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2nd Congress of the European Academy of Paediatrics, Nice, France, October 24-28, 2008


European Paediatric Immediate Life Support (EPILS)
one day course (8 hours)
24 November 2008

The European Paediatric Immediate Life Support  one day course will take place on November 24,2008 a part of the EAP congress  and is aimed at training non-specialized nurse, paramedics and non-emergency physicians to recognize and manage critically ill children and children in cardiorespiratory arrest whilst awaiting the arrival of the Medical Emergency Team (1 to 5 minutes). The course will also train the candidate to work as a member of the Resuscitation team.
The EPILS course is conducted in small group and taught by EPLS instructors.
Candidates to the course will be continuously assessed during the course and will receive an ERC certificate providing they reach a satisfactory standard according to ERC criteria.

Proposed programme for the one day EPILS course

8h30 – 8h40

Welcome and objectives

10’

8h40 – 9h25

Lecture: Recognition of the critically ill child

45’

9h25 – 9h40

BLS Demonstration

15’

9h40 – 10h40

Workshop : BLS

60’

10h40 – 10h55

Coffee break

15’

10h55 – 11h25

Workshop FB

30’

11h25 – 12h25

Airway opening , Bag & Mask, Oxygen delivery, Oral airway Incl. scenarios and practice

60’

12h25 – 12h55

Vascular access and drugs preparation

30’

12h55 – 13h40

Lunch time

45’

13h40 – 13h55

Scenario demo

15’

13h55 – 14h25

ALS cardiac arrest algorithms

30’

14h25 – 15h10

Scenario 1

45’

15h10 – 16h25

Coffee break

15’

16h25 – 17h10

Scenario 1

45’

17h10 – 17h30

Conclusion and Feed-back

20’

Themes of the EPILS course

 

Pre-MCQ: 20 questions

1

Lecture: causes of cardiac arrests, recognition of the very sick child, principles of management. Bases on the algorithm “rapid ABC assessment and treatment algorithm manual” p13
Examples and movies

2

BLS and FBAO: Demo + 4 stages approach

3

Opening the airway plus C Spine stabilisation Ac (only with the hands)
Bag mask ventilation – self-inflating bag
Oral airways (Guedel)
O2 delivery (mask & reservoir and non-threatening methods) through scenarios

4

Vascular access

  • I.O skill
  • Algorithm of vascular access

Drugs: adrenaline, glucose
Fluid: saline dose and administration
Blood sampling

5

Cardiac arrest algorithm: shockable & non shockable rhythms

6

Demo als and team work

7

6 Scenarios:
Compensated respiratory insufficiency
Decompensated respiratory insufficiency
Compensated circulatory insufficiency
Decompensated circulatory insufficiency
Cardiac arrest (non-shockable) and shockable

8

Continuous evaluation and individual feed-back
Outcome:
Recognise a critically ill child
Open airway according to the age
Perform Bag and Mask Ventilation
Recognize cardiac arrest
Perform efficient chest compression
 

Goals of the EPILS course

This one day course (8-9h)  is aimed to teach non specialized nurses, paramedics and non emergency physicians to recognize and manage critically ill children and children in cardio-respiratory arrest while waiting the MET (1 to 5 minutes) and to be able to work as a member of the team during resuscitations
The EPILS can be organized for one to 4 groups of 6 candidates with 1 instructor (+ 1 helper).
Instructors must be EPLS qualified instructors. Supervision must be made by an EPLS course director or recognized center. Constant presence of the CD is not mandatory.

Recognition of the very sick child

Slides borrowed from EPLS. The goal is to give a tool to identify the critically ill child. The lecture must be very interactive with examples and movies more than a strict lecture (more a workshop with slides and movies)
May be completed with an algorithm for calling the MET

OBJECTIVES:

  • Cardiac arrests in adults and children
  • Recognition of  the critically ill child at risk of cardiorespiratory arrest
  • Be able to recognize circulatory or respiratory insufficiencies
  • Discuss how to handle it
At the end of the lecture, candidates must be able to theoritically:
  • Explain the rapid ABC assessment and simple principles of treatment  
  • Explain evaluation criterias of ABC
  • Establish the priority of the management according to the child’s condition
  • Know how and when to call an expert or the Medical Emergency Team
BLS Demonstration and workshop

OBJECTIVES

Demo: The objective is to insure that all the participants use the same BLS reference.
Exercise BLS technique without adjunct

1.Demonstration by an instructor of a 1 minute BLS sequence for one rescuer without material in front of all participants
This demo is made by an instructor in real time according to the 4 stages principle on a baby manikin and on a child manikin. When stages 1, 2 are done, candidates are allowed to ask questions. Then stage 3 (demo by the instructor with comment by a candidate) is performed.

2. The group of candidates is split in two and each is accompanied by an instructor.
One group works on the baby manikin and the other on the child manikin. Then groups swap.

Airway opening and BM ventilation

For all the group.

OBJECTIVES

At the end the candidate must be able to identifiy airway status, to clear and open the child’s airway.
He must be able to recognize the child who needs free flow oxygen versus BM  Ventilation, to choose the adequate material for BMV, place an oral airway
He must be able to adequately ventilate the child with an adapted-to-age bag and mask.
Work on scenarios

Material to be demonstrated

  • Oral airways
  • Self-inflating bag
  • Masks
  • Mask with reservoir
  • Non threatening oxygen delivery

Training on manikin or ventilation head

Vascular Access

OBJECTIVES

Understand algorithm of placement of vascular access during resuscitation
Know the material and perform IO on chicken or turkey legs or on manikin legs.
Prepare adrenaline and glucose boluses for resuscitation
Discuss fluid bolus
Blood sampling

Cardiac arrest
 Or cardiorespiratory insufficiency

=> intraosseous (endotracheal)

Decompensated shock

=> intraosseous (peripheral 3 attempts)

Compensated shock

=> Peripheral
              => Central
                             => Intraosseous

Vascular access must be performed AFTER BLS has been adequately performed (Airway, Breathing and Circulation)

Resuscitation cart may be presented at this stage

Scenarios

Scenarios are performed in team

Candidates must start BLS with a structured approach, call for MET and be member of the MET team

OBJECTIVES

The candidate recognizes the child that needs resuscitation. He uses the techniques taught during the day for BLS with one and two rescuers and becomes a a member of the MET

Annexes: Scenarios

Outcome Based Assessment

At the end of the day, each candidate receives a personal feed-back on his performances
Succeeds the course if following goals are reached

  • Know how to assess a critically ill child
  • Know BLS algorithm
  • Can perform BLS (one and two rescuers)
  • Can perform adequate BMV
  • Know how and when to call the MET
  • Know ALS algorithm
  • Can use AED
  • Understand the safety issues when a defibrillator is used
  • Can be part of a rescue team
  
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