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 (OHCA	In-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

Group	Total no. of Nurses	Completed BLS (AHA)	Completed PALS (AHA)
ER	30	6	0
PICU	38	5	0

*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)

Group	Number of Nurses	Avg Pre-Test Score	Avg Post- Test Score
PICU	38	63%	86%
ER	30	58.6%	85.4%

Pre-test and Post-test Performance (PALS)

Group	Number of Nurses	Avg Pre-Test Score	Avg Post -Test Score
PICU	38	60%	84%
ER	30	53.6%	82.7%

Knowledge Retention after 2 Weeks (BLS and PALS)

Group	Avg Post-Test Score (%)	Avg Retest Score (%)	% Retained
PICU (BLS)	86	82	95.3
ER (BLS)	85.4	76	88.9
PICU (PALS)	84	80	95.2
ER (PALS)	82.7	74	89.5

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. Suresh chelliah
Senior Consultant Paediatrician

Dr. Muthuvel R
Paediatric Intensivist

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

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

S. Jeevitha1, Suresh Chelliah2, Muthuvel R3

Journals

S. Jeevitha¹, Suresh Chelliah², Muthuvel R³