Resuscitation 85 (2014) 1769–1774
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Simulation and education
Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR夽 Jan Stroobants a,∗ , Koenraad G. Monsieurs b , Bart Devriendt a , Christa Dreezen c , Philippe Vets a , Pierre Mols d a
Emergency Department, ZNA Middelheim Hospital, Lindendreef 1, B-2020 Antwerp, Belgium Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium c Business Intelligence Department, Ziekenhuis Netwerk Antwerp, Lange Beeldekensstraat 267, B-2060 Antwerp, Belgium d Emergency Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, Boulevard de Waterloo 129, B-1000 Brussels, Belgium b
a r t i c l e
i n f o
Article history: Received 25 June 2014 Received in revised form 6 October 2014 Accepted 15 October 2014 Keywords: Attitude Bystander CPR Education Schoolchildren Training
a b s t r a c t Introduction: We investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR. Methods: In 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children. Results: A total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n = 822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P < 0.001). For every child-instructor 1.7 people changed their attitude towards BCPR positively. Conclusions: Instructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction A change in attitude to learn and to perform more bystander CPR (BCPR) is of major importance to save lives.1–6 Although not very well quantified, some authors even believe that this change in behaviour towards BCPR could save more lives than fine-tuning the Basic Life Support (BLS) guidelines7 and the training level of the rescuer.8 Around communities, the willingness to be educated in BLS and to provide BCPR varies extremely.9,10 Simplifying BLS instructions towards cardiac compression alone seems to enhance
夽 A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.10.013. ∗ Corresponding author. E-mail address: [email protected] (J. Stroobants). http://dx.doi.org/10.1016/j.resuscitation.2014.10.013 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
the willingness to perform bystander CPR.11–14 Many attempts have been made to change the attitude by television campaigns,15 dispatcher-assisted CPR campaigns,16 or by training specific target groups.17 Previous CPR-training seems to have a positive impact on attitude,18 even when this training is limited to educational videos,19 with a positive effect of regular repetition.20 Involving schoolchildren as teachers to achieve a change of attitude in their environment towards behavioural issues is an effective strategy in chronic conditions such as obesity or asthma.21,22 Relatives and friends have a natural interest in what their beloved children learn at school, even when they are not familiar with it themselves. That could be a stimulus to pick up or repeat important messages. The primary endpoint of the current study was to investigate the impact on the attitude to perform BCPR of supporting schoolchildren to become the BLS teacher of their relatives and friends. We expected a general
1770
J. Stroobants et al. / Resuscitation 85 (2014) 1769–1774
improvement of attitude towards BCPR after the training by the child. In many countries, there is not only a natural difference in interest and attitude between primary and secondary schoolchildren, but also a difference in school environment (i.e. one single teacher in primary school versus many teachers for different topics in secondary school). Therefore, we expected that the school level could have an impact on the change of attitude of the trainees as well as on the knowledge transfer, but we did not know whether this would be in favour of primary or secondary school trainees. The secondary endpoint was to investigate whether there were differences in impact on attitude and knowledge between trainees of primary and secondary schoolchildren or not.
2. Materials and methods In 2012, the city authorities as well as the schools, classes and parents of all 8.000 last year of primary schoolchildren and first year of secondary schoolchildren of the city of Antwerp (Belgium) were intensively informed through the school media about the goal of the study. Schools registered for this education programme received an individual package for each child (age span 11–13 years), containing a personal noncommercial low cost training manikin (Minipop),23 constructed by the investigators, an instruction video produced by the investigators and additional information. The 30 min instruction video with a cardiac arrest scenario, only focused on recognition of cardiac arrest, activation of the Emergency Medical Services-system and chest compressions, not on the use of Automated External Defibrillator nor on rescue breathing. A link towards a motivating instruction video with a youth idol was provided through social media.24 Additional CPR instructors (all emergency physicians) were provided at the request of the class teacher if they felt uncomfortable about teaching the right techniques. This support was given directly to the teacher himself and not to the children. The teachers trained their children using the video as a guide. The children were invited to take their personal package home and to instruct their relatives and friends, but without specific instructions about the choice of their trainees; they could choose to instruct anyone in their environment. Finally, the trainees of the children were motivated by the children to participate in a web survey and a theoretical test about their knowledge after they had received the CPR-instruction (see Table 1). Every manikin had its own ID and was linked to his owner (child-instructor, class, school). The participants used this manikinID in the identification procedure, in order to link the results of the survey and the test with the characteristics of the child-instructor. The registered characteristics of the child consisted of their school level (primary or secondary) and whether the class teacher was assisted by a professional or not. The registered characteristics of the trainee consisted of their relationship to their child-instructor, gender, their attitude towards BCPR before and after the instructions by the child, whether they had received CPR training in the past, their opinion on the used methodology to involve schoolchildren in this BCPR promotion campaign, and a test. The test consisted of four multiple choice questions with four potential answers each of which one was correct. We tested on: (1) the phone number a witness of cardiac arrest should call, (2) the rate of chest compressions, (3) the right place on the chest to perform cardiac compressions and (4) the compression depth. There was one point per correct answer. To avoid “false inputs” in the web based survey and test, a number of controls were built in, such as time stampings, computer ip-stamping and email address checks. Only validated forms were used for statistical analysis. The chi-squared test and student’s ttest were used for descriptive analyses. Multivariate analyses were
Table 1 Trainee questionnaire. Choices Question Gender Before this training, would you have started BLS in case of cardiac arrest? Would you start BLS from now on in case of cardiac arrest? What is your relationship with your child instructor?
Did you receive any CPR training before this study?
Do you support the idea that children should receive CPR training at school? Do you support the idea that children should be motivated to give CPR training to their relatives and friends after they have learned this at school? Test question Which number should you call in case you see someone in cardiac arrest?
How many chest compressions per minute should you perform in case of cardiac arrest?
Where should you perform the chest compressions?
What is the correct cardiac compression depth for an adult victim?
Male Female Yes No Yes No Parent Grandparent Brother/sister Uncle/aunt Cousin Neighbour Acquaintance Unknown Yes,
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Simulation and education
Schoolchildren as BLS instructors for relatives and friends: Impact on attitude towards bystander CPR夽 Jan Stroobants a,∗ , Koenraad G. Monsieurs b , Bart Devriendt a , Christa Dreezen c , Philippe Vets a , Pierre Mols d a
Emergency Department, ZNA Middelheim Hospital, Lindendreef 1, B-2020 Antwerp, Belgium Emergency Department, Antwerp University Hospital, Wilrijkstraat 10, B-2650 Edegem, Belgium c Business Intelligence Department, Ziekenhuis Netwerk Antwerp, Lange Beeldekensstraat 267, B-2060 Antwerp, Belgium d Emergency Department, Saint-Pierre University Hospital, Université Libre de Bruxelles, Boulevard de Waterloo 129, B-1000 Brussels, Belgium b
a r t i c l e
i n f o
Article history: Received 25 June 2014 Received in revised form 6 October 2014 Accepted 15 October 2014 Keywords: Attitude Bystander CPR Education Schoolchildren Training
a b s t r a c t Introduction: We investigated the impact of Cardio-Pulmonary Resuscitation (CPR) instruction by children on the attitude of people to perform bystander CPR. Methods: In 2012, children from primary and secondary school (age span 11–13 years) received a free individual CPR training package containing an inexpensive manikin and a training video. After a CPR training session by their class teacher, they were invited to teach their relatives and friends. After the training, the trainees of the children were invited to participate in a web survey, containing a test and questions about prior CPR training and about their attitude towards bystander CPR (BCPR) before and after the training. We measured the impact on the attitude to perform BCPR and the theoretical knowledge transfer by the children. Results: A total of 4012 training packages were distributed to 72 schools of which 55 class teachers subscribed their students (n = 822) for the training programme for relatives and friends. After a validation procedure, 874 trainees of 290 children were included in the study. In comparison to trainees of secondary schoolchildren, trainees of primary schoolchildren scored better for the test as well as for a positive change of attitude towards future BCPR (P < 0.001). For every child-instructor 1.7 people changed their attitude towards BCPR positively. Conclusions: Instructing schoolchildren to teach their relatives and friends in Basic Life Support (BLS) led to a more positive attitude towards BCPR. The results were more positive with trainees from primary schoolchildren than with trainees from secondary schoolchildren. © 2014 Elsevier Ireland Ltd. All rights reserved.
1. Introduction A change in attitude to learn and to perform more bystander CPR (BCPR) is of major importance to save lives.1–6 Although not very well quantified, some authors even believe that this change in behaviour towards BCPR could save more lives than fine-tuning the Basic Life Support (BLS) guidelines7 and the training level of the rescuer.8 Around communities, the willingness to be educated in BLS and to provide BCPR varies extremely.9,10 Simplifying BLS instructions towards cardiac compression alone seems to enhance
夽 A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.10.013. ∗ Corresponding author. E-mail address: [email protected] (J. Stroobants). http://dx.doi.org/10.1016/j.resuscitation.2014.10.013 0300-9572/© 2014 Elsevier Ireland Ltd. All rights reserved.
the willingness to perform bystander CPR.11–14 Many attempts have been made to change the attitude by television campaigns,15 dispatcher-assisted CPR campaigns,16 or by training specific target groups.17 Previous CPR-training seems to have a positive impact on attitude,18 even when this training is limited to educational videos,19 with a positive effect of regular repetition.20 Involving schoolchildren as teachers to achieve a change of attitude in their environment towards behavioural issues is an effective strategy in chronic conditions such as obesity or asthma.21,22 Relatives and friends have a natural interest in what their beloved children learn at school, even when they are not familiar with it themselves. That could be a stimulus to pick up or repeat important messages. The primary endpoint of the current study was to investigate the impact on the attitude to perform BCPR of supporting schoolchildren to become the BLS teacher of their relatives and friends. We expected a general
1770
J. Stroobants et al. / Resuscitation 85 (2014) 1769–1774
improvement of attitude towards BCPR after the training by the child. In many countries, there is not only a natural difference in interest and attitude between primary and secondary schoolchildren, but also a difference in school environment (i.e. one single teacher in primary school versus many teachers for different topics in secondary school). Therefore, we expected that the school level could have an impact on the change of attitude of the trainees as well as on the knowledge transfer, but we did not know whether this would be in favour of primary or secondary school trainees. The secondary endpoint was to investigate whether there were differences in impact on attitude and knowledge between trainees of primary and secondary schoolchildren or not.
2. Materials and methods In 2012, the city authorities as well as the schools, classes and parents of all 8.000 last year of primary schoolchildren and first year of secondary schoolchildren of the city of Antwerp (Belgium) were intensively informed through the school media about the goal of the study. Schools registered for this education programme received an individual package for each child (age span 11–13 years), containing a personal noncommercial low cost training manikin (Minipop),23 constructed by the investigators, an instruction video produced by the investigators and additional information. The 30 min instruction video with a cardiac arrest scenario, only focused on recognition of cardiac arrest, activation of the Emergency Medical Services-system and chest compressions, not on the use of Automated External Defibrillator nor on rescue breathing. A link towards a motivating instruction video with a youth idol was provided through social media.24 Additional CPR instructors (all emergency physicians) were provided at the request of the class teacher if they felt uncomfortable about teaching the right techniques. This support was given directly to the teacher himself and not to the children. The teachers trained their children using the video as a guide. The children were invited to take their personal package home and to instruct their relatives and friends, but without specific instructions about the choice of their trainees; they could choose to instruct anyone in their environment. Finally, the trainees of the children were motivated by the children to participate in a web survey and a theoretical test about their knowledge after they had received the CPR-instruction (see Table 1). Every manikin had its own ID and was linked to his owner (child-instructor, class, school). The participants used this manikinID in the identification procedure, in order to link the results of the survey and the test with the characteristics of the child-instructor. The registered characteristics of the child consisted of their school level (primary or secondary) and whether the class teacher was assisted by a professional or not. The registered characteristics of the trainee consisted of their relationship to their child-instructor, gender, their attitude towards BCPR before and after the instructions by the child, whether they had received CPR training in the past, their opinion on the used methodology to involve schoolchildren in this BCPR promotion campaign, and a test. The test consisted of four multiple choice questions with four potential answers each of which one was correct. We tested on: (1) the phone number a witness of cardiac arrest should call, (2) the rate of chest compressions, (3) the right place on the chest to perform cardiac compressions and (4) the compression depth. There was one point per correct answer. To avoid “false inputs” in the web based survey and test, a number of controls were built in, such as time stampings, computer ip-stamping and email address checks. Only validated forms were used for statistical analysis. The chi-squared test and student’s ttest were used for descriptive analyses. Multivariate analyses were
Table 1 Trainee questionnaire. Choices Question Gender Before this training, would you have started BLS in case of cardiac arrest? Would you start BLS from now on in case of cardiac arrest? What is your relationship with your child instructor?
Did you receive any CPR training before this study?
Do you support the idea that children should receive CPR training at school? Do you support the idea that children should be motivated to give CPR training to their relatives and friends after they have learned this at school? Test question Which number should you call in case you see someone in cardiac arrest?
How many chest compressions per minute should you perform in case of cardiac arrest?
Where should you perform the chest compressions?
What is the correct cardiac compression depth for an adult victim?
Male Female Yes No Yes No Parent Grandparent Brother/sister Uncle/aunt Cousin Neighbour Acquaintance Unknown Yes,
