NNF : National NRP Day

Added: 2026-05-07

[00:00:03]I've changed.

[00:00:05]>> Okay.

[00:00:44]There were >> Yes sir.

[00:00:48]>> Could you please call Serena?

[00:00:51]Okay sir.

[00:00:52]>> Not join then my issue.

[00:01:19]>> So people are joining. Yeah. Yeah. Lenj around 410 15 people have already joined. So I think we should start the meeting. I'm >> waiting for another one minute and waiting for SA to otherwise I'll start.

[00:01:34]>> Yeah. Otherwise you start.

[00:01:40]>> Ma'am is ma'am uh is about to join.

[00:01:44]Yeah.

[00:01:58]Heat.

[00:02:14]Sir is joining.

[00:02:16]>> Okay.

[00:02:17]>> Good evening sir.

[00:02:19]>> So I think now it's uh 85 so we should start.

[00:02:36]Are you going to start? Should I start?

[00:02:39]Okay.

[00:02:39]>> Sir, 400 participants. Shall we start, sir? 4:45.

[00:02:43]>> Yeah. Yeah. Yeah.

[00:02:44]>> Okay.

[00:02:48]>> Hello everyone. Good evening and welcome to this session. This session has been planned in such a way that uh we bring everybody all the instructors and the course coordinators all across the country on one platform.

[00:03:04]First of all, I would like to congratulate everybody not just the uh organizing committee but um all the practitioners, pediatricians, neonatlogists from all over the country for such a great response. We are overwhelmed actually. We were not prepared for this kind of a response. Um and u uh the this initiated this session is actually planned so that all the courses now now we have reached about a thousand courses today so that all the courses which are done all across the country are maintain they maintain a certain standard of uniformity and quality and also how to perform and organize this session over 4 hours which is a stipulated time. So we will have different sessions um taken by different panelists that you're seeing on the panel. But before that I would like to invite our president to deliver his address to the nation.

[00:04:00]>> Namaskar.

[00:04:02]Good evening all the respected faculty member coordinator and my dear newborn care champion across the country. At the outset, I sincerely thank each one of you from bottom of my heart for your passion, commitment and dedication you all have shown for this initiative.

[00:04:32]The overwhelming response to this NRP day are key presidential election plans we have received from Ladak to Laxadi the remote part of the northern northeast Manipur Tirura Arunachal and many other places. This clearly shows that we are not just conducting a program.

[00:05:03]We are building a strong national movement for every newborn in India to receive the first breath in golden minute. So friend, we are coming together with one common goal to standardize and strengthen newborn research station practices across the country whether it is the busiest or the remotest one and we have already reached everywhere.

[00:05:34]So today's meeting objective is very very clear to ensure uniform teaching. So every trainer should speak the same language of NRP.

[00:05:48]Then hands-on skill need to be reinforced again and again.

[00:05:56]A strict adherance to the algorithm and ensuring quality over the quantity.

[00:06:03]This is the most important thing.

[00:06:06]For that we have a team of quality control in all the drone. who would look into the quality of this course.

[00:06:16]And finally, every step should be performed correctly and confidently by all our trainers.

[00:06:27]Friends, we all know we all know that birth is the most vulnerable period of the life and a delay even a second in providing the right intervention can make the difference between life and death or lifelong disability and that's where NRP become the powerful NRP is not just a course It is not just a skill. It is a lifesaving intervention at the right time in the right way. And today all of you are here because you are the trainer, influencer and the leader who will multiply this impact across the country.

[00:07:20]So particularly I would like to emphasize anticipation is the key in the preparation. You will be learning details by the different uh instructor and the bag and mass ventilation. This is the most critical lifesaving skill and if ventilation is done correctly we can save majority of the baby who need resuscitation.

[00:07:51]So my message for all the trainers we must remember this is not just a lecture based program. You all know many of you you all are trainer many of you may have not done for two to three years. So that's why this course has been planned. So this is not not a lecture based course. This is a skill-based training. So we need to ensure more time on the hands-on practice.

[00:08:23]There won't be any slide and all time on the demonstration a strict adurance to the time very very important and we should focus on PET that is performance evaluation test.

[00:08:38]Again I'll reiterate that the quality training is our priority not the number.

[00:08:46]As a trainer your responsibility is immense. You are not just teaching a course. You are building confidence correcting the mistakes of the participants and solving life indirectly.

[00:09:03]So every participant you train become the lifeline for a newborn across the country.

[00:09:14]If we do this program correctly, confidently and from the bottom of heart, I think this NRP day 2026 will not just be an event. it will reach to the unreached area and we have already reached unreached and it will be a turning point in the newborn care in India. So friends together let us ensure no newborn dies for lack of timely resuscitation.

[00:09:49]So with that my best wishes for happy learning. Thank you very much for all of you for being the part of this mission.

[00:10:01]Thank you. Thank you Saria for giving me this opportunity.

[00:10:09]>> Thank you sir for those wonderful and encouraging words. Uh truly inspirational. Um now we'll move on to the next part of the session. Uh so the way we have organized the session is that um we will take you through all the steps of the course.

[00:10:26]>> Can we can we ask Dr. Amitad Dr. Amit to say a few word before we move to the >> Sure. Sure.

[00:10:34]>> Amit please uh as you have explained it quite well.

[00:10:40]This session is just a revision course and um so that everybody does a standardized uh training at their uh all the coordinators should ensure that u everything which is needed. you get all those papers. Uh you print them for everybody and the method of teaching is standardized across all the centers and this um online course is just uh it's not a training as such but it is just ensuring that everybody uh remembers all the steps and u helps us keep the standardized pattern of training everywhere. Thank you.

[00:11:20]>> Thank you. Thank you Amit. Thank you very much.

[00:11:26]Um so moving on. Thank you sir for those words. Thank you.

[00:11:30]>> Uh moving on we have the next uh part of the session which is we're going to be discussing uh skill station one uh which is preparation for birth and this will be handled by Dr. Vikas Goyel. Over to you sir.

[00:11:44]>> Thank you Sharia. So good evening to all of you. uh the first session of this training is preparation for birth. The time for uh this session is 30 minutes.

[00:11:58]So in the next few minutes I will discuss what to do and how to conduct this session. So when we are talking about uh preparation for birth, there are two aspects of preparation. First is anticipation and planning and the second important part is preparation of personnel equipment and supplies required for resuscitation.

[00:12:22]So first I will discuss what how we should anticipate and plan. As our president rightly said that anticipation is the key. If you will anticipate and prepare then only you will success otherwise you are prepared for failure.

[00:12:37]If you are not prepared for success then we are prepared for failure. So anticipation is the key. So whenever you get a call on uh or your for an labor room delivery then there are certain things that you should do. First is you should anticipate what is going to happen. So you have to ask what what are the risk factors. Now there are two type of risk factors. One is the risk factors which are in the antiatal period of life till incept conception to the delivery point and then second is what are the risk factors which happened after the patient get admitted in the hospital that is during labor. So we have to ask about these two things. The first thing is uh anticipation. So now the risk factors I will briefly outline. you should ask uh all the participants to uh inquire about these risk factors every time when they go into a delivery room. So the major antiatal risk factors are whether the baby is pre-term or post-term. First is if it is pre-term less than 37 weeks if it is more than 41 then it is an disturbance. Second is is there any hypertension in the mother or ecleia or preeacclampsia diagnosis in the mother then the baby is high risk. Then whether there is a single pregnancy or multiple gastation twins triplets then it is an uh risk factor whether there is if any ultrasound has been done whether it shows any poly or oligadinos or IGR then it becomes a risk factor. Is there any significant fetal mal formation or suppose if a parent if a mother comes with no antiatal care? No antiatal care never shown to any doctor then also it is an risk factors. So these are the major antiatal risk factors. Now we are coming to the intraartum risk factors.

[00:14:34]It means the risk started after the patient got admitted in our hospital in labor. So what are the risk factor? The most important is suppose most important risk factor for doing LSCs is that there is fetal braic cardia or fetal distress.

[00:14:50]If there is fetal distress it is in risk factor. Then for any cause if there is an emergency uh cesarian is being done then it is a risk factor. Third is any use of instrument for the delivery or vacuum for the delivery it is a risk factor. Any presentation other than vertex suppose it is breach hands first or transverse line then it is in risk factor. Then suppose if there is a significant intraartum bleeding during labor the patient is come bleeding then it is in risk factor. If mikonium is present it is in risk factor. If any pleasantal absure pleasant to you are suspecting then it is a risk factor and also if you are giving magnesium or general anesthesia to the patient then it becomes a risk factor. So this is how you will enquire whenever you go for an delivery call you will inquire about these risk factors briefly antiatal risk factors you can see in the uh file of the patient and intraartum risk factors briefly ask about the risk factors which are available. Now what will happen if risk factors are present? If risk factors are present then you have to be alert that something the baby might require resuscitation.

[00:16:08]So this is the first step if any risk factor is present you become alert.

[00:16:13]Second point is you should call for help. Call anybody who is available in your hospital who can help you. He he or she can be trained in basic NRP. If he or she is not trained in basic NRP also then also you can call him to help in in certain things. Second thing is do you have any personal available in your facility who can do advanced NRP skills?

[00:16:39]If yes then please call that person.

[00:16:41]Suppose if there is nobody available or nobody can call on call in your hospital then where you are uh shifting these type of babies earlier also these type of babies he's been delivering in your hospital where are you shifting this baby call that particular hospital and tell the personnel over there that we are going for an delivery and it is an high-risk delivery the baby may require admission or advanced technique so be prepared is there bed empty warmer.

[00:17:15]Then the last point is how will you shift this baby from your facility to that particular facility. That is very important. You should check whether you are shifting it from ambulance or from some private vehicle. Then you should check whether it is available or not.

[00:17:32]Second thing is who will accompany the baby because you you yourself should accompany that baby to that facility.

[00:17:39]Suppose the baby is not breathing, you are ventilating, then you have to go with the baby ventilating the baby.

[00:17:46]Third point is how will you maintain the temperature of that baby while shifting it is very important. So if suppose a baby is pre-term breathing on itself but we have to shift it to another place then the temperature maintenance is very important. So what you can do is either you can do shift the baby into transport incubator if it is not available then you can shift the baby on skin-to-skin contact with any family members or relatives of that baby or if it is going with private vehicle give instructions that the AC should not be on in the car or vehicle and a heater is available in every vehicle private vehicle. So they should start the heater and keep the temperature of the car warm. So these are the important points and anticipation and planning. Remember anticipation and planning is the crux of preparation. Now the second step is preparation of personnel equipments and supplies required for resuscitation at your center. Now I will ask uh uh Dr. Prakash to please start that video. So all of you see that video, see this video and in this video you will be shown how to prepare for personnel equipment and supplies.

[00:19:08]Dr. Praash >> uh can I share the video sir?

[00:19:15]>> Yeah yeah yeah you shared the video.

[00:19:22]Yeah, I'm sharing from the delivery room preparation.

[00:19:25]>> Yeah, >> sharing the delivery room and your equipment.

[00:19:30]>> The sound audio.

[00:19:31]>> First step is to prepare the environment to keep the newborn warm.

[00:19:35]>> First, close the windows. This prevents cold drafts from entering into the room.

[00:19:41]Second, close the cutins. This will help in maintaining room temperature and provides privacy. Third, switch off the fans. Even a ceiling fan can create air currents that rapidly cool a wet newborn. Turn it off before the delivery. Fourth, switch on the radiant former. Turn it on at least 15 minutes prior to the expected delivery so that the warming surface is ready to receive the baby. Now let us move to the next critical step that is hand hygiene. Turn on the water. Wet your hands completely under running water.

[00:20:21]Apply adequate quantity of soap onto your hands.

[00:20:25]Rub your palms together. Now rub the back of each hand with the opposite palm. Interlace your fingers to clean between them. Clean the backs of your fingers by rubbing them against your opposite palm with your fingers locked.

[00:20:40]Use your right palm to clean your left thumb in a rotating motion. Repeat for the right thumb with your left palm.

[00:20:53]Rub your fingertips against your palm in a circular motion to clean under your nails. Do this for both the hands.

[00:21:11]Rinse your hands thoroughly under running water. Ensure all the soap is washed off.

[00:21:24]Dry your hands with clean towel. The entire process should take at least 40 to 60 seconds.

[00:21:34]After hand washing, wear your gloves.

[00:21:50]While preparing equipment, first you need at least two warm dry towels to receive the baby. Extra pair of gloves.

[00:22:01]Suction apparatus. C lamp clamp.

[00:22:05]Cotton balls and gauze pieces.

[00:22:09]Scissors for cutting the cord.

[00:22:12]Vitamin K injection syringes.

[00:22:18]Ventilation device with proper reservoir and oxygen tubing.

[00:22:26]Masks for ventilation both sizes pre-term as well as term. Stethoscope for oscultating heart rate.

[00:22:37]Shoulder roll.

[00:22:53]If you are using wall suction apparatus, make sure the pressure is not beyond 80 to 100 mm of HG.

[00:23:12]Ensure there is working oxygen source.

[00:23:18]For bag and mask ventilation, we need appropriate size face masks that is both preterm and term. Attach the mask to the bag in a screwing motion to check whether the bag is functioning properly or not. See whether bag is getting recoiled back after squeezing.

[00:23:40]Next, whether you can feel the gush of air coming onto your hand while you are squeezing the bag.

[00:23:48]Now hold the mask against your palm and squeeze the bag and check for the pop-up wall whether you are able to hear the hissing sound or not.

[00:24:01]So to summarize the learning points from this video before every delivery anticipate the risk review the maternal history note down the antiatal or intraartum risk factors if there are any and prepare the team accordingly.

[00:24:14]Prepare the environment that is close the windows, curtains, switch on the radiant bomber, maintain hand hygiene, wash your hands thoroughly, prepare the equipment and be ready for receiving the baby.

[00:24:28]>> Yeah.

[00:24:30]Now as you all have seen this video. So now what is important as an instructor you will get only 30 minutes for this session. So what is important is whenever when you will start this program this training first you will show demonstrate all the things which are shown in this video and as I have told you how to anticipate and plan and then you will show how to prepare for personal equipment and supplies. Second thing is when you are showing the two important points here are how to wash your hands and how to check the bag and mask. So what you will do is let all the participants imitate you when you are doing the hand washing. Tell them to show how you will wash hands. So all the participant in grip will show you hand washing and let all the participants show you how to check bag and mask.

[00:25:21]Third thing is because the time is very less. It will already consume 15 20 minutes of you. So now what you can do is you can make one or two people do this preparation. Show you them how to prepare for birth. So make a team of two three person. One person will become a gynecologist. One person will become the uh healthcare worker who is going for NRP and one can become helper and they can show how they see how they communicate with gynec regarding asking about the uh uh risk factors and after asking the risk factors what they are doing. So I suggest you you should make two scenarios. In one scenario you should give that a baby is a pre-term baby 28 weaker baby and delivery is going to happen. Then see how they anticipate and plant. Second is you can give a case where the baby is having fetal bradic cardia fullterm baby but the baby is severe uh distress fetal distress and forep delivery is going to happen. Then how they prepare how they anticipate how they plan and prepare. So not more than two persons will be able to do this but make sure that every participant all 10 of your participant show you how to wash their hands and second how to check bag and mask and third there is no uh you should not remember all the >> yeah you should not know how all the equipments and you should have an checklist posted in your labor room where you can see and check whether all the equipment and things are present or So this is from my side. So uh now uh we will go to if there are any questions.

[00:27:06]Briender is there any questions regarding this session? So I can answer in few minutes.

[00:27:12]>> Uh sir uh one question only. Uh uh Dr. Lingardi asked about the embrace for safety. Do you recommend >> what >> sir? Embrace. Embrace.

[00:27:25]>> Embrace.

[00:27:26]>> Yeah. Embrace for transportation. Yeah.

[00:27:32]>> Yes sir.

[00:27:33]>> Yeah. We recommend that thing. So I have already told if any incubator, Embrace or skin-to-skin contact whatever facility is available just ask the participant what is the facility available at your your uh place and then act accordingly. Some because we are talking pan India there are different type of facilities available at different parts of time. So we have to accommodate according to we have to adapt according to the facilities available at your center. So no baby should every baby should be given the advantage of everything every knowledge uh which we have suppose there is no equipment then also we can do something.

[00:28:11]So this is only the method how you anticipate and plant and do better. This is our plan. So now I will ask Charinia to go over to our next session which is initial steps in routine care by uh Dr. Praash.

[00:28:30]>> Thank you sir. Thank you for that session.

[00:28:32]>> Sir remaining question we will uh remaining question we will take into last. No.

[00:28:39]>> Yeah.

[00:28:39]>> Yeah we can we can begin we can take the question later on also. Let let the >> okay start. Okay, >> we will move on to the next session. Uh >> yeah, >> by Praash.

[00:28:55]>> Thank you. Thank you for the invite. Uh so uh this session will uh we went in two uh will cover two stations. One is the preparation of I mean birth of a baby who is crying and who where we provide protein care and the second one is when the after drying baby's still not breathing and what would be the initial steps for the baby to cry. So all uh what uh we I want you to understand is here in this session uh one request is that please stick on to the protocol you know what is shown in the video do not deviate because you know uh this is a uh you know basic NRP program where we understand there are not going to be very high-risisk deliveries going to happen. This is for the common scenarios where you know baby is not going to require I mean there not be very complicated scenarios. We're just going to teach them how to provide positive pressure ventilation at the end. Now in this two sessions the first session is you know the you know the this will be your second uh station in your workshop where we talk to them regarding what will you do when the baby is you know crying after birth. So important things to cover here is we know baby is in a very warm environment.

[00:30:14]It is now coming out will be very cold.

[00:30:17]So first thing we'll take care will be the warmth of the baby. So we just dry the baby and then suction. We discourage at this point of time there's no suctioning even there is melonium stain like and then put the baby onto the mother's abdomen immediately. The next thing we do is uh here is that you know uh we warm and remove the lin and maintain temperature. The second is umbilical cord you know clamping delayed deferred or delayed umblical cord clamping which should be done after 1 to 3 minutes and then we immediately encourage the baby to be put on breastfeeding cover the baby again and then tell the mother uh regard the baby and tell the what she should be looking for and then you know at the end of it we also give vitamin K injection right so this is about uh you know what you will see in routine care and that is what will be seen in your video also and please don't confuse with advanced NRP training there's a little bit of change between this and that you need to change mode this is adopted to an uh you know to a primary care level so I'll play the video of the uh routine care and followed by we will see uh initial steps in this video we will learn about what to do immediately after birth and how to provide routine care for the baby. Once the baby is delivered, note the time of birth. Time of birth is 58 p.m. Receive the baby in dry linen. Place the baby over mother's abdomen.

[00:31:56]Turn. So this will be a uh a pre-warmed alignment liner where you would have kept it in during the preparation under the warmer of the baby to one side.

[00:32:14]If there are any visible secretions wipe the mouth and nose.

[00:32:21]So here uh for the instructors to understand the uh please as far as possible do not turn the baby's uh know mannequin or head uh just tell them that it should be moved but do not you know this is a video demonstration that is shown like that because the mannequin will actually get spoiled. So do not turn the head too roughly uh the joints will break and it'll damage the mannequin. Please do it very softly.

[00:32:49]Dry the baby thoroughly.

[00:32:55]Remove the wet linen.

[00:32:59]Observe for the baby's breathing. Yes, baby's breathing. So in this uh station what we do is we call upon volunteers and try to you know imitate this on the uh you know abdomen on the uh you know you put the baby on to the uh abdomen and on the mannequin onto the you know make someone sit on the chair and uh you know uh you know inform them and then put on the abdomen to demonstrate to just see how it can be performed rather than putting it on the table.

[00:33:30]Well, as baby is breathing well, we can continue routine care for the baby. We can continue skin-to-skin care with the mother and cover the baby and mother with dry and warm linen.

[00:33:46]Clamp and cut the cord. After one to three minutes, place the baby over mother's chest and explain the mother about the baby's condition and start breastfeeding for the baby. To summarize the learning points from this video once the baby is born, note the time of birth immediately. Receive the baby in a dry and warm linen and place the baby over mother's abdomen in prone position. Turn the head of the baby to one side. Wipe the secretions if there are any visible secretions. Dry the baby thoroughly and remove the wet linen. Now assess for the breathing of the baby. The baby is breathing well. We can continue routine care for the baby which includes skin-to-skin contact with the mother.

[00:34:37]Clamp and cut the cord after 1 to 3 minutes. Start breastfeeding for the baby and monitor the baby for breathing and color with the mother.

[00:34:53]So that's come to the end of the uh you know birth and routine uh care. So three the what we need to remember is you know baby skin-to-skin contact which is very important in many places still they do not do it and we need to encourage them to do that you know skin-to-skin contact drying the baby and maintaining the temperature and then next is you know delayed you know cord clamping breastfeeding and of course the video missed out on vitamin K injection vitamin K injection should be given okay that also needs to be insisted on so next is like uh now what we do is we take it like a story. The next station what you do is you tell them uh you know you start the station telling that so far you know what if the baby cries what you should be doing. Now let us uh see a baby who does not cry at birth and what should be done. Now remember crying is assessed only after drying and uh unlike you know advanced NRV here crying is assessed only after drying you know drying is that removed wet line and then only they assess for breathing. uh please do not you know uh you know assess get confused between between the advanced NRP and uh basic NRP. So in this also it is like similar you uh try to you know uh do things on the mother's abdomen. Uh I think there is one extra I don't know why that is coming black band is coming. Black band is >> are you uh actually see the uh >> I am also seeing this black band.

[00:36:26]>> Uh how do I take it? There is now not seen in my screen. Okay let me stop and share again.

[00:36:31]>> Yeah yeah yeah >> it is coming. Yeah.

[00:36:35]>> Now uh you stop and share again.

[00:36:37]>> Share.

[00:36:57]We can see nothing.

[00:36:59]Yes. I'm just just start Yeah, now it's good.

[00:37:24]>> It's good. Okay, sir. Thank you.

[00:37:25]>> Yeah, just start.

[00:37:28]>> Sorry. Sorry for about the interruption.

[00:37:31]Right. So now uh here in initial steps what we're going to say is now we have tell them that so far we know what to do in a baby who was breathing. Now let us see even after drying if the baby doesn't breathe what should be done to facilitate breathing. So that will be the objective of this station. So once a baby breathes after initial steps then the rest all the steps are almost same as uh routine care. So what they do uh in in this also baby till baby is drying there's no change they receive the baby put on to skinto- skin care and then dry the baby and remove the wet linen and again put the baby on uh the you know they assess the baby for breathing. Now if the baby does not breathe then here it is you know different from the protocol of the uh this thing there you know here then we you know uh clamp and then shift the baby to the warmer then we do something called PSSR that is we do position uh you know suction stimulating stimulation and reposition you know when you stimulate you're going to change the position of the baby so you need to reposition and then you need to you know in this time you need to take care of the uh you know shoulder role align the airway um make the air open the to open the airway and then once this is done and then uh you know once baby starts breathing then you assess baby is the baby breathing well to you know sure that baby is going to be which can be safe enough to be shifted back to the mother and we initiate breastfeeding and again tell them that you know mother to you know observe the baby even more intensively and you know and every 15 minutes for the first 1 hour and then 30 minutes after uh uh in the second hour. Okay.

[00:39:16]So, we will see uh the video uh the same thing which will be demonstrated in the video. Thank you.

[00:39:28]In this video, we will learn birth and initial steps. Once the baby is delivered, note the time of birth. Time of birth is 58 p.m. Receive the baby in dry linen. Place the baby over mother's abdomen.

[00:39:45]Turn the head of the baby to one side.

[00:39:48]If there are any visible secretions, wipe the mouth and nose.

[00:40:00]Dry the baby thoroughly.

[00:40:06]Remove the wet linen.

[00:40:10]Observe for the baby's breathing. If the baby is not breathing, clamp and cut the cord immediately and shift the baby to radiant warmer for performing initial steps. If the baby is not breathing after birth, we shall proceed to initial steps. In the initial steps, first we shall place the baby over radiant warmer. In initial steps, the first step is to keep the baby in proper position that is sniffing position in which the head and neck should be in line. So for which we can use a shoulder roll.

[00:40:58]Now we shall stimulate the baby by gently rubbing over the back couple of times.

[00:41:06]And in stimulation we shall avoid vigorous rubbing or slapping over the back and shaking the baby. Now reposition the head and neck.

[00:41:23]If there are visible secretions are present, we shall do suction of the mouth first followed by nose. So when using suction catheter precaution should be taken that it should not go beyond 5 cm into the mouth and next 2 cm into the nose. And one more precaution we should to take while doing suction is avoid vigorous suction and which which will injure the mucosa and it can cause bradicardia. If you are using suction catheter with a wall suction machine the pressure should be between 80 to 100 mm of hg. After initial steps, we have to assess for the breathing of the baby. If the baby is breathing well, we shall shift the baby to observational care.

[00:42:07]The baby is not breathing. After performing initial steps, we shall proceed with bag and mask ventilation.

[00:42:13]The baby is breathing after these initial steps. The baby should be kept in observational care with >> before that how do you know how how do the how do how do the partic well? So they should have a the baby should be breathing at the rate of about 30 to 60 breaths per minute. There should not be any uh retractions or grunting and then the b the uh baby should have both sides of the chest should move equally. So if they observe these three then they label this as breathing well and they have to count for 1 minute.

[00:42:49]mother. During the observational care, place the baby on mother's chest. Cover the baby and mother together with a warm cloth and initiate breastfeeding. Along with this, we need to monitor the neonate for temperature, heart rate, breathing and color every 15 minutes during the first 1 hour and then every 30 minutes in the next 1 hour.

[00:43:16]Now we shall summarize the learning points from this video. Immediately after the birth, note the time of birth.

[00:43:23]Receive the baby in a warm towel. Place the baby over mother's abdomen. Turn the head of the baby to one side. Wipe the secretions if any visible secretions.

[00:43:35]Dry thoroughly and remove the wet linen.

[00:43:38]Assess for the breathing of the baby. If the baby is not breathing, clamp and cut the cord and shift the baby to the raden warmer for performing initial steps. The first initial step is position the baby followed by stimulation of the baby.

[00:43:54]Next, reposition of the baby and suction of the secretions if there are any visible secretions. If the baby is breathing after initial steps, shift the baby to the mother for observational care. If the baby is not breathing after initial steps start bag and mask ventilation for the baby.

[00:44:13]>> So uh in that you know the you could use uh the initial steps as you know as I told you that PSSR can also be used or what has been told. So the steps of the sequence of the steps are not very strict. They have to do only this way.

[00:44:28]But remember that they should do all this you know position the baby you know they should clear airway by suctioning stimulate the baby and then reposition so that you know the airway is you know open so that is what you need to understand so don't get too uh thising about you know the is a step PSSR or is it for stimulation and then suction and they have to understand that these all things needs to be done right okay so uh I think this comes to the conclusion of my the session on uh if the baby who breathes protein care provided and initial steps and remember the vitamin K should be given that also should be insisted.

[00:45:07]So uh with that I stop my this thing. If there are any questions probably I'll be happy to.

[00:45:16]>> So presenter is there any question?

[00:45:19]>> Sir no sir all questions are answered by sir and none answer text message.

[00:45:30]So uh with that >> do we have time for two three questions?

[00:45:37]We have some on the chat box.

[00:45:44]>> So Praash are you going to >> shoulder roller is not mandatory.

[00:45:49]uh if the if you feel the baby's airway is open without the shoulder roll your need it will be definitely uh in a baby who pre-term and very severe IUGR where oxip occiput will be very prominent so that you need to you know teach them how how what is that sniffing position is >> sir three new questions are there sir can we take >> yeah I I think we can take British >> uh wix has to be removed or not.

[00:46:24]Dr. Malish Goodwa is not able to maintain or if there is neck flex >> some other question is pulse oxyter first. No, no, we are not demonstrating pulse oxy meter in this uh NSSK. Please change your mode from advanced NRP to NRP in basic NRP understand with basic designers also answer some of the questions. Yeah.

[00:47:13]Anything else? Yeah, please >> sir. Uh, next question is sir, why we should avoid vigorous stimulation while rubbing back of the baby?

[00:47:22]Dr. Sachin Kumar, >> why we should avoid rigorous stimulation?

[00:47:27]>> Yes sir.

[00:47:29]>> Okay. Now remember the the the best stimulation which will stimulate breathing is the tactile stimulation.

[00:47:37]The tactile stimulation is just touching and you know comes under tactile you know touching I mean touching and rubbing vigorous will actually put the pressure or pain and that will actually can induce apnea again can actually reduce the chances of breathing. So uh definitely do not do don't do rigorous anything vigorous on a neonate.

[00:48:00]So next question is uh is cap must for the temperature maintenance?

[00:48:06]>> Yes. Yes. Cap is a must.

[00:48:09]>> Next question is dry baby is dried you have to put on the cap. Even even if the baby is on skin to skin care.

[00:48:18]>> Next question is the sequence should not be strict but uh can uh not do stimulation before suction.

[00:48:29]Yeah, that's what I told you. Uh I I not sure that if they need to really follow that sequence, you can uh you know tell them that these are things they should do at the end of it. They should understand that they need to position to open the airway and then they need to you know clear airway because airway should be clear for the baby to breathe and then they should stimulate because you're stimulating you would have changed the position so you need to reposition.

[00:48:56]Sir. Uh, next question. When to reveal the >> position itself? You should talk about shoulder role.

[00:49:02]>> Sir, uh, next question. When to reveal gender of the baby?

[00:49:08]>> Yeah, I I think that can be unit protocol. It is not part of the uh NS, NSSK or you know basic NRP. I think you can have your unit protocol whenever the baby is fine and uh uh you know at least and then and skin-to-skin contact should be given for 1 hour after birth.

[00:49:31]>> One request from Dr. BD please send the video for the sewing in the class and for uniformity in all center. So we already sent video >> available with all of them. Yes sir.

[00:49:44]Sir Dr. Nup Pandi asking for the uh sir please tell mode of the warmer.

[00:49:51]>> Yeah. Uh okay warmer mode is like usually there is two types. If the warmer which you're using is a resistation warmer which if if it has a pre-warm mode you just have to switch on about 20 to 30 minutes before put on pre-warm mode. What it does is it will start with 100% and starts coming down and it'll stop at around 20 to 30% of heat output and remain there. This is to avoid hypothermia.

[00:50:17]>> Yeah. Praash the >> in case if you are not >> uh yeah the ventilators uh most of the them have a manual mode. Manual mode.

[00:50:26]>> Okay. So that's what I'm coming to that sir. Now in case in case if you're not having a pre-warm mode then you put the baby in put the warmer in manual mode and put the heater output to 100%. And then based on the you know the this thing heat generated there then you can control once a baby comes you connect the thermister to the baby and then you can move to a servo mode.

[00:50:53]>> Uh sir one next question Dr. Mallay code about stomach was already raised. Thank you for raising that >> sir about stomach was required or not?

[00:51:05]No, no, no stomach wash. Even in a mun like we do not do stomach wash. We don't teach rails tube this thing here insertion also here.

[00:51:17]Sir Pani asking about how to do steps in LSCS delivery.

[00:51:26]right now the uh you know the recommendation even in LSCS also it is skin-to-skin care delayed cord clamping and all that but then you have to you know talk to the anesthetist and your obstitrician to convince them so if they ask that whether in LSCs is it feasible it is definitely feasible so many centers do that so you need to you know put the baby on skinto-skin care between the in the oblical cord length is good enough to be pushed you know put the baby onto the abdomen I mean onto the uh chest and then we can actually delay the cord clamping and then put the baby on breastfeeding.

[00:52:10]>> So next question by Dr. to crank up if there is no activity no breathing in child should be check heart rate with a stethoscope before doing initial steps.

[00:52:21]>> Okay. Now remember this program is designed for uh you know for you know in a facility where the resource is very poor and people are do not have a very trained hands and we are trying to you know do the best possible. So here we whatever the baby's condition is even in advanced NRP we don't have to look at the heart rate if the baby's not breathing the earliest time you should initiate positive pressure ventilation is what is recommended even in advanc NRP only if you are you know having another person in hand then only you go and check the heart rate so don't give importance to heart rate even if the baby is totally flat yeah you know you just you know deliver the baby onto the abdomen dry the baby and that you know that will also be stimulating the baby still not breathing you know clamp and then shift the baby to the warmer. Please keep this uniformly you know taught to them. Do not complicate too much and know to ask them to look at the heart rate. So in this uh you know module we just only teach them uh we they put the the the protocol is same for all babies. However they are born they are totally floppy also. The baby is taken put on to skin-to-skin care dry the baby remove the wet linen then they put cover with a dry uh wet in warm linen again and then they assess for breathing and if the baby is not breathing then the baby is cl the the cord is clamped inform the mother and shift the baby to the warmer.

[00:53:48]Sir, one query for management like all skill station per table happens with same instructor or uh we rotate in groups.

[00:53:58]>> Okay. The instructor only will rotate the participants do not rotate.

[00:54:03]Participants will stick on to the table from the first station till the end till the end of the session.

[00:54:11]>> Rakash. Now I would like to clarify for all the instructors. Uh the one case scenario 28 week please avoid because this time the line you have given is mainly to uh you know cover the baby to provide you know routine the routine care and a baby who is needing resuscitation of a late pre-term and term baby the you know baby less than 28 weeks delivery they should really look into other you know programs or there I'm sure there should be a pediatrician is available who will be able to take care of advanced care but here we don't teach them to keep the plastic wrap ready.

[00:54:52]>> Yeah Praash only one thing I want to add that regarding the rotation. So for the rotation what we have made since the preparation for birth and initial care and routine care are 30 30 minutes work session. So we will first rotation will be done after initial routine and initial care. So for first 30 minutes and 30 minutes after first hour we will rotate first. Okay not after because it will disrupt all the things. So all of you remember that the first rotation has to be done after the completion of routine care and initial steps. Second rotation has to be done after the ventilation and third rotation will be done after that. So that I will also explain in the uh last session. So for uh uh this time you should remember that the first rotation will be done after repression and doing routine care and initial steps. Also remember the time for routine care and initial steps is only 30 minutes. So as an instructor you will first demonstrate how to do routine care and initial steps. Not everybody will be able to do both the PCL 2 and three. So what you will do is s few people will do routine care and some will do initial steps. Okay.

[00:56:24]>> Yes sir.

[00:56:25]>> I think sa now >> to move to the next >> we have a time constant in this as you go to the second stage you will yes I would invite next now we have seen the baby. Oh sorry Dr. Please go on >> sir. I hope you're done sir. Praash sir, can I move on?

[00:56:47]>> Yeah. Yeah, please.

[00:56:48]>> Okay. Uh thank you sir for that uh really clear session. I think a lot of questions were also answered but we'll take the rest of the questions at the end of the session. Um the only thing that I want to stress on is like uh Dr. Vikas was mentioning uh the rotation of the tables. So I I'm uh I I hope everybody is clear about when to rotate.

[00:57:08]So the participants stay at the table and the faculty rotates. And the other most important thing is uh use of PCL's at every station. Um so the PCLs have been shared in the participants folder as well as in the course coordinator folder. PCL's are the performance checklists which are for each station.

[00:57:28]So they are designed for that particular station. And um we do not want uh to talk too much about theory. It's not theoretical. It's going to be very practical, hands-on. Um, so we we should make a uh either note down or a mental picture of what are the salient points that we are going to discuss. What are the most important points that should not be missed at every station and the PCL has to be performed um because we have 10 uh participants at each table.

[00:58:02]uh generally we um insist that every participant does the PCL but u because we have 10 in each table we can also design it in such a way that five people do one part of the PCL and the other five do the other part of the PCL um so for example five can do routine care and five can do initial steps so you know it can be done so that everybody gets wellversed with doing hands-on so it's not going to be lecture-based um teaching it is going to be more hands-on like uh Vikasar was mentioning even showing the baby being put on the mother's abdomen has to be demonstrated sorry has to be demonstrated with um a a volunteer or a participant on a chair.

[00:58:50]Um now we move on to the next part of the uh of this evening session which will be taken by uh Dr. Akash. This is on PPV.

[00:59:01]Over to you Akash.

[00:59:04]>> Am I audible?

[00:59:08]>> Am I audible, Sarin?

[00:59:10]>> Yes. Yes. Yes. Yes. Please.

[00:59:11]>> Yeah. Okay. Okay.

[00:59:13]>> Okay. Thank you so much. Thank you everyone. And uh thanks Arina for inviting me. Uh so uh before we go ahead I just wanted to uh remind the participants uh of this meeting something that wrote in the uh chat box also we have to remember that this session is uh this session has two aims. Okay. The first aim is to revise the algorithm the NNF uh the the NRP algorithm basic NRP algorithm. So that is the science part of it. uh most of us know that and we are just kind of uh revising making a uh quick revision. The second important part of today's second important aim of today's uh session is to help all of you who are going to be instructors on 10th May to help all of you plan your teaching sessions. So uh uh it is important that all of us start planning uh our sessions uh mentally so we are ready with kind of a lesson plan how we are going to conduct each session uh when we uh uh go as instructor on 10th.

[01:00:19]>> So uh the next segment as you know uh the next PCL talks about brief ventilation. So here uh the one of the most important thing in the whole workshop is the skill of ventilation.

[01:00:32]the actual skill of ventilation and if you look at the agenda you will realize that there is uh around 75 minutes devoted for PCL 4 5 and 6. PCL 4 is brief ventilation which is first 30 seconds of ventilation. PCL 5 and 6 is prolonged ventilation with normal and slow heart rate. So uh how are you going to uh teach this skill in 75 minutes? So roughly 45 to 60 minutes should be devoted to first part brief ventilation part because that is the part where you are actually going to talk about the skills of ventilation and the corrective steps and remaining 15 to 30 seconds. So around total 75 minutes you will have to divide mentally like this.

[01:01:17]uh please do not spend too much of time in uh I would say don't spend time at all in discussing theory because uh we will have 10 participants for each faculty and we will have to ensure that so unlike preparation where we can skip we can make one or two people uh demonstrate the whole preparation part and then uh skip for others. Unlike that for ventilation we need to ensure that each and every single participant out of those 10 have been able to show the correct ventilation technique the correct uh use of corrective action and all those things. So here don't spend any time in teaching let's say parts of the back or no need to even repeat the scenario starting from birth drying initial steps no need to do that. So uh we can directly start by saying that okay a baby was born he was dried on mother's abdomen and baby was still not breathing. So baby's cord was cut uh and baby was shifted to radiant warmer. Here the initial steps were were given and still the baby is not breathing. So we start the scenario from there that what that does is that gives them that gives them an idea where this particular segment of ventilation is in the big picture of algorithm. So it is kind of uh talking about indication. So we start with that and as Dr. Vikas said for not only for this but for each segment you have to first demonstrate. So you first demonstrate and then quickly make each one of them part uh practice. Okay. So we'll see the video but before that let us just go through the ventilation scenario. So in the brief ventilation you will start by saying that okay this baby is still not breathing after initial steps. So what should we do? So we should give ventilation to this baby.

[01:03:03]So where to stand? So talk about where to stand. How to choose the correct size of mask. So explain that you can talk about which hand to uh which hand the bag should be held in. So we uh usually say that dominant hand, right-handed person should hold the uh bag in right hand. How to apply mask on the bag? So mask re mask application you will have to show that putting the thumb uh inside the mask putting two fingers like this and then uh screwing motion say mask to be applied to the back. Then how to hold the mask on the face using the EC. So you with your two fingers uh making a C like this you will be facing the mask on the baby's face. You will be pressing the mask on the baby's face and using the other three fingers you'll be uh realigning the position and then start ventilation by giving breath 2 three breath 2 three. Now here so each of these skills is important because some of the participants will be doing this for the first time in life. So talk about this breath 2 three. So explain to them that it has to be done like breath 2 three breath 2 three. So explain to them that breath 2 three breath 2 three this is not the correct technique or using the um rhythm like instead of using the rhythm breath 2 three saying breath 2 three breath 2 three this is not a correct matter. So like this you can explain uh how to use the rhythm breath 2 three then tell them that after you start uh ventilation within few breaths within first five breaths we have to look for the chest r. So here unlike advanced NRP uh we need to most of the participants will be doing this for the first time but most of the instructors would already be tuned to advanced NRP. So it is very important to switch to the basic NRP mode and so understand that here the effectivity of ventilation in basic NRP is judged by chest r uh checked within first five breaths. So look for chest r. If there are no chest there is no chest r seen in first five breaths then we go for corrective steps. If chest r is visible then we don't even need to wait for five breaths. We we we don't need to waste time. If chest rise is visible within one or two breaths we start doing 30 seconds of positive pressure ventilation. If the chest rise is not visible in first five breaths then we go for corrective steps. Corrective steps include M and R which is mask reapplication and reposition of the neck uh done together and then again tried few breaths then again if chest rise is not there then suction and increase the pressure. So MR then few breaths then SP if chest rise is not there. Whenever good chest rise is there from there 30 seconds of ventilation starts. Again explain to them that it is not that as if you have got chest rise in the beginning that uh that ensures that chest rise is there throughout the ventilation. So explain to them emphasize to them that chest rise should be carefully monitored throughout the 30 seconds of ventilation. So you start doing bread 2 three bread 2 3 bread 2 3 for 30 seconds. During these 30 seconds you are monitoring for chest rise.

[01:06:29]Uh one common mistake that uh we do as instructors is when a participant has got a good chest rise just to make them verbalize the MRSP we say that no there is no chest rise. Now this demotivates uh learners. So if someone by by on their own by default if someone has got good chest rise then applaud them and don't talk about corrective steps there.

[01:06:54]You can say that very good you have got a good chest rise. What if there was no chest rise? Then what you would have done that you can ask. But otherwise the basic aim is that everyone should be able to get a good chest rise. If they are not getting then they should be able to do these corrective steps. They should be able to manipulate so that they get good chest rise. So that is the basic aim. If someone has got that don't interrupt them. Another important thing here is to make everyone do uh actual ventilation for actual 30 seconds. So we don't want to cut down uh ventilation.

[01:07:28]Let's say after 10 seconds they will say 30 seconds is over. That is not done. So let them actually do let each participant demonstrate effective ventilation with good chest rise for full 30 seconds. So uh that is how each one of them should be uh required to demonstrate to you. Then towards the end of the 30 seconds the the question that we ask is are spontaneous breathing efforts present. If spontaneous breathing efforts are present then we slowly taper off. So that you can do people use different uh uh methods. You can say breath 2 3 4 breath 2 3 4 5 breath 2 3 4 5 6 like that you can taper off. After tapering off now remember till now we were giving ventilation. Now we have tapered off. Now we have to observe the baby's spontaneous breathing. So after tapering off and start stopping the positive pressure ventilation. Now we will observe the baby for around 1 minute. And now during this 1 minute we will observe the baby's spontaneous breathing rate also whether there is any grant there are any retractions. All these things we will observe. And if the baby is breathing well then this baby goes for observational care. Observational care has already been discussed. Okay. So this concludes the fourth PCL that is brief ventilation that is ventilation for first 30 seconds. Okay. Now so as I said this you should devote around 45 to 50 or at the most 60 minutes for this brief ventilation part. Last 15 to 20 30 minutes should be devoted for prolonged ventilation. So what is prolonged ventilation? So after um u 30 seconds of ventilation if the baby is still not breathing then what to do then that that we continue ventilation that becomes prolonged ventilation. So let us watch the uh video on brief ventilation first discuss that and then we go on to prolonged ventilation. So Praash uh you can show the brief ventilation video number five.

[01:09:39]Shall I play the video?

[01:09:41]>> Yes. Yes. Brief ventilation video.

[01:09:46]>> Yeah. Yeah.

[01:09:53]Okay.

[01:10:04]Ventilating the baby's lungs using a bag and mask represents the most critical intervention in neal resistation. In this video, we will demonstrate the proper technique and sequence for bag and mask ventilation. If the baby fails to breathe after you complete the initial steps, begin bag and mask ventilation immediately. So for performing bag and mask ventilation one can be placed at the head end of the baby so that you can have access to the chest which will help us in checking the chest r whether we are doing effective ventilation or not. So while performing bag and mask ventilation the most important thing is to select the appropriate size mask. For pre-term babies we can use premium mask that is zero size and for term babies we can use term mask that is one size. So this mask should be applied firmly to the bag. So while applying the mask onto the face make sure the mask covers the chin, mouth and nose. And we have to take the precaution that the mask should not come onto the eyes.

[01:11:15]Whenever we are doing bag and mask ventilation when we need to place the mask onto the baby's face with C and E technique. C is by using thumb and index finger we shall encircle the mask onto the baby's face and with E is formed by three fingers. So these fingers will be used to extend the neck a bit so that airway is in line. So and the and we should not press the eye of the baby. At the same time we should not press the airway and the pressure required to inflate should be as minimum as possible which can have minimal gentle chest rise. When we are doing bagen mask ventilation we need to do ventilations at a rate of 40 to 60 breaths per minute. So this can be done by following the rhythm breathe 2 3 breathe 2 3. So we need to inflate when we say the term breathe and we need to deflate or leave it when we say the terms 2 and three.

[01:12:12]Breathe 2 three. Breathe 2 three.

[01:12:15]Breathe 2 three. Once we start bag mask ventilation, we shall do five breaths.

[01:12:21]Breathe 2 three. Breathe 2 3. Breathe 2 3. Breathe 2 three. And check for chest r. If there is no chest r, we need to do ventilation corrective steps. First mask adjustment. Then repositioning of the neck.

[01:12:37]Next again we'll start ventilations.

[01:12:40]Breathe. 2 3 breathe 2 3 breathe 2 3 breathe 2 3 breathe 2 3 After five breaths we shall assess for chest r after five breaths there is no chest r then we shall do other ventilation corrective steps like suction and then open the mouth and we shall continue ventilations Breathe 2 3. Breathe 2 3. Breathe 2 3.

[01:13:17]Breathe 2 3. Breathe 2 3. Breathe 2 three. After five breaths, we shall again assess for the chest r. There's no chest r then we shall increase the pressure in the back. Breathe 2 3.

[01:13:29]Breathe 2 3. Breathe 2 3. Breathe 2 3.

[01:13:33]Breathe 2 3. Breathe 2 3.

[01:13:37]Once chest rise is there, we need to continue ventilations for 30 seconds using the sequence. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 three. Breathe 2 three.

[01:14:05]Breathe 2 three. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. Breathe 2 3. After 30 seconds of ventilation, we shall assess baby's breathing. The baby is breathing well. We shall slowly stop ventilations using the sequence breathe 2 3 4.

[01:14:27]Breathe 2 3 4 5.

[01:14:31]Breathe 2 3 4 5 6. Breathe. 2 3 4 5 6 7.

[01:14:38]Then we can stop the ventilations and we can shift the baby to observational care. The baby is breathing. After these initial steps, the baby should be kept in observational care with the mother. During the observational care, place the baby on mother's chest. Cover the baby and mother together with a warm cloth and initiate breastfeeding. Along with this, we need to monitor the neonate for temperature, heart rate, breathing and color every 15 minutes during the first 1 hour and then every 30 minutes in the next 1 hour. Now we shall summarize the learning points from this video. Bag and mask ventilation is the most important and effective step in neonal resuscitation. Always ensure clear airway before ventilation. Position yourself onto the head or to the side position so that you have clear view of the baby's chest. Mask sizes required are both pre-term that is size zero and term that is size one. When you are applying the mask onto the baby's face, ensure you cover the chin, mouth, and nose and not the eyes. Breathing rate is 40 to 60 breaths per minute. So the rhythm we need to use is breathe 2 3 breathe 2 3. After 30 seconds of effective wagon mask ventilation, assess for the breathing of the baby. If there is no adequate chest tries, we need to do ventilation corrective steps. These are adjustment of the mask, repositioning of the neck, suction of the oral cavity and nose and opening the airway and increasing the pressure in the back. Assess for breathing status after 30 seconds of effective bag and mask ventilation of the baby.

[01:16:37]Okay, thank you. So, uh if there are any questions in the chat box, we can take those questions right now. uh a few things here. Uh so if just to uh summarize what are the most important points of this particular PCR one ensuring that every participant is able to demonstrate how to do ventilation, how to hold the mask, how to give the ventilation the rhythm and to produce good chest rise. If there is no chest rise, every participant knows what to do. Okay, what are the corrective steps to be done? Every participant demonstrates to you actual full 30 seconds of PPV and every participant knows how to end ventilation. So what to do after 30 seconds that every participant is able to demonstrate. So these are three or four learning points of this particular segment. If there are any questions I would like to take them.

[01:17:33]So I think first question I could read was that uh is there any uh specific time given for tapering of of uh ventilation? No, there is no specific time. People uh give different uh ways.

[01:17:46]One common way that uh is told in basic NRB trainings is uh uh basically increasing the gap between two breaths.

[01:17:55]So instead of breath 2 3 you start saying bread 2 3 4 bre 2 3 4 5 bread 2 3 4 5 6 So that the gap between two breaths is slowly increasing and then you stop.

[01:18:08]Any other questions >> sir um sir for congenital anomy we have follow same procedure. This is question from Kumal Chitra. Yeah. So depending on the uh what is the congenital anomaly for every baby who is not breathing after drying and initial steps you would be attempting PPV first right now depending on the exact anomaly that that uh will become an advanced care scenario. So uh it will depend on what exactly anomaly is there right.

[01:18:42]So next uh just qu the >> as I said see one important thing that I want to say is that as I said this is a basic NRP program and the participants are going to be people who would probably have never had the chance to uh do wagon mask ventilation. We are teaching them this important skill. So basic focus of this particular session should be ensuring that every participant uh gets that skill. Okay. So rather than discussing theory or rather than discussing uh rare scenarios it is important because time is also limited.

[01:19:18]So it is important that we focus on the skill transfer >> is not not included in basic NRP.

[01:19:30]>> Yes sir.

[01:19:30]>> The PT PT need to be uploaded as well as the attendance seat. This is query and uh should be >> sir all the >> we also require to send the hard copy >> sir all the documentation organization logistics related queries we can take at the end towards end. Are there any queries related to brief ventilation segment >> in basic NRP should we teach the participants to have someone to keep the timer? This is qui from Monica. So timer should be there in the equipment. So one clock with second hand should be there uh in the uh in your equipment. However, if you carefully see heart rate assessment has still not come. We have still not assessed baby's heart rate. In basic NRP the heart rate assessment comes after 30 seconds of ventilation.

[01:20:21]I'm going to talk about it. So just uh let us be clear about that. Secondly, we have still not attached oxygen. We are still ventilating with room air. The first 30 seconds ventilation is with room air. Third, there was a question after 30 seconds baby goes to observational care or post resuscitation care. For basic NRP, please remember babies needing less than uh 1 minute of ventilation or you can also keep you can also teach that babies who need brief ventilation. So brief ventilation while babies will go for observational care.

[01:20:57]Prolong ventilation while babies will go for postition.

[01:21:02]So >> mass selection should be done prior while we are asking for risk factor or before ventilation.

[01:21:09]>> Uh uh say it again. Pardon? I didn't get it.

[01:21:11]>> Sir uh uh asking about the mass selection should be uh before uh uh when ble ventilation is starting or ask about after before asking the risk factor.

[01:21:24]No no no definitely mask size determination has to be done before we start ventilation right we need a correct size mask so that's what I said before ventilation just talk of two important things where to stand and which mask size is the correct size selection of appropriate size mask and your position >> sir can you explain how to open the mouth should we manipulate the tongue position with our finger >> okay So uh for the current basic NRP edition open mouth that particular corrective action has been removed.

[01:22:02]Okay. So we have we are teaching the government uh manual the government module and so we have to stick to these four corrective steps MR mask reapplication and reposition of neck then few breaths and then suction if needed and pressure pressure increase.

[01:22:22]So here there is no open mouth right now in this algorithm.

[01:22:27]>> Your protocol for the thick MSL and thin MSL non-b breathing baby.

[01:22:32]>> So I think again uh we have come a long way now. So we are not considering any different management of a meonium stained lyer. The current recommendation even for advanced NRP is that meonium stained lyer doesn't change management.

[01:22:47]Management is same >> to hold the mask for applying the mask E C and E technique to be demonstrated.

[01:22:56]>> Yes, of course. So as I said for every uh faculty we'll first demonstrate and then only ask the participants to practice or give demonstration.

[01:23:08]So for each segment we first demonstrate and then ask each of the 10 participants to give reverse demonstration.

[01:23:17]Shall we go to the next segment we can take the other questions later. There is a small video remaining. Okay. So u uh yeah yeah so as I said we discussed a brief ventilation which is the first 30 seconds of positive pressure ventilation. We discussed the scenario where within first 30 seconds baby starts spontaneously breathing and we saw how we taper off the ventilation and how we send this baby for observational care after ensuring that the baby is breathing well. Now what to do if at the end of 30 seconds we note that there are no spontaneous breathing efforts. Now this baby of course needs continued ventilation. This is called as prolonged ventilation. So ventilation will continue happening breath 2 three breath 2 three. Now we will call for help. So there are three points you will teach.

[01:24:05]Three points are call for help. Tell the helper to attach oxygen.

[01:24:11]Okay. And count heart rate. These are the three points that you can tell the participants. You can also tell the formula H OD. Tell them that whenever there's a problem we call H O. So H stands for heart rate. O stands for oxygen. D stands for doctor which means advanced care. So these three things we do and we continue ventilation as it is.

[01:24:32]So we continue doing breath 2 3 breath 2 3 for 30 seconds. Now only difference is every 30 seconds we will keep on checking heart rate because further management will depend on heart rate.

[01:24:43]When the heart rate is found to be slow which is less than 100.

[01:24:48]This uh baby needs advanced care urgently. So we will have to uh get the advanced care advanced NRP a person trained in advanced NRP urgently. If the heart rate remains more than 100 then this baby can be managed by ventilation alone. So you continue giving ventilation and every 30 seconds you keep checking the heart rate. So that's all about prolonged ventilation. Uh Praash please uh show the video number six that is prolonged ventilation and then if there are any questions and if time permits we can discuss bag and mask ventilation after 30 seconds. Following 30 seconds of effective ventilation, you must assess the baby's breathing status. If spontaneous breathing has not started, immediately call for additional help.

[01:25:54]Request another health care worker with NRP training to assist you. Connect the oxygen source to the bag. Attach oxygen reservoir only if you require more than 40% oxygen concentration. For lower concentrations, continue ventilating without reservoir. Now evaluate baby's heart rate. Use a stethoscope for accurate heart rate assessment. Position the stethoscope on the left side of the chest. We can oscultate for the heart rate for about 6 seconds. And whatever is the heartbeat in the 6 seconds, multiply that into 10, which will give us the heart rate of the baby. For example, if you if you escalate around 12 beats in a 6 seconds, 12 into 10 that is 120 is the heart rate of the baby.

[01:26:42]After 30 seconds of effective bag and mask ventilation, if the heart rate is more than 100 beats per minute and the baby is breathing, begin reducing your ventilation rate gradually until you stop completely. Check that breathing quality is adequate or not. Good breathing is characterized by vigorous crying or regular rhythmic chest movements. When breathing is adequate and you provided ventilation for less than 1 minute in total, transfer the baby to the mother for observational care. After 30 seconds of effective bag and mask ventilation, the heart rate remains above 100 beats per minute, but the baby is not breathing spontaneously.

[01:27:26]Continue bag and mask ventilation.

[01:27:28]Reassess breathing status every 30 seconds. When the baby initiates breathing, progressively decrease your ventilation rate and eventually discontinue bag and mask ventilation. If you have provided bag and mask ventilation for more than 1 minute in total, transfer the baby to postresistation care rather than observation care. After 30 seconds of bag and mask ventilation, if the heart rate remains below 100 beats per minute, immediately verify for adequacy of chest tries. If chest movement is insufficient, implement corrective steps again to improve ventilation effectiveness. Continue bag and musk ventilation without interruption. If your facility lacks a health care personnel trained in comprehensive neodal resistation program, arrange immediate transfer to a higher center.

[01:28:21]Maintain continuous ventilation with bag and mask throughout the transfer. When to stop resuscitation? Continue bag and mask ventilation until the baby establishes spontaneous breathing.

[01:28:33]However, in certain circumstances, stopping may be appropriate. If there are absolutely no signs of life at birth, meaning no breathing, no heart sounds and no movements, and this absence persists beyond 20 minutes after birth, ventilation may be discontinued.

[01:28:51]If any signs of life appear during resuscitation efforts, continue those efforts for a full 30 minutes before considering termination. When withdrawing or withholding resuscitation, our focus must shift to ensure the comfort and dignity of both the baby and the family. So to summarize the learning points which we have learned in this video, the first thing is after 30 seconds of ventilation assess for breathing. If there is no breathing, call for help immediately.

[01:29:24]Attach oxygen source and attach reservoir if more than 40% of oxygen concentration is required. Assess for the heart rate with a stethoscope on left side of the chest. After 30 seconds of ventilation, assess for heart rate and breathing. If the heart rate is more than 100 beats per minute and the baby is breathing, we stop ventilations gradually. If the heart rate is more than 100 beats per minute and the baby is not breathing, continue ventilation and reassess after 30 seconds. If the heart rate is less than 100 beats per minute and the baby is not breathing, call for help immediately. And if there is no trained person in the facility, arrange for transfer and continue ventilations during transfer of the baby to higher center.

[01:30:17]>> Yeah. Thank you. So yeah. So am I audible?

[01:30:35]>> Yes. Yes. Yes, you are audible.

[01:30:36]>> Yeah. So if there are any questions, Dr. Vijendra, you can put those questions.

[01:30:42]Uh as I said many question just remember H O H for heart rate O for oxygen and D for doctor or advanced care >> sir many question are there but time uh slot not allowed so we can move for the next slot >> Dr. Pan sorry sorry Dr. Uh Akash I have one one one question constantly asked in the uh you know chat boxes that know the video demonstrate opening the mouth and and you know what to do. Would you just shall we take one stand on it so that people understand what to say in that?

[01:31:17]>> Yeah. So I would invite comments from other panelists also. But uh my answer to that question is uh understand that corrective steps are basically to ensure effective ventilation. Now effective ventilation most of the times is because of uh leak somewhere from the between mask and face or a blocked airway. So if you take care of basically mask reapplication and reposition of head most of the problems will be solved.

[01:31:50]Most of the problems will be lying there.

[01:31:52]uh suction and increasing pressures are two more corrective steps that are to be done if after M and R the chest edge is not there. For some reason the government module has removed O which is open mouth.

[01:32:07]>> Yeah. Yeah. Akash I I would Akash I would like to add something. Why this open mouth was there? It is only for very pre-term babies where the nears because when we ventilate a baby with bag and mask the air passes through the ns of the baby but what happens suppose when there is a very small baby or pre-term baby and ns are very small then the air may not pass through that nes through the lungs. So for a special situation like very pre-term babies it is required that you should open your mouth with your finger and then apply the mask and then ventilate the baby. So in most of the situation it is not uh not to be used. So therefore we have removed it from the basic NRP because very pre-term 24 weeks 25 weeks only it is there or if there is obstruction to ns. So it is an very rare situation and we should not discuss about this. So please focus on the four points that Dr. Akash has said and don't give more stress on open work. We have very less time. So you should in that 4 hours training you should be able to tell the participants or give them the skills to ventilate the baby that is more important. Thank you.

[01:33:35]>> Thank you. Can I suggest something you would say that if in case they by mistake >> sorry if in case you say opening the mouth do not have to reverse it just continue with it and also have a faculty meeting and just you know discuss on what your uh uh what you're going to say so that just to maintain uniformity cuz opening the mouth is not wrong. So just to you know decide what to say and then say if by mistake you say also just continue with it.

[01:34:06]Yeah, that's fine. But if you don't if if you don't use it, you have the government manual to back you up. So that's fine. Perfectly fine.

[01:34:15]>> So we have to follow this PCL what we are providing all of you. Don't get confused because you have very limited time, right? And you have to teach them.

[01:34:26]So please follow the PCL. It is clearly mentioned in the PCL and follow the PCL.

[01:34:32]Many of I know many of you are the advanced and RP trainer or trained person. So there are this thing such things are there. So don't get confused here. Here most of the participant would be the nursing staffs right. So don't get them confused. Just follow uh the PCL.

[01:34:55]>> Right? Just to just just to reemphasize in the PCL as well as in the algorithm it is MR and SP only these four sides are there.

[01:35:05]>> One more question that is popping up in the chat box is 30 seconds pay observational care or poster station care. Please remember this is different from advanced NRP. We again and again are uh requesting you to switch to the basic NRP mode. Go through the PCL properly. In PCL it is very clear that brief ventilation walabacha will go for observational care. Prolonged ventilation walabacha will go for post resuscitation care.

[01:35:32]If there are no further questions then we can go ahead for pet which is another important segment.

[01:35:39]>> There are many questions are there but uh time slot not allowed for the we can take in last last Q& that can give answer otherwise we can move to the next session.

[01:35:50]>> Yeah. Yeah. Brigender we can post in the chat box also. Akash you can type in that chat box now.

[01:35:56]>> Yeah I'll type in the chat box because right now I cannot I cannot see the chat box. So I'll after this session I will type in the chat box.

[01:36:04]>> You you type in the Akash. Do you see question and answer there? Q&A >> you have to click on that you able to see. No because I'm able to see that's why I'm asking you.

[01:36:13]>> Praash I'm able to see that but I can't talk and type at the same time. So after Yeah. Yeah.

[01:36:21]>> Yeah. Okay.

[01:36:23]>> Okay. Thank you so much.

[01:36:28]>> Thank you Akash.

[01:36:30]That was uh a very important session because as you know basic NRP we always concentrate on the most important step in resuscitation which is PPV and uh PPV station is divided into brief ventilation and prolonged ventilation.

[01:36:45]So that is the most important difference from advanced NRP. So like everybody has been telling you before please switch over from advanced NRP we are teaching basic NRP and we are going to have a lot of people who are attending this course for the first time and that is also the strength of this program I think um and um now we are moving on to the uh next session and very very important session how are we going to evaluate the participants at the end of the course um by this is going to be done by using performance evaluation tests the PET forms just for because there were a lot of questions in the chat uh about um difference between PCL and PET and what is this? So the performance checklist is a checklist that we use at every station. Uh you can even start off your station with a PCL but a PCL needs to be used at every station. The pet is what is used at the end of the course. After you've completed your stations, you will be using the pet. U over to Vikas sir to discuss about pet.

[01:38:00]>> Yeah. Thank you Sharia. Now uh regarding this PCL and pet the PCL is for practice.

[01:38:10]Okay. So we practice the uh resuscitation skills in uh pieces. We are doing we have six PCLs. So we are doing uh preparation for birth. We are doing initial steps. We are doing bag and mask ventilation and all these things. Now what is PET? In PCL we don't have any time limit. The participant take can take his own time and perform.

[01:38:37]This is for practice only to memorize the steps and how to do the it correctly onto the mannequin. Now after this training comes the performance evaluation test in which there are two important things. First is that the pet should be done in real time as the baby is born. What is our goal? Our goal is that the baby should get ventilated within 1 minute of life. So this has to be interpreted in this pet. So when the baby is born we should see how the participants work on this and how they perform ventilation if the baby is not breathing within 1 minute of flight. So for this session what is important is first as an instructor you will demonstrate how to do pet then the participants will follow. Please remember this you see how you will do pet and you should not falter in timing.

[01:39:37]So you should practice this pet in at your home before going to the training otherwise it will not be good in front of participants you will not be able to do in time. So the performance evaluation time the first thing is you will assess risk factors and demonstrate preparation of equipment and supplies.

[01:40:00]Again I am saying because of the d of time we have only 75 minutes and this pet has to be done by every participants.

[01:40:10]So we will get only five to 6 minute each participants. So what you will do is the risk factor demonstration and preparation and equipment and supplies because it takes a very long time. So what you will do is you will show them you will tell one or two participants to do it but afterwards you will start from the uh delivery of the baby. So it this is preparation equipment and supplies.

[01:40:38]If the time permits you can do it with all the participants. If the time does not permits at least one or two participants should show it or you yourself should show how to assess risk factor demonstrate preparation equipment and supplies but the rest of them will start with function of bag and mass and delivery the delivery of the baby. Now in this performance evaluation test there are three columns 0 1 and two zero. If the participant does not do that step then you have to tick on zero.

[01:41:12]If the participant do the particular step but he has not done it correctly or he has not done that step in order then you will take on one two number you will give when the participant has done it correctly and at the correct place then you will give the number two for this training for the sake of this training I am again saying you as it is written that student must perform perform each of five bold items correctly. What are the five bold items? First is they should test the function of bag and mask. Second is they should know when to uh when the baby will require positive pressure ventilation because after initial steps if the baby is not breathing they should say that now this baby will require positive pressure ventilation. Third point is take corrective action if chest rise is not present. So they should know that chest r is not present. And then the most important part is ventilate for 30 seconds effectively with chest r on the baby. And then the fifth point is that the person should call for help add oxygen and count heart rate if the baby is not breathing after brief ventilation. So these are five points for the sake of this program. I would say you at least at least your participant should start the ventilation within 1 minute of after 1 minute of birth. You should check the time. You should imitate that the baby is has been born and then you should see whether in 1 minute the person is able to start the ventilation and after starting the ventilation if the per if the healthcare workers is able to do effective ventilation for 30 seconds then you can pass that participant. Don't be very strict only stick to two two points.

[01:43:17]Don't go into further details. Even if the participant is able to first start the uh ventilation within 1 minute and do effective ventilation in 30 seconds, you can pass that uh particular participant. And remember in the previous workstation also your focus should be that every participant should get enough time on mannequin to practice bag and mask ventilation. There are two things in bag and mask ventilation.

[01:43:52]First is how to make seal. There are two different ways to make seal. One is C type E type. Then if there are two persons available, he can make a seal with two hands. Two hands and the importance is of seal and then maintain the correct rate and rhythm. Remember when you are anxious when the baby is not breathing always you will not maintain the required rate. You will ventilate with a very higher rate. So you have always you should always speak out breathe two three breathe two three breathe two three make sure that the participant always speak out when he is ventilating he or she is ventilating otherwise what will happen they will ventilate at a very high rate breathe breathe breathe breathe breathe breathe they will do it like this so please tell them please speak out breathe two three breathe 2 three this is the crux of training first is how to make a seal properly and then how to ventilate properly for 30 seconds. So in this piece uh pet this is very important and remember you should lead you should show them how to uh ventilate. If you are not prepared you will fail. I remember when I first went as an instructor, my teacher told me to practice thousand times on the menu. So this is the key.

[01:45:25]You see all the videos, you practice.

[01:45:29]Don't discuss theory. Don't discuss theory. Show them how to do it. Showing them is more important and doing is more more important. If some step is missed, it is of no importance. But you miss how to ventilate a baby because I have seen in many trainings that they are giving importance to all other things but they are not showing how to ventilate baby properly. Even the instructors are not able to do it properly. So as an instructor I request you all you all have mannequin with you. you with bag and mask you first practice yourself how to properly ventilate the baby and then show them practice them. So this is the crux. So again I am speaking in pet time is very important.

[01:46:20]Second thing is two things you have to see that the baby should be ventilated within 1 minute and the baby ventilation should start within 1 minute if the baby is not breathing and second thing is the person should be able to ventilate the baby effectively in 30 seconds. Suppose a person is healthare worker is not able to do it. Then you stop that scenario.

[01:46:46]Tell that person to come in the end.

[01:46:49]Give him a second chance. Let him see what others are doing. He will learn and then give him another another chance to do it. And if you do do it properly, then you can pass the participant.

[01:47:05]any questions or any uh Brigender?

[01:47:11]>> Uh yes sir.

[01:47:12]>> Yeah.

[01:47:14]>> So sir uh next question is what what O2 to start with and how will we know the PO2 requirement and how to adjust where there are no O2 vendor.

[01:47:26]>> There is no in this basic NRP. Please remember come out of your mindset of advanced NRP. Come out of your mindset of advanced NRB whether we require 40% 100% it doesn't matters if the baby is not breathing and heart rate is less than 100 you have to give 100% oxygen is it clear is this clear to everybody or is there any sense if the heart rate is less than 100 you have to give 100% oxygen any other questioner M >> uh sir uh yes sir so how to assess the requirement percentage of oxygen when we need to connect wire >> I have already cleared it if in this basic NRB we don't have any pulse oximter or anything so what we are talking is if the baby heart rate is less than 100% less than 100 then you have to attach the oxygen and you have to give 100% oxygen is is clear.

[01:48:36]>> Okay. So, can we move to the next chara?

[01:48:41]>> Okay. I think there is no more question.

[01:48:45]So, I think now can we move to the next?

[01:48:49]>> Yeah. Yes sir. Um, thank you sir. Uh, pardon my video. We had a power cut at the exact moment that I'm supposed to talk. Um but um I think we are moving on to the most important uh session which is a lot of doubts. We have been receiving a lot of queries about logistics um and uh we have been trying to uh answer all the queries on all the WhatsApp groups but I'll just go through the entire flow of the course now and at the end of the session we'll take queries about all the logistics. Um so I've divided the session into three parts which is precourse during the course and postc course what are the responsibilities of the instructors and the course coordinators.

[01:49:40]So uh the most important thing precourse is uh to ensure uh enrollment and registration of all the participants. Um and uh I would like to take this moment to inform you uh just like the election results we've been having live results of all our courses and participants that we've been sharing and we have reached 998 courses as of now. So just two short of thousand courses and uh we have 18,77 participants registered on the portal.

[01:50:14]Um and out of that 13,000 have already completed the pre and post test. So that that is a great number. Uh but we would like all the course coordinators to um ensure that all your participants the estimated number of participants get enrolled onto your um dashboard. Um and the other thing to ensure is your instructor to participant ratio and your mannequins. Please ensure that you have the mannequins and make sure that the mannequins are working so that we do not have uh you know any uh problems on the on the on the day of the course and uh uh ensure that the venue has enough space for the tables and the equipments to be arranged. The equipment checklist has been shared on both the folder I mean on the on the course coordinator folder. Um so at least a day prior to your um to the course please ensure that the equipments are ready. The banner and the backdrop has also been shared. Uh now this can be printed out. It can be a flex or it can even be a soft copy or at at the backdrop of your uh uh the the course where it's being conducted. So it is totally up to the course coordinator to take that call. Um as for refreshments, it's a 4hour course. So um uh refreshments can be arranged um uh as per the venue. Um and we uh want you to have good communication with the participants so that you know that there is enough participant engagement and to ensure that they turn up on time so that it's the course does not I mean the we stick on to the agenda.

[01:51:56]Um it would be good to have a faculty meeting uh maybe a couple of days before the actual course so that all the faculty and all the instructors are on the same page uh as to when when when to start the course, what is the agenda, how to stick to the timing and what are the points that are going to be discussed at each station. Um now I just want to show you the um course coordinator dashboard.

[01:52:37]Um, is my screen visible?

[01:52:41]>> Yes.

[01:52:46]>> So, just a minute.

[01:52:58]So your u if you click on your course coordinator uh link uh it will take you to this page where you sign in with your course uh coordinator ID and this is your dashboard. So in your dashboard you will see a tab called my courses list and all the courses registered under you. Some people might have one, some might have two. The courses will show on your dashboard. So, please go to action.

[01:53:26]Green means your course has been approved. If you go to action, you will actually see the number of expected participants and the number of participants that have already registered. So, scroll down and go to manage your course roster. Now this course roster will show you all the registered participants and their details their phone number and uh the date at which they have registered.

[01:53:52]Now on the day of the course if you want to mark attendance so this is the excel uh list that I mean the the uh dashboard that you will see. So in case you want to mark their attendance, not in case actually you need to mark the attendance, go to edit button and you will see a result or attendance tab.

[01:54:16]So you can actually choose pass, retrain or absent if the person didn't turn up.

[01:54:23]So this acts as both a result page and an attendance page. So say at the end of pet you are marking this person as past and here you see a choose file. Now if you go here if you have a soft copy of this particular person's performance evaluation test if you have taken a photograph or a PDF copy then you can attach it here. So it'll show up as a file and you can save this.

[01:54:57]Now once you have saved that on your dashboard again it will show you that you have saved a document and this person has passed.

[01:55:08]So at the end of the course the course coordinator has to ensure that the list has been completed.

[01:55:15]Even before the course please log to your um course coordinator dashboard. go to my courses and ensure that all your participants are getting registered by making sure that you're reaching the registered number as per your expected number. So this is something that you will have to do uh before the course.

[01:55:36]Now um during the day of the course, so once the participants start walking in um you could have a registration sheet at the at the um front desk or at the beginning of the course. Again, for this registration sheet, you can just use your same course roster. So if you go to your course roster and do an Excel sheet, there's an Excel option here. If you click on Excel, so it will generate a complete attendance sheet for you where you will have the participants and you can actually use this as a registration sheet as well. So as and when participants come in they can sign on the column and this will become your registration sheet. So you don't have to create a sheet another sheet you can use the same sheet.

[01:56:25]Now once registration is done divide your participants into uh batches of 10 and assign them a table. Um and the faculty also need to be assigned to each table. Say for example you have a course of 40 participants. So four groups of 10 each will be allotted to each table and one faculty to each table.

[01:56:50]Now uh like it was already mentioned by uh Dr. Vikas the faculty will rotate and the participants will remain stationary at the same table.

[01:57:02]So we've already discussed about doing PCL at each table and finishing your course with uh doing the pets uh just for the benefit of those who have not seen the agenda.

[01:57:15]So the agenda is goes like this. There's 15 minutes for registration and for you to have maybe a brief introduction to the course.

[01:57:24]Session one which is preparation we have 30 minutes. Session two for routine care and initial steps we have 30 minutes.

[01:57:32]Session three which is PPV station we have 75 minutes. And for performance evaluation we have 75 minutes. So once the performance evaluation is done and uh uh the pet forms have been collected by the course coordinator then we finish the course by doing uh maybe a completing the session a brief talk a photo session video session and feedback. Now the video can be done instead of doing it at the end uh can be done during the course of the session a one minute video to show the tables the faculty teaching the participants and all the participants in the course. Uh this is to ensure that you know we do have some proof of all these courses being done in all the in in across um all the states and uh the photo session um uh we need two which are mandatory one at the beginning of the course and one at the end of the course. This is again to ensure that uh we do maintain the quality and uh uniformity of the courses. Um so um take a geotagged and timestamp photo at the beginning and one at the end of the course. Now these photos and videos uh can be shared on your state WhatsApp groups. Every state has a WhatsApp group and these will be collected by the state coordinator. Now the good thing about these WhatsApp groups is uh the people from the central NNF office are also on the group. So they will also be able to help the state coordinators collect all this data.

[01:59:13]uh in the end.

[01:59:16]Now this is during the course a postc course like we already said. So there are three ways in which uh the pet forms can be submitted. One is individually take a a copy of each PT and upload it on the dashboard like I showed you. Or the other way of doing it is just a minute I will just show you. Um we have created a online uh pet form. So we will share the Google uh uh link with you uh shortly after the session. So instead of doing a paper copy copy of a pet you can use this online Google form also uh just on your phone to assess each candidate. So this uh you will need just basic details like email the the participants email course ID instructor name and uh name of the candidate and just like your pet this has all the options. the uh 012 can be marked.

[02:00:30]So finish this and mark as pass or reevaluate any remarks that you want to write here and submit this form. So this is a completely online form. If you do this uh you do not have to upload a pet form separately. But if you're using a paper copy, please upload the form either individually on the course coordinator's dashboard or collate all your forms, make a single PDF and share it with your state coordinator. So there are three ways of uploading your pet forms.

[02:01:08]Now we also uh want you to take a print out of the participants list at the end after you've marked the results.

[02:01:17]The results will be marked on the dashboard. So please take a print out of that particular form as an excel sheet or as a PDF form and please sign the form and place your stamp on it. So that this also will be another way of u knowing that this is authentic and has uh the the course has taken place. Like I already said the pictures and the video can be sent uh to the state coordinator on the respective WhatsApp groups. So this is postc course. What about certificates? There are two types of certificates. One is an attending certificate and the other is the provider certificate. Uh so for uh the attending certificate the the format has already the soft copy has been shared on the course coordinators folder. Now this is not mandatory. Um many centers had requested us that they want physical certificates to be given away at the end of the course. So it is totally up to the center and the course coordinator to uh take a call on this. If you do want to distribute physical certificates, please take printouts and physically fill in the details like the uh the participants name, venue and it does have a place for a sign of the course coordinator and the lead instructor and this can be given to all participants at the end of the course. Again this is not mandatory.

[02:02:42]Uh as for the provider certificates for all candidates who uh successfully complete the course the ecertificates will be sent to them once the results have been collected and all the results have been verified.

[02:02:57]What about uh results of the post uh test that also many people have been asking. So we are just waiting for all the participants to complete enrollment and uh complete their post tests. Once this is done, uh the post test results will be sent to each course coordinator individually. So you will have those results before the day of the course and u uh this will come into play only when you have um a doubt about anyone's performance evaluation test. So say the participant has been extremely good and you have passed the participant based on just the PT, you will not have to look at the post test scores. Suppose there is somebody who's borderline and you are unsure whether you want to reevaluate or if you want to give pass then you can look at the poster scores and make a final decision.

[02:03:51]Um now yes for for us to be able to send these scores across to all the course coordinators uh we do need at least 2 days to collect all these results and send them over. So we please request that you know you urge all your participants to complete registration in the next one day. We were actually supposed to close all our participant registrations today. Um today is the 6th to so by uh midnight of 7th please ensure that all your participants have not just enrolled but also completed their uh pre-EST and post- test.

[02:04:29]Um I think we have covered yes um a very important thing about um maintenance of mannequins. So whether it is mannequins arranged by each center or whether it is um uh mannequins sent from sent over from central NF uh please make sure that the mannequins are being the the maintained the uh because they are you know with the like Vikas was mentioning with turning of the head to one side sorry Praash was mentioning there is a possibility that the the tube gets cut off and then the mannequin is not usable at all. So please ensure that there is no liquid leakage or no damage to the mannequin. Um this also is a very important aspect of conducting NRPS.

[02:05:21]Um I hope I have covered all logistics Akash anything that I have left out Len sir.

[02:05:37]Oh no, you have covered almost all the aspect Serena. The only one thing I want to add is uh that uh for authentication point of view after completion of the course the course coordinator has to sign and give the their stamp and also take uh signature of one or two person who is not part of this course. Right.

[02:06:07]So that would be the witness that this course has been completed otherwise you have covered everything.

[02:06:18]Uh Dr. Akars anything you want to add?

[02:06:24]No sir most of the jobs are covered.

[02:06:26]Yeah, >> there are some question in Q&A situ.

[02:06:41]>> Yeah.

[02:06:41]>> Uh post test, when should it be completed? Uh yes, please try to complete the post test by tomorrow.

[02:06:49]Enrollment and post test. So we have some time to collect the results and send it over to the course coordinators.

[02:06:56]Um, somebody has said we not I'm not able to access my dashboard. Um, please ensure you're uh using the correct coast coordinator ID. If you're still having problems, uh, get in touch with uh, us, one of us at NF office and we'll be able to help you out.

[02:07:13]Um, extend deadline for completing post test. Um, we are 3 days away from our course. So yeah uh we we would like that everything is done by tomorrow so that uh you know we can start collecting all our results.

[02:07:34]So please uh push your participants to it. It it actually doesn't take too much time. Uh you know it's it's a very if they have just 45 minutes to 1 hour they can complete the entire pre-EST videos and post test and they do not have to log in to watch the videos. Actually the video links have been sent separately also. So you can share it with them and they can watch it in bits and pieces also whenever they have time and then complete the pre and post test. So that is also a possibility.

[02:08:03]Some centers have not received mannequins. Um I think the mannequin status is being um shared on all the state groups. Uh so if you can just share the mannequin status on the state groups, the state coordinator also will be able to take your queries.

[02:08:23]>> Sir, there is one question about uh what you said about witness. Can you please tell that again?

[02:08:31]She asylum has returned. Please repeat that. So sam we need to get the uh document uh I mean the attendance and all these things signed by the course coordinator and we need to take two witnesses right anybody from your hospital you can just take the sign that that means that we have conducted this course nothing else >> any from the participants Anyone apart from the participant as well as the instructor?

[02:09:08]>> Instructors.

[02:09:10]>> Yes.

[02:09:19]Uh how there is one more question. How to cross check whether participants have completed pre and post test? Um so um as of now the course coordinator will not be able to see that. So that we request that you ask them to send you a screenshot of their completion. They will get a uh final page where they have submitted and if they have given an email ID they will also get an email which confirms submission.

[02:09:44]Um but uh like I already mentioned if you if everybody finishes by tomorrow then we can collate all the results and send it to you that will be proof that all your participants have finished the post test.

[02:10:00]How to see my participants course ID?

[02:10:02]Your participants will be registered under your course ID. So they should be registered. You should be providing them with your course ID to register.

[02:10:14]Um are there any other questions that I'm missing?

[02:10:18]>> Dr. Arunar Mangalik has asked a question that if the neonatal water fillable neonatalies are not available then can BLS um mannequins be used. So any mannequin that can show chest rise or that can show ventilation effectivity can be used.

[02:10:44]There is one more question. Participants are entering into other courses. Yeah, this is uh exactly why we want you to give them the correct course ID uh and ask them to register into those courses because we've having a lot of requests for deletion of participants and re um which is extremely difficult at this point because we we are 3 days from uh the program. So please ensure that you give them the correct course ID but if there have been um errors like this get in touch with the office and we will be able to correct it for you.

[02:11:20]>> Can we add ma'am?

[02:11:21]>> One question one question the uh online uh this online PT Google form is to be done on every participant's phone or on evaluator's phone for each participants.

[02:11:35]Uh so sorry I didn't get the pets to be done for >> for each participants uh by their mobile or from aut uh instructor mobiles for each participants.

[02:11:46]>> Instructor mobile >> instructor's mobile instructor's mobile yeah it is to be accessed only by >> instructor mobile and also for each participant form should be filled and and if you are not comfortable please take the hard copy and do on that. Yeah.

[02:12:08]Also please uh ensure the Google form that we are sharing is not shared in your um course WhatsApp groups because that is to be accessed only by the instructors and the course coordinators not by the participants. So it's extremely important that access is limited only to uh course coordinators and instructors.

[02:12:33]>> Uh ma'am one query uh >> uh Dr. Sithal asking uh uh she has 16 participant and only one instructor and uh one mannequin. How to conduct this course? Actually >> uh we will have to ensure the 1 is to 10 ratio for mannequins and instructors. So either try to source another mannequin and an instructor or uh you will have to rest restrict your participants maybe ask them to do two courses. Two courses correct one for morning and another in the evening >> that will better.

[02:13:10]>> Yeah. Yes sir. I just wanted to add one more more point in the the for the pet forms you are doing it online. Uh we will be able to share a viewing excel sheet in case you just wanted to see whether all your participants have entered. You may have to download that sheet sort the uh course ids then you'll be able to see what are the participants are there in your uh where they have registered in your course. But you will only be able to view, you won't be able to uh edit. So in that which case you may have to download that sheet and then do your uh manipulations.

[02:13:54]So there any other questions?

[02:14:02]I think Dr. Om Prakas has raised hand.

[02:14:10]Can we unmute Dr. Praas or you you can just write down the question sir.

[02:14:19]>> Ma'am Dr. Den is asking uh any chance to edit the participant list those who already registered by mistake please clarify only office can do.

[02:14:30]>> Yes.

[02:14:33]Other option is they should they enroll into two courses and and participate in the course they are supposed to and anyway it will be marked absent in the other uh course. So that is one other way to include them into your course.

[02:14:55]>> The video to be taken during the course at what time please?

[02:15:01]any time during the course. It is it just has to show your venue, your arrangement, participants and the faculty being present.

[02:15:12]>> So they're asking about the instructor certificate.

[02:15:16]>> Yes, all faculty will receive a certificate at the end of the course.

[02:15:25]Yes, if we >> asking about the uh sorry if we don't have the neonali if you do have an infant mannequin which shows chest r because there are two types of mannequins one is only for chest compressions it does not show chest r so if you do have one with chest r yes yes you can use I think there are some more questions related to instructors, lead instructors etc. These uh we can give a general answer that these can be discussed with the state coordinators >> right >> every question won't be able to be answered here on this platform.

[02:16:14]>> So can we conduct course on some other day? Yes, definitely you can conduct a course on some other day. The only thing is it will not come under this particular initiative. Uh this particular initiative is one day one nation one mission. So we're trying to do it as a single day multiple venues initiative. So people who are unable to source mannequins or instructors yes you can do it in another day but it will not appear under this initiative.

[02:16:44]Uh one more is when two particular question yeah that particular question says 20 nurses in one day so do two courses no pre-launch post lunch >> Dr. S do two courses do it on 10th May only.

[02:17:10]>> Is there a scheduled time by which it should start? No, there is no scheduled start time. If you look at the agenda, we have only mentioned the time for each station. So whether you start at 8 or 9, it is uh uh the course goes on for 4 hours. That's that's the way agenda has been designed. Um so people who are doing two courses are doing 9 to 1 and 2 to 6. So you can pick um any time.

[02:17:38]>> No the only thing is if they have very less number of participants then it may not require four hours. Suppose they're doing for five or something like that then probably the time will really come down.

[02:17:49]>> Yeah. But the minimum participant is 10 right? We have kept 10. No s.

[02:17:54]>> No sir. No sir.

[02:17:58]Maximum per instructor is 10. But then even >> Yeah. Yeah.

[02:18:02]>> So we don't have any course which has gone below eight. So the lowest that we have in a course is eight in some of the remote areas.

[02:18:09]>> Almost. Yes.

[02:18:15]So um uh Harishan sir asking about the can we allow more participant and add a instructor in the course ID already registered. Yes, you can. But you have to inform the office. They can edit that >> sir. More than 10, sir.

[02:18:42]>> No, they can add the instructor as well.

[02:18:48]>> Is there a cap for each course? 40 per course or they can do more than 40?

[02:18:55]>> No upper. There is no up >> with appropriate instructor. If you are having the mannequin and instructor you can go. There is no upper limit. People are doing.

[02:19:04]>> Yes sir. But in the >> when they register they can only enter four instructor name.

[02:19:11]>> That has been edited sir. So we have uh gone up to seven at the most because that was the request was the highest request. So right now we can add up to seven in one course.

[02:19:23]Uh um ma'am actually many center asking for uh two three person extra like 40 is registered and 42 43 41 44 then we can allow or not.

[02:19:35]>> So they as Akas has said they can discuss all these things with the state coordinator.

[02:19:43]>> Okay sir Alan sir one question is Dr. Huninger is asking can we make the ratio as 1 is to 12? You have to take a call on that. I think >> uh again depends upon they can take the call at the local level.

[02:20:02]Suppose you have one mannequin, one participant and suppose one more participant come you cannot deny right.

[02:20:13]>> Then you have to increase the time of training.

[02:20:15]>> Yeah.

[02:20:16]>> You will have to increase the time.

[02:20:18]>> Right. But if if possible stick to the >> yeah we need to >> we have to increase the time 5 hours 6 hours he can train that any other question >> I think we can wrap >> okay so it was excellent session so may I request our treasurer Dr. Rabi Sachan to propose vote of thanks. Thank you everyone. Thank you very much for the excellent discussion and uh all the faculty member. Thank you very much.

[02:20:54]Over to Dr. Rabi.

[02:20:55]>> Thank you sir.

[02:20:56]>> Thank you sir for giving the uh opportunity to present my vote of thanks. Uh I sincerely thanks uh to all the national coordinators and uh journal coordinators, state coordinators, faculty members and uh all the participants for you know uh making this momentum a national a true national program and we are treating the frontline uh you know training and the frontline healthcare worker creating a capacity building in a in a major scale which is uh which is at a global level And uh thank you sir for your uh our president sir for visionary leadership and uh guiding us all uh throughout this uh program and I can assure you sir that uh all our teams are they are working uh day and night and uh we'll make it a true uh vision for this and I thanks our honorary secretary Dr. Dritupyas for uh he's making uh the tireless effort to make this program successful and uh our IP mentor Dr. Vikas Goyel he has an already and always give a very grout very critical input which are required for the execution of the program and uh professor Akash he's very meticulous in all you know sorting out the queries and detailing all the fine fine things and uh a special thanks to Sara she's not leaving any stone unturned to make it the grand success planning and executing in a very grassroot level and connecting to the Such a massive skill is not an easy job.

[02:22:37]Uh thank you so much Sana for your putting an extra effort extra mile you know to making it a success grand success and then uh it's all about the participants you know so I can only say just keep keep this momentum high keep your juice high we are at the level of making a history and probably we'll make it in with a great success grand success which is never in the in the history you know it is never precedented So thank you so much for you know >> and also our office and also our office staff who is working day day in day and night deun and the new staff >> all all staff >> everybody's our office office executive right from the everybody every staff member and office uh the people are working very hard >> and everybody's working very hard >> yeah yeah nituj also So and she's also planning for that. Thank you everyone for uh you know joining so late. Thank you. Thank you sir. Thank you so any housekeeping are you going to do this course again if somebody has uh not joined or uh >> yeah so >> yeah so if there are enough people who have not joined today then we can uh take one more session tomorrow.

[02:24:07]Similar same time we can have another session but uh maybe you can take a call sir if there are enough people who say that they have not been able >> we can review we can review the attendance and then we can take a call on that.

[02:24:21]>> Yeah >> right.

[02:24:23]Okay.

[02:24:24]>> We can communicate on the state groups.

[02:24:25]Uh sir we can put it on the state group.

[02:24:28]>> Uh see if the enough people are available for tomorrow we can do the same session tomorrow.

[02:24:33]>> We can put a poll in all state groups.

[02:24:35]Have you attended today's session? Yes.

[02:24:37]No.

[02:24:38]>> Yeah.

[02:24:38]>> That will give >> correct. Yeah.

[02:24:40]>> And if the majority is not joining and then if they are willing then can they can join. If if >> Yeah.

[02:24:45]>> If even then for today's session if they want to further clarify they can again join.

[02:24:50]>> So let the people decide.

[02:24:58]>> Okay.

[02:24:59]>> Okay sir. Okay. Okay. Thank you.

[02:25:04]>> Screenshot sir. Yeah.

[02:25:11]>> Okay. Ready?

[02:25:20]>> Yeah. Thank you.

[02:25:21]>> Okay. Thank you, sir. Thank you.

[02:25:23]>> Thank you so much. Thank you. Bye. Bye.

[02:25:24]>> Thank you. Thank you, sir. Good night.

[02:25:27]>> Good night. Thank you.

[02:25:29]>> Bye.

[02:25:30]>> Good night.

[02:25:30]>> Yeah. Thank you all of you.

[02:25:31]>> Good night, sir. Good night, sir. Thank you. Thank