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Half-Hour CPR Courses: When Less Is Better

Although basic cardiopulmonary resuscitation (CPR) has been definitively shown to save lives, particularly in witnessed cases of ventricular fibrillation (VF) and childhood drowning events, its frequency remains low in most venues. In turn, this has limited survival chances for potentially salvageable patients, even in matured, rapidly responding EMS systems.

One major contributing factor is that widespread CPR training often requires a focus on captured audiences. Studies have shown that, although most people think that learning to perform CPR is very important, getting them to the classroom to do so has been a very tough task overall. Exceptions have been communities that have health care as a major industry or those that have required CPR training in the school systems.

One other option is to require CPR (or make it easily available) in the workplace. Most employers would tend to think that this is a very good thing. Moreover, it s something nice to do for the workforce because it could be seen as benefiting the employees families as well. The difficulty, however, is clearing the time for a productive workforce and also encumbering enough trainers to train perhaps hundreds or even thousands of workers. Given that the traditional three- to four-hour class requires an entire morning or afternoon off for the workforce and that the traditional training requires a ratio of one instructor to five or six trainees, the logistical obstacles become enormous. These issues don t even address the expense considerations, including training equipment, instructor and/or location fees, and creature-comfort concerns, such as refreshments.

Even where s there has been well-entrenched CPR training in schools, ever-busier school curricula and new requirements compete more and more for time and instructors, let alone the fiscal concerns.

If only CPR courses could be taught on a lunch break and require only one instructor for 50 people.

Well, in fact, they can be.

CPR, choking & AED training in < 30 minutes

Using adult learning principles and video technology, CPR training researchers, working in concert with the American Heart Association (AHA) and the Laerdal Corp., recently developed a 20-minute CPR course, called CPR Anytime for Family and Friends. In a subsequent research effort, it was demonstrated that adults could indeed be taught CPR in a video-based training session within 20 minutes and subsequently perform CPR as well as those just taught via a three- to four-hour traditional course. In the session, a facilitator simply instructs each of the participants to open the provided box containing a small, inflatable manikin, and then the facilitator plays a video for the group. What that means is that the training no longer has to be so labor intensive in terms of instructors.

After the quick, guided set-up, the 40 or 50 students in the room simply follow along with the video, first learning compressions, then mouth-to-mouth and then integrating the two steps at a 30:2 compressions-to-breaths ratio. Then they practice some more, and then continue to practice even further. In fact, they do more hands-on practice than trainees in traditional courses. The facilitator simply stands by to answer any questions and ensure the protocol is followed.

At this past year s annual AHA meeting, Roppolo, Idris, et al, presented the results of an elegant study that they conducted using several hundred subjects from the American Airlines headquarters in Dallas. In this study, they compared the traditional CPR course with an updated version of the 20-minute course that now also added in choking and AED training (each only five minutes in duration).

This CCD-30 (CPR, choking and defibrillation in 30 minutes) course proved to not only be just as successful in terms of measured performance, but the results were the same when student skills were measured six months later, thus demonstrating excellent retention as well. The investigators actually showed that AED use was superior using the five minutes that it took to train the participants compared with the much longer traditional AED courses!

Long-term implications

The implications here are dramatic. If my boss wants to host a lunch and supply the inflatable manikins to everyone (available at www.cpranytime.org), the employees come back from their half-hour break having learned how to save a life. They also get to take the training boxes home so that they can now be the facilitators for their family and friends.

In addition, re-training can take place even more frequently, given the fact that it takes such a short period of time and little resources in terms of instructors and materials. You could see such sessions at churches, civic group and mass CPR sessions anywhere you can get a big video screen and sound system. The long-term results will likely be more people in a given community trained in the latest techniques, and we know that likely will translate into more lives being saved in the coming decades.

Once again, it follows one of my own old adages: Sometimes, less is better.

A key coordinator of the "Eagles" coalition, Dr. Paul Pepe, is a Professor of Medicine, Surgery, Public Health and Chair of Emergency Medicine at the University of Texas Southwestern Medical Center and Parkland Hospital Emergency-Trauma Center in Dallas. He is also the City of Dallas Director of Medical Emergency Services for public safety, public health and homeland security as well as the jurisdictional medical director for the regional EMS system. A distinguished academician (with some 500 published scientific papers/abstracts), Dr. Pepe's credits include the original American Heart Association "Chain of Survival" paper and a host of ground-breaking clinical trials in the EMS setting. Serving as assistant to the medical directors of the Seattle Fire Department EMS in the 1970-80's, he subsequently was appointed the first physician Director of the City of Houston EMS System (1982-96) and later as Commonwealth Emergency Medical Director for Pennsylvania until his recruitment to Dallas in 2000. A winner of numerous international/national awards and honors, he has also served as emergency medicine-trauma consultant to the White House Medical Unit, U.S. Secret Service, FBI, U.S. DHHS, NIH and several network news organizations.

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