An evaluation of objective feedback in basic life support (BLS) training

Investigating BLS instructors' ability to evaluate CPR performance: focus on compression depth, rate, and recoil

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) presents significant challenges with low survival rates, emphasizing the need for effective bystander CPR training. In Basic Life Support (BLS) training, the role of instructors is pivotal as they assess and correct learners' cardiopulmonary resuscitation (CPR) techniques to ensure proficiency in life-saving skills. This study evaluates the concordance between CPR quality assessments by Basic Life Support (BLS) instructors and those determined through Quantitative CPR (QCPR) devices, utilizing data from BLS courses conducted at National Cheng Kung University Hospital from October 2017 to April 2018.

METHODS

The study analyzed existing data from BLS courses, comparing CPR quality assessments made by instructors with those recorded by QCPR devices. Key metrics such as chest compression speed, depth, and recoil were examined to identify the degree of consistency between human and automated evaluations.

RESULTS

In this study, CPR performance was analyzed using QCPR devices and BLS instructors across metrics like speed, depth, and recoil. Employing the Cohen kappa statistic revealed moderate to low interrater reliability, the kappa value is 0.65 (95% C.I. 0.65-0.65) for depth, 0.56 (95% C.I. 0.33-0.79) for speed, and 0.50 (95% C.I.0.28-0.71) for recoil. Correlation analysis visualized in a heatmap indicated a higher consistency in depth evaluations (correlation coefficient = 0.7) compared to speed and recoil, suggesting a need for improved alignment in CPR training assessments.

CONCLUSIONS

The study underscores the importance of refining CPR training methods and adopting advanced technological aids to enhance the reliability of CPR skill assessments. By improving the accuracy of these evaluations, the training can be better tailored to increase the effectiveness of life-saving interventions, potentially boosting survival rates in out-of-hospital cardiac arrest scenarios.

Basic Life Support (BLS) Knowledge Among the Ha'il Region Population, Saudi Arabia: A Cross-Sectional Study

Aims and background This study aims to evaluate Basic Life Support (BLS) knowledge among residents of the Ha'il region. It will reveal the public's familiarity with BLS and identify sources of BLS knowledge. The findings can guide policymakers in improving BLS training, potentially saving lives, especially during cardiac emergencies. Annually, heart attacks and strokes cause millions of deaths, with projections indicating a potential increase without intervention. In Saudi Arabia and globally, public awareness and education on BLS are insufficient, highlighting the need for better dissemination of BLS knowledge to improve emergency response before ambulance arrival. Objectives Measuring the level of BLS knowledge among the Ha'il region population, seeking the sources from which individuals acquire their BLS knowledge, and determining various factors that may influence BLS knowledge among the Ha'il population. Methods In Ha'il, Saudi Arabia, the survey was disseminated to the general public and included 380 participants. All participants are residents of Ha'il and are at least 18 years old. Data were collected via an online questionnaire, which was validated and translated into Arabic. Results The study surveyed 380 adults aged 18-36, with 62% (n = 236) females and 38% (n = 144) males. Most (60%) had a university degree, 46% were employed, and 29% were students. Slightly over half (51%) of participants were aware of BLS. Among those aware, 17% were very aware of the importance of BLS, while 42% had moderate awareness. The remaining participants had no awareness of BLS. A significant majority (83%) of participants believed that BLS increases the chances of patient survival. Conclusions The vast majority of people think that BLS is essential, but awareness and training are lacking. There were gender disparities in BLS willingness, with women being more conscious of and inclined to pursue BLS training. Furthermore, age and BLS awareness were related.

A comparison between the effects of simulation of basic CPR training and workshops on firefighters' knowledge and skills: experimental study

BACKGROUND

One of the most common causes of death worldwide is cardiopulmonary arrest. Firefighters are among the first responders at the scenes of accidents and can, therefore, play a key part in performing basic cardiopulmonary resuscitation (CPR) for victims who need it. The present study was conducted to compare the effects of simulation training against workshops on the CPR knowledge and skills of firefighters in the south of Iran.

METHODS

This experimental (Interventional) study was conducted on 60 firefighters of south of Fars province, Iran. The study was undertaken from March to July 2023. Through random allocation, the participants were divided into two groups: simulation-based training (30 members) and traditional workshop training (30 members). The participants' CPR knowledge and practical skills were measured before, immediately after, and three months after intervention.

RESULTS

The findings of the study revealed a statistically significant difference between the pretest and posttest CPR knowledge and skill mean scores of the simulation groups as compared to the workshop group (p < 0.001). As measured three months after the intervention, the firefighters' knowledge and skill mean scores were still significantly different from their pretest mean scores (p < 0.001); however, they had declined, which can be attributed to the fact that the study population did not frequently exercise CPR.

CONCLUSION

Based on the findings of the study, even though both methods of education were effective on enhancing the firefighters' CPR knowledge and skill, simulation training had a far greater impact than training in workshops. In view of the decline in the participants' knowledge and skill scores over time, it is recommended that short simulation training courses on CPR should be repeated on a regular basis.

Data-driven resuscitation training using pose estimation

BACKGROUND

Cardiopulmonary resuscitation (CPR) training improves CPR skills while heavily relying on feedback. The quality of feedback can vary between experts, indicating a need for data-driven feedback to support experts. The goal of this study was to investigate pose estimation, a motion detection technology, to assess individual and team CPR quality with the arm angle and chest-to-chest distance metrics.

METHODS

After mandatory basic life support training, 91 healthcare providers performed a simulated CPR scenario in teams. Their behaviour was simultaneously rated based on pose estimation and by experts. It was assessed if the arm was straight at the elbow, by calculating the mean arm angle, and how close the distance between the team members was during chest compressions, by calculating the chest-to-chest distance. Both pose estimation metrics were compared with the expert ratings.

RESULTS

The data-driven and expert-based ratings for the arm angle differed by 77.3%, and based on pose estimation, 13.2% of participants kept the arm straight. The chest-to-chest distance ratings by expert and by pose estimation differed by 20.7% and based on pose estimation 63.2% of participants were closer than 1 m to the team member performing compressions.

CONCLUSIONS

Pose estimation-based metrics assessed learners' arm angles in more detail and their chest-to-chest distance comparably to expert ratings. Pose estimation metrics can complement educators with additional objective detail and allow them to focus on other aspects of the simulated CPR training, increasing the training's success and the participants' CPR quality.

TRIAL REGISTRATION

Not applicable.

Early or late booster for basic life support skill for laypeople: a simulation-based randomized controlled trial

PURPOSE

Retention of skills and knowledge has been shown to be poor after resuscitation training. The effect of a "booster" is controversial and may depend on its timing. We compared the effectiveness of an early versus late booster session after Basic Life Support (BLS) training for skill retention at 4 months.

METHODS

We performed a single-blind randomized controlled trial in a simulation environment. Eligible participants were adult laypeople with no BLS training or practice in the 6 months prior to the study. We provided participants with formal BLS training followed by an immediate BLS skills post-test. We then randomized participants to one of three groups: control, early booster, or late booster. Based on their group allocation, participants attended a brief BLS refresher at either 3 weeks after training (early booster), at 2 months after training (late booster), or not at all (control). All participants underwent a BLS skills retention test at 4 months. We measured BLS skill performance according to the Heart and Stroke Foundation's skills testing checklist for adult CPR and the use of an automated external defibrillator.

RESULTS

A total of 80 laypeople were included in the analysis (control group, n = 28; early booster group, n = 23; late booster group, n = 29). The late booster group achieved better skill retention (mean difference in checklist score at retention compared to the immediate post-test = - 0.8 points out of 15, [95% CI - 1.7, 0.2], P = 0.10) compared to the early booster (- 1.3, [- 2.6, 0.0], P = 0.046) and control group (- 3.2, [- 4.7, - 1.8], P < 0.001).

CONCLUSION

A late booster session improves BLS skill retention at 4 months in laypeople.

TRIAL REGISTRATION NUMBER

NCT02998723.

Short-Term Learning Effects of a Cardiopulmonary Resuscitation Program with Focus on the Relationship between Learning Effect and Trainees' Perceived Competence

High-quality education and training are essential for effectively improving the quality of cardiopulmonary resuscitation (CPR); however, the relationship between the acquisition of motor skills and learners’ psychological characteristic has not been investigated fully. Therefore, we investigated the relationship between intrinsic motivation for training, self-efficacy for CPR, and CPR skill acquisition through training. Twenty health sciences undergraduate students participated in a 3-hour basic life support course. Their chest compression skills were assessed before and after the course. The main outcome of this study was the chest compression score, with changes in the score from pretest to posttest regarded as the short-term learning effects from training. The chest compression score was significantly higher after the course (median 53.5%, interquartile range [IQR] 39.8–83.0) than before the course (median 14.0%, IQR 0–43.3, p < 0.001). Furthermore, we found a significant correlation between perceived competence after the training and changes in the chest compression score from pretest to posttest (r = 0.483, p = 0.031), but other psychological indices did not correlate with changes in the chest compression score. A significant correlation was noted between trainees’ perceived competency and the short-term learning effects of CPR training. We suggest instructors focus on psychological components of training, including trainees’ perceived competence.

A non-inferiority randomised controlled trial comparing self-instruction with instructor-led method in training of layperson cardiopulmonary resuscitation

Our study aimed to compare the effect of self-instruction with manikin feedback to that of instructor-led method on cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skill performance. In our randomized non-inferiority trial, 64 non-healthcare providers were randomly allocated into self-instruction and instructor-led groups. Both groups watched a 27-min standardized teaching video. Participants in the self-instruction group then performed hands-on practice on the Resusci Anne QCPR with a device-driven feedback, while those in the instructor-led group practiced manikins; feedback was provided and student's questions were answered by instructors. Outcomes were measured by blinded evaluators and SkillReporter software. The primary outcome was the pass rate. Secondary outcomes were scores of the knowledge test and items of individual skill performance. The baseline characteristics of the two groups were similar. The pass rates were 93.8% in both group (absolute difference 0%, p = 0.049 for noninferiority). The knowledge test scores were not significantly different. However, the self-instruction group performed better in some chest compression and ventilation skills, but performed worse in confirming environmental safety and checking normal breathing. There was no difference in AED skills between the two groups. Our results showed the self-instruction method is not inferior to the instructor-led method.

Changes of knowledge and practical skills before and after retraining for basic life support: Focused on students of Dental School

Background: Considering the increasing possibility of emergency situations in dental clinics over time, we conducted this study to evaluate the changes in the knowledge and practical skills of students of dental school before and after retraining for 2 years after the initial education on basic life support (BLS) of the American Heart Association (AHA). Methods: All third-year students of dental school who had received the same education on BLS provider training of the AHA 2 years earlier were included in this study. Among them, 98 students were asked to answer a questionnaire about BLS knowledge and conduct a practical skills assessment of high-quality cardiopulmonary resuscitation using Little Anne QCPR before and after retraining. Results: After retraining, the level of BLS knowledge increased in all 7 categories, and BLS performance increased in all 19 subcategories. Comparison of the QCPR numerical data items before and after retraining showed that all items after retraining met the criteria recommended by the AHA. Conclusion: Students of dental school had low levels of knowledge and practical skills of BLS before retraining after 2 years from the initial education and had high levels after retraining. Therefore, BLS training must be updated periodically, and more effective education methods are required to maintain BLS knowledge and practical skills.

Retention of Basic-Life-Support Knowledge and Skills in Second-Year Medical Students

Purpose

Basic life support (BLS) training is crucial in improvement of cardiopulmonary resuscitation (CPR) outcomes. Many studies have demonstrated improvement of skills after BLS training but the skills significantly decrease over time. Our study aimed to evaluate the retention of knowledge and skills after training following 2010 BLS guidelines in second year medical students at Faculty of Medicine, Thammasat University.

Materials and Methods

One hundred and forty-nine second-year medical students were enrolled in the prospective cohort study. Participants were tested for knowledge and skills of BLS prior to training (pre-test), immediately after training (post-test) and six months after training (retention test).

Results

The mean scores of pre-test, immediate post-test and retention-test were 8.52 (SD 1.88), 12.12 (SD 1.52) and 10.83 (SD 1.95), respectively. Improvement in knowledge score post-test and retention test were 3.60 (95% CI 3.22,3.99 P<0.001) and 2.31 (95% CI 1.92,2.70 P<0.001) respectively, compared with pre-test score. In post-test, detection skill, activation skill and compression skill were improved 1.67 (95% CI 1.28,2.19 P<0.001), 5.15 (95% CI 3.41,7.77 P<0.001) and 3.88 times (95% CI 2.24,6.71 P<0.001) compared with pre-test evaluation. Comparison between retention test and pre-test was improved detection skill 1.72 (95% CI 1.31,2.26 P<0.001), activation skill 4.4 (95% CI 2.93,6.75 P<0.001) and compression skill 2.56 (95% CI 1.44,4.57 P=0.001). Knowledge decreased 1.29 times in retention test compared with post-test (95% CI −1.67,0.92 P<0.001). In retention test, detection skill increased 1.03 times (95% CI 0.81,1.29 P = 0.810), activation skill decreased 0.86 times (95% CI 0.98,1.10 P =0.24) and compression skill decreased 0.66 times (95% CI 0.45,0.98 P=0.04) compared with post-test.

Conclusion

Knowledge and skills of BLS significantly improved after training in second year medical students. However, the knowledge decreased at 6 months after training although the BLS skills still remained.

Long-term benefits of chest compression-only cardiopulmonary resuscitation training using real-time visual feedback manikins: a randomized simulation study

Objective

Cardiopulmonary resuscitation (CPR) education with a feedback device is known to result in better CPR skills compared to one without the feedback device. However, its long-term benefits have not been established. The purpose of this study was to evaluate the long-term CPR skill retention after training using real-time visual manikins in comparison to that of non-feedback manikins.

Methods

We recruited 120 general university students who were randomly divided into the real-time feedback group (RTFG) and the non-feedback group. Of them, 95 (RTFG, 48; non-feedback group, 47) attended basic life support and automated external defibrillation training for 1 hour. For comparison of retention of CPR skills, the two groups were evaluated based on 2-minute chest compression performed immediately after training and at 3, 6, and 9 months. The CPR parameters between the two groups were also compared using a generalized linear model.

Results

At immediately after training, the performance of RTFG was better in terms of average chest compression depth (51.9±1.1 vs. 45.5±1.1, p<0.001) and a higher percentage of adequate chest compression depth (51.0±4.1 vs. 26.9±4.2, p<0.001). This significant difference was maintained until 6 months after training, but there was no difference at 9 months after training. However, there was no significant difference in the chest compression rate and the correct hand position at any time point.

Conclusion

CPR training with a real-time visual feedback manikin improved skill acquisition in chest compression depth, but only until 6 months after the training. It could be a more effective educational method for basic life support training in laypersons.

Evaluation of manual chest compressions according to the updated cardiopulmonary resuscitation guidelines and the impact of feedback devices in an educational resuscitation course

Background

The cardiopulmonary resuscitation guidelines revised in 2015 recommend target chest compression rate (CCR) and chest compression depth (CCD) of 100–120 compressions per minute (cpm) and 5–6 cm, respectively. We hypothesized that the new guidelines are harder to comply with, even with proper feedback.

Methods

This prospective observational study using data collected from the participants of an Immediate Cardiac Life Support course included the evaluation of chest compressions using performance data from a feedback device after the completion of the course. Participants completed chest compressions for 1 min and were provided with feedback, after which they performed another cycle of CC. Primary outcome measures were CCR and CCD as well as the correct CCR percentage and CCD percentage for pre and post feedback.

Results

The study included a total of 88 participants. The median pre-CCR was 112.5 cpm (interquartile range [IQR] 108–116 cpm), and the median correct pre-CCR percentage was 96% (IQR 82.5–99.5%). After the feedback, there was a slight increase in the correct CCR percentage (99% [IQR 92.5–100%]). Conversely, the median pre-CCD was 5.4 cm (IQR 4.9–5.8 cm), and the median pre-correct CCD percentage was 66% (IQR 18.5–90%). The increase in the median post-correct CCD percentage to 72% (IQR 27–94%) observed after the feedback was not statistically significant (P = 0.361).

Conclusions

Compliance with the new guidelines for chest compressions, especially those regarding the CCD, might be difficult. However, whether the changes in guidelines affect outcomes in actual clinical settings is uncertain and requires further investigation.

External Cardiac Massage Training of Medical Students: A Randomized Comparison of Two Feedback Methods to Standard Training

BACKGROUND

The most recent recommendations support learning of external cardiac massage (ECM) through feedback devices.

OBJECTIVES

The objective was to compare the effects on immediate and 3-month retention of ECM technical skills when using feedback devices compared with training without feedback as part of a half-day training session in medical students.

METHODS

This randomized study was performed using the Resusci Anne QCPR manikin in 64 medical students. We compared the quality of ECM with nonfeedback training in the control group (group 1) vs. 2 feedback learning methods (group 2, PocketCPR and group 3, Skill Reporter each used with visual display available to the trainee). At the end of the training session and 3 months later, students performed chest compressions blindly during a 2-min assessment session. The median compression score was the primary outcome for assessing immediate and long-term retention.

RESULTS

Regarding immediate retention, the median compression score was significantly lower in group 1 (23%) than in groups 2 (81%) and 3 (72%) (p < 0.05) with no difference between the 2 feedback methods. At 3 months, mean compression scores remained high but not significantly different between the 2 feedback groups.

CONCLUSION

The use of a feedback device used for ECM training improves the quality of immediate retention of technical ECM skills compared with traditional teaching in medical students. At 3 months, the 2 groups with feedback retained a high level of performance. No significant difference could be demonstrated between the 2 feedback methods.

Real-Time Audiovisual Feedback Training Improves Cardiopulmonary Resuscitation Performance: A Controlled Study

OBJECTIVE

The aim of the study was to quantitatively measure the effect of teaching cardiopulmonary resuscitation (CPR) using a real-time audiovisual feedback manikin system on first-year medical student's CPR performance.

METHODS

This is a prospective, manikin-based intervention study, including 2 consecutive classes of medical school students enlisted to a mandatory first aid course. One class (control group) was taught using manikin-based standard CPR education models. The second class (intervention group) was taught similarly, but with the addition of real-time CPR quality feedback provided by the manikins. Students' performance was assessed using a standardized Objective Structured Clinical Examination scenario, during which no real-time feedback was provided. Critical CPR parameters were measured including compression depth, chest recoil, ventilation volume, and "hands-off" time.

RESULTS

A total of 201 participants were included in the study, 106 in the control group and 95 in the intervention group. Baseline demographic characteristics and previous medical knowledge were similar for the 2 groups. A significant improvement was observed for all primary study outcomes in favor of the real-time feedback group for median (interquartile range) chest compression fraction [57 (52.75%-60%) vs. 49 (43%-55%), P < 0.001], compressions with adequate depth [66.5 (19.5%-95.25%) vs. 0 (0%-12%), P < 0.001], ventilations with adequate volume [68.5 (33%-89%) vs. 37 (0%-70%), P < 0.00], and a simulator-derived composite "total CPR score" [39 (24%-61.25%) vs. 13 (3.5%-22%), P < 0.001]. In multiple regression analysis, the real-time feedback group's performance was significantly better than the control group in all primary outcomes, adjusting for participant's characteristics of age, sex, and body mass index.

CONCLUSIONS

The use of audiovisual feedback techniques to teach CPR improves skill acquisition with significant improvement in crucial prognosis-improving parameters, as tested in a "no-feedback" test scenario.

Comparing student nurse knowledge and performance of basic life support algorithm actions: An observational post-retention test design study

This study aims to identify which basic life support skills of student nurses deteriorate in a period of four months. Secondly, it investigates the link between a specific cognitive skill and its corresponding motor skill in BLS. The population for this study consisted of 169 general nursing students within the first year cohort of a three-year undergraduate nursing education program. Following a BLS course, a multiple-choice questionnaire and a BLS performance test on a manikin was administered two weeks (post) and four months (retention) after the course. Seven BLS subcomponents were compared. In both the post and retention test, knowledge was better than the corresponding motor skill for five of the seven subcomponents. Two weeks after training, more than 50% of the students failed to perform 'time to check respiration', 'ventilation volume', 'compression depth' and 'compression frequency' correctly. Four months after training, significantly more students reached a correct 'ventilation volume' but performed it incorrectly. Nurse educators are recommended to spend more time on hands-on skills practice than on theory. Special attention should be given to the performance of a correct ventilation technique, a sufficiently deep chest compression and a correct compression frequency.

Advantage and Limitation of Using a Visual Feedback Device during Cardiopulmonary Resuscitation Training

INTRODUCTION

Recent cardiopulmonary resuscitation (CPR) guidelines recommend the use of CPR prompt/feedback devices during CPR training because it can improve the quality of CPR.

PROBLEM

Chest compression depth and full chest recoil show a trade-off relationship. Therefore, achievement of both targets (adequate chest compression depth and full chest recoil) simultaneously is a difficult task for CPR instructors. This study hypothesized that introducing a visual feedback device to the CPR training could improve the chest compression depth and ratio of full chest recoil simultaneously.

METHODS

The study investigated the effects of introducing a visual feedback device during CPR training by comparing the results of skill tests before and after introducing a visual feedback device. The results of skill tests from 2016 through 2018 were retrospectively reviewed. The strategy of emphasizing chest compression depth was implemented during the CPR training in 2017, and a visual feedback device was introduced in 2018. The interval between the CPR training and skill tests was seven days. Feedback was not provided during the skill tests.

RESULTS

In total, 159 students completed skill tests. Although the chest compression depth increased significantly from 50 mm (42-54) to 60 mm (59-61) after emphasizing chest compression depth (P < .001), the ratio of full chest recoil decreased simultaneously from 100% (100-100) to 81% (39-98; P < .001). The ratio of full chest recoil increased significantly from 81% (39-98) to 95% (77-100) after introducing a visual feedback device (P = .018). However, the students who did not achieve 80% of the ratio of full chest recoil remained significantly higher than in 2016 (1% in 2016, 49% in 2017, and 27% in 2018; P < .001).

CONCLUSIONS

Although introducing a visual feedback device during CPR training resulted in increasing the ratio of full chest recoil while maintaining the adequacy of chest compression depth, 27% of the students still did not achieve 80% of the ratio of full chest recoil. Another educational strategy should be considered to increase the qualities of CPR more completely.

The effects of feedback timing and frequency on the acquisition of cardiopulmonary resuscitation skills of health sciences undergraduate students: A 2 x 2 factorial quasi randomized study

Background

High-quality training is required to improve the cardiopulmonary resuscitation (CPR) skills. Although it has been reported that the use of a feedback device is effective, the effects of feedback timing and frequency on CPR training have not been investigated. The aim of this study was to clarify the influence of feedback frequency and timing on the acquisition of CPR skills.

Methods

Sixty-eight undergraduates were first divided into female (n = 32) and male (n = 36) groups, and randomly assigned to one of four groups for each sex: concurrent-100%, concurrent-50%, terminal-100%, and terminal-50% feedback groups. The randomization was performed using a lottery method. This study consisted of a pre-test, practice sessions, a post-test, and a follow-up test. In the practice sessions, the participants performed six 2-minute CPR sessions in accordance with the condition assigned using mannequins and feedback devices. The post-test was conducted 24 hours after the completion of the practice sessions and the follow-up test was conducted 3 months after the completion of the practice sessions. The primary outcome of the study was the overall score at the follow-up test.

Results

The results of the overall score at the follow-up test for each group were 88.2 ± 9.6% for concurrent-100%, 92.2 ± 6.4% for concurrent-50%, 82.6 ± 16.4% for terminal-100%, and 85.2 ± 16.9% for terminal-50%. We did not find any statistically significant difference for the overall score at the follow-up test among the four groups (p = 0.173). The ANOVA for the test sessions revealed that there were no significant main effects of feedback timing (p = 0.135) or frequency (p = 0.765), and no significant interaction between timing and frequency (p = 0.997).

Conclusion

The present study reveals that the use of feedback devices is an important factor for higher quality CPR training, regardless of the timing and frequency with which they are used.

Basic Life Support Training Methods for Health Science Students: A Systematic Review

The acquisition of competencies in basic life support (BLS) among university students of health sciences requires specific and updated training; therefore, the aim of this review was to identify, evaluate, and synthesise the available scientific knowledge on the effect of training in cardiorespiratory resuscitation in this population. A comprehensive literature search was conducted in MEDLINE, CUIDEN, Web of Science, Wiley Online Library, CINAHL, and Cochrane, including all randomised clinical trials published in the last ten years that evaluated basic life support training methods among these students. We selected a total of 11 randomissed clinical trials that met the inclusion criteria. Participants were nursing and medicine students who received theoretical and practical training in basic life support. The studies showed a great heterogeneity in training methods and evaluators, as did the feedback devices used in the practical evaluations and in the measurement of quality of cardiorespiratory resuscitation. In spite of the variety of information resulting from the training methods in basic life support, we conclude that mannequins with voice-guided feedback proved to be more effective than the other resources analysed for learning.

The evaluation of laypersons awareness of basic life support at the university in Izmir

Objectives

Basic Life Support (BLS) is the application of cardiopulmonary resuscitation (CPR) in order to save the lives of cardiac arrest victims by members of the public pending the arrival of the Emergency Medical Service (EMS). The aim of this study was to evaluate the effectiveness of training in order to ensure society understands the importance of early initiation of BLS, and to provide information concerning BLS and automated external defibrillators (AED).

Methods

This study consisted of 150 participants, of whom none were healthcare professionals. The research data were collected from 150 pre-tests and 100 post-tests. A Comparison of nominal data was analyzed by both McNemar's test and Pearson's chi-square exact test.

Results

Of the participants, 39% had received the BLS training prior to the study. It was observed that the participants' desire for applying BLS increased from 43% to 78% post training, and the ratio of ability to distinguish the need for BLS increased from 54% to 79%. Our results also indicated that the knowledge level of the CPR application increased after the study. The proportion of participants who knew the purpose of using AED increased from 79.8% to 95.7%.

Conclusions

It was concluded that the BLS Awareness training increased in relation to the application of BLS, improved the BLS knowledge and increased awareness of the use of AED.

Bedside chest compression skills: Performance and skills retention in in-hospital trained pediatric providers. A simulation study

PURPOSE

To assess the effects of a real-time feedback device and refresher sessions in acquiring and retaining chest compression skills.

METHODS

Healthcare providers participated in refresher sessions at 3-time points (blocks) over 1-year. At each block, chest compression (CC) skills were assessed on an infant and adult task trainer, in one 2-min trial without feedback (blinded), and up to three 2-min trials with feedback (unblinded). Skills retention over time was explored at three time lags: 1-3, 3-6, >6 months. Data collected included chest compression rate (100-120/min), depth (4 cm for infants and 5 cm for adults), and recoil between compressions.

RESULTS

Among 194 participants, achievement of excellent CC (≥90% of adequate compressions for all parameters) increased with feedback. Linear mixed models found significant (p < 0.05) improvement in rate, depth, and recoil. Performance between last unblinded trial in block 1 with the following blinded trial in block 2 significantly decayed in rate on both task trainers irrespective of time passed, while depth and recoil performance were maintained only for infants.

CONCLUSIONS

A real-time visual feedback device improved CC skills with better results in infants. Skills decayed over time despite two refresher sessions with feedback.

Professionalizing peer instructor skills in basic life support training for medical students: A randomized controlled trial

Background:

The Radboud university medical center designed an obligatory basic life support and first-aid course for first-year medical students.

Objectives:

We evaluated the value of an additional train-the-trainer course following European Resuscitation Council guidelines, which focuses on practical basic life support training and providing feedback, in comparison with standard in-service instructor training.

Methods:

This study was a prospective randomized controlled trial. A total of 10 intervention instructors, 14 control instructors, and 337 first-year medical students participated in the study. Students, blinded for the type of instructor, completed questionnaires evaluating the quality of the basic life support training (theoretical and practical) and provided feedback. The secondary endpoint was the basic life support examination to assess whether the instructors’ training influenced the quality of the participants’ basic life support.

Results:

The response rate of the questionnaire was 82% on average. No differences were found between intervention and control group concerning theoretical basic life support training. The intervention instructors scored significantly higher on practical basic life support training according to student evaluations ( p < 0.001). The pass rate on basic life support examinations did not differ significantly ( p = 0.669). Appreciation of given feedback was independent of instructors’ educational training.

Conclusion:

This study is the first to establish that the 12-h train-the-trainer course following European Resuscitation Council guidelines improves students’ appreciation of practical basic life support training. The additional course did not influence appreciation of theoretical basic life support training or perceived feedback.

Effect of introducing a feedback device during adult and infant cardiopulmonary resuscitation training: A ‘before and after’ study

Objective:

This study aimed to verify the effect of introducing a feedback device during adult and infant cardiopulmonary resuscitation training.

Methods:

A feedback device was introduced in the cardiopulmonary resuscitation training course of our medical school in the middle of the last semester. The cardiopulmonary resuscitation training course consisted of 2 h of instructor-led cardiopulmonary resuscitation training and 1 h of self-practice time. All students should complete the adult and infant cardiopulmonary resuscitation skill tests just after the course. Each test consisted of five cycles of single-rescuer cardiopulmonary resuscitation. A feedback device was introduced only in the self-practice session. The cardiopulmonary resuscitation parameters of the skill tests before ( n = 40) and after ( n = 39) introducing the feedback device were analysed.

Results:

The ratios of correct rate significantly increased after introducing the feedback device in both the skill tests (adult test: 58.5 ± 37.2 vs 85.5 ± 21.4, p = 0.001; infant test: 55.0 ± 32.4 vs 80.2 ± 20.7, p = 0.001). Although the average depths did not significantly differ between those before and after introducing the feedback device in the adult test (58.4 ± 4.0 mm vs 59.0 ± 3.7 mm, p = 0.341), it increased significantly after introducing the feedback device in the infant test (38.3 ± 4.3 mm vs 40.8 ± 1.1 mm, p = 0.001).

Conclusion:

Introducing a feedback device might have enhanced the accuracies of compression rate in adult and infant cardiopulmonary resuscitation training. However, the potential positive effect on chest compression depth was limited to infant cardiopulmonary resuscitation training.

Cardiopulmonary resuscitation by Emergency Medical Services in South Africa: Barriers to achieving high quality performance

INTRODUCTION

Survival rates from out-of-hospital cardiac arrest significantly improve when high-quality cardiopulmonary resuscitation (CPR) is performed. Despite sudden cardiac arrest being a leading cause of death in many parts of the world, no studies have determined the quality of CPR delivery by Emergency Medical Services (EMS) personnel in South Africa. The aim of this study was to determine the quality of CPR provision by EMS staff in a simulated setting.

METHODS

A descriptive study design was used to determine competency of CPR among intermediate-qualified EMS personnel. Theoretical knowledge was determined using a multiple-choice questionnaire, and psychomotor skills were video-recorded then assessed by independent reviewers. Correlational and regression analysis were used to determine the effect of demographic information on knowledge and skills.

RESULTS

Overall competency of CPR among participants (n = 114) was poor: median knowledge was 50%; median skill 33%. Only 25% of the items tested showed that participants applied relevant knowledge to the equivalent skill, and the nature and strength of knowledge influencing skills was small. Demographic factors that significantly influenced both knowledge and skill were the sector of employment, the guidelines EMS personnel were trained to, age, experience, and the location of training.

CONCLUSION

Overall knowledge and skill performance was below standard. This study suggests that theoretical knowledge has a small but notable role to play on some components of skill performance. Demographic variables that affected both knowledge and skill may be used to improve training and the overall quality of Basic Life Support CPR delivery by EMS personnel.

Safety and applicability of a pre-stage public access ventilator for trained laypersons: a proof of principle study

BACKGROUND

Contemporary resuscitation guidelines for basic life support recommend an immediate onset of cardiac compressions in case of cardiac arrest followed by rescue breaths. Effective ventilation is often omitted due to fear of doing harm and fear of infectious diseases. In order to improve ventilation a pre-stage of an automatic respirator was developed for use by laypersons.

METHODS

Fifty-two healthy volunteers were ventilated by means of a prototype respirator via a full-face mask in a pilot study. The pre-stage public access ventilator (PAV) consisted of a low-cost self-designed turbine, with sensors for differential pressure, flow, FO₂, FCO₂ and 3-axis acceleration measurement. Sensor outputs were used to control the respirator and to recognize conditions relevant for efficiency of ventilation and patients' safety. Different respiratory manoeuvres were applied: a) pressure controlled ventilation (PCV), b) PCV with controlled leakage and c) PCV with simulated airway occlusion. Sensor signals were analysed to detect leakage and airway occlusion. Detection based upon sensor signals was compared with evaluation based on clinical observation and additional parameters such as exhaled CO₂.

RESULTS

Pressure controlled ventilation could be realized in all volunteers. Leakage was recognized with 93.5% sensitivity and 93.5% specificity. Simulated airway occlusion was detected with 91.8% sensitivity and 91.7% specificity.

CONCLUSION

The pre-stage PAV was able to detect potential complications relevant for patients' safety such as leakage and airway occlusion in a proof of principle study. Prospectively, this device provides a respectable basis for the development of an automatic emergency respirator and may help to improve bystander resuscitation.

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.

Real-time visual feedback during training improves laypersons' CPR quality: a randomized controlled manikin study

OBJECTIVE

The chances of surviving an out-of-hospital cardiac arrest depend on early and high-quality cardiopulmonary resuscitation (CPR). Our aim is to verify whether the use of feedback devices during laypersons' CPR training improves chest compression quality.

METHODS

Laypersons totalling 450 participating in Basic Life Support and Automated External Defibrillation (BLS/AED) courses were randomly divided into three groups: group No Feedback (NF) attended a course without any feedback, group Short Feedback (SF) a course with 1-minute training with real-time visual feedback, and group Long Feedback (LF) a course with 10-minute training with real-time visual feedback. At the end of each course, we recorded 1 minute of compression-only CPR. The primary end point was the difference in the percentage of compressions performed with correct depth.

RESULTS

There was a significant improvement in the percentage of compressions with correct depth in the groups receiving feedback compared to the other (NF v. LF, p=0.022; NF v. SF, p=0.005). This improvement was also present in the percentage of compressions with a complete chest recoil (71.7% in NF, 86.6% in SF, and 88.8% in LF; p<0.001), compressions with the correct hand position (93.2% in NF, 98.2% in SF, and 99.3% in LF; p<0.001), and in the Total CPR Score (79.4% in NF, 90.2% in SF, and 92.5% in LF; p<0.001). There were no significant differences for all of the parameters between group SF and group LF.

CONCLUSIONS

Real-time visual feedback improves laypersons' CPR quality, and we suggest its use in every BLS/AED course for laypersons because it can help achieve the goals emphasized by the International Liaison Committee on Resuscitation recommendations.

Retention of Basic Life Support in Laypeople: Mastery Learning vs. Time-based Education

OBJECTIVE

To compare the effectiveness of a mastery learning (ML) versus a time-based (TB) BLS course for the acquisition and retention of BLS knowledge and skills in laypeople.

METHODS

After ethics approval, laypeople were randomized to a ML or TB BLS course based on the American Heart Association (AHA) Heartsaver course. In the ML group, subjects practiced and received feedback at six BLS stations until they reached a pre-determined level of performance. The TB group received a standard AHA six-station BLS course. All participants took the standard in-course BLS skills test at the end of their course. BLS skills and knowledge were tested using a high-fidelity scenario and knowledge questionnaire upon course completion (immediate post-test) and after four months (retention test). Video recorded scenarios were assessed by two blinded, independent raters using the AHA skills checklist.

RESULTS

Forty-three subjects were included in analysis (23ML;20TB). For primary outcome, subjects' performance did not change after four months, regardless of the teaching modality (TB from (median[IQR]) 8.0[6.125;8.375] to 8.5[5.625;9.0] vs. ML from 8.0[7.0;9.0] to 7.0[6.0;8.0], p = 0.12 for test phase, p = 0.21 for interaction between effect of teaching modality and test phase). For secondary outcomes, subjects acquired knowledge between pre- and immediate post-tests (p < 0.005), and partially retained the acquired knowledge up to four months (p < 0.005) despite a decrease between immediate post-test and retention test (p = 0.009), irrespectively of the group (p = 0.59) (TB from 63.3[48.3;73.3] to 93.3[81.7;100.0] and then 93.3[81.7;93.3] vs. ML from 60.0[46.7;66.7] to 93.3[80.0;100.0] and then 80.0[73.3;93.3]). Regardless of the group after 4 months, chest compression depth improved (TB from 39.0[35.0;46.0] to 48.5[40.25;58.0] vs. ML from 40.0[37.0;47.0] to 45.0[37.0;52.0]; p = 0.012), but not the rate (TB from 118.0[114.0;125.0] to 120.5[113.0;129.5] vs. ML from 119.0[113.0;130.0] to 123.0[102.0;132.0]; p = 0.70). All subjects passed the in-course BLS skills test. Pass/fail rates were poor in both groups at both the simulated immediate post-test (ML = 1/22;TB = 0/20; p = 0.35) and retention test (ML pass/fail = 1/22, TB pass/fail = 0/20; p = 0.35). The ML course was slightly longer than the TB course (108[94;117] min vs. 95[89;102] min; p = 0.003).

CONCLUSIONS

There was no major benefit of a ML compared to a TB BLS course for the acquisition and four-month retention of knowledge or skills among laypeople.

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.

Can the British Heart Foundation PocketCPR application improve the performance of chest compressions during bystander resuscitation: A randomised crossover manikin study

This study aims to determine whether the British Heart Foundation PocketCPR training application can improve the depth and rate of chest compression and therefore be confidently recommended for bystander use. A total of 118 candidates were recruited into a randomised crossover manikin trial. Each candidate performed cardiopulmonary resuscitation for 2 min without instruction or performed chest compressions using the PocketCPR application. Candidates then performed a further 2 min of cardiopulmonary resuscitation within the opposite arm. The number of chest compressions performed improved when PocketCPR was used compared to chest compressions when it was not (44.28% vs 40.57%, p < 0.001). The number of chest compressions performed to the required depth was higher in the PocketCPR group (90.86 vs 66.26). The British Heart Foundation PocketCPR application improved the percentage of chest compressions that were performed to the required depth. Despite this, more work is required in order to develop a feedback device that can improve bystander cardiopulmonary resuscitation without creating delay.

Impact of simulation training on Jordanian nurses' performance of basic life support skills: A pilot study

BACKGROUND

Providing efficient basic life support (BLS) training is crucial for practicing nurses who provide direct patient care. Nevertheless, data addressing the impact of BLS courses on the skills and performance of Jordanian nurses are scarce. This study aimed to assess the effectiveness of a BLS simulation training on Jordanian nurses' skill improvement in cardiopulmonary resuscitation.

METHODS

A prospective quasi-experimental, single group pretest-posttest design was used to study the effect of BLS simulation; using a 9-item checklist; on the spot training; American Heart Association, on a group of Jordanian nurses. A pre-test was conducted following a CPR scenario to test the skills using 9-item checklist extrapolated from the American Heart Association guidelines. After debriefing, an interactive on spot training was provided. Later, participants undertook an unscheduled post-test after four weeks that included the same nine items.

RESULTS

Thirty registered nurses with a mean clinical experience of 6.1years participated in the study. Comparing pre-test (M=4.6, SD=2.9, range=0 to 9) with post-test results (M=7.5, SD=1.7, range=4 to 9) showed an overall improvement in skills and BLS scores after the simulation training program (t=7.4, df=29, p<0.0001).

CONCLUSIONS

BLS simulation training sessions are associated with significant improvement in skills and performance among Jordanian nurses. A refreshment BLS training session for nurses is highly recommended to guarantee nurses' preparedness in actual CPR scenarios.

An exploration of attitudes toward bystander cardiopulmonary resuscitation in university students in Tianjin, China: A survey

BACKGROUND

Despite the importance of early effective bystander cardiopulmonary resuscitation (CPR) to improve survival rates from out-of-hospital cardiac arrest, the attitudes toward performing, learning and disseminating CPR in university students of China are still unclear.

METHODS AND AIMS

To assess the attitudes regarding performing, learning and disseminating bystander CPR in university students of China.

RESULTS

The results indicated that except for the scenario where the victim was their own family member or close friend, all other scenarios showed a relatively dismally lower rate of positive response. Besides, it showed a greater willingness to perform chest compression only CPR (CC) than chest compression with mouth-to-mouth ventilation (CCMV) (P < 0.05). Females were more willing to perform CC across seven of the hypothetic scenarios than males. University students of medical-related specialties (45.3%) than university students of non-medical specialties (29.9%) were more willing to perform bystander CPR (P < 0.05). The top four reasons for being unwilling to perform bystander CPR were lack of confidence (32.9%), fear of legal disputes (17.2%), fear of disease transmission (16.0%) and feeling embarrassed (14.0%). 92.6% of respondents wanted to learn CPR and 80.3% of respondents were willing to disseminate CPR.

CONCLUSIONS

CPR technique, victim's status, respondent's specialty and respondent's gender affected the attitudes of respondents toward performing bystander CPR. The top four reasons for being unwilling to perform bystander CPR were lack of confidence, fear of legal disputes, fear of disease transmission and feeling embarrassed. However, the key reason for being unwilling to perform bystander CPR differed in different specialties and particularly 'feeling embarrassment' might be a cultural phenomenon. The attitudes toward learning and disseminating CPR were positive and affected by respondent's gender and specialty.

Determining content for a simulation-based curriculum in pediatric emergency medicine: results from a national Delphi process

OBJECTIVES

By the end of residency training, pediatric emergency medicine (PEM) residents are expected to have developed the confidence and abilities required to manage acutely ill children. Acquisition of competence requires exposure and/or supplemental formal education for critical and noncritical medical clinical presentations. Simulation can provide experiential learning and can improve trainees' knowledge, skills, and attitudes. The primary objective of this project was to identify the content for a simulation-based national curriculum for PEM training.

METHODS

We recruited participants for the Delphi study by contacting current PEM program directors and immediate past program directors as well as simulation experts at all of the Canadian PEM fellowship sites. We determined the appropriate core content for the Delphi study by combining the PEM core content requirements of the Royal College of Physicians and Surgeons of Canada (RCPSC) and the American Board of Pediatrics (ABP). Using the Delphi method, we achieved consensus amongst the national group of PEM and simulation experts. The participants completed a three-round Delphi (using a four-point Likert scale).

RESULTS

Response rates for the Delphi were 85% for the first round and 77% for second and third rounds. From the initial 224 topics, 53 were eliminated (scored <2). Eighty-five topics scored between 2 and 3, and 87 scored between 3 and 4. The 48 topics, which were scored between 3.5 and 4.0, were labeled as "key curriculum topics."

CONCLUSION

We have iteratively identified a consensus for the content of a national simulation-based curriculum.

Factors affecting the accuracy of chest compression depth estimation

OBJECTIVE

We aimed to estimate the accuracy of visual estimation of chest compression depth and identify potential factors affecting accuracy.

METHODS

This simulation study used a basic life support mannequin, the Ambu man. We recorded chest compression with 7 different depths from 1 to 7 cm. Each video clip was recorded for a cycle of compression. Three different viewpoints were used to record the video. After filming, 25 clips were randomly selected. Health care providers in an emergency department were asked to estimate the depth of compressions while watching the selected video clips. Examiner determinants such as experience and cardiopulmonary resuscitation training and environment determinants such as the location of the camera (examiner) were collected and analyzed. An estimated depth was considered correct if it was consistent with the one recorded. A multivariate analysis predicting the accuracy of compression depth estimation was performed.

RESULTS

Overall, 103 subjects were enrolled in the study; 42 (40.8%) were physicians, 56 (54.4%) nurses, and 5 (4.8%) emergency medical technicians. The mean accuracy was 0.89 (standard deviation, 0.76). Among examiner determinants, only subjects' occupation and clinical experience showed significant association with outcome (P=0.03 and P=0.08, respectively). All environmental determinants showed significant association with the outcome (all P<0.001). Multivariate analysis showed that accuracy rate was significantly associated with occupation, camera position, and compression depth.

CONCLUSIONS

The accuracy rate of chest compression depth estimation was 0.89 and was significantly related with examiner's occupation, camera view position, and compression depth.

Feedback for simulation-based procedural skills training: a meta-analysis and critical narrative synthesis

Although feedback has been identified as a key instructional feature in simulation based medical education (SBME), we remain uncertain as to the magnitude of its effectiveness and the mechanisms by which it may be effective. We employed a meta-analysis and critical narrative synthesis to examine the effectiveness of feedback for SBME procedural skills training and to examine how it works in this context. Our results demonstrate that feedback is moderately effective during procedural skills training in SBME, with a pooled effect size favoring feedback for skill outcomes of 0.74 (95 % CI 0.38-1.09; p < .001). Terminal feedback appears more effective than concurrent feedback for novice learners' skill retention. Multiple sources of feedback, including instructor feedback, lead to short-term performance gains although data on long-term effects is lacking. The mechanism by which feedback may be operating is consistent with the guidance hypothesis, with more research needed to examine other mechanisms such as cognitive load theory and social development theory.

Schoolchildren as life savers: at what age do they become strong enough?

OBJECTIVE

It is not clear when schoolchildren become enough strong to perform good quality chest compressions (CC). Our purpose was to assess CC quality in schoolchildren.

METHODS

721 children, 10-15 years old (YO) participated in 1 h hands-on training session. Subjects were tested during performing 2 min of continuous CC by means of Laerdal Resusci Anne(®) with Skillreporter(®), without feedback.

RESULTS

Mean compression depth (MCD) increased with age, from 30.7 mm in 10YO to 42.9 mm in 15YO (p<0.05) and was related to height, weight, and BMI. Boys delivered significantly deeper CC than girls in the 10, 13, 14 and 15YO groups (p<0.001). The percentage of children who achieved the MCD goal (50-60 mm), increased with age, from 0.0% at 10 years to 26.5% at 15 years (p<0.001). Mean compression rate (MCR) ranged from 121 min(-1) in 15YO to 134 min(-1) in 12YO. The percentage of children who achieved a CC rate inside the goal (100-120 min(-1)), ranged from 20.3% in 11YO to 31.0% in 15YO. Correct CC fraction was low and ranged from 2% in the 10YO to 22% in the 15YO (p<0.05). Children older than 13YO obtained better results than younger ones for all analyzed variables (p<0.001). Performance decreased with time: 12% of children achieved >50% of correct CC fraction in first minute, while only 5% did it in second minute (p<0.001).

CONCLUSIONS

In schoolchildren, age, sex and anthropometry are significant CPR quality factors. Although quality increases with age, their global performance is poor. Thirteen years is the minimum age to be able to achieve a minimum CPR quality similar to the one adult possess. CPR performance in schoolchildren significantly deteriorates within 60 s.

[Teaching basic life support to the general population. Alumni intervention analysis]

OBJECTIVES

The aim of this study was to investigate the rate at which the alumni of basic life support courses witnessed and intervened in out-of-hospital emergency situations, and to identify the variables characterizing those alumni associated with a greater number of witnessing events and interventions. An analysis of the efficiency of the courses was also carried out.

DESIGN

A descriptive, cross-sectional study was made.

SETTING

A district in the province of Almería (Spain).

PATIENTS

Alumni of a mass basic life support training program targeted to the general population «Plan Salvavidas» conducted between 2003-2009.

INTERVENTIONS

In 2010 the alumni were administered a telephone survey asking whether they had witnessed an emergency situation since attending the program, with the collection of information related to this emergency situation.

MAIN VARIABLES OF INTEREST

Rate of out-of-hospital emergencies witnessed by the alumni. Rate of intervention of the alumni in emergency situations. Variables characterizing alumni with a greater likelihood of witnessing an emergency situation.

RESULTS

A total of 3,864 trained alumni were contacted by telephone. Of 1,098 respondents, 63.9% were women, and the mean age was 26.61±10.6 years. Of these alumni, 11.75% had witnessed emergency situations, an average of three years after completing the course. Of these emergencies, 23.3% were identified as cardiac arrest. The alumni intervened in 98% of the possible cases. In 63% of the cases, there was no connection between the alumni and the victim. The majority of the emergency situations occurred in the street and in public spaces. A greater likelihood of witnessing an emergency situation was associated with being a healthcare worker and with being over 18 years of age.

CONCLUSIONS

The rate of out-of-hospital emergencies witnessed by these alumni after the course was 11.75%. The level of intervention among the alumni was high. The most efficient target population consisted of healthcare workers.