The document provides training objectives and guidelines for responding before the Code Blue team arrives. It outlines the roles and responsibilities of the first, second, third, and fourth responders. The first responder starts chest compressions and delegates roles. The second responder activates the code blue and sets up the crash cart. The third responder manages the airway with an Ambu bag. The fourth responder ensures all tasks are completed and acts as recorder if possible. The guidelines emphasize effective communication, crew resource management, and high-quality CPR.

1. Before the Code Blue
Team Arrives
Are you comfortable knowing what to do
before the Code Blue team arrives?
Fawn Olson RN, CCRN, MICU/CCU
Nancy Yazici RN, CCRN-CMC, MICU/CCU
Yvonne Lin-Chen, MN, RN, Nurse Educator/Sim Lab

2. Training Objectives
• Participants will be familiar and able to demonstrate
current AHA 2010 BLS Guidelines
• Participants will understand the Crisis Resource
Management (CRM) concept and be able to utilize CRM
communication techniques in order to demonstrate
teamwork BEFORE code blue team arrives.
• Participants will understand the role of each responder
(responder 1,2,3&4)

3. AHA 2010 BLS Guidelines
C – Compressions
Rate 30:2
• At least 2 inches deep
• At least 100 per minute
• Allow complete chest recoil
A – Airway
Head tilt-chin lift
Suction available if needed
B – Breathing
Use Ambu bag, chest rise, O2 wide open (16L)
D – Defibrillation
AED mode, correct placement of pads, be ready to shock if advised

4. Crew Resource Management
(CRM)

5. CRM continued…
• Call for help early
• Activate Code Blue team (internal 911)
• Establish role clarity
• Ensure responder roles (1,2,3 &4+) are filled.
• Knowing environment
• Move out extra furniture. Move bed away from wall
• Communicate effectively
• Don’t be afraid to speak up
• Closed-loop communicate (read back/repeat back)

6. 1st Responder
(AllBLScertifiedstaff)
• Verify patient is pulseless
• Activate internal 911 (code blue)
• Start chest compressions
• Delegate roles of subsequent responders entering room
• Swap role with 3rd responder (airway) every 2 minutes

7. 2nd Responder
• Follow through that the internal 911- Code Blue has been
activated
• Bring in crash cart (make sure to unplug the cord from the
wall first)
• Turn on AED/Defibrillator first, THEN, apply the pads. (this
is so time is not wasted while the machine is warming up).
• Insert back board to ensure high quality compressions are
being provided as early as possible.
• Deliver shock if advised by Zoll defibrillator.

8. 3rd Responder
• Airway mangement: use the Ambu bag from the crash cart
• Confirm Ambu bag is inflated
• Turn up O2 all the way (wide open)
• Pull bed out from away the wall (remain at head of bed)
• Swap role with 1st responder (compressor) every 2
minutes

9. 4th Responder (if available)
• Follow through to make sure everything is being done:
• make sure internal 911- code blue is called
• someone is doing compressions
• there is a backboard underneath the patient (high quality
compressions is very important)
• AED is turned on, and PADS applied properly with right location
• Someone is managing the airway, and the O2 is up
• If above is all done, then 4th responder will be the
RECORDER.