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PALS Certification for Anesthesiologists?

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Should PALS be a requirement for anesthesiologist credentialing?

  • Yes

    Votes: 4 22.2%
  • No

    Votes: 14 77.8%

  • Total voters
    18
  • Poll closed .

Korba

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Hey guys,

Our Chief Medical Officer dug up an old regulation that requires all anesthesia providers maintain current PALS certification. Don't know about you, but this was news to me and will be a giant pain in the ass to get all of my providers certified if this is the direction they decide to go. We are Level II trauma facility and yes, we take care of kids, but usually bread and butter peds, nothing too crazy. On the one hand, I can understand their argument which goes something like "why, if you are taking care of children in an operative setting, should we not expect the provider to have the proper skills/knowledge/certification to manage a crisis situation". Somewhat hard to argue, but I would counter with "Residency training in anesthesiology already establishes expertise in the management of anesthetic emergencies, to include cardiac arrest. Airway management and resuscitation skills are a core competency of all anesthesiologists, and this certification will not enhance patient care".

Conflicted on this one though. What do you guys think?
 

urge

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Do you require ACLS?

If so, I say PALS should be required.
 

PainDrain

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It costs about $100 and 1 hour of your time to get "PALS" certified.

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Or think of it this way: 1 hour of your time and $100 vs a lawsuit costing you your career when, by fault of your own, some kid has a bad outcome. PALS=priceless when taking questions from a malpractice lawyer.
 

GravelRider

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Or think of it this way: 1 hour of your time and $100 vs a lawsuit costing you your career when, by fault of your own, some kid has a bad outcome. PALS=priceless when taking questions from a malpractice lawyer.

If a kid has a bad outcome then you are screwed even if your PALS card is dipped in gold and signed by the Pope.
 
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Korba

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Do you require ACLS?

If so, I say PALS should be required.
Not sure if that is a good reason. Using that logic we should require the entire fa
Do you require ACLS?

If so, I say PALS should be required.
By that logic, everyone with BLS should have ACLS/PALS/NALS/and Advanced Rescue Diver
 
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urge

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Not sure if that is a good reason. Using that logic we should require the entire fa

By that logic, everyone with BLS should have ACLS
huh?

If you require ACLS then it implies that there is some value in it over the general anesthesia training. Why would you deny the value of PALS to your pediatric patients? Other than the usual status quo of being ok providing inferior care to children?

I think it is indefensible asking for ACLS but not for PALS when they are taking care of both adults and children.
 
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Korba

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Do you require ACLS?

If so, I say PALS should be required.
Do you require BLS?

If so, I say ACLS/PALS/NALS/and Advanced Rescue Diver
It costs about $100 and 1 hour of your time to get "PALS" certified.

Sent from my SM-G920T using SDN mobile
If you're talking about getting an internet cert, I can tell you now they won't accept it.
 

urge

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If so, I say ACLS/PALS/NALS

Don't see why you bringing up BLS or any diver course.

If they take care of neonates of course they should take NALS, if you are requiring ACLS to take care of adults.

By your attitude it is obvious you are requiring ACLS to take care of adults. My question is why? Whatever your answer is, it applies to children also.
 
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Korba

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huh?

If you require ACLS then it implies that there is some value in it over the general anesthesia training. Why would you deny the value of PALS to your pediatric patients? Other than the usual status quo of being ok providing inferior care to children?

I think it is indefensible asking for ACLS but not for PALS when they are taking care of both adults and children.
The requirement for ACLS is corporate one, not one that we impose on ourselves. So a requirement from above implies nothing about it's value, and some would even argue that a 2 day training course once every 2 years provides very little value, and is really not necessary at least for anesthesiologists. I know at our institution, board certified EM docs are exempt from any of these certifications.

Your whole thesis is really full logical fallacies....since your instituion requiresACLS, that in itself implies value ( appeal to authority/tradition)....therefore PALS must have value(converse error)....not having PALS=inferior care to children....therefore you must not care about children getting good care (ad hominem). I mean, really? I would think you would offer up reasons other than appeal to tradition, maybe cite evidence that these kinds of certifications actually lead to safer/better care.
 

Korba

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Don't see why you bringing up BLS or any diver course.

If they take care of neonates of course they should take NALS, if you are requiring ACLS to take care of adults.

By your attitude it is obvious you are requiring ACLS to take care of adults. My question is why? Whatever your answer is, it applies to children also.
See my other response.
 

urge

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Your whole thesis is really full logical fallacies....since your instituion requiresACLS, that in itself implies value ( appeal to authority/tradition)....therefore PALS must have value(converse error)....not having PALS=inferior care to children....therefore you must not care about children getting good care (ad hominem). I mean, really? I would think you would offer up reasons other than appeal to tradition, maybe cite evidence that these kinds of certifications actually lead to safer/better care.

If you disagree you should direct all your effort towards eliminating the ACLS requirement. So far you are the one who has yielded to authority/tradition.

Your institution is the one asking for the PALS. I'm pointing out the logic behind it that you seem to fail to grasp.

Don't see the converse error. If you have yielded to ACLS for adults, seems pretty logical that you must yield to PALS for children, since you have a track record on yielding to authority already.

Don't see the ad hominem attack when it is pretty clear that the reason you are trying to fight it is for its inconvenience. A logical argument would be that PALS at worst is useless and at best is beneficial. Since the harm of PALS is zero with some potential gain, then denying its usefulness implies a lack of commitment towards this population.
 
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Korba

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If you disagree you should direct all your effort towards eliminating the ACLS requirement. So far you are the one who has yielded to authority/tradition.

Your institution is the one asking for the PALS. I'm pointing out the logic behind it that you seem to fail to grasp.

Don't see the converse error. If you have yielded to ACLS for adults, seems pretty logical that you must yield to PALS for children, since you have a track record on yielding to authority already.

Don't see the ad hominem attack when it is pretty clear that the reason you are trying to fight it is for its inconvenience. A logical argument would be that PALS at worst is useless and at best is beneficial. Since the harm of PALS is zero with some potential gain, then denying its usefulness implies a lack of commitment towards this population.
Changing policy for a huge health system is a fool's errand and would end up accomplishing nothing.

My institution is asking for my input before implementing this requirement. That is why I asked the question.

Again, you make many assumptions about what I have yielded to. Where did I say I "yielded" to the ACLS requirement? For all you know, I may have been fighting this policy for years. And as a matter of fact, I have been.

The converse error is thus: your institution requires ACLS, therefore it must have value. If PALS is required by your institution at a later time, it too must have value. Using this argument, you could make similar fantastical assumptions about what training clinicians need for every contingency.

The ad hominem is your assumption that this is purely out of inconvenience and that I value convenience over patient safety. You are the one who is jumping to conclusions.
 

urge

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The converse error is thus: your institution requires ACLS, therefore it must have value. If PALS is required by your institution at a later time, it too must have value. Using this argument, you could make similar fantastical assumptions about what training clinicians need for every contingency.

The ad hominem is your assumption that this is purely out of inconvenience and that I value convenience over patient safety. You are the one who is jumping to conclusions.

I never said ACLS was useful or not. I used it as logical analogy. The premise of its usefulness comes from your employer.

Still don't see the ad hominem if the whole issue is based on a double standard of needing an advance resuscitative course to take care of adults, but not children.
 
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deleted171991

Hey guys,

Our Chief Medical Officer dug up an old regulation that requires all anesthesia providers maintain current PALS certification. Don't know about you, but this was news to me and will be a giant pain in the ass to get all of my providers certified if this is the direction they decide to go. We are Level II trauma facility and yes, we take care of kids, but usually bread and butter peds, nothing too crazy. On the one hand, I can understand their argument which goes something like "why, if you are taking care of children in an operative setting, should we not expect the provider to have the proper skills/knowledge/certification to manage a crisis situation". Somewhat hard to argue, but I would counter with "Residency training in anesthesiology already establishes expertise in the management of anesthetic emergencies, to include cardiac arrest. Airway management and resuscitation skills are a core competency of all anesthesiologists, and this certification will not enhance patient care".

Conflicted on this one though. What do you guys think?
I think that, if one takes care of kids, PALS should be required. If not, then not.
 
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Random Anesthesiologist

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Do you require BLS?

If so, I say ACLS/PALS/NALS/and Advanced Rescue Diver

Finally! I always wanted to fish someone out of the fountain and throw them in the hyperbaric chamber

Funny story, the hospital was harassing one of thebCT surgeons about her BLS that was expiring, right after a case with cardiac massage. The irony was beautiful.
 
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deleted171991

Funny story, the hospital was harassing one of thebCT surgeons about her BLS that was expiring, right after a case with cardiac massage. The irony was beautiful.
That's strange. Doesn't the surgeon have ACLS certification?
 

GravelRider

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To be honest, ACLS and the like is a box for administration to check off to cover themselves. Renewing every two years with some silly course where you a lumped with all sorts of "providers" seems like a waste of time to me. I don't need to stand in line practing intubations on a dummy. I think renewal makes some sense because we hopefully don't have codes everyday. However, I think the renewal should be done online and more of a knowledge based check-up rather than playing with mannequins.

I know some EP docs who are instrumental in writing the ACLS guidelines who have had to sit through those classes.
 

aneftp

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Why are we even arguing about this?

There are a lot of real AHA local providers in most places. The AHA really is cracking down on providers just giving out AHA Acls pals cards etc. (pals took 1.5 hours extra). So Acls and bls was around 4.5 hours

Anyways. I found a legit AHA provider. Did Acls bls pals with tests in about 6 hours.

Most places once u tell them you are anesthesiologist will cut u a lot of slack and not have to do mundane stuff.

There are lot of AHA instructors. Just call them and ask how long they will take.

Personally I do not like the official AHA online base stuff. Plus u still need to come in and do ur hands on stuff.
 
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deleted547339

This is insane that this is even a conversation. These silly merit badges are not intended for experts, they're intended for novices.

An attending trauma surgeon isn't the intended audience for ATLS. A PICU attending shouldn't need PALS.

These are protocol driven absurdities (most of which are either not rooted in evidence or contrary to a fair amount of evidence). They're great for EMTs, med students and floor nurses - if an anesthesia attending can't run a code, they made some poor life decisions.
 
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Noyac

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Or think of it this way: 1 hour of your time and $100 vs a lawsuit costing you your career when, by fault of your own, some kid has a bad outcome. PALS=priceless when taking questions from a malpractice lawyer.
Do you really think having PALS will prevent you from being found at fault when something goes south in a case like this?
 
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Noyac

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It is ridiculous for anesthesiologists to have to take ACLS or PALS. This is what we do. We don't follow stupid algorithms which were designed to remove the thought processes out of situations. That's for people with either lesser training or less knowledge.

Don't let non anesthesiologist dictate what you should or should not do. They have no idea of your knowledge, training and abilities are. They are only imposing their inadequacies on you.
 
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PainDrain

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Do you really think having PALS will prevent you from being found at fault when something goes south in a case like this?

No, not at all. But do I think it would be used against me if I didn't have it... Yes.
 

Noyac

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No, not at all. But do I think it would be used against me if I didn't have it... Yes.
I'm not so sure about that but then again I've never been in that position and hope I never will.
My point is that these certifications are just busy work for an anesthesiologist that is created by clipboard wielding *****s that have no idea of our specialty.
 
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aneftp

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Do you really think having PALS will prevent you from being found at fault when something goes south in a case like this?
Well. If you don't have pals and something goes wrong. It's an "easy picture" for the dumb audicine (jurors) to see.

Jurors are dumb. Most don't understand what's malpractice and what's not. There are many gray areas. But they do understand. No Pals cards. It means. You don't have a pals card. Pretty clear cut.
 

GravelRider

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If you want to do PALS or ACLS to force yourself to keep current on recommendations then fine. But if I am forced to sit in a class then I want to be with doctors and taught by doctors. Having some EMT read me a manual is not helpful, it's time consuming, and it's expensive.
 

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If you want to do PALS or ACLS to force yourself to keep current on recommendations then fine. But if I am forced to sit in a class then I want to be with doctors and taught by doctors. Having some EMT read me a manual is not helpful, it's time consuming, and it's expensive.
How often do you code a ped? If it's less than n times/year, is it not beneficial to rehash?
I take ACLS every two years, I intubate daily, and think my processes by the minute, while doing ped cases. There's some positive/benefit to re-acknowledge the latest and greatest. IMO.


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meister

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I don't know if it's more ridiculous that they have me (radiologist) do ACLS or have you all do it. I mean the idea that I'm going to initiate therapeutic hypothermia is laughable, not to mention all the med studs and RNs with whom I took the course.

But at least for me it didn't feel *insulting*, which is what I think I would feel if I was a gasman and some suit told me I needed to practice bagging a dummy. Ridiculous.
 
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vector2

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I don't know if it's more ridiculous that they have me (radiologist) do ACLS or have you all do it. I mean the idea that I'm going to initiate therapeutic hypothermia is laughable, not to mention all the med studs and RNs with whom I took the course.

But at least for me it didn't feel *insulting*, which is what I think I would feel if I was a gasman and some suit told me I needed to practice bagging a dummy. Ridiculous.

We have a pretty quick rapid response team, but considering the number of codes or near-codes I've responded to in CT, MRI, IR, ultrasound, XR, I don't think having the physicians who work there be trained in some kind of life support is the most unreasonable thing. Granted, ACLS may be overkill...I would be happy if y'all just knew to call for help, initiate effective CPR, grab a code cart, put the pads and standard monitors on, bag/slap on supplemental O2, and start/make sure an IV is working.

As for anesthesiologists, I know everyone else here on SDN is a rockstar who's never forgotten any of their previously acquired emergency training, but speaking for myself as someone who usually goes to a code to put the tube in and then leaves, I appreciate having a refresher in the finer points of ACLS every so often.
 
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pgg

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Guidelines intended to be applied by non-physicians, that were conjured and sorta-validated based on data from pre-hospital and often unwitnessed events, shouldn't be assumed to be applicable to or useful for the witnessed events with usually-obvious etiologies that we see in the OR. It's silly to require anesthesiologists to have BLS, ACLS, PALS, or NRP certification, when our training is far superior for managing the events we actually come across.

None of it should be required for us.
 
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Doctor Bob

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maxxor

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We have a pretty quick rapid response team, but considering the number of codes or near-codes I've responded to in CT, MRI, IR, ultrasound, XR, I don't think having the physicians who work there ...
This assumes the reading room is anywhere near the scanners. The worst is when I'm in the ER reading room and a possible contrast reaction happens on an inpatient scanner 2 buildings and 6 floors away. Code team will assuredly be there before I get there.
 
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deleted171991

It costs about $100 and 1 hour of your time to get "PALS" certified.

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FYI, its about 12 hours of time, in total, if it's AHA. Part 1 gets 10.5 CME hours for a reason. And part 2 ate up uselessly 3 hours of my life.
 
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