EMC Testing Policy

 In Instructor Memos

We continue to have concerns from instructors stating that they are being told to modify our syllabus or testing policies during classes. The following is the uniform way that we like to operate; and the only way if you are teaching with us.

My goal is for 100% of the participants to pass on the day they attend the class. However, we are also charged with the professional and ethical responsibility of not merely “socially promoting” a student who is not prepared; when we issue an AHA card, our client (hospital, fire department, office or state board) expects that the recipient has a base level of knowledge.

Yes, we realize that a paramedic is different than an ED nurse, who is different than a respiratory therapist….we get it.

At the end of the day (or class) does this person possess the didactic knowledge to meet the AHA’s standard of 84% passing knowledge with no outside assistance on the written exam and the ability to recognize and manage respiratory or cardiac arrest? Can they function as a team member during cardiac arrest and do they know on their own to shock VF, perform high quality CPR and administer Vasopressors for non-shockable rhythms and Vasopressors and Anti-dysrhythmics for shockable rhythms as appropriate? (Before referring to the Tri-Fold or Reference Card)

Finally, do they know that post resuscitatively the patient must be ventilated, have vitals stabilized and evaluated for STEMI or the need for Target Temp. Management (induced hypothermia)? (This is where a reference card could be used since these treatments are not as emergent)

This is the basic knowledge

Use of reference card – The reference card should be used as just that, a reference, and not as directions on how to manage the initial portion of a cardiac arrest. Not all nurses or medics and not all code carts will have reference materials readily available.

Does the cath tech or respiratory therapist need to know how to mix Levophed? Probably not, but they need to know that “someone” needs to be called to fix the problem.

Yes, we realize that there is “some” subjectivity in there…that’s why we pick who teaches for us, work with them, have them monitored and personally come watch them..We keep the people with a passion to do this, the knowledge to present it and the professional personality to do this right…You guys are the best around!


For the written exam: Our participants take the first version of the exam without any “resources”.

If the participant was able to pass the scenario section:
84% is passing on the written exam

If they score 78% or above, they can just re-take the missed questions 1 time. We do not give them their previous answer sheet or tell them the correct answer; they simply re-do those missed. If they are still below 84%, they must take the other version of the exam. (see below)

If the initial score is below 78%, or if they fail the first version twice, they must take the other version of the exam. The second version of the exam can ONLY be taken once. The instructor should review the questions missed on previous exam. Resources can be used on the second version of the exam (card or text). The time limit is a strict 45 minutes for ACLS and PALS and 20 minutes for BLS. (See last page for sample answer key)

*Instructors CAN read/ask the question to those with reading/comprehension issues, if needed*. (Exam 1 or Exam 2)

Scenario (Megacode) Evaluation:  We follow the AHA’s recommendation for using a “team” approach when running the mandatory cases (Vfib/VT, plus 2 other rhythms, either before or after VF, then post resuscitation care). However, the team leader is who is being evaluated, hence he/she needs to be defined at the beginning of the scenario and be “in charge” by him/herself relevant to their job. (i.e. a med/surg nurse can have someone else “hang” pressors, but they should know it’s needed). The instructor manual says they can get “some” input from the team but must be “in charge”. A student should never be standing in front of an instructor alone, being questioned on “what to do” without an actual scenario and skills being performed.

*See the following pages of this document explaining exactly how a scenario should be run.

This section on AHA testing covers some ACLS, PALS, and BLS- Chapters 1,2,3 from your instructor manuals.

Use of reference card – The reference card should be used as just that, a reference, and not as directions on how to manage the    initial portion of a cardiac arrest. Not all nurses or medics and not all code carts will have reference materials readily available.


ACLS – Everyone must perform compressions, ventilations (that create chest rise 1 & 2 person mask seal PRN), defib, be drug person, and be evaluated as an individual team leader based on their professional role (no fake CPR or ventilations).

  • ACLS CPR sequence – For VF during the end of the compression cycle (around compression 20), the defibrillator should be charged, the “drug person” should have the next med ready, then during the “10 second or less stop” the team leader should check the rhythm, then request the team to push the drug, defibrillate (if it is VF/VT), and start CPR again.  There are a couple of acceptable variations, but this works well for the inexperienced and keeps us consistent; please do it this way.

– After the initial assessment, we only need to check a pulse when we see a rhythm that may produce one.
– After the initial 5 rounds, we can use 3 rounds of compressions between each drug to simulate 2 minutes.
– Scenarios should only be relevant to the students’ work area (i.e. don’t give a Tele nurse an EMS or ICU scenario).
– Each participant should have the opportunity to manage their own scenario – not one long run on scenario with multiple team leaders (i.e. a 7 person group should do 7 scenarios).
– The AHA text and our packets contain appropriate scenarios, 3 rhythms        (including a portion of  VF), and post resus. care (ventilations, rate, rhythm, B/P stabilization).

PALS – requires a “mini megacode” – basically addressing good CPR, quick rhythm review, quick defib in the rare case that it’s needed, and rapid administration of Epi for asystole or PEA.  All students complete roles in this station the same as ACLS above.

PALS also requires a respiratory distress/failure and a shock station (one or the other) be completed.  In our course for emergency staff, we also have a seizure and “unconscious” section/scenarios.

BLS course and the BLS station in an ACLS or PALS course – remains unchanged– Everyone must complete every skill.  Everyone must pass the exam with an 84%.

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