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Thursday, January 20, 2011

The AHA Scores A Bullseye!

I rejoice in the AHA's recommendation that all State Legislatures pass legislation requiring middle and high school students learn CPR in school.

At the same time, I would argue that the legislatures would benefit from additional guidance, and I would urge the AHA to provide some specific guidance to those legislatures in order to maximize the impact an minimize the unintended consequences of this wonderful initiative. I respectfully suggest that the guidance address the following:

Background: SLICC is a presence in the public school system, the parochial school system, and in several private schools in Chatham County and in South Georgia. SLICC has been teaching CPR, AED use, the Heimlich maneuver, and stroke recognition to students ranging from fifth grade through 12th grade for several years. The course takes less than one hour. The students are given a test during the week before the class and they are given the same test during the week following the test. The pre-test tells us where were are starting. The post test tells us how well we did our teaching job. Here is what we have learned:
    1. With some exceptions, fifth and sixth grade students are often without the physical strength or emotional maturity to adequately benefit from the experience.
    2. Middle school students are quite capable of absorbing the material, but by the eighth grade, it is best to segregate the classes by gender, if you hope to have anything approaching their undivided attention.
    3. Toward the end of the hour, the eyes start to glaze over, and the attention wanders. There is no question in my mind that running a longer class would be a waste of everyone's time.
    4. Communication is enhanced by using blunt, accurate language and by relating the material to the students' family and friends.
    5. There is, in general, a great deal of confusion in most students' minds with respect to the difference between a heart attack, a stroke, and a cardiac arrest.
    6. What the students see on TV represents the foundation of their medical education. (Thank you, Hollywood.)
I sincerely hope that all the legislatures do pass the legislation requested. What I fear is that the legislators will write the bills in terms of certificated courses - normally a three and one half hour ordeal. The negatives associated with this are:
    1. As Drs. Roppollo, Pepe et al. showed in 2007 (Resuscitation (2007) 74, 276-285)) a thirty minute treatment of CPR and AED use is as good as (CPR) or better than (AED) the traditional certification class. There is no good to be gained by taking three and one-half hours to accomplish what can be covered in a far shorter time.
    2. The choking / stroke recognition portion of the course is roughly as important in terms of preventing death and disability as is the CPR and AED segment and could be included without exceeding the normal class length.
    3. Scheduling a three and a half hour session for each student will be a significant burden on the individual schools.
    4. Certification courses are not without cost: if nothing else, the cost of the card must be paid.
    5. Remember that the application of the skills learned by the students will be primarily as Bystanders. Please require that they teach a Bystander course, not a full CPR course. Those students who need certification for employment as baby-sitters, lifeguards, and the like can still take those mandated courses from the AHA or ARC.
Specifically, what I am urging is that the committee that made the "required in the schools" recommendation go one step further. I am asking that the recommendations specify that the course to be taught be a bystander course that includes CPR, AED use, choking emergencies, and stroke recognition. I would further suggest that they develop such a course and make it available to all the schools for no more than the cost of producing, reproducing, and mailing the DVD. I would also urge that the recommendation be expanded to include suggested training cycle definitions that would result in providing courses every year with attendance staggered so that every new student in the school is trained in the year of their entrance and that every student in the school is trained every other year. The students' ability to retain what they learned is not the issue. Rather, as the students mature, they will get different insights from the same material, Further, if history is any guide, the guidelines will continue to evolve through the period a student passes through middle and high school, and they should benefit from that improvement.

I sincerely hope that this initiative succeeds. The volunteers at SLICC would like nothing more than to be able to withdraw from the battle as the school systems take over. We have plenty to do to keep us busy.

Bob Trenkamp