Elsevier

Resuscitation

Volume 104, July 2016, Pages 46-52
Resuscitation

Simulation and education
Innovative cardiopulmonary resuscitation and automated external defibrillator programs in schools: Results from the Student Program for Olympic Resuscitation Training in Schools (SPORTS) study

https://doi.org/10.1016/j.resuscitation.2016.04.010Get rights and content

Abstract

Background

Bystander cardiopulmonary resuscitation (CPR) rates are low. Our study objective was to encourage Philadelphia high school students to develop CPR/AED (automated external defibrillator) training programs and to assess their efficacy. The focus was on developing innovative ways to learn the skills of CPR/AED use, increasing willingness to respond in an emergency, and retention of effective psychomotor resuscitation skills.

Methods and results

Health education classes in 15 Philadelphia School District high schools were selected, with one Control and one Study Class per school. Both completed CPR/AED pre- and post-tests to assess cognitive knowledge and psychomotor skills. After pre-tests, both were taught CPR skills and AED use by their health teacher. Study Classes developed innovative programs to learn, teach, and retain CPR/AED skills. The study culminated with Study Classes competing in multiple CPR/AED skills events at the CPR/AED Olympic event. Outcomes included post-tests, Mock Code, and presentation scores. All students’ cognitive and psychomotor skills improved with standard classroom education (p < 0.001). Competition with other schools at the CPR/AED Olympics and the development of their own student-directed education programs resulted in remarkable retention of psychomotor skill scores in the Study Class (88%) vs the Control Class (79%) (p < 0.001). Olympic participants averaged 93.1% on the Mock Code with 10 of 12 schools ≥94%.

Conclusion

Students who developed creative and novel methods of teaching and learning resuscitation skills showed outstanding application of these skills in a Mock Code with remarkable psychomotor skill retention, potentially empowering a new generation of effectively trained CPR bystanders.

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

References (25)

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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.

d

Current affiliation: Nemours Children's Health System, United States.

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