Course Director: Dr. Eduardo Velasco Sánchez Guadalajara, México
U.S. Faculty: Susan Fuchs, MD, FAAP, Chicago, Illinois
Stephen R. Karl, MD, FAAP, Sioux Falls, South Dakota
Marianne Gausche-Hill, MD, FAAP, Torrance, California
Loren Yamamoto, MD, FAAP, Honolulu, Hawaii
Michael Gerardi, MD, FAAP, Morristown, New Jersey
James H. Hammel, MD
México Faculty: Dr. José Luis Ortega, General Coordinator, La Paz, México
Dr. Luz María Corro, Guadalajara, México
Dr. Karla Isis Avilés Martínez, Guadalajara, México
Dr. Eduardo de la Torre Martin, Guadalajara, México
Dr. Mauro De La O Vizcarra, Irapuato, México
Equipment Specialists: Víctor Hugo Arroyo Romero, Guadalajara, México
David A. Boer, MBA, Sioux Falls, South Dakota
Don Jones, Sioux Falls, South Dakota
The implementation of the APLS course in Los Cabos, México began in April 2008, when AAP staff first met with members of the Los Cabos Children's Foundation and Amigos de Los Niños at the AAP headquarters in Elk Grove Village, Ilinois.
As a result, the first ever APLS course in Cabo San Lucas, México was held November 13-15, 2008 at the Sheraton Hacienda del Mar Resort & Spa in Los Cabos. The course was attended by 61 participants; they represented multiple medical fields and geographic locations within a 5-state region of México.
All of the teaching was conducted in Spanish by a predominantly bilingual faculty who led the course and shared in presenting the eight lectures. Members of the APLS Steering Committee assisted them with the five skills stations, as well as numerous small group discussions. The typical student-to-instructor ratio was 8:1. APLS textbooks, lecture presentations, and examinations were provided in Spanish. The lectures delivered were Pediatric Assessment, Airway, and Nontraumatic Surgical Emergencies. The skills stations included Airway, Cardiovascular, and Advanced Trauma.
On the eve of the course, course planners invited APLS faculty and staff to a welcome orientation whereupon key individuals who were directly responsible for the dissemination of the course in Los Cabos gave moving speeches regarding the need to help children in the region.
On the first day, the course opened with welcome speeches from Dr. Karl, Dr. Velasco, and Dr. Ortega, as well as from Eileen Schoen, the APLS Program Manager. Each speaker emphasized the vision for the course and the commitment to children throughout this learning opportunity. All of the local faculty, as well as members of the APLS Steering Committee and AAP staff, were introduced at this time.
Although some of the instructors were relatively new to the APLS program, they had experience from other educational courses in México. As such, their motivation and enthusiasm were in abundance. They made the small group discussions and hands-on skills stations their own, commanding the audience's attention at all times. In short, they were very impressive and clearly enjoyed the opportunity to share and exchange ideas with those from another country.
By the second day, course participants and faculty had really gotten to know one another, despite minor language barriers. Participants asked numerous course-related questions of the faculty and were particularly enamored with the hands-on skills stations that took place in the late morning. It was rewarding to watch their facial expressions as they prepared for skills such as I/O needle insertion on chicken legs and eggs, suturing skills on pig's feet and sausages, as well as work on pig tracheas and pork ribs. In fact, several participants asked staff to take pictures of them performing their respective skills.
As the second day of the course progressed, more skill practice took place in the afternoon. Members of the Steering Committee worked with the students on intubation. Individuals were thoroughly engaged in this particular skill, and many practiced multiple times. Their smiles grew wider at the prospect of completing this correctly.
On the third and final day of the course, participants were able to witness the vast attributes of the two SimNewBs (Interactive Neonatal Simulators). Faculty enjoyed the opportunity to showcase these simulators to attendees, especially the extensive newborn traits and lifelike clinical feedback of neonates. As predicted, participants were thoroughly engaged with these simulator models. They appreciated the different features of the models and participated in many of the scenarios presented by faculty, such as normal/abnormal breath sounds, umbilical pulse, and Intraosseous Access. They were resoundingly amused by the various vocal sounds (crying, grunting, hiccups), and the cyanosis presentation.
At the end of this day, all learners took the APLS written exam, and a majority of them passed. At the conclusion, attendees were presented with several items recognizing their participation in the course: Certificate of Attendance (issued by the AAP), Certificado (issued by Reanimacion Cardiopulmonar and Los Cabos Children's Foundation), APLS Provider cards (to those who passed the exam), and a group photo of the faculty, participants, and staff. In addition, AAP, Reanimacion Cardiopulmonar, and Los Cabos Children's Foundation presented the faculty with their own certificates.
At the closing of the course, Avera Health Foundation in Sioux Falls, South Dakota donated 10 color-coded pediatric bags full of training equipment, each one valued at $1,900. These bags are being held by the Los Cabos Children's Foundation with a specific goal in mind: to encourage course participants to conduct APLS courses in their own regions. Dr. Stephen Karl was pleased to award the first bag to Dr. Eduardo Velasco for his exuberant efforts in planning the first APLS course.
The Los Cabos Children's Foundation expressed its dedication and commitment to the children of the region. All individuals who participated in the course expressed their continued resolve to establish health organizations that can have a positive impact on the lives of children in their region.
This course was made possible by the Los Cabos Children's Foundation.
Special thanks go out to Jeanie Conzemius, Cindy Walsh, Tom Walsh,
Gay Thatcher de Herrera, and Rodolfo Rosales.
APLS Skill Station Tips
What to do when you cannot find the plastic umbilical cords
Submitted by Susan Fuchs, MD, FAAP, FACEP
While not everyone does umbilical vein catheterization as part of their APLS course, those who do may find these tips helpful. They use the idea of placing the umbilical cord into a baby bottle with a nipple top, and then threading the line into the water and withdrawing simulated blood.
If you are using umbilical artery catheters, do not throw away the sheaths they come in—use them as the arteries. Then use regular IV tubing as the vein.
Wrap these three tubes with plastic wrap (Saran or Handi-wrap) or place two arteries and one vein into a larger tube (suction tubing, chest tube to pleurevac tubing) and then cut it into the appropriate size for the baby bottles. (You may need to use a lubricant—either water-soluble or intubation head spray—to get everything to fit inside.)
Cut the tip off of the nipple and insert the umbilical cord.
Another option is to get an infant nasal cannula: use the very thin tubing that goes to the infant's nostrils as your artery and the larger portion of the tubing (the part that connects to the air source) as your vein. Wrap these in plastic wrap or insert them into larger tubing (7/16-inch outer diameter PVC tubing or suction tubing, chest tube to pleurevac tubing), and then place in the baby bottle. (You can also purchase this tubing at a home improvement/hardware store. Look for clear PVC tubing, either 7/16-. 5/8- or 3/4-inch outer diameter.)
Another option is to purchase some of this tubing in advance. It is available from hardware Web sites. Go to the tubing section and look for polycarbonate tubing. Get the 3/4-, 7/16-, or 5/8-inch size outer diameter—this serves as the umbilical cord.
For the arteries, search under plastic tubing and select PVC tubing. The 1/16-inch outer diameter works (you will not be able to thread the catheter through this). If this is unavailable, you could also use rubber (latex) tubing that is 1/16-inch in diameter.
For the vein, search under rubber tubing and get the 1/8-inch diameter rubber (latex) tubing.
Assemble as above.
NOTE: If you are allergic to latex, there is more expensive tubing available.
APLS Steering Committee News
Submitted by Eileen Schoen and Marta Foster
We never like to say goodbye, but the time has come to say au revoir to Marianne Gausche-Hill, MD, FACEP, FAAP. Dr. Gausche-Hill has been on the APLS Steering Committee for 10 years, serving as the committee chair for the past four years. She was one of the three editors of APLS: The Pediatric Emergency Medicine Resource, Fourth Edition and the primary editor of APLS: The Pediatric Emergency Medicine Instructor Manual, Third Edition. Dr. Gausche-Hill has given much of her heart to the APLS program—we will miss seeing her at committee meetings. We are certain, however, that APLS will continue to need her in a less time-consuming role, and we are confident that she will not be able to say no to us!
We would like to extend a heartfelt welcome to the new Chair of the APLS Steering Committee, Loren Yamamoto, MD, MPH, MBA, FAAP, FACEP. Dr. Yamamoto joined the Committee in 2004 as one of the editors of the fourth edition of APLS materials. We knew a good thing when we saw one, so we refused to let him go! Dr. Yamamoto is a professor of pediatrics at the Kapiolani Medical Center for Women and Children at the John A. Burns School of Medicine in Honolulu, Hawaii. He has a reputation for being a quiet leader with high-tech ideas that continually inspire the Committee. We can hardly wait to see where Dr. Yamamoto leads us in the next edition.
Earlier in 2008, we were faced with the retirement of a long-standing APLS Steering Committee member, Michael Gerardi, MD, FAAP, FACEP. Dr. Gerardi retired after six years on the Committee. Although he will be missed, he is on to bigger and better things. Dr. Gerardi recently became an ACEP board member! Fortunately, we remain at the top of his list of favorites. Dr. Gerardi still found time to teach APLS with the Committee in Los Cabos this past November, and he generally makes himself available to teach APLS at the AAP National Conference.
Dr. Gerardi's vacancy provided us with an opportunity to work with Frederick C. Blum, MD, FACEP, FAAP. Dr. Blum is the past president of the American College of Emergency Physicians. He is an associate professor of emergency medicine and pediatrics at West Virginia University School of Medicine, and he practices at Ruby Memorial Hospital in Morgantown, West Virginia. Passionate about improving emergency medical care and the care of children in particular, Dr. Blum has testified before Congress numerous times on issues such as crowding, boarding, and ambulance diversion. He also has served as president of the West Virginia Chapter of ACEP and as secretary general and president of the International Federation of Emergency Medicine. Dr. Blum joins Susan Fuchs, MD, FAAP, FACEP; Steve Karl, MD, FAAP, FACS; and Brent King, MD, FAAP, FACEP, on the Committee, as well as a new ACEP representative to be appointed in these first months of 2009.
Now that we have this brilliant group together, it is time for the Committee to begin work on the fifth edition of APLS materials. The APLS Steering Committee will meet March 6-7 to begin brainstorming and exploring new ideas for the educational materials and course design. Here is where you come in. Whether you have directed, taught, or learned from APLS materials, we would like to hear your thoughts. Your input can only help us improve!
Publisher: Kimberly Brophy
Jones and Bartlett Publishers
Frequently Asked Questions
How do I claim credit for Check Your Knowledge online modules?
Upon completion of each Check Your Knowledge module, you will be able to print a certificate that states that you have earned 1 CME credit.
The link below explains how the American College of Emergency Physicians (ACEP) grants Category 1 AMA credit for these online CME modules. ACEP members can report this credit when they renew their membership every three years:
CME credit (not AMA credit) can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics. The link "Recording CME Credit" details step-by-step directions for claiming your credits.
Why do I have to pay $15 per online module after I have completed a one-day course?
The additional online modules were designed to replace lecture topics that an individual would have had to participate in on the second day if they had completed a two-day course. Instead of making the second day mandatory, we give learners the opportunity to gain that knowledge at their own pace. The charges for online modules cover the CME credit that a person earns with each module. The fees also help cover various expenses such as administrative costs, the ability to maintain an online system and an internal database to track CME, and to comply with ACCME guidelines.
Please note that the modules are optional. If you do not want the wallet-sized APLS Provider Card, and you are not interested in earning additional CME, you do not need to complete the additional modules.
How do I get my course approved as an official AAP/ACEP course?
You will need to log in first to the APLS Web site using your e-mail address and password: www.APLSonline.com. Then, select "Application for Course Implementation" and complete the entire application. Upon submission of application, please e-mail your course schedule and faculty list to our office for review: email@example.com.
Once we review your supplemental materials, you will receive notification via e-mail about the status of your course application. Within a few weeks time, you should receive the approval letter from our office. At that time it is now an officially approved AAP/ACEP course!
Martha Bushore-Fallis APLS Award
Dr. Martha Bushore-Fallis is one of the founders of the APLS program. In 1988, she received the AAP Distinguished Service Award for the creation of the field of Pediatric Emergency Medicine. She continues to have an active interest in APLS and shares her vision with the APLS Steering Committee.
The APLS Award has been established through an endowment to the American Academy of Pediatrics for Dr. Bushore-Fallis in honor of her parents, Ralph A. and Jane Turner Smith, who always inspired her with the simple maxim, "In return for the gift of life, we have an obligation to make the world a better place."
2008 APLS Award
The APLS Steering Committee was pleased to select Eduardo J. Velasco Sánchez, MD, FAAP, as the recipient of the 2008 Martha Bushore-Fallis Award. The award recognizes an individual who has helped to further the goal of early recognition and stabilization of life-threatened children through the auspices of the APLS program. The award was presented at the AAP's National Conference & Exhibition (NCE) in Boston, Massachusetts on October 11, 2008.
Dr. Velasco is a graduate of the Universidad Autónoma de Guadalajara, Pediatrics in Hospital Infantil Privado in México, D.F. He has been the course director of more than 146 basic and advanced life support programs. He has been an itinerant instructor for Latin America, and he performed the first APLS Program in Latin America. Dr. Velasco has collaborated on more than 10 life support-related books. He is a staff member at the following hospitals in Guadalajara, México: Hospital Angeles del Carmen, Hospital Real San José, and Centro Médico Puerta de Hierro.
2009 APLS Award
Watch for the 2009 Call for Nominations to appear on www.aplsonline.com. Qualified candidates are those who have demonstrated commitment to pediatrics through innovation of a new procedure or equipment, through development of a new educational methodology, through advancing legislation in support of the life-threatened child, through teaching APLS in underserved communities (either nationally or internationally), or through other accomplishments deemed exceptional by the APLS Steering Committee.