Optimal refresher training intervals for AED and CPR skills: A randomised controlled trial

Developing and evaluating a brief, socially primed video intervention to enable bystander cardiopulmonary resuscitation: A randomised control trial

BACKGROUND

Over 30,000 people experience out-of-hospital cardiac arrest in the United Kingdom annually, with only 7-8% of patients surviving. One of the most effective methods of improving survival outcomes is bystander intervention in the form of calling the emergency services and initiating chest compressions. Additionally, the public must feel empowered to act and use this knowledge in an emergency. This study aimed to evaluate an ultra-brief CPR familiarisation video that uses empowering social priming language to frame CPR as a norm in Scotland.

METHODS

In a randomised control trial, participants (n = 86) were assigned to view an ultra-brief CPR video intervention or a traditional long-form CPR video intervention. Following completion of a pre-intervention questionnaire examining demographic variables and prior CPR knowledge, participants completed an emergency services-led resuscitation simulation in a portable simulation suite using a CPR manikin that measures resuscitation quality. Participants then completed questionnaires examining social identity and attitudes towards performing CPR.

RESULTS

During the simulated resuscitation, the ultra-brief intervention group's cumulative time spent performing chest compressions was significantly higher than that observed in the long-form intervention group. The long-form intervention group's average compressions per minute rate was significantly higher than the ultra-brief intervention group, however both scores fell within a clinically acceptable range. No other differences were observed in CPR quality. Regarding the social identity measures, participants in the ultra-brief condition had greater feelings of expected emergency support from other Scottish people when compared to long-form intervention participants. There were no significant group differences in attitudes towards performing CPR.

CONCLUSIONS

Socially primed, ultra-brief CPR interventions hold promise as a method of equipping the public with basic resuscitation skills and empowering the viewer to intervene in an emergency. These interventions may be an effective avenue for equipping at-risk groups with resuscitation skills and for supplementing traditional resuscitation training.

Health Professionals can Sustain Proficiency in Motivational Interviewing With a Moderate Amount of Training: An Intervention Fidelity Study

INTRODUCTION

Motivational interviewing (MI) proficiency may erode quickly, limiting its effectiveness. We examined whether health professionals completing a 2-day workshop, with 3 to 5 hours of personalized coaching, and twice-yearly group reflections sustained proficiency for the duration of a hip fracture rehabilitation trial and whether intervention was implemented as intended.

METHODS

A fidelity study was completed as part of a process evaluation of the trial that tested whether physical activity increased among hip fracture patients randomly allocated to receive MI (experimental) compared with dietary advice (control) over ten 30-minute sessions. Twelve health professionals (none were proficient in MI before trial commencement) delivered the intervention for up to 952 days. Two hundred experimental sessions (24% of all sessions, 83 patients) were randomly selected to evaluate proficiency using the MI Treatment Integrity scale; along with 20 control sessions delivered by four dietitians. Linear mixed-effects regression analyses determined whether proficiency was sustained over time. Dose was assessed from all experimental sessions ( n = 840, 98 patients).

RESULTS

Intervention was implemented as intended; 82% of patients received at least eight 30-minute sessions. All motivational interviewers were proficient, whereas dietitians did not inadvertently deliver MI. Time had no effect on MI proficiency (est < 0.001/d, P = .913, 95% CI, -0.001 to 0.001).

DISCUSSION

MI proficiency was sustained in a large trial over 2.6 years by completing a 2-day workshop, 3 to 5 hours of personalized coaching, and twice-yearly group reflections, even for those without previous experience; further research needs to establish the maximum duration of training effectiveness.

Remediation practices for health profession students and clinicians: An integrative review

BACKGROUND

The current state of practices in health care remediation is not well known. The purpose of this review is to characterize, assess, and present synthesized results of current student and professional remediation practices described in the literature.

METHODS

This study used an integrative review process including article extraction and review, descriptive characterization and statistics, classification of levels of evidence, assessment of risk of bias, and examination of relationships between factors and types of remediation. Articles were located in a search of PubMed (MEDLINE) and EBSCO (CINAHL Complete) last accessed in May 2022.

INCLUSION CRITERIA

Full text journal articles and Briefs published between January 2001 and May 2022, English language, focus on remediation in health science education programs and professionals, identified key words in title, abstract, or article.

EXCLUSION CRITERIA

Published outside the date range; focus of study or article outside health sciences; main focus not on remediation process or program (defined above), books, presentations and abstracts.

RESULTS

97 articles were included. Design rigor clustered around Level 6 (case-controlled studies, case series, case reports). All programs and activities were reported as successful. There was a statistically significant relationship (p < 0.01) between healthcare discipline and type of remediation.

CONCLUSIONS

A variety of remediation methods for health care students and professionals are reported to be successful. Higher level studies are needed to help define best practices for remediation activities in health care professional knowledge and skill.

A prospective randomized study to compare standard versus intensive training strategies on long-term improvement in critical care ultrasonography proficiency

BACKGROUND

Critical care ultrasonography (CCUS) has become a daily diagnostic tool for intensivists. While the effective training measures for ultrasound novices are discussed widely, the best curriculum for the novices to retain a long-term proficiency is yet to be determined.

METHODS

Critical care medicine fellows who underwent an introductory CCUS workshop were randomly allocated into the standard training (ST) or the intensive training (IT) group. The IT group received an 8-h training besides the standardized fellowship education that the ST group received. Participant improvement in CCUS proficiency tests (maximum score, 200) after a 6-month training intervention was compared between the groups. CCUS examinations performed in patient care were observed over 2 years.

RESULTS

Twenty-one fellows were allocated into the ST (n = 10) or the IT (n = 11) group. No statistically significant difference was observed in the median (interquartile range [IQR]) improvement in CCUS proficiency tests between the ST group and the IT group: 18 (3.8-38) versus 31 (21-46) (P = .09). Median (IQR) test scores were significantly higher in postintervention than preintervention for both groups: ST, 103 (87-116) versus 124 (111-143) (P = .02), and IT, 100 (87-113) versus 143 (121-149) (P < .01). Participating fellows performed 226 examinations over the 2 years of observation.

CONCLUSIONS

Fellows improved their CCUS proficiency significantly after 6-month training intervention. However, an additional 8-h training did not provide further benefits.

Simulation-Based Outreach Program Improves Rural Hospitals’ Team Confidence in Neonatal Resuscitation

Introduction: Neonatal resuscitation is a high acuity, low occurrence event (HALO), and in rural community hospitals, low birth rates prevent providers from regular opportunities to maintain essential resuscitation skills. Simulation is an effective training modality for medical education, although resources for simulation are often limited in rural hospitals. Our primary objective was to test the hypothesis that in situ neonatal resuscitation simulation training improves rural hospitals' delivery room team confidence in performing key Neonatal Resuscitation Program^® (NRP^®) skills. Our secondary objective was to compare confidence to performance as measured by adherence to NRP® guidelines.

Methods: We conducted a quasi-experimental pre-training survey and post-training survey of delivery room team confidence in NRP^® skills at five level one delivery hospitals before and after an in situ simulation training program. Participants included rural hospitals’ usual delivery room team members. Participants rated their confidence on a five-point Likert scale. Simulations were analyzed using an adapted version of a validated scoring tool for NRP^® adherence and presented as overall percentage scores.

Results: Our data demonstrate a significant improvement in self-assessed confidence levels pre- and post-simulation training in key areas of neonatal resuscitation. Participants reported higher confidence in airway management (4 vs. 3, p=0.003), emergency intravenous access (3 vs. 2, p=0.007), and the ability to manage a code in the delivery room (4 vs. 3, p=0.013) and the operating room (4 vs. 3, p=0.028). Improvements were also noted in their team member’s knowledge and skills to perform neonatal resuscitation. While improvements were appreciated in confidence, the performance of skills (NRP^® adherence scores) was often in the sub-optimal performance range.

Conclusions: An in situ-based neonatal resuscitation outreach simulation program improves self-confidence among rural delivery room teams. Additional research is needed to understand how to translate improved confidence into actual improved performance. 

Tailoring First Aid Courses to Older Adults Participants

Relevant organizations emphasize the importance of first aid (FA) for older adults due to the increased risk of injuries and sudden illnesses in old age. Even though FA training guidelines have been developed, no program for an FA course adapted for the older adults has been formally adopted in Europe. This study's objective is to identify older adults' needs, beliefs, desires, advantages, and possible limitations in connection with FA. This qualitative study used semistructured interviews with 22 laypersons and retired health professionals older than 60 years old. The qualitative content analysis indicated that the major themes elicited by the older adults are motivation to participate in the FA training, older adults' specific features as a resource or obstacle for participating in FA training, general suggestions, and content suggestions for FA training. Older adults are very differently motivated to participate in FA training due to the heterogeneity of their psychophysical abilities. They need and want to obtain additional knowledge from the field of FA and health protection for which any psychophysical limitations are not as relevant as when learning cardiopulmonary resuscitation. They want to learn how to recognize emergency situations and more about calling emergency services with the use of modern technology. In addition to cardiopulmonary resuscitation without rescue breaths, they also want to learn about topics related to the treatment of injuries. Those who had practiced FA in their work-life think that they can be a good source to transfer their knowledge to persons from their generation. While planning an FA training course, it has to be taken into consideration that older adults want a short course, adjusted to their varied psychophysical abilities. Due to the wide array of contents they want to learn, it would be reasonable to prepare a selection of different programs for short training courses.

Post-Crash First Response by Traffic Police in Nepal: A Feasibility Study

Background: Road traffic injuries are a significant and increasing public health burden in Nepal, but there is no national coverage of regulated and standardized emergency medical service systems. Therefore, this study was designed to develop a first responder trauma training program for the Nepal traffic police and to evaluate the feasibility of its delivery and follow up. Methods: A training needs assessment with traffic-police officers in a single district of Nepal informed the development of a 3-day first-response course which was provided to officers in May 2019. Participants were supplied with a trauma-pack and asked to complete a report form when first-responder skills were used. Knowledge and confidence face-to-face surveys were used before and after training to assess learning, and were repeated at 6 months to assess retention of knowledge. The surveys at 6 months assessed the factors affecting application of first response skills. Results: Most (97%) participants believed giving first-aid was part of their responsibilities and 95% had experience of transporting road crash victims to hospital with a range of injuries. Low levels of first-aid training and variable course content were reported. Knowledge and confidence scores improved post-intervention but were reduced at 6-months. During attendance at 303 road crashes in the 6-months follow-up period, 44% of the participants self-reported using at least one skill from the course; applying them on 92 occasions. Incident report-forms were frequently not completed. Barriers to providing treatment included: the patient already en-route to hospital when police arrived at scene; resistance to providing care from relatives or bystanders; and competing police duties (e.g., traffic management). Conclusions: Delivering a first-response training program for traffic-police in Nepal is feasible. Knowledge was retained and used, and skills were in frequent demand. A study of effectiveness and cost-effectiveness appears warranted to determine if extending the training to other districts can improve outcomes in road traffic injury patients in the absence of formal emergency medical services.

Nursing Students Perceptions of Using YouTube to Teach Psychomotor Skills: A Comparative Pilot Study

Introduction

Current techniques to teach psychomotor skills to nursing students involve the traditional modeled performance by an instructor followed by rote memorization and practice. This outdated model presents many issues including no reference to refer back to, lacks technology integration, and only meets a few learning styles. A developmental study utilizing the social media platform YouTube was examined to gain student’s perspective on this as a teaching tool to assist in skill acquisition.

Objective

Do nursing students, who are enrolled in a Bachelor of Science Nursing (BSN) program and who are taught psychomotor nursing skills via demonstration on the social media platform YouTube, prefer this technology to traditional demonstration, and to evaluate their overall perceptions of YouTube?

Methods

Data collection was done utilizing a nursing cohort enrolled in a BSN program. Participants were split into two groups. The control group was taught intravenous (IV) skills in the traditional teacher demonstration followed by practice. Experimental group was given access to a YouTube video series consisting of the identified IV skills. After testing for competency was concluded, control group was given access to the videos. A questionnaire was developed and sent out for evaluation.

Results

Participants reported that their preferred learning style when learning new nursing skills was visual (41.7%) followed by a combination of visual, tactile, and auditory (41.7%). All respondents (100%) reported YouTube videos increased their learning. Respondents (100%) also noted that having access to the videos better prepared them. In experimental group, all participants (100%) watched the videos, and in the control group, only (16.7%) of students watched the videos after the skill had been learned.

Conclusion

Results demonstrated that students prefer YouTube videos when learning new skills. They reported feeling better prepared to learn. YouTube is a potential way to increase skill acquisition and integrate technology into the nursing curriculum.

A novel retraining strategy of chest compression skills for infant CPR results in high skill retention for longer

Infant cardiopulmonary resuscitation (iCPR) is often poorly performed, predominantly because of ineffective learning, poor retention and decay of skills over time. The aim of this study was to investigate whether an individualized, competence-based approach to simulated iCPR retraining could result in high skill retention of infant chest compressions (iCC) at follow-up. An observational study with 118 healthcare students was conducted over 12 months from November 2019. Participants completed pediatric resuscitation training and a 2-min assessment on an infant mannequin. Participants returned for monthly assessment until iCC competence was achieved. Competence was determined by passing assessments in two consecutive months. After achieving competence, participants returned just at follow-up. For each 'FAIL' during assessment, up to six minutes of practice using real-time feedback was completed and the participant returned the following month. This continued until two consecutive monthly 'PASSES' were achieved, following which, the participant was deemed competent and returned just at follow-up. Primary outcome was retention of competence at follow-up. Descriptive statistics were used to analyze demographic data. Independent t-test or Mann-Whitney U test were used to analyze the baseline characteristics of those who dropped out compared to those remaining in the study. Differences between groups retaining competence at follow-up were determined using the Fisher exact test. On completion of training, 32 of 118 participants passed the assessment. Of those achieving iCC competence at month 1, 96% retained competence at 9-10 months; of those achieving competence at month 2, 86% demonstrated competence at 8-9 months; of those participants achieving competence at month 3, 67% retained competence at 7-8 months; for those achieving competence at month 4, 80% demonstrated retention at 6-7 months.   Conclusion: Becoming iCC competent after initial training results in high levels of skill retention at follow-up, regardless of how long it takes to achieve competence. What is Known: • Infant cardiopulmonary resuscitation (iCPR) is often poorly performed and skills decay within months after training. • Regular iCPR skills updates are important, but the optimal retraining interval considering individual training needs has yet to be established. What is New: • Infant chest compression (iCC) competence can be achieved within one to four months after training and once achieved, it can be retained for many months. • With skill reinforcement of up to 28 minutes after initial training, 90% of individuals were able to achieve competence in iCC and 86% retained this competence at follow-up.

Why Do Not Physicians Attend Hospital Cardiopulmonary Resuscitation Training?

Introduction

Cardiopulmonary resuscitation (CPR) training is mandatory in most hospitals. Despite this, some hospital staff do not attend CPR training on a regular basis, but the barriers to training attendance are sparsely investigated. This study aimed to investigate CPR course attendance, barriers to participation, and possible initiatives to increase CPR course attendance.

Methods

Physicians from one university hospital and one regional hospital in the Central Denmark Region were included. Questionnaires were handed out at daily staff meetings at departments of internal medicine and surgery.

Results

In total, 233 physicians responded (response rate: 92%, male: 54%). Overall, 32% of physicians had not attended CPR training at the hospital. Mean (±standard deviation) time since the last CPR course participation was 17 (±3) months. Frequent barriers to attending courses included not knowing when courses are conducted (70%) and where to sign up for training (45%). The majority (60%) of physicians responded that the reason why they prioritize course participation is to be professionally updated. In contrast, 16% stated that they had sufficient CPR skills and therefore CPR training was unnecessary. Physicians stated that the following factors would improve CPR training participation: an annual day protected (no clinical work) for course attendance (72%), use of short booster sessions (49%), shorter courses combined with e-learning (51%) and shorter courses held over 2 days (46%).

Conclusion

One-third of physicians did not attend hospital CPR training at two Danish hospitals. Several barriers to course participation exist, of which course registration seems to be a crucial factor. Alternative CPR training methods may help improve training participation.

Public attitudes towards cardiopulmonary resuscitation training and performance in Singapore

Background

Bystander cardiopulmonary resuscitation (CPR) rates remain fairly low through most communities despite multiple interventions through the years. Understanding the attitudes and fears behind CPR training and performance would help target education and training to raise the rates of bystander CPR and consequently survival rates of victims. 7909 participants at a single-day mass CPR training session in Singapore were given survey questionnaires to fill out. 6473 people submitted completed forms upon the conclusion of the training session. Some issues looked at were the overall level of difficulty of CPR, difficulty levels of specific skills, attitudes towards refresher training, attitudes towards performing CPR, and fears when doing so.

Results

The mean level of difficulty of CPR was rated 3.98 (scale of 1–10), with those with previous CPR training rating it easier. The skills rated most difficult were performing mouth-to-mouth breathing and chest compressions, while the easiest rated was recognizing non-responsiveness. A majority (69.7%) would agree to go for refresher training every 2 years and 88.7% felt everyone should be trained in CPR. 71.6% would perform full CPR for a member of the public in cardiac arrest and only 20.7% would prefer to only do chest compressions. The most cited fear was a low level of confidence, and fears of acquiring infections or aversion to mouth-to-mouth breathing were low.

Conclusions

The survey results show that most participants in Singapore are keen to perform conventional CPR for a member of the public and can help to target future CPR training accordingly.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12245-021-00378-1.

Simulation Improves Internal Medicine Resident Confidence With Defibrillation, Cardioversion, and Transcutaneous Pacemaker Use

Introduction

While many graduate medical education programs require residents to be certified in advanced cardiac life support, this does not cover all aspects of cardiac stabilization in patients with a pulse. Residents are often on the front lines of providing care to patients with life-threatening dysrhythmias. Our residents expressed a lack of confidence in their ability to provide this care.

Methods

A convenience sample of internal medicine, preliminary medicine, and transitional year residents from our large community-based tertiary care hospital participated in our survey and training. We utilized a pre-post survey method of our residents’ confidence in domains that are critical to caring for patients requiring cardiac resuscitation and stabilization. Our pre-post survey was a modified Likert scale. Our training consisted of a 1-hour faculty-led hands-on training session focused on these critical domains in our hospital’s simulation suites. Follow-up survey data were collected immediately after the training and at six and 11 months after the training using mean confidence across all five domains as the study variable.

Results

Resident mean confidence in the five domains (placing leads and pads, manipulating defibrillator controls, performing defibrillation, performing synchronized cardioversion, and performing transcutaneous pacemaker use) increased immediately after our training compared to before the training (p<0.001). This increase in confidence from before the training was sustained at six and 11 months after the training (p=0.001 and p=0.002, respectively). Confidence was lower at six and 11 months than immediately after training (p=0.01 and p=0.004, respectively).

Conclusion

Our project showed that simulation-based training was effective in improving our trainee’s confidence in providing care to patients with life-threatening dysrhythmias. As with previous studies in simulation, confidence degradation was seen over time and likely mirrors skill degradation in these low-frequency encounters. As such, future aims include identification of ideal time intervals between training.

Basic life support training in schools

Older children and adolescents are able to learn and perform cardiopulmonary resuscitation maneuvers in a satisfactory manner. Schools are places where training in basic life support can be carried out. This narrative review was carried out to assess the effectiveness of training in basic life support in schools, analyzing different learning methodology, age groups, and gaining confidence in performing cardiopulmonary resuscitation in a real situation. The search was conducted in the MEDLINE database. Articles published from 01/01/2014 to 12/31/2019, with children under 18 years of age, published in English, Portuguese and Spanish, were selected. Three hundred and nine articles were found, of which 15 met the inclusion criteria in the study. There was great heterogeneity in the methodologies evaluated, making it difficult to compare some studies. Cardiopulmonary resuscitation taught to school children has resulted in the retention of skills and knowledge. There was a direct relationship between age group and quality of cardiopulmonary resuscitation. Learning cardiopulmonary resuscitation can also change the stigma and fear associated with procedures. We conclude that the teaching of cardiopulmonary resuscitation by different methodologies is effective in the learning of children and adolescents and improves their confidence in doing it. Although older than 12 years of age have a greater ability for depth of compression, other points of basic life support can be developed in younger children.

Training general practitioners in melanoma diagnosis: a scoping review of the literature

BACKGROUND

General practitioners (GPs) play a key role in early melanoma detection. To help GPs deal with suspicious skin lesions, melanoma diagnostic training programmes have been developed. However, it is unclear whether these programmes guarantee the acquisition of skills that will be applied by GPs in their daily clinical practice and maintained over time.

OBJECTIVES

This scoping review aimed to examine and compare educational programmes designed to train GPs in melanoma diagnosis using clinical (naked eye) examination alone or dermoscopy±clinical examination, and sought to inform on the long-term sustainability of the GPs' acquired skills.

ELIGIBILITY CRITERIA

Studies eligible for inclusion evaluated educational programmes for teaching diagnosis of melanoma to GPs. MEDLINE, EMBASE and Cochrane databases were searched for relevant articles from 1995 to May 2020.

RESULTS

Forty-five relevant articles were found assessing 31 educational programmes. Most programmes that improved the diagnostic accuracy and long-term performances of the GPs, that is, increase in confidence, decrease in dermatologist referral for benign skin lesions and improvement in the benign/malignant ratio of excised skin lesions, trained the GPs in clinical diagnosis, followed by dermoscopy. To maintain long-term performances, these programmes provided refresher training material.

CONCLUSION

This review shows that studies generally report positive outcomes from the training of GPs in melanoma diagnosis. However, refresher training material seemed necessary to maintain the acquired skills. The optimal form and ideal frequency for these updates have yet to be defined.

Bystanders' Views on the Use of Automated External Defibrillators for Out-of-Hospital Cardiac Arrest: Implications for Health Promotions

Despite the widespread availability of automated external defibrillators, not everyone is enthusiastic about using them. The aim of this study was to examine the reasons for not using an automated external defibrillator (AED) and predictors of the reasons. The study had a cross-sectional design using an online survey. Data were collected in eighteen districts in Hong Kong to be representative of the city. The questionnaire consisted of questions on demographics, knowledge and attitude towards AED use, reasons for not using AED, and whether the kind of victim could affect the decision of the bystanders. There was a high significant correlation between knowledge and attitude, with r = 0.782 and p < 0.001. Of the respondents, 53.3% agreed that the kind of victim would affect their willingness to operate an AED. A binary logistic regression model revealed that a higher education (OR 6.242, 95% CI: 1.827–21.331), concern about the kind of victim involved (OR 2.822, 95% CI: 1.316–6.052), and a younger age were significant predictors of worrying about taking on responsibility in using AED. Other than knowledge, other barriers included a desire to avoid legal liability, and the kind of victim they encountered. Life experiences in adulthood could possibly affect the social responsibility and influence the behaviors of adults to operate AEDs.

Training of airway management for anesthesia teams - Measurement of transfer into daily work routine by questionnaire

THEORY

Problems in airway management are rare in anesthesia but when they occur, they have serious consequences for the patient. For this reason, training is recommended for professionals involved in anesthetic care. Here we investigated, if a newly developed technical/ non-technical hybrid airway training would be relevant for daily practice in a tertiary referral hospital.

HYPOTHESES

We hypothesized that: (a) both parts of the validated questionnaires meet the quality criteria for the application in anesthesia teams, (b) even though the team regularly deals with airway management, airway management training is relevant to all professions and (c) contents of the developed training can be integrated into the behaviour of the teams.

METHOD

In this observational study, 104 professionals took part in a one-day technical/non-technical hybrid airway training programme. Participants received a questionnaire six months after training, based on selected scales of the validated tools; "Training Evaluation Inventory" and "Transfer Climate Questionnaire".

RESULTS

The scales of "perceived usefulness", "task cues" and "positive reinforcement" showed good internal consistency and all were rated higher than 3.9 on a 5-point Likert scale (1=complete rejection; 5=fullest approval). The scale "negative reinforcement and punishment" showed satisfactory internal consistency for physicians (rated 2.75 ± 0.8). By removing an item in each case, the scales "attitude towards training" (rated 4.93 ± 0.2) and "extinction" (rated 3.02 ± 0.8) showed satisfactory internal consistency for nurses and anesthetic technicians. "Social Cues" did not meet qualitative criteria. There was no difference in the assessment by the professional groups.

CONCLUSIONS

The presented training course was perceived as useful by both professional groups equally, which supported the interprofessional concept. The content was positively reinforced in practice six months after training and is relevant for professionals who are regularly confronted with the topic "airway management". Scales which meet qualitative criteria for only one profession and the scale "social cues" should be reconsidered in the context of an interprofessional team.

Evolution of Bystander Intention to Perform Resuscitation Since Last Training: Web-Based Survey

BACKGROUND

Victims of out-of-hospital cardiac arrest (OHCA) have higher survival rates and more favorable neurological outcomes when basic life support (BLS) maneuvers are initiated quickly after collapse. Although more than half of OHCAs are witnessed, BLS is infrequently provided, thereby worsening the survival and neurological prognoses of OHCA victims. According to the theory of planned behavior, the probability of executing an action is strongly linked to the intention of performing it. This intention is determined by three distinct dimensions: attitude, subjective normative beliefs, and control beliefs. We hypothesized that there could be a decrease in one or more of these dimensions even shortly after the last BLS training session.

OBJECTIVE

The aim of this study was to measure the variation of the three dimensions of the intention to perform resuscitation according to the time elapsed since the last first-aid course.

METHODS

Between January and April 2019, the two largest companies delivering first-aid courses in the region of Geneva, Switzerland sent invitation emails on our behalf to people who had followed a first-aid course between January 2014 and December 2018. Participants were asked to answer a set of 17 psychometric questions based on a 4-point Likert scale ("I don't agree," "I partially agree," "I agree," and "I totally agree") designed to assess the three dimensions of the intention to perform resuscitation. The primary outcome was the difference in each of these dimensions between participants who had followed a first-aid course less than 6 months before taking the questionnaire and those who took the questionnaire more than 6 months and up to 5 years after following such a course. Secondary outcomes were the change in each dimension using cutoffs at 1 year and 2 years, and the change regarding each individual question using cutoffs at 6 months, 1 year, and 2 years. Univariate and multivariable linear regression were used for analyses.

RESULTS

A total of 204 surveys (76%) were analyzed. After adjustment, control beliefs was the only dimension that was significantly lower in participants who took the questionnaire more than 6 months after their last BLS course (P<.001). Resisting diffusion of responsibility, a key element of subjective normative beliefs, was also less likely in this group (P=.001). By contrast, members of this group were less afraid of disease transmission (P=.03). However, fear of legal action was higher in this group (P=.02).

CONCLUSIONS

Control beliefs already show a significant decrease 6 months after the last first-aid course. Short interventions should be designed to restore this dimension to its immediate postcourse state. This could enhance the provision of BLS maneuvers in cases of OHCA.

A Longitudinal Analysis of a Law Enforcement Intranasal Naloxone Training Program

INTRODUCTION

The opioid crisis continues to claim lives at historically unprecedented levels and shows few signs of abating. One means of mitigating the harm from opioid abuse and unintentional overdose is training and equipping police officers to administer intranasal (IN) naloxone as part of a broader public health response. While an increasing number of state and local agencies have implemented law enforcement officer (LEO) naloxone training programs, due to the novelty of these programs, the evidence of program efficacy is limited. This study describes the implementation and evaluation of a LEO training program in opioid overdose recognition, management, and administration of IN naloxone.

METHODS

This evaluation consisted of a secondary analysis of de-identified administrative quality assurance data. Police officers in Howard County, Maryland (n=281) underwent an IN naloxone training program between June and July 2015. The training program entailed a 30-minute online component, a 45-minute in-service session, and a 15-question post-test (n=228). The success of the training program was evaluated via an opioid overdose knowledge survey administered at 30 days (n=207) and 6 months (n=182) after training.

RESULTS

The 30-day and 6-month scores for all knowledge outcomes indicated that officers retained the contents of the training program well over time. After six months, 100% of respondents correctly identified the physiological effects of naloxone administration, and 95.6% correctly identified the opioid-containing drugs that may result in overdose. At the six-month mark, 74.59% correctly identified the initial signs of opioid overdose, and 60.99% correctly identified the time required for IN to begin working.

CONCLUSION

LEOs exhibit the ability to retain the contents of IN training over 30-day and 6-month periods and express confidence in their ability to assist suspected opioid overdose victims. Further research is necessary to determine the degree to which further knowledge decay might occur, the sustained ability to implement this knowledge under real-world conditions, and the subsequent effects on overdose victim survival.

The general public's ability to operate automated external defibrillator: A controlled simulation study

BACKGROUND

Automated external defibrillators (AEDs) enable laypeople to provide early defibrillations to patients undergoing cardiac arrest, but scant information is available on the general public's ability to use AEDs. This study assessed the ability of laypeople to operate AEDs, the effect of a 15-minute training, and whether skills differed by age.

METHODS

From May 1 to December 31, 2018, a prospective simulation study was conducted with 94 laypeople aged 18-65 years (32 aged 18-24 years, 34 aged 25-54 years, and 28 aged 55-65 years) with no prior AED training. The participants' AED skills were assessed individually pre-training, post-training, and at a three-month follow-up using a simulated cardiac arrest scenario. The critical actions and time intervals were evaluated during the AED operating process.

RESULTS

Only 14 (14.9%) participants (eight aged 18-24 years, four aged 25-54 years, and two aged 55-65 years) successfully delivered defibrillations before training. AED operation errors were more likely to occur among the participants aged 55-65 years than among other age groups. After training, the proportion of successful defibrillations increased significantly (18-24 years old: 25.0% vs. 71.9%, P<0.01; 25-54 years old: 11.8% vs. 70.6%, P<0.01; 55-65 years old: 7.1% vs. 67.9%, P<0.01). After three months, 26.1% of the participants aged 55-65 years successfully delivered defibrillations, which was significantly lower than that of participants aged 18-24 years (54.8%) and 25-54 years (64.3%) (P=0.02). There were no differences in time measures among three age groups in each test.

CONCLUSIONS

The majority of untrained laypeople cannot effectively operate AEDs. More frequent training and refresher courses are crucial to improve AED skills.

A follow-up report on the effect of a simplified basic life support training program for non-medical staff working at a university hospital: changes in attitude toward cardiopulmonary resuscitation and automated external defibrillator use through repeat training

Aim

This study aimed to investigate the effect of repeat training and the interval of reattending a simplified basic life support (BLS) training course.

Methods

We administered a questionnaire on the attitude toward cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use (check for response, chest compression, and using an AED) before and immediately after a 45‐min BLS training program provided for non‐medical staff working at a university hospital from September 2010 to November 2018. The main outcome was positive willingness of the participants toward CPR and AED use. The effect of repeat training was assessed with McNemar’s test and multivariable logistic regression analysis. Differences in the interval of reattending the simplified BLS training course were assessed with Fisher’s exact test.

Results

Fifty‐nine training courses were held. Among the total participant count of 1,025, 760 individuals attended, of whom 126 attended the training multiple times. The proportion of participants showing a positive attitude toward chest compression before the course increased as the number of attendances increased (adjusted odds ratio 1.62: 9.8% at first training to 58.8% at sixth training). The positive attitude of participants before the course was significantly greater when the training interval was <1 year (36.1% versus 18.7%). There was no significant difference for a 6‐month interval (40% versus 23.2%).

Conclusions

Repeat training for non‐medical staff in a chest compression‐only CPR training course showed a cumulative effect of repeat attendance. A course interval of <1 year from the previous attendance would be important for maintaining a positive attitude toward CPR and AED use.

Transfer of an interprofessional emergency caesarean section training program: using questionnaire combined with outcome data of newborn

PUPROSE

An emergency caesarean section is a potentially life-threatening situation both for the mother and the newborn. Non-technical skills can be improved by simulation training and are necessary to manage this urgent situation successfully. The objective of this study was to investigate, if training of emergency caesarean section can be transferred into daily work to improve the outcome parameters pH an APGAR of the newborn.

METHODS

In this pre-post study, 141 professionals took part in a training for emergency caesarean section. Participants received a questionnaire, based on the tools "Training Evaluation Inventory" and "Transfer Climate Questionnaire" 1 year after training. Outcome data of the newborn were collected from the hospitals information system.

RESULTS

Except the scale "extinction", Cronbach's alpha was higher than 0.62. All scales were rated lower than 2.02 on a 5-point Likert Scale (1 = fullest approval; 5 = complete rejection). "Negative reinforcement" was rated with 2.87 (SD 0.73). There were no significant differences in outcome data prior. The questionnaire fulfils criteria for application except the scale "extinction".

CONCLUSION

The presented training course was perceived as useful by the professionals and attitudes toward training were positive; the content was positively reinforced in practice 1 year after training. Parameters of the newborn did not change. It is conceivable that other outcome parameters (e.g. posttraumatic stress disorder) are addressed by the training. The development of relevant outcome parameters for the quality of emergency sections needs further investigation.

Traditional versus blended CPR training program: A randomized controlled non-inferiority study

Cardiopulmonary resuscitation (CPR) training and its quality are critical in improving the survival rate of cardiac arrest. This randomized controlled study investigated the efficacy of a newly developed CPR training program for the public in a Taiwanese setting. A total of 832 adults were randomized to either a traditional or blended (18-minute e-learning plus 30-minute hands-on) compression-only CPR training program. The primary outcome was compression depth. Secondary outcomes included CPR knowledge test, practical test, quality of CPR performance, and skill retention. The mean compression depth was 5.21 cm and 5.24 cm in the blended and traditional groups, respectively. The mean difference in compression depth between groups was -0.04 (95% confidence interval -0.13 to infinity), demonstrating that the blended CPR training program was non-inferior to the traditional CPR training program in compression depth after initial training. Secondary outcome results were comparable between groups. Although the mean compression depth and rate were guideline-compliant, only half of the compressions were delivered with adequate depth and rate in both groups. CPR knowledge and skill retained similarly in both groups at 6 and 12 months after training. The blended CPR training program was non-inferior to the traditional CPR training program. However, there is still room for improvement in optimizing initial skill performance as well as skill retention. Clinical Trial Registration: NCT03586752; www.clinicaltrial.gov.

Medical Student Skill Retention After Cardiopulmonary Resuscitation Training: A Cross-Sectional Simulation Study

INTRODUCTION

The retention of cardiopulmonary resuscitation skills and the ideal frequency of retraining remain unanswered. This study investigated the retention of cardiopulmonary resuscitation skills by medical students for up to 42 months after training.

METHODS

In a cross-sectional study, 205 medical students received 10 hours of training in basic life support in 3 practical classes, during their first semester at school. Then, they were divided into 4 groups, according to the time elapsed since the training: 73 after 1 month, 55 after 18 months, 41 after 30 months, and 36 after 42 months. Nineteen cardiopulmonary resuscitation skills and 8 potential technical errors were evaluated by mannequin-based simulation and reviewed using filming.

RESULTS

The mean retention of the skills was 90% after 1 month, 74% after 18 months, 62% after 30 months, and 61% after 42 months (P < 0.001). The depth of chest compressions had the greatest retention over time (87.8%), with no significant differences among groups. Compressions performed greater than 120 per minute were less likely to be done with adequate depth. Ventilation showed a progressive decrease in retention from 93% (n = 68) after 1 month to 19% (n = 7) after 42 months (P < 0.001). All 205 students were able to turn the automated external defibrillator on and deliver the shock.

CONCLUSIONS

The depth of chest compressions and the use of an automated external defibrillator were the skills with the highest retention over time. Based on a skills retention prediction curve, we suggest that 18 to 24 months as the minimum retraining interval to maintain at least 70% of skills.

Quantification of Passive Ventilation Produced by Manual Chest Compressions Using a New Cardiopulmonary Resuscitation Feedback Device

Several studies have shown that chest compressions (CC) alone may produce in addition to blood circulation, a short-term passive ventilation. However, it is not clear whether high CC quality may produce in even greater amount of ventilation volumes. The aim of this study was to evaluate whether CC, using a new feedback device, can produce a substantial and sustainable passive volumes compared to standard CC. Thirty inexperienced volunteers performed CC for 2 min on a developed thoracic lung model and using a new feedback device. Participants were randomized into two groups that performed either CC with feedback first, followed by a trial without feedback, or vice versa. Efficient compression rate (correct CC rate and depth simultaneously) was significantly higher in feedback session (43.6% versus 25.5%; P = 0.006). As well, CC rate and depth efficiency were improved with feedback. Moreover, average tidal volumes and minute volumes that occurred during CC alone were significantly improved in feedback session (79.8 ± 5 ml versus 72.9 ± 7 ml) and (8.8 l/min versus 7.9 l/min), respectively (P &lt; 0.001). Yet, no significant difference was found between the first and the 90th second interval (9.04 l/min versus 8.68 l/min, P = 0.163) in the feedback session. Conversely, a significant difference was evident after the first 15th seconds interval without feedback (8.77 l/min initially versus 8.38 l/min; P = 0.041). This study revealed that the new CPR feedback device improved CC quality in inexperienced volunteers. As well, the passive ventilation volumes were significantly increased and sustained when the device was used.

Video-enhanced follow-up training improves basic life support skills retention in laypersons: A prospective randomized controlled trial

Background:

Retraining and retention for basic life support skills after initial basic life support education are important for high-quality basic life support performance at the scene.

Objectives:

We investigated whether delivery of a personal-training video clip reduced basic life support skill degradation in laypersons.

Methods:

After a basic life support layperson training course, the participants were randomized to the video group and control group. The layperson learners in the video group were provided with a video clip of themselves during basic life support education course and a follow-up text message every 3 months after initial basic life support course. The control group only received a follow-up text message every 3 months, without a video clip. The performances of all participants were reviewed initially and after 12 months in each group.

Results:

The total number of participants was 186. Among them, 22 in the video group and 29 in the control group completed the follow-up and final basic life support skill tests. In the control group, basic life support skill level of the participants was at 60.1% after 12 months compared with the initial test and 79.8% in the video group. The performance differences in each basic life support skill score between the initial and follow-up test at 12 months were significantly different between the video group and control group: non-compression, 0.0 (0.0–1.0) versus 1.0 (1.0–2.0); compression, 1.0 (0.0–1.3) versus 1.0 (0.0–4.0); automated external defibrillator, 2.0 (1.0–3.0) versus 3.0 (2.0–4.5) and total score, 4.0 (2.0–5.0) versus 6.0 (3.0–9.5), respectively (all p-values < 0.05).

Conclusion:

Delivery of a basic life support personal-training video clip to laypersons who received basic life support training can reduce performance degradation at 12 months.

Basic Life-Support Learning in Undergraduate Students of Sports Sciences: Efficacy of 150 Minutes of Training and Retention after Eight Months

Several professional groups, which are not health professionals, are more likely to witness situations requiring basic life support (BLS) due to the nature of their job. The aim of this study was to assess BLS learning after 150 min of training in undergraduate students of sports science and their retention after eight months. Participants trained on BLS (150-min session: 30 theory, 120 practice). After training (T1) and after 8 months (T2), we evaluated their performance of the BLS sequence and two minutes of cardiopulmonary resuscitation (CPR). At T1, the 23 participants presented a mean score of 72.5 ± 21.0% in the quality of the CPRs (compressions: 78.6 ± 25.9%, ventilation: 69.9 ± 30.1%). More than 90% of the participants acted correctly in each step of the BLS sequence. At T2, although the overall quality of the CPR performed did not decrease, significant decreases were observed for: correct hand position (T1: 98.2 ± 8.8, T2: 77.2 ± 39.7%), compression depth (T1: 51.4 ± 7.9, T2: 56.0 ± 5.7 mm), and compression rate. They worsened opening the airway and checking for breathing. In conclusions, participants learned BLS and good-quality CPR after the 150-min training session. At eight months they had good retention of the BLS sequence and CPR skills. Training on airway management and the position of the hands during CPR should be reinforced.

Experiences among firefighters and police officers of responding to out-of-hospital cardiac arrest in a dual dispatch programme in Sweden: an interview study

OBJECTIVES

The objective of this study was to explore firefighters' and police officers' experiences of responding to out-of-hospital cardiac arrest (OHCA) in a dual dispatch programme.

DESIGN

A qualitative interview study with semi-structured, open-ended questions where critical incident technique (CIT) was used to collect recalled cardiac arrest situations from the participants' narratives. The interviews where transcribed verbatim and analysed with inductive content analysis.

SETTING

The County of Stockholm, Sweden.

PARTICIPANTS

Police officers (n=10) and firefighters (n=12) participating in a dual dispatch programme with emergency medical services in case of suspected OHCA of cardiac or non-cardiac origin.

RESULTS

Analysis of 60 critical incidents was performed resulting in three consecutive time sequences (preparedness, managing the scene and the aftermath) with related categories, where first responders described the complexity of the cardiac arrest situation. Detailed information about the case and the location was crucial for the preparedness, and information deficits created stress, frustration and incorrect perceptions about the victim. The technical challenges of performing cardiopulmonary resuscitation and managing the airway was prominent and the need of regular team training and education in first aid was highlighted.

CONCLUSIONS

Participating in dual dispatch in case of suspected OHCA was described as a complex technical and emotional process by first responders. Providing case discussions and opportunities to give, and receive feedback about the case is a main task for the leadership in the organisations to diminish stress among personnel and to improve future OHCA missions.

Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association

The formula for survival in resuscitation describes educational efficiency and local implementation as key determinants in survival after cardiac arrest. Current educational offerings in the form of standardized online and face-to-face courses are falling short, with providers demonstrating a decay of skills over time. This translates to suboptimal clinical care and poor survival outcomes from cardiac arrest. In many institutions, guidelines taught in courses are not thoughtfully implemented in the clinical environment. A current synthesis of the evidence supporting best educational and knowledge translation strategies in resuscitation is lacking. In this American Heart Association scientific statement, we provide a review of the literature describing key elements of educational efficiency and local implementation, including mastery learning and deliberate practice, spaced practice, contextual learning, feedback and debriefing, assessment, innovative educational strategies, faculty development, and knowledge translation and implementation. For each topic, we provide suggestions for improving provider performance that may ultimately optimize patient outcomes from cardiac arrest.

Endotracheal intubation skills of pediatricians versus anesthetists in neonates and children

This study compares the performance of pediatricians and anesthetists in neonatal and pediatric endotracheal intubations (ETI) during simulated settings. Participants completed a questionnaire and performed an ETI scenario on a neonatal and a child manikin. The procedures were recorded with head cameras and cameras attached to standard laryngoscope blades. The outcomes were successful intubation, time to successful intubation, number of attempts, complications, total performance score, end-assessment rating, and an assessment whether the participant was sufficiently able to perform an ETI. Fifty-two pediatricians and 52 anesthetists were included. For the neonatal ETI, the rate of successful intubation was in favor of anesthetists although not significant. Anesthetists performed significantly better in all other outcomes. Of the pediatricians, 65% was rated sufficiently adept to perform a neonatal ETI vs 100% of the anesthetists. Pediatricians (29%) overestimated while anesthetists (33%) underestimated their performance in neonatal ETI. For the pediatric ETI, all outcomes were significantly better for anesthetists. Only 15% of all pediatricians were considered sufficiently able to perform pediatric ETI vs 94% of the anesthetists.Conclusion: Anesthetists are far more adept in performing ETI in neonates and children compared with pediatricians in a simulated setting. Complications are expected to occur less frequently and less seriously when anesthetists perform ETI. What is Known: • Endotracheal intubation (ETI) performed by inexperienced care providers can lead to unsuccessful and/or prolonged intubation attempts. This can cause complications such as hypoxemia, trauma to the oropharynx and larynx, and prolonged interruption of resuscitation, which results in a high morbidity/mortality. • Fifty to 60 real-life ETI procedures are needed before ETI can be performed with a 90% success rate. Despite this, 18% of providers still require some assistance even after performing 80 intubations. Skill fade will occur if there is too little exposure. What is New: • This study shows that, on both neonatal and child manikins, anesthetists perform better in ETI compared with pediatricians. Besides this, complications are expected to occur less frequently and less seriously when anesthetists are performing the ETIs on neonates and children. • In those countries where there are no clear interprofessional agreements made in general hospitals on who will perform ETI on neonates and children in acute care settings, these agreements are urgently necessary.

Cognitive Aids Do Not Prompt Initiation of Cardiopulmonary Resuscitation in Simulated Pediatric Cardiopulmonary Arrests

INTRODUCTION

Although American Heart Association guidelines exist for proper management of cardiopulmonary arrest (CPA), in-hospital cardiopulmonary resuscitation (CPR) may be of poor quality and is not performed in all indicated situations. Cognitive aids have been created to assist in rapid, accurate recall of guidelines for pediatric CPA management.

METHODS

Pediatric residents participated in individual mock codes for two years. Using a high-fidelity simulator, each resident participated in a standardized scenario that required management of both pulseless ventricular tachycardia and pulseless electrical activity. The primary study objective was to calculate the proportion of residents (a) who were not performing CPR on a simulated "pulseless" patient when cognitive aid use was first initiated and (b) who subsequently initiated CPR after cognitive aid use.

RESULTS

One hundred thirty-two (83.5%) of 158 pediatric residents participated, and of 125 videos available for review, 107 residents (85.6%) used a cognitive aid. Mean (SD) time to cognitive aid use was 106 (100) seconds after the mannequin became pulseless. Most common immediate actions prompted by cognitive aid use were the following: defibrillation, 43 (40%) of 107; and adrenaline (epinephrine) administration, 28 (26%) of 107. Most alarmingly, 58 (54%) of 107 were not performing CPR on the pulseless patient when cognitive aid use was initiated and only two (3.4%) of 58 were subsequently prompted to initiate chest compressions.

DISCUSSION

Cognitive aids in use during this study did not prompt timely initiation of CPR, potentially contributing to delays and errors in CPA management. Failure of these aids to prompt CPR initiation represents a "missed opportunity" to enhance performance of this vital skill.

Clinical instructors' perceptions of virtual reality in health professionals' cardiopulmonary resuscitation education

Objectives:

Cardiopulmonary resuscitation (CPR) is lifesaving. Yet, cardiac arrest survival remains low despite CPR intervention. Education has been highlighted as a strategy to overcome this issue. Virtual Reality technology has been gaining momentum in the field of clinical education. Published studies report benefits of virtual reality for CPR education; yet, perceptions of CPR instructors towards virtual reality remain unexplored. CPR instructors are key stakeholders in CPR education and their perceptions are valuable for the design and adoption of virtual reality-enhanced learning. The purpose of this study is therefore to understand the perceptions of CPR instructors towards using virtual reality for health professionals’ CPR education. The aim was addressed via three research questions: (1) What are the perceptions of CPR instructors towards current health professionals’ CPR education? (2) What are the perceptions of CPR instructors towards features of virtual reality ideal for health professionals’ CPR education? (3) What are the perceptions of CPR instructors towards the potential role of virtual reality in health professionals’ CPR education?

Methods:

A total of 30 CPR instructors were surveyed on their views towards current health professionals’ CPR education and the use of virtual reality for health professionals’ CPR education, before and after interacting with a CPR virtual reality simulation. Responses were analysed using interpretative thematic analysis.

Results:

CPR instructors perceived current health professionals’ CPR education as limited due to unideal test preparation (resources, practice, motivation, and frame of mind) and performance. They perceived fidelity, engagement, resource conservation, and memory enhancement as features of virtual reality ideal for health professionals’ CPR education. Virtual reality was viewed by CPR instructors as having potential as a blended learning tool, targeting both ‘novice’ and ‘experienced’ health professionals.

Conclusion:

The study highlighted the gaps in current health professionals’ CPR education that can be addressed using virtual-reality-enabled learning. Future research could investigate virtual reality simulations with features desirable for CPR education of target populations.

Impact of training in Advanced Cardiac Life Support (ACLS) in the professional career and work environment

We sought to evaluate the impact of Advanced Cardiac Life Support (ACLS) training in the professional career and work environment of physicians who took the course in a single center certified by the American Heart Association (AHA). Of the 4631 students (since 1999 to 2009), 2776 were located, 657 letters were returned, with 388 excluded from the analysis for being returned lacking addressees. The final study population was composed of 269 participants allocated in 3 groups (< 3 years, 3-5 and > 5years). Longer training was associated with older age, male gender, having undergone residency training, private office, greater earnings and longer time since graduation and a lower chance to participate in providing care for a cardiac arrest. Regarding personal change, no modification was detected according to time since taking the course. The only change in the work environment was the purchase of an automated external defibrillator (AED) by those who had taken the course more than 5 years ago. In multivariable analysis, however, the implementation of an AED was not independently associated with this group, which showed a lower chance to take a new ACLS course. ACLS courses should emphasize also how physicians could reinforce the survival chain through environmental changes.

Self-learning basic life support: A randomised controlled trial on learning conditions

AIM OF THE STUDY

To investigate whether pure self-learning without instructor support, resulted in the same BLS-competencies as facilitator-led learning, when using the same commercially available video BLS teaching kit.

METHODS

First-year medical students were randomised to either BLS self-learning without supervision or facilitator-led BLS-teaching. Both groups used the MiniAnne kit (Laerdal Medical, Stavanger, Norway) in the students' local language. Directly after the teaching and three months later, all participants were tested on their BLS-competencies in a simulated scenario, using the Resusci Anne SkillReporter™ (Laerdal Medical, Stavanger, Norway). The primary outcome was percentage of correct cardiac compressions three months after the teaching. Secondary outcomes were all other BLS parameters recorded by the SkillReporter and parameters from a BLS-competence rating form.

RESULTS

240 students were assessed at baseline and 152 students participated in the 3-month follow-up. For our primary outcome, the percentage of correct compressions, we found a median of 48% (interquartile range (IQR) 10-83) for facilitator-led learning vs. 42% (IQR 14-81) for self-learning (p = 0.770) directly after the teaching. In the 3-month follow-up, the rate of correct compressions dropped to 28% (IQR 6-59) for facilitator-led learning (p = 0.043) and did not change significantly in the self-learning group (47% (IQR 12-78), p = 0.729).

CONCLUSIONS

Self-learning is not inferior to facilitator-led learning in the short term. Self-learning resulted in a better retention of BLS-skills three months after training compared to facilitator-led training.

Knowledge and attitudes of Singapore schoolchildren learning cardiopulmonary resuscitation and automated external defibrillator skills

INTRODUCTION

Victims of out-of-hospital cardiac arrests require timely cardiopulmonary resuscitation (CPR) and early defibrillation. Callers to emergency medical services are asked to provide dispatcher-guided responses until an ambulance arrives. Knowing what to expect in such circumstances should reduce both delay and confusion.

METHODS

This study was conducted among schoolchildren aged 11-17 years using ten-item pre- and post-training surveys. We aimed to observe any knowledge and attitude shifts regarding CPR and automated external defibrillator (AED) use subsequent to the training.

RESULTS

A total of 1,196 students across five schools completed the pre- and post-training surveys. Survey questions tested basic CPR knowledge and attitudes towards CPR and AED use. The overall response rate was 80.8% and 81.5% in the pre- and post-training surveys, respectively. There was a statistically significant improvement in the students' CPR knowledge. The number of students who selected all the correct answers for the knowledge-based questions in the post-training survey increased by 64.7% (95% confidence interval 61.9%-67.5%; p < 0.001). There was also an improvement in their willingness to administer CPR (likely/very likely to administer CPR pre-training vs. post-training: 13.0% vs. 71.0%; p < 0.001) and use AED (likely/very likely to administer AED pre-training vs. post-training: 11.7% vs. 78.0%; p < 0.001) after training.

CONCLUSION

The training programme imparted new information and skills, and improved attitudes towards providing CPR and using AED. However, some concerns persisted about hurting the victim while performing CPR.

Shocking the system: AEDs in military resuscitation

Automated external defibrillator (AED) devices have been in routine clinical use since the early 1990s to deliver life-saving shocks to appropriate patients in non-clinical environments. As expectations of survival from out-of-hospital cardiac arrest increase, and evidence incontrovertibly points to reduced timelines as the most crucial factor in achieving return of spontaneous circulation, questions regarding the availability and location of AEDs in the UK military need to be readdressed. This article explores the background of AEDs and reviews their history, life-saving potential and defines current and best practice. It goes on to review the evidence surrounding training and looks to identify knowledge gaps that might be addressed effectively by future research. Finally, it makes recommendations regarding training, availability of AEDs on military bases and locations most likely to deliver good outcomes for military personnel in the future.

Kids (learn how to) save lives in the school with the serious game Relive

INTRODUCTION

Relive is a serious game focusing on increasing kids and young adults' awareness on CPR. We evaluated the use of Relive on schoolchildren.

METHODS

A longitudinal, prospective study was carried out in two high schools in Italy over a 8-month period, divided in three phases: baseline, competition, and retention. Improvement in schoolchildren's CPR awareness, in terms of knowledge (MCQ results) and skills (chest compression (CC) rate and depth), was evaluated. Usability of Relive and differences in CC performance according to sex and BMI class were also evaluated.

RESULTS

At baseline, students performed CC with a mean depth of 31mm and a rate of 95 cpm. In the competition phase, students performed CC with a mean depth of 46mm and a rate of 111 cpm. In the retention phase, students performed CC with a mean depth of 47mm and a rate of 131 cpm. Thus, the training session with Relive during the competition phase affected positively both CC depth (p<0.001) and rate (p<0.001). Such an effect persisted up to the retention phase. CC depth was also affected by gender (p<0.01) and BMI class (p<0.01). Indeed, CC depth was significantly greater in male players and in players with higher BMI. Seventy-three percent of students improved their CPR knowledge as represented by an increases in the MCQ score (p<0.001). The participants perceived the Relive to be easy to use with effective feedback.

CONCLUSIONS

Relive is an useful tool to spread CPR knowledge and improve CPR skills in schoolchildren.

Improvement in Trainees' Attitude and Resuscitation Quality With Repeated Cardiopulmonary Resuscitation Training: Cross-Sectional Simulation Study

INTRODUCTION

This study investigated the effect of increasing numbers of training sessions in cardiopulmonary resuscitation (CPR) on trainees' attitude and CPR quality.

METHODS

Cardiopulmonary resuscitation training for hospital employees was held every year from 2006 to 2010. Participants were recruited among the trainees in 2010. The trainees' attitudes toward CPR were surveyed by questionnaire, and the quality of their CPR was measured using 5-cycle 30:2 CPR on a manikin. Participants were categorized according to the number of consecutive CPR training sessions as T1 (only 2010), T2 (2009 and 2010), T3 (from 2008 to 2010) and T4-5 (from 2006 or 2007 to 2010). The trainee attitude and CPR quality were compared among the 4 groups.

RESULTS

Of 923 CPR trainees, 267 were enrolled in the study. There was significant increase in willingness to start CPR and confidence in chest compression and mouth-to-mouth ventilation (MTMV) with increasing number of CPR training sessions attended (especially for ≥ 3 sessions). There was a significant increase in mean compression depth and decrease in percentage of chest compressions with depth of less than 38 mm in the T3 and T4-5 compared with the T1 and T2. No-flow time decreased significantly, and the percentage of MTMV with visible chest rise increased, as the number of training sessions increased.

CONCLUSIONS

Repeated CPR training improved trainees' attitude and CPR quality. Because the number of training sessions increased (≥3), the willingness to start CPR and the confidence in skills increased significantly, and chest compression depth, no-flow time, and MTMV improved.

Quality of basic life support education and automated external defibrillator setting in schools in Ishikawa, Japan

BACKGROUND

Automated external defibrillators (AED) have been installed in schools in Japan since 2004, and the government strongly recommends teaching basic life support (BLS). We therefore examined the quality of BLS education and AED installation in schools.

METHODS

We conducted a prefecture-wide questionnaire survey of all primary and junior high schools in 2016, to assess BLS education and AED installation against the recommendations of the Japan Circulation Society. The results were analyzed using descriptive statistics and chi-squared test.

RESULTS

In total, 195 schools out of 315 (62%) responded, of which 38% have introduced BLS education for children. BLS training was held in a smaller proportion of primary schools (18%) than junior high schools (86%). More than 90% of primary school staff had undergone BLS training in the previous 2 years. The most common locations of AED were the gymnasium (32%) followed by entrance hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location were that it was obvious (34%), convenient for staff (32%), could be used out of hours (17%), and the most likely location for a heart attack (15%). Approximately 18% of schools reported that it takes >5 min to reach the AED from the furthest point.

CONCLUSION

BLS training, AED location, and understanding of both are not sufficient to save children's lives efficiently. Authorities should make recommendations about the correct number of AED, and their location, and provide more information to improve the quality of BLS training in schools.

Rapid Deterioration of Basic Life Support Skills in Dentists With Basic Life Support Healthcare Provider

The aim of this study was to investigate the correlation between basic life support skills in dentists who had completed the American Heart Association's Basic Life Support (BLS) Healthcare Provider qualification and time since course completion. Thirty-six dentists who had completed the 2005 BLS Healthcare Provider course participated in the study. We asked participants to perform 2 cycles of cardiopulmonary resuscitation on a mannequin and evaluated basic life support skills. Dentists who had previously completed the BLS Healthcare Provider course displayed both prolonged reaction times, and the quality of their basic life support skills deteriorated rapidly. There were no correlations between basic life support skills and time since course completion. Our results suggest that basic life support skills deteriorate rapidly for dentists who have completed the BLS Healthcare Provider. Newer guidelines stressing chest compressions over ventilation may help improve performance over time, allowing better cardiopulmonary resuscitation in dental office emergencies. Moreover, it may be effective to provide a more specialized version of the life support course to train the dentists, stressing issues that may be more likely to occur in the dental office.

Quality of Basic Life Support - A Comparison between Medical Students and Paramedics

INTRODUCTION

Poor survival rates after cardiac arrest can partly be explained by poor basic life support skills in medical professionals.

AIM

This study aimed to assess quality of basic life support in medical students and paramedics.

MATERIALS AND METHODS

We conducted a prospective observational study with 100 early medical students (group A), 100 late medical students (group B) and 100 paramedics (group C), performing a 20-minute basic life support simulation in teams of two. Average frequency and absolute number of chest compressions per minute (mean (±SD)), chest decompression (millimetres of compression remaining, mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching positions between ventilation and chest compression (per 20 minutes) and rate of sufficient compressions (depth ≥50mm) were assessed as quality parameters of CPR.

RESULTS

In groups A, B and C the rates of sufficiently deep chest compressions were 56%, 42% and 52%, respectively, without significant differences. Male gender and real-life CPR experience were significantly associated with deeper chest compression. Frequency and number of chest compressions were within recommended goals in at least 96% of all groups. Remaining chest compressions were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and 4s/min (±1), which was significantly different across all three groups.

CONCLUSION

Overall, paramedics tended to show better quality of CPR compared to medical students. Though, chest compression depth as an important quality characteristic of CPR was insufficient in almost 50% of participants, even in well trained paramedics. Therefore, we suggest that an effort should be made to find better ways to educate health care professionals in BLS.