PALS is a team sport! It takes several providers working together in order to successfully resuscitate a patient.
The PALS Team:
Team Leader
Team Member Roles
Airway
Chest Compressor (2 or more)
Recorder/Timekeeper
IV/IO Access and Administer Medications
Monitor/Defibrillator
Team Leader Responsibilities
Organizes team
Directs team members
Monitors effectiveness of team
Teaches and guides rest of team
Focuses on comprehensive care
Provides backup for other team members as needed
Evaluates, critiques , and educates team after emergency is over
Team Leader Responsibilities
Provide care within scope of practice
Understand and deliver interventions as directed by team leader
Skilled in resuscitation techniques
Know BLS and PALS algorithms
Commitment to outstanding care
In an effective team:
Everyone should have/be assigned a role
Each team member must know his or her individual role
Each team member understands the responsibilities of every other team member, too
Share knowledge and information
Speak loudly and clearly but stay calm; DO NOT YELL OR ACT AGGRESSIVELY
Share important updates in the patient’s status with the entire team
Ask for suggestions from the team when needed
Use closed-loop feedback
Effective Communication
Closed Loop Communication
Concise, Clear Messages
Clear Definition of Responsibilities and Roles
Team Members Know their Limitations
Sharing of Knowledge
Constructive Education
Evaluation of Team and Resuscitation Efforts
Respect
Closed Loop Communication
Closed Loop Communication occurs between the team leader and individual team members. It ensures that team members correctly hear instructions and that the team leader knows that interventions are understood and carried out.
Team Leader Responsibilities
Team Member Responsibilities
Gives instruction to individual team member.
Confirms that a team member has received and understood instructions by listening and making eye contact.
Delegates only one task at a time.
Confirms that an assigned task is completed as ordered prior to ordering another intervention.
Verbally confirms that the team leader’s instructions are understood and carried out.
Keeps team leader appraised of when an order is initiated and concluded.
Clarifies orders with team leader prior to carrying them out.
Concise, Clear Messages
During an emergency, especially one involving a child, emotions run high. It is essential that communication be delivered with a controlled voice. Only one person should speak at a time. No yelling, shouting, or criticizing should occur during an emergency.
Team Leader Responsibilities
Team Member Responsibilities
Speak clearly.
Give clear, easily understood orders.
Clarify communications as needed.
Communicate calmly .
Repeat instructions.
Request clarification of instructions as needed.
Speak in a calm voice; at a normal voice level.
Clear Definition of Responsibilities and Roles
Each team member must understand his or her responsibilities. If fewer than six team members are present; each team member must be willing and able to take on additional tasks, as directed by the team leader. The effectiveness of the team and patient outcomes suffer when a clear definition of roles and responsibilities is not present. Tasks may be omitted, repeated, or performed out of sequence.
Team Leader Responsibilities
Team Member Responsibilities
Provide clear instructions.
Ask for feedback from team members.
Assign duties based upon each team member’s skill level.
Distribute duties equitably.
Carry out instructions and assigned tasks within one’s own scope of practice and level of competency
Inform team leader if he or she does not have the skill to carry out an intervention
Advise team leader if instructed to carry out an instruction which is out of one’s own scope of practice
Be flexible and competent to carry out assigned tasks
Team Members Know their Limitations
Every team member has strengths and weaknesses. It is the responsibility of each team member to recognize his or her own skill levels. The team leader must be aware of each team members’ skill levels so that the interventions may be carried out in an efficient and productive manner, which leads to an optimal patient outcome.
Team Leader Responsibilities
Team Member Responsibilities
Self-knowledge about skills and limitations
Being upfront about own skills and limitations
Asks for help when unable to complete a task independently or readily
Provide help to other team members as requested
Asks for help from experienced team members and other experts as needed
Does not practice new skills in emergency situations
Self-knowledge about skills and limitations
Being upfront about own skills and limitations
Asks for help when unable to complete a task independently or readily
Provide help to other team members as requested
Asks for help from experienced team members and other experts as needed
Does not practice new skills in emergency situation
Sharing of Knowledge
Sharing information may seem like an obvious component of effective communication. However, in critical situations, people often become so focused on the task at hand and their own views about what is happening, that communication suffers. Sharing information is vitally important.
Team Leader Responsibilities
Team Member Responsibilities
Avoid thinking with a narrow focus; such thinking that “everything is fine”, “my way is the only way”, and “we can treat or do anything but…”.
Encourage input from team members regarding interventions, observations, and patient status.
Consider all factors which impact the resuscitation and resolution of the underlying causes of the crisis
Ask about ,and be aware of, interventions which may have been omitted.
Provide information to the team leader about observations and changes in the patient’s condition and response to interventions.
Share information with the rest of the team.
Attempt to identify underlying causes which may have led to the cardiac/respiratory arrest or hampered resuscitative efforts.
Constructive Education
Sometimes a prescribed treatment is incorrect. At other times, a member of the team may carry out an order incorrectly. Constructive, kind, intervention is needed at those times to ensure that the patient receives the best treatment available. The intervention should be brief and discussed further if needed after the resuscitation is concluded.
Team Leader Responsibilities
Team Member Responsibilities
Be kind, tactful, and to the point when pointing out an error
Conduct a debriefing after the crisis, if needed
Guide team members as needed to ensure that interventions are delivered correctly
Reassign team members as needed to ensure that the patient is receiving care delivered in an optimal manner
Ask the team leader or team members if you believe that an intervention is not being carried out correctly or if you believe a mistake is about to be made
Be receptive to constructive intervention without taking it personally
Do not argue if you are the target of a constructive intervention
Discuss concerns after the resuscitative efforts have concluded
Suggest alternatives if you believe that an order is incorrect
Accept reassignment graciously, without complaint.
Evaluation of Team and Resuscitation Efforts
While the team leader bears most of the responsibility for evaluating, reevaluating, and summarizing, every team member contributes to the process. The recorder plays a key role in evaluation and summarizing. Ongoing evaluation is necessary to monitor the child’s response to treatment and to plan for the future interventions. Summarizing facilitates planning and coordination of efforts.
Team Leader Responsibilities
Team Member Responsibilities
Continually monitor and evaluate the child’s response to treatment.
Evaluate the effectiveness of interventions performed.
Ask for the team’s input regarding diagnoses and factors which may impede resuscitative efforts.
Remain flexible.
Summarize information frequently for the rest of the team.
Notify team members of the future steps which will be implemented.
Review each medication frequently.
Change the treatment plan if resuscitative procedures are ineffective, or if new information is available that impacts the child’s condition.
Inform newly arriving personnel of the patient’s status and treatment plan.
Carefully pay attention to the team leader’s evaluation and summary of the child’s condition and treatment plan
Carefully observe and report changes in the child’s condition
Remain flexible for changes in the treatment plan
Ask the team leader to clarify any evaluation or summary statements that you are unclear about
Increase monitoring if the patient’s condition declines
Respect
For a resuscitative team to function well; mutual respect is required of all members. The goal of treatment is not to support individual egos or beliefs regarding treatment. The only goal is to save a child’s life and to enable the child to experience the highest quality of life once resuscitated.
Team Leader Responsibilities
Team Member Responsibilities
Speak calmly in a normal tone of voice.
Provide positive feedback.
Intervene if team members do not speak respectfully or raise their voices.
Remember that each team member is doing the best that he or she can to provide care in a highly stressful situation.
Speak calmly in a normal tone of voice
Remember that each team member is doing the best that he or she can to provide care in a highly stressful situation
