Retention of Pediatric Advanced Life Support (PALS) course concepts.

The purpose of this study was to measure, in a population of experienced state-certified paramedics, the decline of Pediatric Advanced Life Support (PALS) course concepts during the 2-year recertification cycle recommended by the American Heart Association. The PALS course contains a written examination designed to measure understanding of course concepts. To successfully complete the course, a PALS course participant must achieve a minimum grade of 84% on this test. In our study, 99 experienced PALS-certified Advanced Life Support (ALS) providers completed a 70-question written test. Nested within this test were all of the PALS examination questions that the participants had previously passed to complete the PALS course. Each participant's PALS test questions were extracted and scored to obtain a "retest score" that measured retention of PALS course principles. These 99 dual-trained paramedic/firefighters comprised more than 90% of the staff of a countywide EMS system averaging 60,000 calls per year. Study participants averaged 10 years of ALS experience, and 3-4 pediatric patient calls per month. In this study, "pediatric patient" was defined as an individual 18 years of age or less. Results revealed that 25 (25%) of the 99 providers achieved a minimum passing score of 84% or greater on the PALS retest. Another 40 (40%) scored within one standard deviation below the minimum passing score. Retest score was unaffected by years of ALS experience, number of pediatric patients seen per month, or by PALS Instructor status. The average retest score was 16 points lower than the original test score. The original test score did not reliably predict a passing grade on the retest. We conclude that the average decline of PALS course principles is such that a 2-year retraining schedule is appropriate for prehospital personnel caring for an average of three to four pediatric patients per month.