ACLS, BLS and PALS from a Med Student’s Perspective
Have you ever been in a situation, lets say an exam, where you sit, staring blankly at the question for over 2 minutes. You once knew the answer to this question. You read it. But it’s gone. It has been lost, traveled too deep in the network of your cerebral neurons. Surely, we’ve all had experiences where we remember seeing/reading some piece of information casually, but it comes up later in a more important context and you think to yourself, “man, I wish I had paid more attention when I read that”. If only we could have known it was bound to come up later. During our ACLS and BLS certification courses in medical school, this idea, this fear, persisted in the back of my mind. When it comes to a test, no big deal. When it applies to saving a human life… BIG DEAL. Certification in emergency life support is so important because you cannot afford to forget it. What I have described above is one of the worst feelings. I can only imagine how frustrated I would be with myself if I had once known the proper steps to save this persons life, but have since forgot and now cannot help. I was meticulous to pay such close attention during out ACLS, BLS courses because I had understood the importance of this training and had an awareness that you have absolutely know clue when it is going to come up necessary. Tomorrow, 5 years, 20 years down the road. Walking down a busy city street, in a passenger airplane, or in your office complex, when emergency life support is needed, it is one of the fortunately few moments in life that require a “drop-everything-now” approach.
I remember hearing sometime during those courses that CPR is performed when it should be only about 40% of the time. Those numbers may have since changed, but the message still holds true: the majority of people are not comfortable performing CPR when they should. It is clear more people need to be BLS trained, and more importantly in my opinion, reminded of the basic procedural guidelines every now and again (2 inches deep, pace of the song Stayin’ Alive, and 30:2 compression to breath ratio). It could be as simple as those 3 facts, that could be the difference between someone who has absolutely know clue what to do, and someone who has remotely know idea what they’re doing, but knows enough at least to keep that blood rolling through those internal carotids until EMS arrives. Per the old adage that we’ve all heard a million times: if you don’t use it, you lose it. I believe the same applies to BLS and because of the stakes that BLS surrounds, its importance exponentially surpasses many other facts of knowledge the average person should have. Those 3 facts that I mentioned above should be known universally. More known than the fact that Angelina Jolie and Brad Pitt are married, in my opinion. With those 3 facts, even someone without BLS training would likely be confident enough to take a stab at chest compressions (not the same way as Dwight from The Office). So I propose a campaign to sear those 3 facts (and maybe a few others if deemed important, such as tilt of the head before breaths) into peoples memories. If it is impractical for every person in the world to get BLS certified and recertified routinely (which it likely is), this at least makes some general information about emergency life support more common knowledge and at worst, potentially there is someone at the scene who can help remind another helping civilian at the scene to joggle their memory on the steps of CPR.
Regarding insight and advice for students entering the field, I was very delighted to see how seriously my classmates took this training. I suspect for reasons similar to the sentiments I have shared above: they see it’s importance. As future health care professionals we are, for the most part, very self-motivated people and all have a common goal of trying to save human life. I would thus hope that it follows the incentive to take seriously BLS, ACLS and PALS certifications should come intrinsically from its nature. One point I do think deserves a stronger emphasis, however, is that it is okay to do mouth-to-mouth CPR. I don’t think I have ever had a certified teacher come out and say that fact directly. They always defer to, “well, if you have a mask on you, use that”. Well yes, of course, but who carries a mask around? Particularly in todays culture, where everyone is required to remain 6-ft-apart and be wearing a mask at all times, I think this emphasis is even more important. I think this point should be made remotely clear to trainees: CPR surrounds life or death circumstance, and you should be prepared to take any reasonable measure possible to save this individuals life, even if that makes you uncomfortable. Of course, nobody wants to perform mouth to mouth on a stranger. But when it comes down to it, it is crucially important. I can’t help but suspect many individuals would be leery of removing their masks and delivering mouth to mouth breaths today, even though that is 100% the right thing to do in those circumstances.