My life would be very different without the skills I’ve learned from BLS, ACLS, and PALS. My journey with BLS began at the age of sixteen. I acquired my first BLS certification while training to be a lifeguard. Within weeks of getting certified, I used my new skills to perform back pats and abdominal thrusts on my mother to dislodge a piece of chicken from her esophagus. It was terrifying, but my training took over and she is alive and well today. Over the next two years, I became the Manager of a neighborhood pool. I held weekly in-services for my lifeguards where we practiced BLS scenarios and skills to be prepared for any situation that may arise. I went on to college and graduated with my Bachelor’s of Science in Nursing, taking a position as a nurse in a Medicine Intensive Care Unit. The patient population in the MICU had a very high acuity and required certification in ACLS. Later, my career took me to the Pediatric Cardiac Intensive Care Unit, which led me to obtain my PALS certification. Though I am still working as a Pediatric ICU nurse, I decided to return to school to pursue a degree in Master’s of Science in Nurse Education. My hope is to become a nurse educator and impart my knowledge and experience to our future generations of healthcare professionals.
Because of my experience inside and outside of the healthcare setting, it is my belief that all people should be taught Basic Life Support. It’s an essential skill that may never be used, but can mean the difference between life and death in an emergency situation. Outside the healthcare setting, I have performed the Heimlich Maneuver once on my mother, once on my son, and twice on my daughter. It saved their lives. During my career in the hospital setting, I have been involved in countless code blue situations, both with adults and pediatrics. Some codes have been expected, and others very unexpected. Some have gone smoothly, while others have had opportunities for improvement. There are several lessons I’ve learned from all these experiences, but the best advice I can give is to prepare, practice, and prepare some more.
Emergency situations are incredibly stressful, whether you’re a medical professional or not. This is where the “prepare, practice, prepare some more” method can be an extremely beneficial tool. In the healthcare setting, I make it a habit to prepare for every shift by locating my emergency equipment in every area I work. Part of my routine at the beginning of a shift, is to do a safety check in the room immediately after receiving report. We prepare our rooms with suction equipment, oxygen set ups with an ambu bag, appropriately sized LMA’s (Laryngeal Mask Airways), and emergency medication sheets specific to the patient’s weight in Kilograms. Ensuring your emergency supplies are available, will prevent a delay in care for the patient if an emergency were to arise. Occasionally, you may find yourself pulled to work on a unit you’re unfamiliar with. Prepare yourself at the beginning of the shift by locating the code cart. Think, how would you get help? Is there a code blue lever you can pull? Where is it located? Knowing the answer to these questions will prevent you from scrambling around when the time comes and you need help. Asking yourself these questions will help you even if you do not work in a hospital. When I go to different places out in public, or at doctor’s offices, I notice where AED’s are located. For example, the Chic-Fil-A our family frequents has one by the front door, our church has their AED on the wall outside the sanctuary, and home depot has one by the front desk. Even in the absence of rescue equipment, the most important things we can do to help someone are call for help and provide high quality chest compressions in the absence of a pulse.
Another important thing to remember when in a code situation, is to understand your boundaries and comfort level. In code situations in the healthcare facility, roles are usually assigned. There are people rotating chest compressions, a documenter, the code leader, someone pulling up drugs, someone to manage access and pushing drugs, someone to control the defibrillator, and usually someone available to run and get supplies as needed. When I was a fresh off orientation, there were several new nurses on my unit one night. We had a code blue situation arise. There was someone pushing for someone to take over the documentation and all the other roles were filled. I was the only one left and felt pressured to do it, even though I was not sure what a documenter’s role was. I took the role and it did not go smoothly. Thankfully, the Rapid Response team showed up and took over. I have since learned, that if you are uncomfortable in a role, speak up. The documenter is actually a critical part of a smooth code. They keep track of what medications are given, when they can be administered next, if shocks were delivered, how many rounds of compressions have been done, and ensure the ACLS or PALS algorithm is being followed. Sometimes the best thing you can do is the role you know you are comfortable in. The same statement is true for other areas too. If you are out in public and witness a cardiac arrest, the most important things you can do for that patient are activate the emergency response system and begin high quality chest compressions until help arrives.
Sometimes tensions run high when in a code blue event. Occasionally you may receive feedback from a team leader that seems critical. The goal is not to take it personally. I have always been sensitive to criticism and get my feelings hurt easily. Years ago, I changed the way I thought about criticism. Failures became opportunities to learn and criticism became feedback. Although it can still be difficult to receive corrective feedback at times, the goal is to give the patient the best care and the best chance at survival as possible. When you take yourself out of the equation and think about the patient as the most important aspect of the code, it’s easier to not take things personally. Feedback and debriefing can be an important aspect of a code. Talking about what things went well and what things had the opportunity for improvement is a valuable tool to help your team grow. This should be done after every code, if possible, because it can be so beneficial to strengthen your skills and team dynamics.
The last advice I can offer, is about codes that do not end in a win. Sometimes patients can’t be saved, no matter what you do or how well you do it. It can be traumatic, especially the first time you experience it. Remember, that death is a part of life and be confident that you did everything you could to try to save that patient. As BLS, ACLS, and PALS providers, we must practice good self-care. If you are having a difficult time with a situation or experience, make sure you take advantage of the resources available to you. Talk to co-workers, friends or family, and most work places offer some type of counselling services. Be prepared that you may experience loss in your field and that’s okay.
In conclusion, basic life support is an incredibly valuable tool. Though you may never have to use it in your career, it’s important to “prepare, practice, and prepare some more” so that you can provide the best care possible during that moment. Know how you would call for help, where your AED or defibrillator is located, and do you have emergency equipment at the bedside setup and working? The best thing you can do in a code, is to be comfortable in your role and make sure you speak up if you’re not prepared for the role you are assigned. Learn to take feedback constructively and look at it as an opportunity to grow. Finally, learn to accept that you did your best no matter the outcome. Always remember to take care of yourself, mentally, physically, spiritually, and emotionally.