# ALS Course 2026: RCUK Assessments, Algorithm & Practice Questions

> Prepare for the 2026 RCUK Advanced Life Support (ALS) course: pre-course MCQ, CASTest, 2025 ALS algorithm and five practice questions with answers.

- Source: https://studyforgelabs.com/als-course-exam-guide/
- Publisher: Studyforge Labs Ltd (UK company number 17563947)
- Last updated: 6 November 2026

The Resuscitation Council UK (RCUK) Advanced Life Support (ALS) course is a face-to-face provider course for doctors, nurses, paramedics and other healthcare professionals who manage adult cardiac arrest as part of their clinical role. Before the course you complete e-learning and a mandatory multiple-choice (MCQ) paper with an **80% pass mark** ; on the course you are assessed continuously on practical skills and finally in a **cardiac arrest simulation test (CASTest)** . Successful candidates receive an RCUK ALS provider certificate that is **valid for four years** .

This guide is for study purposes only and is not clinical guidance: always follow the current RCUK guidelines and your local policies in practice.

## ALS course key facts

| Key fact | Details |
| --- | --- |
| **Awarding body** | Resuscitation Council UK. Courses run at RCUK-approved Course Centres across the UK. |
| **Course options** | The two-day ALS course, e-ALS (self-paced e-learning followed by one face-to-face day) and a one-day ALS Recertification course for current or recently expired certificate holders. |
| **Pre-course work** | You are registered on the RCUK Learning Management System (LMS), receive the course manual about one month before the course and must complete the pre-course MCQ paper before attending. |
| **Pre-course MCQ** | Mandatory, pass mark 80%, multiple attempts allowed before the course; the mark does not count towards your final course result. |
| **On-course assessment** | Continuous assessment of resuscitation skills, high-quality CPR and defibrillation, followed by a CASTest at the end of the course. |
| **Certificate** | Valid for four years; you can recertify up to one year after it expires. |
| **Guidelines** | RCUK published its 2025 Resuscitation Guidelines on 27 October 2025 and said updated courses and manuals would be available from January 2026. |
| **Fees** | Set locally by each Course Centre, so check with the centre and the RCUK website before booking. |

## What is the RCUK Advanced Life Support course?

The ALS course teaches you to manage adult cardiac arrest and lead or work within a resuscitation team. RCUK aims it at healthcare professionals who use advanced life support in their clinical duties or teach it regularly, such as doctors, paramedics and nurses in acute areas or on resuscitation, medical emergency or critical care outreach teams.

You must hold a professional healthcare qualification or be training for one; final-year medical students may be accepted under local arrangements. Others are directed to the RCUK Immediate Life Support (ILS) course.

## ALS course format and assessments

### Pre-course e-learning and MCQ

Under the current [RCUK Advanced Provider Course Regulations](https://www.resus.org.uk/sites/default/files/2025-11/RCUK%20Advanced%20Course%20Regulations%202025-011%20V1.9.pdf) (version 1.9, effective 12 November 2025), the pre-course MCQ is mandatory, the pass mark is 80%, and you may make several attempts before the face-to-face course. The regulations set no minimum or maximum time for the e-learning.

### Is there a course MCQ on the day?

Older descriptions of the ALS course mention an end-of-course MCQ. The current regulations describe the pre-course MCQ as the only written element, so your result depends on the skills assessments and the CASTest. Check your Course Centre joining instructions to confirm.

### Skills assessment

Instructors assess you continuously at skill stations and during simulations. You need to show competence in airway management and related resuscitation skills, high-quality CPR and defibrillation. If you do not demonstrate a skill first time, you can practise and be reassessed in later sessions, but a candidate who has not passed the skills by the time of the CASTest fails the course.

### Cardiac arrest simulation test (CASTest)

The CASTest is a standardised cardiac arrest scenario in which you lead the team and manage the arrest using the ALS algorithm. It is supervised by at least one full instructor and another qualified faculty member. If you do not pass the first CASTest, you are entitled to a retest using a different scenario and different instructors. If that is also unsuccessful, you may be offered a third and final attempt within three months, or advised to repeat the whole course.

### Recertification

You can recertify on the full ALS course, e-ALS or the one-day Recertification course. The Recertification course requires a valid ALS certificate or one that expired within the last year; after that, you need the full course again.

## ALS algorithm essentials for the 2025 guidelines

Your CASTest, skills stations and MCQ all follow the [RCUK adult ALS algorithm](https://www.resus.org.uk/sites/default/files/2025-10/Adult%20ALS%20algorithm%202025.pdf). RCUK states there are no major changes since the 2021 guidelines, with more emphasis on effective oxygenation and ventilation and on correct pad placement. Key points:

| Topic | Details |
| --- | --- |
| **Start** | For an unresponsive patient with absent or abnormal breathing, start CPR at 30:2, attach a defibrillator and call the resuscitation team. |
| **Rhythm checks** | After each shock, or after each rhythm check in a non-shockable rhythm, immediately resume CPR for 2 minutes before reassessing. |
| **Shockable (VF/pulseless VT)** | Shock, then resume CPR immediately. Give adrenaline 1 mg IV/IO after the third shock, then every 3 to 5 minutes. Give amiodarone 300 mg IV after a total of three shocks and a further 150 mg after a total of five shocks. Lidocaine 100 mg is an alternative if amiodarone is unavailable or locally preferred. |
| **Non-shockable (PEA/asystole)** | Resume CPR immediately and give adrenaline 1 mg as soon as possible, then every 3 to 5 minutes. |
| **Reversible causes (4Hs and 4Ts)** | Hypoxia; hypovolaemia; hyper/hypokalaemia, -calcaemia, -magnesaemia and hypoglycaemia (metabolic); hypo/hyperthermia; thrombosis (coronary or pulmonary); tension pneumothorax; toxins; and cardiac tamponade. |
| **During CPR** | Minimise pauses in compressions, give oxygen, use waveform capnography, and gain IV access (IO if IV is not possible). Once a tracheal tube or supraglottic airway is in place, compressions become continuous with ventilation at 10 breaths per minute. |
| **After ROSC** | Use an ABCDE approach, aim for SpO2 94 to 98% and normal PaCO2, keep systolic blood pressure above 100 mmHg, record a 12-lead ECG, treat the cause and control temperature. |

## How to prepare for the ALS course

1. Start the manual as soon as it arrives and read steadily rather than cramming.
2. Complete the LMS modules and pass the pre-course MCQ early, so you have time to revisit topics you got wrong.
3. Learn the algorithm until you can draw it from memory, including drug doses and the shock count that triggers each drug.
4. Practise rhythm recognition: VF, pulseless VT, PEA, asystole and the common peri-arrest rhythms.
5. Rehearse the team-leader role out loud: allocate tasks, plan ahead for the next rhythm check and state when drugs are due.
6. Use practice questions to test recall of reversible causes and post-resuscitation care.

## Common mistakes in the ALS course

- Pausing to check a pulse or rhythm straight after a shock instead of resuming CPR for 2 minutes.
- Giving adrenaline before the third shock in VF/pulseless VT, or delaying it in PEA or asystole.
- Mixing up amiodarone doses: 300 mg after three shocks, then 150 mg after five.
- Long hands-off time while charging the defibrillator or securing the airway.
- Forgetting to look for reversible causes early and say them aloud during the scenario.
- Leading silently instead of stating your plan aloud.

## ALS practice questions

These original questions follow the 2025 RCUK adult ALS algorithm. They are not taken from RCUK papers.

### Question 1

An adult in cardiac arrest is in ventricular fibrillation (VF). You have just delivered the first shock. What should happen next?

- A. Check for a pulse for 10 seconds
- B. Immediately resume CPR for 2 minutes
- C. Give adrenaline 1 mg IV
- D. Deliver a second shock straight away

**Answer: B.** After each shock, CPR should resume immediately for 2 minutes before the next rhythm check. Pausing to check for a pulse straight after a shock adds hands-off time.

### Question 2

In VF or pulseless VT, when is the first dose of adrenaline given?

- A. Before the first shock
- B. After the first shock
- C. After the third shock
- D. Only once ROSC is achieved

**Answer: C.** In shockable rhythms, adrenaline 1 mg is given after the third shock and then every 3 to 5 minutes while ALS continues.

### Question 3

A patient remains in VF after a total of three shocks. What amiodarone dose does the RCUK algorithm recommend at this point?

- A. 150 mg IV
- B. 300 mg IV
- C. 450 mg IV
- D. 1 mg IV

**Answer: B.** Amiodarone 300 mg IV is given after three shocks. A further 150 mg is given after a total of five shocks.

### Question 4

A patient in cardiac arrest has pulseless electrical activity (PEA). When should adrenaline 1 mg be given?

- A. After the third rhythm check
- B. As soon as possible, once IV or IO access is available
- C. Only if the rhythm changes to VF
- D. Immediately after giving amiodarone

**Answer: B.** In non-shockable rhythms (PEA and asystole), adrenaline 1 mg is given as soon as possible and repeated every 3 to 5 minutes. Amiodarone is not part of the non-shockable pathway.

### Question 5

Which of the following is NOT one of the reversible causes (4Hs and 4Ts) on the RCUK ALS algorithm?

- A. Tension pneumothorax
- B. Hypovolaemia
- C. Cardiac tamponade
- D. Hypertension

**Answer: D.** The 4Hs are hypoxia, hypovolaemia, metabolic disturbances such as hyper/hypokalaemia, and hypo/hyperthermia. The 4Ts are thrombosis, tension pneumothorax, toxins and tamponade. Hypertension is not on the list.

## Frequently asked questions

### How hard is the ALS course?

The ALS course is demanding but manageable with proper preparation. The pre-course MCQ has an 80% pass mark and can be attempted more than once, and the main challenge on the day is leading the cardiac arrest simulation test confidently.

### How long should I study for the ALS course?

RCUK sends the course manual about one month before the course, and that month is a sensible study window. There is no official minimum study time, but you should read the whole manual, complete the e-learning modules and pass the pre-course MCQ before you attend.

### What is the pass mark for the ALS pre-course MCQ?

The RCUK ALS pre-course MCQ has a pass mark of 80% under the current Advanced Provider Course Regulations. It is mandatory and must be completed before the face-to-face course, and you can make multiple attempts. The mark does not count towards your final course result.

### Can I retake the ALS CASTest if I fail?

Yes. Under RCUK regulations, a candidate who fails the first cardiac arrest simulation test is entitled to a retest with a different scenario and different instructors. If the retest is also unsuccessful, a third and final attempt may be offered within three months, or you may be advised to repeat the whole course.

### How much does the ALS course cost?

RCUK does not set a single course price, because each RCUK-approved Course Centre sets its own fee, which includes registration and the manual. At the time of writing, RCUK charges Course Centres £31.57 per candidate registration and £35.89 per ALS manual. Check the current fee with your chosen Course Centre before booking.

### How long is an ALS certificate valid?

An RCUK ALS provider certificate is valid for four years. You can recertify on a one-day Recertification course while your certificate is valid or up to one year after it expires. If it expired more than a year ago, you need to take the full ALS or e-ALS course again.

## Official resources

- [Resuscitation Council UK: ALS 2-day course](https://www.resus.org.uk/training-courses/adult-life-support/als-2-day-course-advanced-life-support)
- [Resuscitation Council UK: 2025 adult advanced life support guidelines](https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/adult-advanced-life-support-guidelines)
- [Resuscitation Council UK: adult ALS algorithm 2025 (PDF)](https://www.resus.org.uk/sites/default/files/2025-10/Adult%20ALS%20algorithm%202025.pdf)
- [Resuscitation Council UK: Advanced Provider Course Regulations (PDF)](https://www.resus.org.uk/sites/default/files/2025-11/RCUK%20Advanced%20Course%20Regulations%202025-011%20V1.9.pdf)

This guide is published by Studyforge Labs Ltd for study purposes and was last reviewed on 6 November 2026. Studyforge Labs and its apps are independent and are not affiliated with, endorsed by or connected to Resuscitation Council UK. Exam details, fees and dates can change, so always confirm them with the official sources above before you book.

## Practice app

[ALS Resuscitation Prep](https://apps.apple.com/gb/app/als-resuscitation-prep/id6793771847) by Studyforge Labs: Advanced Life Support MCQs and an ECG rhythm trainer. Free to download on iPhone and iPad; full access is an in-app purchase. Android and web versions are coming soon.