A scientific statement from the American Heart Association (AHA) recommends that training in cardiopulmonary resuscitation (CPR) and familiarization with automated external defibrillators (AEDs) be required elements of secondary school curricula, and was published online Jan. 10 in Circulation.
Diana M. Cave, RN, from Vanderbilt University School of Nursing in Nashville, and colleagues on behalf of several AHA councils and committees, noted that 36 states have legislation, state department of education curriculum content standards or frameworks that refer to teaching CPR in schools; however, the implementation of such teaching programs varies greatly.
Only six states explicitly require CPR training courses that routinely include skills practice. In those states, schools are required to provide CPR training as part of the mandatory health education curriculum for all students. In the other 30 states, laws or curriculum content standards describe training expectations for students in a variety of less rigorous ways, according to the statement.
In the remaining 14 states and Washington, D.C., CPR training in schools is not mentioned in legislation or curriculum content standards. Only Massachusetts and Iowa have provisions in their laws that refer to funding for CPR training.
The three most prevalent barriers to teaching CPR in secondary schools, according to a survey of Washington state high schools, are time, funding and instructor training and scheduling.
Of the respondents that offered training in CPR, many incorporated it in health courses. In nearly half of schools that require students to perform community service for graduation, CPR training would fulfill that requirement. "Both strategies, alone or combined, are reasonable ways to efficiently include CPR training in the school curriculum," according to the AHA scientific statement.
To obtain funding, the authors of the statement noted that most of the states that mandate CPR training have "no commensurate allocation of funding to support those programs" and many schools look for community partners.
Regarding instructor training and scheduling, the authors said this barrier can be addressed by opting to use "outside" instructors for instructor-led training courses. "Outsourcing training to a commercial entity may or may not increase overall costs compared with maintaining the instructor status of some staff and faculty," they wrote.
The statement said it is reasonable to limit practice of adult CPR chest compression skills to children greater than 13 years old because of the physical nature of CPR and the importance of delivering high-quality compressions.
Automated external defibrillators
AEDs, which are now readily available in many public locations, are of little consequence if bystanders do not know how they function. "It is reasonable, then, that all CPR training should explain the purpose and basic function of an AED to all trainees regardless of age," the AHA researchers concluded.
The statement noted several studies attesting to the simplicity of AED use, even for "sixth-grade students who had no previous training with the use of an AED."
The AHA recommended the use of an AED or AED trainer when the CPR training is part of an overall response plan at a specific location where AEDs have been installed, including schools.
It also recommended that training programs that include AED skills emphasize reinforcing the skills of pad placement and clearing the patient (no physical contact) during the two critical stages of rhythm analysis and shocking.
The statement concluded by saying that CPR training and familiarization of AEDs be a requirement for graduation from secondary schools.