Hostname: page-component-848d4c4894-2xdlg Total loading time: 0 Render date: 2024-06-13T23:16:55.709Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiopulmonary resuscitation and automatic external defibrillator training in schools: “Is anyonelearning how to save a life?”

Published online by Cambridge University Press:  04 March 2015

Devin Hart ,
Oscar Flores-Medrano ,
Steve Brooks ,
Jason E. Buick  and
Laurie J. Morrison
Devin Hart
Affiliation:
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, and St. Michael's Hospital, University of Toronto, Toronto, ON Faculty of Science, McGill University, Montreal, QC
Oscar Flores-Medrano
Affiliation:
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, and St. Michael's Hospital, University of Toronto, Toronto, ON Faculty of Science, Western University, London, ON
Steve Brooks
Affiliation:
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, and St. Michael's Hospital, University of Toronto, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON Department of Emergency Medicine, Queen's University, Kingston, ON
Jason E. Buick
Affiliation:
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, and St. Michael's Hospital, University of Toronto, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
Laurie J. Morrison*
Affiliation:
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, and St. Michael's Hospital, University of Toronto, Toronto, ON Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON Department of Emergency Services, St Michael's Hospital, Toronto, ON
*
Rescu, Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON M5B 1W8; morrisonl@smh.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

Bystander resuscitation efforts, such as cardiopulmonary resuscitation (CPR) and use of an automatic external defibrillator (AED), save lives in cardiac arrest cases. School training in CPR and AED use may increase the currently low community rates of bystander resuscitation. The study objective was to determine the rates of CPR and AED training in Toronto secondary schools and to identify barriers to training and training techniques.

Methods:

This prospective study consisted of telephone interviews conducted with key school staff knowledgeable about CPR and AED teaching. An encrypted Web-based tool with prespecified variables and built-in logic was employed to standardize data collection.

Results:

Of 268 schools contacted, 93% were available for interview and 83% consented to participate. Students and staff were trained in CPR in 51% and 80% of schools, respectively. Private schools had the lowest training rate (39%). Six percent of schools provided AED training to students and 47% provided AED training to staff. Forty-eight percent of schools had at least one AED installed, but 25% were unaware if their AED was registered with emergency services dispatch. Cost (17%), perceived need (11%), and school population size (10%) were common barriers to student training. Frequently employed training techniques were interactive (32%), didactic instruction (30%) and printed material (16%).

Conclusions:

CPR training rates for staff and students were moderate overall and lowest in private schools, whereas training rates in AED use were poor in all schools. Identified barriers to training include cost and student population size (perceived to be too small to be cost-effective or too large to be implemented). Future studies should assess the application of convenient and cost-effective teaching alternatives not presently in use.

Keywords

automatic external defibrillationbystander resuscitationcardiac arrestclassroom-based educationeducationself-directed education
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 15 , Issue 5 , September 2013 , pp. 270 - 278
Copyright
Copyright © Canadian Association of Emergency Physicians 2013

References

REFERENCES

1.Vaillancourt, C, Stiell, IG. Cardiac arrest care and emergency medical services in Canada. Can J Cardiol 2004;20:1081–90.Google ScholarPubMed
2.Nichol, G, Thomas, E, Callaway, CW, et al. Regional variation in out-of-hospital cardiac arrest incidence and outcome. JAMA 2008;300:1423–31, doi:10.1001/jama.300.12.1423.CrossRefGoogle ScholarPubMed
3.Weisfeldt, ML, Sitlani, CM, Ornato, JP, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol 2010;55:1713–20, doi:10.1016/j.jacc.2009.11.077.CrossRefGoogle ScholarPubMed
4.Breckwoldt, J, Schloesser, S, Arntz, HR. Perceptions of collapse and assessment of cardiac arrest by bystanders of out-of-hospital cardiac arrest (OOHCA). Resuscitation 2009;80:1108–13, doi:10.1016/j.resuscitation.2009.06.028.CrossRefGoogle ScholarPubMed
5.2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2005;112(24 Suppl):IV1-203.Google Scholar
6.Heart and Stroke Foundation of Canada. Chain of Survival. c2010. Available at: http://restart.heartandstroke.ca/chainsurvival.Google Scholar
7.Gallagher, EJ, Lombardi, G, Gennis, P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA 1995;274:1922–5, doi:10.1001/jama.1995.03530240032036.CrossRefGoogle ScholarPubMed
8.Herlitz, J, Ekstrom, L, Wennerblom, B, et al. Effect of bystander initiated cardiopulmonary resuscitation on ventricular fibrillation and survival after witnessed cardiac arrest outside hospital. Br Heart J 1994;72:408–12, doi:10.1136/hrt.72.5.408.CrossRefGoogle ScholarPubMed
9.Herlitz, J, Svensson, L, Holmberg, S, et al. Efficacy of bystander CPR: intervention by lay people and by health care professionals. Resuscitation 2005;66:291–5, doi:10.1016/j.resuscitation.2005.04.003.CrossRefGoogle ScholarPubMed
10.Larsen, MP, Eisenberg, MS, Cummins, RO, et al. Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 1993;22:1652–8, doi:10.1016/S0196-0644(05)81302-2.CrossRefGoogle ScholarPubMed
11.Rea, TD, Eisenberg, MS, Culley, LL, et al. Dispatcherassisted cardiopulmonary resuscitation and survival in cardiac arrest. Circulation 2001;104:2513–6, doi:10.1161/hc4601.099468.CrossRefGoogle ScholarPubMed
12.Stiell, IG, Wells, GA, Field, B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med 2004;351:647–56, doi:10.1056/NEJMoa040325.CrossRefGoogle ScholarPubMed
13.Waalewijn, RA, Tijssen, JG, Koster, RW. Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). Resuscitation 2001;50:273–9, doi:10.1016/S0300-9572(01)00354-9.CrossRefGoogle ScholarPubMed
14.Van Hoeyweghen, RJ, Bossaert, LL, Mullie, A, et al. Quality and efficiency of bystander CPR. Belgian Cerebral Resuscitation Study Group. Resuscitation 1993;26:47–52, doi:10.1016/0300-9572(93)90162-J.CrossRefGoogle ScholarPubMed
15.Wik, L, Steen, PA, Bircher, NG. Quality of bystander cardiopulmonary resuscitation influences outcome after prehospital cardiac arrest. Resuscitation 1994;28:195–203, doi:10.1016/0300-9572(94)90064-7.CrossRefGoogle ScholarPubMed
16.Valenzuela, TD, Roe, DJ, Nichol, G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med 2000;343:1206–9, doi:10.1056/NEJM200010263431701.CrossRefGoogle ScholarPubMed
17.Swor, R, Khan, I, Domeier, R, et al. CPR training and CPR performance: do CPR-trained bystanders perform CPR? Acad Emerg Med 2006;13:596–601, doi:10.1111/j.1553-2712.2006.tb01017.x.Google ScholarPubMed
18.Axelsson, A, Herlitz, J, Ekstrom, L, et al. Bystander-initiated cardiopulmonary resuscitation out-of-hospital. A first description of the bystanders and their experiences. Resuscitation 1996;33:3–11, doi:10.1016/S0300-9572(96)00993-8.CrossRefGoogle ScholarPubMed
19.Abella, BS, Aufderheide, TP, Eigel, B, et al. Reducing barriers for implementation of bystander-initiated cardiopulmonary resuscitation: a scientific statement from the American Heart Association for healthcare providers, policymakers, and community leaders regarding the effectiveness of cardiopulmonary resuscitation. Circulation 2008;117:704–9, doi:10.1161/CIRCULATIONAHA.107.188486.CrossRefGoogle ScholarPubMed
20.Olasveengen, TM, Wik, L, Steen, PA. Standard bystander CPR versus continuous chest compressions only in out-ofhospital cardiac arrest. Resuscitation 2008;77:S10, doi:10.1016/j.resuscitation.2008.03.041.CrossRefGoogle Scholar
21.Todd, KH, Braslow, A, Brennan, RT, et al. Randomized, controlled trial of video self-instruction versus traditional CPR training. Ann Emerg Med 1998;31:364–9, doi:10.1016/S0196-0644(98)70348-8.CrossRefGoogle ScholarPubMed
22.Vaillancourt, C, Stiell, IG, Wells, GA. Understanding and improving low bystander CPR rates: a systematic review of the literature. CJEM 2008;10:51–65.CrossRefGoogle Scholar
23.Eisenburger, P, Safar, P. Life supporting first aid training of the public—review and recommendations. Resuscitation 1999;41:3–18, doi:10.1016/S0300-9572(99)00034-9.CrossRefGoogle ScholarPubMed
24.Lafferty, C, Larsen, PD, Galletly, D. Resuscitation teaching in New Zealand schools. N Z Med J 2003;116:U582.Google ScholarPubMed
25.Lyttle, J. Mandatory CPR training for students may improve cardiac-arrest survival rate, MDs say. CMAJ 1996;155:1172–4.Google ScholarPubMed
26.Isbye, DL, Rasmussen, LS, Ringsted, C, et al. Disseminating cardiopulmonary resuscitation training by distributing 35,000 personal manikins among school children. Circulation 2007; 116:1380–5, doi:10.1161/CIRCULATIONAHA.107.710616.CrossRefGoogle Scholar
27.Parnell, MM, Pearson, J, Galletly, DC, et al. Knowledge of and attitudes towards resuscitation in New Zealand highschool students. Emerg Med J 2006;23:899–902, doi:10.1136/emj.2006.041160.CrossRefGoogle Scholar
28.Ontario Ministry of Education and Training. Ontario secondary schools - grades 9–12: program and diploma requirements. Toronto: Queen’s Printer for Ontario; 1999.Google Scholar
29.Ontario Ministry of Education and Training. The Ontario curriculum - grades 9 and 10: health and physical education. Toronto: Queen’s Printer for Ontario; 1999.Google Scholar
30.Lotfi, K, White, L, Rea, T, et al. Cardiac arrest in schools. Circulation 2007;116:1374–9, doi:10.1161/CIRCULATIONAHA.107.698282.CrossRefGoogle ScholarPubMed
31.Braslow, A, Brennan, RT, Newman, MM, et al. CPR training without an instructor: development and evaluation of a video self-instructional system for effective performance of cardiopulmonary resuscitation. Resuscitation 1997;34:207–20, doi:10.1016/S0300-9572(97)01096-4.CrossRefGoogle ScholarPubMed
32.Heart and Stroke Foundation of Canada. CPR anytime. c2007. Available at: https://resuscitation.heartandstroke.ca/resources/training_materials/CPR_Anytime_Kit (accessed Feb 25, 2013).Google Scholar
33.Potts, J, Lynch, B. The American Heart Association CPR Anytime Program: the potential impact of highly accessible training in cardiopulmonary resuscitation. J Cardiopulm Rehabil 2006;26:346–54, doi:10.1097/00008483-200611000-00002.CrossRefGoogle ScholarPubMed
34.Batcheller, AM, Brennan, RT, Braslow, A, et al. Cardiopulmonary resuscitation performance of subjects over forty is better following half-hour video self-instruction compared to traditional four-hour classroom training. Resuscitation 2000;43:101–10, doi:10.1016/S0300-9572(99)00132-X.CrossRefGoogle ScholarPubMed
35.Einspruch, EL, Lynch, B, Aufderheide, TP, et al. Retention of CPR skills learned in a traditional AHA Heartsaver course versus 30-min video self-training: a controlled randomized study. Resuscitation 2007;74:476–86, doi:10.1016/j.resuscitation.2007.01.030.CrossRefGoogle Scholar
36.Isbye, DL, Rasmussen, LS, Lippert, FK, et al. Laypersons may learn basic life support in 24min using a personal resuscitation manikin. Resuscitation 2006;69:435–42, doi:10.1016/j.resuscitation.2005.10.027.CrossRefGoogle ScholarPubMed
37.Roppolo, LP, Saunders, T, Pepe, PE, et al. Layperson training for cardiopulmonary resuscitation: when less is better. Curr Opin Crit Care 2007;13:256–60, doi:10.1097/MCC.0b013e32814db81f.CrossRefGoogle ScholarPubMed
38.Todd, KH, Heron, SL, Thompson, M, et al. Simple CPR: a randomized, controlled trial of video self-instructional cardiopulmonary resuscitation training in an African American church congregation. Ann Emerg Med 1999;34:730–7, doi:10.1016/S0196-0644(99)70098-3.CrossRefGoogle Scholar
39.Berger, S, Utech, L, Hazinski, MF. Lay rescuer automated external defibrillator programs for children and adolescents. Pediatr Clin North Am 2004;51:1463–78, doi:10.1016/j.pcl.2004.04.009.CrossRefGoogle ScholarPubMed
40.Rosafio, T, Cichella, C, Vetrugno, L, et al. Chain of survival: differences in early access and early CPR between policemen and high-school students. Resuscitation 2001;49:25–31, doi:10.1016/S0300-9572(00)00341-5.CrossRefGoogle ScholarPubMed
41.Kelley, J, Richman, PB, Ewy, GA, et al. Eighth grade students become proficient at CPR and use of an AED following a condensed training programme. Resuscitation 2006;71:229–36, doi:10.1016/j.resuscitation.2006.03.015.CrossRefGoogle ScholarPubMed
42.Hill, K, Mohan, C, Stevenson, M, McCluskey, D. Objective assessment of cardiopulmonary resuscitation skills of 10-11-year-old schoolchildren using two different external chest compression to ventilation ratios. Resuscitation 2009;80:96–9, doi:10.1016/j.resuscitation.2008.08.005.CrossRefGoogle ScholarPubMed
43.Lynch, B, Einspruch, EL. With or without an instructor, brief exposure to CPR training produces significant attitude change. Resuscitation 2010;81:568–75, doi:10.1016/j.resuscitation.2009.12.022.CrossRefGoogle ScholarPubMed
44.Kromann, CB, Jensen, ML, Ringsted, C. The effect of testing on skills learning. Med Educ 2009;43:21–7, doi:10.1111/j.1365-2923.2008.03245.x.CrossRefGoogle ScholarPubMed
45.Aufderheide, T, Hazinski, MF, Nichol, G, et al. American Heart Association Emergency Cardiovascular Care C, Council on Clinical C, Office of State A. Community lay rescuer automated external defibrillation programs: key state legislative components and implementation strategies: a summary of a decade of experience for healthcare providers, policymakers, legislators, employers, and community leaders from the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy. Circulation 2006;113:1260–70, doi:10.1161/CIRCULATIONAHA.106.172289.CrossRefGoogle Scholar
46.Strömsöe, A, Andersson, B, Ekstöm, L, et al. Education in cardiopulmonary resuscitation in Sweden and its clinical consequences. Resuscitation 2010;81:211–6, doi:10.1016/j.resuscitation.2009.10.014.CrossRefGoogle ScholarPubMed
47.Mirza, M, Brown, TB, Saini, D, et al. Instructions to “push as hard as you can” improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation. Resuscitation 2008;79:97–102, doi:10.1016/j.resuscitation.2008.05.012.CrossRefGoogle Scholar
48.Myers, JB, French, D, Webb, W. Lack of integration of automated external defibrillators with EMS response may reduce lifesaving potential of public-access defibrillation. Prehosp Emerg Care 2005;9:339–43, doi:10.1080/10903120590961969.CrossRefGoogle ScholarPubMed
49.Ecker, R, Rea, TD, Meischke, H, et al. Dispatcher assistance and automated external defibrillator performance among elders. Acad Emerg Med 2001;8:968–73, doi:10.1111/j.1553-2712.2001.tb01096.x.CrossRefGoogle ScholarPubMed
50.Caffrey, SL, Willoughby, PJ, Pepe, PE, et al. Public use of automated external defibrillators. N Engl J Med 2002;347: 1242–7, doi:10.1056/NEJMoa020932.CrossRefGoogle ScholarPubMed
51.The Heart and Stoke Foundation of Ontario. Restart. 2010. Available at: https://resuscitation.heartandstroke.ca/ (accessed Feb 23, 2013).Google Scholar
52.The Mikey Network. About The Mikey Network. c2010. Available at: http://mikeynetwork.com/mikey-defibrillators (accessed Feb 23, 2013).Google Scholar
53.ACT Foundation of Canada. Ontario high school students give MPPs a lesson in lifesaving [press release]. February 24, 2010. Available at: http://actfoundation.ca/wp-content/uploads/2012/10/act-Media-Releases-Archive-2010-PressRelease-ForWeb.pdf (accessed Feb 25, 2013).Google Scholar
54. An Act to provide for defibrillators in premises accessed by members of the public, Bill 41, 39th Legislature, 2nd Session (2010).Google Scholar