TRAINING CENTER FACULTY/ INSTRUCTOR Update …minnstate.edu/system/asa/workforce/mrtc/pals/PALS-TCF.pdf · Email instructor candidate the PALS Instructor Workbook ... 1. 5. 2. 6

TRAINING CENTER FACULTY/ INSTRUCTOR Update Outline ~for the MnSCU Multi-Regional Training

Center~ I. Introduction TCF in room--they are your resources II. AHA Hierarchy National in Dallas Regional MN ECC Committee (meet quarterly)

Enact AHA policies/goals in MN, QA focus, disseminate info to state Training Center Coordinators—36 in MN, Gayle Steiner is TCC for MnSCU MRTC and AHA BLS Regional Faculty.

Contact info: 651-201-1796 or [email protected] Training Center Faculty (experienced instructors, QA partners with TC, teach instructor classes and do instructor monitoring. Must be current instructor. Appointed and trained by training center coordinator. Instructors (do provider level classes, key to community training #’s) (3,000 Instructors in MRTC) The MRTC trained >28,000 students so far this year.

III. Aligning with TC AHA requires all instructors to be aligned with a training center as a base of support. MRTC—we are national, and can move with you if you teach around the country. Database/web/online ordering and rental of equipment is unique. Instructor Re-certification Must attend a classroom renewal course every 2 years.

See Program Administration Manual (PAM) on the Instructor Network under Additional Tools, pg 54. Ideally good to renew within the Training Center. Ok to recert at another TC, but need our Instructor Profile form to stay with MRTC.

Instructor Profile form-use only for those joining the MRTC, other generic AHA forms in PAM for non-MRTC instructors attending an MRTC Instructor course. Send in Profile form when all completed/+monitoring form+dues+AHA I.N. registration. If a card has not been received within a week call us.

Call Gayle 651-201-1796 for AHA questions/ course issues Call MRTC Asst. at 651-201-1795 for website support/ordering/billings

IV. Resources: Resources: www.heart.org & www.onlineaha.org & www.AHAInstructorNetwork.org

Various AHA apps/YouTube for Hands Only and FAST stroke assessment Registering for AHA Instructor Network You must register to get your AHA ID# that you put on all provider cards you issue. The MRTC puts your AHA ID# on your instructor card. This site is an on-going resource (PAM, forms, Updates, certification reminders).

Program Administration Manual on AHA I.N. only. MRTC Website: Go through website, entering classes, ordering online. http://tinyurl.com/MRTC-OnlineOrderingSite ECC Provider Course Matrix—lists classes that you can teach with your certification, see MRTC website: http://minnstate.edu/system/asa/workforce/mrtc/updates/index.html under Resources Instructor Manuals for specific courses w/lesson maps & Skills Checklists must

have at all classes you teach, lots of new info in the most current manuals.

mailto:[email protected]

http://www.heart.org/

http://www.onlineaha.org/

http://www.ahainstructornetwork.org/

http://tinyurl.com/MRTC-OnlineOrderingSite

http://minnstate.edu/system/asa/workforce/mrtc/updates/index.html

V. Courses 2015 Guidelines all ACLS, BLS, HS, PALS materials are available. HCP (now BLS Provider) There is a new course DVD for BLS renewal courses HeartCode Part 1, online and Part 2 in the classroom—new requirements for practice.

Accelerated versions (less practice) for ACLS and BLS available. Agendas on AHA I.N.

VI. Miscellaneous Manikins –discuss cleaning, have Safety Data Sheet for bleach solution for OSHA. 2019 Feedback Manikin/Device requirement measures rate/depth. Peds coming. HS Cards paper/eCards increased in price on 10/3/2017, books decreased. HS in K-12 Schools card version for students & staff, use same HS curriculum Instructors keep: roster-w/test scores, skills checklists & evals. x 3yrs for possible audit Cards: must give a card for any certification course.

1. E-card will be required in 2018. My Card User Guide on MRTC website Ordering Materials page in eCard Section (and on AHA Instructor Network). You can use up your hard copy cards they won’t expire.

2. Hardcopy cards & eCards d iscounted if purchased by the 96-pack. Must print hardcopy cards. No handwriting. Tips on website on Ordering Materials page.

Monitoring of Instructors New Instructors (monitored before teaching on their own)

and renewing (within the 2 year certification period). Come to renewal class with this completed. New monitoring form on website under Forms/Instructor Forms.

Heart Safe Community Project Promotes CPR training for bystanders. If meet all the criteria, signage under city name to say “Heart Safe City”. http://www.health.state.mn.us/divs/healthimprovement/programs-initiatives/in-

communities/heartsafe.html MN Resuscitation Consortium grant $$ available for training projects.

www.mrc.umn.edu great resource for AED registration questions also (see below). You’re the Cure all AHA members to join. Keeps you in the loop on MN heart related political nationally and locally issues. No obligation, just join at:

http://yourethecure.org/aha/advocacy/default.aspx . New bill to be introduced to mandate a maintenance plan for anyone who has an AED.

Heart Walks around the state. Looking for volunteers to staff AED or CPR demos, etc.

http://www2.heart.org/site/TR/HeartWalk/MWA-MidWestAffiliate?pg=entry&fr_id=3161 MN Sudden Cardiac Arrest Survivor’s Network a good resource to enhance your classes. VII. Cover Questions TCFUpdateMay2018.doc

http://www.health.state.mn.us/divs/healthimprovement/programs-initiatives/in-communities/heartsafe.html

http://www.health.state.mn.us/divs/healthimprovement/programs-initiatives/in-communities/heartsafe.html

http://www.mrc.umn.edu/

http://yourethecure.org/aha/advocacy/default.aspx

http://www2.heart.org/site/TR/HeartWalk/MWA-MidWestAffiliate?pg=entry&fr_id=3161

PALS Instructor Update Course Agenda Prerequisites: I. The instructor candidate needs a current PALS Instructor card; II. Needs to have taught at least 4 provider courses in the past renewal period; III. Bring completed Course monitoring form to class. Day One: 8 hours I. Introduction: self, students. Discuss agenda of full course (verify prerequisites completed, discuss classroom agenda and course monitoring requirement). II. Hand-out PALS Instructor Profile forms. (Optional: to show the PALS Instructor Essentials Classroom DVD or view PALS Product & Course orientation on the AHA Instructor Network. On Dashboard page under COURSES>PALS>PALS Product & Course Orientation). III. Test out on skills using the PALS Skills Checklists in the Profile packet. IV. Give the PALS Instructor written exam and correct. BREAK V. Show and discuss PALS and PEARS Instructor manuals and HeartCode agenda.

VII. Go over the Instructor Update form. VIII. Send in completed Profile form & dues payment to the MnSCU MRTC. IX. Answer Questions and have student complete PALS Instructor Evaluation form.

PALSInstructorUpdateCourseAgendaJune2017

PALS Instructor Essentials Course Agenda Prerequisites for NEW Instructors:

I. The instructor candidate needs a current PALS Provider card; II. Instructor candidate to contact a training center to align with for PALS Instructor

and purchase a PALS Instructor Manual; III. Email instructor candidate the PALS Instructor Workbook IV. Candidate to register on the www.AHAInstructorNetwork.org and bring AHA ID#

to class; V. Candidate to take the PALS Instructor Essentials course on the

www.onlineAHA.org site and bring the certificate of completion to class.

Day One: 8 hours

I. Introduction: self, students. Discuss agenda of full course (verify prerequisites completed, classroom agenda, and course monitoring requirement).

II. Hand-out PALS Instructor Profile forms.

III. View PALS Instructor Essentials classroom DVD.

IV. Test out on skills, have them test out each other using the PALS Skills Checklists in the Profile packet.

V. Give the PALS Instructor written exam and correct.

BREAK

VI. Show and discuss PALS/PEARS Instructor manuals A. Preparing section very informative; B. Teaching section has the skills checklists; C. Testing D. Course overview E. Lesson Maps F. Certification vs Renewal courses

VII. Go over the Instructor Update form

This will cover AHA information and MRTC resources.

VIII. Offer mentoring opportunities if possible. Set up plan for monitoring of first class.

IX. Candidate or TCF to keep PALS Instructor Profile forms until monitoring is done. Then send in Profile form & dues payment to the MnSCU MRTC address on the packet.

X. Answer Questions and have students complete PALS Instructor Evaluation form. PALSNewInstructorCourseAgendaJune2017

http://www.ahainstructornetwork.org/

http://www.onlineaha.org/

PALS Instructor Course Evaluation

KJ0920 PALS INST 4/13 © 2013 American Heart Association

Please answer the following questions about the course content.

1. The course learning objectives were clear. a. Yes b. No

2. The overall level of difficulty of the course was a. Too hard b. Too easy c. Appropriate

3. The content was presented clearly. a. Yes b. No

4. The quality of videos and written materials was a. Excellent b. Good c. Fair d. Poor

Please answer the following questions about your skill mastery.

1. I am confident I can use the skills the course taught me. a. Yes b. No c. Not sure

2. I feel confident I can assess students’ skills performance and manage a class effectively. a. Yes b. No c. Not sure

3. I took this course to obtain professional education credit or continuing education credit. a. Yes b. No c. Not applicable

Optional questions:

Were there any strengths or weaknesses of the course that you would like to comment on?

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

What would you like to see in future courses developed by the AHA?

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

After Completing This Evaluation

Please return this evaluation to your Faculty member before you leave the class.

Alternatively, you can send the evaluation to your Training Center. Ask your Faculty member for the contact information.

If you have significant problems or concerns with your course, please contact the AHA at 877-AHA-4CPR.

Pediatric Advanced Life Support Course RosterEmergency Cardiovascular Care Programs

Course Information

� New Course

� Update Course

� Instructor

� Provider

Lead Instructor __________________________________________ Lead Instructor ID# Card Expiration Date Training Center Training Center ID# Training Site Name (if applicable) Address City, State ZIP Course Location

Course Start Date/Time

No. of Cards Issued

Course End Date/Time

Student-Manikin Ratio

Total Hours of Instruction

Issue Date of Cards

Assisting Instructor (Attach copy of instructor aligned with a TC other than the primary TC)

Name and Instructor ID# Card Exp. Date Name and Instructor ID# Card Exp. Date

1. 5.

2. 6.

3. 7.

4. 8.

I verify that this information is accurate and truthful and that it may be confirmed. This course was taught in accordance with AHA guidelines.

Signature of Lead Instructor Date

KJ1216 BLS 4/16 © 2016 American Heart Association

KJ1216 BLS 4/16 © 2016 American Heart Association

Name and EmailPlease PRINT as you wish your name to appear on your card. Please print

email address legibly.Mailing Address/Telephone

Complete/ Incomplete

Remediation/DateCompleted

(if applicable)

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Course Participants

Date Course Lead Instructor Lead Instr. ID#

Multi-Regional Training Center

PALS Instructor Check List

Check that all pages filled out completely, must have an email address

Enter courses you taught in the MRTC database (4 Minimum)

http://mymrtc.org/

Pay for MRTC biennial membership dues (see last page for instructions)

Sign last page

Mail or email completed Profile Form

Instructors:

Please note: the Minnesota State MRTC Instructor Profile Form should be

used for any Instructor Certification classes. Section A of this form should be

re-submitted whenever any personal information in Section A changes or you

may access your information and change online yourself.

The completion of this form confirms that you have successfully

completed your Instructor Course (initial or renewal) per the AHA standards.

Members of the Minnesota State MRTC, will receive an American Heart

Association, Instructor card and a packet of materials from the MRTC

regarding resources (website/database/online ordering, etc.).

If you are not currently a member but would like to join our Multi-Regional

Training Center, please see the “Joining the MRTC” page in this form, or call

651-201-1795 or x1796

Any missing information will delay the process of updating your

instructor status and may lead ot suspension of account

http://mymrtc.org/

PALS Instructor Profile Form Minnesota State – Multi-Regional Training Center

30 7th St. E, Suite 350, Wells Fargo Place, St. Paul, MN 55101-7804

Toll Free: 800-311-3143 Office: 651-201-1795 Fax: 651-649-5409

Section A: Instructor Profile Information-- This section is for information on instructors applying for

membership or who are renewing their membership with the Minnesota State MRTC. Please complete and return Section A

any time this information changes or update on your database information page.

Applicants’ Name:___________________________________ MRTC Member # ________________

Home Address: _____________________________________ AHA ID # ______________________

City:____________________________________ State:__________ Zip Code: _________________

County of Residence:___________________ E-mail Address* ________________________________ *Must have an email address

Telephone Numbers: Home _________________________ Work ________________________

Employers’ Name: _________________________ Work E-mail: ______________________________

Address: ________________________________________ City: _____________________

State: __________ Zip Code: ____________ Fax: ______________________________

Year you started teaching PALS: _____________________

Specialized Health Care Qualifications (R.N., L.P.N., EMT, etc.) _________________________

Last Date of last Renewal: ______________________ Instructor Name: _________________________

PALS Essentials Course completion date (form attached if new Instructor): _______________________

PALS Instructor/Experienced Instructor Documentation Record

Section B

INSTRUCTIONS: Submit this entire form as documentation that the applicant has successfully

completed the Instructor course. Instructors must retain copies of all provider documents (i.e. roster forms,

test scores, skill checklists and evaluation forms) for a minimum of three years.

Course Director: ___________________________ _________________________________ Signature Print Name

Physician Instructor*: ___________________________ Print Name

* If a physican was not in the classroom, then list name of physician available for consult during this course.

Requesting AHA Instructor Card for: PALS Instructor PALS Instructor Renewal

Training Center Faculty

PALS Written Test Score: _______

Skills: Pass Fail Remediate

Remediation Plan:______________

Minimum Teaching Requirements:

Note: Re-Certifying Instructors must teach/assist in a minimum of four provider classes in two years.

MRTC Faculty must teach/assist in four classes and at least one Instructor course.

Instructors: If entered on line √ here: then you do not need to list below. Otherwise please list minimum required dates taught (if not online):

-OR-

MRTC Faculty: If entered online √ here: then you do not need to list below. Otherwise please list minimum required dates taught (if not online):

To enter classes online login http://mymrtc.org/ then click “Enter Courses” in the navigation pane on the left.

Provider: 1) Date: ______________ 2) _____________ 3) _____________ 4) ________________

Course: ______________ _____________ _____________ ________________

# of Students: ______________ _____________ _____________ ________________

Instructor: 1) Date: _____________ 2) _____________ 3) _____________ 4) ________________

Course: ______________ _____________ _____________ ________________

# of Students: ______________ _____________ _____________ ________________

http://mymrtc.org/

Pediatric Advanced Life Support Child CPR and AED Skills Testing Checklist

Student Name __________________________________________________ Date of Test _______________________________

Hospital Scenario: “You are working in a hospital or clinic, and you see a child who has suddenly collapsed in the hallway. You check that the scene is safe and then approach the patient. Demonstrate what you would do next.”

Prehospital Scenario: “You arrive on the scene for a child who is not breathing. No bystander CPR has been provided. You approach the scene and ensure that it is safe. Demonstrate what you would do next.”

Assessment and Activation☐ Checks responsiveness ☐ Shouts for help/Activates emergency response system/Sends for AED☐ Checks breathing ☐ Checks pulse

Cycle 1 of CPR (30:2) *CPR feedback devices preferred for accuracy

Child Compressions☐ Performs high-quality compressions*:

• Hand placement on lower half of sternum• 30 compressions in no less than 15 and no more

than 18 seconds• Compresses at least one third the depth of the

chest, about 2 inches (5 cm)• Complete recoil after each compression

Child Breaths☐ Gives 2 breaths with a barrier device:

• Each breath given over 1 second• Visible chest rise with each breath• Resumes compressions in less than

10 seconds

AED (follows prompts of AED)☐ Powers on AED ☐ Correctly attaches pads ☐ Clears for analysis ☐ Clears to safely deliver a shock☐ Safely delivers a shock

Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed ☐ Compressions ☐ Breaths ☐ Resumes compressions in less than 10 seconds

Resumes Compressions ☐ Ensures compressions are resumed immediately after shock delivery

• Student directs instructor to resume compressions or• Student resumes compressions

Once student shouts for help, instructor says, “Here’s the barrier device. I am going to get the AED.”

Rescuer 2 says, “Here is the AED. I’ll take over compressions, and you use the AED.”

STOP TEST

Instructor Notes

• Place a ✓ in the box next to each step the student completes successfully.• If the student does not complete all steps successfully (as indicated by at least 1 blank check box), the student must receive

remediation. Make a note here of which skills require remediation (refer to Instructor Manual for information about remediation).

Test Results Check PASS or NR to indicate pass or needs remediation: PASS NR

Instructor Initials __________ Instructor Number _____________________________ Date _____________________________

© 2016 American Heart Association 3

Pediatric Advanced Life SupportInfant CPRSkills Testing Checklist (1 of 2)


Hospital Scenario: “You are working in a hospital or clinic when a woman runs through the door, carrying an infant. She shouts, ‘Help me! My baby’s not breathing.’ You have gloves and a pocket mask. You send your coworker to activate the emergency response system and to get the emergency equipment.”

Prehospital Scenario: “You arrive on the scene for an infant who is not breathing. No bystander CPR has been provided. You approach the scene and ensure that it is safe. Demonstrate what you would do next.”

Assessment and Activation☐ Checks responsiveness ☐ Shouts for help/Activates emergency response system ☐ Checks breathing☐ Checks pulse

Cycle 1 of CPR (30:2) *CPR feedback devices preferred for accuracy

Infant Compressions☐ Performs high-quality compressions*:

• Placement of 2 fingers in the center of the chest,just below the nipple line

• 30 compressions in no less than 15 and no morethan 18 seconds

• Compresses at least one third the depth of thechest, about 1½ inches (4 cm)

• Complete recoil after each compression

Infant Breaths☐ Gives 2 breaths with a barrier device:

• Each breath given over 1 second • Visible chest rise with each breath • Resumes compressions in less than

10 seconds

Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed ☐ Compressions ☐ Breaths ☐ Resumes compressions in less than 10 seconds

Once student shouts for help, instructor says, “Here’s the barrier device.”

Rescuer 2 arrives with bag-mask device and begins ventilation while Rescuer 1 continues compressions with 2 thumb–encircling hands technique.

Cycle 3 of CPR

Rescuer 1: Infant Compressions☐ Performs high–quality compressions*:

• 15 compressions with 2 thumb–encircling handstechnique

• 15 compressions in no less than 7 and no morethan 9 seconds

• Compress at least one third the depth of the chest,about 1½ inches (4 cm)

• Complete recoil after each compression

Rescuer 2: Infant BreathsThis rescuer is not evaluated.

(continued)

© 2016 American Heart Association

4

Pediatric Advanced Life Support Infant CPRSkills Testing Checklist (2 of 2)


STOP TEST

Instructor Notes






Cycle 4 of CPR

Rescuer 2: Infant CompressionsThis rescuer is not evaluated.

Rescuer 1: Infant Breaths☐ Gives 2 breaths with a bag-mask device:

• Each breath given over 1 second • Visible chest rise with each breath • Resumes compressions in less than

10 seconds

5

Rhythm Disturbances/Electrical Therapy Skills Station Competency Checklist

Student Name ____________________________________________________________ Date of Test _______________________

Critical Performance Steps ✓ if donecorrectly

Applies 3 ECG leads correctly (or local equipment if >3 leads are used)

• Negative (white) lead: to right shoulder

• Positive (red) lead: to left lower ribs

• Ground (black, green, brown) lead: to left shoulder

Demonstrates correct operation of monitor

• Turns monitor on

• Adjusts device to manual mode (not AED mode) to display rhythm in standard limb leads(I, II, III) or paddles/electrode pads

Verbalizes correct electrical therapy for appropriate core rhythms

• Synchronized cardioversion for unstable SVT, VT with pulses

• Defibrillation for pulseless VT, VF

Selects correct paddle/electrode pad for infant or child; places paddles/electrode pads in correct position

Demonstrates correct and safe synchronized cardioversion

• Places device in synchronized mode

• Selects appropriate energy (0.5 to 1 J/kg for initial shock)

• Charges, clears, delivers current

Demonstrates correct and safe manual defibrillation

• Places device in unsynchronized mode

• Selects energy (2 to 4 J/kg for initial shock)

• Charges, clears, delivers current

STOP TEST

Instructor Notes






6

Vascular Access Skills Station Competency Checklist

Student Name ____________________________________________________________ Date of Test _______________________

Critical Performance Steps ✓ if donecorrectly

Verbalizes indications for IO insertion

Verbalizes sites for IO insertion (anterior tibia, distal femur, medial malleolus, anterior-superior iliac spine)

Verbalizes contraindications for IO placement

• Fracture in extremity

• Previous insertion attempt in the same bone

• Infection overlying bone

Inserts IO catheter safely

Verbalizes how to confirm IO catheter is in correct position; verbalizes how to secure IO catheter

Attaches IV line to IO catheter; demonstrates giving IO fluid bolus by using 3-way stopcock and syringe

Shows how to determine correct drug doses by using a color-coded length-based tape or other resource

The following is optional:

Verbalizes correct procedure for establishing IV access

STOP TEST

Instructor Notes






7

American Heart Association Emergency Cardiovascular Care Program Instructor Monitor Tool

Instructor Monitor Tool Revised: January 2018

Instructions: Training Center Faculty (TCF) or Regional Faculty (RF) should use this form to assess the competencies of instructor candidates and renewing instructors. For each competency, there are several indicators or behaviors that the instructor may exhibit to demonstrate competency.

To be used in conjunction with the Instructor/TCF Renewal Checklist. Role of the RF/TCF Observer: The role of the RF/TCF observer for this monitoring is to observe only. Debriefing or correcting the instructor during the course should be avoided. If critical components are not being completed, contact the TC Coordinator or Course Director outside the classroom setting immediately.

Evaluating the Critical Actions: The following questions are critical actions required for a successful course. Each item is written to maximize the objectivity and minimize the subjectivity of the evaluator. For each item, mark one of the following:

Yes for items present or completed if there are no required changes for improvement. There may be recommendations for improvement and comments but no required changes.

Yes with req. (Yes with requirements) for items that were completed but changes are required for full compliance. Fill in the comment box with the required change and rationale.

No if the required action was not done or was done incorrectly. Not Observed for items the observer did not witness during monitoring.

SECTION 1:

General information for the individual and course being observed.

Instructor or instructor candidate name:

Instructor ID #: Instructor card expiration date:

Course reviewed: Heartsaver® BLS ACLS ACLS EP PALS PEARS®

Purpose of review: Initial application Instructor renewal Remediation

SECTION 2:

Instructor competencies and indicators. Observed by TCF or RF in a class setting. Course Delivery: Presents AHA course content as intended by using AHA course curricula and materials

2.1 Delivers all core content consistent with AHA published guidelines, Instructor Manual, Lesson Plans, and agenda

Yes Yes with req. No Not observed

Reviewer's comments: __________________________________________________________________________________________________________________________________________



2.2 Uses videos, checklists, equipment, and other tools as directed in the Instructor Manual

Yes Yes with req No Not observed


2.3 Allows adequate time for content delivery, skills practice, and debriefing



2.4 Promotes retention by reinforcing key points



2.5 Delivers course in a safe and nonthreatening manner



2.6 Relates course material to audience (prehospital or in-facility)



2.7 Effectively operates technology used in the course





2.8 Adapts terminology appropriate to location, audience, and culture



2.9 Accommodates students who have disabilities and other special needs



2.10 Provides timely and appropriate feedback to students



2.11 Uses principles of effective team dynamics during small group activities


Reviewer's comments: _____________________________________________________________________ _____________________________________________________________________

2.12 Facilitates debriefings after scenarios to improve individual and team performance



Testing and Remediation: Measures students’ skills and knowledge against performance guidelines and provides remediation when needed to consolidate learning

2.13 Tests students by using AHA course materials according to instructions in the Instructor Manual





2.14 Provides feedback to students in a private and confidential manner



2.15 Provides remediation by directing students to reference material and by providing additional practice opportunities



2.16 Retests students when indicated



Professionalism: Maintains a high standard of ethics and professionalism when representing the AHA 2.17 Demonstrates professional behavior in physical presentation and teaching, including enthusiasm,

honesty, integrity, commitment, compassion, and respect



2.18 Follows HIPAA, FERPA, and/or local guidelines maintaining confidentiality





2.19 Recognizes and appropriately responds to ethical issues encountered in training



2.20 Maintains student confidentiality when appropriate



Overall comments from TCF or RF observer:

Review completed:

Successful

Comment:

Remediation needed

Comment:

Unsuccessful

Comment:

RF/TCF name:

RF/TCF signature: Date:



SECTION 3:

Review of candidate or instructor. To be completed by TC Coordinator.

I have reviewed the Instructor Monitor Tool with my TC Coordinator, and my instructor status has been reviewed with me. Overall comments from monitored candidate or instructor:

Candidate or instructor name:

Candidate or instructor signature: Date:

TC Coordinator name:

TC Coordinator signature: Date:

Joining/Re-aligning with the Minnesota Multi-Regional Training Center

1) New/Renewing Instructors: Mail this completed Instructor Profile Packet—all pages, along with the

bi-annual membership dues. Your card and materials will be mailed upon receiving this AHA required information.

2) Payment of the biennial $25.00 membership dues by one of three ways:

a. Check (please make checks payable to Minnesota-MRTC)

b. Purchase Order (include PO # here: ___________________)

(Must have Credit Application for invoicing/PO if not a state agency—call 651-201-1795 for application).

c. Credit Card (Master card and Visa Only) pay dues online at: MRTC Online (No S/H or Sales Tax) PER PAYMENT CARD REGULATIONS WE CAN ONLY ACCEPT CREDIT CARD TRANSACTIONS THRU OUR SECURED

ONLINE ORDERING SYSTEM.

You will receive an email receipt.

The American Heart Association strongly promotes knowledge and proficiency in all AHA courses and has

developed instructional materials for this purpose. Use of these materials in an educational course does not

represent course sponsorship by the AHA. Any fees charged for such a course, except for a portion of the fees

for materials, do not represent income to the AHA.

I agree to adhere to American Heart Association and Minnesota State/Multi-Regional Training Center policies, using appropriate AHA materials and issuing certification cards. ____________________________ _______________________________ _______________________

Print Name Signature Date

******************************************************************************

MRTC Office Use Only:

Form of Payment: Check # __________________ Name on Check__________________________________

Cash

Credit Card (Type): ________________

Date routed to MRTC Support: __________________________ Initials: __________

Date Receipt sent:____________________

Minnesota State

Multi-Regional Training Center 30 7th St., E., Suite 350, St. Paul, MN 55101-7804

Toll Free: 800-311-3143 Office: 651-201-1795 Fax: 651-649-5409

http://store360.collegestoreonline.com/ePOS?this_category=26&store=360&form=shared3%2fgm%2fmain%2ehtml&design=360

Documents

TRAINING CENTER FACULTY/ INSTRUCTOR Update …minnstate.edu/system/asa/workforce/mrtc/pals/PALS-TCF.pdf · Email instructor candidate the PALS Instructor Workbook ... 1. 5. 2. 6