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Gamberini L, Del Giudice D, Tartaglione M, Allegri D, Coniglio C, Pastori A, Gordini G, Semeraro F. Logistic and cognitive-emotional barriers experienced by first responders when alarmed to get dispatched to out-of-hospital cardiac arrest events: a region-wide survey. Intern Emerg Med 2024; 19:813-822. [PMID: 38123905 DOI: 10.1007/s11739-023-03487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major public health concern with low survival rates. First responders (FRs) and public access defibrillation (PAD) programs can significantly improve survival, although barriers to response activation persist. The Emilia Romagna region in Italy has introduced a new system, the DAE RespondER App, to improve the efficiency of FR dispatch in response to OHCA. The study aimed to evaluate the association between different logistic factors, FRs' perceptions, and their decision to accept or decline dispatch to an OHCA scene using the DAE RespondER App. A cross-sectional web survey was conducted, querying 14,518 registered FRs using the DAE RespondER app in Emilia Romagna. The survey explored logistic and cognitive-emotional perceptions towards barriers in responding to OHCAs. Statistical analysis was conducted, with responses adjusted using non-response weights. 4,644 responses were obtained (32.0% response rate). Among these, 1,824 (39.3%) had received at least one dispatch request in the past year. Multivariable logistic regression showed that being male, having previous experience with OHCA situations, and having an automated external defibrillator (AED) available at the moment of the call were associated with a higher probability of accepting the dispatch. Regarding FRs' perceptions, logistic obstacles were associated with mission rejection, while higher scores in cognitive-emotional obstacles were associated with acceptance. The study suggests that both logistical and cognitive-emotional factors are associated with FRs' decision to accept a dispatch. Addressing these barriers and further refining the DAE RespondER App can enhance the effectiveness of PAD programs, potentially improving survival rates for OHCA. The insights from this study can guide the development of interventions to improve FR participation and enhance overall OHCA response systems.
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Affiliation(s)
- Lorenzo Gamberini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | | | - Marco Tartaglione
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
| | - Davide Allegri
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
| | - Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Antonio Pastori
- Settore Assistenza Ospedaliera, Direzione Generale Cura Della Persona, Salute E Welfare, Assessorato Politiche Per La Salute, Regione Emilia, Bologna, Italy
| | - Giovanni Gordini
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
| | - Federico Semeraro
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
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Sørensen OB, Milling L, Laerkner E, Mikkelsen S, Bruun H. Professional prehospital clinicians' experiences of ethical challenges associated with the collaboration with organised voluntary first responders: a qualitative study. Scand J Trauma Resusc Emerg Med 2023; 31:79. [PMID: 37964364 PMCID: PMC10644536 DOI: 10.1186/s13049-023-01147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Volunteer First Responders are used worldwide. In the Region of Southern Denmark, two types of programs have been established. One of these programs consists of voluntary responders without any requirements of education or training who are summoned to prehospital cardiac arrests. The other type of program is established primarily in the rural areas of the region and consists of volunteers with some mandatory education in first aid. These volunteers are summoned to all urgent cases along with the ambulances. Cooperation between professional healthcare workers and nonprofessionals summoned through official channels may be challenging. This study aimed to explore prehospital clinicians' experiences of ethical challenges in cooperation with volunteer first responders. METHODS We conducted 16 semi-structured interviews at four different ambulance stations in the Region of Southern Denmark. Five emergency physicians and 11 emergency medical technicians/paramedics were interviewed. The interviews were transcribed, and the data were analysed using systematic text condensation. RESULTS The study's 16 interviews resulted in the identification of some specific categories that challenged the cooperation between the two parties. We identified three main categories: 1. Beneficence, the act of doing good, 2. The risk of harming patients' autonomy 3. Non-maleficence, which is the obligation not to inflict harm on others. CONCLUSION This study provides an in-depth insight into the ethical challenges between prehospital clinicians and voluntary first responders from the perspective of the prehospital clinicians. Both programs are considered to have value but only when treating patients with cardiac arrest. Our study highlights potential areas of improvement in the two Danish voluntary programs in their current form.
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Affiliation(s)
- Oliver Beierholm Sørensen
- Department of Clinical Research, University of Southern Denmark, 5000, Odense, Denmark
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark
| | - Louise Milling
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
- Department of Cardiology, Nord Zealand Hospital, 3400, Hillerød, Denmark
| | - Eva Laerkner
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, Research Unit in Anesthesiology, University of Southern Denmark, 5000, Odense, Denmark
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark.
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark.
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, 5000, Odense, Denmark.
| | - Henriette Bruun
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, 5000, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5000, Odense, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, 5500, Middelfart, Denmark
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Schnaubelt S, Orlob S, Veigl C, Sulzgruber P, Krammel M, Lauridsen KG, Greif R. Out of sight - Out of mind? The need for a professional and standardized peri-mission first responder support model. Resusc Plus 2023; 15:100449. [PMID: 37638096 PMCID: PMC10448200 DOI: 10.1016/j.resplu.2023.100449] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
First responders are an essential part of the chain (-mail) of survival as they bridge and reduce the time to first chest compressions and defibrillation substantially. However, in the peri-mission phase before and after being sent to a cardiac arrest, these first responders are in danger of being forgotten and taken for granted, and the potential psychological impact has to be remembered. We propose a standardized first responder support system (FRSS) that needs to ensure that first responders are valued and cared for in terms of psychological safety and continuing motivation. This multi-tiered program should involve tailored education and standardized debriefing, as well as actively seeking contact with the first responders after their missions to facilitate potentially needed professional psychological support.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Austrian Resuscitation Council, Graz, Austria
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Simon Orlob
- Austrian Resuscitation Council, Graz, Austria
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria
- Drueck Mich! Arbeitsgemeinschaft fuer Notfallmedizin, Graz, Austria
| | - Christoph Veigl
- Department of Emergency Medicine, Medical University of Vienna, Austria
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
| | - Patrick Sulzgruber
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Mario Krammel
- PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- Emergency Medical Service Vienna, Austria
| | - Kasper G. Lauridsen
- Department of Medicine, Randers Regional Hospital, Randers, Denmark
- Research Center for Emergency Medicine, Aarhus University, Aarhus, Denmark
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, USA
| | - Robert Greif
- University of Bern, Switzerland
- School of Medicine, Sigmund Freud University, Vienna, Austria
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Nabecker S, Huwendiek S, Roten FM, Theiler L, Greif R. Team leadership assessment after advanced life support courses comparing real teams vs. simulated teams. Front Psychol 2022; 13:1020124. [PMID: 36571051 PMCID: PMC9768360 DOI: 10.3389/fpsyg.2022.1020124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 12/12/2022] Open
Abstract
Aim Effective team leadership is essential during cardiopulmonary resuscitation (CPR) and is taught during international advanced life support (ALS) courses. This study compared the judgement of team leadership during summative assessments after those courses using different validated assessment tools while comparing two different summative assessment methods. Methods After ALS courses, twenty videos of simulated team assessments and 20 videos of real team assessments were evaluated and compared. Simulated team assessment used an instructor miming a whole team, whereas real team assessment used course participants as a team that acted on the team leader's commands. Three examiners individually evaluated each video on four different validated team leadership assessment tools and on the original European Resuscitation Council's (ERC) scenario test assessment form which does not assess leadership. The primary outcome was the average performance summary score between all three examiners for each assessment method. Results The average performance summary score for each of the four assessment tools was significantly higher for real team assessments compared to simulated team assessments (all p-values < 0.01). The summary score of the ERC's scenario test assessment form was comparable between both assessment methods (p = 0.569), meaning that participants of both assessments performed equally. Conclusion Team leadership performance is rated significantly higher in real team summative assessments after ALS courses compared to simulated team assessments by four leadership assessment tools but not by the standard ERC's scenario test assessment form. These results suggest that summative assessments in ALS courses should integrate real team assessments, and a new assessment tool including an assessment of leadership skills needs to be developed.
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Affiliation(s)
- Sabine Nabecker
- Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, ON, Canada,Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland,ERC ResearchNET, Niel, Belgium,Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Fredy-Michel Roten
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesia, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland,ERC ResearchNET, Niel, Belgium,School of Medicine, Sigmund Freud University Vienna, Vienna, Austria,*Correspondence: Robert Greif
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Yu Y, Liu X, Wang L, Gao Y, Ding Y, Ao H. Evaluation of cardiopulmonary resuscitation quality during the pandemic of COVID-19. BMC Emerg Med 2022; 22:193. [PMID: 36471252 PMCID: PMC9724342 DOI: 10.1186/s12873-022-00754-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is an important technique of first aid. It is necessary to be popularized. Large-scale offline training has been affected after the outbreak of Coronavirus disease 2019 (COVID-19). Online training will be the future trend, but the quality of online assessment is unclear. This study aims to compare online and offline evaluations of CPR quality using digital simulator and specialist scoring methods. METHODS Forty-eight out of 108 contestants who participated in the second Chinese National CPR Skill Competition held in 2020 were included in this study. The competition comprised two stages. In the preliminary online competition, the contestants practiced on the digital simulator while the specialist teams scored live videos. The final competition was held offline, and consisted of live simulator scoring and specialist scoring. The grades of the simulator and specialists in different stages were compared. RESULTS There was no statistical significance for simulator grades between online and offline competition(37.7 ± 2.0 vs. 36.4 ± 3.4, p = 0.169). For specialists' grades, the video scores were lower than live scores (55.0 ± 1.4 vs. 57.2 ± 1.7, p < 0.001). CONCLUSION Simulator scoring provided better reliability than specialist scoring in the online evaluation of CPR quality. However, the simulator could only collect quantified data. Specialist scoring is necessary in conjunction with online tests to provide a comprehensive evaluation. A complete and standardized CPR quality evaluation system can be established by combining simulator and specialist contributions.
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Affiliation(s)
- Yang Yu
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaojie Liu
- grid.412521.10000 0004 1769 1119Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lijuan Wang
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuchen Gao
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yao Ding
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hushan Ao
- grid.415105.40000 0004 9430 5605Department of Anesthesiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Nabecker S, Huwendiek S, Seidl C, Hana A, Theiler L, Greif R. Assessment of Human Factors After Advanced Life Support Courses Comparing Simulated Team and Real Team Assessment: A Randomized Controlled Cohort Trial. Front Cardiovasc Med 2022; 9:840114. [PMID: 35911508 PMCID: PMC9335945 DOI: 10.3389/fcvm.2022.840114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
AimHuman factors are essential for high-quality resuscitation team collaboration and are, therefore, taught in international advanced life support courses, but their assessment differs widely. In Europe, the summative life support course assessment tests mainly adhere to guidelines but few human factors. This randomized controlled simulation trial investigated instructors’ and course participants’ perceptions of human factors assessment after two different summative assessments.MethodsAll 5th/6th-year medical students who attended 19 advanced life support courses according to the 2015 European Resuscitation Council guidelines during one study year were invited to participate. Each course was randomized to either: (1) Simulated team assessment (one instructor simulates a team, and the assessed person leads this “team” through a cardiac-arrest scenario test); (2) Real team assessment (4 students form a team, one of them is assessed as the team leader; team members are not assessed and act only on team leader’s commands). After the summative assessments, instructors, and students rated the tests’ ability to assess human factors using a visual analog scale (VAS, 0 = no agreement, 10 = total agreement).ResultsA total of 227 students participated in the 1-day Immediate Life Support courses, 196 students in the 2-day Advanced Life Support courses, additionally 54 instructors were included. Instructors judged all human factors significantly better in real team assessments; students rated leadership and situational awareness comparable between both assessments. Assessment pass rates were comparable between groups.ConclusionSummative assessment in real teams was perceived significantly better to assess human factors. These results might influence current summative assessment practices in advanced life support courses.
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Affiliation(s)
- Sabine Nabecker
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesiology and Pain Management, Sinai Health System, University of Toronto, Toronto, ON, Canada
- ERC Research NET, Niel, Belgium
- Graduate School for Health Sciences (GHS), University of Bern, Bern, Switzerland
- *Correspondence: Sabine Nabecker,
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Christian Seidl
- EMS Rescue Service of the Canton Basel-Stadt, Basel, Switzerland
| | - Anisa Hana
- Department of Intensive Care Medicine, Laurentius Hospital, Roermond, Netherlands
| | - Lorenz Theiler
- Department of Anesthesia, Kantonsspital Aarau, Aarau, Switzerland
| | - Robert Greif
- Department of Anesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- ERC Research NET, Niel, Belgium
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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Scquizzato T, Belloni O, Semeraro F, Greif R, Metelmann C, Landoni G, Zangrillo A. Dispatching citizens as first responders to out-of-hospital cardiac arrests: a systematic review and meta-analysis. Eur J Emerg Med 2022; 29:163-172. [PMID: 35283448 DOI: 10.1097/mej.0000000000000915] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mobile phone technologies to alert citizen first responders to out-of-hospital cardiac arrests (OHCAs) were implemented in numerous countries. This systematic review and meta-analysis aim to investigate whether activating citizen first responders increases bystanders' interventions and improves outcomes. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 24 November 2021, for studies comparing citizen first responders' activation versus standard emergency response in the case of OHCA. The primary outcome was survival at hospital discharge or 30 days. Secondary outcomes were discharge with favourable neurological outcome, bystander-initiated cardiopulmonary resuscitation (CPR), and the use of automated external defibrillators (AEDs) before ambulance arrival. Evidence certainty was evaluated with GRADE. Our search strategy yielded 1215 articles. After screening, we included 10 studies for a total of 23 351 patients. OHCAs for which citizen first responders were activated had higher rates of survival at hospital discharge or 30 days compared with standard emergency response [nine studies; 903/9978 (9.1%) vs. 1104/13 247 (8.3%); odds ratio (OR), 1.45; 95% confidence interval (CI), 1.21-1.74; P < 0.001], return of spontaneous circulation [nine studies; 2575/9169 (28%) vs. 3445/12 607 (27%); OR, 1.40; 95% CI, 1.07-1.81; P = 0.01], bystander-initiated CPR [eight studies; 5876/9074 (65%) vs. 6384/11 970 (53%); OR, 1.75; 95% CI, 1.43-2.15; P < 0.001], and AED use [eight studies; 654/9132 (7.2%) vs. 624/14 848 (4.2%); OR, 1.82; 95% CI, 1.31-2.53; P < 0.001], but similar rates of neurological intact discharge [three studies; 316/2685 (12%) vs. 276/2972 (9.3%); OR, 1.37; 95% CI, 0.81-2.33; P = 0.24]. Alerting citizen first responders to OHCA patients is associated with higher rates of bystander-initiated CPR, use of AED before ambulance arrival, and survival at hospital discharge or 30 days.
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Affiliation(s)
- Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Olivia Belloni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
| | - Federico Semeraro
- Department of Anaesthesia, Intensive Care and Emergency Medical Services, Ospedale Maggiore, Bologna, Italy
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
- School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Camilla Metelmann
- Department of Anaesthesiology, University Medicine Greifswald, Greifswald, Germany
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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Schnaubelt S, Schnaubelt B, Pilz A, Oppenauer J, Yildiz E, Schriefl C, Ettl F, Krammel M, Garg R, Niessner A, Greif R, Domanovits H, Sulzgruber P. BLS courses for refugees are feasible and induce commitment towards lay rescuer resuscitation. Eur J Clin Invest 2022; 52:e13644. [PMID: 34185325 PMCID: PMC9285446 DOI: 10.1111/eci.13644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/29/2021] [Accepted: 06/26/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND High-quality Basic Life Support (BLS), the first step in the Utstein formula for survival, needs effective education for all kinds of population groups. The feasibility of BLS courses for refugees is not well investigated yet. METHODS We conducted BLS courses including automated external defibrillator (AED) training for refugees in Austria from 2016 to 2019. Pre-course and after course attitudes and knowledge towards cardiopulmonary resuscitation (CPR) were assessed via questionnaires in the individuals' native languages, validated by native speaker interpreters. RESULTS We included 147 participants (66% male; 22 [17-34] years; 28% <18 years) from 19 countries (74% from the Middle East). While the availability of BLS courses in the participants' home countries was low (37%), we noted increased awareness towards CPR and AED use after our courses. Willingness to perform CPR increased from 25% to 99%. A positive impact on the participants' perception of integration into their new environment was noted after CPR training. Higher level of education, male gender, age <18 years and past traumatizing experiences positively affected willingness or performance of CPR. CONCLUSION BLS education for refugees is feasible and increases their willingness to perform CPR in emergency situations, with the potential to improve survival after cardiac arrest. Individuals with either past traumatizing experiences, higher education or those <18 years might be eligible for advanced life support education. Interestingly, these BLS courses bear the potential to foster resilience and integration. Therefore, CPR education for refuge should be generally offered and further evaluated.
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Affiliation(s)
- Sebastian Schnaubelt
- Department of Emergency MedicineMedical University of ViennaViennaAustria
- Zurück ins LebenAssociation for First Aid Courses for MigrantsViennaAustria
- Austrian Cardiac Arrest Awareness Association–PULSViennaAustria
| | | | - Arnold Pilz
- Zurück ins LebenAssociation for First Aid Courses for MigrantsViennaAustria
- Department of PulmonologyClinic PenzingVienna Healthcare GroupViennaAustria
| | - Julia Oppenauer
- Department of Emergency MedicineMedical University of ViennaViennaAustria
| | - Erdem Yildiz
- Zurück ins LebenAssociation for First Aid Courses for MigrantsViennaAustria
- Department of OtorhinolaryngologyMedical University of ViennaViennaAustria
| | - Christoph Schriefl
- Department of Emergency MedicineMedical University of ViennaViennaAustria
- Austrian Cardiac Arrest Awareness Association–PULSViennaAustria
| | - Florian Ettl
- Department of Emergency MedicineMedical University of ViennaViennaAustria
- Austrian Cardiac Arrest Awareness Association–PULSViennaAustria
| | - Mario Krammel
- Austrian Cardiac Arrest Awareness Association–PULSViennaAustria
- Emergency Medical Service ViennaViennaAustria
| | - Rakesh Garg
- All India Institute of Medical SciencesNew DelhiIndia
| | - Alexander Niessner
- Division of CardiologyDepartment of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Robert Greif
- Department of Anaesthesiology and Pain MedicineBern University HospitalUniversity of BernBernSwitzerland
- School of MedicineSigmund Freud University ViennaViennaAustria
| | - Hans Domanovits
- Department of Emergency MedicineMedical University of ViennaViennaAustria
- Austrian Cardiac Arrest Awareness Association–PULSViennaAustria
| | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association–PULSViennaAustria
- Division of CardiologyDepartment of Internal Medicine IIMedical University of ViennaViennaAustria
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Nabecker S, Huwendiek S, Theiler L, Huber M, Petrowski K, Greif R. The effective group size for teaching cardiopulmonary resuscitation skills - A randomized controlled simulation trial. Resuscitation 2021; 165:77-82. [PMID: 34107336 DOI: 10.1016/j.resuscitation.2021.05.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY The ideal group size for effective teaching of cardiopulmonary resuscitation is currently under debate. The upper limit is reached when instructors are unable to correct participants' errors during skills practice. This simulation study aimed to define this limit during cardiopulmonary resuscitation teaching. METHODS Medical students acting as simulated Basic Life Support course participants were instructed to make three different pre-defined Basic Life Support quality errors (e.g., chest compression too fast) in 7 min. Basic Life Support instructors were randomized to groups of 3-10 participants. Instructors were asked to observe the Basic Life Support skills and to correct performance errors. Primary outcome was the maximum group size at which the percentage of correctly identified participants' errors drops below 80%. RESULTS Sixty-four instructors participated, eight for each group size. Their average age was 41 ± 9 years and 33% were female, with a median [25th percentile; 75th percentile] teaching experience of 6 [2;11] years. Instructors had taught 3 [1;5] cardiopulmonary resuscitation courses in the year before the study. A logistic binominal regression model showed that the predicted mean percentage of correctly identified participants' errors dropped below 80% for group sizes larger than six. CONCLUSION This randomized controlled simulation trial reveals decreased ability of instructors to detect Basic Life Support performance errors with increased group size. The maximum group size enabling Basic Life Support instructors to correct more than 80% of errors is six. We therefore recommend a maximum instructor-to-participant ratio of 1:6 for cardiopulmonary resuscitation courses.
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Affiliation(s)
- Sabine Nabecker
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Anesthesia and Pain Management, Sinai Health System, University of Toronto, Toronto, Canada; ERC ResearchNET.
| | - Sören Huwendiek
- Department for Assessment and Evaluation, Institute for Medical Education, University of Bern, Bern, Switzerland
| | - Lorenz Theiler
- Department of Anaesthesia, Kantonsspital Aarau, Aarau, Switzerland
| | - Markus Huber
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; Statistical Unit, Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Katja Petrowski
- Department for Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern, Bern, Switzerland; ERC ResearchNET; School of Medicine, Sigmund Freud University Vienna, Vienna, Austria
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