Basic Life Support Skills Research Articles

Comparison of two training programmes on paramedic-delivered CPR performance

ObjectiveTo compare CPR performance in two groups of paramedics who received CPR training from two different CPR training programmes.MethodsConducted in June 2014 at the Hamad Medical Corporation Ambulance Service, the...

Basic life support knowledge of first-year university students from Brazil

We aimed to evaluate knowledge of first aid among new undergraduates and whether it is affected by their chosen course. A questionnaire was developed to assess knowledge of how to activate the Mobile Emergency Attendance Service - MEAS (Serviço de Atendimento Móvel de Urgência; SAMU), recognize a pre-hospital emergency situation and the first aid required for cardiac arrest. The students were also asked about enrolling in a first aid course. Responses were received from 1038 of 1365 (76.04%) new undergraduates. The questionnaires were completed in a 2-week period 1 month after the beginning of classes. Of the 1038 respondents (59.5% studying biological sciences, 11.6% physical sciences, and 28.6% humanities), 58.5% knew how to activate the MEAS/SAMU (54.3% non-biological vs 61.4% biological, P=0.02), with an odds ratio (OR)=1.39 (95%CI=1.07-1.81) regardless of age, sex, origin, having a previous degree or having a relative with cardiac disease. The majority could distinguish emergency from non-emergency situations. When faced with a possible cardiac arrest, 17.7% of the students would perform chest compressions (15.5% non-biological vs 19.1% biological first-year university students, P=0.16) and 65.2% would enroll in a first aid course (51.1% non-biological vs 74.7% biological, P<0.01), with an OR=2.61 (95%CI=1.98-3.44) adjusted for the same confounders. Even though a high percentage of the students recognized emergency situations, a significant proportion did not know the MEAS/SAMU number and only a minority had sufficient basic life support skills to help with cardiac arrest. A significant proportion would not enroll in a first aid course. Biological first-year university students were more prone to enroll in a basic life support course.

Comparison of two feedback devices for training Basic Life Support Skills

Comparison of two feedback devices for training Basic Life Support Skills

Awareness of basic life support (BLS) among Dental interns and Dental practitioners

AbstractIt is important that every member of the community be trained in effective BLS technique to save lives. At least doctors including medical, dental and paramedical staff should be trained in CPR, as it is a basic medical skill which can save many lives if implemented timely. Aim: To assess the awareness of Basic Life Support (BLS) among dental interns and dental practitioners in Mangalore, Karnataka, India. Material and Methods: This cross-sectional study was conducted during November-December 2014 among dental interns and dental practitioners. This study was conducted by assessing response to twenty selected multiple choice questions pertaining to BLS among dental interns and dental practitioners. The results are present in the form of frequency and percentages. Statistical Analysis:The data was collected and analyzed using software Statistical Package for Social Sciences (SPSS) version 12.0. Result: In this study one hundred and twenty five responders were included them, 70(56%) were interns (Bachelor in dental surgery) and remaining 55(44%) were dental practitioners. Surprisingly none out of one hundred and twenty five had the complete knowledge of BLS. Looking closely at the individual groups dental practitioners scored 61.5%, as being aware with the BLS knowledge and skills but needs to be updated with change in protocols done by American Heart Association after every time period and sadly dental interns score 41.2% which shows that BLS course should be considered for inclusion in the Bachelor in dental surgery curriculum Conclusions: This study suggests that dental interns and dental practitioners may not be adequately prepared in the management of medical emergencies and should improve the knowledge and skills regarding BLS.

Brief Bedside Refresher Training to Practice Cardiopulmonary Resuscitation Skills in the Ambulatory Surgery Center Setting.

Cardiac arrest can occur in any health care setting at any time, requiring nursing staff to be prepared to quickly and adequately perform basic cardiopulmonary resuscitation (CPR). Currently, the American Heart Association certifies health care providers in Basic Life Support (BLS) for a 2-year period, but evidence indicates that psychomotor skills decline well before the end of the certification time frame. Nurses in the ambulatory surgery setting expressed concern regarding their ability to implement CPR successfully, given the infrequent occurrence of cardiac and respiratory arrests. Using a study by Niles et al. as a model, the authors piloted the implementation of brief CPR refresher training at the bedside of an ambulatory surgery center to assess and increase nurse confidence in BLS skills.

Peer education for BLS-training in schools? Results of a randomized-controlled, noninferiority trial

BackgroundThe rate of bystanders who provide cardiopulmonary resuscitation (CPR) is low in Germany. To increase the bystander CPR rates of lay-rescuers in Germany, the national “einlebenretten” (“save one life”) campaign was initiated, and the introduction of CPR-training for all seventh-grade students was recommended. To meet the requirement of offering effective and low-cost mass-training to lay-rescuers, we adopted peer education for the basic life support (BLS) training of the students. MethodsWe used an experimental, prospective, randomized, controlled, and open-label noninferiority trial to test whether the hands-on BLS training of the students that was provided by peers was inferior to the training by professional instructors using a predefined noninferiority margin of 5%. The students from eight different schools were trained in one 45min practice session to perform BLS based on the educational framework provided by “einlebenretten”. The students were randomly assigned to be trained either by peer-instructors (students in the same school who had been instructed in advance) or by professional instructors. In a structured practical assessment, the eight essential skills of BLS were tested and the examination was scored as either pass or fail. ResultsThe study included 1087 students 14–18 years of age. The performance in the assessment was similar between the two groups: 40.3% (n=471) of the students in the peer-led group and 41.0% (n=466) in the professional-led group passed the examination. ConclusionThe students who were trained by peer-instructors showed comparable skills in BLS to the students who were trained by professional instructors. The sample size was too small to demonstrate the noninferiority of the peer-led training.

乳児心肺蘇生シミュレーション実習にて習得した技能の経時的変化(The changes in CPR skills with time learned in an infantile simulation–based resuscitation training)

【背景】小児科医が蘇生事象に立ち会う頻度は低く，対応し得る技能の習得にはoff–the–job trainingが必要である。しかし，習得方法や再履修の時期は明らかではない。【目的】シミュレーション実習で習得した技能の経時的変化を評価し，技能維持に必要な再履修を考慮した効果的な蘇生教育プログラムを立案する。【対象】国立成育医療研究センター 2009年度新規採用レジデント18名（集中治療科6名および総合診療部12名）を対象とした。【方法】乳児心停止例を想定した4か月間のシミュレーション実習を施行した。対象者は，1か月に1度以上の頻度で実習に参加し，中央値2±0回のチームリーダー役を担当した。習得した技能の定量評価として，乳児の心室細動を想定した実技試験でBLSおよびALSの各手技実施までの時間を計測し，実習前・実習直後・実習終了後から4か月・8か月での変化を検討した。【結果】BLS手技の人工呼吸と胸骨圧迫は実習前後で，それぞれ51→31秒（中央値），65→38秒（同）に有意に改善した（p<0.05）。しかし，実習終了後から4か月以降には60秒以内に実施できない者がいた。ALS手技の除細動の完了時間は，実習直後の160秒（中央値），その4か月後は189秒（同）で，有意に遅延していた（p<0.05）。また，蘇生事象に立ち会う頻度が少ない総合診療部レジデントは，頻度の高い集中治療科レジデントより技能が経時的に悪化する傾向があった。【結語】実習により習得した蘇生技能は経時的に減衰し，蘇生事象に携わる機会の乏しい医療従事者で顕著であった。技能維持には一般的な蘇生コースが求めている2年に1度の再履修では不充分であると考えられた。しかし，再履修を実技講習で頻回に行うことは容易ではなく，今後はe–learning等の役割に関する検討をしていきたい。 Background: Because of infrequent pediatric cases of cardiopulmonary arrest (CPA), off–the–job training for cardiopulmonary resuscitation (CPR) skills is essential for pediatricians. However, the optimal method and the appropriate timing for refresher training are not clear. Objectives: The purpose of this study was to evaluate the change in CPR skills of pediatric residents with time, and to establish an effective education program to retain CPR skills. Subjects: Eighteen newly hired residents (six in critical care medicine and 12 general pediatrics) at the National Medical Center for Children and Mothers in 2009 were included in the study. Methods: Participants received simulation–based pediatric resuscitation training for 4 months. Participants received training at least once per month and were assigned to perform CPR as a leader (median = 2±0 times) during the training period. The CPR skills of participants were quantitatively evaluated by a simulation–based test that measured the time required prior to resuscitative interventions of basic life support (BLS) and advanced cardiac life support (ACLS). We used a scenario of ventricular fibrillation in an infant and examined the change in CPR skills immediately after training and at 4 and 8 months after training. Results: There was significant improvement in the median duration of BLS skills immediately after the training, from 51s to 31s for ventilation and from 65s to 38s for chest compression (p<0.05). However, several residents could not perform BLS skills (ventilation and chest compression) in 60s at 4 and 8 months after the training. Defibrillation skill showed significant decline at 4 months after training compared with the skill immediately after training (from 160s to 189s, p<0.05). Decline of CPR skills was more apparent in general pediatrics residents than in critical care medicine residents, who performed pediatric CPR more frequently. Conclusions: The CPR skills learned and acquired in a simulation–based resuscitation training declined with time and the decline was apparent in residents who performed CPR infrequently. Refresher training every 2 years may be inadequate for retention of CPR skills, but it appears difficult to perform simulation refresher training more frequently. Further study is required to evaluate other retraining methods such as e–learning. 小児の心肺停止は成人と比較して発生頻度が少ないため 1，診療のなかで蘇生の技能を習得することは困難である。そのため小児蘇生のoff–the–job trainingは重要であり，Pediatric Advanced Life Support（PALS）プロバイダーコースなどのシミュレーション教育の有効性が示唆されている 2, 3。しかし，習得した知識と技能の経時的な減衰も報告されており 4, 5，効果的な蘇生教育プログラムは技能を習得させるとともに，その技能を維持させることが求められる。そのためPALSプロバイダーコースでは2年間に1度の再履修により，技能維持を図っている。しかし，技能維持に必要な再履修の頻度や方法は明らかではない。 シミュレーション実習にて習得した乳児二次救命処置における技能の経時的変化を評価し，技能維持に必要な再履修の蘇生教育プログラムを立案する。 国立成育医療研究センター 2009年度新規採用レジデント 集中治療科6名および総合診療科12名の計18名を対象とした。集中治療科レジデントは，初期研修修了かつ後期研修を1年以上経験していることを条件に採用され，主な業務は小児集中治療室における重症患者の診療である。一方，総合診療科は初期研修修了を条件に採用され，主な業務は一般病棟での診療である。当施設では，以前より集中治療科と総合診療科のレジデントに対して蘇生教育を行ってきており，今回の研究の対象に選定した。 乳児心停止例を想定した4か月間のシミュレーション実習を施行した後に実技試験を行い，シミュレーション実習の前，直後，実習終了後から4か月後，8か月後に習得した技能の経時的変化を評価した。 4か月間 実習前，実習終了後，実習終了後から4か月，8か月 R（The R foundation for Statistical Computing, Vienna, Austria, version 2.13.0）を医療統計用にカスタマイズしたEZR（自治医科大学埼玉医療センター；http://www.jichi.ac.jp/saitama–sct/SaitamaHP.files/statmed.html）を用いた。習得した技能の経時的変化にはFriedman検定（対応のある3群以上の間の比較）を用い，Holm法にて多重比較における有意確率の調整を行った。 対象レジデント18名（集中治療科6名，総合診療科12名）の医師経験年数は，中央値3±1.5年であった（Table 1）。総合診療科レジデントの多く（9/12名）は初期研修終了直後であり，小児心肺蘇生事象の経験は，中央値1±1回と少なかった。対象全員がPALSプロバイダーコースを受講していたが，その受講後期間は受講1か月後から4年以上経過と広い幅を認めた。対象レジデントは，1か月に1度以上の頻度で中央値5±0.5回実習に参加し，中央値2±0回のリーダー役を担当した。当直業務や診療上の都合で実習当日に参加できないことが判明することもあり，実習参加回数およびリーダー役の回数に幅が生じた。 実習前後で両方の手技を実施するまでの時間は有意に改善した（Fig. 1）。実習後には有意な経時的悪化はみられなかったが，実習直後には全員が約60秒以内に両方の手技を実施できていたにも関わらず，実習終了後から4か月以降には60秒以内に実施できない者があった。60秒以内に実施できなかった者は，人工呼吸では実習終了後から4か月で1名，8か月で2名，胸骨圧迫では実習終了後から4か月で2名，8か月で6名と増加傾向にあった。 Changes with time of CPR skills. Time required to perform each skill of basic life support (BLS) and advanced cardiac life support (ACLS) is shown. 実習直後には全員が実施できたが，実施までの時間に有意な改善はなかった（Fig. 1）。実習後の経時的変化では，実習終了後から4か月より有意な悪化を認め，4か月には3人（17%），8か月には5人（28%）が7分間の実技試験中に除細動を実施できなかった。 実習直後には非実施率が61%から22%に改善したが，実施までの時間に有意な改善はなかった（Fig. 1）。実習後の経時的変化では，非実施率および実施までの時間に変化を認めなかった。 蘇生事象に立ち会う頻度の高い集中治療科レジデント（n=6）と，一般小児の診療にあたることが多い総合診療科レジデント（n=12）の経時的変化を比較した。総合診療科レジデントの除細動実施までに要した時間は，実習終了後から8か月には統計学的に有意に悪化した。BLSおよびALSの各手技施行までの時間は，総合診療科レジデントにおいて悪化する傾向があったが，集中治療科レジデントに一定の傾向は認めなかった（Fig. 2）。 Changes with time of CPR skills (a comparison of general pediatrics and critical care medicine residents). Time required to perform each skill of basic life support (BLS) and advanced cardiac life support (ACLS) is shown in each group. 効果的な蘇生教育プログラムには，技能維持に必要な再履修の時期を考慮する必要がある。過去の報告では技能の評価として，実技試験による処置実施の有無やその質が評価されてきたが，時間の要素に関する評価はほとんどなされていない 7。心停止症例の転帰改善には適切かつ迅速な介入が重要であり 8, 9，今回我々はBLSおよびALSの各手技実施までの時間を用いて，シミュレーション実習にて習得した技能の経時的変化を評価した。 本研究の結果，ALSの手技である除細動実施までの時間は経時的に遅延することがわかった。BLSの手技は経時的な悪化はみられなかったものの，実習直後には全員が60秒以内に両方の手技を実施できたが，実習終了後から4か月以降には60秒以内に実施できない者があった。また，集中治療科レジデント（n=6）より総合診療科レジデント（n=12）において技能が経時的に悪化する傾向があった。当施設では，集中治療科レジデントは小児集中治療室と一般病棟での蘇生事象に対応するのに対し，総合診療科では主に一般病棟において一般小児診療を行っている。そのため蘇生事象の臨床経験に差が生じ，実習後の技能維持に影響した可能性が考えられた。 Smithら 5は，133名の看護師を対象としたBLSとALSに対する知識と技能の維持を筆記試験と実技試験にて評価した。実習終了後から3か月にはBLS，ALSともに悪化したが，知識と比較して技能が，BLSと比較してALSがより早期に悪化したと報告している。Yangら 7は，ALSの知識と技術の維持に関するシステマティックレビュー（11編の文献）の中で，ALS技能の低下は平均して実習終了後から6～12か月には生じるが，実習前または実習後に蘇生事象の臨床経験があるとALSの技能が維持される傾向があったと報告している。今回，我々は乳児蘇生におけるBLSおよびALSの各手技実施までに要した時間という新たな評価概念にて経時的変化を検討した。Smithら 5およびYangら 7の報告は成人の蘇生について述べてはいるが，実技試験による処置実施の有無やその質の経時変化は我々の研究と同様の結果であった。すなわち，BLSおよびALSの技能は低下するものであり，その低下は特に蘇生事象の経験がないもので顕著である。そのため，蘇生事象に携わる機会の乏しい医療従事者は，その技能を維持するための再履修が必要である。 では，適切な再履修はどのくらいの頻度で行えばよいのであろうか？この質問に対する明確な回答はないが，少なくとも一般的な蘇生コースが求めている2年に1度の再履修では不充分であると考えられている 7。Berdenら 10は，3か月および6か月毎に再履修した群は技能を維持したが，12か月毎の群では技能を維持できなかったと報告している。我々は，過去の報告から技能が減衰してくると推測される実習終了後から6～12か月 7よりも早期の，実習終了後から4か月，8か月の時点で経時的変化を評価した。我々の結果では実習終了後から4か月にはALSの技能が低下しており，やはり過去の報告と同様に2年に1度の再履修では不充分であると考えられた。 しかし，再履修を実技講習で頻回に行うには，場所，時間，費用，人員確保などの問題があり困難であることが多い。DVDやインターネットなどの情報技術を用いて教育を行うe–learningを取り入れるなど，再履修の問題を解決する方法を検討する必要があり，今後の重要な課題である。 本研究の限界としては，追跡期間が実習終了後から8か月と短期間である点，評価期間中の臨床経験をレジデントの所属のみで評価している点，また過去の臨床経験の影響を検討していない点が挙げられる。また，今回評価をしたBLSとALSの各手技実施までの時間の先行研究は乏しく，各手技の理想的な達成時間は明確に定められておらずシミュレーション実習の効果自体を適切に評価できていない可能性もある。なお，本研究はAHAガイドラインに準拠し実習を行っているが，4か月間にわたる独自のoff–the–job trainingであり，PALSなど短期間の定型的な訓練コースと必ずしも比較できるものではない。 シミュレーション実習により習得した蘇生技能は実習後に経時的な減衰を認め，蘇生事象に携わる機会の乏しい医療従事者において顕著であった。習得した技能を維持するためには一般的な蘇生コースが求めている2年に1度の再履修では不充分であると考えられた。再履修を実技講習で頻回に行うことは容易ではなく，技能維持に果たすe–learning等の利用を検討していきたい。 謝辞：ご協力を頂いた国立成育医療研究センター 集中治療科スタッフならびにシニアレジデントの皆様，シミュレーション実習にご参加頂いた総合診療部および集中治療科の新規レジデントの皆様に深く感謝を致します。 日本救急医学会の定める利益相反に関する開示事項はありません。

Impact of simulation training on Jordanian nurses' performance of basic life support skills: A pilot study

Providing efficient basic life support (BLS) training is crucial for practicing nurses who provide direct patient care. Nevertheless, data addressing the impact of BLS courses on the skills and performance of Jordanian nurses are scarce. This study aimed to assess the effectiveness of a BLS simulation training on Jordanian nurses' skill improvement in cardiopulmonary resuscitation. A prospective quasi-experimental, single group pretest-posttest design was used to study the effect of BLS simulation; using a 9-item checklist; on the spot training; American Heart Association, on a group of Jordanian nurses. A pre-test was conducted following a CPR scenario to test the skills using 9-item checklist extrapolated from the American Heart Association guidelines. After debriefing, an interactive on spot training was provided. Later, participants undertook an unscheduled post-test after four weeks that included the same nine items. Thirty registered nurses with a mean clinical experience of 6.1years participated in the study. Comparing pre-test (M=4.6, SD=2.9, range=0 to 9) with post-test results (M=7.5, SD=1.7, range=4 to 9) showed an overall improvement in skills and BLS scores after the simulation training program (t=7.4, df=29, p<0.0001). BLS simulation training sessions are associated with significant improvement in skills and performance among Jordanian nurses. A refreshment BLS training session for nurses is highly recommended to guarantee nurses' preparedness in actual CPR scenarios.

E-learning in pediatric basic life support: A randomized controlled non-inferiority study

ObjectiveDissemination of pediatric basic life support (PBLS) skills is recommended. E-learning is accessible and cost-effective, but it is currently unknown whether laypersons can learn PBLS through e-learning. The hypothesis of this study was to investigate whether e-learning PBLS is non-inferior to instructor-led training. Study designParticipants were recruited among child-minders and parents of children aged 0–6 years. Participants were randomized to either 2-h instructor-led training or e-learning using an e-learning program (duration 17min) including an inflatable manikin. After training, participants were assessed in a simulated pediatric cardiac arrest scenario. Tests were video recorded and PBLS skills were assessed independently by two assessors blinded to training method. Primary outcome was the pass rate of the PBLS test (≥8 of 15 skills adequately performed) with a pre-specified non-inferiority margin of 20%. ResultsIn total 160 participants were randomized 1:1. E-learning was non-inferior to instructor-led training (difference in pass rate −4%; 95% CI −9:0.5). Pass rates were 100% among instructor-led trained (n=67) and 96% among e-learned (n=71). E-learners median time spent on the e-learning program was 30min (range: 15–120min) and the median number of log-ons was 2 (range: 1–5). After the study, all participants felt that their skills had improved. ConclusionE-learning PBLS is non-inferior to instructor-led training among child-minders and parents with children aged 0–6 years, although the pass rate was 4% (95% CI −9:0.5) lower with e-learning.

A multiple linear regression analysis of factors affecting the simulated Basic Life Support (BLS) performance with Automated External Defibrillator (AED) in Flemish lifeguards

BackgroundResearch investigating lifeguards’ performance of Basic Life Support (BLS) with Automated External Defibrillator (AED) is limited. AimAssessing simulated BLS/AED performance in Flemish lifeguards and identifying factors affecting this performance. MethodsSix hundred and sixteen (217 female and 399 male) certified Flemish lifeguards (aged 16–71 years) performed BLS with an AED on a Laerdal ResusciAnne manikin simulating an adult victim of drowning. Stepwise multiple linear regression analysis was conducted with BLS/AED performance as outcome variable and demographic data as explanatory variables. ResultsMean BLS/AED performance for all lifeguards was 66.5%. Compression rate and depth adhered closely to ERC 2010 guidelines. Ventilation volume and flow rate exceeded the guidelines. A significant regression model, F(6, 415)=25.61, p<.001, ES=.38, explained 27% of the variance in BLS performance (R2=.27). Significant predictors were age (beta=−.31, p<.001), years of certification (beta=−.41, p<.001), time on duty per year (beta=−.25, p<.001), practising BLS skills (beta=.11, p=.011), and being a professional lifeguard (beta=−.13, p=.029). 71% of lifeguards reported not practising BLS/AED. DiscussionBeing young, recently certified, few days of employment per year, practising BLS skills and not being a professional lifeguard are factors associated with higher BLS/AED performance. ConclusionMeasures should be taken to prevent BLS/AED performances from decaying with age and longer certification. Refresher courses could include a formal skills test and lifeguards should be encouraged to practise their BLS/AED skills.

Basic life support knowledge and skills of Iranian general dental practitioners to perform cardiopulmonary resuscitation.

Background:When cardiopulmonary arrest occurs, the dentist's ability to perform cardiopulmonary resuscitation (CPR) is the most important factor to minimize morbidity and mortality. This study assessed the basic life support (BLS) knowledge and performance of general dental practitioners in Hamadan, Iran.Materials and Methods:The participants in the study were 80 Iranian general dental practitioners who were chosen randomly. Their CPR knowledge was evaluated by verbal questions and their CPR skills were determined by CPR execution on a special manikin. Nearly 39% (n = 31) of dentists answered none of the questions and only 2.50% (n = 2) answered all of the questions correctly. Thirty six dentists had been participated CPR course after graduation.Result:There was a significant difference between dentists who participated in CPR training course and those that did not participate (P value = 0.000). Only 3.75% (n = 3) were able to perform CPR properly.Conclusion:The results showed that the amount of CPR knowledge and skills were low in participated Iranian general dental practitioners. However, CPR training courses after graduation increased the amount of knowledge significantly, thus, retraining CPR courses is necessary for dentists.

L’emergenza medica nello studio odontoiatrico: riconoscimento e primo intervento

ObjectivesDentists daily perform surgical procedures in unprotected health facilities; therefore they must be able to recognize the signs and symptoms occurring in medical emergencies that may compromise the patient's vital parameters. Materials and methodsA review of current guidelines for first aid in neurological, respiratory and cardiovascular emergencies was carried out. ResultsThe current guidelines for Basic Life Support (BLS) are reported. The parameters for diagnosis and treatment of major urgent cases and emergencies in a dental office are also described. ConclusionsThe entire dental team should be trained to master BLS skills and to provide diagnostic and outpatient treatment of clinical urgent cases and emergencies.

BASIC LIFE SUPPORT- A STITCH IN TIME

AbstractBasic Life Support is the identification of emergency medical conditions such as stroke, cardiac arrest, foreign body obstruction; cardiopulmonary resuscitation (CPR) and defibrillation. The main aim of CPR is to increase the blood supply to the brain and the heart. Any delay in providing CPR reduces the chances of survival for the victim. Thus timely CPR is also mandatory. Training in Basic life Support skills is a must for medical and paramedical professionals and students. Moreover, it is essential to train even the layman in these skills as bystanders are the first and the best rescuers if trained adequately. American Heart Association (AHA) guidelines are one of the most widely accepted ones in terms of measures for basic life support. These guidelines are updated every five years. The last update was in 2010. Through, this article an attempt has been made to throw light on the 2005 protocol and 2010 updates as recommended by AHA.

Cardiopulmonary Resuscitation in Resource-limited Health Systems-Considerations for Training and Delivery.

In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive "chain-of-survival," which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result from CPR training in low- and middle-income countries (LMICs). It is determined that for many health care systems, CPR training may have financial and ethically-deleterious, unintended consequences. Evidence shows Basic Life Support (BLS) skills training in a community is an effective intervention to improve public health. But, health care systems with limited resources should include CPR training only after considering the full implications of that intervention.

Outpatient Cataract Surgery: Incident and Procedural Risk Analysis Do Not Support Current Clinical Ophthalmology Guidelines

To evaluate whether an ophthalmologist-led, non-anesthesia-supported, limited monitoring pathway for phacoemulsification/intraocular lens cataract surgery, can be performed safely with only a medical emergency team providing support. Retrospective, observational, cohort study. All patients who underwent elective phacoemulsification/intraocular lens surgery under topical anesthesia in the ophthalmology outpatient unit between January 1, 2011, and December 31, 2012. Cataract surgery was performed by phacoemulsification under topical anesthesia. The intake process mainly embraced ophthalmic evaluation, obtaining a medical history, and proposing the procedure. A staff ophthalmologist performed the procedure assisted by 2 registered nurses in an independent outpatient clinic operating room within the hospital. The clinical pathway was without dedicated presence of or access to anesthesia service. Perioperative monitoring was limited to blood pressure and plethysmography preoperatively and intraoperatively. Patients were offered supportive care and instructed to avoid fasting and continue all their chronic medication. The primary outcome measure was the incidence of adverse events requiring medical emergency team (MET) interventions throughout the pathway. Secondary outcome measures were surgical ocular complication rates, use of oral sedatives, and reported reasons to perform the surgery in the classical operation room complex. Within the cataract pathway, 6961 cases (4347 patients) were eligible for analysis. Three MET interventions related to the phacoemulsification/intraocular lens pathway occurred in the 2-year study period, resulting in an intervention rate of 0.04%. None of the interventions was intraoperative. All 3 patients were diagnosed as vasovagal collapse and recuperated uneventfully. No hospital admittance was required. Eight other incidents occurred within the general ophthalmology outpatient unit population during the study period. Cataract surgery can be safely performed in an outpatient clinic, in the absence of the anesthesia service and with limited workup and monitoring. Basic first aid and basic life support skills seemtobesufficient in case of an adverse event. An MET provides a generous failsafe for this low-risk procedure.

Comparison of an interactive CD-based and traditional instructor-led Basic Life Support skills training for nurses

BackgroundBasic Life Support (BLS) is a life-saving and fundamental skill in resuscitation. However, studies have reported limitations in BLS training outcomes for both health professional and lay populations, and noted the resource and time-intensive nature of traditional training approaches. PurposeThis exploratory study evaluated the effectiveness of an interactive CD-based BLS training programme that included unsupervised manikin practice compared with a traditional instructor-led BLS training programme involving demonstration and supervised practice. MethodsA quasi-experimental post-test with follow-up design was used. The sample was comprised of two cohorts: Novice second-year undergraduate Nursing students (n=187) and Practising Nurses (n=107) in their first year of hospital employment. BLS skill outcomes were assessed at one week and again at eight weeks post training. FindingsNo statistically significant differences were found between the CD and traditional instructor-led BLS training methods in BLS skills of Novice and Practising Nurses at one week and eight weeks post training. However, there was a decrement in skill between one week and eight weeks post-training across both groups and an overall low level of competence. ConclusionThe failure to find a difference between the CD-based BLS programme with unsupervised manikin practice and a resource-intensive traditional instructor-led BLS training programme may indicate equivalence of the programmes or, even study design limitations. It is concerning that competence displayed by trainees from both groups was less than optimal and suggests the need for renewed efforts to develop and evaluate BLS training programmes which can achieve high rates of competence with acceptable skill retention over time.

Effectiveness of Basic Life Support Instruction in Physical Education Students—A Pilot Study

Background: According to the literature, 40% of injuries affecting school-age children are sports related. The role of physical education students, as future teachers, seems to be of high importance in terms of protecting children's safety during sports classes. Purposes: The aim is to evaluate the level of basic life support (BLS) knowledge and skills in physical education students instructed with the use of different methods. Methods: Second-year physical education students (n = 104, M age = 20 ± 0.6 years) were randomly assigned to three groups: experimental 1 (E1), experimental 2 (E2), and control (C). Group E1 students participated in a 2-hour BLS course based on computer-assisted presentations. Group E2 trainees practiced BLS algorithm in pairs during a 2-hour course. No manikins were used in both intervention groups. Students of Group C were asked to learn BLS algorithm on their own. All groups fulfilled a 10-question multiple-choice test on BLS at the beginning and the end of the experiment. After completing the course participants performed BLS on a manikin. Results: The results of knowledge test were not significant before an experiment but differed essentially among the groups afterward (analysis of variance contrast analysis, p <.05). Regardless of teaching method used, no significant differences were found among the students in preparatory BLS actions and cardiopulmonary resuscitation (CPR) performance on a manikin. The level of CPR performance was very low in all groups. Conclusions: Students of both intervention groups improved their BLS knowledge after the training. Teaching methods used in the current study seemed to be ineffective in terms of practical CPR skills. Access to greater number of modern manikins should improve the BLS training in physical education students. Moreover, permanent consultation on instructional methods with emergency medicine experts is recommended for university teachers.

Code blue: overcoming the fear.

Code blue: overcoming the fear.

Knowledge about basic life support in European students

Better knowledge and skills of basic life support can save millions of lives each year in Europe. The aim of this study was to measure the knowledge about basic life support in European students. From 13 European countries 1527 volunteer participated in the survey. The questionnaire consisted of socio-demographic questions and knowledge regarding basic life support. The maximum possible score was 18. Those participants who had basic life support training earned 11.91 points, while those who had not participated in lifesaving education had 9.6 points (p<0.001). Participants from former socialist Eastern European countries reached 10.13 points, while Western Europeans had average 10.85 points (p<0.001). The best results were detected among the Swedish students, and the worst among the Belgians. Based on the results, there are significant differences in the knowledge about basic life support between students from different European countries. Western European youth, and those who were trained had better performance.

Basic life support skills of junior high school students before and after cardiopulmonary resuscitation training with a musical video: An intervention study

Basic life support skills of junior high school students before and after cardiopulmonary resuscitation training with a musical video: An intervention study