Teaching public access defibrillation to lay volunteers—a professional health care provider is not a more effective instructor than a trained lay person

Abstract

Survival improves in witnessed out-of-hospital cardiac arrest if the victim receives bystander-initiated cardiopulmonary resuscitation and rapid defibrillation (BLS/AED). The European Resuscitation Council has a simple programme to teach these life-saving skills that require no previous experience of automated external defibrillators (AEDs). To be able to implement the use of AEDs widely, many instructors are needed, and therefore, lay persons may also be used as trainers. The purpose of this randomized study was to compare lay volunteers trained by a lay person with those trained by a health care professional using the Objective Structured Clinical Examination (OSCE). Eight instructors, including four lay persons and four health care professionals, were given a basic course and an instructor course in CPR-D by the same instructor. All newly trained instructors trained 38 lay volunteers (19 pairs) who had no previous training in the use of a defibrillator. The lay volunteers performed the OSCE 2-3 weeks after the course. The OSCE comprised two scenarios with a manikin: the first, a patient in cardiac arrest with ventricular fibrillation, and the second, an imminent cardiac arrest with asystole as the initial rhythm. The same OSCE was performed by a group of lay first aiders practicing every 2 weeks who served as the control group. No statistical difference was present between the two groups of lay volunteers in the OSCE. All were able to use the AED and follow instructions. They identified patients with ventricular fibrillation and cardiac arrest, but had difficulties identifying cases with imminent cardiac arrest. The control group of trained first aiders performed significantly more effectively than the newly trained lay persons. No significant benefit exists in the trainer being a health care professional, but thorough training and subsequent rehearsing of the skills learned are crucial.