TEAM ROLES IN PEDIATRIC ADVANCED LIFE SUPPORT
Effective resuscitation requires a well-coordinated team, where each member has a clear role and communicates efficiently. Rapid role assignment and teamwork significantly improve outcomes in pediatric emergencies.
Key Goals of an Effective Resuscitation Team:
Clear leadership and role delegation. Closed-loop communication to prevent errors. Effective collaboration and mutual support. Continuous assessment and adjustment based on patient response.
PRIMARY TEAM ROLES IN PALS RESUSCITATION
| Role | Primary Responsibilities |
|---|---|
| Team Leader | Directs resuscitation, assigns roles, makes treatment decisions. |
| Airway Manager | Manages airway using BVM, intubation, or supraglottic airway. |
| Compressor | Provides high-quality chest compressions (switches every 2 min). |
| Defibrillator Operator | Attaches leads, analyzes rhythm, delivers shocks or pacing. |
| Medication Administrator | Prepares and administers drugs, ensures correct doses. |
| Recorder | Documents interventions, times medication delivery, monitors trends. |
Every resuscitation should have a clearly assigned leader, even if the team is small.
DETAILED BREAKDOWN OF EACH TEAM ROLE
1. TEAM LEADER 
(Usually the most experienced provider)
Coordinates the entire resuscitation process. Makes clinical decisions and prioritizes interventions. Delegates roles and responsibilities. Uses closed-loop communication to confirm tasks. Ensures PALS algorithms are followed.
Common Pitfall: Poor leadership leads to confusion and missed interventions—leaders must be decisive and clear.
2. AIRWAY MANAGER 
(Usually a respiratory therapist, anesthetist, or experienced provider)
Ensures open airway using head-tilt/chin-lift or jaw thrust. Provides bag-mask ventilation (BMV) with oxygen. Performs endotracheal intubation (if needed). Monitors chest rise, breath sounds, and capnography (ETCO₂).
Common Pitfall: Delayed or poor ventilation can worsen hypoxia—early airway management is critical!
3. COMPRESSOR 
(Rotates every 2 minutes)
Delivers high-quality chest compressions (100-120/min). Ensures full chest recoil and minimizes interruptions. Switches roles with another rescuer every 2 minutes to prevent fatigue.
Common Pitfall: Inadequate depth or inconsistent compressions reduce effectiveness—monitor ETCO₂ (>15 mmHg indicates good CPR).
4. DEFIBRILLATOR OPERATOR 
(Works closely with team leader)
Attaches ECG leads and prepares defibrillator. Recognizes shockable rhythms (VF/pVT) vs. non-shockable (PEA/asystole). Delivers defibrillation (2 J/kg, then 4 J/kg, max 10 J/kg). Performs synchronized cardioversion (if indicated for unstable tachycardia).
Common Pitfall: Failing to clear the patient before shocking—always confirm “CLEAR!” before delivering energy!
5. MEDICATION ADMINISTRATOR 
(Usually a nurse, pharmacist, or physician)
Prepares and administers IV/IO medications. Verifies correct drug, dose, and timing (weight-based dosing). Flushes IV line after medication delivery. Communicates each medication given to the team leader.
Common Pitfall: Incorrect drug calculations—use Broselow Tape or standardized dosing charts.
6. RECORDER (DOCUMENTATION ROLE) 
(Critical but often overlooked)
Documents time of all interventions (medications, shocks, airway management). Tracks patient response trends (HR, BP, ETCO₂). Assists team leader by reminding of medication timing or next steps.
Common Pitfall: Lack of documentation makes post-resuscitation debriefing and review difficult.
EFFECTIVE TEAM COMMUNICATION: CLOSED-LOOP TECHNIQUE
Closed-loop communication reduces errors and ensures accountability.
| Step | Example |
|---|---|
| Leader Gives a Clear Order | “Administer Epinephrine 0.01 mg/kg IV now.” |
| Team Member Repeats Order Back | “Giving Epinephrine 0.01 mg/kg IV now.” |
| Leader Confirms Execution | “Thank you. Let me know when it’s in.” |
Prevents miscommunication and ensures clarity in high-stress situations.
TEAM DYNAMICS: KEYS TO SUCCESS
Establish Roles Early: Assign clear roles when the code starts. Use Closed-Loop Communication: Repeat back instructions to prevent mistakes. Encourage Speaking Up: All team members should feel comfortable questioning potential errors. Rotate CPR Providers: Switch compressions every 2 minutes to avoid fatigue. Debrief After Every Code: Identify strengths and areas for improvement.
A well-coordinated team saves lives—poor teamwork can cost them.
COMMON PITFALLS & HOW TO AVOID THEM
Mistake Consequence Prevention
Unclear leadership Delayed interventions, confusion Assign a clear leader at the start
Poor communication Missed medication doses or incorrect actions Use closed-loop communication
Frequent CPR interruptions Lower survival rates Minimize pauses; rotate compressors every 2 min
Hyperventilation Decreased cardiac output, worsened perfusion Ventilate only 20-30 breaths/min (avoid excessive breaths)
Failure to track medication timing Epinephrine delays, poor drug sequencing Recorder must document all doses and times
In pediatric resuscitation, organization and teamwork are just as important as medical knowledge!
FINAL TAKEAWAYS: WHY TEAMWORK MATTERS IN PALS
Resuscitation teams function best when roles are assigned early and clearly defined. Closed-loop communication prevents errors and ensures accountability. Effective teamwork minimizes delays in critical interventions. A strong leader sets the tone for efficient, high-quality resuscitation. Post-resuscitation debriefing improves future team performance.
Takeaway: A well-trained, coordinated team saves lives—”Right roles, clear communication, and strong teamwork make the difference in pediatric resuscitation!”