Teaching Cardiopulmonary Resuscitation in the Schools Stephen W. Carveth, MD
INTRODUCTION The most common serious medical emergency in the United States today is sudden death from a heart attack. The American Heart Association estimates that more than one million people have a heart attack each year; and approximately 650,000, or more than half, prove to be fatal. About 350,000 of these deaths occur outside the hospital, usually within two hours after the onset of symptoms. Sudden death from heart attack is certainly the most prevalent medical emergency today. I Studies indicate that many of these deaths could be prevented by prompt, appropriate action. Many times a friend, relative or bystander is present but may not be trained to help. Estimates from studies performed in Sweden and elsewhere suggest that when the bystander recognizes the nature of the emergency and is prepared to treat the person with sudden respiratory or cardiac arrest, the victim has a greater than 50% chance of survival. 2-4 When the bystander is not prepared, the victim has less than a 20% chance. The bystander, therefore, is the key to life support for the victim of a heart attack until emergency medical services arrive. A bystander trained in cardiopulmonary resuscitation (CPR) can provide this basic life support. WHAT IS CARDIOPULMONARY RESUSCITATION? Cardiopulmonary resuscitation is a key part of emergency cardiac care which includes all the following elements: 1. Recognition of early warning signs of heart attacks, prevention of complications, reassurance of the victim, and transportation to a life support unit without delay. 2. Provision, when necessary, of immediate basic life support at the scene. 3. Provision of advanced life support as quickly as possible. 4. Transportation of the stabilized victim for continued cardiac care. APRIL 1979
Basic life support is a procedure that consists of recognition of airway obstruction, cardiac arrest and the proper application of CPR. This includes the ABC steps of cardiopulmonary resuscitation. m4*) A = kmav ~~
\
Artificial ventilation
)
)
B = Breathing c = Circulation /Artificial circulation
Opening the airway and restoring breathing are the basic steps of artificial ventilation. These steps can be performed quickly without equipment or assistance from another person. The most important factor for successful resuscitation is the immediate opening of the airway. This can often be accomplished by tilting the victim’s head backward as far as possible. Sometimes this action is all that is needed to restore breathing. If the victim does not resume breathing, resuce breathing must be started. Mouth-to-mouth and mouth-to-nose breathing are types of artificial ventilation. Absence of the pulse is the sign indicating that artificial circulation must be started. Artificial circulation is accomplished by means of external cardiac compression. The skills needed to master the technique of basic CPR are not difficult but do require an orderly approach under the guidance of a trained CPR instructor. It is most appropriate for this instruction to start during the school years.
ROLE OF THE SCHOOLS A number of communities throughout the United States have developed CPR training programs in the schools. These programs include sessions on healthful living habits, methods for activating the local emergency medical system or getting family or friends to the nearest emergency room, and ways of assisting families in establishing an emergency cardiac plan for the community, if none exists. Students also master the THE JOURNAL OF SCHOOL HEALTH
223
mechanical skills for performing CPR. They learn how to perform two-rescuer CPR and how to identify cardiac arrest. Students can motivate parents, friends and relatives to take courses in CPR. As each community develops its own emergency plan, students may discover special needs in their community and bring them to the attention of community leaders. A 1973 conference on standards for CPR and Emergency Cardiac Care cosponsored by the American Heart Association, the National Academy of Sciences, National Research Council, and the American Medical Association recommended that CPR be taught to the general public and integrated into the school systems as soon as possible. Studies conducted with respect to the training of the general public indicate a need for reinforcement of learning, especially the motor skills involved in CPR. The school system can certainly meet these needs. The 1973 conference recommended that CPR be taught in the eighth grade and reviewed in each grade thereafter to reinforce this learning. It has been estimated that over 5% or 12 million Americans know CPR. Results of the Gallup Poll indicated that more than 80% of the people interviewed who were familiar with CPR believed that CPR should be taught in the school system. The school system has the educational specialty of training large numbers of people. These programs can be supported with visual aids, national standards and materials from the American Heart Association.
’
ROLE OF THE AMERICAN HEART ASSOCIATION The American Heart Association has pioneered CPR standards and has a unique role in assisting communities and schools in providing basic cardiac life support training. A recent survey of AHA Affiliates in all 50 states indicated that 75% have some form of CPR school program, ranging from the presentation of a single course within a school system to a comprehensive plan. Your local Heart Association can: 1. Provide standards and teaching aids. These teaching aids are being updated and further developed continually. 2. Qualify and certify teachers through special courses. 3. Contact school administrators and community leaders to guide in the development of school training programs. 4. Make national data, statistics and training materials available. 5 . Work with community agencies to provide funds for training aids. 224
THE JOURNAL OF SCHOOL HEALTH
Your state Affiliate can: 1. Work with the state health and education departments to provide curriculum guidance. 2. Organize special courses. 3. Work with the state emergency medical system to provide training aids and expertise. 4. Develop model and pilot programs and guidelines. 5 . Work with state educational organizations to provide workshop seminars. 6. Conduct training sessions to qualify teachers as instructors. w ’ ) The National Center of the American Heart Association in Dallas, Texas, provides guidance to the state Affiliates. At the present time, a committee of educators is developing materials specifically for teaching CPR in the schools. Five percent of our total population are students in grades 9-12. If all graduating seniors were trained in CPR, we could increase our cadre of trained bystanders by 5% each year. With this important countrywide CPR training program in action, the national statistics of 450,000 persons who die annually of sudden respiratory or cardiac arrest possibly could be reduced to less than 250,000 persons. Stated more positively, when all school systems develop CPR training programs according to the American Heart Association standards and when all communities have emergency medical service systems, we could save more than 250,000 per year who develop sudden cardiac or respiratory arrest. Because life is so precious and because lives can be saved when the bystander knows CPR, let us individually accept the challenge to introduce CPR training into our school systems. REFERENCES
I . American Heart Association: Hew? Facts 1979, p 17. 2. Lund I, Skulberg A: Cardiopulmonary resuscitation by lay people. Lance? 2(7988):702-704, 1976. 3. Baum RS, Alvarez H, Cobb LA: Survival from out-of-hospital ventricular fibrillation. Circulation 50:1231-1235, 1974. 4. Carveth SW: Stadium resuscitation (A life support unit). In Stephenson HE (ed): Cardiac Arrest and Resuscitation. St. Louis, C.V. Mosby, 1974, ~ ~ 6 2 5 - 6 3 3 . 5. Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). Supplement to the JAMA 227:838, 1974. 6. Britton RJ: CPR in the schools. Synergkr 6:9-10, 1978. 7. The Gallup Poll. June 30, 1977.
Stephen W. Carveth, MD, Chairman, Working Group on CPR in the Schools, American Heart Association, National Center, Dallas, TX; Past chairman, AHA Subcommittee on Emergency Cardiac Care; Chairman, AHA Working Group on CPR in the schools; cardiovascular and thoracic surgeon, 5440 South Street, Suite 1200, Lincoln, NE 68506. APRIL 1979
INTRODUCTION The most common serious medical emergency in the United States today is sudden death from a heart attack. The American Heart Association estimates that more than one million people have a heart attack each year; and approximately 650,000, or more than half, prove to be fatal. About 350,000 of these deaths occur outside the hospital, usually within two hours after the onset of symptoms. Sudden death from heart attack is certainly the most prevalent medical emergency today. I Studies indicate that many of these deaths could be prevented by prompt, appropriate action. Many times a friend, relative or bystander is present but may not be trained to help. Estimates from studies performed in Sweden and elsewhere suggest that when the bystander recognizes the nature of the emergency and is prepared to treat the person with sudden respiratory or cardiac arrest, the victim has a greater than 50% chance of survival. 2-4 When the bystander is not prepared, the victim has less than a 20% chance. The bystander, therefore, is the key to life support for the victim of a heart attack until emergency medical services arrive. A bystander trained in cardiopulmonary resuscitation (CPR) can provide this basic life support. WHAT IS CARDIOPULMONARY RESUSCITATION? Cardiopulmonary resuscitation is a key part of emergency cardiac care which includes all the following elements: 1. Recognition of early warning signs of heart attacks, prevention of complications, reassurance of the victim, and transportation to a life support unit without delay. 2. Provision, when necessary, of immediate basic life support at the scene. 3. Provision of advanced life support as quickly as possible. 4. Transportation of the stabilized victim for continued cardiac care. APRIL 1979
Basic life support is a procedure that consists of recognition of airway obstruction, cardiac arrest and the proper application of CPR. This includes the ABC steps of cardiopulmonary resuscitation. m4*) A = kmav ~~
\
Artificial ventilation
)
)
B = Breathing c = Circulation /Artificial circulation
Opening the airway and restoring breathing are the basic steps of artificial ventilation. These steps can be performed quickly without equipment or assistance from another person. The most important factor for successful resuscitation is the immediate opening of the airway. This can often be accomplished by tilting the victim’s head backward as far as possible. Sometimes this action is all that is needed to restore breathing. If the victim does not resume breathing, resuce breathing must be started. Mouth-to-mouth and mouth-to-nose breathing are types of artificial ventilation. Absence of the pulse is the sign indicating that artificial circulation must be started. Artificial circulation is accomplished by means of external cardiac compression. The skills needed to master the technique of basic CPR are not difficult but do require an orderly approach under the guidance of a trained CPR instructor. It is most appropriate for this instruction to start during the school years.
ROLE OF THE SCHOOLS A number of communities throughout the United States have developed CPR training programs in the schools. These programs include sessions on healthful living habits, methods for activating the local emergency medical system or getting family or friends to the nearest emergency room, and ways of assisting families in establishing an emergency cardiac plan for the community, if none exists. Students also master the THE JOURNAL OF SCHOOL HEALTH
223
mechanical skills for performing CPR. They learn how to perform two-rescuer CPR and how to identify cardiac arrest. Students can motivate parents, friends and relatives to take courses in CPR. As each community develops its own emergency plan, students may discover special needs in their community and bring them to the attention of community leaders. A 1973 conference on standards for CPR and Emergency Cardiac Care cosponsored by the American Heart Association, the National Academy of Sciences, National Research Council, and the American Medical Association recommended that CPR be taught to the general public and integrated into the school systems as soon as possible. Studies conducted with respect to the training of the general public indicate a need for reinforcement of learning, especially the motor skills involved in CPR. The school system can certainly meet these needs. The 1973 conference recommended that CPR be taught in the eighth grade and reviewed in each grade thereafter to reinforce this learning. It has been estimated that over 5% or 12 million Americans know CPR. Results of the Gallup Poll indicated that more than 80% of the people interviewed who were familiar with CPR believed that CPR should be taught in the school system. The school system has the educational specialty of training large numbers of people. These programs can be supported with visual aids, national standards and materials from the American Heart Association.
’
ROLE OF THE AMERICAN HEART ASSOCIATION The American Heart Association has pioneered CPR standards and has a unique role in assisting communities and schools in providing basic cardiac life support training. A recent survey of AHA Affiliates in all 50 states indicated that 75% have some form of CPR school program, ranging from the presentation of a single course within a school system to a comprehensive plan. Your local Heart Association can: 1. Provide standards and teaching aids. These teaching aids are being updated and further developed continually. 2. Qualify and certify teachers through special courses. 3. Contact school administrators and community leaders to guide in the development of school training programs. 4. Make national data, statistics and training materials available. 5 . Work with community agencies to provide funds for training aids. 224
THE JOURNAL OF SCHOOL HEALTH
Your state Affiliate can: 1. Work with the state health and education departments to provide curriculum guidance. 2. Organize special courses. 3. Work with the state emergency medical system to provide training aids and expertise. 4. Develop model and pilot programs and guidelines. 5 . Work with state educational organizations to provide workshop seminars. 6. Conduct training sessions to qualify teachers as instructors. w ’ ) The National Center of the American Heart Association in Dallas, Texas, provides guidance to the state Affiliates. At the present time, a committee of educators is developing materials specifically for teaching CPR in the schools. Five percent of our total population are students in grades 9-12. If all graduating seniors were trained in CPR, we could increase our cadre of trained bystanders by 5% each year. With this important countrywide CPR training program in action, the national statistics of 450,000 persons who die annually of sudden respiratory or cardiac arrest possibly could be reduced to less than 250,000 persons. Stated more positively, when all school systems develop CPR training programs according to the American Heart Association standards and when all communities have emergency medical service systems, we could save more than 250,000 per year who develop sudden cardiac or respiratory arrest. Because life is so precious and because lives can be saved when the bystander knows CPR, let us individually accept the challenge to introduce CPR training into our school systems. REFERENCES
I . American Heart Association: Hew? Facts 1979, p 17. 2. Lund I, Skulberg A: Cardiopulmonary resuscitation by lay people. Lance? 2(7988):702-704, 1976. 3. Baum RS, Alvarez H, Cobb LA: Survival from out-of-hospital ventricular fibrillation. Circulation 50:1231-1235, 1974. 4. Carveth SW: Stadium resuscitation (A life support unit). In Stephenson HE (ed): Cardiac Arrest and Resuscitation. St. Louis, C.V. Mosby, 1974, ~ ~ 6 2 5 - 6 3 3 . 5. Standards for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). Supplement to the JAMA 227:838, 1974. 6. Britton RJ: CPR in the schools. Synergkr 6:9-10, 1978. 7. The Gallup Poll. June 30, 1977.
Stephen W. Carveth, MD, Chairman, Working Group on CPR in the Schools, American Heart Association, National Center, Dallas, TX; Past chairman, AHA Subcommittee on Emergency Cardiac Care; Chairman, AHA Working Group on CPR in the schools; cardiovascular and thoracic surgeon, 5440 South Street, Suite 1200, Lincoln, NE 68506. APRIL 1979
