Trainees will be aware that possession of a current ALS certificate is a mandatory requirement for training in the acute medical specialties, including core medical training/internal medicine training. As the pandemic with COVID-19 has struck, ALS courses have been suspended preventing trainees from immediate renewal of their certification and preventing others whose ALS certification has lapsed for a more prolonged period, from renewing. Ensuring capability for any specific task lies, of course, with the medical director of the employing organisation but in the absence of a certificating course the following is suggested:
- Trainees who are looking to renew a certificate which is still current but will lapse in the near future or trainees where the certificate has lapsed within the last year should be reviewed by an ALS instructor and their knowledge of the management of the acutely deteriorating patient and of the current resuscitation algorithm tested. This could be recorded as part of a supervised learning event (SLE) in the trainee’s portfolio. If the trainer is satisfied then the trainee should be able to continue in the acute work required by the employing organisation and lead the cardiac arrest team. If the trainer is not satisfied, the trainee should review the areas that have proved less than satisfactory and then ask the trainer to review them again.
- Trainees whose certification has lapsed over 12 months ago but who are now being asked to take on the management of acutely ill patients should also be reviewed by an ALS instructor and their knowledge of the management of the deteriorating patient and the current resuscitation algorithm tested. If this is proven to be satisfactory then the trainee should be engaged in seeing acutely ill patients but with immediately available supervision to ensure that decision making is based on good judgment. If this is demonstrated to be adequate the trainee should be entrusted to act at the level appropriate to their overall training. The trainee can be part of the cardiac arrest team but an ALS trained person should also be present. An ALS instructor should review the trainee in a simulated cardiac arrest situation and be satisfied about their performance before the trainee is allowed to lead the team.
For the purposes of this paper an ALS instructor could be practising in one of a number of disparate professions but it does not include instructor candidates.
Further information including the possibility of e learning may be available from the Resuscitation Council of the United Kingdom in the coming days. In the meantime, they have published resources on their website including a new COVID-19 ALS algorithm.