Elsevier

Resuscitation

Volume 60, Issue 1, January 2004, Pages 17-28
Resuscitation

Skill acquisition and retention in automated external defibrillator (AED) use and CPR by lay responders: a prospective study

https://doi.org/10.1016/j.resuscitation.2003.09.006Get rights and content

Abstract

This prospective study evaluated the acquisition and retention of skills in cardio-pulmonary resuscitation (CPR) and the use of the automated external defibrillator (AED) by lay volunteers involved in the Department of Health, England National Defibrillator Programme. One hundred and twelve trainees were tested immediately before and after an initial 4-h class; 76 were similarly reassessed at refresher training 6 months later. A standardised test scenario that required assessment of the casualty, CPR and the use of an AED was evaluated using recording manikin data and video recordings. Before training only 44% of subjects delivered a shock. Afterwards, all did so and the average delay to first shock was reduced by 57 s. All trainees placed the defibrillator electrodes in an ‘acceptable’ position after training, but very few did so in the recommended ‘ideal’ position. After refresher training 80% of subjects used the correct sequence for CPR and shock delivery, yet a third failed to perform adequate safety checks before all shocks. The trainees self-assessed AED competence score was 86 (scale 0–100) after the initial class and their confidence that they would act in a real emergency was rated at a similar level. Initial training improved performance of all CPR skills, although all except compression rate had deteriorated after 6 months. The proportion of subjects able to correctly perform most CPR skills was higher following refresher training than after the initial class. Although this course was judged to be effective in teaching delivery of counter-shocks, the need was identified for more emphasis on positioning of electrodes, pre-shock safety checks, airway opening, ventilation volume, checking for signs of a circulation, hand positioning, and depth and rate of chest compressions.

Sumàrio

Este estudo prospectivo avaliou a aquisição e retenção de capacidade em ressuscitação cardiopulmonar (CPR) e no uso de desfrilhador automático externo (AED) por reanimadores leigos envolvidos no Departamento de Saúde do England National Defrillator Programme. Foram testados 112 candidatos imediatamente antes e após um aula inicial de 4 horas; 76 foram igualmente reavaliados em treino repetido 6 meses depois. Foi avaliado o desempenho num cenário de teste normalizado que requeria avaliação da vı́tima, CPR e utilização de um AED, através de informação gravada pelos manequins e gravação vı́deo. Antes do treino apenas 44% dos candidatos efectuaram um choque. Após o treino todos o fizeram e o tempo médio para o 1° choque foi reduzido em 57 segundos. Todos os candidatos colocaram os eléctrodos do desfrilhador numa posição “aceitável” após o treino mas muito poucos o fizeram na posição “ideal” recomendada. Após treino repetido 80% dos candidatos usaram a sequência correcta para CPR e aplicação do choque, no entanto 1/3 falhou na verificação adequada da segurança antes de todos os choques. O score de competência em AED por auto-avaliação dos candidatos foi 86 (escala 0–100) após a aula inicial e a sua confiança de que actuariam numa emergência real foi avaliada num nı́vel similar. O treino inicial melhorou a performance de todas as capacidades para CPR, embora todas tenham deteriorado após 6 meses, excepto a frequência das compressões. A avaliação da proporção de candidatos capazes de realizar correctamente a maioria das competências para CPR foi maior após o treino repetido do que após a aula inicial. Embora este curso tenha sido avaliado como eficaz no ensino da administração dos choques, foi identificada a necessidade de maior ênfase no posicionamento dos eléctrodos, nas avaliações de segurança pré-choque, na permeabilização da via aérea, no volume de ventilação, na avaliação dos sinais de circulação, no posicionamento das mãos, na profundidade e na frequência das compressões torácicas.

Resumen

Este estudio prospectivo evaluó la adquisición y retención de destrezas en reanimación cardiopulmonar (CPR) y el uso de desfibriladores automáticos externos (AED) por voluntarios legos involucrados en el departamento de salud, en el Programa Nacional de Desfibrilación de Inglaterra. Ciento once alumnos fueron examinados inmediatamente antes y después de una clase inicial de 4 hrs; 76 fueron reevaluados de forma similar durante un curso de reentrenamiento seis meses después. Se evaluó un escenario estandarizado que requerı́a evaluación de la vı́ctima, CPR y el uso de un AED usando datos del registro de un maniquı́ y registros en cintas de video. Antes del entrenamiento solamente 44% de los sujetos entregaron una descarga. Después, todos lo hicieron y la demora promedio a la primera descarga fue reducida en 57 s. Todos los alumnos ubicaron los electrodos de desfibrilación en una posición ’aceptable’ después del entrenamiento, pero muy pocos lo hicieron en la posición ’ideal’ recomendada. Después del reentrenamiento el 80% de los sujetos usaron la secuencia correcta de CPR y entrega de descarga eléctrica, pero aún un tercio fracasó en garantizar seguridad antes de todas las descargas entregadas. Los alumnos se evaluaron a si mismos en competencia en uso del AED con un puntaje de 86 (escala de 0–100) después de la clase inicial y su confianza de que actuarı́an bien en una emergencia real fue evaluada en un nivel similar. El entrenamiento inicial mejoró el desempeño de todas las destrezas de CPR, aunque todas, salvo la frecuencia de compresiones, se deterioraron después de 6 meses. La proporción de sujetos capaces de realizar correctamente la mayorı́a de las destrezas de CPR evaluadas fue mayor después de el curso de reentrenamiento que después de la clase inicial. Aunque este curso fue juzgado como efectivo en la enseñanza de entrega de descargas eléctricas, se identificó la necesidad de mayor énfasis en el posicionamiento de los electrodos, las evaluaciones de seguridad antes de entregar las descargas, apertura de vı́a aérea, volumen ventilatorio, evaluación de signos de circulación, posición de las manos, y profundidad y frecuencia de las compresiones torácicas.

Introduction

The use of automated external defibrillators (AEDs) in community programmes is becoming widespread [1], [2], [3], [4], [5]. However, few reports have been published on the effectiveness of training programmes for lay persons using AEDs, and no general agreement has been reached on the optimum intervals for refresher training. In accordance with government policy [6], the Department of Health in England has placed AEDs in busy public places such as airports and railway stations [7]. We were commissioned to assess the effectiveness of a 4-h training course in basic life support and AED use, the subsequent degree of skill decay after 6 months, and the value of refresher training at that time. Our findings have implications for all training programmes for responders who are not health care professionals but who may be deployed to a cardiac arrest to use an AED and provide cardio-pulmonary resuscitation (CPR).

Section snippets

Subjects

Airport employees aged 18 years or over who volunteered to take part in the Department of Health, England National Defibrillator Programme. Demographics are reported in Table 1.

Test scenario

Before initial training, participants were asked to manage a standardised manikin simulation of a cardiac arrest. During the assessment, an AED was available but no prompt or other encouragement to use it was given. The scenario used had previously been tested in a pilot study with three groups of five participants.

Demographics

Of the 132 subjects approached to participate in the research, 112 completed both pre- and post-initial training assessments. Seventy-six subsequently undertook refresher training and completed further assessments both before and after this class. Demographic data are reported in Table 1.

The dropout rate of subjects between the initial and refresher classes was considerable despite attempts to encourage all trainees to attend both sessions using letters and telephone contact. There were no

Discussion

Automated external defibrillators have been available for over 20 years [15], but only recently has their true potential begun to be realised. AEDs have made early defibrillation more generally available within the community [16], [17], [18], and in England the Department of Health has placed nearly 700 in busy public places and arranged training for lay employees working at the site who are most likely to be in a position to use them. There have been few reports about the effectiveness of

Acknowledgements

The authors gratefully acknowledge Jeremy Johnstone, Ian Jones, and David Morris, seconded from the Welsh Ambulance Service NHS Trust as Research Assistants, for their help with the assessments, and George Murphy who made these staff available. Bristol International Airport accommodated the needs of the study specifically, and Symon Clifford and Ivor Valentine of the Airport Fire Service co-ordinated the training courses and trainee availability. We are particularly grateful to Sian Davies from

References (39)

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