Neonatal Resuscitation Program (NRP)
Evidenced-based Updates

Volume/Issue 27 Number (No) 2 Fall/Winter 2018

Updated: December 24, 2018; Published: December 24, 2018

Suctioning: Who, When and Why?

Palm Desert Resuscitation Education (PDRE) and the Neonatal Resuscitation Program (NRP) Steering Committee have been following diligently the steady stream of NRP Instructor Updates for the Fall and Winter Seasons of 2018. These fresh revised guidelines and recommendations for “Newborn Resuscitation” obviously come from the Members of the NRP Steering Committee and the American Heart Association (AHA) developed the 2015 United States (U.S.) Guidelines for Neonatal Resuscitation. The most recent guidelines are also reprinted in the appendix of the Textbook of Neonatal Resuscitation, 7th edition. Palm Desert Resuscitation Education (PDRE) and the NRP education materials via these scholarly provider manuals translate these prominent guidelines and recommendations into medical and clinical practice.

For instance, the NRP Steering Committee receives many questions about the current recommendation for suctioning the newborn at birth. This is actually Part 1 of a three-part series regarding newborn suctioning in the delivery room.

The Obstetric Provider and Newborn Suctioning: When the Amniotic Fluid is Meconium-stained

In the past, obstetric management of the meconium-stained newborn included procedures that were meant to reduce the risk of meconium aspiration syndrome (MAS). These procedures have historically included tracheal suction of vigorous and non-vigorous newborns and suctioning the hypo-pharynx before delivery of the shoulders (intrapartum suction). While intrapartum suctioning and tracheal suctioning of the vigorous newborn have not been recommended since the 2010 Guidelines, the 2015 Guidelines stated there was insufficient evidence to continue routine tracheal suctioning for non-vigorous babies born through meconium-stained amniotic fluid. A definitive randomized controlled trial is still needed.

In 2017, the American College of Obstetricians and Gynecologists (ACOG) published Committee Opinion Number 689 that concurred with the 2015 U.S. Guidelines for Neonatal Resuscitation. The American Academy of Pediatrics (AAP), AHA and ACOG agreed that non-vigorous meconium-stained babies should be moved to the radiant warmer for initial steps and be resuscitated in the same manner as babies with clear amniotic fluid. Implications for not transferring the neonatal baby to the radiant warmer quickly after birth – whether having risk factors or not necessitating neonatal resuscitations dependent on the amount of babies being delivered, gestation age, amniotic fluid consistency and make-up, and perinatal risk factors – may include mild (temperature between 36 C and 36.4 C or 98.6 F and 97.6 F), moderate (temperature between 32 C and 35.9 C or 89.6 F and 96.6 F), and severe (temperature between less than 32 C or less than 89.6 F) hypothermia due to the neonate’s inefficient thermoregulation system and jeopardy for hypothermia and cold stress syndrome which may lead to heat loss, increase in metabolic heat production, tissue hypoxia and neurologic damage with possible cardiorespiratory compromise needing neonatal resuscitation.

When the Amniotic Fluid is Clear

The current Textbook of Neonatal Resuscitation, 7th edition recommends bulb suction as part of the initial steps of newborn care if the newborn is having difficulty clearing the airway, if secretions are obstructing the airway, or if the baby is apneic or gasping and PPV is anticipated. Intrapartum suctioning is not ever recommended.

If a baby is unexpectedly born limp and apneic and the obstetric provider had planned to delay cord clamping, it is reasonable to quickly bulb suction the newborn’s mouth and nose and gently stimulate the baby to breath following delivery of the baby. If the baby does not begin to breathe immediately, the umbilical cord should be clamped and cut, and the baby moved to the radiant warmer for the initial steps of newborn care and further evaluation.

NRP Online Exam – Test Your Knowledge

After chest compressions with coordinated ventilations are started, the heart rate should be assessed:

  1. After 60 seconds
  2. After 30 seconds
  3. After 90 seconds
  4. When spontaneous respirations return

Answer to NRP Online Exam – Test Your Knowledge

The correct answer is: A. After 60 seconds

The heart rate should be assessed after 60 seconds of continuous chest compressions with coordinated ventilations in 100% oxygen.

Studies have shown that it may take a minute or more for the heart rate to increase after compressions are started. When compressions are stopped coronary artery perfusion is decreased and requires time to recover once compressions are resumed. Therefore, it is recommended that you provide 60 seconds of well-coordinated chest compressions and ventilation before briefly pausing compressions to assess the heart rate.

A cardiac monitor is the preferred method for assessing heart rate when chest compressions are required. Auscultation with a stethoscope can be difficult, prolonging the interruption in compressions, and potentially yield inaccurate results. A pulse oximeter may not reliably detect the baby’s pulse, especially when the baby’s perfusion is very poor.

Resources:

  • 2015 AHA Guidelines Update for CPR and ECC – CERCP
  • The American College of Obstetricians and Gynecologists (ACOG) Committee Opinion on Obstetric Practice – Number 767 (Replaces Committee Opinion Number 692) – MS NO: ONG-18-2174

Disclaimer:

Statements and opinions expressed in this publication are those of the authors of Palm Desert Resuscitation Education LLC (PDRE) and are not necessarily those of the American Academy of Pediatrics (AAP) or American Heart Association (AHA).

PDRE Pricing And Purchasing Options

As an authorized American Heart Association (AHA) training site, PDRE follows the authority in resuscitation science, research and training as published in the official AHA Guidelines for CPR and Emergency Cardiovascular Care (ECC). Our competent and experienced instructors interpret these Guidelines into the most premier quality training courses and programs in CPR, first aid and advanced emergency cardiovascular care for healthcare professionals, first responders, employees and the general public. We thank you for selecting PDRE as your preferred authorized AHA training site in Southern California.

This is a full listing of classroom-based and online courses as well as other services and products that PDRE offers. Please click on the specific course and program or services to view the full details and purchase options.

GROUP CLASSROOM-BASED COURSE
AND PROGRAM CATALOG

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
GROUP CLASSROOM-BASED COURSE AND PROGRAM CATALOGINITIALRENEWAL
ACLS for Healthcare Providers
ACLS – Advanced Cardiovascular Life Support
     Classroom-based course

    • ACLS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$280$200
     2015 ACLS Provider Manual or 2015 Handbook for ECC$50$50
     Total for the course and book$330$250
PALS for Healthcare Providers
PALS – Pediatric Advanced Life Support
     Classroom-based course

    • PALS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$280$200
     2015 PALS Provider Manual$50$50
     Total for the course and book$330$250
BLS – Basic Life Support
BLS for Healthcare Providers (English & Spanish)
     Classroom-based course$50$45
     2015 BLS Provider Manual$25$25
     Total for the course and book$70$65
Workplace Training
Heartsaver® Bloodborne Pathogens
     Classroom-based course $65 $65
     2015 Heartsaver Bloodborne Pathogens Workbook (required)$15$15
     Total for the course and book$80$80
Heartsaver® First Aid (English & Spanish)
     Classroom-based course $75 $75
     2015 Heartsaver First Aid Provider Manual$10$10
     Total for the course and book$85$85
Heartsaver® CPR AED (ENGLISH & SPANISH)
     Classroom-based course $75 $75
     2015 Heartsaver CPR AED Provider Manual$10$10
     Total for the course and book$85$85
Heartsaver® First Aid CPR AED (English & Spanish)
     Classroom-based course $110 $110
     2015 Heartsaver First Aid CPR AED Provider Manual$10$10
     Total for the course and book$120$120
Heartsaver® First Aid CPR AED for K-12 Students, Faculty, & Staff
     Classroom-based course $110 $110
     Heartsaver First Aid CPR AED Provider Manual$10$10
     Total for the course and book$120$120
Heartsaver® Health & Safety Training
     Classroom-based course $225 $210
     2015 Heartsaver® Health & Safety Training Manual (optional) $25 $25
     Total for the course and book $250 $235
Heartsaver® Pediatric First Aid CPR AED (English & Spanish)
     Classroom-based course $110 $110
     2015 Heartsaver First Aid Provider Manual$10$10
     Total for the course and book$120$120
Airway Management
     Classroom-based course

$125

$150

ECG & Pharmacology Course
     Classroom-based course $145 $145
     ECG & Pharmacology Student Workbook (optional)$25$25
     Total for the course and book $170 $170
Neonatal
Resuscitation Program (NRP) for Healthcare Providers
     Classroom-based course

    • Neonatal Resuscitation Program (NRP): In-Person Hands-On Skills Evaluation Testing (i.e., Performance Checklist/Megacode) ONLY $80 per NRP Provider Learner.
      • The special offer does not include the current NRP provider manual.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
 $135$135
     Textbook of Neonatal Resuscitation, 7th Edition (required) $70$70
     Total for the course and book$205$205
Pediatric Emergency Advanced Assessment, Recognition and Stabilization (PEARS)
     Classroom-based course without the provider manual (required) $150$125
Sugar, Temperature, Airway, Blood Pressure, Lab Work, and Emotional Support (S.T.A.B.L.E.) Program
     Classroom-based course $120$100
     The S.T.A.B.L.E. Program Learner and Provider Manual, 6th Edition$65$65
     Total for the course and book $185$165
Management of Assaultive Behavior (MAB)/AB-508 Violence Prevention
     Classroom-based course $70$65
PDRE’s Dog Lovers First Aid and CPR/CPCR Course
     Classroom-based course $70$65
Intravenous (IV) Therapy & Blood Withdrawal Certification by Palm Desert Resuscitation Education LLC (PDRE) & Replenish 360 (R360) IV Hydration Therapy (OPEN FOR ENROLLMENT NOW!)

Classroom-based course

$280$200
Preventive Health & Safety Practices (PHSP) Training Program For Child Care Providers

Classroom-based course

$225

$120

$105

$225

$120

$105

CERTIFIED NURSE ASSISTANT (CNA)/NURSE ASSISTANT TRAINING PROGRAM (NATP) CURRICULUM BY SOUTHERN CALIFORNIA NURSING ACADEMY, INC. (SOCAL NURSING)

Classroom-based course

    • CNA/NATP – Full Tuition Payment 
    • CNA/NATP – Payment Plan – 2 Scheduled Installments
    • CNA/NATP – Payment Plan – 3 Scheduled Installments
$2,350

$1,175

$783.33

$2,350

$1,175

$783.33

PRIVATE CLASSROOM-BASED COURSE
AND PROGRAM CATALOG

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
  • Private classroom-based courses charges may vary on season, location, and scheduling.
    • Private ACLS classroom-based courses = Additional $50 Fee
    • Private BLS classroom-based courses = Additional $30 Fee
    • Private Heartsaver classroom-based courses = Additional $30 Fee
    • Please call us to verify any extra fees and charges for private classroom-based courses at (760) 832-4277 or (909) 809-8199; email us at [email protected]; or fill out our questionnaire on our Locations & Contact Us informational page.
PRIVATE CLASSROOM-BASED COURSE AND PROGRAM CATALOGINITIALRENEWAL
ACLS for Healthcare Providers
ACLS – Advanced Cardiovascular Life Support
     Classroom-based course

    • ACLS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$300$280
     2015 ACLS Provider Manual or 2015 Handbook for ECC$50$50
     Total for the course and book$350$330
PALS for Healthcare Providers
PALS – Pediatric Advanced Life Support
     Classroom-based course

    • PALS – Save Money! Seasonal Discount!
      • $170 Provider or Initial Class
      • $130 Update or Renewal Class
      • Required provider manual, sold separately.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
$300$280
     2015 PALS Provider Manual$50$50
     Total for the course and book$350$330
BLS – Basic Life Support
BLS for Healthcare Providers (English & Spanish)
     Classroom-based course$150$130
     2015 BLS Provider Manual$25$25
     Total for the course and book$175$155
Workplace Training
Heartsaver® Bloodborne Pathogens
     Classroom-based course$110$105
     2015 Heartsaver Bloodborne Pathogens Workbook (optional) $15$15
     Total for the course and book $125 $120
Heartsaver® CPR AED (ENGLISH & SPANISH)
     Classroom-based course $120 $120
     2015 Heartsaver CPR AED Provider Manual$10$10
     Total for the course and book$130$130
Heartsaver® First Aid CPR AED for K-12 Students, Faculty, & Staff
     Classroom-based course $155 $155
     Heartsaver First Aid CPR AED Provider Manual $10 $10
     Total for the course and book $165 $165
Heartsaver® Health & Safety Training
     Classroom-based course $225 $210
     2015 Heartsaver® Health & Safety Training Manual (optional) $25 $25
     Total for the course and book $250 $235
Heartsaver® Pediatric First Aid CPR AED (English & Spanish)
     Classroom-based course $155 $155
     2015 Heartsaver First Aid CPR AED Provider Manual $10 $10
     Total for the course and book $165 $165
Airway Management
     Classroom-based course

$125

$150

ECG & Pharmacology Course
     Classroom-based course $145 $145
     ECG & Pharmacology Student Workbook (optional) $25 $25
     Total for the course and book $170 $170
Neonatal
Resuscitation Program (NRP) for Healthcare Providers
     Classroom-based course

    • Neonatal Resuscitation Program (NRP): In-Person Hands-On Skills Evaluation Testing (i.e., Performance Checklist/Megacode) ONLY $80 per NRP Provider Learner.
      • The special offer does not include the current NRP provider manual.
      • Rules and regulations of this special offer are subject to change without prior notice.
      • Only applies to PDRE LLC customers and cannot be combined with any other coupons or discounts.
 $135$135
     Total for the course and book $205$205
Pediatric Emergency Advanced Assessment, Recognition and Stabilization (PEARS)
     Classroom-based course without the provider manual (required) $150$125
Sugar, Temperature, Airway, Blood Pressure, Lab Work, and Emotional Support (S.T.A.B.L.E.) Program
     Classroom-based course $120$100
     The S.T.A.B.L.E. Program Learner and Provider Manual, 6th Edition$65$65
     Total for the course and book $185$165
Management of Assaultive Behavior (MAB)/AB-508 Violence Prevention
     Classroom-based course $70$65
PDRE’s Dog Lovers First Aid and CPR/CPCR Course
     Classroom-based course $70$65
Intravenous (IV) Therapy & Blood Withdrawal Certification by Palm Desert Resuscitation Education LLC (PDRE) & Replenish 360 (R360) IV Hydration Therapy (OPEN FOR ENROLLMENT NOW!)

Classroom-based course

$280$200
Preventive Health & Safety Practices (PHSP) Training Program For Child Care Providers

Classroom-based course

$225

$120

$105

$225

$120

$105

CERTIFIED NURSE ASSISTANT (CNA)/NURSE ASSISTANT TRAINING PROGRAM (NATP) CURRICULUM BY SOUTHERN CALIFORNIA NURSING ACADEMY, INC. (SOCAL NURSING)

Classroom-based course

    • CNA/NATP – Full Tuition Payment 
    • CNA/NATP – Payment Plan – 2 Scheduled Installments
    • CNA/NATP – Payment Plan – 3 Scheduled Installments
$2,350

$1,175

$783.33

$2,350

$1,175

$783.33

ONLINE COURSE AND PROGRAM CATALOG

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
ONLINE COURSE AND PROGRAM CATALOGINITIALRENEWAL
Courses for Healthcare Professionals
Acute Stroke (Online)
     Online course only with Access Key $60$55
Nonvalvular Atrial Fibrillation (Online)
      Online course only with Access Key $60$55
Workplace Training
Heartsaver® Bloodborne Pathogens (Online)
     Online course only with Access Key $70$70
     Skills Tests only (optional) $35$35
     Bundle package ($10 Savings!)

    • Purchase of both online course Access Key and Skills Tests*
 $95*$95*
Heartsaver® First Aid (Online Part 1) And Skills Tests
    Heartsaver® First Aid (Online Part 1) And Skills Tests$80$80
    Heartsaver® First Aid Skills Tests (Only if Online Part 1 is Complete)$40$40
    Heartsaver® First Aid (Online Part 1) $40 $40
Heartsaver® CPR AED (Online Part 1) And Skills Tests
   Heartsaver® CPR AED (Online Part 1) And Skills Tests $90$90
   Heartsaver® CPR AED Skills Tests (Only if Online Part 1 is Complete)$50$50
  Heartsaver® CPR AED (Online Part 1)$40$40
Heartsaver® Health & Safety Training
     Online course only with Access Key N/A N/A
     Skills Tests only N/A N/A
     Bundle package

    • Purchase of both online course Access Key and Skills Tests*
 N/AN/A
Heartsaver® Pediatric First Aid CPR AED (Online Part 1) And Skills Tests

Heartsaver® First Aid CPR AED (Online Part 1) and Skills Tests

   Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) And Skills Tests $110 $110
   Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) Skills Tests Only $60$60
   Heartsaver® (Adult/Pediatric) First Aid CPR AED (Online Part 1) $50$50
HeartCode® ACLS (Online Part 1) and Skills Tests
ACLS – Advanced Cardiovascular Life Support
    HeartCode® ACLS (Online Part 1) and Skills Tests$250$250
    HeartCode® ACLS (Online Part 1) Skills Tests Only$150$150
    HeartCode® ACLS (Online Part 1)$100$100
HeartCode® PALS (Online Part 1) And Skills tests
PALS – Pediatric Advanced Life Support
    HeartCode® PALS (Online Part 1) and Skills Tests$250$250
    HeartCode® PALS Skills Tests Only$150$150
    HeartCode® PALS (Online Part 1)$100$100
HeartCode® BLS for Healthcare Providers (Online Part 1) And Skills Tests
BLS – Basic Life Support
    BLS for Healthcare Providers (Online Part 1) and Skills Tests$90$90
    BLS for Healthcare Providers Skills Tests Only$50$50
    BLS for Healthcare Providers (Online Part 1)$40$40

HeartCode® BLS (Online Part 1)
    HeartCode® BLS (Online Part 1) and Skills Tests$90$90
    HeartCode® BLS Skills Tests Only $50 $50
    HeartCode® BLS (Online Part 1)$40 $40
Learn:® Rhythm Adult (Online)
     Online course only with Access Key$70$65
Learn:® Rhythm Pediatric (Online)
 Online course only with Access Key $60 $55
Learn:® Rapid STEMI ID (Online)
     Online course only with Access Key $70 $65

PROVIDER MANUALS

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
PROVIDER MANUALSPRICE

 2015 HEARTSAVER FIRST AID PROVIDER MANUALS

 $10

 2015 HEARTSAVER CPR AED PROVIDER MANUALS

 $10

 2015 HEARTSAVER FIRST AID CPR AED PROVIDER MANUALS

 $10

 2015 HEARTSAVER PEDIATRIC FIRST AID CPR AED PROVIDER MANUALS

$10

2015 BLS PROVIDER MANUALS

 $25

2015 ACLS PROVIDER MANUALS

$50

2015 EMERGENCY CARDIOVASCULAR CARE (ECC) HANDBOOK

$50

2015 PALS PROVIDER MANUALS

 $60

 2015 PEARS PROVIDER MANUAL

$60

THE S.T.A.B.L.E. PROGRAM, LEARNER/PROVIDER MANUAL 6th EDITION

 $65

 TEXTBOOK OF NEONATAL RESUSCITATION (NRP) 7th EDITION

 $70

Note: Reference Cards Guides are also available upon request for purchase(s).

Note: Electronic Manuals in the form of E-Books are also available upon request for purchase(s).

Price may vary

OTHER PRODUCTS

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
OTHER PRODUCTSPRICE
Emergency Disposable CPR Face Shield $1

Adhesive Vinyl Hard Hat Decal, Legend “CPR FIRST AID CERTIFIED AND TRAINED” (Graphic, 2-1/4″ Diameter, White on Red)

$2.50

Pocket Reference Card (for all of the disciplines)

$12

Adult CPR Pocket Resuscitator Mask

$15

Adult Ambu Bag (Bag Valve Mask/Device)

$40

Pediatric Ambu Bag (Bag Valve Mask/Device)

$45

OTHER SERVICES

  • Note: Policies, terms, conditions, and prices may be subject to change without prior notice at any time depending on market value and vendor pricing in addition to yearly, seasonal and daily discounts and specials. Palm Desert Resuscitation Education (PDRE) reserves the right to update or modify these policies, terms, conditions and prices.
SERVICESPrice
Automated External Defibrillator (AED) Service Package for your Business or Home
Each AED Purchase + Standard Cabinet with Alarm
Philips HeartStart Home Defibrillator (AED)

  • Previous Retail Price: $1,995.00
  • PDRE Price: $1,100.00 ($895 Savings!)
  • Refer to the AED Service Package Plan for more information about this product
  • First Voice AED Basic Wall Standard Cabinet with Alarm
  • Previous Retail Price: $229.00
  • PDRE Price: $200.00 ($29 Savings!)
  • Pricing and rates does not include tax and shipping fees
$1,300
Labor and Installation Fee at your location

  • Mounting of AED and standard cabinet with alarm
  • Includes Accuform Signs Projection Sign, Legend “AED” with Graphic, 6” x 5” Panel, 0.10” Thick High-Impact Plastic
    • Previous Retail Price: $30.00
    • PDRE Price: $0.00 ($30 Savings!)
$150
Monthly AED Service Support Fee (Optional)

  • Includes access to AED Maintenance Plan
  • Available for one year contract

$30/month

$250/year

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Palm Desert cities:

WEST FROM PDRE
Redlands (92373, 92374, 92375)
Morongo Valley (92256)
Cabazon (92230)
Banning (92220)
Beaumont (92223)
Yucaipa (92399)
San Jacinto (92581, 92582, 92583)
Hemet (92543, 92544, 92545, 92546)
Temecula (92589, 92590, 92591, 92592, 92593)
NORTH FROM PDRE
Twentynine Palms (92277, 92278)
Yucca Valley (92284, 92286)
Big Bear Lake (92315)
EAST FROM PDRE
Joshua Tree (92252)
Salton Sea (92275)
Brawley (92227)
El Centro (92243, 92244)
Blythe (92225, 92226)
Calexico (92231, 92232)
SOUTH FROM PDRE
Borrego Springs (92004)
Anza (92539)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Redlands area cities:

  • Fontana (92331, 92334, 92335, 92336, 92337)
  • Riverside (92501, 92504, 92505, 92502, 92503, 92506, 92507, 92513, 92514, 92515, 92516, 92517, 92519, 92521,92508, 92509, 92522)
  • Corona (92877, 92878, 92879, 92880, 92881, 92882, 92883)
  • Rancho Cucamonga (91730, 91701, 91729, 91737, 91739)
  • Upland (91784, 91785, 91786)
  • San Bernardino (92401, 92402, 92403, 92406, 92408, 92404, 92405, 92407, 92410, 92411, 92412, 92414, 92415, 92423, 92424, 92427, 92413, 92418)
  • Murrieta (92562, 92563, 92564)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Riverside cities:

  • Fontana (92331, 92334, 92335, 92336, 92337)
  • Riverside (92501, 92504, 92505, 92502, 92503, 92506, 92507, 92513, 92514, 92515, 92516, 92517, 92519, 92521,92508, 92509, 92522)
  • Corona (92877, 92878, 92879, 92880, 92881, 92882, 92883)
  • Rancho Cucamonga (91730, 91701, 91729, 91737, 91739)
  • Upland (91784, 91785, 91786)
  • San Bernardino (92401, 92402, 92403, 92406, 92408, 92404, 92405, 92407, 92410, 92411, 92412, 92414, 92415, 92423, 92424, 92427, 92413, 92418)
  • Murrieta (92562, 92563, 92564)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding Orange County and Lake Forest cities:

  • Aliso Viejo (92637, 92656)
  • Anaheim (92801, 92802, 92803, 92804, 92805, 92806, 92807, 92808, 92809, 92812, 92814, 92815, 92816, 92817, 92825, 92831, 92832, 92850, 92870, 92880, 92899)
  • Anaheim Hills (92807)
  • Brea (92821, 92822, 92823, 92886)
  • Buena Park (90620, 90621, 90622, 90623, 90624)
  • Costa Mesa (92626, 92627, 92628, 92646, 92707)
  • Dana Point (92624, 92629)
  • Fountain Valley (92728)
  • Fullerton (90621, 90631, 92801, 92831, 92832, 92833, 92834, 92835, 92836, 92837, 92838)
  • Garden Grove (90680, 92703, 92840, 92841, 92842, 92843, 92844, 92845, 92846)
  • Huntington Beach (90742, 92605, 92615, 92646, 92647, 92648, 92649)
  • Irvine (92602, 92603, 92604, 92606, 92610, 92612, 92614, 92616, 92617, 92618, 92619, 92620, 92623, 92637, 92650, 92657, 92679, 92697, 92782, 92889)
  • La Palma (90623)
  • Laguna Beach (92651, 92652)
  • Laguna Hills (92637, 92653, 92654, 92656)

Classroom Based CPR Classes, First Aid, BLS, ACLS, and PALS Certification and Recertification Courses available for surrounding San Diego cities:

WEST FROM PDRE
Redlands (92373, 92374, 92375)
Morongo Valley (92256)
Cabazon (92230)
Banning (92220)
Beaumont (92223)
Yucaipa (92399)
San Jacinto (92581, 92582, 92583)
Hemet (92543, 92544, 92545, 92546)
Temecula (92589, 92590, 92591, 92592, 92593)NORTH FROM PDRE
Twentynine Palms (92277, 92278)
Yucca Valley (92284, 92286)
Big Bear Lake (92315)
EAST FROM PDRE
Joshua Tree (92252)
Salton Sea (92275)
Brawley (92227)
El Centro (92243, 92244)
Blythe (92225, 92226)
Calexico (92231, 92232)SOUTH FROM PDRE
Borrego Springs (92004)
Anza (92539)