The arrest alarm triggers in Bay 6. The registrar is four minutes away. The team is already moving – but everyone is looking at you. In that moment, there’s no time to think about who should be doing what. The team either functions as a unit or it doesn’t. And the difference almost always comes down to one thing: role clarity.
Resuscitation outcomes aren’t determined by individual skill alone. The research is unambiguous on this – high-performing resus teams share one consistent trait: every member knows their role before the arrest alarm stops ringing. Doesn’t matter if you’re stepping up as team leader for the first time or refining how you run a code as a senior ICU nurse. Role definition is the foundation everything else is built on.
This guide breaks down every core resuscitation team role – team leader, compressor, airway manager, IV/IO and medication nurse, monitor/defibrillator operator, scribe, and runner – covering responsibilities, communication expectations, and the handover cues that keep a code running smoothly. Written for registered nurses and healthcare clinicians, not first-timers.
What Are the Roles in a Resuscitation Team?
A resuscitation team typically consists of five to seven defined roles, each with specific responsibilities that must be established at the start of every code. Clear role assignment prevents task duplication, reduces cognitive load on the team leader, and is strongly associated with improved patient outcomes in cardiac arrest. The core roles are consistent across Australian hospital settings and align with ANZCOR advanced life support guidelines.
- Team Leader – directs the resuscitation, assigns roles, communicates with the incoming medical team, and maintains situational awareness throughout
- Compressor – delivers continuous, high-quality chest compressions and rotates at regular intervals to maintain effectiveness
- Airway Manager – maintains airway patency using BVM, supraglottic airway, or intubation support as directed
- Medication/IV Nurse – manages IV/IO access, draws and administers drugs per the ALS algorithm (adrenaline, amiodarone), and confirms dosing aloud
- Monitor/Defibrillator Operator – applies pads, reads and calls rhythms, charges and delivers shocks on team leader instruction
- Scribe – documents time of arrest, interventions, drug doses, rhythm checks, and shock delivery in real time
- Runner – retrieves equipment, medications, and additional resources; manages the perimeter and controls access to the resus space
The Team Leader | Running the Code Without Running Into It
The team leader is the only person in the resus space whose job is to see everything and do nothing hands-on. That’s not a passive role – it’s the hardest discipline in the room.
When the arrest alarm goes off, the team leader’s first job isn’t clinical. It’s organisational. Role assignment needs to happen fast – before the crash cart arrives, before the team starts improvising. Delayed assignment is consistently the most common source of task duplication identified in resus debriefs – two people drawing up adrenaline while nobody is managing the airway, or multiple nurses crowding the compressor position while the monitor sits unattended. The team leader stops that from happening before it starts.
Positioning Matters More Than Most People Realise
ANZCOR guidelines position the team leader at the foot of the bed – and there’s a reason for that. Standing at the foot gives simultaneous sightlines to the monitor, the airway, and IV access. You can read the rhythm, watch chest rise, and track what the medication nurse is doing without moving. The moment the team leader steps to the side of the bed to help with a procedure, they lose that overview. And the team loses its anchor.
Closed-Loop Communication
Every instruction the team leader gives needs to complete a loop. Instruction → read-back → confirmation. Not because it’s protocol, but because in a high-noise, high-pressure environment, assumed compliance is where errors live. If you call for adrenaline 1mg IV and you don’t hear it read back, you don’t know if it was heard. Closed-loop communication isn’t bureaucratic – it’s the difference between a drug given and a drug missed.
Handing Over Leadership
This one catches people out. If the team leader has to perform a procedure, leadership doesn’t transfer automatically. It has to be stated explicitly. “I’m stepping in to assist with IV access. [Name], you have team leadership.” Without that explicit handover, you end up with two people trying to direct the team, or nobody directing it at all.
The team leader assigns the role – but the compressor owns the outcome of every compression cycle.
The Compressor | Why Technique Matters More Than Effort
If there’s one role where effort and effectiveness can quietly diverge, it’s this one. A compressor who is working hard but compressing at the wrong depth, or not allowing full chest recoil, is not delivering the perfusion the team thinks they are. Technique is the variable. Not effort.
The ANZCOR 2024 parameters are specific: 100–120 compressions per minute, 5–6cm depth, and full chest recoil between every compression. All three matter. Rate without depth is ineffective. Depth without recoil prevents venous return. And no-flow time – the time when compressions stop for any reason – is the single most predictive variable for ROSC. Every pause costs perfusion pressure that takes time to rebuild. That’s not a reason to avoid rhythm checks. It’s a reason to make every pause deliberate and as short as possible.
Rotation and Handover
Fatigue-related compression depth degradation begins earlier than most people expect. The rotation interval isn’t arbitrary – it’s set to catch the compressor before quality drops, not after. The rotation needs to be seamless: the outgoing compressor announces “switching” on the upstroke, the incoming compressor positions their hands before contact breaks. There’s no gap. No pause. The chest keeps moving.
Common Errors Worth Knowing
The errors that show up most consistently in resus debriefs aren’t dramatic. They’re subtle. Leaning on the chest between compressions – which prevents full recoil. Compressions centred too high on the sternum. Rate creeping above 120 because the compressor is anxious. And depth loss as fatigue sets in, with no external cue that it’s happening. CPR feedback devices, increasingly common in Australian hospitals, catch this in real time – and they’ve made self-correction during the code a realistic expectation for the compressor role.
While compressions maintain perfusion, the airway manager is fighting a parallel battle that determines whether that perfusion delivers anything useful.
⚠️ No-Flow Time: Every interruption to chest compressions costs perfusion pressure that takes time to rebuild. Compress until you are told to stop. Not until you think it's time.
The Airway Manager | Beyond the Mask
The airway manager’s job doesn’t start when the supraglottic goes in. It starts the moment the patient is unresponsive – and it doesn’t stop until the airway is definitively secured and confirmed.
Before any device goes near the patient, positioning comes first. Head tilt-chin lift for the unresponsive patient without suspected cervical injury. Jaw thrust if there’s any concern about the spine. Both get rushed in a chaotic code onset – and a poorly positioned airway undermines every ventilation attempt that follows.
Two-Person BVM | The Standard, Not the Backup
Solo BVM is a last resort, not a default. Two-person BVM delivers significantly higher tidal volumes and a better mask seal than a single operator working alone. One person forms a two-handed E-C grip on the mask, the other squeezes the bag. Tidal volume targets during resus are lower than most people expect – just enough to see visible chest rise. Over-ventilation increases intrathoracic pressure, reduces venous return, and compromises cardiac output during CPR.
Supraglottic Airways and Intubation Support
The iGel has become the preferred supraglottic airway in most ED and ICU settings due to insertion speed and seal quality – no cuff inflation means one less step and one less failure point. When intubation is directed, the airway manager’s role shifts to preparing RSI medications if instructed, maintaining oxygenation via BVM until the laryngoscopist is ready, and holding cricoid pressure only if specifically requested. The ANZCOR position is that routine cricoid pressure during RSI is not recommended as standard practice.
If waveform ETCO2 is available, use it. A sudden rise above 40 mmHg is one of the strongest indicators of ROSC before a rhythm check confirms it. Call it out loud. Any change in airway status – loss of seal, regurgitation, desaturation – gets called out immediately and loudly. The team leader can’t act on information they don’t have.
The Medication Nurse | Precision Under Pressure
The medication nurse is working in one of the highest-consequence roles in the resus space. Wrong drug, wrong dose, wrong timing – any one of those errors can alter the trajectory of a resuscitation. The discipline that prevents them has to be habitual, especially when the room is loud and everyone wants something at once.
Peripheral IV is the first attempt. If access fails or the clinical picture is deteriorating faster than access can be established, intraosseous via EZ-IO is the escalation. The medication nurse should be anticipating this and have the equipment ready before the team leader asks.
The ALS Drug Sequence
The sequence is algorithm-driven, and deviation needs a clinical reason, not a logistical one.
| Rhythm Type | Drug | Dose | Timing | Route |
|---|---|---|---|---|
| Non-shockable (PEA/Asystole) | Adrenaline | 1mg | As soon as access established, then every 3–5 min | IV/IO |
| Shockable (VF/pVT) | Adrenaline | 1mg | After 3rd shock, then every 3–5 min | IV/IO |
| Shockable – refractory | Amiodarone | 300mg | After 3rd shock | IV/IO |
| Shockable – refractory (2nd dose) | Amiodarone | 150mg | After 5th shock | IV/IO |
Every syringe drawn gets labelled before it leaves your hand. Drug name, dose, route. Every time. Before administration, the medication nurse announces it aloud – drug, dose, route, time. The scribe records it simultaneously. This gives the team leader one final opportunity to intercept an error before it reaches the patient.
Drug timing is only as reliable as the rhythm information the monitor operator is feeding the team.
💉 Medication Safety: Every syringe drawn during a resuscitation must be labelled before it leaves your hand. Drug name, dose, route. Announce it aloud before you push it. The scribe records it. This sequence is non-negotiable.
The Monitor/Defibrillator Operator | Reading the Rhythm, Calling the Shots
Every clinical decision in a resuscitation runs through the monitor operator. The team leader calls the shots – but they’re calling them based on what the monitor operator is seeing and reporting. If the rhythm read is wrong, the algorithm response is wrong. That’s the weight that sits with this role.
Anterior-lateral pad placement is the default: right infraclavicular, left lateral chest wall. Anterior-posterior is used when anterior-lateral isn’t viable – typically for patients with implanted devices or when pad contact is poor. Good pad contact matters. Hair, moisture, and positioning errors all increase transthoracic impedance and reduce shock effectiveness.
Rhythm Recognition and Shock Delivery
The four arrest rhythms – VF, pVT, PEA, and asystole – require different responses. Fine VF is where people hesitate: it’s shockable, asystole is not. pVT has organised complexes but no pulse – the clinical check confirms it. Movement artefact during compressions can mimic VF, which is why rhythm checks require a pause, not a read-through compressions. Call what you see, not what you expect to see.
The monitor operator charges the defibrillator on team leader instruction – not in anticipation of it. The “stand clear” call means visually confirming – not just verbally – that no team member is in contact before discharge. After shock delivery, CPR resumes immediately. The rhythm check happens at the next interval – not before. Even a successfully cardioverted rhythm may not generate effective cardiac output immediately, and that perfusion pressure is not expendable.
Every rhythm call, every shock, every drug – none of it exists in the medico-legal record unless the scribe captures it in real time.
The Scribe | The Role Most Teams Underestimate
The scribe isn’t the person who couldn’t get a clinical role – they’re the person holding the entire event together in real time. Without accurate documentation, the team is flying blind on drug timing, the incoming medical team has no handover record, and the medico-legal exposure for everyone in that room increases significantly.
The scribe’s record starts the moment arrest is confirmed and runs in parallel with the resuscitation. It captures: time of arrest, time CPR commenced, rhythm at each check, all medications (name, dose, route, time), shock delivery times and energy levels, and ROSC time if achieved. The resuscitation record is a medico-legal document. An incomplete or retrospectively completed record creates real liability exposure for everyone who was in the room.
The Time Call and Handover
The scribe announces elapsed time at regular intervals – keeping compressor rotation on schedule, prompting the team leader for the rhythm check, and keeping the medication nurse tracking adrenaline timing without the team leader watching the clock. When the team leader asks “when was the last adrenaline?” the scribe answers immediately. That’s a clinical safety check, not an administrative one.
On handover, the scribe reads the record aloud to the receiving team in chronological order. Not a summary – the formal record, in sequence. A scribe who drifts into clinical tasks produces neither good documentation nor good clinical care. The role must be protected. If they’re pulled into a clinical task, the team leader names a replacement before that happens.
Behind every well-documented resuscitation is a runner who made sure the team had everything they needed to do their jobs.
🕐 The Time Call: The scribe's time announcements keep the entire team on the ALS algorithm. "Rhythm check in 30 seconds" is not administrative — it is a clinical intervention. Own it.
The Runner | Undervalued, Indispensable
The runner is the role that gets assigned last and appreciated least – until the crash cart isn’t there, the IO kit can’t be found, and nobody has called the ward coordinator. At that point, the absence of a competent runner becomes the most obvious problem in the room.
This isn’t a junior role by default. It requires situational awareness, initiative, and the confidence to manage access to a resus space under pressure. Done well, it’s invisible. Done poorly, it creates a cascade of problems the team leader has to manage on top of everything else.
The runner’s first job is to confirm the crash cart is present and complete. After that, priority follows clinical need as directed by the team leader. The runner doesn’t decide what gets retrieved – the team leader does. The runner executes, confirms back, and returns to the perimeter ready for the next task. A runner who disappears and doesn’t report back creates uncertainty about whether a task is done.
Ward arrests draw people – well-meaning but untasked staff who crowd the resus space and degrade team performance without realising it. The runner manages that perimeter. Access is for people with an assigned role. Everyone else waits. If clinical numbers drop, the runner is the first escalation point – transitioning to whichever role is most urgent on explicit team leader direction, with the runner role immediately reassigned to keep perimeter and logistics covered.
Even a fully staffed, well-prepared team will face moments where the structure begins to fracture – and knowing how to recover is what separates a good team from a great one.
When Roles Break Down | And How to Recover
Every nurse who has been through enough codes knows the textbook version and the real version aren’t always the same thing. Role breakdown isn’t a sign of a bad team – it’s an inevitable feature of high-pressure environments. What matters is recognising it fast and knowing how to recover.
The most common failure pattern isn’t dramatic: two people performing the same task while a critical task goes undone. It almost always traces back to absent or unclear role assignment at code onset. If you’re the first clinician present, the priority is unambiguous – start compressions, call for help, do not leave the patient. Call specifically: “Call a code blue, Bay 4” is more useful than a general shout. Keep compressing.
A chaotic code mid-resuscitation is recoverable. The team leader calls a brief communication pause – compressions continue, but all other activity stops while roles are explicitly reassigned. It feels counterintuitive to stop and talk when the pressure is highest. But a short reset is worth more than several more minutes of duplicated effort and missed tasks.
A structured debrief after a resuscitation is the single highest-yield team development activity available. Not a formal review weeks later – a hot debrief while the sequence of events is still clear. Teams that debrief regularly show measurable improvement in role clarity, communication, and compression quality over time. The debrief isn’t about blame. It’s about the one or two things that, if done differently, would have changed the team’s performance.
Ready to Practise These Roles in a Real Simulation?
Knowing the resuscitation team roles on paper and executing them under pressure are two different things. The gap between them isn’t filled by reading articles – it’s filled by practising in environments that replicate the pressure, the noise, and the decision-making demands of a real code. That’s what simulation does, and it’s why structured ART training produces a different kind of confidence than ward experience alone.
Every role covered in this guide – team leader, compressor, airway manager, medication nurse, monitor operator, scribe, runner – carries its own discipline, its own communication expectations, and its own failure modes. Understanding those failure modes before they happen in a real resuscitation is the difference between a team that recovers cleanly and one that spends valuable time duplicating effort while a critical task goes undone.
ART courses run exclusively for registered healthcare professionals. You’ll rotate through every resuscitation role in a high-fidelity simulation environment – with structured debrief from instructors who have run real codes. If your AHPRA renewal is coming up, or you’re working toward a charge or leadership role that requires demonstrated resuscitation competency, this is the course designed for exactly that.
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