Advanced Life Support (ALS) certification and working in acute medicine

26 Mar 2020

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:

  1. 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.
  2. 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.

Addendum:

Since this was published two facts have emerged. Firstly the Resuscitation Council have offered to award all certificates that expire in 2020 a 6-month extension. This is extremely helpful. The advice in the published paper is however still pertinent for those returning to clinical practice and indeed those who feel that they no longer have capabilities related to leading a cardiac arrest team.

Secondly, trainees should not have to organise their own refresher experiences. It is clear that the overall responsibility for ensuring any doctor has relevant capabilities while working in a hospital lies with the medical director. It is suggested that the trainee who has not been actively involved in leading cardiac arrest or the management of the acutely ill patient in the last 12 months should discuss the need for a revision of ALS skills with the clinician who is supervising their day-to-day activities. That individual is most likely to know the local systems and will be best placed to identify those who are ALS instructors in the locality including the local resuscitation lead. Contact with such individuals should be facilitated to permit updates as outlined in the published paper to occur.

If a trainee who does not hold active certification is inadvertently rostered to be part of the cardiac arrest team the trainee should alert the rota coordinator as soon as possible to ensure that either they receive the adequate training in advance of their shift, or, if this is not possible, a replacement is found for the cardiac arrest team.