Study guide
14.1 High-Performance Team Roles
AHA PALS Provider Pediatric Advanced Life Support
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1 Chapter 1: Course Overview & Exam Logistics
1.1 Current Exam Facts 1.2 Audience, Prerequisites & Study Plan
2 Chapter 2: Systematic Pediatric Assessment
2.1 Pediatric Assessment Triangle (PAT) 2.2 Evaluate–Identify–Intervene Sequence 2.3 Primary Assessment: ABCDE 2.4 Secondary Assessment, SAMPLE & Vitals by Age
3 Chapter 3: Respiratory Distress & Failure
3.1 Respiratory Distress vs Failure 3.2 Recognition & Immediate Intervention Priorities 3.3 Oxygen Delivery & Basic Airway Support
4 Chapter 4: Airway Problems & Ventilation Strategies
4.1 Upper Airway Obstruction 4.2 Lower Airway, Lung Tissue Disease & Disordered Control 4.3 Bag-Mask Ventilation & Advanced Airways During CPR
5 Chapter 5: Shock Fundamentals & Hypovolemia
5.1 Compensated vs Hypotensive (Decompensated) Shock 5.2 Hypovolemic Shock 5.3 Isotonic Fluid Bolus 10–20 mL/kg & Reassessment
6 Chapter 6: Distributive, Cardiogenic & Obstructive Shock
6.1 Distributive & Septic Shock Pathway 6.2 Cardiogenic Shock 6.3 Obstructive Shock
7 Chapter 7: Pediatric BLS & High-Quality CPR
7.1 High-Quality CPR Metrics 7.2 Compression-Ventilation Ratios 7.3 CPR Quality Monitoring: ETCO2 & Diastolic BP
8 Chapter 8: Pediatric Cardiac Arrest Algorithm
8.1 Arrest Recognition & Systematic Approach 8.2 VF/pVT & Defibrillation Energy 8.3 Asystole & PEA 8.4 Epinephrine in Arrest: Dose & Timing
9 Chapter 9: Bradycardia & Narrow-Complex Tachycardia
9.1 Bradycardia with Poor Perfusion 9.2 Sinus Tachycardia vs SVT 9.3 Stable SVT: Vagal Maneuvers & Adenosine
10 Chapter 10: Unstable Tachycardia & Wide-Complex Rhythms
10.1 Unstable Tachycardia & Synchronized Cardioversion 10.2 Wide-Complex Tachycardia & VT with Pulse 10.3 Antiarrhythmics for Tachycardia with Pulse
11 Chapter 11: Reversible Causes & Special Circumstances
11.1 Reversible Causes: The H's and T's 11.2 Special Circumstances at Exam Level 11.3 Extracorporeal CPR (ECPR) Overview
12 Chapter 12: Post–Cardiac Arrest Care
12.1 Post-ROSC Oxygenation & Ventilation 12.2 Post-Arrest Hemodynamic Support 12.3 Temperature Control & Glucose 12.4 Neuroprognostication & Transport
13 Chapter 13: Vascular Access & Core Pharmacology
13.1 IV and Intraosseous Access 13.2 Epinephrine Dosing in Depth 13.3 Amiodarone, Lidocaine & Adenosine 13.4 Weight-Based Dosing Aids & Drugs to Avoid Routinely
14 Chapter 14: Team Dynamics & Megacode Readiness
14.1 High-Performance Team Roles 14.2 Closed-Loop Communication 14.3 Constructive Intervention, Debriefing & Exam Integration
14.1 High-Performance Team Roles
Key Takeaways Explain This Topic AI
High-performance PALS teams assign clear roles early: team leader, compressor, airway, monitor/defibrillator, vascular access/medications, and recorder.
The team leader directs, prioritizes, and maintains situational awareness—and does not try to perform every hands-on task personally.
Role clarity, mutual respect, clear messages, and knowing limitations prevent chaos during pediatric resuscitation and megacode testing.
Megacode evaluation assesses team performance (coordination, communication, algorithm execution), not only isolated individual skills.
Rotate compressors about every 2 minutes, keep interventions parallel when safe, and reassign tasks immediately if a member states a limitation.
Last updated: September 2026
Why Team Dynamics Are a Tested PALS Domain
Pediatric Advanced Life Support is not only algorithms and milligrams per kilogram. AHA evaluates team behavior in the PALS core cases, but it does not publish a current written-exam percentage or case-scoring weight for team dynamics. How people work together under time pressure matters clinically and during scenario assessment. A team that knows every epinephrine dose but cannot assign a compressor, clear for shock, or pass a weight-based order without confusion will fail the child—and often fail the course station.
Resuscitation environments are noisy, emotionally charged, and cognitively overloaded. Multiple tasks must happen in parallel : compressions, ventilation, pad placement, vascular access, medication preparation, rhythm interpretation, and documentation. Parallel work only works when roles are explicit . When roles are vague, people either collide on the same task (three people fighting for the airway while no one compresses) or freeze waiting for someone else to act.
AHA high-performance team concepts apply across BLS, ACLS, and PALS. PALS adds pediatric-specific load: weight-based dosing , length-based resuscitation aids, age-specific vitals, smaller airways, and family presence. The structure of the team remains the same—clear leader, clear roles, closed-loop communication (Section 14.2), and constructive intervention (Section 14.3)—but the content of orders is pediatric.
Assign roles early—before the next crisis deepens
As soon as a second rescuer arrives (and certainly when a full code team assembles), the person taking leadership should name roles out loud :
"I am team leader. You—chest. You—airway and bag. You—monitor and defibrillator. You—IO and meds. You—record and call time."
Early assignment beats late improvisation. In megacode testing, instructors watch whether leadership organizes the room within the first moments of recognition. On real units, the same habit compresses chaos into coordinated care.
The Team Leader: Direct, Do Not Do Everything
The team leader owns the overall resuscitation strategy. Primary duties include:
Assign and reassign roles based on skill, scope, and who is available.
Run the algorithm (respiratory failure, shock type, bradycardia, tachycardia, arrest pathway) out loud so the team shares one mental model.
Monitor CPR quality and intervention timing—rate, depth cues, pause length, when the next rhythm check is due, when epinephrine is next due.
Prioritize when resources are limited (airway first if failure is progressive; shock energy and early epinephrine when indicated; reversible causes).
Solicit input and summaries without surrendering clear decision authority.
Protect safety —clear for shock, confirm drug/dose/route before push, stop unsafe actions.
Critical leadership trap: task fixation
A common megacode failure is the leader who grabs the bag, starts the IO, and pushes meds while no one owns rhythm interpretation or timekeeping. Hands-on help is appropriate when the team is tiny (two rescuers must multitask), but as soon as enough people arrive, the leader should step back to the foot of the bed , maintain a macro view, and stop competing for tasks. Macro perspective preserves:
- Awareness of the full timeline (2-minute cycles, epi every 3–5 minutes)
- Recognition of shockable vs nonshockable pathways
- Detection of silent problems (leaning compressor, hyperventilation, wrong weight)
- Bandwidth to hear safety concerns from the team
- Leader behavior Effect
- Clear role assignment early Parallel, efficient care
- Stands back, watches whole room Situational awareness
- Speaks algorithm priorities aloud Shared mental model
- Performs every procedure personally Blind spots, delayed decisions
- Vague orders ("give some epi") Dose/route errors
- Leadership is not dictatorship without listening
High-performance leadership is directive and respectful . The leader decides when conflicting options exist, but invites critical data: "What is the last BP?" "Is that sinus tach or SVT by history?" "Do we have a weight from the length-based tape?" Mutual respect means junior staff can raise concerns without ridicule—covered further under constructive intervention in Section 14.3.
Loading diagram... Core PALS Resuscitation Team Roles
Core Bedside Roles (Know Duties and Boundaries)
Exact titles vary by hospital, but PALS megacode and AHA team-dynamics teaching map cleanly onto these six functions . One person may hold two roles when the team is small; larger teams split them.
1. Compressor
Delivers high-quality CPR: 100–120/min , depth ≥ one-third AP diameter, full recoil, minimal interruptions (Chapter 7).
Uses age-correct technique (infant heel-of-hand or 2 thumb–encircling; child one or two hands).
With two rescuers and no advanced airway, coordinates 15:2 for infants and prepubertal children, or 30:2 after puberty.
Rotates about every 2 minutes (or sooner if fatigue shows)—fatigue destroys depth long before the compressor admits it.
Does not leave the chest unattended for "just a quick look" beyond planned brief checks.
2. Airway / ventilation
Opens and maintains the airway; suctions as needed; provides bag-mask ventilation with visible chest rise only.
Avoids excessive rate and volume (hyperventilation worsens venous return and cerebral blood flow).
Prepares for advanced airway when indicated; confirms placement with clinical findings and waveform capnography when available.
With advanced airway, ventilates about 1 breath every 2–3 seconds (≈20–30/min) with continuous compressions (Chapter 4 / 7).
3. Monitor / defibrillator operator
Applies pads correctly for size/age; selects pediatric attenuator or pediatric pads when indicated.
Watches rhythm continuously; announces clear rhythm labels at check times ("asystole," "VF," "sinus tach," "SVT").
Charges to the ordered energy ( 2 J/kg first shock , 4 J/kg second , then at least 4 J/kg , capped at 10 J/kg or adult maximum —Chapter 8).
Ensures everyone is clear before shock; resumes CPR immediately after defibrillation.
Pre-charges near the end of a 2-minute cycle when a shockable rhythm is anticipated to shorten peri-shock pause.
4. Vascular access / medications
Establishes IV or IO access promptly; IO is appropriate when IV is delayed in arrest or critical shock (Chapter 13).
Uses length-based tape / known weight for dosing—never guess adult doses for small children.
Draws and labels meds; administers only after closed-loop confirmation.
Core dose checks: epinephrine arrest 0.01 mg/kg (0.1 mL/kg of 0.1 mg/mL), maximum 1 mg , IV/IO every 3–5 minutes ; indicated SVT adenosine 0.1 mg/kg (max 6 mg) then 0.2 mg/kg (max 12 mg) ; septic-shock isotonic fluid 10 or 20 mL/kg aliquots with reassessment. Other shock types need their own treatment strategy.
Flushes after meds so the drug reaches central circulation.
5. Recorder / timer
Documents rhythm checks, shocks, drugs, doses, routes, and times.
Prompts the team : "Two minutes—ready for rhythm check," "Epinephrine due," "Last shock was 2 J/kg—next is 4 J/kg if still shockable."
Prevents the common silent failure of "we forgot the second epi" during a long code.
6. Additional / flexible roles when staff allows
Family liaison / support —explains events, manages presence at bedside per protocol.
Runner / equipment —brings airway cart, second defibrillator, blood products, PICU team.
Procedure specialist —difficult airway backup, ultrasound, chest tube for tension pneumothorax.
Role clarity prevents chaos—clinical picture
A 9-month-old becomes unresponsive in the ED. Without roles: three people shout for epinephrine while compressions are shallow and pads are not on. With roles: assessment finds no effective breathing and no definite pulse within 10 seconds, so the compressor starts high-quality CPR; airway bags with oxygen; monitor pads on and rhythm identified as asystole; access/meds establishes IO and prepares 0.01 mg/kg epi ; recorder clocks the first dose and the 2-minute mark; leader states "nonshockable pathway—CPR, epi early, search H's and T's" and keeps the room synchronized.
Knowing limitations and mutual respect
Every member must know professional and skill limitations . If assigned intubation without competency, say so immediately so the task is reassigned—do not attempt a dangerous first try while the child desaturates. Mutual respect means experienced clinicians coach without humiliation and less-experienced staff speak up about safety (wrong dose drawn, leaning on the chest, unclear order).
Megacode: team performance, not a solo exam
The PALS megacode evaluates whether the group executes assessment (PAT, Evaluate–Identify–Intervene), correct algorithms, high-quality CPR, and team dynamics . A technically skilled compressor cannot "carry" a station if communication fails, roles collide, or the leader never prioritizes. Conversely, strong dynamics can salvage imperfect individual technique by catching errors early.
Bottom line for 14.1: Assign leader, compressor, airway, monitor/defibrillator, access/meds, and recorder early; keep the leader in a directing, macro role; practice mutual respect and limitation disclosure; remember that PALS skills testing grades the team system , not isolated heroics.