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Understanding the provision for basic life support training in London schools for children aged 11–18
90
Abstracts / Resuscitation 96S (2015) 43–157
AP115 The effects of different retraining frequency of simulation-based short advanced life support training on health professionals Ming-Ju Hsieh 1,∗ , Chih-Wei Yang 2 , Wen-Chu Chiang 1 , Hui-Chih Wang 1 , Hao-Yang Lin 1 , Shu-Hsien Hsu 1 , Weiting Chen 1 , Kah-Meng Chong 1 , Cheng-Chung Fang 1 , Matthew Huei-Ming Ma 1 1
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
Purpose of the study: The optimal retraining frequency of advanced life support (ALS) was unclear. The aim of our study was to explore the effects of different retraining frequency of simulationbased short ALS courses. Materials and methods: In this randomized controlled study, junior residents and nurses were recruited and assigned into 3 groups. After receiving initial simulation-based ALS training, three groups received the same retraining courses with different intervals respectively: 3 months, 6 months and 12 months. There were 5 or 6 participants in every course. The one-hour retraining course included an 8-min resuscitation simulation in-situ on a high-fidelity manikin followed by debriefing. One year after the initial training, all participants completed paper-based test and self-efficacy questionnaires on teamwork performance in addition to resuscitation simulation in-situ. The blinded evaluators used validated checklists to assess the performance by reviewing the simulation videos. Results: Eighty-two out of 89 participants completed the protocol. They had similar characteristics, including age and working years. The 6-month group had less resuscitation experiences within recent one year. One year after initial training, the 3 groups had significant differences in mean scores of knowledge (3-month vs. 6-month vs. 12-month, 7.54 ± 1.72 vs. 6.37 ± 1.36 vs. 6.55 ± 1.31, p = 0.012), and 3-month group had higher scores than 6-month group (p = 0.009) and 12-month group (p = 0.018). The 3 groups also had significant differences in median scores of skill performance (3-month vs. 6-month vs. 12-month, 31 vs. 28 vs. 23.5, p < 0.0001), with 3-month group higher than 6-month group (p = 0.04) and 6-month group higher than 12-months group (p = 0.013). Threemonth group also performed best in self-evaluated teamwork performance. Conclusions: Our study showed that the retraining interval of 3-month achieved the greatest effects when health professionals joined the simulation-based short ALS retraining courses. http://dx.doi.org/10.1016/j.resuscitation.2015.09.212 AP116 Effectivity of CPR trainings for nurses Stephanie Horschitzka 1,∗ , Ingeborg Eberl 2 1
University of Vienna, Vienna, Austria University Hospital of Ludwig Maximilians University, Munich, Germany 2
Purpose of the study: Immediate Life Support (ILS) training is designed for care staff usually not involved with critically ill patients and takes into account specific functions of participants. In contrast, CPR (cardiopulmonary resuscitation) training in Austria is often delivered in short in-house courses aimed at
nurses of normal wards. These courses are rarely based on evidence concerning training methods nor are they standardized nor do they include simulation training. The aim of this study was to compare nurses’ effectivity in providing CPR in a simulated cardiac arrest following either ILS training or internal CPR trainings. Materials and methods: This cross-sectional study used a post-test, quasi-experimental design and identified skills through completion of an evaluation sheet, while a questionnaire was used to assess intervening variables. Results: 118 registered nurses from 9 hospitals (47.5%: in-house training; 52.5%: ILS-training) were included. Checking for response and normal breathing of a patient were significantly more often performed correctly by participants in the ILS training. This was also true for activation of the emergency response system and correct placement of hands on the patients’ thorax. ILS participants observed correct compression depth and rate as well as compression/ventilation ratio. They significantly reduced no-flow-time to a greater extent. Also, ventilation was performed correctly significantly more often. None of the participants in internal CPR training used a laryngeal tube, whereas 16.1% did not use it in ILS group. To 58.9% of participants in internal resuscitation training, no defibrillator for training was available. Conclusions: Key components of CPR (reduction of no-flowtime, quality of chest compressions, sufficient ventilation) were performed significantly better within the ILS group. These results were scarcely influenced by questionnaire variables, the crucial factor being the type of training. ILS training provides necessary resources for training. It should be favored over the investigated in-house CPR trainings. http://dx.doi.org/10.1016/j.resuscitation.2015.09.213 AP117 Understanding the provision for basic life support training in London schools for children aged 11–18 Dominic C. Marshall ∗ , Mark Sykes, Alexander Wood, Stephanie Joppa, Madhurima Sinha, Justin D. Salciccioli, P. Boon Lim Imperial College, London, UK Introduction: Basic life support (BLS) training in schools is associated with improved outcomes from cardiac arrest.1 ILCOR has previously recommended universal BLS training for school-aged children.2 The current practice of BLS training in London schoolaged children is unknown. The aim of this study was to assess current practices of BLS training in London secondary schools. Methods: A registered prospective audit of BLS training in London secondary schools was conducted. Schools were contacted by email initially and a subsequent telephone interview was conducted with school staff familiar with local training practices. Survey response data were anonymised and captured electronically. Universal training was defined as any program which delivers BLS training to all students in the school. Simple descriptive statistics were used to summarise the results. Results: A total of 65 schools completed the survey covering an estimated student population of 65,396. There were 6 (9%) schools which provide universal training programs for students and an additional 31 (48%) offer training as part of an extra-curricular. An AED was available in 18 (28%) schools, unavailable in 40 (61%) and 7 (11%) which reported their AED provision as unknown. The most common reasons for not having a universal BLS training program is the requirement for additional class time (28%) and that funding is
Abstracts / Resuscitation 96S (2015) 43–157
unavailable for such a program (28%). There were 5 students who died from sudden cardiac arrest in the preceding 10 years. Discussion: BLS training rates in London secondary schools are low and the majority of schools do not have an AED available in case of emergency. These data highlight an opportunity to improve BLS training rates and to improve AEDs provision in the United Kingdom. Future studies should assess programs which are costeffective and which do not require significant amounts of additional class time. http://dx.doi.org/10.1016/j.resuscitation.2015.09.214 AP118 The science of BLS education: Current knowledge and future directions Peter iserbyt KU Leuven, Leuven, Belgium Purpose: In 2003 the ILCOR committee recognized that despite the nearly three decades of public instruction in CPR classes (hospitals, lifeguard training, school curricula and several lay organisations) most people who complete CPR training will not perform effective basic CPR even immediately after training. Therefore, researchers have emphasised the need for instructional methods which can raise the level of BLS performance or reduce instructional time while preserving performance level over time. This has led to the development of innovative instructional methods and tools such as video-, DVD- and CD-ROM-based self-training, peer learning and interactive computer training with and without an instructor. Materials and methods: A series of four randomized controlled trial studies were performed focusing on the use of science-based learning tools embedded in a powerful learning environment. The first study investigated the effect of a formally embedded peer assessment when learning BLS in dyads using the reciprocal learning format with task cards. Task cards combine a picture of the BLS skill with a picture of the skills. The second study implemented the spatial contiguity principle on task cards. This principle suggests that people learn more deeply when instructions are placed close (i.e., integrated) rather than far from to the corresponding part of the picture on the page (or screen). A third study compared reciprocal learning with task cards taught by non experts compared to a standardized format by the Red Cross. Finally, based on the findings from these studies, a free application for iPad was developed incorporating science from the cognitive and educational domain to maximize learning outcomes in a 45 min lesson format. Results: Results demonstrated that small changes in the pedagogical approach and the educational design of learning tools have significant impact on learning outcomes. Peer assessment led to superior performance, as did the application of the spatial contiguity effect. When non-experts in BLS are able to construct a powerful learning environment (i.e., reciprocal learning) and use sciencebased learning tools they achieve equally high learning outcomes as their expert counterparts. Conclusions: These studies demonstrate the importance of educational design and cognitive science in BLS education. http://dx.doi.org/10.1016/j.resuscitation.2015.09.215
91
AP119 Annual CPR-training can provide secondary school students with the essential skills – A three-year cohort study in The Netherlands monitoring the quality of their CPR-skills Petra Schuffelen 1,∗ , Julie Sijmons 2 , Ali Ghossein 2 , Hesam Amin 2 , Jerremy Weerts 2 , Anton Gorgels 1 1 Maastricht University, CAPHRI, Maastricht, The Netherlands 2 Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
Background and purpose: Annual short CPR training sessions in secondary schools can contribute to achieve the goal of more by standard CPR and providing the next generation with knowledge and skills to act in case of a sudden cardiac arrest. This study reports on the students’ skills participating in a three-year cohort study. Materials and methods: In a Meuse-Rhine Euregion CPR training program: EMuRgency, 108 secondary school students participated. Annual training consisted of 90-min hands-on training: each student having an own manikin with medical students as CPRinstructors. Before and after the CPR training, a questionnaire was completed on self-assessment of their CPR confidence. After the training, students performed CPR on a manikin in a test-scenario. Outcome criteria were chest compression depth and frequency, ventilation volume and CPR confidence. Results: Demographic variables included: mean age: 15.9 (SD:0.8), male: 50.9%, educational level being classified as: (1) higher level education (38%), (2) preparatory scholarly education (33%), and (3) preparatory scholarly education with Latin (29%). The results from the test-scenario showed an average compression depth of 47.7 mm and compression rate of 102.4 p min−1 . Average compression depth for male students was 50.7 mm (95% CI 48.7–52.7, SD: 7.5), female students 44.5 mm (95% CI 42.6–46.4, SD: 6.8) (p = 0.00). Results for compression rate were 102.5 p min−1 (95% CI 99.0–105.7, SD: 11.9) and 102.2 p min−1 (95% CI 99.0–105.4, SD: 11.6) (p = 0.88) respectively. Only 27% of the female students scored a compression depth between 50 and 60 mm compared to 70% of the male students. Average compression depth increased by school year: 3rd year 46.6 mm, 4th year 47.8 mm, 5th year 49.8 mm (p = 0.31). Conclusions: Annual short CPR training increases resuscitation skills in secondary school students, but male students tend to be more capable in performing the correct compression depth. Overall, the quality of the CPR skills improved per higher school year. Further study is required into improving gender performance. http://dx.doi.org/10.1016/j.resuscitation.2015.09.216 AP120 Can simulation based introduction for new employees improve patient safety? Eva Svensson Stuart, Annika Englund Linköping University, Department of Medical and Health Sciences, Linköping, Sweden Background: In emergency situations, a competent evaluation of the patient, the correct interpretation of relevant findings and adequate treatment are crucial for survival. Lack of experience increases stress and may hamper performance. To prepare our new staff for acute situations, we designed a practical simulation based program to improve patient safety. The aim of this study was to
Abstracts / Resuscitation 96S (2015) 43–157
AP115 The effects of different retraining frequency of simulation-based short advanced life support training on health professionals Ming-Ju Hsieh 1,∗ , Chih-Wei Yang 2 , Wen-Chu Chiang 1 , Hui-Chih Wang 1 , Hao-Yang Lin 1 , Shu-Hsien Hsu 1 , Weiting Chen 1 , Kah-Meng Chong 1 , Cheng-Chung Fang 1 , Matthew Huei-Ming Ma 1 1
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan 2 Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
Purpose of the study: The optimal retraining frequency of advanced life support (ALS) was unclear. The aim of our study was to explore the effects of different retraining frequency of simulationbased short ALS courses. Materials and methods: In this randomized controlled study, junior residents and nurses were recruited and assigned into 3 groups. After receiving initial simulation-based ALS training, three groups received the same retraining courses with different intervals respectively: 3 months, 6 months and 12 months. There were 5 or 6 participants in every course. The one-hour retraining course included an 8-min resuscitation simulation in-situ on a high-fidelity manikin followed by debriefing. One year after the initial training, all participants completed paper-based test and self-efficacy questionnaires on teamwork performance in addition to resuscitation simulation in-situ. The blinded evaluators used validated checklists to assess the performance by reviewing the simulation videos. Results: Eighty-two out of 89 participants completed the protocol. They had similar characteristics, including age and working years. The 6-month group had less resuscitation experiences within recent one year. One year after initial training, the 3 groups had significant differences in mean scores of knowledge (3-month vs. 6-month vs. 12-month, 7.54 ± 1.72 vs. 6.37 ± 1.36 vs. 6.55 ± 1.31, p = 0.012), and 3-month group had higher scores than 6-month group (p = 0.009) and 12-month group (p = 0.018). The 3 groups also had significant differences in median scores of skill performance (3-month vs. 6-month vs. 12-month, 31 vs. 28 vs. 23.5, p < 0.0001), with 3-month group higher than 6-month group (p = 0.04) and 6-month group higher than 12-months group (p = 0.013). Threemonth group also performed best in self-evaluated teamwork performance. Conclusions: Our study showed that the retraining interval of 3-month achieved the greatest effects when health professionals joined the simulation-based short ALS retraining courses. http://dx.doi.org/10.1016/j.resuscitation.2015.09.212 AP116 Effectivity of CPR trainings for nurses Stephanie Horschitzka 1,∗ , Ingeborg Eberl 2 1
University of Vienna, Vienna, Austria University Hospital of Ludwig Maximilians University, Munich, Germany 2
Purpose of the study: Immediate Life Support (ILS) training is designed for care staff usually not involved with critically ill patients and takes into account specific functions of participants. In contrast, CPR (cardiopulmonary resuscitation) training in Austria is often delivered in short in-house courses aimed at
nurses of normal wards. These courses are rarely based on evidence concerning training methods nor are they standardized nor do they include simulation training. The aim of this study was to compare nurses’ effectivity in providing CPR in a simulated cardiac arrest following either ILS training or internal CPR trainings. Materials and methods: This cross-sectional study used a post-test, quasi-experimental design and identified skills through completion of an evaluation sheet, while a questionnaire was used to assess intervening variables. Results: 118 registered nurses from 9 hospitals (47.5%: in-house training; 52.5%: ILS-training) were included. Checking for response and normal breathing of a patient were significantly more often performed correctly by participants in the ILS training. This was also true for activation of the emergency response system and correct placement of hands on the patients’ thorax. ILS participants observed correct compression depth and rate as well as compression/ventilation ratio. They significantly reduced no-flow-time to a greater extent. Also, ventilation was performed correctly significantly more often. None of the participants in internal CPR training used a laryngeal tube, whereas 16.1% did not use it in ILS group. To 58.9% of participants in internal resuscitation training, no defibrillator for training was available. Conclusions: Key components of CPR (reduction of no-flowtime, quality of chest compressions, sufficient ventilation) were performed significantly better within the ILS group. These results were scarcely influenced by questionnaire variables, the crucial factor being the type of training. ILS training provides necessary resources for training. It should be favored over the investigated in-house CPR trainings. http://dx.doi.org/10.1016/j.resuscitation.2015.09.213 AP117 Understanding the provision for basic life support training in London schools for children aged 11–18 Dominic C. Marshall ∗ , Mark Sykes, Alexander Wood, Stephanie Joppa, Madhurima Sinha, Justin D. Salciccioli, P. Boon Lim Imperial College, London, UK Introduction: Basic life support (BLS) training in schools is associated with improved outcomes from cardiac arrest.1 ILCOR has previously recommended universal BLS training for school-aged children.2 The current practice of BLS training in London schoolaged children is unknown. The aim of this study was to assess current practices of BLS training in London secondary schools. Methods: A registered prospective audit of BLS training in London secondary schools was conducted. Schools were contacted by email initially and a subsequent telephone interview was conducted with school staff familiar with local training practices. Survey response data were anonymised and captured electronically. Universal training was defined as any program which delivers BLS training to all students in the school. Simple descriptive statistics were used to summarise the results. Results: A total of 65 schools completed the survey covering an estimated student population of 65,396. There were 6 (9%) schools which provide universal training programs for students and an additional 31 (48%) offer training as part of an extra-curricular. An AED was available in 18 (28%) schools, unavailable in 40 (61%) and 7 (11%) which reported their AED provision as unknown. The most common reasons for not having a universal BLS training program is the requirement for additional class time (28%) and that funding is
Abstracts / Resuscitation 96S (2015) 43–157
unavailable for such a program (28%). There were 5 students who died from sudden cardiac arrest in the preceding 10 years. Discussion: BLS training rates in London secondary schools are low and the majority of schools do not have an AED available in case of emergency. These data highlight an opportunity to improve BLS training rates and to improve AEDs provision in the United Kingdom. Future studies should assess programs which are costeffective and which do not require significant amounts of additional class time. http://dx.doi.org/10.1016/j.resuscitation.2015.09.214 AP118 The science of BLS education: Current knowledge and future directions Peter iserbyt KU Leuven, Leuven, Belgium Purpose: In 2003 the ILCOR committee recognized that despite the nearly three decades of public instruction in CPR classes (hospitals, lifeguard training, school curricula and several lay organisations) most people who complete CPR training will not perform effective basic CPR even immediately after training. Therefore, researchers have emphasised the need for instructional methods which can raise the level of BLS performance or reduce instructional time while preserving performance level over time. This has led to the development of innovative instructional methods and tools such as video-, DVD- and CD-ROM-based self-training, peer learning and interactive computer training with and without an instructor. Materials and methods: A series of four randomized controlled trial studies were performed focusing on the use of science-based learning tools embedded in a powerful learning environment. The first study investigated the effect of a formally embedded peer assessment when learning BLS in dyads using the reciprocal learning format with task cards. Task cards combine a picture of the BLS skill with a picture of the skills. The second study implemented the spatial contiguity principle on task cards. This principle suggests that people learn more deeply when instructions are placed close (i.e., integrated) rather than far from to the corresponding part of the picture on the page (or screen). A third study compared reciprocal learning with task cards taught by non experts compared to a standardized format by the Red Cross. Finally, based on the findings from these studies, a free application for iPad was developed incorporating science from the cognitive and educational domain to maximize learning outcomes in a 45 min lesson format. Results: Results demonstrated that small changes in the pedagogical approach and the educational design of learning tools have significant impact on learning outcomes. Peer assessment led to superior performance, as did the application of the spatial contiguity effect. When non-experts in BLS are able to construct a powerful learning environment (i.e., reciprocal learning) and use sciencebased learning tools they achieve equally high learning outcomes as their expert counterparts. Conclusions: These studies demonstrate the importance of educational design and cognitive science in BLS education. http://dx.doi.org/10.1016/j.resuscitation.2015.09.215
91
AP119 Annual CPR-training can provide secondary school students with the essential skills – A three-year cohort study in The Netherlands monitoring the quality of their CPR-skills Petra Schuffelen 1,∗ , Julie Sijmons 2 , Ali Ghossein 2 , Hesam Amin 2 , Jerremy Weerts 2 , Anton Gorgels 1 1 Maastricht University, CAPHRI, Maastricht, The Netherlands 2 Maastricht University, Faculty of Health, Medicine and Life Sciences, Maastricht, The Netherlands
Background and purpose: Annual short CPR training sessions in secondary schools can contribute to achieve the goal of more by standard CPR and providing the next generation with knowledge and skills to act in case of a sudden cardiac arrest. This study reports on the students’ skills participating in a three-year cohort study. Materials and methods: In a Meuse-Rhine Euregion CPR training program: EMuRgency, 108 secondary school students participated. Annual training consisted of 90-min hands-on training: each student having an own manikin with medical students as CPRinstructors. Before and after the CPR training, a questionnaire was completed on self-assessment of their CPR confidence. After the training, students performed CPR on a manikin in a test-scenario. Outcome criteria were chest compression depth and frequency, ventilation volume and CPR confidence. Results: Demographic variables included: mean age: 15.9 (SD:0.8), male: 50.9%, educational level being classified as: (1) higher level education (38%), (2) preparatory scholarly education (33%), and (3) preparatory scholarly education with Latin (29%). The results from the test-scenario showed an average compression depth of 47.7 mm and compression rate of 102.4 p min−1 . Average compression depth for male students was 50.7 mm (95% CI 48.7–52.7, SD: 7.5), female students 44.5 mm (95% CI 42.6–46.4, SD: 6.8) (p = 0.00). Results for compression rate were 102.5 p min−1 (95% CI 99.0–105.7, SD: 11.9) and 102.2 p min−1 (95% CI 99.0–105.4, SD: 11.6) (p = 0.88) respectively. Only 27% of the female students scored a compression depth between 50 and 60 mm compared to 70% of the male students. Average compression depth increased by school year: 3rd year 46.6 mm, 4th year 47.8 mm, 5th year 49.8 mm (p = 0.31). Conclusions: Annual short CPR training increases resuscitation skills in secondary school students, but male students tend to be more capable in performing the correct compression depth. Overall, the quality of the CPR skills improved per higher school year. Further study is required into improving gender performance. http://dx.doi.org/10.1016/j.resuscitation.2015.09.216 AP120 Can simulation based introduction for new employees improve patient safety? Eva Svensson Stuart, Annika Englund Linköping University, Department of Medical and Health Sciences, Linköping, Sweden Background: In emergency situations, a competent evaluation of the patient, the correct interpretation of relevant findings and adequate treatment are crucial for survival. Lack of experience increases stress and may hamper performance. To prepare our new staff for acute situations, we designed a practical simulation based program to improve patient safety. The aim of this study was to