Page 8 - Occupational Health & Safety, January/February 2020

DEFIBRILLATORS & CPR
Reimagining CPR Training to Enable More Real-World Applications
Relatively few people get formal training, while the public generally perceives that only formally trained people can do CPR.
BY RICHARD A. LAZARLooked at objectively, the current emphasis on formal CPR training—go to a class, get a card—isn’t succeeding very well according to some key measures. Relatively few people get formal training, while the public generally perceives that only formally trained people can do CPR. As a re- sult, the vast majority of sudden cardiac arrest (SCA)
victims don’t get CPR.
This misconception is one reason for the low
SCA survival rates in this country. Alternative ap- proaches, however, have the potential to educate massive numbers of people and dramatically in- crease the number of SCA victims who get CPR. That, in turn, could give us the much-needed power to finally improve survival rates.
Anatomy of Sudden Cardiac Arrest
The sheer magnitude of SCA as a public health threat is easy to describe. Nearly 400,000 people experience SCA outside of hospitals in the United States every year. Approximately 120,000 of these—roughly 30 percent— are stricken in public places outside of the home.
Now, imagine a map of the United States—all 3.8 million square miles—with a dot on every office building and campus, shopping mall, retail store, ho- tel, manufacturing plant, airport, amusement park, gambling establishment, government building, health club, school, church, sports arena, public park, side- walk, and every other similar workplace and com- munity setting (that’s a lot of dots!). These are the public locations where one of the 120,000 SCA events per year might happen at any given moment. But, of course, it is impossible to predict precisely who, when or where SCA may strike. At any one of these given locations, SCA can only be expected roughly once ev- ery 10 to 40 years.
We know that quickly delivering CPR can help keep an SCA victim’s heart “defibrillation-ready” for a time and, along with AED use, can contribute to sav- ing the lives of many more SCA victims. This means there must be someone nearby at the time SCA strikes who is equipped and willing to do CPR. But today, only about six in 100 SCA victims are likely to survive, in part because there are too few volunteer bystand- ers allowed, willing and able to quickly start CPR (and because of the AED shortage1).
CPR Training, Effectiveness
and Success Barriers Today
The dominant training model today harkens back to the 1960s, the dawn of CPR education for the general
public. It emphasizes (or requires) formal, in-person, fee-based, instructor-led, card-issuing CPR training and is widely touted as the best way to educate and get volunteer lay-bystanders to do CPR. Is this model working? Arguably not.
Logistically, a very large volunteer “SCA responder squad” is needed to ensure someone is almost always nearby who is willing to help.2 But less than five per- cent of the U.S. public is formally trained in CPR due to time and cost barriers, among other reasons. And only about one-quarter of SCA victims receive bystander CPR in public. There are many reasons for this persistently low CPR rate, but here are some of the biggest barriers:
Widespread public perception that only formal- ly trained people, with a valid course completion card, are permitted to try CPR. This perception is created by AED laws (see below), training organiza- tions, lawsuits, social media, etc., and dramatically reduces the number of people who might otherwise try to help.
Difficulty recognizing SCA. Upwards of 50 per- cent of trained and untrained bystanders fail to accu- rately identify SCA and start CPR. This is not surpris- ing since a SCA situation is one they may encounter perhaps once in a lifetime.
Persistent concerns about legal liability. As an ex- pert witness in SCA lawsuits where CPR is not started, I see first-hand how real the liability risk is and why many bystanders remain fearful of helping, a sentiment that is not likely to wane in our highly litigious society.
Another giant barrier is created by AED laws in 30+ states that require formal CPR training for volunteer lay-bystanders in public access AED programs. While these requirements have little impact on AED program preparation or performance, they dramatically increase the cost of having AEDs and contribute to the percep- tion that current training is a precondition to being al- lowed to perform CPR. This is particularly true when the training requirement is linked to the availability of Good Samaritan legal protections.
Bottom line: The current emphasis on formal, in- structor-led, course completion card-based training, coupled with other barriers to success, leaves most SCA victims without a potentially life-saving inter- vention they desperately need.
Reimagining CPR Training
for Meaningful Impact
So, how do we create a large-scale SCA responder squad that gets more people to learn and do CPR?
8 Occupational Health & Safety | JANUARY/FEBRUARY 2020
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