Advanced Life Support (ALS): Protocols, Skills, and Modules

Advanced Life Support (ALS), also referred to as Advanced Cardiac Life Support (ACLS), is a set of life-saving protocols and skills that extend beyond Basic Life Support (BLS).

It is used to provide urgent treatment to cardiac emergencies such as cardiac arrest, stroke, myocardial infarction, and other conditions.

The Chain of Survival

ALS is one of the vital steps in the American Heart Association's Chain of Survival, which is a sequence of actions that can increase survival rates of sudden cardiac arrest (SCA) and other emergencies. The five critical actions include:

• Immediate recognition of cardiac arrest and activation of the emergency response system
• Early high-quality CPR with an emphasis on chest compressions
• Rapid defibrillation
• Effective advanced life support
• Integrated post-cardiac arrest care

High-quality cardiopulmonary resuscitation (CPR) and early defibrillation should be performed within the first 3-4 minutes of a sudden cardiac arrest. The American Heart Association recommends advanced cardiovascular life support be performed within the first 8 minutes of sudden cardiac arrest or another cardiac emergency for the patient's best chance of survival.

ALS vs. BLS: Key Differences

Basic Life Support is a level of medical skill used to treat victims experiencing life-threatening illnesses or injuries until they can be given full medical care at a hospital. BLS requires knowledge and skills related to CPR, use of AEDs, and relieving airway obstructions. Emergency medical technicians, paramedics, or even qualified bystanders can perform BLS.

ALS should be performed only by paramedics and healthcare providers. Professionals qualified to provide advanced cardiac life support are trained and authorized to administer medication, perform injections, and conduct airway procedures prior to the arrival of the patient at an advanced care facility and/or in a hospital environment.

Advanced Life Support (ALS) Modules

The Advanced Life Support (ALS) Modules offer high-level topics beyond Advanced Cardiovascular Life Support (ACLS) content and Continuing Education (CE) Credit. Each module uses the self-directed True Adaptive™ learning technology. The AHA’s ALS Modules are for advanced healthcare providers who are seeking additional content beyond ACLS. This includes personnel in emergency response, emergency medicine, intensive care, and critical care units such as physicians, nurses, paramedics, and others.

Trauma Module

The Trauma Module covers the systematic evaluation of a trauma patient, including performing initial lifesaving maneuvers. Course content includes the following:

• Assessment, approaches, and treatment of systematic evaluation of a trauma patient
• Key concerns during an assessment
• Adjuncts to the primary trauma survey
• Airway obstruction maneuvers and securing the airway
• Identifying shock and providing treatment
• Hemodynamic instability and hemorrhage control
• Trauma resuscitation
• Permissive hypotension
• Massive transfusions
• Traumatic brain injury, burn injuries, and musculoskeletal injuries

After successfully completing this course, students should be able to:

• Describe the systematic evaluation of a trauma patient including performing initial lifesaving maneuvers
• Explain how to ensure that a trauma patient has a secure and functional airway
• Describe the pathophysiology of shock in trauma
• Identify sources of hemodynamic instability and how to perform lifesaving maneuvers for initial hemorrhage control
• Describe the management of trauma patients with traumatic central nervous system injury, burn injuries, and fractures
• Explain the indications and contraindications of resuscitative thoracotomy in case of traumatic cardiac arrest

Maternal Cardiac Arrest (MCA) Module

Maternal Cardiac Arrest (MCA) is a life-threatening event that may occur in any healthcare setting, even outside the hospital. Cardiac arrest in this population poses unique challenges to a healthcare team since there are critical actions affecting two patients. The ALS: Maternal Cardiac Arrest Module explores the why of MCA and how to treat pregnant cardiac arrest patients within a hospital.

After successfully completing this course, students should be able to:

• Identify current factors influencing maternal morbidity and mortality in the United States in relation to maternal cardiac arrest
• Describe how to determine a different diagnosis for maternal cardiac arrest
• Describe the relevant physiologic changes of pregnancy that impact the resuscitation of Mother and Fetus during maternal cardiac arrest
• Discuss modifications that are required in maternal resuscitation protocols
• Describe key components of the management schema for response to cardiopulmonary arrest during pregnancy
• Discuss implementation strategies for ongoing resuscitation measures when initial resuscitation strategies are unsuccessful to achieve ROSC

Procedural Sedation Module

The Procedural Sedation Module covers pre-procedural considerations for the use of procedural sedation, including identification of the levels of sedation and when sedation becomes general anesthesia. The course describes how to evaluate patients prior to, during, and post-procedural sedation. It educates providers on equipment needed for monitoring patients, common medications to use, as well as reversal agents to have on hand to safely perform procedural sedation. Criteria for a safe discharge post-sedation is also covered.

After successfully completing this course, students should be able to:

• Explain the Pre-Procedure preparation for Procedural Sedation
• Describe the Intra-Procedural considerations for Procedural Sedation
• Describe the Post-Procedural considerations for Procedural Sedation

Advanced ECG Module

The Advanced ECG Module describes more complex arrhythmias, such as second and third-degree heart blocks, wide complex tachycardia, and narrow complex tachycardia.

After successfully completing this course, students should be able to:

• Recognize the factors to consider when diagnosing wide complex tachycardia (WCT)
• Recognize the factors to consider when diagnosing narrow complex tachycardia (NCT)
• Explain the use of Adenosine for NCT and WCT
• Recognize the factors to consider when diagnosing different types of bradycardias

Advanced Airway Management Module

The Advanced Airway Management Module is designed to teach providers how to evaluate and determine the need for an advanced airway in patients. This course provides instruction on the strategies of oxygen monitoring and delivery prior to advanced airway placement. It also demonstrates the strategies and goals of advanced airway insertion, troubleshooting issues, ensuring proper placement, and monitoring the patient.