Carolyn Lester

The need for wider dissemination of CPR skills: are schools the answer?

The value of instructing members of the public in CPR is now widely recognised, but community training schemes which rely largely on volunteers may fail to reach their targets. CPR training for lay people is often a once only activity and it has been shown that, without revision, skills deteriorate rapidly. By teaching CPR in secondary schools all social classes and ethnic groups could be reached, and retention of skills improved by regular revision. Health education has shown that it may be beneficial to use older pupils as instruction assistants.

Effectiveness of the BBC's 999 training roadshows on cardiopulmonary resuscitation: video performance of cohort of unforewarned participants at home six months afterwards

Abstract Objective: To examine the competence of a cohort trained in cardiopulmonary resuscitation by the BBCs 999 training roadshows. Design: Descriptive cohort study applying an innovative testing procedure to a nationwide systematic sample. The test sample received an unsolicited home visit and without warning were required to perform cardiopulmonary resuscitation on a manikin while being videoed. The videos were then analysed for effectiveness and safety using the new test. Setting: Nine cities and surrounding areas in the United Kingdom. Subjects: 280 people aged between 11 and 72. Results: Thirty three (12%) trainees were able to perform effective cardiopulmonary resuscitation, but of these 14 (5%) performed one or more elements in a way that was deemed to be potentially injurious. Thus only 19 (7%) trainees were able at six months to provide safe cardiopulmonary resuscitation. In addition, large numbers of subjects failed to shout for help, effectively assess the status of the patient, or alert an ambulance. Significantly better performances were recorded by those under 45 years old (31 (14%) v 2 (4%) gave effective performances respectively, P<0.05), those who had attended a subsequent cardiopulmonary resuscitation course (8 (40%) v 25 (10%) gave effective performances respectively, P<0.0001), and those confident in their initial ability (26 (20%) v 7 (6%) gave effective performances respectively, P<0.005). Females were significantly less likely than males to perform procedures in a harmful way (117 (62%) v 10 (12%) performed safely respectively, P<0.005). Conclusion: Television is an effective means of generating large training cohorts. Volunteers will cooperate with unsolicited testing in their home, such testing being a realistic simulation of the stress and lack of forewarning that would surround a real event. Under such conditions the performance of cardiopulmonary resuscitation was disappointing. However, retraining greatly improves performance. Key messages Training for the lay public in cardiopulmonary resuscitation has increased with such initiatives as BBC televisions 999 national roadshows, but the effectiveness of this training has not been rigorously evaluated In this study 280 people who had attended a roadshow were tested, unforewarned, six months later in their home, their management of a simulated case of cardiac arrest being videotaped for later analysis Only 12% of subjects performed cardiopulmo- nary resuscitation effectively As well as performing cardiopulmonary resusci- tation ineffectively, 39% of subjects performed one or more procedures in a way that could complicate the recovery of a casualty Although the 999 roadshows undoubtedly recruit many lay people, attention should now be given to retraining strategies

TEACHING SCHOOLCHILDREN CARDIOPULMONARY RESUSCITATION

Forty-one children aged 11-12 years received tuition in cardiopulmonary resuscitation (CPR) and subsequently completed questionnaires to assess their theoretical knowledge and attitudes their likelihood of performing CPR. Although most children scored well on theoretical knowledge, this did not correlate with an assessment of practical ability using training manikins. In particular only one child correctly called for help after the casualty was found to be unresponsive, and none telephoned for an ambulance before starting resuscitation. These omissions have important implications for the teaching of CPR and the resulting effectiveness of community CPR programmes.

Lay CPR trainees: retraining, confidence and willingness to attempt resuscitation 4 years after training

Two independent samples of 800 lay CPR trainees from an original cohort of 7584 were surveyed postally 4 years after training. Only 2% of respondents had used CPR, but 92 had used other aspects of their life support training. Those who had retrained were more confident than those who had not and 89% of those who had not retrained were willing to do so. More than 80% expressed willingness to perform full CPR on casualties who were unknown to them, but this fell to 40% where facial blood was present and 48% where the victim was a gay man.

Evaluating CPR performance in basic life support: the VIDRAP protocol

This paper presents the second part of the validated Cardiff test for one rescuer basic life support skills, based on observation of video recording combined with the Recording Resusci Anne printout (VIDRAP). The authors believe that this is a robust evaluation tool which is capable of assessing the potential value to a casualty of a simulated resuscitation. The adoption of a widely accepted test methodology would facilitate comparison of research in different centres, which is not possible at present.

Assessing with CARE: An innovative method of testing the approach and casualty assessment components of basic life support, using video recording

The resuscitation community is now moving towards a set of basic life support guidelines but different countries and training centres have their own individual methods of instruction. It would be advantageous if a universal testing method were available to facilitate intercentre comparison. This could lead to an international course which had been rigorously assessed and evaluated. Taking this as a starting point, the Cardiff Assessment of Response and Evaluation (CARE) was developed. CARE is an innovative assessment technique using video recording for testing the preliminary steps of life support as outlined by the European Resuscitation Council. The assessment was validated by testing 67 members of the public who had been trained in cardiopulmonary resuscitation, 27 shortly after instruction and 40 between 6 and 18 months after instruction. All subjects were tested without prior warning and video recorded for independent scoring by two researchers and a paramedic training officer. Scores were compared using the k correlation which showed a high level of agreement between observers. Video recording and marking using the CARE schedule and guidelines is a reliable method for assessing the preliminary steps in life support.

Unplanned pregnancies at antenatal clinic

Abstract Between May and June 1986 a case control study of late and early attenders at antenatal clinic took place in two South Wales hospitals, one urban and one rural. The study examined the social and attitudinal characteristics of 115 late attenders (18 weeks or later) and a similar number of age matched early attenders (15 weeks or earlier). It was found that 52% of study pregnancies were unplanned with a significantly greater proportion in late attenders at the urban hospital but similar proportions in late and early attenders at the rural hospital. The proportion of unplanned pregnancies was greater in manual workers compared with non manual workers when measured by the respondents most frequent paid employment at both hospitals and greater in manual partners at the urban hospital. Unplanned pregnancy was more common in women with unemployed partners at the rural hospital. Of those with an unplanned pregnancy 79% had used no contraception or had used their chosen method inconsistently with no significant difference between late and early attenders in the proportions using contraception or in the method used.