JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas –
The Cardiothoracic Intensive Care Unit 3 South Unit Practice Council launched the first Surgical Cardiac Advanced Life Support certification program at Brooke Army Medical Center Aug. 18-21, 2025.
The Cardiac Surgical Unit-Advanced Life Support training is designed to equip nurses, advanced practice providers, and other frontline clinicians with advanced skills and evidence-based protocols specific to the needs of post-operative cardiac patients.
“This initiative marks a significant step forward in ensuring the highest standards of care for patients undergoing complex cardiac surgeries,” said Victoria Morgan, critical care registered nurse, who is the co-chair of the 3 South UPC. “As a high-acuity unit specializing in post-operative care for cardiovascular and thoracic surgical patients, 3 South is leading the way in integrating specialized training into everyday practice.”
The four-day training held at BAMC certified three critical care registered nurses and one cardiothoracic surgeon as trainers and certified 14 other medical personnel in SCALS.
“The certification process itself has always been costly and was not previously approved for purchase, which created a barrier,” explained Deborah Skinner, critical care registered nurse. “Thankfully, through grant funding, we were able to obtain this certification, making it possible for us to officially validate and strengthen the work we have already been doing.”
Valerie Garza, critical care registered nurse, believes the training is important because it lends credibility to an alternate approach in responding to an arresting open-heart patient with a sternotomy approach.
“To better treat and respond to emergencies on our floor, our new CSU-ALS certifications enable us to train not only our own new staff, but other members of the hospital Code Blue response teams” Garza said. “It validates our teaching to staff who are not familiar with the risks of traditionally coding an open-heart patient.”
“All open-heart facilities train on the possibility of an emergent resternotomy, but not all are nationally certified to do so,” said Morgan.
Resternotomy is a surgical procedure in which the chest is reopened by re-dividing the sternum following a previous sternotomy, typically to access the heart, lungs, or other structures within the chest.
The CSU-ALS curriculum includes advanced resuscitation algorithms tailored to cardiac surgical patients, team-based simulations, and hands-on training with real-world scenarios. Participants will be prepared to recognize and intervene in life-threatening conditions such as cardiac tamponade, ventricular assist device complications, and post-operative cardiac arrest using protocols beyond standard ACLS.
“The CSU-ALS protocol improves outcomes for post cardiac surgery patients because it’s tailored to their more specific risks,” said Garza. “It empowers our ICU staff through training and simulation to react in emergencies with confidence in standardized protocols to act faster in using pacing wires, recognizing arrhythmias and defibrillating quickly, and sets a threshold for re-opening the chest. All of this leads to higher survival rates and decrease in long-term complications after arresting post-cardiac surgery.”
Skinner agrees.
“CSU-ALS certification equips our team with structured, proven approaches that reduce errors and improve response time,” she said. “This directly translates to improved patient outcomes, particularly by reducing mortality rates during these high-risk emergencies.”
In the future, this training will be extended to key members of the hospital’s Code Blue team, the Trauma Surgery on-call team, and affiliated cardiac providers, further broadening the unit’s impact and preparedness across the institution.
“Currently, BAMC is the first and only Military Treatment Facility to have certified Cardiac Surgical Unit-Advanced Life Support education and trained providers,” Morgan said. “Facilities that implemented this protocol saw significant decreases in their Failure to Rescue rates. One being as high as 53% down to 13% after staff was trained.”
“This certification represents our unwavering commitment to clinical excellence, patient safety, and continuous professional development,” she added. “By investing in this level of specialized education, we are strengthening our readiness to respond to the unique and complex emergencies that can arise in the Cardiovascular Intensive Care Unit and Cardiothoracic Intensive Care Unit.”