Empowering lifesavers: Impact of BLS and PALS training for PICU and critical care nurses

S. Jeevitha1, Suresh Chelliah2, Muthuvel R3

1DNB (Paediatrics) Resident, MAA Kauvery, Trichy

2Senior Consultant Paediatrician, MAA Kauvery, Trichy

3Paediatric Intensivist, MAA Kauvery, Trichy

Background

Incidence of Cardiac Arrest in Pediatric Population;

Out-of-Hospital Cardiac Arrest (OHCAIn-Hospital Cardiac Arrest (IHCA)
Incidence of OHCA in children 5 to 10 per 100,000 children per year

Survival rates for OHCA in the pediatric population remain low (7–9%)
Incidence of IHCA: 2 to 6 per 1,000 hospital admissions

Survival rates for IHCA are better: 27 – 32% surviving to hospital discharge

Introduction: Importance of BLS and PALS

BLS (Basic Life Support)

First-responder interventions are critical for survival

  • High-quality CPR
  • Early defibrillation

PALS (Paediatric Advanced Life Support)

  • Focused on systematic assessment and management of critically ill children
  • Early recognition of shock and respiratory failure – to prevent IHCA
  • Improves outcomes when resuscitation is needed.

Impact on ER and PICU Nurses

Pivotal in managing life-threatening situations where rapid response can significantly improve survival. Timely and accurate use of BLS and PALS protocols can increase survival rate.

Need for In-House Training

  • Limited access to continuous external training
  • Ability to adapt training to the specific needs of nurses and patients – ensures effective handling of emergencies
  • Regular training and reassessment improve confidence in delivering life-saving interventions

Baseline Data

GroupTotal no. of NursesCompleted BLS (AHA)Completed PALS (AHA)
ER3060
PICU3850

*Only 20% of ER nurses and 13% of PICU nurses have completed AHA BLS training. None of them completed AHA PALS training.

Objectives

  • To evaluate the effectiveness of the BLS and PALS training conducted in-house at Maa Kauvery Hospital for ER and PICU nurses.
  • To assess the knowledge retention over time through pre-test, post-test and two-week reassessments, ensuring sustainability of critical resuscitation skills.

Training Overview

Training format: Program was adapted from AHA Guidelines

  • The training was modelled on the American Heart Association’s (AHA) BLS and PALS programs – The gold standard in resuscitation protocols.
  • BLS and PALS were modified to suit the hospital needs, focusing on key skills for frontline nursing staff

Trainers: Three consultants trained in AHA BLS and PALS

Trainees: 68 Nurses (38 from PICU and 30 from ER). They were divided into 6 batches and trained over 2 weeks

Training Scheudule

BLS Training (Day 1)PALS Training (Day 2)
Comprehensive half-day training session covering

  • Recognition of cardiac arrest

  • High quality CPR for adults, children and infants

  • Early defibrillation with AED

  • Effective rescue breathing

  • Role of teamwork in resuscitation scenarios

  • Management of Choking.

A half-day customized PALS session focusing on

  • Cardiac arrest management: Algorithms for shockable and non-shockable rhythms

  • Team management skills

  • Assessment of sick child

  • Use of manual defibrillator.

    Assessment Protocol

    Pre-test: A written (15 MCQs) and practical exam was administered before the start of both BLS and PALS training

    Post-test: After each day of training, nurses underwent immediate post-test (15 MCQs) to evaluate their understanding and ability to apply the skills.

    Reassessment after 2 weeks: They were reassessed with both written (15 MCQs) and practical exam after two weeks to measure knowledge retention and the sustainability of practical skills

    Results

    Pre-test and Post-test Performance (BLS)

    GroupNumber of NursesAvg Pre-Test ScoreAvg Post- Test Score
    PICU3863%86%
    ER3058.6%85.4%

    Pre-test and Post-test Performance (PALS)

    GroupNumber of NursesAvg Pre-Test ScoreAvg Post -Test Score
    PICU3860%84%
    ER3053.6%82.7%

    Knowledge Retention after 2 Weeks (BLS and PALS)

    GroupAvg Post-Test Score (%)Avg Retest Score (%)% Retained
    PICU (BLS)868295.3
    ER (BLS)85.47688.9
    PICU (PALS)848095.2
    ER (PALS)82.77489.5

    Analysis

    Improvement in knowledge and skills: Pre-test vs Post-test

    Significant improvement were observed in both BLS and PALS knowledge. The average Pre-test score was low – reflects the need for formal training in resuscitation protocols. Substantial improvement in post-test scores – effective learning and immediate application of knowledge gained.

    Improvement in Knowledge and Skills: Knowledge retention

    Two–week reassessment: Retest score remained around 90% of post-test score – Near complete retention of information.

    PICU vs ER nurses: PICU nurses performed better in reassessment. It could be due to more frequent engagement with critical care situations in PICU.

    Challenges in long-term retention

    • Although retention was generally high, minor drop in BLS & PALS scores after 2 weeks
    • This suggests that periodic refreshers and practice simulations are required to retain the skills obtained.

    Areas for Improvement

    1. Regular refresher courses

    Conduct refresher training every 3-6 months to prevent skill decay & focus on critical skills like high-quality CPR and pediatric cardiac arrest management.

    2. Simulation-Based Learning

    Use high-fidelity simulations to improve long-term retention

    Focus on team dynamics and real-life scenarios to enhance hands-on skills.

    3. Team-based Drills and Role Clarity

    Conduct regular interdisciplinary drills involving both PICU and ER teams to foster collaboration and improve communication.

    4. Technology-Enhanced Learning (TEL)

    Introduce e-learning platforms and mobile apps for ongoing education and practice bw formal trainings.

    5. Customized PALS for resource-limited settings

    Continue with tailored PALS training focused on cardiac arrest, team communication and the systematic assessment of critically ill children.

    6. Foster a culture of continuous improvement

    Create an environment that values continuous improvement and incorporate regular feedback loops.

     

    Dr. Jeevitha Sivakumar
    Postgraduate Resident in Paediatrics

    Dr. D. Suresh Chelliah - Pediatrician in Trichy

    Dr. Suresh chelliah
    Senior Consultant Paediatrician

    Dr. Muthuvel R
    Paediatric Intensivist

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