Journal of Surgical Simulation 2019; 6: A: 2 - 2
Published: 06 November 2019
Special Issue: Out of hospital cardiac arrest and CPR training awareness in the community
NHS England reported that the ambulance services attempt to resuscitate approximately 28,000 cardiac arrests a year outside of hospital. Currently, fewer than 1 in 10 people survive cardiac arrests in the UK. CPR is attempted in only 20-30% of out-of-hospital cases. Evidence suggests that where CPR is attempted, survival rates are doubled. If bystander-initiated CPR is increased from 32% to 42%, nationally we can expect to save 300 more lives per year. Statistics show that only 1 in 20 people feel knowledgeable, confident and willing to act in a dire scenario, 7 in 10 adults lack the knowledge and confidence to act if someone collapsed and was unresponsive, and nearly 7 in 10 people polled that they lack the knowledge and confidence to act if someone was bleeding heavily. In addition to these scenarios, 8 in 10 adults said they lack the knowledge and confidence to act if a baby was choking.
As a nation, the UK can do much better. In countries where CPR is routinely taught in school, survival rates can be as high as 50%. For example in Denmark, where learning CPR has been part of the school curriculum for children over the age of 11 since 2005. There was a study period between 2001 and 2010, in which an increase in survival following out-of-hospital cardiac arrest was significantly associated with an increase in by-stander CPR. During this study period, bystander CPR increased from 21% to 44.9%.
The time to initiating CPR in cardiac arrest is critical to outcome. Even the highest-performing ambulance services will be unable to get to the patient and start CPR more rapidly than a bystander who is present at the scene of cardiac arrest. The Cardiovascular Disease Outcomes strategy specifically relates to improving the performance of the middle two links, specifically improving the rate of bystander CPR and the use of automated external defibrillators, which are perceived to be the two weakest links in England at present. Evidence from Scandinavia and some parts of the USA show that targeting these can prove to be the most impactful in terms of improving survival rates.
But how can bystander CPR be improved? It can be delivered through mass training events, and can be targeted at family members of patients at risk of cardiac arrest. Basic CPR training should be mandatory as part of the driving licence qualification, and there should be community CPR and CPR training in schools. Another way to improve bystander assisted CPR is by using dispatcher-assisted CPR, which dramatically reduces the time to the first chest compression, compared with waiting for the arrival of an ambulance crew.
Basic life support should be taught more widely in the workplace, leisure centres and schools. The Resuscitation Council of the UK recommends everyone who is able to should learn CPR, it should be taught in all schools and defibrillators should be available wherever there are large numbers of people. In 2013, the government’s Cardiovascular Disease Outcomes Strategy for England set the target of increasing survival from out-of-hospital cardiac arrest by 50%, leading to an additional 1000 lives saved each year. There are schemes run across the UK to help with teaching basic life saving skills. There is the Heartstart scheme, which is a free two hour course. There are over 1500 of these schemes run across the UK. Little Rescuer is a course designed to teach first aid in a funny way to nursery and primary school children. From 2020 onwards, all state-funded schools in England will be required to teach first aid as part of the health education curriculum, and secondary school pupils will be taught further first aid like how to administer CPR. CPR being taught in schools could create a nation of lifesavers, and thousands more mums, dads, grandparents and children could be saved every year.
Conclusion: As a teenager, I realise that some people of my generation are reliant on technology, and it has a big role to play in our lives. Because of this, I believe that a technological approach to education on CPR would be extremely beneficial, and would help spread awareness to engage school children on this matter. There are different types of innovative technology, such as apps that engage with the user to create an interactive means of education, apps that use the geolocation of the user to display the location of the nearest AED for a dire situation and other apps, such as iResus, that display resuscitation algorithms. These uses of technology can have a vital role for improving the outcomes of cardiac arrest. They can be used to spread awareness and education on the subject, and are compelling tools for effecting change. The prospect of saving someone’s life is scary, but your hands can save a life if you know what to do with them.
CPR awareness; community; CPR training; basic life support
This presentation was given at the 8th Annual Homerton Simulation Conference, Homerton University Hospital, London, UK, on 6 December 2018.