Page 10 - Occupational Health & Safety, January/February 2020

DEFIBRILLATORS & CPR
Let’s break things down into bite-size pieces to help us reimagine new models for success.
Measure the right things. In a reimagined SCA responder model, the most important measures are the number of general public members who learn CPR skills from any source and the number of SCA victims who get early CPR. It is not the number of course completion cards issued.
Clearly define the limited skills expected of the general pub- lic for effective hands-only CPR. We want SCA responder squad members to:
■ Know how to recognize SCA
■ Call 9-1-1
■ Quickly volunteer to try and help
■ Put his/her hands in the right place
■ Do two-inch deep chest compressions 100 to 120 times per
minute, while allowing the chest to come all the way up each time
■ Not stop until an AED is applied, or professional emergency
medical services resources arrive to take over
Expressly allow and encourage lots of different ways to com- municate CPR skills. Deem members of the general public as “trained” regardless of where they learn CPR skills. Leverage on- line-only learning platforms, augmented reality (AR) technologies, social media, video platforms, stadium video screens, kiosks, and every other medium that can communicate CPR content. Studies show that good CPR effectiveness can be achieved using online training only—even without skills practice—and ultra-brief vid- eos. These technologies are the only way to scalably “train” large
numbers of people. We should not hesitate to put them to good use. Don’t let perfection be the enemy of the good. Good CPR is hard to do for both volunteer bystanders and professional health- care workers alike. Simply put, CPR is a difficult skill for anyone, at any skill level, to perform well, particularly for people who may first be called upon to perform the task unexpectedly at one highly stressful and emotional point in time. CPR quality under a mass- training model admittedly won’t be perfect, but for the three out of four SCA victims who don’t get CPR now, less-than-perfect CPR is
much better than none.
Recognize the limitations of formal training. Formal CPR
training does not result in “certification” from any regulatory body. Trainees simply receive a course completion card saying they suc- cessfully completed a class as determined by a course instructor. Importantly, such training is not evidence of competence nor a predictor of how lay bystanders will act when faced with an ac- tual emergency. Given these limitations, it is better to scalably train masses of people in lots of different ways than limit the pool of potential rescuers willing to help by requiring formal training.
Change the laws. There is certainly a role for formal CPR training for those types of jobs that should require it, and many organizations will continue to formally train employees even under a reimagined model. For lay-bystanders working in places with AED programs, formal training should not, however, be a legal requirement. AED laws should be changed to reflect this and to encourage everyone to learn CPR skills in whatever way works best for them. Good Samari- tan laws should also be strengthened to provide real legal protections for everyone who steps in to try and help SCA victims.
Let the market evolve a wide variety of CPR training business models. Fee-based, formal CPR (and AED) training is big busi- ness with revenues of about $500 million annually. But, because of time and cost barriers, it necessarily limits the number of people trained and willing to help. If allowed to emerge and thrive, one can imagine a wide range of new business models supporting alterna- tive training methods. Examples might include free, advertising- based, subscription-based, traditional fee-based and many others. The training market will find its own path, orders-of-magnitude more members of the general public will be trained, and more SCA victims will get early CPR. Win-win-win.
Wrapping Things Up
Arming massive numbers of the general public with CPR skills and allowing and encouraging everyone to try CPR when faced with a person believed to be in SCA are critical steps if we truly want to meaningfully increase SCA survival rates. Reimagining and imple- menting a new CPR training model can realistically help us achieve that goal. We simply can’t ignore that change is needed in order to make it happen. This matters too much. Lives are in the balance, just waiting for us to act.
Richard A. Lazar is a leading national AED program design, opera- tions, and compliance expert and President of Readiness Systems.
REFERENCES
1. https://readisys.com/the-aed-shortage/
2. https://readisys.com/squad-goals-moving-the-needle-on-sudden- cardiac-arrest-requires-a-new-model/
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