Make CPR training part of family safety measures

Learned skills can be refreshed in case of emergency

Training in cardiopulmonary resuscitation is the ultimate "homeland security," says Vinay Nadkarni, MD, a spokesperson for the American Heart Association (AHA) and medical director of the Center for Simulation, Advanced Education and Innovation at Children's Hospital of Philadelphia.

People tend to think of homeland security in terms of terrorist attacks, yet the most likely catastrophe is sudden cardiac arrest. "People can be prepared for this with the ultimate homeland security — and that is CPR training," says Nadkarni.

While knowledge of the steps for CPR is important for all people to learn, the skill is especially important for parents, because breathing cessation, difficulty breathing, or blocked breathing is the primary cause of cardiac arrest in young children and infants, adds Nadkarni.

There are two important elements of preparing for an emergency that would require CPR, according to Nadkarni. The first is the initial training, and the second is practice. Families often do fire drills once or twice a year to plan an escape route and make sure fire extinguishers and smoke detectors are working. Steps for responding to a medical emergency could be incorporated in their fire safety drills, says Nadkarni. This would cover what to do if one of their children choked or collapsed and wasn't breathing.

It is especially important for parents with children who are at a higher risk for emergencies requiring CPR to be prepared, says Nadkarni.

That's why classes are offered on the neonatal intensive care unit at the Fairview Riverside Campus in Minneapolis at 10 a.m. on Tuesdays and Thursdays and at 9 a.m. on Saturdays. Additional classes are added if needed, including special classes for non-English-speaking families who need an interpreter. The instruction is given by nurses from the patient learning center, all of whom have advanced CPR training. The instructors follow the American Heart Association guidelines and use manikins to practice the skills.

Along with CPR, nurses cover what to do for choking and give practical examples of what to do for various emergency scenarios.

"The purpose of our class is to promote a safe discharge at a time of tremendous stress for these families. Finding the time to seek out a community class after discharge may be too overwhelming. That is why we offer this class before they go home. We want to be sure they know what to do in an emergency and that they have spent some time thinking through various scenarios," explains Nancy Goldstein, MPH, FAHCEP, patient education program manager, University of Minnesota Medical Center, Fairview and University of Minnesota Children's Hospital, Fairview, Minneapolis.

Family CPR instruction also is part of a pediatric cardiology discharge class. Instruction is given at the patient learning center on the university campus, which is near the patient care units. Classes are held on Tuesdays and Thursdays at 1 p.m., but individual instruction can be scheduled if needed. The discharge care coordinators are instrumental in getting families and caregivers to the class, says Goldstein.

Families with infants in the NICU at Providence Sacred Heart Children's Hospital must complete a CPR class before their infant is discharged. It is offered every Friday at 2:30 p.m. and 4 p.m. through Community Health Education and Resources (CHER), a service of Inland Northwest Health Services, a nonprofit corporation in Spokane, WA, that works with its member hospitals.

Flexibility good for numbers

"We try to give parents plenty of opportunity to take a class before their baby goes home and to provide a set schedule for the nursing staff and the case managers in the NICU," says Emily Fleury, the health education manager at CHER.

She adds that CHER is very flexible and provides additional classes to accommodate a family who cannot attend the regularly scheduled classes. Also, interpreters join a class if parents do not speak English.

"The parents that are not in the NICU are also encouraged to attend a class by both the nurse in the hospital and the CHER educator who teaches them prepared childbirth," says Fleury. Also, literature about CPR classes is distributed at physician offices and at the hospital.

The inpatient classes on Fridays are mainly for parents with babies in the NICU. While other parents can attend, if it is inconvenient, they can enroll in a community class offered by CHER at a central location once a month. Monthly instruction includes "Friends and Family" pediatric CPR, "Heartsaver First Aid," and health care provider and renewal CPR classes.

In 2009, CHER taught 1,560 people in the Spokane area the skill of CPR. According to Fleury, courses approved by the American Heart Association are best for several reasons. The AHA has done studies to determine the most effective type of CPR and performs most of the research in this area. Also, she says, the organization sets rules for their instructors, such as the amount of practice time required in class, and has a system to monitor class quality, including how many people can be in a class. In addition, instructors are certified every two years, so they are up to date on the latest guidelines, says Fleury.

While CPR training is important, people should know that research shows skills drop in three to six months following training, says Nadkarni. "But their skills are rapidly refreshed by talking to a 911 emergency operator who walks them through it, or spending a few seconds seeing someone do CPR on an iPhone app, or looking at a poster. If they have never taken a course or been exposed to CPR, they don't feel confident," he adds.

People remember very little of the specifics of CPR, but the skill can be brought back very quickly once they have learned it, says Nadkarni.

What is important is for people to recognize a life-threatening emergency, know how to activate the emergency response system, and start CPR, he adds. A 911 operator should be able to call up the steps for CPR on a computer screen and talk people through it.

While posters, pamphlets, and smart phone applications are all good training tools, they tend to be difficult to follow in an emergency. It is difficult for people to read a poster and follow the directions when someone is dying in front of them, says Nadkarni. That is why it is good to prepare for an emergency in advance and use such tools as a way to refresh ones' memory, he adds.

In Seattle, a great push for CPR training has been made in recent years, according to Nadkarni. Therefore, if someone were to collapse in Seattle, there is a 60% chance that someone trained in CPR would be nearby.

"We don't want people to think everyone will survive with CPR, because that is not the case; but they can double and quadruple the chances for survival for their child if they know CPR," says Nadkarni.