CCNEPal teaches BLS and ACLS since 2011 in Nepal, and we travel around the country. One time we planned to travel to Biratnagar and the local contact person asked: “How many CPR manikins do you bring?”
My answer was, “Seven.”
“How do you get them on the bus?”
“Easy, they all fit into one suitcase along with every thing else.”
Anyway, the key about teaching ACLS is the knowledge and attitude imparted in the class, not the use of the fancy toys. Toys are nice to have, but don’t let your lack of them prevent you from discussing how to improve critical care response!
Here is what goes in the suitcase, in no particular order.
1) eight rubber balls, the kind that schoolkids use on the playground. These are used instead of a CPR manikin. When I first came to Nepal, I noticed that every school of nursing owned one CPR manikin. If they taught a CPR class, the whole group stood around and only one person at a time got to use the manikin. This is not the best classroom management. Let’s find a way so that every body is active. That’s when I started using the rubber balls.
2) a pump with needles for the balls. I deflate them when I travel, and they become very small and portable.
3) five bag-valve-masks. Airway is important, and as I have previously blogged, not every body knows how to clean and maintain these devices. I bought mine at Thapathali for 2,000 nrs each. You don’t need an “intubation manikin” to demo these, either.
4) two AT -35 rhythm generators from Pinnacle Tech Industries. Okay, these did cost money. But they are fun! We use a monitor or defibrillator from the host agency, and the AT -35 allows us to show rhythms such as VFib on their own screen.
5) Five sets of “Onliest six rhythms” cards. laminated and colorcoded. each group assitaqnt gets a set and they are used to show “dynamic rhythm response” – i.e., the rhythm changes based on the actions the team took, and now the team must respond to the new rhythm. 5a) Five Sets of the scenario list, one for each assistant.
6) a couple of shawls, Gorkhali topis, etc – props for role play.
7) The Certificates: The ones for CCNEPal are nice ones, highly desirable.
8) handouts: copies of rythms for practice; the “Guide to the Six Step Method for Ryhthm Interpretation,” the handout on Bag-Valve-Mask, the ACLS protocol handout.
9) Dissection tools and ET tubes for when we do the Phokso lab. A box of clean medical gloves.
10) Whiteboard marker pens. I don’t use PowerPoint or a DVD because of the ever present threat of loadshedding. This is a practical, interactive class.
The Bottom Line
In USA when I first started doing this, we did not have the fancy stuff you now see on the Heart Association videos. We used what we could improvise.
This background is useful for Nepal, because this is a low resource setting, and the typical school needs to find a way to teach the content without spending a lot of money on equipment. SO, here in Nepal, I teach the course without all the fancy stuff. Hospitals and Schools of Nursing, and Medical Schools, do not need to invest a lot of money in order to teach using these techniques.