Whether you run a cardiac arrest call once a week or once a year, training is a key component of high-performance CPR. In its High-Performance CPR Toolkit, the Resuscitation Academy recommends regular, hands-on training: “Training responders on the key principals of HP CPR on a regular basis will keep skills sharp and lead to more successful resuscitation attempts. Yearly evaluations, bi-annual and monthly trainings and timely training updates are effective in making sure staff is ready for the next call.”
But are most providers getting the needed training? We asked our Facebook fans, “What kind of training (and how often) does your agency provide to measure and improve your CPR skills?”
The most common response was that providers train on CPR more than once a year, although almost the same number of respondents indicated that they train only every two years. Several respondents indicated that they need more training, including John. S., who noted, “Not enough, and now that I'm actually here in Seattle at their Resuscitation Academy it's obvious we ALL need to do more.”
But some agencies are doing great. Harold W. trains on CPR every three months. “We have the best CPR protocols I have seen in 18 years and have done great this year, with a 40% increase in saves and walk out of the hospital,” he writes. “We follow a strict team approach, switching every 2 minutes, and focus just on CPR until more help arrives. We treat the patient there and don't transport unless we get ROSC. If we can't get them back after 45 minutes we are allowed to stop. We can do just about everything the ER can do.”
For those whose training is limited to every two years, it’s important that the training be as thorough as possible. Barb I. notes that her agency provides the training around the two-year recertification, and that it’s a “full evening of training, video and hands-on evaluation by certified instructors.”
The Resuscitation Academy recommends scenario-based training: “The most effective form is a hands-on approach. Understanding what 100 compressions/minute feels like and being in the middle of a well-choreographed resuscitation will give responders a better understanding of the different roles people play and how all of these different roles fit together.” Beverly K. notes that her organization has mock codes through the facility at least once a month. Of course, there’s nothing like real experience to serve as an instructor—“Seems like every shift I work I get a refresher,” says Matt R.
Technology is also an important part of the training process. Devices that measure CPR in real-time have been available for several years now and are starting to see widespread adoption. “We get data from the pads as it's occurring, so we can modify tempo/depth, etc.,” says Alyssa W. Such immediate feedback is a form of training in itself, and the data can also be used for quality assurance/quality improvement purposes. Kent M. says his organization provides the crew with “feedback after every call, extracted from the defib recorder. The data is mostly used for keeping hands-on time around 90–95%”
In a related poll, 41% of respondents indicated that the biggest benefit of CPR feedback devices is to ensure adherence to the AHA Guidelines during real-time CPR, while 12% said it was best used for initial training and another 12% said it was most beneficial for re-training; 35% said it was best used for QI/QA purposes.
Another technological advancement that can play an important role in improving CPR quality is mechanical CPR. Two Facebook respondents noted that their organizations use mechanical CPR. “So the quality isn't an issue,” says Les L. “We just refine our team-based approach.”
Unfortunately, some agencies don’t provide personnel with the needed training time. “I can't remember the last refresher course I did for anything,” says Andrew H. “Training days stopped ‘due to increase in call rate’ a few years ago and haven’t been reinstated yet! Everything is done on your own time.”
If you’re in a similar situation, look for opportunities to practice on your own. “I'm a CPR instructor, and more and more I view every class as an opportunity to reinforce a point to myself as well,” says Alyssa W. “I encourage the students to critique what I'm doing in the same way that I critique them. (I've met a couple of paramedics who are perfect, but I am not.) If I don't teach or run a full arrest, I practice 30 minutes, once a week, randomized adult or child. I have the manikins and equipment. Therefore, I have no excuse.”
You may not be a CPR instructor with access to all the equipment, but with a little ingenuity it’s not difficult to set up a quick training session.
So what is the best kind of CPR training? Jason K. takes the award for simplicity: “Hands on, and a lot.”