For decades, only one major organization—the American Heart Association (AHA)—provided standardized training and certifications in Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS). This changed in 2019 when the American Red Cross rolled out a suite of courses that teach the same science and skills in a more learner-centered way. Despite the broad acceptance of Red Cross certifications by national accrediting bodies, state agencies, and thousands of hospitals and clinics, some medical centers, nursing schools, and community colleges have policies that do not recognize both organizations’ certifications. This imposes an undue burden on new hires and rotating trainees who are certified by one organization but cannot start work before they are recertified by the other.

Background

From its founding in 1881 to today, the American Red Cross has taught tens of millions of Americans first aid and other lifesaving skills, including CPR. It also offers a comprehensive “CPR for the Professional Rescuer” course. In 2015, it introduced Basic Life Support (BLS) training and certification for EMS personnel. Their response was so enthusiastic that the Red Cross expanded its offerings.

After three years of curriculum development and testing, the Red Cross launched a package of courses that includes BLS, ALS, and PALS training with certification in 2019. All three leverage the latest educational methodologies.

Scientific Rigor

Red Cross resuscitation courses closely align with the International Liaison Committee on Resuscitation (ILCOR) recommendations. Major resuscitation organizations worldwide meet in this forum to share knowledge and best practices. Each year, ILCOR issues “Consensus on Science with Treatment Recommendations” (CoSTR) to its member organizations, including the International Federation of the Red Cross (IFRC) and the AHA. Because both organizations base their curricula and periodic updates on ILCOR guidance, they convey the same concepts and practice standards.

The Red Cross Scientific Advisory Council

Red Cross courses are regularly reviewed and updated by a Scientific Advisory Council (SAC) comprising 60+ nationally and internationally recognized experts from a wide range of disciplines. In addition to analyzing ILCOR updates, the SAC members consider guidance issued by the ACEP, the American Academy of Pediatrics, the Society of Critical Care Medicine, and other leading groups. Their findings are summarized in periodic releases entitled Focused Updates and Guidelines.

Learner-Centered Education

Red Cross training programs are designed to actively engage adult learners, reduce training time, and minimize training costs. Educational advances include the following:

• Besides instructor-led training, the Red Cross offers a blended learning option. This allows participants to access course content through their smartphone or personal computer to learn at a pace, place, and times of their choosing.
• Because the Red Cross’ online content is adaptive, participants can test out of content they already know and tailor their learning path. This can reduce an individual’s training time by up to 50 percent with no decrement in learning.
• Instead of actors, Red Cross training videos use actual physicians, nurses, and support staff to demonstrate clinical decision making and teamwork. This makes the material more relevant to health professionals.

Initial Rollout

America’s Military Health System (MHS) was the first major organization to adopt Red Cross ALS and PALS training. Initially, following an initial “beta test” with military medical students and faculty at the Uniformed Services University in Bethesda, Md., the Defense Health Agency (DHA) convened a team of subject matter experts to systematically compare the guidance conveyed in the Red Cross curricula to that offered by the AHA. When they confirmed equivalence, the MHS formally adopted Red Cross BLS, ALS, and PALS training for relevant military and civilian personnel. The transition began in January 2019.

At a recent meeting at Red Cross headquarters, a DHA leader reported that their decision to switch saved the MHS more than $23 million in 2022 and $25 million in 2023. Even more important, the transition saved 830,000 student and instructor training hours in 2022 and nearly one million hours in 2023.

National Recognition

Red Cross resuscitation certifications are accepted by:

• The Joint Commission
• The Accreditation Council for Continuing Medical Education (ACCME)
• The American Nurses Credentialing Center (ANCC)
• Commission on Accreditation for Prehospital Continuing Education (CAPCE)
• The National Registry of Emergency Medical Technicians (NREMT)
• The EMS agencies of all 50 states
• The Veterans Healthcare Administration (VHA)
• The DHA and MHS

ACEP POLICY NOTE

ACEP Believes You Exceed the Need for Short Course Merit Badges, Offers Cards

ACEP believes that certification by ABEM or AOBEM supersedes the need for so-called “merit badge” short courses. Such courses are generally designed for a broad spectrum of clinicians including non-emergency physicians and non-physicians. These are sometimes required for medical staff privileges.

Scan or click to get your cards.

Many credentialing bodies, however, still require emergency physicians to produce evidence of completion of the short courses.

For emergency physicians required to have a card, ACEP offers its members a set of personalized cards online, which attest that they are currently Board Certified by ABEM or AOBEM and have expertise in Procedural Sedation, Cardiac Resuscitation, and Trauma.

More than three million Red Cross BLS, ALS, and PALS certifications have been issued to health care personnel working in thousands of facilities, including some of the largest governmental, nonprofit, and for-profit health care systems in the U.S.

Benefits of Dual Acceptance

Health systems and educational institutions have every right to train their staff using the curricula they like best. Still, all academic programs and health care organizations should recognize both American Red Cross and AHA certifications. Those that do can onboard new hires without requiring them to retake time-consuming coursework. Dual acceptance allows health systems to “test drive” the other organization’s approach without conflicting with their policies or creating confusion at the bedside. When it comes time to renew a training contract, those who accept both organizations’ certifications are in a stronger negotiating position than those who do not.

The Bottom Line

Red Cross BLS, ALS, and PALS courses convey the same clinical and scientific content as those of the AHA. Health system experience suggests that Red Cross blended and adaptive learning is less costly and burdensome with no decrement in clinical performance. Health care systems can choose which organization they want to work with, but all should recognize both organizations’ certifications.

Dr. Kellermann is an emergency physician, former medical school dean, and former academic health system CEO.

Dr. Kirsch is an emergency physician and expert in disaster medicine who previously served on the Red Cross Scientific Advisory Council.

Both advise the American Red Cross on a part-time basis. Their views are their own.