The Comprehensive Advanced Life Support Course (CALS) Program is alive and well in the state of Montana, thanks in large part to the support of ACEP at both the national and state chapter level. Montana CALS has put on three provider courses and trauma modules. Sixty-five Montana rural emergency care providers are now certified CALS providers, and 20 of those are also CALS instructors. These team members include MDs, DOs, physician assistants, nurse practitioners, registered nurses, certified registered nurse anesthetists, and emergency medical technician–paramedics. The course evaluations from the students have been extremely positive. The veteran instructors from Minnesota, where CALS was born, have given high marks to the Montana instructors. As a result, further courses are in the planning stages.

What Is CALS?

CALS was developed in Minnesota more than 20 years ago to improve rural emergency medical care through improved provider education. The two-day provider course is comprehensive because it teaches a universal approach to the evaluation and treatment of a seriously ill or injured person and because its content incorporates the current guidelines for the care of adult, pediatric, neonatal, and obstetric patients suffering medical illness or traumatic injury.

The CALS provider course differs from the classic, focused emergency care courses— advanced cardiovascular life support (ACLS), advanced trauma life support (ATLS), pediatric advanced life support (PALS), neonatal resuscitation program (NRP)—not only by being comprehensive but also by bringing the course directly to the rural communities to be able to train teams of providers. Because emergency care is clearly a team effort, it only made sense to the CALS founders to have the rural emergency team members train together in managing the many scenarios, which are the highlight of the course.

The three-hour CALS trauma module teaches team leaders critical trauma skills, including surgical airway management, needle and tube thoracostomy placement, and the e-FAST exam. Team members are updated in trauma assessment, helmet removal, and femoral traction as appropriate for their role in the team. The trauma module added to the provider course is necessary for CALS to serve as a substitute for recertification in ATLS for emergency providers in critical-access hospitals according to the state trauma system in Montana as well as in Minnesota and Wisconsin.

What Is the Role of ACEP?

ACEP is committed to improving rural emergency medical care. The College also recognizes that the reality of the workforce landscape is that many rural emergency departments are being staffed by primary care physicians and advanced practice providers. The current Chair of ACEP’s Rural Section is Darrell Carter, MD, FACEP, who is one of the founders of CALS and who is actively practicing in rural Minnesota. The Board Liaison to the Rural Section is John Rogers, MD, FACEP, who practices in rural Georgia and who is deeply devoted to improving rural emergency medical education. I started practice in rural Minnesota four decades ago but moved to Montana before CALS was born. However, many of my former colleagues are CALS instructors and providers, and I became enthusiastic about CALS from hearing their stories.