To save lives, increased CPR training and public access to AEDs needed

For best results dispel fear of AEDs and encourage hands-on CPR education

Although more and more people are beginning to learn cardio-pulmonary resuscitation, not enough have mastered this skill, states John Mouw, technical training supervisor for Baptist Health in Miami.

If someone were to experience sudden cardiac arrest on a city street and 10 bystanders came to help, probably none would know CPR, he says.

Yet the American Heart Association (AHA) has developed researched-based curriculum for training people in CPR and also has gathered statistics on the effectiveness of CPR. (See guidelines.)

When CPR is not administered following sudden cardiac arrest the victim's chance of survival drops 7% to 10% for every minute of delay before defibrillation.

According to the AHA, 95% of sudden cardiac arrest victims die before reaching the hospital. Why? Because few attempts at resuscitation are successful if CPR and defibrillation are not provided within minutes of collapse. Within four to six minutes following cardiac arrest brain death begins to occur if CPR and defibrillation are not administered.    

While it is important for the average citizen to learn CPR, the only effective treatment for cardiac arrest is the use of an automated external defibrillator (AED). CPR will buy time either for the ambulance to arrive or for someone to obtain an AED. Therefore when the 911 emergency call is made someone should get the AED at the same time, says Dana M. Layne, instructor for organizational development education at Ohio Health Corp. in Columbus.

That is why the AHA encourages public access defibrillation campaigns to inform people of the need for AEDs in public places.

The national average response time for medical crews is 10 minutes, explains Layne. In that time frame a person's survival rate is minimal when he or she has experienced cardiac arrest. However, with CPR the time frame is extended and if a bystander did CPR and defibrillation then the survival rate can jump to 75%.

"If defibrillation is utilized for sudden cardiac arrest within the first three to five minutes then survival is as great as 75% — that is an amazing statistic," says Layne.

When a person's chance of survival drops by as much as 10% for every minute that goes by without an electric shock administered by an AED if it takes the paramedics eight minutes to arrive the survival rate is 20%, calculates Mouw. "That is not very good," he adds.

Public access advised

To increase access to AEDs Baptist Health supports public access defibrillation programs. Recently the city of Miami obtained a grant to place AEDs in such public places as parks and Baptist Health will provide training and information to carry it out, says Mouw.

Deborah R. Belknap, RN, CDE, an instructor with Community Health Education Resources for Inland Northwest Health Services in Spokane, WA, chairs the Public Access Defibrillation Committee for the city. She has been an AHA basic life support instructor for more than 20 years.

The committee was formed to educate the public about the importance of AEDs and how easy they are to use.

Belknap says to demonstrate their ease of use when they were first introduced, AHA instructors grabbed a janitor from the hallway and had him walk to the mannequin, turn the AED on and administer the shock according to the machine's instructions. He had administered the first shock correctly within 90 seconds.

Mouw says AEDs are foolproof. The pads have a diagram of where to place them and once the machine is on it has self-prompts. For example, it instructs the person administering the electric shock to attach the electrodes. Once the machine analyzes the victim experiencing cardiac arrest it will charge if a shock is required and instruct the user to push the button with the flashing red light.

"There is no way to harm the victim because even if you misplace the electrodes the machine will recognize they are not placed right and not charge up. If there is no need for a shock, no matter how many times you hit the shock button, it cannot defibrillate because it will not charge," explains Mouw.

The mission of the citywide committee in Spokane is to get an AED in every public building, says Belknap.

However one of the biggest stumbling blocks in this campaign is the fear of being sued for using them. That's why the committee held a breakfast meeting for CEOs and safety officers of various companies at which a lawyer was the featured speaker. According to the lawyer there is more of a liability for companies that do not have an AED than for those who do. Belknap says one reason is that the automated machines will not shock a person who is not in cardiac arrest.

Mouw agrees. "It is difficult to get businesses to realize they won't get sued for using it but they might get sued for not having it," he says. He says a Good Samaritan law protects businesses when companies properly train staff in the use of the AED.

"There is much data that shows that AEDs and CPR combined will save a life. The trouble is getting enough people trained in its use," says Mouw.

Making training available

At Baptist Health families of cardiac patients who are at high risk are offered free CPR training. If the patient hasn't had an internal defibrillator placed inside their body staff suggest they purchase an AED. The cost is about $1,200.

In addition community outreach courses are offered regularly.

Ohio Health also offers community pediatric and adult CPR classes on a monthly basis. These include classes that provide credentialing and those that help people become familiar with CPR but don't offer certification. "There are a variety of classes based on the needs and experience of the audience. We really support the American Heart Association's mission, which is to train as many people as possible," says Layne.

Ohio Health also offers CPR training at its cardiac rehab center for cardiac patients and their family members. School outreach programs, which teach CPR to grade students, are offered as well.

It's best to hold public outreach classes on a Saturday or Sunday afternoon or evening because when people have worked all day their mind and physical stamina are not suited for the teaching, says Layne. They learn better when they are well-rested.

Best practice for CPR training is to show people a skill and then have them try it, says Layne. Once a step is mastered the class progresses to the next skill, tying everything together at the end. By the time a person leaves the class he or she will have a memory of what to do. About 80% of the class should be hands-on practice, says Layne.

"Practice is most important because if people don't do CPR correctly it is like they are not doing it at all. If you breathe into someone's mouth and his or her chest doesn't rise it is as if you didn't do it. If you push on a person's chest and you don't push deep enough and hard enough and straight down you can injure them and you won't pump any blood, which is the point of pushing on someone's chest," explains Layne.

To make sure everyone is able to practice there should be no more than eight students per instructor and classes work best when there are only six students per instructor, says Mouw. The idea is that people repeat the steps so many times CPR becomes routine, so a few months later they are still able to do it efficiently, he says.

Programs pushing public access to AEDs as well as CPR training throughout the general public are vital, says Layne.

"The more people who know CPR and are competent in responding to an emergency the more lives you are going to save," says Layne.


For more information on public access to AEDs and CPR training, contact:

  • Deborah R. Belknap, RN, CDE, instructor with Community Health Education and Resources, Inland Northwest Health Services, Spokane, WA. Phone: (509) 473-5439. E-mail:
  • Dana M. Layne, instructor organizational development education, Ohio Health Corp., Columbus, OH. Phone: (614) 566-9443. E-mail:
  • John Mouw, technical training supervisor, Baptist Health, Miami, FL. E-mail: