All secondary school students should be required to be trained in cardiopulmonary resuscitation (CPR) and receive an overview of automated external defibrillators (AEDs), according to an American Heart Association science advisory.
The advisory, published in Circulation: Journal of the American Heart Association, calls for state legislatures to mandate that CPR and AED training be required for graduation, and to provide funding and other support to ensure the educational standard is met.
Last school year, 36 states had a law or curriculum standard encouraging CPR training in schools, according to the advisory. School districts have developed various models for providing and paying for the training and equipment, including using volunteer instructors or video-based programs, and drawing support from businesses, foundations, civic organizations and public agencies.
Challenges include finding time in the curriculum to teach the courses and providing and maintaining CPR manikins, which are vital for training. Schools can keep reusable manikins, replacing key parts for sanitary reasons, or can work with a local agency that provides manikins and training. Some schools provide personal training kits that include DVD-based instructions and an inflatable, reusable manikin.
The statement authors report that the benefits far outweigh the costs. "Training of all secondary education students will add a million trained rescuers to the population every few years," said Mary Fran Hazinski, R.N., M.S.N., co-author of the advisory and professor at Vanderbilt University School of Nursing in Nashville, Tenn. "Those students will be ready, willing and able to act for many years to come, whenever they witness an emergency within the community."
Students trained as rescuers might help save lives at home, where most sudden cardiac arrests occur. Trained students could also respond to cardiac arrests at school and at public places such as malls, health clubs, or swimming pools, or at events such as family reunions.
Cardiac arrest is a leading cause of death in the United States. The American Heart Association reports that emergency medical personnel respond to nearly 300,000 out-of-hospital cardiac arrests in the United States annually, so CPR can help save many of these victims' lives, the authors said.
Effective CPR circulates a small but vital amount of oxygen-rich blood to the heart and brain, which can help keep a victim alive until an AED is available. The AED can give an electric shock to the heart to stop the abnormal heart rhythm and allow a normal heart rhythm to return. AEDs are portable medical devices that can be used with minimal training and are often available in public places.
"Bystander CPR can double or triple survival from cardiac arrest. Currently, only about 30 percent of victims of out-of-hospital sudden cardiac arrest receive any type of CPR," Hazinski said.
According to the statement, most untrained bystanders hesitate to help a cardiac arrest victim. Research has shown that when bystanders have CPR training, they are much more likely to take action.
Bystanders who phone 911 and begin CPR provide the first essential links in a strong, interdependent "chain of survival," Hazinski said. "With activation of 911, early bystander CPR, rapid defibrillation, effective advanced life support and integrated post-resuscitation care, survival rates following sudden cardiac arrest can exceed 50 percent. That's dramatically higher than the 7 percent to 9 percent average survival rate in the U.S. However, nothing is going to happen unless there's a bystander who recognizes the arrest, phones 911 and begins CPR to start that chain of survival. Research has shown that any attempt at CPR can improve the odds of survival for someone who has a cardiac arrest," she said.
CPR training in schools should cover several key areas, including how to recognize an emergency, an emphasis on high-quality chest compressions and skills practice, according to the advisory. At a minimum, AED training should cover the purpose, simplicity and safety of the devices.
"Many schools have overcome barriers to training and begun teaching CPR," Hazinski said. "But I think a legislative mandate and support for training in schools would go a long way."
Co-authors are: Diana Cave, R.N., M.S.N.; Tom P. Aufderheide, M.D.; Jeff Beeson, M.D.; Alison Ellison, B.S.N.; Andrew Gregory, M.D.; Loren F. Hiratzka, M.D.; Keith Lurie, M.D.; Laurie J. Morrison, M.D., M.Sc.; Vincent N. Mosesso, Jr., M.D.; Vinay Nadkarni, M.D.; Jerry Potts, Ph.D.; Ricardo A. Samson, M.D.; Michael Sayre, M.D.; and Stephen M. Schexnayder, M.D. Author disclosures and sources of funding are on the manuscript.
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