A half dozen doctors, nurses and EMTs stood in a semicircle around a partial dummy of a pregnant woman’s belly and pelvis, listening intently as instructor Dr. Pete Olsen described different scenarios they might encounter with a childbirth. Each one took a turn with the dummy, reacting as they might in a real-life situation.
In one, he described a woman with Type 2 diabetes, giving birth to a very large baby who is stuck in the birth canal. It’s a complicated case. Fortunately for the plastic dummy and her baby, the emergency room nurse is a veteran of many childbirths, and knows exactly what to try first and, when that fails, what to try second. On her third option, she succeeds at safely delivering the baby by bringing one of its arms up over its head.
It’s just one of dozens of different real-life medical emergencies they would learn about and practice for over the two-day Comprehensive Advanced Life Support (CALS) training at Community Memorial Hospital late last month.
While there are many different kinds of courses for medical professionals available — advanced cardiac support from the American Heart Association, critical care, advanced support for obstetrics and more — the CALS training is specially designed for smaller hospitals and rural medical care.
“CALS puts it all together but also recognizes that more rural facilities require a team-based approach that includes all of those components because any type of patient might walk through the door,” Olsen said.
He explained that because most rural facilities don’t have all the resources and specialist personnel that a larger hospital usually has, the focus is to quickly recognize and treat life-threats of patients and to expedite their delivery to “definitive care,” or a larger center with more resources.
“Because rural centers are the first point of contact, CALS focuses especially on the first 30 minutes of patient care and how to treat any patient with any problem with a team-based approach,” Olsen continued. “So it’s a critical resource for rural facilities and hospitals.”
Started in 1996 in Minnesota by a grassroots coalition of volunteer health care providers with the goal of improving patient care and outcomes in rural settings, the CALS program has hosted courses in numerous other states, eight countries and trains embassy medical personnel for American embassies around the globe. Recently physicians from Haiti and Kenya traveled to the University of Minnesota, where CALS is housed, to take the CALS training. The trauma director and an emergency room doctor at CMH, Olsen is also a CALS trainer.
There were 23 students at the CALS training at CMH last month — the 300th training session for that particular group of instructors — from places like Crosby, Virginia, Albany, Aurora and Cloquet, all mostly smaller towns and cities in the state.
They are not the minority in terms of healthcare providers. Olsen pointed out that the majority of care around the world is given in rural settings, not state-of-the-art urban hospitals.
While Olsen discussed possible childbirth scenarios in the Birch Room at CMH, Lucas Goodin was one of four healthcare providers working with the CALS students on neonatal resuscitation in the Pine Room. Goodin, an EMT-P in the Community Memorial Hospital Emergency Room and a volunteer with the Wright Fire Department, is also a CALS instructor. He was specifically helping people practice intubating a newborn in case the baby breathed in its meconium, basically a baby’s first bowel movement, while still in the womb.
Andrew Hebdon, CALS program coordinator and an emergency room nurse in Minneapolis, explained that the instructors come from multiple backgrounds, areas of expertise and rural and urban providers, which “brings multiple levels of experience” to the training.
The training is a combination of some lecture and more scenario-based work, ideally practiced by teams of providers, Olsen explained, adding that the CALS job is to help those teams learn to better coordinate the care they provide through scenarios.
“Each person has a particular role on a care team, but our job is to coordinate those roles as team,” Olsen explained. “It’s not your typical top-down approach where there’s a physician who guides everything. In a rural facility, people have to be able to overlap their roles. We help coordinate that process: teaching nurses how to help provide care and establish room for the physician to make the diagnosis, physicians to provide support to nurses in the care they’re providing, EMTs to provide that foundation of care in a pre-hospital environment.”
He gave an example of a recent case where a woman — a mother of 12 — was being transferred to a larger hospital in Duluth from Cloquet when she went into cardiac arrest, only blocks away from CMH. The EMTs turned the ambulance around at the gas station and came back to CMH.
“We were able to get her heart restarted within six minutes,” Olsen said. “But it wasn’t a single person — a doctor or a nurse or an EMT — who saved that patient. It was the entire team who coordinated the care. The EMT started CPR in the prehospital environment, the nurses established all our IV access and medications and the physician guided that care and, as a team, we took excellent care of that patient.”