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Comprehensive Advanced Life Support CALS

Overview of CALS. CALS is an educational program designed specifically for rural health providers to meet their advanced life support training needs.The two-day, interactive Provider Course and one-day Benchmark Skills Lab is conducted using a TEAM approach to anticipate, recognize and treat life-

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Comprehensive Advanced Life Support CALS

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    1. Comprehensive Advanced Life Support (CALS) A Team Approach to Rural Emergency Care Paula Nelson, RN, BSN, CEN Texas CALS Coordinator

    2. Overview of CALS CALS is an educational program designed specifically for rural health providers to meet their advanced life support training needs. The two-day, interactive Provider Course and one-day Benchmark Skills Lab is conducted using a TEAM approach to anticipate, recognize and treat life-threatening emergencies.

    3. History of CALS CALS was developed by a grassroots team of health care providers who recognized the need for a concise resuscitation course that could be taken to community hospitals. CALS was initiated in 1993 by Dr. Darrell Carter, a family physician from Granite Falls, MN, who proposed one course that would cover concepts of all areas of resuscitation. MN Academy of Family Physicians sponsored a working group that developed the curriculum.

    4. History of CALS, Cont’d. This working group was comprised of physicians, nurses, physician’s assistants and paramedics. Dr. Ernest Ruiz, Professor Emeritus, former Director of the Emergency Medicine Dept. at Hennepin County Medical Center and the Emergency Medicine Program at the University of Minnesota, developed the Benchmark Skills Lab and sections of the provider manual.

    5. Benefits of CALS Designed for rural healthcare practitioners but can be adapted to the urban setting Is ONE course that covers concepts contained in many of the other advanced life support courses Emphasizes teamwork in a team training environment

    6. Benefits of CALS, cont’d. Provides a favorable ratio of students to instructors for optimal learning Focus is the UNIVERSAL approach to emergency care Identifies essential equipment Includes all age groups, from birth to geriatrics Offers classroom and lab components

    7. Delivery of Rural Emergency Care NRHA EMS Agenda for the Future - Rural Public Access “The further one is from a large emergency medical facility - the more one needs a high level of local emergency capacity and the less likely it is that the emergency capability will be available.” Life or death in rural communities depends on a small team of providers.

    8. Delivery of Rural Emergency Care Cont’d. Customary medical training does not prepare providers for the demands of rural practice. Rural facilities lack back - up staff. State-of-the-art equipment often lacking in rural facilities. Medical - legal expectations are the same for rural facilities as they are for urban.

    9. Rural Emergency Care Suffers Due to: Lack of ongoing education in advanced emergency care. Limited availability of appropriate RURAL ALS training. Lack of sufficient volume for providers to retain emergency knowledge and skills. The high cost of ALS training - multiple ALS courses.

    10. Results in Rural Communities Disparity between rural and urban areas, especially evident in trauma care Difficulty of recruiting medical personnel to rural communities Increased provider burnout Mounting medical - legal risks

    11. Concept of CALS A single ALS course for rural providers “Couldn’t be done, but had to be done.” CALS working group formed Jan. 1993 Thousands of volunteer hours 1st class Sept. 1996 Grant money $2.5 million - pro bono

    12. What is CALS? CALS is an advanced life support training program designed for rural healthcare providers. Developed for the whole emergency TEAM including physicians, nurses, midlevel providers and paramedics, basically anyone involved in the resuscitation of the emergency patient in the rural setting.

    13. What is CALS, Cont’d. CALS is an educational program in ALS including trauma, OB, cardiac, airway management, pediatrics, etc… CALS includes a two-day provider course and a one-day Benchmark Skills Lab that is offered separately from the provider course.

    14. What is CALS, Cont’d. CALS educates practitioners in a universal approach, rather than focusing on specific categories of emergencies. CALS is designed with rural healthcare providers in mind and provides exposure to critical situations using interactive case scenarios.

    15. CALS Mission Statement “The primary mission of CALS is to improve patient care by enhancing the provider’s established scope of practice through advanced education.” We envision the quality of emergency critical care provided in rural communities by primary care teams to be enhanced by use of a systematic approach, mastery of skills and knowledge, and utilization of essential equipment.

    16. What makes CALS unique? Four key concepts: 1) Universal Algorithm Approach 2) Teamwork 3) Transport Decision-Making 4) Clinical Pathways Instruction in the proper emergency equipment for rural hospitals.

    17. Educational Components Home Study - CALS Manual and study guide. The manual consists of 3 volumes, Vol. 1 - “The First 30 Minutes” Vol. 2 - “Emergency Skills” Vol. 3 - “Diagnostic/Treatment Portals Two-day CALS Provider Course - Consists of airway, cardiac, trauma, pediatric, OB, neonatal and medical ALS training.

    18. Education Components, Cont’d. One-day CALS Benchmark Lab - Covers about 50 skills useful for stabilization of critically ill or injured patients. This lab experience is “cockpit white-knuckle training” for rural teams. Stresses teamwork, preparation and hands-on skills, learning and practice. The setting is realistic, but friendly.

    19. Distribution of CALS Education In MN - Over 2400 providers trained in 117 courses Training of the US Dept. of State Embassy Medical Personnel in 50 countries, including NASA Astronauts Wisconsin, Missouri and Texas have conducted courses and are applying for chapter status

    20. Distribution of CALS Education Cont’d. Currently pursuing a relationship with the military medical units that need to prep their soldiers for a variety of emergencies. Researching the development of “Afri-CALS,” a curriculum for Africa.

    21. Results of CALS Training Surveys conducted by the Office of Rural Health Primary Care, a part of the MN Department of Health discovered some common themes after visiting with Critical Access Hospitals in MN. Theme #1: CALS provides a comprehensive, realistic, team-based approach to handling emergency medicine in rural hospitals.

    22. Results of CALS Training Cont’d. Theme #2: CALS Benchmark Lab increases the comfort levels of rural emergency personnel by exposing them to procedures rarely encountered on the job. Theme #3: CALS provides a rural based standard for assessing the medical equipment needs of small hospitals and clinics.

    23. Results of CALS Training Cont’d. Theme #4: CALS teaches everyone to anticipate and prepare for a patient’s needs prior to arrival, improving the speed and efficiency of treatment, leading to better patient outcomes. Theme #5: CALS has heightened the speed and efficiency of transferring critical patients to higher levels of care.

    24. MN Trauma System Statement on CALS Training “Hospitals that have hosted or successfully completed a CALS course did have a significant head start in preparation to meet most of the Level III and IV trauma facility criteria. Specifically, education, equipment, treatment and transfer guidelines were largely in place. “The CALS philosophy of rapid assessment, stabilization and definitive care decisions mesh nicely with the optimal care of the trauma patient.”

    25. Why bring CALS to Texas? CALS has had a positive impact on rural emergency care. CALS has been recognized by the AHA and Joint Commission Facilities are using CALS as their “gold standard” for rural emergency medical care and eliminating other requirements. Support is available through the National Chapter.

    26. Components to Develop a State CALS Chapter Identify a state infrastructure to conduct CALS courses Identify and train instructors Develop a CALS Skills Lab with the help of National CALS faculty Conduct the initial 2 to 4 Skills Labs in the state Obtain educational materials from National

    27. Where do we start? Generate funding to begin classes Conduct a minimum of 2 classroom courses with a total of 48 participants, identifying people with instructor potential Apply for chapter status Train instructors, set up skills lab

    28. What have we done in Texas?

    29. Funding Process Office of Rural and Community Affairs (ORCA) has provided Flex Grant funding Participant registration fees generate revenue Charitable contributions from not-for-profit sources

    30. Texas CALS Courses 1st provider and instructor courses in Georgetown, Jan. 2008 with 16 participants trained as providers and 11 instructor candidates 2nd provider course in Rockdale, June 2008 with 16 participants trained and 3 instructors validated

    31. Texas CALS Courses

    32. Evaluation Comments The most valuable part of the course: Scenarios. Great information and great learning environment. Instructors were awesome! I really liked the team approach. Just getting familiar with all the equipment and different approaches.

    33. Evaluation Comments Cont’d. EKG interpretation. Peds/OB - my weak points. Intubation/meds involved and the great team involvement. I have been a nurse for 20 years and have never been to a more informative course. Thanks you guys!

    34. CALS Contact Information CALS Website: www.calsprogram.org Paula Nelson, RN, BSN, CEN, TX CALS Coord. #512-626-5015 or e-mail at paulanbear@aol.com Glenda Grawe, MD, TX Medical Director, #763-439-3390 or e-mail at ghgrawe@yahoo.com Darrell Carter, MD, Program Director, #320-564-2511 or e-mail at dlcarter@mchsi.com Kari Lappe, RN, Program Manager, #612-624-5901 or e-mail at kdlappe@umn.edu

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