intervention for respiratory emergencies (distress and failure).
• Recognition and management of different types of shock.
• Recognition and early management of cardiopulmonary arrest.
• Age-specific considerations for interventions, dosages, and assessment techniques.
• High-performance team dynamics and communication in pediatric resuscitation.

1.3 Course Formats

PALS courses are offered in both traditional instructor-led training (ILT) and blended-learning formats (e.g., HeartCode PALS), providing flexibility for students and instructors.

2.1 Systematic Approach to Pediatric Assessment

Teaching PALS requires a nuanced understanding of pediatric physiology. Instructors must train students in the effective use of the PALS Systematic Approach Algorithm to accurately assess and classify pediatric patients. This involves:

• Pediatric Assessment Triangle (PAT): Rapid, visual assessment of Appearance, Work of Breathing, and Circulation to Skin.
• Primary Assessment: A (Airway), B (Breathing), C (Circulation), D (Disability), E (Exposure).
• Secondary Assessment: Focused history (SAMPLE) and physical exam.
• Diagnostic Tests: Understanding the role of labs, imaging, and other diagnostics.

Emphasis should be placed on rapid recognition of signs of respiratory distress, shock, and cardiac arrest in children, which often present differently than in adults. Instructors must teach age-specific considerations for interventions, dosages, and assessment techniques.

2.2 Infant/Child CPR and AED Use

Instructors must ensure students are proficient in age-appropriate high-quality CPR and AED use. Key teaching points include:

• Compression Depth and Rate: Specific guidelines for infants and children.
• Hand Placement: Two fingers for infants, one or two hands for children.
• Ventilations: Proper bag-mask technique and tidal volume.
• AED Pad Placement and Dose Attenuation: Specific for pediatric patients (attenuated dose, anterior-posterior placement if pads touch).
• Team Dynamics: Emphasizing continuous, high-quality CPR within a team setting.

2.3 Airway Management

Comprehensive coverage of appropriate pediatric airway management techniques and devices is essential. Instructors should teach:

• Basic airway maneuvers (head-tilt chin-lift, jaw thrust) adapted for children.
• Use of bag-mask devices with proper mask size and seal.
• Advanced airways (endotracheal tubes, supraglottic airways) and confirmation techniques (e.g., capnography).
• Recognition and management of upper and lower airway obstructions.

2.4 IV/IO Access and Fluid Management

Instructors must guide students on the critical skill of vascular access in pediatric emergencies.

• Intravenous (IV) Access: Techniques for establishing peripheral IVs in children, recognizing challenges.
• Intraosseous (IO) Access: When and how to perform IO insertion, emphasizing its importance as an alternative when IV access is difficult.
• Fluid Bolus Administration: Age- and weight-specific fluid bolus dosages for shock management (e.g., 20 mL/kg isotonic crystalloid).
• Glucose Checks: Importance of rapid blood glucose checks, especially in infants and young children, and treatment of hypoglycemia.

2.5 Arrhythmia Emergencies and Electrical Therapy

Instructors need to teach the recognition and management of common pediatric arrhythmias.

• Bradycardia: Recognition of symptomatic bradycardia and the PALS Bradycardia Algorithm.
• Tachycardia: Differentiating between narrow-complex and wide-complex tachycardias, and stable vs. unstable.
• Defibrillation and Synchronized Cardioversion: Age- and weight-specific energy doses and pad placement.
• Pharmacology: Drugs used for arrhythmias (e.g., adenosine, amiodarone, procainamide).

3.1 High-Performance Team Dynamics in Pediatrics

A core component of PALS is high-performance team dynamics, adapted for pediatric resuscitation. Instructors must train students on:

• Effective team leadership, including how to assign roles and ensure continuous high-quality CPR.
• Fostering clear communication within the resuscitation team, emphasizing closed-loop communication.
• Clear, concise messaging during high-stress situations, especially given the emotional intensity of pediatric emergencies.
• Knowledge sharing, encouraging team leaders to solicit ideas for differential diagnoses and observations from team members.
• Constructive intervention: tactfully and professionally correcting errors or offering suggestions when observed during scenarios.

3.2 Designing and Debriefing Pediatric Case Scenarios

PALS instruction heavily relies on dynamic case scenarios that mirror real-life pediatric emergencies. Instructors must be proficient in designing and facilitating these simulations, which often focus on:

• Respiratory emergencies (e.g., severe asthma, croup, foreign body airway obstruction).
• Management of various types of shock (e.g., hypovolemic, distributive, cardiogenic, obstructive).
• Dysrhythmias and electrical therapy (defibrillation, synchronized cardioversion).
• Post-cardiac arrest care in pediatric patients.
• Recognition and management of the "H's and T's" (reversible causes of cardiac arrest) in a pediatric context.

The module should provide opportunities for instructors to practice playing different roles while participating in and leading high-performance teams during these simulations. Prebriefing and debriefing sessions are crucial for enhancing learning and retention, particularly in complex pediatric cases. Instructors must master structured debriefing skills, which involve facilitating discussions about what went well, what could be improved, and the clinical reasoning behind decisions made during the scenario. The concept of CPR coaching, specifically adapted for pediatric BLS, should also be incorporated into the training.

3.3 Case Discussion and Critical Thinking

Beyond simulation, instructors should facilitate in-depth case discussions to promote critical thinking and clinical reasoning. This includes:

• Analyzing complex pediatric cases from presentation to outcome.
• Discussing differential diagnoses and management strategies.
• Exploring ethical considerations and communication with families.
• Reviewing evidence-based guidelines and their application to specific scenarios.

4.1 Best Practices for Providing Constructive Feedback and Remediation

Providing constructive feedback is crucial for student skill development and confidence across all AHA courses. Instructors should be trained in techniques that go beyond simple criticism:

• Directly explain why something is not working, then immediately demonstrate or show the correct solutions.
• Acknowledge and praise students when they perform actions correctly to reinforce positive behaviors and build confidence.
• Focus on what you do want students to do, rather than solely on what they don't want, maintaining a positive and supportive tone.
• Approach struggles with empathy (e.g., "I noticed you're struggling with giving breaths. That's okay.").
• Leverage small mistakes as valuable teaching points for the entire class.

For remediation, instructors should guide students to relevant reference materials and provide additional practice opportunities tailored to their specific deficits. Retesting should be conducted when indicated to confirm skill acquisition. Instructors should also actively solicit student feedback on their teaching methods.

4.2 Strategies for Creating an Engaging and Safe Learning Environment

Creating an engaging and safe learning environment is fundamental to effective instruction:

• Establish rapport with students by greeting them warmly, putting them at ease, and making themselves available for questions.
• Set clear procedures and guidelines for safe and respectful skill practice.
• Utilize active learning techniques, such as a mix of interactive activities, discussions, and group work.
• Ensure adequate time for questions and skill practice, avoiding the temptation to rush.
• Consider cultural factors and be prepared to accommodate students with disabilities or special needs.
• Begin each session with a clear explanation of course objectives and an emphasis on the importance of the training.

4.3 Maintaining Currency: Incorporating AHA Guidelines Updates and Training Bulletins

Maintaining currency is a continuous responsibility for all AHA instructors:

• Instructors receive regular updates on changes to AHA guidelines and protocols through various online platforms, newsletters, and specific training bulletins.
• The Program Administration Manual (PAM) serves as a central and critical resource for all aspects of program administration, policies, and procedures, available in a digital, online format.
• The Atlas platform is a key resource for accessing the latest information on guidelines, protocols, and teaching resources.
• Instructor renewal requirements typically include the completion of required provider and instructor updates.

Table: PALS Instructor: Key Responsibilities & Teaching Strategies

Responsibility Area	Recommended Teaching Strategy/Approach
Pediatric Assessment Teaching	Instruct on the PALS Systematic Approach Algorithm. Emphasize age-specific physiological differences and their impact on assessment and intervention.
Infant/Child CPR & AED	Teach age-appropriate CPR techniques (depth, rate, hand placement) and AED use (pad placement, dose attenuation). Focus on high-quality delivery.
Airway Management	Cover basic and advanced pediatric airway techniques, including bag-mask ventilation, advanced airway devices, and confirmation methods like capnography.
IV/IO Access & Fluids	Guide on establishing IV/IO access, age-specific fluid bolus administration, and the importance of glucose checks in pediatric emergencies.
Arrhythmia Management	Teach recognition and management of pediatric bradycardia and tachycardia, including appropriate electrical therapy (defibrillation, cardioversion) and pharmacology.
Scenario Design & Debriefing	Train instructors to design and facilitate dynamic pediatric emergency scenarios. Focus on structured prebriefing and debriefing to enhance learning and team performance.
Team Dynamics in Pediatrics	Teach and model high-performance team dynamics, including effective communication, role assignment, and CPR coaching specific to pediatric resuscitation.
Case Discussion & Critical Thinking	Facilitate in-depth discussions of complex pediatric cases to promote clinical reasoning and problem-solving.
Vulnerable Population Focus	Address the unique psychological and emotional aspects of pediatric emergencies for both providers and instructors.