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Is the protocol intended to credential nurses to open the chest independently?


No. The protocol is intended to teach all members of the team the indications for opening the chest, how to open the chest safely and efficiently as a team. Even though it is unlikely Nurses will open the chest independently without a surgical provider present, they may play a role in assisting the providers who are doing so. Having a good understanding of the process and the equipment makes the overall procedure more efficient and more likely to be successful.



How should we approach CSU-ALS/ CALS Training in the setting of the COVID 19 epidemic?


Our recommendation is that you follow your local, state and hospital rules with regards to gatherings, numbers of attendees and PPE.  Our experience in North America is that this varies from city to city.  We would recommend a mask during the course for all attendees and faculty, gloves during the moulages for all participants and cleaning the manikin in between moulages.



Can I become a CSU-ALS Trainer by taking the E-learning course only?


No. The E-learning course is an adjunct to the education and is not in part or in whole a replacement for the live courses and proctorships that are required to become an accredited CSU-ALS Trainer. For more information on becoming a trainer please see the Certification tab on our website.



Do we have to have a simulation center to teach the course?


No. The course has been designed so that it can be offered in as sophisticated a venue as a high- end simulation center or in one as unsophisticated as a hotel ballroom. There are key components to the education and key pieces of equipment that are common to most education departments and ICUs. For a list of these please see the Unit Based Training Courses Options tab. Furthermore , the Training the Trainers course fully trains practitioners  in working in this wide range of different teaching environments so as to maximize the educational potential of the provider course.


What do we do in patients that have not had a sternotomy but have had cardiac surgery via another approach (mini-thoracotomy)?


The protocol is designed for patients who have had a sternotomy only BUT the ethos of the training teaches the need to prepare for every eventuality which can occur post-operatively with such patients. Simply put the operating surgeon must ensure that the staff members are fully aware of how an emergency reopening should be performed should cardiac arrest occur in these patients. Further guidance on how emergency access to such patients hearts and the performance of internal cardiac massage can be found on the document CALS AND MINIMAL ACCESS CARDIAC SURGERY.



Is it ok to open the chest without putting on a gown and gloves?


No. We recommend you put on a gown and gloves unless they are so unavailable it would delay opening the chest beyond 5 minutes of arrest. Most ICUs have gowns and gloves readily available. Safe and efficacious gowning and gloving is a practical skill taught during the CSU ALS provider day to practitioners who rarely do it in the routine clinical environment.


Does this protocol apply to floor patients?


The protocol is intended for ICU patients up to 10 days post-op.  This is for a number of reasons. Firstly, the disease processes that cause cardiac arrest after day 10 are unlikely to be those for which emergency re-sternotomy will be efficacious. Secondly, that by this time intra-pericardial adhesions are forming which makes emergency re-sternotomy and internal cardiac massage difficult for all but the most experienced cardiac surgeons. We thus suggest that if someone arrests at Day 10 (or after that) standard ACLS be initiated ,  but with the proviso that delaying CPR for 3 stacked DC shocks and an attempt to emergency pace  in the case of Asystole be carried out. The operating surgeon needs to be immediately contacted and their opinion re emergency re-sternotomy be sort. There are certainly elements of the training that can be taught to floor staff such as delaying CPR to defibrillate or pace. We leave this up to the individual centers as there is variation in the availability and proximity of code carts on step-down units and there is variability with regards to training (i.e., some step-down nurses are not ACLS trained).


How do we buy a manikin?


The manikin is for sale in our Store. The price is substantially reduced for formal Centers. We are the sole distributor of manikins for the world. For more information contact us at


Do we have to become a center to teach CSU-ALS courses?





Once I am a Trainer, can I teach the course at another hospital or some other location if I leave my position with my current hospital?


No.  You must be associated with an accredited CSU-ALS/ CALS Center to teach the courses and only at those Centers unless otherwise invited to teach by CSU-ALS/ CALS.



What is the difference between CALS and CSU-ALS?


CSU-ALS training is referred to as CALS outside of the Americas. There is a trademarking issue in the US that prevents us from calling it CALS. The education is fundamentally the same although there are some differences culturally that show up in the education. The protocol was developed by the CALS group 14 years ago. CSU-ALS partnered with CALS in 2014 to bring it to the US, Canada and South and Central America.





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10/20/2020 » 10/22/2020
Flinders Medical College CALS Provider Courses - Internal Staff Only

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1435 Taylor Wood Rd, Simpsonville, KY
Phone: (540) 383-2817


The Lanterns, Sandy Lane, STAFFS ST5 5DP, UK
Phone (+44)  7515911116


To ensure that cardiac patients receive the best possible care during the worst possible times

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