Simulation and educationInnovative cardiopulmonary resuscitation and automated external defibrillator programs in schools: Results from the Student Program for Olympic Resuscitation Training in Schools (SPORTS) study☆
Introduction
Cardiac arrest is the third leading cause of death in the United States (US), responsible for over 395,000 out of hospital cardiac arrests (OHCA)/year.1, 2 Pediatric cardiac arrests comprise 2–3% of all cardiac arrests in the US.2, 3 The survival rate to hospital discharge for adults who experience an OHCA is 5.5–11%2, 4 and for children is 7.9%.2 Bystander cardiopulmonary resuscitation (CPR) rates are low in most communities averaging 15–30% prior to emergency medical services (EMS) arrival.5, 6
In recent years, additional attention has been focused on automated external defibrillator (AED) placement and education in schools.7, 8, 9, 10 The American Heart Association specifically recommends that AED training and skills practice should be included in school CPR training.10 When resuscitation efforts occur, high rates of bystander CPR (up to 94%), shock with an AED (up to 83%) and survival to hospital discharge (up to 64–74%) have been reported in schools.9
Instruction in practical hands-on skills results in greater improvement in performance skills than theoretical knowledge alone. In Norway, training 50,000 school children led to an increase in bystander CPR from 60% to 73%.11 Students with training are more willing to perform CPR.11 Currently, 31 states in the US mandate CPR education in the high school.12
In 2011–2012 Youth Heart Watch (YHW) at The Children's Hospital of Philadelphia (CHOP) initiated a research study of CPR/AED education in the Philadelphia School District (PSD), the Student Program for Olympic Resuscitation Training in Schools (SPORTS). Our research study focused on helping students within 15 Philadelphia high schools develop innovative ways to learn and retain lifesaving CPR and AED skills within their high school health class curriculum. Our rationale was that high school students thrive on competition and group activities. We hypothesized that empowered students who assumed leadership roles in developing the CPR/AED curriculum would enhance their own learning.
Section snippets
Methods
This study was an IRB approved (10-007748) prospective trial in a high school classroom using an intervention, only in the Study Class, to develop novel CPR and AED education programs. The Study Class presented their programs at a CPR/AED Olympic Day and competed against other Philadelphia High Schools.
Study setting
The School District of Philadelphia, by enrollment, is the eighth largest school district in the nation, serving a racially and ethnically diverse student population. As of December 6, 2012, African-Americans made up 54.5% of those enrolled; Asian/Pacific Islanders, 7.8%; Caucasian/Euro-Americans, 14.3%; Hispanics/Latinos/as, 18.6%; Native Americans, 0.2%; and Multiracial/Others, 4.6%. During the testing year, the PSD served an enrollment of 149,535 students.
Study population
Schools were selected on a first come first served basis from volunteers solicited by the PSD Physical and Health Education Department. Students became eligible when health teachers, who taught CPR/AED instruction, agreed to participate in our SPORTS study. Those eligible Health Class students assented to participate in an education, training, and assessment program and, only for the Study Class, the CPR/AED Olympics. Testing and enrollment began in February 2011 and was completed in May 2012
Detailed study methods and study flow
The study included 15 high schools in the PSD. From each school, two Health classes were selected, one Study Class and one Control Class. The study flow is shown in Fig. 1.
The Control Class received the usual Health Education class CPR program at their school, was tested in the same manner as the Study Class, but did not participate in the CPR/AED Olympics. The Study Class received the usual Health Education class instruction but were asked to develop innovative programs to teach other high
Study population
The study population for analysis consisted of 412 participants who completed all testing, aged 15.9 ± 1.3 years, female (63.6%), grade level 10.2 ± 1.0 (Table 1). No significant differences between the Control and Study Classes were found. The study population for analysis was lower than expected due to a 25% daily absenteeism rate. Comparison of post testing between those schools with (6) and those without Retention testing (7) showed only minor differences with the exception of better
Discussion
Barriers to CPR training in schools have been noted to include lack of trained instructors, lack of time in the school curriculum, and lack of funding.13 Students note that their willingness to use CPR or AED skills is related to concerns about lack of knowledge and to their fear of imperfect performance.10, 14 School-based interventions reach all races and ethnicities regardless of socioeconomic status and have the potential to decrease disparities in the delivery of bystander CPR and use of
Conclusions
Students who developed creative and novel methods of teaching and learning resuscitation skills showed outstanding application of these skills in a Mock Code. Harnessing adolescent characteristics of teamwork, competitiveness, and creativity produced novel and effective methods of teaching resuscitation skills, potentially empowering a new generation of effectively trained CPR bystanders.
An effort to educate the young citizens in our communities and provide them with the self-efficacy to act in
Conflict of interest statement
None declared.
Financial support/grant/research support
American Heart Association/Laerdal Foundation Grant Award: SPORTS (Student Program for Olympic Resuscitation Training in Schools); Institutional support from CHOP for CPR/AED Olympic event.
Acknowledgments
We would like to acknowledge all of the volunteers from The Children's Hospital of Philadelphia, the University of Pennsylvania and other groups who assisted with the CPR/AED Olympics and without whose participation this study could not have been completed. Special thanks to Drs. Vinay Nadkarni of CHOP and Lance Becker of the Center for Resuscitation Science at the University of Pennsylvania for their support and assistance with this study and to CHOP Office Government Affairs, Community
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2022, European Journal of Medical Research
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2016.04.010.
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Current affiliation: Nemours Children's Health System, United States.