Transcript Document

CALS
Comprehensive Advanced
Life Support Program
A Team Approach to Rural
Emergency Care
CALS
Delivery of Rural Emergency Care
• Emergency/Critical Care in Urban settings – subspecialty
trained personnel with latest equipment.
• Life or Death in rural communities depends on a small
team of providers.
• Customary medical training does not prepare providers for
the demands of rural practice.
• Advanced life support courses – fall short
• Medical-legal expectations
• Rural - lack of state-of-the-art equipment
• Rural - lack backup staff
CALS
Agenda for the Future - Rural
Public Access
• “The further one is from a large emergency
medical facility – the more one needs a high
level of local emergency capacity and the
less likely it is that the emergency capability
will be available”.
CALS
Rural Emergency Paradox
• On a clinical bases, a rural emergency
medical paradox results because Advanced
Life Support (ALS) Services are difficult to
establish and maintain in systems that
experience insufficient volume to enable
advanced providers to be paid and to retain
their skills.
CALS
Rural Emergency Care Suffers
due to:
• Lack of ongoing education in advanced
emergency care.
• Limited availability of appropriate RURAL
ALS training.
• Lack of sufficient volume for providers to
retain emergency knowledge and skills.
CALS
Rural Emergency Care Suffers
due to (cont):
• The high cost of ALS training – multiple
ALS Courses.
• Inadequate patient volume to pay for
emergency training based on a fee-forservice revenue system.
• Lack of appropriate equipment.
CALS
Results in Rural
Communities
• Disparity between rural and urban – especially
evident in trauma care
• Difficulty of recruiting medical personnel to rural
communities
• Increased provider burnout
• Mounting medical-legal risks
CALS
The Need
• Provide better patient
care
• Solve the feelings of
being inadequate
• Address medical-legal
concerns
• Help with professional
burn-out
CALS
What is CALS?
• Educational program or educational
experience in ALS including trauma, OB,
cardiac, airway management, pediatrics, etc.
• Developed for the whole emergency TEAM
including nurses, midlevel providers,
physicians and other paramedical personnel.
CALS
Primary Focus of CALS
• Train medical personnel in a team approach.
• Training targeted for health care
professionals who provide emergency and
critical care.
• Specifically designed for rural providers
who must treat a broad range of
medical/traumatic emergencies.
CALS
CALS Mission Statement
“The primary mission of CALS is to improve
patient care by enhancing the provider’s
established scope of practice through
advanced education”.
CALS
CALS Vision
We envision that the quality of emergency
and critical care provided in rural
communities by primary care provider
teams can be enhanced by the use of the
resuscitation triangle consisting of:
* A systematic approach
* Mastery of skills and knowledge
* Utilization of essential equipment.
CALS
CALS Value Statements
• We demonstrate our commitment to
improving rural medical care by providing
quality education especially designed to
meet the needs of Rural Health Care
Providers.
• We strive to provide information that is
State-of-the-art and Evidence Based.
CALS
CALS Values Statements (cont)
• We believe each member of the health care
team provides a value regardless of
professional status and thus we emphasize
the Team Approach to patient care.
CALS
Educational Components of the
CALS Program
• Home study – CALS Manual and study-focusing
question guide.
• Two-day CALS Provider Course – consisting of
airway, cardiac, trauma, pediatric, obstetrical,
neonatal, environmental, and medical advanced
life support training.
• One-day CALS Benchmark Lab – covering
about 50 skills useful for stabilization of critically
ill or injured patients.
CALS
CALS Educational Materials
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CALS Provider Manual
2-day CALS Scenario-based Classroom Course
Benchmark Lab Manual
1-day Benchmark Skills Lab Training Course
CALS Instructor Manual
CALS Instructor Course
CALS Emergency Procedures CD
CALS RSI Card
CALS Rescue Airway Card
CALS Equipment List
CALS
CALS Provider Manual
CALS
CALS Provider Manual
• 3 volume - loose leaf manual
*Vol 1 – “The First 30 Minutes”
*Vol 2 – “Emergency Skills”
*Vol 3 – “Diagnostic and Treatment Portals”
• Study guide – 100 questions to help focus precourse studying
• Pre-course questionnaire – help focus training to
the needs of the providers
• Pre-test - CME
CALS
CALS 2–Day
Interactive Provider Course
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Brought to the rural communities.
Taught to teams of rural providers.
20 to 30 providers per course.
Interactive scenario based.
Conducted in the rural settings in the local
hospital.
CALS
Components of the CALS
Provider Course
• Didactic group sessions (interactive -- Not
Lectures!)
• Small group demonstrations and hands-on practice
of skills
• Case-based learning
• Emphasis on a team approach
• Practice a Universal Approach to Emergency Care
• Opportunity for dialogue between different
disciplines and practice settings
• Emphasize transfer of learning
CALS
Airway Management: Rapid Sequence
Intubation
CALS
The CALS Benchmark Lab
• Intense hands-on instruction in 50 critical
&/or life saving emergency procedures.
• Full eight hour day of skills training.
• Taught in teams consisting of 4 providers.
CALS
CALS Instructor Course
• Teach “transfer of learning” theory
• Review essential components of CALS
training
* Universal Approach to patient care
* Team Work
* Difficult Airway management
• Practice scenario-based interactive teaching
CALS
CALS Benchmark Emergency
Skills CD
• Reviews the life
saving skills taught in
the Lab
• Includes the many
difficult airway
techniques, chest tube
insertion, newborn
procedures, etc.
CALS
CALS Airway Cart
CALS
Essential Aspects Unique to CALS
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Team development
CALS universal approach to ALS
Approach to the difficult airway
Rapid Sequence Intubation (RSI)
Advanced airway skills
Additional topics not covered in current ALS
courses
• Instruction in the proper emergency equipment for
rural hospitals
CALS
Developmental Goals of CALS
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To be the most comprehensive ALS Course
Cover all of the ALS needs of rural providers
Cover the essentials of all of the other ALS courses
Maximize the emergency skills of the rural providers
(especially in airway management)
• Improve the quality of emergency care in rural
communities
• Improve the outcomes of emergency care in rural areas
• Help rural hospitals be correctly equipped to handle
emergencies
CALS
Most Valuable Parts of the CALS
Provider Course
• Based on evaluations provided by 377
CALS Provider Course participants (200203)
* RSI Training
* Teamwork training
* Scenario-based interactive learning
* 12-lead ECG interpretation
CALS
Most Valuable Parts of the CALS
Benchmark Lab
• Based on evaluations provided by 137
CALS Skills Lab participants (2002)
* Hands-on learning
* The learning of advanced and surgical
airway management skills
* The learning of chest tube insertion skill
CALS
CALS Courses through
December 2005
• First course – September of 1996
• 112 courses held throughout state of MN
• 2500+ participants (33% physicians, 53% nurses,
6% PA/NP, 3% allied health, 5% EMPT)
• Includes the Medical Personnel that work in the
US Embassies throughout the world (US
Department of State)
CALS
CALS training for State Dept. Personnel
• Trained 258 providers who staff the US
Embassies throughout the world.
• Many are in very remote areas with limited
resources available.
• One week CALS course in Minnesota.
CALS
Embassy Personnel Training (cont)
• “Thanks again for the wonderful course. It’s
unanimous that this was among the best we have
ever had.” Larry Brown MD, Medical Director –
Department of State and Foreign Service.
• “CALS was the best CME I’ve ever attended (and
I used to be an ACLS and ATLS instructor) and
we are still raving about it.” Tom – Singapore
• “I can honestly say that I will not panic if there is
a major problem at my Embassy. I could not say
that a week ago.”
CALS
Obtaining Acceptance of CALS
in Minnesota
• Built the case for the need for CALS type of
training among the Trauma Centers, University of
MN Med School, NICU, Cardiac Care Centers,
etc.
• Sought and received support from the leaders of
the MN ACLS and ATLS Programs.
• The observed change in rural emergency/critical
care after CALS Training - spoke for itself to the
urban referral centers.
CALS
Financial Support for CALS
Development
• Initial development largely pro bono
• Early seed money from MAFP, MN ACEP,
University of MN Dept of FP.
• Lab developed by Dr Ruiz, Emergency Physician
at U of MN and HCMC Trauma Center.
• Support from EMS Regulatory Board, MN
ORHPC, MAFP, MN ACEP, Trauma hospital
leaders – led to state legislative funding to help
off-set cost of conducting the courses and labs.
CALS
Financial Support (cont)
• MN state legislative support – grant money
administered through the EMS Regulatory Board:
* Off-sets part of cost of the lab and provider
course.
* Assists in the development and editing of the
CALS Provider Manual.
* Helps with CALS Office expenses.
* Helps with CALS Instructor training.
* Helped develop the CALS Benchmark Lab CD.
CALS
Financial Support (cont)
• Support from the MN ORHPC – flex grants:
* Financed much of the development of the
CALS Benchmark Lab CD.
* Helped CAH providers attend CALS courses
and labs.
* Financed some emergency equipment for
CAHs.
* Conducted Site-Study on the value of CALS
training in a CAH.
CALS
Future Distribution of CALS
• The need for CALS type of training is
universal in rural communities.
• Up until now CALS Training has only been
in Minnesota.
• We believe that we have a responsibility to
share the CALS Program with other states if
there is interest in the CALS training.
CALS
Conclusion about Rural
Emergency Care Training
• It is possible to create a Rural Emergency Team.
• It is possible to prepare for the unknown.
• A Rural Health Care Team can stabilize most
medical/trauma emergencies.
• Rural Health Care Teams can practice state-of-theart emergency care with the use of basic
emergency equipment, the mastery of needed
skills and working in an organized fashion as a
team.
CALS
Conclusions about the CALS Program
• CALS training is helping to make some
order out of the chaos and nightmares of
rural emergency care
• CALS is positively impacting the rural
emergency care in Minnesota
• CALS MD “Physicians in Minnesota
consider CALS the gold standard for rural
emergency medical care”
CALS
To contact CALS
www.calsprogram.org
Kari Lappe, RN, CALS Program Manager
[email protected]
612-624-5901
CALS