-

LY
N
O
SE
U
L
A
N
R
TE
N
-I
E
PL
M
SA

instructor
resource guide
version 9.0, 2023
 TABLE OF CONTENTS
About This Instructor Manual....................................3 Lesson Plans.........................................................23
Keywords & Definitions ............................................4 Initial Training,Traditional Classroom.....................25
Outline & Time Frame..........................................25
Program Design & Instructional Tools...................5
Day One Introduction...........................................27
Program Design.......................................................7
Lessons 1-8.........................................................28
Program Overview...................................................7

-
Day Two Introduction...........................................29

LY
Class Types.............................................................8
Case Studies.......................................................30
Class Methods........................................................8
High-Quality Skills & Teamwork...........................31
Class Prerequisites..................................................8
Performance Evaluation.......................................33
Lesson Plans...........................................................8

N
Written Exam.......................................................35
Training Content....................................................10
Documentation & Certification.............................36

O
Initial Training, Traditional Classroom ...................10
Renewal Training, Traditional Classroom...............37
Renewal Class.......................................................12
Outline & Time Frame..........................................37
Instructional Tools.................................................13

SE
Renewal Introduction...........................................38
Class Requirements & Administration.................15 Resuscitation Simulation Equipment (optional)....39
Class Requirements..............................................17 Airway Management & Adult BLS........................40
Course Planning ...................................................17 Case Studies.......................................................42

U
Learning Environment............................................17 Performance Evaluation.......................................45
Classroom Space..................................................17 Written Exam.......................................................47
Classroom Safety..................................................17

L Documentation & Certification.............................48

Student Illness & Other Emergencies.....................17
A
Appendix................................................................49
Preventing Injury....................................................18
Sample Classroom Layout.....................................53
N
Equipment & Materials List....................................19
Class Roster Instructions......................................54
Conducting a Class...............................................20
R

Class Roster..........................................................55
Administration.......................................................21
Scenario Sheets....................................................58
Skill Evaluation......................................................21
TE

Debriefing Sheet....................................................83
Remediation..........................................................21
Drug Cards............................................................84
Written Exam.........................................................21
Performance Evaluations.......................................90
Class Documentation............................................22
N

Written Exams.....................................................106
Class Roster .........................................................22
CACPE Information & Data Collection Form........136
Written Exam.........................................................22
-I

Event Record.......................................................138
Performance Evaluation Sheets.............................22
Sample Initial Class Confirmation Letter..............139
Rate Your Program Course Evaluation ..................22
Chapter 9 Post-Test Prerequisite Answer Sheet..140
E

EMS Continuing Education Available.....................22

PL
M
SA

ACLS | Advanced Cardiac Life Support © Health & Safety Institute 1

 INITIAL TRAINING, TRADITIONAL CLASSROOM
INITIAL TRAINING,
TRADITIONAL CLASSROOM
Outline & Time Frame
Approx.
Lesson Lesson Title Length

-
(hr:min.)

LY
Intro Day One Introduction 0:15

N
1 Chain of Survival & High-Quality Cardiopulmonary Resuscitation 1:00

O
2 Teams 0:30

3 Patient Assessment & Resuscitation Therapies 0:30

SE
4 The Patient with Respiratory Compromise 2:00*

5 Bradycardias 0:30

U
6 Tachycardias 0:30

7 Acute Coronary Syndromes

L 1:00
A
8 Acute Ischemic Stroke 1:00
N
Breaks 0:30
R

Day One Total 7:00

TE

Intro Day Two Introduction 0:15

9 Case Studies 1:30

N

10 High-Quality Skills & Teamwork 4:00*

-I

Performance Evaluation 1:00

E

Written Exam 0:45

PL

Documentation & Certfication 0:15

Breaks 0:30
M

Day Two Total 8:00

SA

Total Time 29
15 hours

* Indicates a skill practice

29 Stated class times are based on covering required lessons and evaluation
time. Lesson times are influenced by student and Instructor preparation, available
equipment, Instructor efficiency, and number of students. Instructors may adjust
the lesson plan as needed to reach students with varying abilities and experience.
Adult education guidelines recommend a break for at least 5 minutes each hour.
Class timing can vary. Because of this, no specific breaks have been designated in
this class outline. Class size, class location, Instructor-to- student ratios, and other
factors will affect the actual schedule. Breaks should be provided, but may be
rearranged or combined as required or desired.

ACLS | Advanced Cardiac Life Support © Health & Safety Institute 25

 ACLS | Advanced Cardiac Life Support, Initial Training, Traditional Classroom

HIGH-QUALITY SKILLS & TEAMWORK

PREPARE

 Duration  Class Format: Initial Training

4 Hours Delivery Method: Traditional Classroom

-
LY
 Equipment and Materials:
Per Team:
‫ ׹‬HSI ACLS Scenario Sheets ‫ ׹‬Advanced airway and all equipment/supplies

N
‫ ׹‬Adult CPR training manikin for correct insertion, (per student scope of
practice)

O
‫ ׹‬Metronome/audio prompting device
‫ ׹‬ECG simulator
‫ ׹‬Adult CPR mask
‫ ׹‬Electrodes

SE
‫ ׹‬Nasopharyngeal & oropharyngeal airway set
‫ ׹‬Pacing/defibrillator pads
‫ ׹‬Adult bag mask, reservoir, and tubing
‫ ׹‬Drug cards (or empty packaging)
‫ ׹‬Adult AED training device

U
‫ ׹‬Non-rebreathing mask

Per Student:
‫ ׹‬Nonlatex disposable gloves

L ‫ ׹‬ACLS Study Guide, Sixth Edition

‫ ׹‬1-way valve
A ‫ ׹‬Other appropriate memory aids
N
 Instructional Notes
ْ You may need explain and/or demonstrate how to operate the monitor/defibrillator and simulators (ECG,
R

pacemaker rhythm, and waveform capnography), and depending how the small groups are set up, you
may need to demonstrate how to properly facilitate a scenario in real-time.
TE

PRESENT
N

 Why This Topic Matters

-I

Teamwork and leadership training have been shown to improve performance in actual resuscitation.30 By actively
participating in advanced cardiac life support simulations, seasoned healthcare providers will improve their ability
to lead and participate in the emergency assessment and treatment of pre-arrest, arrest, and post-arrest patients.
E
PL
M
SA

30 Hunziker S, et al. Teamwork and leadership in cardiopulmonary resuscitation. J Am Coll Cardiol. 2011 Jun 14;57(24):2381-8

ACLS | Advanced Cardiac Life Support © Health & Safety Institute 31

 ACLS | Advanced Cardiac Life Support, Initial Training, Traditional Classroom

PRACTICE & ASSESS

 Conduct a Hands-On Student Practice

ْ Allow adequate time for students to practice high-quality skills and teamwork.
ْ Arrange students into small groups (teams).
✓ Review resuscitation team member roles and responsibilities (Leader, Members, Recorder).
✓ Students may use their ACLS Study Guide, Sixth Edition as reference.

-
✓ Teaching/Learning Cases may be practiced in any order.

LY
ْ Assign an HSI ACLS Instructor to each team.
✓ Alternatively, have each student rotate through the role of Facilitator (see Part One, pg. 11).
ْ Instructor/Facilitator:

N
✓ Presents the Teaching/Learning Case scenarios using the HSI ACLS Scenario Sheets.

O
✓ Provides the pertinent findings using the case progression prompts (italicized information following the ›
symbol).
✓ Generates the appropriate simulated ECG rhythm (when called for).

SE
✓ Provides the pertinent findings only when asked.
ْ Each team works through all required (non-optional) HSI ACLS Scenario Sheets.
✓ Aim for 5 minutes per student per case.

U
✓ Students rotate roles so that each person functions as a Team Leader several times.
ْ Instructor should:
✓ Keep students on topic and moving through the scenarios.
L
✓ Ensure high-quality skills practice and performance.
A
✓ Monitor Team Leader effectiveness.
N
✓ Encourage group-based problem solving.
R

WRAP UP
TE

 Facilitate a Debriefing Before Moving On to the Next Scenario

N

✓ Follow the model, rules, and best practices as described in the HSI ACLS Debriefing Sheet.
✓ Aim for about a 5-minute debriefing per case.
-I

 Instructional Notes
E

ْ You may need to offer remediation to student(s) who are experiencing difficulty. Use gentle correction
of skills and positive coaching. If possible, assist student(s) privately during breaks, lunch, or at the end
PL

of the class. Be polite, considerate, respectful, encouraging, and professional. If possible, have another
Instructor privately work with the student. If a student requires more remediation than can be provided
during a class, recommend that they attend a separate remediation session or attend another class.
M
SA

32 ACLS | Advanced Cardiac Life Support © Health & Safety Institute

 ACLS

SAMPLE CLASSROOM LAYOUT

Maximum Student-to-Instructor Ratio for Scenario Practice & Evaluation: Unlimited (10:1 Recommended)

RTL

-
MdfaH

96
96
96
si RTL

LY
RTM RTM
96
96
MdfaH
si
96

RTM
RTM

N
O
SE
RTM
RTR RTM

U
RTR

L
STUDENT MATERIALS
A
HSI ACLS Student
(students rotate team roles and may also rotate Smartphone with metronome app
N
into role of coach/facilitator)
R

ACLS Student Book

(ACLS Study Guide 6th Ed. Aehlert. Nasopharyngeal & Oropharyngeal Airways
TE

Elsevier © 2023)

ECG Rhythm, Monitor, & Defibrillator

N

96 Drug Cards (or empty packaging)

96
MdfaHsi Simulator
96
-I

AED Training Device Stretcher, bed, or floor mat

E
PL

Bag Mask CPR Manikin

M

INSTRUCTOR MATERIALS
SA

HSI ACLS Instructor HSI ACLS Instructor Guide

CPR Manikin

ACLS | Advanced Cardiac Life Support 1 of 1 © Health

© Health
& Safety
& Safety
Institute 53
Institute
 A C L S S c e n a r i o S h e e t | Teaching/Learning Case #2

PULSELESS VT/VF WITH AED/DEFIBRILLATOR (OPTIONAL)

Scenario

You have been called to aid a man with “trouble breathing.”

Primary Survey/Reassessment Check Off

-
LY
 Ensures scene safety. Takes or communicates standard precautions. Assigns team member roles.
› The scene is safe.
 Verbalizes general impression of patient (appearance, breathing, circulation).

N
› You see a motionless adult, about 70 years of age, slumped on the floor.
 Directs assessment of responsiveness (AVPU).

O
› The patient is unresponsive.
 Activates emergency protocol and directs a team member to get an AED/cardiac monitor/defibrilla-

SE
tor.
 Performs simultaneous assessment of breathing and circulation for no more than 10 seconds (or
directs a team member to do so).
› The patient is taking occasional gasping breaths. There is no pulse. The patient’s skin is

U
mottled, cool, and dry.
 Initiates high-quality CPR. Directs team member to immediately begin chest compressions and
minimize interruptions.

L
 Directs team member to open the airway, insert an oral airway, and begin bag-mask ventilation with
100% oxygen.
A
 Ensures effective bag-mask ventilations are provided once every 6 seconds (over 1 second, with
N
gentle chest rise).
› You observe gentle chest rise.
R

 When available, attaches AED/defibrillator, placing the pads correctly (or directs a team member to
do so). Clears the patient. Analyzes.
TE

› Shock advised.
 Continues high-quality CPR until AED/defibrillator fully charged and ready to shock.
 Clears everyone from the patient and presses the shock button (or directs a team member to do
N

so).
 Directs team to immediately resume high-quality CPR and minimize interruptions.
-I

Secondary Survey/Reassessment Check Off

E

 Directs team to obtain vital signs, apply a pulse oximeter, and to establish vascular access.
› Breathing and pulse are absent. Attempts to establish venous access are not successful.
PL

 Directs team member to establish intraosseous (IO) access.

› IO access is successful.
 Orders (or AED prompts for) rhythm check. Clears the patient. Analyzes.
M

› Shock advised.
 Continues high-quality CPR until AED/defibrillator fully charged and ready to shock.
SA

 Clears everyone from the patient and presses the shock button (or directs a team member to do
so).
 Directs team to immediately resume high-quality CPR and minimize interruptions.
 Orders correct drug and dose (Epinephrine, 1 mg every 3-5 min, IV/IO. Follows with 20 mL flush.
Briefly raises extremity.) Does not stop CPR to administer drug. Considers need for an advanced
airway, waveform capnography.
› Ensures 2 minutes of high-quality CPR.

CONTINUED ON NEXT PAGE 

60 ACLS | Advanced Cardiac Life Support 3 of 25 © Health

© Health
& Safety
& Safety
Institute
Institute
 A C L S S c e n a r i o S h e e t | Teaching/Learning Case #3-1

CARDIAC RHYTHM MANAGEMENT

Scenario

Your patient is a 45-year-old man complaining of a “racing heart.”

Primary Survey/Reassessment Check Off

-
LY
 Ensures scene safety. Takes or communicates standard precautions. Assigns team member roles.
› The scene is safe.
 Verbalizes general impression of patient (appearance, breathing, circulation).

N
› He is aware of your approach and appears to be breathing without difficulty. His skin is
pale; you observe sweat on his forehead and upper lip.

O
 Directs assessment of airway, breathing, and circulation.
› Airway open and clear. Breathing unlabored. Pulse weak and rapid, but regular; skin is

SE
pale, cool, and clammy.

Secondary Survey/Reassessment Check Off

U
 Directs team to obtain vital signs, attach a cardiac monitor/defibrillator. Ensures monitor leads are
properly positioned.
 Directs team to apply a pulse oximeter and to establish vascular access.

L
› O2 sat (room air) 92%, P 180, RR 16, BP 80/43. Venous access is established.
A
 Initiates appropriate O2 therapy to maintain O2 saturation between 95% and 98% (or directs a team
member to do so).
N
 Obtains a brief history and performs a focused physical examination (or directs a team member to
do so).
R

› HISTORY: Racing heart x 30 minutes.

» Allergies: None.
TE

» Medications: None.
» Past history: None.
» Last oral intake: Juice.
N

» Events prior: Symptoms started during an intense morning workout.

› PHYSICAL: Unremarkable.
-I

› ECG shows monomorphic VT.

Unstable Tachycardia
E

 Correctly identifies rhythm. Recognizes patient is symptomatic/unstable and that immediate syn-
PL

chronized cardioversion is warranted.

 Considers sedation.
 Selects the “sync” mode, appropriate energy level, and clears everyone from the patient before
pressing the shock button (or directs a team member to do so).
M

› Shock delivered. Patient loses consciousness. The rhythm changes (ECG shows VF.)
SA

CONTINUED ON NEXT PAGE 

62 ACLS | Advanced Cardiac Life Support 5 of 25 © Health

© Health
& Safety
& Safety
Institute
Institute
 A C L S S c e n a r i o S h e e t | Teaching/Learning Case #6

TACHYCARDIA WITH ADEQUATE PERFUSION

Scenario

Your patient is a 40-year-old man complaining of a “racing heart.”

Primary Survey/Reassessment Check Off

-
LY
 Ensures scene safety. Takes or communicates standard precautions. Assigns team member roles.
› The scene is safe.
 Verbalizes general impression of patient (appearance, breathing, circulation).

N
› The patient is aware of your approach and appears to be breathing without difficulty. His
skin is pink.

O
 Directs assessment of airway, breathing, and circulation .
› Alert, oriented; airway open and clear. Breathing easily at 14 breaths/min. P 180, strong
and regular; skin is pink, warm, and dry.

SE
Secondary Survey/Reassessment Check Off

 Directs team to obtain vital signs, attach a cardiac monitor/defibrillator, apply a pulse oximeter,

U
initiate appropriate O2 therapy, and to establish vascular access.
 Ensures monitor leads are properly positioned.
› O2 sat (room air) 96%, P 180, RR 14, BP 156/94. Venous access is established. ECG
shows a regular, narrow QRS tachycardia.
L
A
 Obtains a brief history and performs a focused physical examination.
› HISTORY: Palpitations for two hours.
N
» Allergies: None.
» Medications: None.
R

» Past history: Nothing pertinent.

» Last oral intake: Scotch.
TE

» Events prior: Smoking cigar.

› PHYSICAL: Unremarkable.
N

Stable Narrow QRS Tachycardia

-I

 Checks monitor and correctly identifies rhythm (regular, narrow QRS tachycardia).
 Recognizes that the patient is symptomatic but stable.
 Attempts vagal maneuvers (or directs a team member to do so).
E

› The rhythm is unchanged.

 Orders correct drug and dose (Adenosine 6 mg rapid IVP. Follows with 20 mL flush. Briefly raises
PL

extremity).
› After 90 seconds, the rhythm remains unchanged.
 Orders correct drug and dose (Adenosine 12 mg rapid IVP. Follows with 20 mL flush. Briefly raises
M

extremity).
› The rhythm changes (Initially sinus bradycardia with ventricular ectopy, then converts to sinus
rhythm).
SA

 Checks monitor and correctly identifies rhythm (sinus rhythm).

 Directs team to obtain vital signs.
› P 80 (sinus rhythm), RR 12, BP 128/76, O2 sat 97%.
 Continues ECG monitoring and ensures O2 saturation is maintained between 95% and 98%.
 Considers need for expert consultation.

End Scenario

Take about 5 minutes to debrief. Use the structured and supported approach on the HSI ACLS Debriefing Sheet.

78 ACLS | Advanced Cardiac Life Support 21 of 25 © Health

© Health
& Safety
& Safety
Institute
Institute
 A C L S S c e n a r i o S h e e t | Teaching/Learning Case #7

TACHYCARDIA WITH INADEQUATE PERFUSION

Scenario

Your patient is a 75-year-old man complaining of “flip-flopping” in his chest.

Primary Survey/Reassessment Check Off

-
LY
 Ensures scene safety. Takes or communicates standard precautions. Assigns team member roles.
› The scene is safe.
 Verbalizes general impression of patient (appearance, breathing, circulation).

N
› You see an older adult sitting up in bed. He is aware of your approach and appears to be
breathing without difficulty. His skin is pale.

O
 Directs assessment of airway, breathing and circulation .
› Alert, oriented; airway open and clear. Breathing easily at 14 breaths/min. P 220, weak

SE
and regular; skin is pale, cool, and clammy.

Secondary Survey/Reassessment Check Off

U
 Directs team to obtain vital signs, attach a cardiac monitor/defibrillator, apply a pulse oximeter,
initiate appropriate O2 therapy, and to establish vascular access.
› O2 sat (room air) 92%, P 220, RR 14, BP 80/60. ECG shows a regular, narrow QRS tachy-
cardia. Venous access is established.

L
 Initiates appropriate O2 therapy to maintain O2 saturation between 95% and 98% (or directs a team
A
member to do so).
N
 Obtains a brief history and performs a focused physical examination.
› HISTORY:
R

» Signs/Symptoms: anxiety, dizziness, “flip-flops and flutters in chest,” denies chest pain.
» Allergies: None.
TE

» Medications: Cholesterol-lowering drug.

» Past history: None.
» Last oral intake: Water.
N

» Events prior: Watching the news.

› PHYSICAL: Unremarkable. Unremarkable.
-I

Unstable Tachycardia
 Checks monitor and correctly identifies rhythm.
E

 Recognizes patient is symptomatic/unstable and that immediate synchronized cardioversion is

warranted.
PL

 Considers sedation.
 Selects the “sync” mode, appropriate energy level, and clears everyone from the patient before
pressing the shock button (or directs a team member to do so).
M

› The rhythm changes (ECG shows sinus tachycardia).

 Directs team to obtain vital signs.
SA

› P 110 (sinus tachycardia), RR 12, BP 138/80, O2 sat 97%.

 Continues ECG monitoring and ensures O2 saturation is maintained between 95% and 98%.
 Considers need for expert consultation.

End Scenario

Take about 5 minutes to debrief. Use the structured and supported approach on the HSI ACLS Debriefing Sheet.

ACLS | Advanced Cardiac Life Support 22 of 25 © Health

© Health
& Safety
& Safety
Institute 79
Institute
 -
LY
N
O
SE
U
L
A
N
R
TE
N
-I

Health & Safety Institute

1450 Westec Drive
E

Eugene, OR 97402
PL

800–447–3177
541-344-7099
E-mail: [email protected]
M

Visit our website at hsi.com

Copyright © 2023 Health & Safety Institute
SA

All rights reserved. Printed in the United States of America.

First Edition—2017, Second Edition —2023
ISBN 978-1-945991-69-1