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Is the protocol intended to credential nurses to open the chest independently in the US or Canada?

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 provider present, they may play a role in assisting the providers who are. Having a good understanding of the process and the equipment makes the overall process more efficient.

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 as unsophisticated a venue 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.


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.


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

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 glovs readily available.


Does this protocol apply to floor patients?

The protocol is intended for ICU patients up to 10 days post-op. 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 Americas. For more information contact us at

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

The education and name CSU-ALS and CALS is proprietary. You can teach open chest courses but you cannot use our materials or name.

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. We partnered with them in 2014 to bring it to the US, Canada and South and Central America.






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