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ED ALS Competency assessment framework
Critical Indicator coverage
Module 1
Module 2
Module 3
Module
4
Current assessment of patient’s condition promotes prompt and appropriate intervention
Identifies that a cardiac arrest has occurred
X
X
X
X
X
X
X
X
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Pt unresponsive and absent or abnormal
breathing
Initiates basic life support
Demonstrates how to attach a defibrillator /
cardiac monitor + how to operate the defibrillator
in manual mode.
X
X
Identification of normal and abnormal rhythms assist with the instigation of appropriate
interventions and promotes patient safety
SHOCKABLE RHYTHMS
Demonstrates knowledge and understanding of
the Advanced Life Support algorithm
X
X
Recognises a shockable rhythm:
X
X
X
X
X
X
X
X
X
X
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Ventricular Tachycardia
Ventricular Fibrillation
Demonstrates management of shockable rhythms
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Pulseless Ventricular Tachycardia
Ventricular Fibrillation
Initiates single shock at 200j Lifepak (3 stacked
shocks at 200j IN SPECIAL CIRCUMSTANCES)
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Demonstrates appropriate safety precautions
when shocking
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prepares patients chest (clean & dry)
removes patches, electrodes, things that
may inhibit appropriate placement of pads
 places pads to STERNUM and APEX
 dials defibrillator to 200j
Calls “STAND CLEAR”
X
ED ALS Competency assessment framework
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uses a firm, loud voice
Visually checks the area, ensuring all staff
and self are clear of the patient and bed
Commences CPR immediately post shock
X
X
X
X
Carotid Pulse check by trained providers is
to take no longer than 10 seconds.
Initiates single shock regime for subsequent shocks X
X
 30 compressions to 2 breaths
Reassesses rhythm and pulse at the end of each
two minute cycle (or 5 cycles of 30:2)

NON-SHOCKABLE RHYTHMS
Recognises non-shockable rhythms
X
 Asystole
 PEA
 Idioventricular
 Sinus bradycardia
 Complete heart block
Demonstrates management of non-shockable
rhythms
X
X
X
X
X
X
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Immediate CPR for 2 minutes or 5 cycles of
30:2
Assesses pulse and rhythm at the end of each two
minute cycle
Knowledge of and demonstrated use of pharmacological therapy assists with the treatment of life
threatening arrhythmias
Demonstrates knowledge of the indications,
dosages and method of administration of the
following drugs

Adrenaline
X
X
X
*Non-Shockable rhythm: 1mg immediately then every 3-5
minutes (alternate cycles of CPR)
*Shockable rhythm: 1mg after second shock then every 35 minutes (alternate cycles of CPR)

Amiodarone
Recurrent/refractory VF or VT
* 300mg in 20mls of 5% dextrose after the 3rd shock at the
recommencement of CPR. A further dose of 150mg can be
considered
Other Drugs to be considered
X
X
X
ED ALS Competency assessment framework
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Calcium Chloride
Sodium Bicarbonate
Magnesium Sulphate
Potassium Chloride
Atropine
States method of administration for the above
medications: Given at the time of commencement
of CPR/ IV or IO/ min 30 ml flush
X
X
X
X
X
X
X
X
X
X
X
Ongoing assessment facilitates patient management
Identifies possible reversible causes
X
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Hypoxia
Hypovolemia
Hypo/hyperthermia
Hypo/hyperkalaemia & metabolic
disorders
 Thrombosis – pulmonary / coronary
 Tamponade
 Tension pneumothorax
 Toxins / poisons / drugs
Transcutaneous (External) Pacing
Recognises necessity for transcutaneous pacing
X
X
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Haemodynamically unstable bradycardias
nonresponsive to medical therapy
Performing Pacing
LIFEPAK
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X
Turns monitor on & selects manual
mode- check that is in Lead 2 or lead with
clearest ECG trace
Attaches monitoring leads to patient
Applies Quick – Combo pacing pads
Presses PACER
Presses RATE to select desired pacing rate
Presses CURRENT to start pacing and
increase until electrical capture occurs
check that mechanical capture has
occurred (this is evident by a palpable
pulse with each paced beat.)
X
DCCV
Recognises necessity
 Ventricular Tachycardia with a pulse
 Tachyarrhythmia with compromise
X
X
ED ALS Competency assessment framework
Performs appropriately
 Synchronised
 Energy selection: 100-200J (3 attempts)
 Analgesia/sedation
Demonstrates appropriate post resuscitation care
X
Verbalises appropriate post-arrest care
X
X
X
X
 Airway/ventilation : SaO2/pO2/ CO2
 Circulation: BP
 Glucose
 Targeted Temperature management
Specific management
 12 lead ECG” ?STEMI
 Underlying cause: Electrolytes etc
 Disposition/transfer
Communication with family
Debriefs with staff
Ceasing resuscitation
Verbalises principles underlying/approaches to
cessation of resuscitation
X