7.1 Integrating BLS with ACLS & PALS

BLS is the foundation of all resuscitation efforts, but when available, Advanced Cardiac Life Support (ACLS) or Pediatric Advanced Life Support (PALS) should be initiated as soon as possible. Healthcare providers performing BLS must know when and how to transition to ACLS/PALS interventions.

Recognizing the Need for ACLS or PALS

While BLS focuses on chest compressions, ventilations, and AED use, ACLS and PALS add advanced interventions, such as:

• Manual defibrillation (beyond AED use)
• Cardiac rhythm analysis
• Advanced airway management (intubation, supraglottic airways)
• IV/IO medication administration

When to Transition from BLS to ACLS/PALS

• As soon as additional healthcare providers with ACLS/PALS training arrive
• When cardiac arrest continues despite BLS efforts
• When a shockable rhythm is detected and advanced defibrillation is available
• For patients requiring advanced airway management

Recognizing Shockable vs. Non-Shockable Rhythms

BLS providers using an AED will be prompted to deliver a shock or continue CPR based on the underlying rhythm.

Shockable Rhythms (AED Will Advise Shock)

• Ventricular Fibrillation (VFib):
  ×

  Ventricular Fibrillation (VFib):

  

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  Disorganized, chaotic electrical activity
• Pulseless Ventricular Tachycardia (VTach):
  ×

  Pulseless Ventricular Tachycardia (VTach):

  

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  Fast, ineffective heart contractions

Non-Shockable Rhythms (AED Will NOT Advise Shock)

• Asystole (Flatline):
  ×

  Asystole (Flatline):

  

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  No electrical activity
• Pulseless Electrical Activity (PEA):
  ×

  Pulseless Electrical Activity (PEA):

  

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  Electrical activity without a pulse

If the AED does not advise a shock, immediately resume CPR and await advanced interventions.

The Role of the BLS Provider in an ACLS/PALS Team

Even when an ACLS or PALS team arrives, BLS-trained providers continue to play a critical role in resuscitation.

Common Roles for BLS Providers in a Code Response

• Performing high-quality chest compressions (switching every 2 minutes to avoid fatigue)
• Operating the AED until manual defibrillation is available
• Assisting with airway management (holding a mask seal, preparing airway equipment)
• Providing ventilation via bag-mask device (if no advanced airway is in place)
• Assisting with medication administration (preparing IV/IO access supplies)

Communication in a Resuscitation Team

• Use closed-loop communication
  ×

  closed-loop communication

  

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  to ensure tasks are acknowledged and completed
• Follow the team leader's instructions but speak up if you notice an error
• Remain calm, clear, and focused—organized teamwork saves lives

Final Thoughts: BLS as the Foundation of Advanced Care

Even in advanced resuscitation settings, high-quality BLS remains the priority:

• Compressions should not be interrupted except for defibrillation or airway management
• Effective ventilation prevents hypoxia and improves patient outcomes
• Even with ACLS/PALS interventions, survival depends on early, high-quality BLS

BLS providers are not just "assistants"—they are essential members of the resuscitation team. Knowing when and how to integrate BLS with ACLS and PALS ensures the best possible outcomes for patients in critical situations.