The European Paediatric Life Support Course

Antonio Rodriguez Nuñez

Coordinator of ERC Paediaric Working Group - Updated 11/2004

Recent history and perspectives

The ERC Paediatric Working Group

SloveniaSpain

Portugal

Italia*

Belgium

ItalyU.K.

Italy

Questions in the past

Do we need life support courses?

Do we need paediatric courses?

Who is the target population?

What is the best model?

How to implement the courses?

How to control the quality?

Survival and neurologic outcome by type of arrest

Respiratory

Cardiac

70 %

21 %

88 %

75 %

1y SurvivorsNeurologically

intactsSevere

disability

6 %

16 %

López-Herce et al, Resuscitation 2004

Goals of Life Support Courses

Adaequate responses to emergency situations: Knowledges and priorities Procedures and skills Reduction of fear and stress

Improve prognosis of cardio-pulmonary arrest: mortality rate neurological outcome

Layperson’s retention

Weaver FJ et al.Trainee’s retention of CPR. How quickly they forget. JAMA 1979;241:901-3.

... And what about health staff?

0

20

40

60

80

100

ImmediatelyOne monthSix months

96 %

36 %

7 %

Healthcare workers retention

Knowledge declines less than skills regular retraining course

True emergencies are rare in paediatrics < 1 % of admissions in a&e < 2 % of pre-hospital emergencies Rare procedures

ERC and Life Support Courses

Main strategical objective

Uniform guidelines

Target population

Spreading of knowledge and skills

Quality control

Accreditation issues

Why Paediatric Life Support Courses are needed?

Specific causes of arrest

Poor prognosis of cardiac arrest in children

Often limited qualification of medical staff

Need of specific and mixed teaching material

Special patient groups - e.g. the newborn

Etiology of CRA in children

30%

19,5%16,5%

16%

8% 7,6%

4%2,5%

Respiratory

Shock

Unknown

Neurologic

Drowning

SIDS

Dysrhythmia

Metabolic

Lopez-Herce et al, Resuscitation 2004

Who needs a Paediatric Life Support Course?

Doctors: all doctors who parents could contact first Paediatricians Emergency doctors

Nurses, Midwifes: Primary care Hospital

Ambulance teams

Life Support teaching models in Europe

U.K.: PALS, APLS

Belgian: RANP

Italian: PALS

Spanish: CRCPAPN

Portuguese: SAVP

Others: AHA,PALS,..

EUROPEAN

EPLS

Paediatric Life Support Teaching situation in Europe - In “past years”

Few groups with structured programs and activities

Only one of them “professional”Few contacts between groupsNo formal adherence to international

guidelinesAbsence of a “common reference”Voluntary basis

European PLS course process

PLS working group founded

Definition of the course: July 2001

Course preparation

“Pilot” course: Verona, July 2002

Presentations and guidelines for practical sessions composed

First course: Florence, October 2002

Course Manual: November 2002

Goals

Uniform guidelines for paediatric life support in Europe (ERC)

Tools for education (manual, slides)

Provider courses

Instructor courses

Groups of enthusiastic instructors

Translations to local languages

European Paediatric Life Support Course Book(1st ed. 2002)

• Introduction• Recognition of the seriously ill child• Paediatric Basic Life Support• Management of the airway• Vascular access• Fluids and medications• Rhythm disturbances in seriously ill child• Special situations in paediatric resuscitation• Trauma child• Stabilisation after resuscitation and transportation• Ethical considerations • Resuscitation of the newly born

Main focuses of the EPLS course

Recognition of children at risk

Cardiac arrest anticipation

Bag-mask ventilation

Intraosseous access

Drugs - Adrenaline

Defibrillation

Integrated approach

Adaptation to special situations

Type of arrest and survival

51,6

21,1

87,1

70

0102030405060708090100

Cardiac Respiratory

InitialAt one-year

López-Herce et al, Resuscitation 2004

percentage

Main focuses of the EPLS course

Recognition of children at risk

Cardiac arrest anticipation

Bag-mask ventilation

Intraosseous access

Drugs - Adrenaline

Defibrillation

Integrated approach

Adaptation to special situations

Bag - Mask Ventilation

Intraosseous access

Main focuses of the EPLS course

Recognition of children at risk

Cardiac arrest anticipation

Bag-mask ventilation

Intraosseous access

Drugs - Adrenaline

Defibrillation

Integrated approach

Adaptation to special situations

Defibrillation

Main focuses of the EPLS course

Recognition of children at risk

Cardiac arrest anticipation

Bag-mask ventilation

Intraosseous access

Drugs - Adrenaline

Defibrillation

Integrated approach

Adaptation to special situations

Integrated Cases

Pre course MCQ test, sent to candidates with the manual

Duration: 2 days -16 effective hours Presentations and demonstrations: 4 hours Skill stations: 5 hours Scenarios: 4 hours BLS and ALS exams: 3 hours

Course Content

25 %

56 %

19 %

Early recognition of critically ill child Particularities of child’s airway and

introduction to airway management Cardiac arrest in children. Recognition

of arrhythmia and defibrillation Trauma management Resuscitation of the Newly-born Post-resuscitation care Ethical aspects

Course Lectures

Course Skill stations

• Basic life support and management of foreign bodies in the airways

• Opening the airway, cervical spine care and bag/mask ventilation

• Oxygen delivery and tracheal intubation

• Vascular access, fluids, drugs• Arrhythmia and defibrillation

Course Integrated cases

• Respiratory failure

• Circulatory failure and Trauma• Resuscitation at birth• Cardiac arrest and teamwork

To permit self-assessment and improvement by the candidate

Make ease a friendly climate in the group

Encourage comments and corrections by colleagues

The instructor:

- First, remark positive aspects

- Then, correct errors

Scenario dynamics

Course evaluations

Of the candidates: Basic life support Written examination Scenario testing

Of the course: By the candidates By the instructors

Requirements for EPLS course candidates

Health care staff

Paediatric or Emergency activity

Basic Life Support Course passed

Pre course study of manual – Pre test

A minimum knowledge of english language

First EPLS courseFlorence 1-2 October, 2002

Target group: Health care providers Interactive method 9 instructors / 24 candidates 2 “observers” Language: English

Origin of candidates1st EPLS Course, 2002

* *

**

** *

*

*

*

* **

*

*

European countries with established paediatric courses programs 2004

United Kingdom

Spain

Belgium

Italy

Portugal

Greece

Germany

Austria

Hungary

Slovenia

Croatia

Denmark

Malta

France

Holland

Norway

PAST

FUTUREPRESENT

Preliminary contacts: Russia, Turkey, Poland...

Spain RC : 50 providers C

5 PIC/year

> 500 instructors

RCUKEPLS Since Since January January 20032003

700 instructors

200 PC/y

Tempus : Start EPLSStart EPLS Dec 2004

Abudhabi : PC + GIC 6 IP

EPLS in non-european countries

The EPLS course in German speaking areas (PBLS + EPLS)

The Sud-Tyrol experience: Multi-cultural, multi-language, interchange of

experiences, basis for development in other areas

Germany: Hannover Viersen Mainz

Austria: Vienna

All centres: Translation of the slides, December 2003

Austria and Germany: PBLS+EPLS - 3 days course

Most of candidates haven’t participate in a PBLS - Course

Performance in BLS is worse than in advanced procedures

Permits more time for stations

Permits to incorporate new modules: e.g. automated external defibrillation

EPLS Courses in Germany 2005

Hannover - Spring 2005

Viersen - Spring / Summer 2005

Mainz - Autumn 2005

EPLS Retraining Courses for British Forces in Germany 2005

Viersen - Spring / Summer 2005

1 day course

Teaching by lectures and in small groups

20 - 28 participiants

ERC - accreditation enquired

Interested collegues ? - please find informations and an application form at the website

www.kinder-notfallkurse.com

Practical barriers to EPLS courses

Need of enthusiastic local organisers

Commitment of National RC

Expenses

Paediatric material

Paediatric mannequins

Experienced Instructors

Material

Instructors

The EPLS as a “core” for other module-derived courses

EPLS

PBLSPBLS+

BMV+AED

Arrhytmias and

defibrillation

Difficult airway

Assisted ventilation

Transport

Post-CPR critical care

Bio-ethics

Newly born

Trauma

EPLS Instructor Courses

Generic Instructor Course vs.

Specific Paediatric Instructor Course

with adaptations to the EPLS course specifications

The immediate future

ERC on-line management of administrative aspects: material, candidates, accreditations, instructors

List of voluntary international instructors

New international guidelines (end of 2005)

New course manual (during 2005)

Translations of the new course manual (during 2005)

2006 Update: New guidelines, new manual

To evaluate

Does the course will achieve a significant increase in the PLS knowledge and skills?

Will it reduce the incidence of cardiac arrest in childhood?

Will it improve the prognosis of paediatric cardio-pulmonary arrest?

Conclusions

A good and effective model

At least 17 countries already involved in the project

Instructor’s courses are needed

Translation of course materials. Courses in local languages are needed.

Thank you for your attention!

Websites:

Europe www.ERC.ecu

Suedtirol www.provinz.bz.it/se/paednotmed

Rheinland www.kinder-notfallkurse.com

Mainz www.EPLS.info

Hannover http://www99.mh-hannover.de/kliniken/paed-kardiol/

Wien http://www.meduniwien.ac.at/kinderreanimation/