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Care Innovations A Novel, 5-Minute, Multisensory Training Session to Teach High-Quality Cardiopulmonary Resuscitation to the Public Alive in Five Lorrel E. Brown, MD; Wendy Bottinor, MD; Avnish Tripathi, MD, PhD; Travis Carroll, BA; William C. Dillon, MD; Christopher Lokits, AAS; Henry R. Halperin, MD, MA; Glenn A. Hirsch, MD, MHS
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early 350 000 people in the United States have out-ofhospital cardiac arrest (OHCA) each year.1 Initiation of bystander cardiopulmonary resuscitation (CPR) improves survival after OHCA; however, there is significant geographic variation in the rates of both bystander CPR and OHCA survival in the United States, as much as 5-fold.2 The disparate geographic survival from OHCA was deemed unacceptable by the Institute of Medicine, prompting a call for strategic efforts to educate and train the public in CPR.2 In response, the American Heart Association set the goal to increase the rate of bystander CPR nationally from 31% to 62% of cardiac arrests by 2020.3 Rates of CPR training in the United States are low (median 2.4% of population) and vary by community, with low-income, rural, and minority communities having disproportionately low rates of CPR training.4 The Institute of Medicine identified this low rate of training as a critical barrier to performance of bystander CPR, recognizing that “initiatives designed to increase bystander CPR must overcome existing barriers… and teach the technical skills necessary to perform CPR with confidence.”2 Traditional 4-hour CPR training is costly in terms of time and money, limiting the number of bystanders who are able to be trained by this method. Despite development of alternative CPR training methods, nationwide rates of both CPR training and bystander-initiated CPR remain low. No true gold standard exists for training the public in CPR that is efficient, effective, and leads to retention of CPR skills.
according to zip code, ranging from 0% to 100%, (Lokits, AAS, unpublished data, 2015; Figure [D]). The challenges faced locally reflect those faced nationally. Several barriers exist to increasing the number of lay-persons trained in CPR, including cost, length of training, and limited training classes. We developed a CPR training method that uses minimal resources and is, therefore, free of charge to the public. Most importantly, this training is short in duration (5 minutes) and engages participants via multiple sensory modalities, including hands-on practice.
Design and Implementation of the Initiative Our CPR training program, called Alive in Five, is a novel, 5-minute, multisensory CPR training suitable for implementation in a public venue. It has been demonstrated that learning and retention are improved via multisensory input.5 Therefore, the program Alive in Five engages subjects via multiple sensory modalities (Figure [A]): 1. Visual input (2-minute video) 2. Auditory input (Stayin’ Alive song) 3. Active live coaching 4. Tactile input (psychomotor practice) 5. Consolidation of learning. In this method, passers-by are recruited to learn CPR in 5 minutes. Participants watch a 2-minute Anytime CPR video created by the American Heart Association, which emphasizes a 2-step response to witnessing a person collapse: (1) call 9-1-1, and (2) push hard and fast in the center of the chest to the beat of the song Stayin’ Alive. After viewing the video, participants practice CPR on noninflatable Little Anne (Laerdal Corporation) mannequins while receiving active verbal coaching to achieve appropriate rate (>100 per min) and depth (>2 inches). After coaching, each participant then performs a timed, 1-minute round of CPR while listening to the song Stayin’ Alive. While other CPR training techniques combine 1 or 2 sensory modalities of teaching, we think the strength of Alive in Five lies in incorporating multiple sensory modalities into a streamlined training.
Goals and Visions of the Program The goal of this innovation was to increase the effectiveness and efficiency of public CPR training by creating and implementing a novel, brief, multisensory CPR training method, which we call Alive in Five.
Local Challenges in Implementation In Jefferson County, Kentucky, the rate of bystander CPR in 2015 was 15.4%, below the national average of 31%; additionally, there was striking disparity in bystander CPR rate
From the Division of Cardiovascular Medicine, University of Louisville School of Medicine, KY (L.E.B., W.B., A.T., T.C., G.A.H.); Baptist Medical Associates, Louisville, KY (W.C.D.); Louisville Metro Emergency Medical Services, KY (C.L.); and Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (H.R.H.). The Data Supplement is available at http://circoutcomes.ahajournals.org/lookup/suppl/doi:10.1161/CIRCOUTCOMES.116.003404/-/DC1. Correspondence to Lorrel E. Brown, MD, Division of Cardiovascular Medicine, University of Louisville School of Medicine, 201 Abraham Flexner Way, Suite 600, Louisville, KY 40202. E-mail
[email protected] (Circ Cardiovasc Qual Outcomes. 2017;10:e003404. DOI: 10.1161/CIRCOUTCOMES.116.003404.) © 2017 American Heart Association, Inc. Circ Cardiovasc Qual Outcomes is available at http://circoutcomes.ahajournals.org
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DOI: 10.1161/CIRCOUTCOMES.116.003404
2 Brown et al Alive in Five
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Figure. Alive in Five cardiopulmonary resuscitation (CPR) training technique is simple and effective. A, Alive in Five CPR training technique. B, CPR mannequins for active practice. C, Primary outcomes included chest compression (CC) rate per minute (median, IQR) and % CC at correct depth (median, IQR). D, Baseline rates of bystander CPR by zip code in Jefferson County, Kentucky, in 2015, with participants trained in each zip code.
State fair attendees were considered an important target audience for CPR training because (1) they represent a diverse population with regards to age, sex, and level of education; (2) attendance at the state fair is high, with daily foot traffic at our station averaging between 5000 and 8000; and (3) attendees travel from throughout the region, creating a geographically diverse population, including those from rural areas.
Implementation Alive in Five was first implemented at the Kentucky State Fair on August 20, 2015. Participants were recruited by study personnel in a health exhibit. In groups of 5, participants completed the brief, multisensory CPR training course as detailed earlier. The timed, 1-minute round of CPR was performed on a Little Anne mannequin equipped with CPR quality monitoring technology (TrueCPR, PhysioControl Inc.). This device silently recorded chest compression (CC) rate and percentage at appropriate depth.
Success of the Initiative We trained 152 adults (≥18 years.) and 66 minors (
