'The year of first aid': effectiveness of a 3-day first aid programme for 7-14-year-old primary school children

Impact of anthropometric factors on chest compression depth during CPR provided by children aged 11-14 in a community-wide study

Objective

To assess the depth of chest compressions (CC) provided by schoolchildren and their relation with providers's anthropometric characteristics.

Methods

We organized 1-hour hands-on training sessions for 11-14y.o. in volunteering schools. After training, willing subjects performed 2 min of recorded continuous CCs by means of Laerdal Resusci Anne® with CPRMeter2®, with visual feedback. Compression pace was given by metronome; instructors supervised the correct body position. Collected data included age, sex, as well as measured body weight and height.

Results

We analyzed records from N = 702 children (mean age: 12.76 ± 1.02 years, 379 (51.63%) boys) out of 761 participating in the study. Their mean median compression depth (MCD) was 46.70 ± 7.74 mm, which was below minimal effective CC depth advised by current guidelines (50 mm). This corresponded to low mean fraction of CCs ≥ 50 mm (CCF ≥ 50 mm, 42.86 ± 33.67%), and only 42.88% of children achieving at least 50% of compressions ≥ 50 mm. Boys had significantly higher mean MCD and CCF ≥ 50 mm than girls (MCD: 49.34 ± 7.05 mm vs 45.97 ± 8.07 mm, p < 0.0001; CCF ≥ 50 mm: 50.23 ± 32.90% vs 40.40 ± 34.97%, p < 0.0001). Age differentiated children who achieved at least 50% of compressions ≥50 mm from those who did not with AUC of 0.69 (for cut-off of 12.1 years: 85% sensitivity, 41% specificity), whereas weight offered an improved prediction (AUC 0.74; for cut-off 44.8 kg: 77.4% sensitivity, 61.1% specificity).

Conclusions

Sex, age and anthropometric factors are significant CC quality factors. Children with higher body weight are more likely to deliver CCF50%≥50 mm. Among the studied population, children ≥12 years old provided more effective chest compressions.

Evaluating the Effectiveness of a First Aid Training Programme for Individuals Without a Background in Medical Education

Objective

People without a medical education background who have the skills and knowledge to provide emergency care can be useful in emergencies, disasters, earthquakes, and pandemics to save or support the life of an injured person until hospitalization or the arrival of an emergency medical team. The purpose of the study is to assess the knowledge and skills of first aid in individuals without a medical education background within a year after training.

Materials and Methods

The study sample included 643 people without a medical education background. The study participants attended basic first aid training, the sessions that lasted for 18 hours. Participants answered a 10-question skills test before and after completing the course, as well as 6 months and 1 year after training. SPSS version 20.0 (IBM Ireland Product Distribution Limited, Ireland) was used for the statistical assessment of data, employing Cochran's Q test. Pairwise comparisons were made between different periods using the Wilcoxon test with Bonferroni correction.

Results

The mean age of the participants was 36 for males, and 42 for females. In the sample, males accounted for 70% (n = 441) and females for 30% (n = 202). The first aid training provided to persons without a medical education background significantly increased their level of knowledge. After 6 and 12 months, their knowledge and abilities remained significantly higher than before the training. However, these results were lower than they had been immediately after training.

Conclusion

The study demonstrated that first aid training significantly increased the knowledge level of non-medical individuals immediately after training and remained elevated after 6 and 12 months. However, there was a decline in the level of knowledge and skills over time, indicating the need for refresher training.

Empowering the next Generation: An innovative "Kids Save Lives" blended learning programme for schoolchildren training

INTRODUCTION

Guidelines recommend teaching resuscitation from school age; however, little is known about the best methods to provide it. We devised a blended learning program for primary and secondary students (Kids Save Lives - KSL) consisting of brief lectures, practical training with mannequins, and virtual reality. We aimed to evaluate its impact on students' attitudes towards intervening during cardiac arrest and their knowledge about basic life support.

METHODS

This observational, prospective, before-and-after study assessed attitudes and basic life support knowledge in primary and secondary school children exposed to the KSL program. 20 events were conducted in the metropolitan area of Bologna, Italy. A multiple-choice test (before and after the course) explored attitude, knowledge and perceptions of realism, engagement, and agreement with the virtual reality method.

RESULTS

A total of 1,179 students (response rate 81.4%) were included in the final analysis, with 12.89% from primary schools, 5.94% from middle schools, and 81.17% from high schools. Students' willingness to intervene during a cardiac arrest rose from 56.9% to 93.1% (p < 0.001) post-course. The course's realism, engagement, and future prospects received positive feedback, with median scores notably higher in primary schools compared to secondary schools.

CONCLUSION

The blended learning method improved students' understanding of basic life support techniques and their attitude to act during cardiac arrest situations. The positive reception of the virtual reality component underscores technology's potential to bolster engagement and should be further explored for basic life support teaching in schoolchildren.

Education of schoolchildren in cardiopulmonary resuscitation - overview of the current literature

PURPOSE OF REVIEW

Recognition of cardiac arrest and initiation of cardiopulmonary resuscitation (CPR) can be learned and adequately replicated by schoolchildren. Regular instruction of schoolchildren in CPR is therefore a core element to increase low bystander CPR rates. Thereby, schoolchildren CPR training evolved as own scientific field within the last decade. Aim was to describe current evidence in terms of epidemiology, teaching approaches and political aspects.

RECENT FINDINGS

Schoolchildren demonstrate a high motivation to be trained in CPR. Teaching approaches that combine theoretical and practical learning sessions guarantee a sustainable learning effect. Schoolchildren can adequately perform chest compressions and mouth-to-mouth ventilation from the age of 12 years. Use of digital media is a highly promising teaching approach. CPR training conducted by teachers from the own school is effective and guarantees continuous development of CPR skills. Integration of schoolchildren CPR training into school curricula is the foundation for a sustainable increase of lay resuscitation rates in the population. Scientific and political promotion of schoolchildren CPR training is needed to sensitize the population and move bystander CPR in the social focus.

SUMMARY

While bystander CPR rates are low in Europe comprehensive establishment of schoolchildren CPR training may sustainably increase survival after cardiac arrest.

Methods to teach schoolchildren how to perform and retain cardiopulmonary resuscitation (CPR) skills: A systematic review and meta-analysis

Background

Worldwide, bystander CPR rates are low; one effective way to increase these rates is to train schoolchildren; however, the most effective way to train them is currently unknown.

Methods

This systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies, evaluated whether CPR training for schoolchildren, using innovative teaching modalities (nonpractical, self, or peer-training) versus standard instructor-led training, resulted in higher quality CPR, self-confidence and short-term (≤3 months post-training) or long-term (>3 months post-training) retention of CPR skills.

Results

From 9793 citations, 96 studies published between 1975 and 2022 (44 RCTs and 52 before/after studies) were included. There were 43,754 students, average age of 11.5 ± 0.9 (range 5.9-17.6) and 49.2% male. Only 13 RCTs compared practical vs. nonpractical training (n = 5), self- vs. instructor-led training (n = 7) or peer- vs. instructor-led training (n = 5). The observed statistically significant differences in mean depth and rate of compressions between children with hands-on practical training and those without were not clinically relevant. Regardless of training modality, compression depth was consistently suboptimal. No differences were observed in CPR skills immediately or ≤ 3 months post-training, between children who were self- or peer-trained vs. instructor-led. Due to lack of data, we were unable to evaluate the impact of these novel training modalities on student self-confidence.

Conclusion

Although innovative training modalities are equally effective to instructor-led training when teaching schoolchildren CPR, compression depth was frequently suboptimal. Recommendations on standardized training and evaluation methods are necessary to understand the best ways to train children.

The Effect of Cardiopulmonary Resuscitation (CPR) Education on the CPR Knowledge, Attitudes, Self-Efficacy, and Confidence in Performing CPR among Elementary School Students in Korea

Cardiopulmonary resuscitation (CPR) education for schoolchildren is emphasized, as bystander CPR is a vital key to increasing the survival rate of out-of-hospital cardiac arrest (OHCA) victims. This study was conducted to verify the effect of CPR education on knowledge, attitudes, self-efficacy, and confidence of Korean elementary school students in performing CPR. Data were collected through structured questionnaires before and after CPR education and analyzed using descriptive statistics, T-tests, and hierarchical regression. Significant improvements in CPR knowledge, attitudes, self-efficacy, and confidence in performing CPR were found after CPR education, with the greatest increase observed in confidence (p = 0.000). The influencing factors on confidence in performing CPR were school grade, attitude, and self-efficacy. Although a significant increase in schoolchildren's CPR knowledge after education was shown, knowledge did not affect confidence in performing CPR. Therefore, early CPR education which focuses on improving confidence in performing CPR is recommended. CPR education might raise attitude and self-efficacy leading to increased confidence in performing bystander CPR. In conclusion, early and regular CPR education for elementary school students is crucial and should be conducted repeatedly.

A six-year teaching life supportive first aid program to eventually generate peer trainer pupils: a prospective case control study

BACKGROUND

Out of hospital cardiac arrest is a life-threatening condition. To improve the chances of survival, lay-person cardio-pulmonary-resuscitation (CPR) is a crucial factor. Many bystanders fail to react appropriately, even if life supporting first aid (LSFA) programs and campaigns including CPR tried to increase the handling of basic cardiac life support. To achieve an enhanced learning of CPR a pupil's grade after grade teaching program was established in a school with medical students.

METHODS

The learning of CPR was investigated in a prospective, case-controlled study at an international school. Pupils (12 ± 3 years old) joining our LSFA courses (n = 538, female: 243, attendance for evaluation: 476) were compared to a control group (n = 129, female: 52, attendance for evaluation: 102). Surveys and quality of CPR (QCPR%) through a computer linked "Resusci Anne" dummy were compared with Chi-squared tests, t-tests pair wisely, and by one-way ANOVA.

RESULTS

Knowledge and skills on the "Resusci Anne" were significantly better in trained grade 9 pupils compared to the control group (QCPR, 59 vs. 25%). The number of LSFA courses each grade 9 student had, correlated with improved practical performance (r² = 0.21, p < 0.001). The willingness to deliver CPR to strangers increased with improved practical performance. Attitudes towards performing CPR were high in all participating grades.

CONCLUSION

Repetitive teaching LSFA to grade 5-9 pupil's grade after grade by medical students has been successfully established. Pupils who finish the program will eventually be able to teach LSFA to younger students. This is furthermore a good way of sharing a "learning by teaching" role and it enables to have more pupils as trainers who can provide instruction to a larger number of pupils with the purpose of having a better-trained population in LSFA.

Schoolteachers Teach First Aid and Trauma Management to Young Primary School Children: An Experimental Study with Educational Intervention

OBJECTIVES

The primary objective of this pilot study was to examine the effectiveness of teaching first aid to 6-8-year-old children within their primary school setting. The study aimed to address two key research questions: (1) Can children of this age group acquire first aid and trauma management skills from their schoolteachers? (2) How long do children retain the acquired first aid knowledge?

METHODS

A pilot experimental study with an educational intervention was conducted in a single primary school in Greece. A total of 60 schoolchildren aged 6-8 years were randomly selected for participation, with 30 children assigned to the training group and 30 children assigned to the control group, which did not receive any intervention. To assess the children's understanding of first aid, a specialized questionnaire was administered to all children one day before the training, as well as to the training group one day after the training, and at two and six months following the training.

RESULTS

Prior to the training, there were no significant differences in first aid knowledge between the children in the training group and those in the control group. However, one day after the training, the trained children demonstrated significantly higher scores (p < 0.05) compared to the control group. Over time, the first aid knowledge of the trained children gradually declined at the two- and six-month follow-up assessments, although it remained higher than their pre-training level.

CONCLUSIONS

First aid training provided by their teachers improved the knowledge of 6-8-year-old primary school children in first aid and trauma management.

Temporarily Removed

BACKGROUND

Basic life support education for schoolchildren has become a key initiative to increase bystander cardiopulmonary resuscitation rates. Our objective was to review the existing literature on teaching schoolchildren basic life support to identify the best practices to provide basic life support training in schoolchildren.

METHODS

After topics and subgroups were defined, a comprehensive literature search was conducted. Systematic reviews and controlled and uncontrolled prospective and retrospective studies containing data on students <20 years of age were included.

RESULTS

Schoolchildren are highly motivated to learn basic life support. The CHECK-CALL-COMPRESS algorithm is recommended for all schoolchildren. Regular training in basic life support regardless of age consolidates long-term skills. Young children from 4 years of age are able to assess the first links in the chain of survival. By 10 to 12 years of age, effective chest compression depths and ventilation volumes can be achieved on training manikins. A combination of theoretical and practical training is recommended. Schoolteachers serve as effective basic life support instructors. Schoolchildren also serve as multipliers by passing on basic life support skills to others. The use of age-appropriate social media tools for teaching is a promising approach for schoolchildren of all ages.

CONCLUSIONS

Schoolchildren basic life support training has the potential to educate whole generations to respond to cardiac arrest and to increase survival after out-of-hospital cardiac arrest. Comprehensive legislation, curricula, and scientific assessment are crucial to further develop the education of schoolchildren in basic life support.

The Role of a First Aid Training Program for Young Children: A Systematic Review

BACKGROUND

Many first aid programs have been conducted in schools, and researchers have identified that interventions improved students' knowledge, skills, and attitude. This study examines the content, practices, and assessment of first aid interventions at primary schools and evaluates their effectiveness.

METHODS

A systematic review was undertaken. We searched MEDLINE and Cochrane library databases from January 1990 to December 2021 using the search terms: ''first aid'' AND ''primary school children''. School-based first aid training targeting 6 to 10 years old studies in English were eligible for inclusion.

RESULTS

We included 11 studies that were approached by experimental (n = 6) and by observational studies (n = 5). Researchers conducted interventions in Europe (n = 9) and America (n = 2). An essential part of the teaching was hands-on practice. Most studies included in their program cardiopulmonary resuscitation (n = 8) and basic life support (n = 7). The main findings showed that trained children have significantly better knowledge of and skills in first aid than those before or without training. Children under 11 years old were not strong enough to achieve the proper depth of chest compressions. Depth of chest compressions correlates with children's age, weight, height (n = 2), and body mass index (n = 3). Conclusions The effectiveness of resuscitative or non-resuscitative first-aid training for primary school children improved students' knowledge and skills. Subsequent research could investigate children's reactions in actual first aid conditions.

RCParvulari training: A basic life support training methodology applied to 5-year-old students: Effectiveness in a cluster-randomized clinical trail

INTRODUCTION

Basic life support training in school age is a topical issue because, with adequate training, any person can help save a life.

METHODS

Cluster clinical trial with data collection through an ad hoc self-administered, semi-structured questionnaire. The target population encompassed the students aged 4-6 years enrolled in 49 educational centres. The centres were randomly allocated to the intervention or control group. The intervention group was trained with the RCParvulari® methodology, consisting of theoretical and practical training on the first link of the chain of survival. The control group only received theoretical training. We evaluated participants before and immediately after the intervention and between 3 and 12 months post intervention by means of the questionnaire. We assessed the acquisition and retention over time of the knowledge and skills covered in the training compared to previous trainings in both groups.

RESULTS

A total of 1327 schoolchildren (79% of the target population) participated. The level of knowledge acquired immediately after training and after 3-12 months compared to baseline was significantly better (P < .001) in the intervention group than in the control group, both in early recognition and contacting of emergency services (112) and in remembering the "mouth-nose-eyes" mnemonic.

CONCLUSIONS

The RCParvulari® methodology significantly contributed to an improved ability to recognize a possible medical emergency, start the chain of survival by alerting an adult and call the 112 emergency number in students in the last year of preschool education.

Compression-Only Cardiopulmonary Resuscitation and Automated External Defibrillator Course for Primary School Students: A Malaysian Pilot Study

The Malaysian national school curriculum currently lacks resources and tools to enforce CPR education. The aim of this study was to investigate the efficacy of a compression-only cardiopulmonary resuscitation and automated external defibrillator course among primary school students to increase their knowledge and technical skills and improve their attitudes. A quasi-experimental study was conducted using a pre−post non-equivalent design involving 38 students aged 10−12. Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) knowledge, technical skills, and attitude towards CPR were assessed in a post test with three-month follow-up. Results of the MANOVA analysis showed significant differences in the level of knowledge (F = 10.29, p < 0.001) and attitude (F = 13.87, p < 0.001) based on the students’ age group at the time of the post test. The proportion of students who passed the technical skills component differed significantly by age (χ2 = 12.12; p = 0.002) and BMI (χ2 = 6.34; p = 0.041). No significant decay was reported in the total mean scores for knowledge, technical skills, and attitude (F = 0.727, p = 0.54) at 3-month follow-up. The course helped students perform CPR and utilize AED effectively while promoting a positive attitude with up to 3 months of retention, demonstrating the feasibility of extending the course within the Malaysian primary school curriculum.

CPR Quality Assessment in Schoolchildren Training

Whilst CPR training is widely recommended, quality of performance is infrequently explored. We evaluated whether a checklist can be an adequate tool for chest compression quality assessment in schoolchildren, compared with a real-time software. This observational study (March 2019–2020) included 104 schoolchildren with no previous CPR training (11–17 years old, 66 girls, 84 primary schoolchildren, 20 high schoolchildren). Simultaneous evaluations of CPR quality were performed using an observational checklist and real-time software. High-quality CPR was determined as a combination of 70% correct maneuvers in compression rate (100–120/min), depth (5–6 cm), and complete release, using a real-time software and three positive performance in skills using a checklist. We adjusted a multivariate logistic regression model for age, sex, and BMI. We found moderate to high agreement percentages in quality of CPR performance (rate: 68.3%, depth: 79.8%, and complete release: 91.3%) between a checklist and real-time software. Only 38.5% of schoolchildren (~14 years-old, ~54.4 kg, and ~22.1 kg/m2) showed high-quality CPR. High-quality CPR was more often performed by older schoolchildren (OR = 1.43, 95% IC:1.09–1.86), and sex was not an independent factor (OR = 1.26, 95%IC:0.52–3.07). For high-quality CPR in schoolchildren, a checklist showed moderate to high agreement with real-time software. Better performance was associated with age regardless of sex and BMI.

First Aid Training for Children in Kindergarten: A Pilot Randomized Control Study

First aid is a fundamental skill for every human of every age, so training in first aid is necessary at a variety of levels. First aid training in schools is essential, but to date, only short reports have been published on the effectiveness of first aid training in kindergarten. We conducted a pilot randomized controlled study on the impact of first aid training on children in kindergarten. We randomly selected 24 children aged 4-5 years from one kindergarten, who were allocated to either a training group (14 children) or a control group (10 children). The training program consisted of three lessons. An eleven-question questionnaire was administered to the children in the training group one day before, one day after, and two and six months after the training, and once to the those in the control group. Before the training, no significant difference was detected in the score on the questionnaire between the two groups. After the lessons, the children in the training group scored significantly higher on the questionnaire than before the lessons, and than the children in the control group. At two and six months after the training, the scores of the children in the training group had decreased but remained higher than before the training and higher that those of the control group. These preliminary results indicate that kindergarten children may benefit from first aid training, but further studies are needed to verify these observations and to explore ways of maintaining the knowledge acquired in training.

Understanding the Importance of the Lay Responder Experience in Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association

Bystander cardiopulmonary resuscitation (CPR) is critical to increasing survival from out-of-hospital cardiac arrest. However, the percentage of cases in which an individual receives bystander CPR is actually low, at only 35% to 40% globally. Preparing lay responders to recognize the signs of sudden cardiac arrest, call 9-1-1, and perform CPR in public and private locations is crucial to increasing survival from this public health problem. The objective of this scientific statement is to summarize the most recent published evidence about the lay responder experience of training, responding, and dealing with the residual impact of witnessing an out-of-hospital cardiac arrest. The scientific statement focuses on the experience-based literature of actual responders, which includes barriers to responding, experiences of doing CPR, use of an automated external defibrillator, the impact of dispatcher-assisted CPR, and the potential for postevent psychological sequelae. The large body of qualitative and observational studies identifies several gaps in crucial knowledge that, if targeted, could increase the likelihood that those who are trained in CPR will act. We suggest using the experience of actual responders to inform more contextualized training, including the implications of performing CPR on a family member, dispelling myths about harm, training and litigation, and recognition of the potential for psychologic sequelae after the event.

Development and semantic validation of an instrument for the assessment of knowledge and attitudes towards cardiopulmonary resuscitation in adolescents

OBJECTIVES

Develop and semantically validate an instrument to assess the knowledge and attitudes of adolescents towards cardiopulmonary resuscitation (CPR).

METHODS

Validation study of an instrument to evaluate the knowledge and attitudes of adolescents towards CPR, developed in three phases: (i) development of the evaluation instruments by the authors; (ii) content validation performed by 14 expert judges in the area using the content validity index for analysis; and (iii) semantic validation carried out with the participation of 30 adolescents between 11 and 13 years old.

RESULTS

In the content validation, the questions on CPR knowledge obtained a content validity index (CVI) between 0.92 and 1.00, with a general index of 0.98; and the questions about attitudes obtained an IVC between 0.85 and 1.00, with a general index also of 0.98. Regarding semantic validation, three questions were modified in the knowledge assessment instruments and five in the attitude assessment instrument.

CONCLUSIONS

Semantic and content validation of the instruments studied showed that they are suitable for assessing the knowledge and attitudes of adolescents related to CPR, so their use is recommended in the evaluation of training actions in this population group.

Hemorrhage Control Training: Preparing Adolescents to Act at Home, at School, or in Public

OBJECTIVES

Uncontrolled bleeding is the leading cause of preventable death after a traumatic event, and early intervention to control bleeding improves opportunities for survival. It is imperative to prepare for local and national disasters by increasing public knowledge on how to control bleeding, and this preparation should extend to both adults and children. The purpose of this study is to describe a training effort to teach basic hemorrhage control techniques to early adolescent children.

METHODS

The trauma and emergency departments at a combined level I adult and level II pediatric trauma center piloted a training initiative with early adolescents (grades 6-8) focused on 2 skills: packing a wound and holding direct pressure, and applying a Combat Application Tourniquet. Students were evaluated on each skill and completed presurveys and postsurveys indicating their likelihood to use the skills.

RESULTS

Of the 194 adolescents who participated in the trainings, 97% of the students could successfully pack a wound and hold pressure, and 97% of the students could apply a tourniquet. Before the training, 71% of the adolescents indicated that they would take action to assist a bleeding victim; this increased to 96% after the training.

CONCLUSIONS

Results demonstrate that basic hemorrhage control skills can be effectively taught to adolescents as young as 6th grade (ages 11-12 years) in a small setting with age-appropriate content and hands-on opportunities to practice the skills and such training increases students' perceived willingness to take action to assist a bleeding victim.

Learning to resuscitate at school. Study in 8-12 year-old schoolchildren

OBJECTIVE

To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.

MATERIAL AND METHODS

Quasi-experimental study with a convenience sample of 567 pupils in 3rd and 5th year of Primary Education, and first year of Compulsory Secondary Education, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.

RESULTS

The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P < .001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P = .030). The following compression quality parameters improved significantly with age: continuity of compressions (P < .001), percentage of compressions performed at correct depth (P = .002), and median depth (P < .001), while the percentage of compressions with correct decompression decreased significantly (P < .001).

CONCLUSIONS

Although their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years old to recognise the emergency, start the chain of survival, and initiate chest compressions.

Training frequency for educating schoolchildren in basic life support: very brief 4-month rolling-refreshers versus annual retraining-a 2-year prospective longitudinal trial

OBJECTIVE

To compare the effectiveness of 4-month rolling-refreshers and annual retraining in basic life support (BLS) on a sample of schoolchildren.

DESIGN

Prospective longitudinal trial.

SETTING AND PARTICIPANTS

Four hundred and seventy-two schoolchildren (8-12 years old).

INTERVENTIONS

Schoolchildren were instructed in BLS and then split into the following three groups: control group (CG), standard group (SG) and rolling-refresher group (RRG). Their BLS skills were assessed within 1 week (T1) and 2 years later (T2). Moreover, CG did not receive any additional training; SG received one 50 min retraining session 1 year later; RRG participated in very brief (5 min) rolling-refreshers that were carried out every 4 months.

PRIMARY AND SECONDARY OUTCOMES

Hands-on skills of BLS sequence and cardiopulmonary resuscitation.

RESULTS

BLS sequence performance was similar in all groups at T1, but SG and RRG followed the steps of the protocol in more proportion than CG at T2. When compared at T2, RRG showed higher proficiency than SG in checking safety, checking response, opening the airway and alerting emergency medical services. In addition, although the mean resuscitation quality was low in all groups, RRG participants reached a higher percentage of global quality cardiopulmonary resuscitation (CG: 16.4±24.1; SG: 25.3±28.8; RRG: 29.9%±29.4%), with a higher percentage of correct chest compressions by depth (CG: 3.9±11.8; SG: 10.8±22.7; RRG: 15.5±26.1 mm).

CONCLUSIONS

In 8-to-12-year-old schoolchildren, although annual 50 min retraining sessions help to maintain BLS performance, 4-month very brief rolling-refreshers were shown to be even more effective. Thus, we recommend implementing baseline BLS training at schools, with subsequently brief rolling-refreshers.

Non-resuscitative first aid training and assessment for junior secondary school students: A pre-post study

School-based first aid interventions can contribute to the number of adults trained in first aid in the community over time but few studies have examined the effectiveness of teaching non-resuscitative first aid on knowledge, attitudes and skills. Currently, there is no consensus on the optimal content and duration of first aid training for junior secondary students. The aim of this study was to evaluated the effectiveness of a 2.5 hour introductory non-resuscitative first aid course for junior secondary students.This prospective, single-centre, pre-post study included 140 students (11-13 years old). Students completed a questionnaire on first aid knowledge, attitude towards first aid and self-confidence to perform first aid before and after a training session. Six emergency medicine physicians taught practical first aid skills training. A game-based formative assessment was undertaken where the instructors assessed small teams of students' role-playing injured classmates and first aid responders (and vice-versa) treating abrasions, ankle sprain, choking and a scald injury.Few students had prior first aid training (14%). After adjusting for student's age, sex, prior first aid training and format delivery, the course was associated with increased mean knowledge score (pre-training 53%, post-training 88%; mean difference [MD] 35%, 95% CI: 32% to 38%), positive attitudes and more confidence in performing first aid after training (all P < .001). All teams showed a good level of competency in treating simulated injuries with first aid kits.This brief non-resuscitative first aid course was associated with noticeable and valuable changes in knowledge score and self-confidence level in performing first aid. The game-based formative assessment facilitated a positive learning environment for skill competency evaluation.

Basic life support training in schools

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

Basic life support training programme in schools by school nurses: How long and how often to train?

BACKGROUND

Cardiopulmonary resuscitation (CPR) training in schools, despite being legislated in Spain, is not established as such within the subjects that children are taught in schools.

OBJECTIVE

to evaluate the acquisition of CPR skills by 11-year-old children after a brief theoretical-practical teaching programme taught by nurses at school.

METHODS

62 students were assessed in a quasi-experimental study on 2 cohorts (51.4% of the sample in control group [CG]). In total, 2 sessions were given, a theoretical one, and a practical training for skill development in children, in which the CG performed the CPR in 2-minute cycles and the intervention group in 1-minute cycles. The anthropometric variables recorded were weight and height, and the variables compression quality and ventilation quality were recorded using the Laerdal ResusciAnne manikin with Personal Computer/Wireless SkillReport.

RESULTS

The assessment showed better results, in terms of BLS sequence performance and use of automated external defibrillator, in the CG and after training, except for the evaluation of the 10-second breathing assessment technique. The quality of chest compressions was better in the CG after training, as was the quality of the ventilations. There were no major differences in CPR quality after training and 4 months after the 1-minute and 2-minute training cycles.

CONCLUSIONS

11-year-old children do not perform quality chest compressions or ventilations but, considering their age, they are able to perform a BLS sequence correctly.

Effects of Cardiopulmonary Resuscitation with Automated External Defibrillator Training among Schoolchildren in Slovenia: A Pre- and Post-test Cohort Study

Introduction

A low proportion of bystanders in Slovenia are willing to provide resuscitation to people experiencing cardiac arrest. We measured knowledge acquired after cardiopulmonary resuscitation training among Slovenian children in the final three grades of primary school.

Methods

This pre- and post-test cohort study included 566 schoolchildren aged 12-15 years. From April to May 2018, we administered a 15-item questionnaire to children in 15 primary schools, to assess the effects of theoretical and practical cardiopulmonary resuscitation training on their knowledge of cardiopulmonary resuscitation at 1-2 months after training. Data were processed using univariate, bivariate, and multivariate analyses.

Results

A significantly greater level of post-training knowledge was noted in all three equally sized school grade groups (p=0.001). The youngest group (mean age 12.5 years) exhibited the greatest increase in knowledge, with test scores increasing by an average 2.65 (range 0-15) points. Age (p=0.001), body mass index (p=0.037), female sex (p=0.006), and previous resuscitation training (p=0.024) were significant independent predictors of pre-training knowledge level. Sex was the only predictor significantly influencing knowledge levels after training (p=0.002); girls scored up to 0.7 points higher than boys, both before and after training.

Conclusions

Among Slovenian schoolchildren aged 12-15 years, a significantly improved level of theoretical knowledge was demonstrated after cardiopulmonary resuscitation training. The introduction of cardiopulmonary training may be most effective in children aged 12.5 years (seventh graders). Early, compulsory resuscitation training might reduce social barriers to performing resuscitation, which may eventually translate into better post-cardiac arrest outcomes.

Learning Effectiveness Assessment between Primary School Students and Adults in Basic Life Support Education

Background

Out-of-hospital cardiac arrest (OHCA) remains a big issue of critical care. It is well known that bystander cardiopulmonary resuscitation (CPR) with an automated external defibrillator (AED) used did improve the survival rate. Therefore, CPR education including basic life support (BLS) and AED has been advocated for years. It showed significant improvement of knowledge and willingness to perform CPR through adolescents after the course. However, little is known regarding the ability and learning effectiveness of school students who attend such courses. Therefore, this study aimed to evaluate the CPR effectiveness of both adolescents (12 years old) and adults who undergo the same course of BLS and AED.

Methods

This is a retrospective study. Sixth-grade elementary school students in Northern Taiwan were selected to compare with the adult group. Both took 90 minutes of the BLS and AED course by the doctor with BLS instructor qualification. The primary outcomes were CPR quality and passing or failing the skill examination parameters. The secondary outcome was the posttraining written test and questionnaire of CPR willingness.

Results

In the written test, there was a statistical difference in the pretest score except AED knowledge, but no difference was revealed in the posttest score. No statistical difference in CPR quality was noted. In the skill examination, only checking breathing status had statistical difference (elementary group (71%) vs. adult group (86%) (p=0.003)).

Conclusion

We revealed that sixth-grade elementary students' performance in CPR and AED was similar to that of adults after completing the current 90-minute course. Therefore, we strongly advocate offering CPR and AED courses to 12-year-old children, and these courses should emphasize checking the victim's breathing status.

Outcome of basic life support training among primary school students in Southeast Asia

Objective

This study aimed to evaluate how BLS courses affect primary school students’ knowledge, attitudes, and life support skills; investigate how medical students’ knowledge and competence in teaching BLS can improve by serving as instructors.

Methods

This experimental study was conducted in a rural primary school. First-year medical students conducted a BLS course for grade 4 and 5 primary school students with a 6–7:1 ratio of trainees-to-trainer. All trainers had completed a BLS course before the course. This 3.5-hour simulation-based course covered chest compressions and automated external defibrillator use. The pre- and post-course assessments included multiple choice questions toward BLS, practical skills test, and attitude test. For medical students, evaluation was conducted by attitude test, both pre- and post-teaching.

Results

The mean pre- and post-test scores increased from 5.74±0.10 to 9.43±0.13 (P<0.01). The increase in the scores was the same for both the students and the teachers (3.05±0.60 vs. 3.68±0.16, P=0.33). After the course, more than 90% of the students could perform all the procedures involved in BLS and automated external defibrillation. Medical students showed an improved understanding of CPR and confidence in performing and teaching CPR (both, P<0.01).

Conclusion

Primary school students can learn how to perform BLS through simulation-based learning. Simulation-based training can improve their attitude and provide them with knowledge and crucial skill sets, improving their confidence in performing BLS. Furthermore, teachers’ attitudes and confidence toward CPR improved after teaching CPR.

[Learning to resuscitate at school. Study in 8-12 year-old schoolchildren]

OBJECTIVE

To quantitatively assess the learning capacity of school children aged between 8-12 years in basic life support (theory and practice) after a feasible school training programme.

MATERIAL AND METHODS

Quasi-experimental study with a convenience sample of 567 pupils in 3rd, 5th and 1st year of Primary Education, and Compulsory Secondary Education, respectively, from 3 public schools in Galicia. They received 2h (one theoretical and another practical) of basic life support training by their Physical Education teachers, as part of the school program. The children were evaluated by a theoretical test and a practical skill test that measured the quality of chest compressions, and assessed the performance of the basic life support sequence.

RESULTS

The level of knowledge increased with respect to the baseline, and was higher in the higher grades (P<.001). The complete basic life support sequence was carried out by 16.5% of pupils in the 3rd year of Primary Education, 54.4% of pupils in the 5th year of Primary Education, and 28.5% of pupils in the 1st year of Secondary Education (P=.030). The following compression quality parameters improved significantly with age: continuity of compressions (P<.001), percentage of compressions performed at correct depth (P=.002), and median depth (P<.001), while the percentage of compressions with correct decompression decreased significantly (P<.001).

CONCLUSIONS

Although their anthropometric characteristics may not allow them to achieve the ideal quality of this manoeuvre, a 2-h theoretical and practical training programme, taught by Physical Education teachers, helps to improve the ability of children younger than 13 years-old to recognise the emergency, start the chain of survival, and initiate chest compressions.

[Can we train the chain of survival while playing? Validation of the tool «Rescube»]

PURPOSE

To validate the content and adequacy of the «Rescube» training material that includes adapted information from the chain of survival.

MATERIAL AND METHODS

The study included three steps: (i)material development by 7 experts, following Delphi method; (ii)assessment of training material by 11 experts by means of a Likert score and calculation of content validity; and (iii)pilot study in two groups of 5 to 8years-old: Rescube group (GR; n=60) and Traditional group (GT; n=60). GR was trained with Rescube and a Teddy bear, while GT was traditionally trained with a pediatric manikin. Participants were individually assessed at baseline, and one week and one month after training.

RESULTS

All content validity indexes calculated are above the recommended cut-off for analysis with more than 9 experts (≥0,80). Children's learning results were positive, with percentages equal or higher than 80% in all registered variables at the first (one week) evaluation and equal or higher than 67% when evaluated one month after training. No significant differences were detected between groups.

CONCLUSION

The Rescube training tool based on infantile pictures is valid and useful to train young schoolchildren in the chain of survival.

The impact of cardiopulmonary resuscitation (CPR) training on schoolchildren and their CPR knowledge, attitudes toward CPR, and willingness to help others and to perform CPR: mixed methods research design

Background

The benefits of cardiopulmonary resuscitation training for schoolchildren are well known, but the appropriate age for introducing training is still being discussed. This is a very important issue, since out-of-hospital cardiac arrest is a major public health concern. The objective of this study was to investigate the effects of implemented cardiopulmonary resuscitation training on the knowledge of schoolchildren in the last three grades of Slovenian elementary schools and theirs willingness, attitudes, and intentions toward helping others and performing cardiopulmonary resuscitation. The experience of training instructors was also explored.

Methods

A mixed methods research design was employed, using a Separate Pre-Post Samples Design and focus groups. Research was conducted in 15 Slovenian public elementary schools offering cardiopulmonary resuscitation training. Focus groups included training instructors and developers. Data was collected with a structured questionnaire from April to June 2018 and analyzed using univariate and bivariate analyses. The three focus groups were convened in September and October 2018. Content analysis of the discussion transcriptions was conducted. The sample included 764 schoolchildren aged 12.5–14.5 years before cardiopulmonary resuscitation training and 566 schoolchildren after training. Three non-homogeneous focus groups included eight cardiopulmonary resuscitation instructors.

Results

Significant progress in cardiopulmonary resuscitation knowledge was noted after training implementation, with the greatest progress seen in the youngest age group (mean age 12.5). The greatest increase after training was seen for the variables Attitude toward helping others (p = 0.001) and Self-confidence (p = 0.001). Analysis of the focus groups yielded two themes: (a) the effects of cardiopulmonary resuscitation training on schoolchildren, and (b) the systemic responsibility of the school system and professional bodies.

Conclusions

Significant progress in schoolchildren’s cardiopulmonary resuscitation knowledge after training was established. Early introduction of training is recommended. Cardiopulmonary resuscitation knowledge raises awareness of the responsibility to help others and increases self-confidence to provide bystander cardiopulmonary resuscitation. It can be concluded that early cardiopulmonary resuscitation training for children is crucial. It should be a mandatory part of school curricula in those countries where cardiopulmonary resuscitation is not yet mandatory.

'The (second) year of first aid': a 15-month follow-up after a 3-day first aid programme

AIM

First aid education in early childhood can be an effective method to increase the number of trained bystanders. Our aim was to evaluate the long-term effects of a 3-day first aid programme for all primary school-age groups (7-14 years old).

METHODS

This study was a 15-month follow-up of our previous investigation. Five-hundred and twenty-four primary school children were involved in this study. Measurements were made on the following topics: adult basic life support, using an automated external defibrillator (AED), handling an unconscious patient, managing bleeding and calling the ambulance. Data collection was made with a self-made questionnaire and skill test.

RESULTS

Knowledge and skills were significantly higher after 15 months than before training (p<0.01). However, these results were significantly worse than immediately and 4 months after training (p<0.01). Based on the questionnaire, more than three-quarters knew the emergency phone number 15 months after training. Approximately two-thirds of the children could use the correct hand position in cardiopulmonary resuscitation, the correct compression-ventilation ratio and an AED, and half of them could perform correct recovery position at 15 months. Correct assessment of breathing was similar in a situation game than before training. Self-efficacy improved significantly after training (p<0.01) and remained improved after 4 and 15 months when compared with before training (p<0.01).

CONCLUSION

Participants could remember some aspects of first aid long term. However, knowledge and skills had declined after 15 months, so refresher training would be recommended. Self-efficacy towards first aid improved after training and remained high after 15 months.

Impact of instructor professional background and interim retesting on knowledge and self-confidence of schoolchildren after basic life support training: a cluster randomised longitudinal study

Introduction

To increase the rate of bystander resuscitation, basic life support (BLS) training for schoolchildren is now recommended on a broad level. However, debate continues about the optimal teaching methods. In this study, we investigated the effects of a 90 min BLS training on female pupils’ BLS knowledge and self-confidence and whether learning outcomes were influenced by the instructors’ professional backgrounds or test-enhanced learning.

Methods

We conducted a cluster randomised, longitudinal trial in a girls’ grammar school in Germany from 2013 to 2014. Pupils aged 10–17 years were randomised to receive BLS training conducted by either emergency physicians or medical students. Using a multiple-choice questionnaire and a Likert-type scale, BLS knowledge and self-confidence were investigated before training (t0), 1 week (t1) and 9 months after training (t2). To investigate whether test-enhanced learning influenced learning outcomes, the questionnaire was administered 6 months after the training in half of the classrooms. The data were analysed using linear mixed-effects models.

Results

The study included 460 schoolchildren. BLS knowledge (mean number of correct answers) increased from 5.86 at t0to 9.24 at t1(p<0.001) and self-confidence (mean score on the Likert-type scale) increased from 8.70 at t0to 11.29 at t1(p<0.001). After 9 months, knowledge retention was good (8.94 at t2; p=0.080 vs t1), but self-confidence significantly declined from t1to 9.73 at t2(p<0.001). Pupils trained by medical students showed a slight but statistically significant greater increase in the knowledge at both t1and t2, whereas instructors’ background did not influence gain or retention of self-confidence. Retesting resulted in a marginally, non-significantly better retention of knowledge.

Conclusions

BLS training led to short-term gains in knowledge and self-confidence. Although knowledge was retained at 9 months after the training session, self-confidence significantly decreased. Interim testing did not appear to impact retention of knowledge or self-confidence. Medical students should be considered as instructors for these courses given their favourable learning outcomes and greater availability.