title: Need for advanced cardiac life-support training in rural, community hospitals.
abstract: OBJECTIVE
  To define the relative needs of the staffs of rural, community hospitals for training in advanced cardiac life support (ACLS), identify weaknesses, and modify a standard ACLS course to meet these needs.
  
  
  METHODS
  Prospective assessment of knowledge and skills relating to the practice of ACLS.
  
  
  METHODS
  Rural, community hospitals in southern Wisconsin.
  
  
  METHODS
  None.
  
  
  RESULTS
  A well-validated, multiple-option, precourse test for life-support knowledge and clinical judgment was administered to the staff nurses, respiratory therapists, and practicing physicians of 12 rural, community hospitals in southern Wisconsin before their participation in a modified, extended, ACLS course, using the pre-1992 American Heart Association standards and guidelines. Testing was accomplished over 4 yrs. Detailed item analysis of the test was performed. A total of 461 persons participated. Overall, physicians performed better (p < .001) than did the nurses. Precourse difficulties included electrocardiographic rhythm strip interpretation, particularly with identification of the atrioventricular (A-V) blocks. Only 39.6% of the nurses and 64.1% of the physicians correctly identified third-degree A-V block. One third of the nurses and 22% of the physicians did not correctly identify coarse ventricular fibrillation. The pharmacologic properties and utility of atropine and epinephrine were not understood. Propranolol was selected for treatment of third-degree A-V block by 31.6% and 22.8% of the nurses and the physicians, respectively. Neither group was able to accurately distinguish between the components of disturbances in acid-base balance. The esophageal obturator airway tube was not a familiar tool to any of the groups. No improvement in overall performance on pretests occurred across the calendar years of the study.
  
  
  CONCLUSIONS
  There is a need for ACLS training in community hospitals. Educational programs for physicians and staffs should be designed to meet that need.
authors.affiliation: Center for Health Sciences, University of Wisconsin Hospital and Clinics, University of Wisconsin-Madison.
authors.forename: M L
authors.initials: ML
authors.lastname: Birnbaum
authors.forename: B M
authors.initials: BM
authors.lastname: Kuska
authors.forename: H L
authors.initials: HL
authors.lastname: Stone
authors.forename: N E
authors.initials: NE
authors.lastname: Robinson
mesh_terms: D002983:Clinical Competence; D004496:Education, Continuing; D004521:Educational Measurement; D006301:Health Services Needs and Demand; D006764:Hospitals, Community; D006801:Humans; D007318:Inservice Training; D007600:Judgment; D008020:Life Support Care / Q000379:methods*; D017202:Myocardial Ischemia / Q000628:therapy*; D010564:Personnel, Hospital / Q000193:education*; D011446:Prospective Studies; D012423:Rural Health; D014922:Wisconsin