Data shows that high-quality CPR saves lives and the American Red Cross has developed a new resuscitation education suite that it says reduces time to competence with adaptive learning methods.


 

According to the American Heart Association (AHA) in 2016 there were more than 350,000 out-of-hospital cardiac arrests and another 209,000 occurred in-hospital.1 In 2018, heart disease and stroke were cited as the #1 and #5 causes of death, respectively.2 These statistics demonstrate the importance of resuscitation training for both healthcare professionals and the general public.

The first and only US training organization directly involved in the creation of resuscitation science and education, the AHA has been a global leader in developing official resuscitation guidelines used by all other US training providers and is committed to the integrity of its programs, training and responsible dissemination/reporting of scientific research, according to Monica Sales, AHA spokesperson.

“The Association is focused on continuous resuscitation quality improvement and improving resuscitation education to increase survival rates from cardiac arrest,” she said.

The AHA trains more than 23 million people globally every year by educating healthcare providers, caregivers and the general public on how to respond to cardiac arrest and first aid emergencies, Sales noted.

“We offer a variety of training delivery methods to meet the needs of learners, including instructor-led training, blended learning (a combination of an online component with a hands-on skills session), and eLearning,” Sales said. “For any American Heart Association course that includes psychomotor skills such as CPR, students must complete a hands-on training to obtain a course completion card.”

Resuscitation Suite

The American Red Cross has joined the AHA in the business of resuscitation training with the release of its Resuscitation Suite, which is based on International Liaison Committee on Resuscitation (ILCOR) science and Emergency Cardiovascular Care (ECC) guidelines. The curriculum also includes science from the American College of Critical Care Medicine and the American Academy of Pediatrics.

The suite is designed to deliver instruction and information on multiple platforms for basic life support (BLS), advanced life support (ALS) and pediatric advanced life support (PALS) and includes “Surviving Sepsis” and “Stop The Bleeding” campaigns as well as training for non-cardiac resuscitation. “The content is beneficial for core cardiac events and empowers healthcare professionals to address broader needs,” said David Markenson, MD, chief medical officer for the American Red Cross Training Services.

According to Markenson, there are two major educational differences between the new resuscitation suite and currently available training programs. “We pre-assess knowledge,” he said, which may result in shorter training time. Individuals who demonstrate competency forego basic cognitive learning and focus on scenarios with live health care providers. The fully blended model presents scenarios that “…lead in from a broad perspective to sepsis, bleeding, stroke and other non-cardiac related respiratory issues, so healthcare professionals are more comfortable with multiple medical situations.”

Additionally, the resuscitation suite addresses major non-cardiac events, including opioid overdose. Markenson noted that this training provides comprehensive recognition in how to intervene, determine if there’s a need to resuscitate and how to modify the approach.

One of the key components of the new training suite is flexibility. Students learn at their own personal pace as the cognitive segment is administered online, while the physical test takes place in person, Markenson indicated. “We also have a full instructor-led training and for students who are experienced there is a challenge option. We have multiple formats to meet the different needs of the students.”

Many civilian hospitals, EMS agencies, training centers and major hospital systems have adopted the new resuscitation suite. The largest and earliest adopter was the Department of Defense (DOD), according to Markenson.

Meeting Military Needs

Colonel Christine Kress, USAF, deputy, Education and Training, Defense Health Agency, explained that Military Health Services and the DOD adopted the new curriculum because of its improved educational design and delivery method for their providers. “What we found really exciting was the opportunity to adapt the training to the students’ needs,” she said. Students can take the training where it meets their needs and not necessarily in the classroom setting, she added.

Another favorable aspect of the Red Cross suite is the ability for providers who use skills frequently and are proficient to test out of the computer-based training. “They can just take the test and come in to demonstrate their skills for us,” Kress said. “Providers have been asking for a long time for different ways to be educated and the Red Cross curriculum met us where we are and where we’re going in the future.”

Kress pointed out that the science on which the Red Cross based its training program is particularly important for military providers as it incorporates knowledge from tactical combat casualty care, including the latest approach to hemorrhage control and trends in tranexamic treatment.

To date, 7,000 instructors have bridged to BLS; 1,377 to ALS; and 322 to PALS, according to Kress. She added that 19,163 students have completed the CPR/AED training, using the Red Cross program; ALS and PALS courses will begin April 1. “We have transitioned to the American Red Cross and no longer will use American Heart Association after March 31,” she said.

Engaging Users

The Red Cross worked with HealthStream to create the resuscitation suite. Luther Cale vice president of HealthStream’s Resuscitation Solutions, reported that HealthStream’s role was to bring choice, innovation and best prices to the project.

Cale noted that current resuscitation training utilizes a significant number of illustrations and animations. He cited data suggesting that users, half of whom are millennials, seek engagement. “We thought video would be a better fit. Real doctors, nurses and technicians demonstrate the necessary skills,” he said. “For instance, pediatric resuscitation takes place in a children’s hospital complete with a crash cart. It’s a realistic learning environment. This suite promotes critical thinking and problem solving.”

The entire suite is accessible on any computer, tablet, or mobile device at the student’s convenience and the materials are ADA compliant, Cale explained, adding that the American Association for Respiratory Care approved the Red Cross ALS training for 6.5 contact hours for RTs and PALS for 6.0 contact hours.

Training Evolution

While the general public might believe that only paramedics, respiratory therapists, nurse and doctors doing advanced CPR can make a difference, Captain Steven C. LeCroy (Ret), MA, CRT, EMTP, director of EMS Sales at Mercury Medical, disagrees. He emphasized the significance of involving community. “You can’t rely only on paramedics. Response times take a while. It’s important to start CPR as soon as possible,” he said. With community-based programs, such as bystander CPR, more individuals will be prepared to step in during an emergency situation. “Positive outcomes—that is, survival—relies on resuscitation policy and training,” he said.

LeCroy added that having two resuscitation training options presents healthy competition. “The Red Cross uses adaptive training, which means they adjust the training to the response. The American Heart Association does structured lecture for participants. There is no proof that one method is better than the other, although the Red Cross believes [its technique] will have better outcomes,” he said.

The Red Cross option to forego the online instruction if already competent does appeal to LeCroy. “If you are up to speed, you can test out. This saves time. Instead of four-hour testing, you can be in and out in one hour. It also saves on cost,” he said, pointing out that this option is not available to those seeking certification for the first time.

As resuscitation training is moving to an online platform, veterans like LeCroy—he’s been a paramedic for 35 years and an RT for 40—find the change somewhat challenging. “In Florida you can do all recertifications online so there’s no need for live lectures,” he said. “But some things you need to see in person. And not every student performs well online.”

Both the Red Cross and American Heart Association continue to use manikins as part of the course work, which provides feedback on compression depth, rate of ventilation and other important measures, according to LeCroy. He noted that manikins in the early 70s/late 80s initially produced a printout so participants could see the results, but had been replaced with inexpensive, unrealistic plastic dolls that offered no feedback. “Manikins now are more sophisticated. They are used especially for advanced staff. They’re hooked up to computers. You learn better when you get feedback,” he said.

When Adam Marden, RRT, EMS Operations Manager at Susquehanna Valley EMS in Pennsylvania, underwent resuscitation training, the bulk of his coursework took place inside the classroom and consisted predominantly of lecturing. “This was most beneficial for the person who hadn’t taken the course yet,” Marden said.

Although the Red Cross’ new training techniques have found favor with several providers, Marden still prefers classroom teaching and hands-on learning. He admits that the online option enables the student to work at his or her own pace yet they could miss important lessons with virtual teaching. “Students could put on a video and walk away,” he said.

Quality Approach to Lifesaving

Kress asserted that learning resuscitation techniques is quite literally an exercise in lifesaving. “We use [resuscitation] to keep people alive when their bodies are trying to shut down. No matter the disease process or injury that caused someone to stop breathing or caused their heart to stop beating, even the best doctors in the world can’t solve the problem if we can’t keep the patient alive long enough to receive treatment,” she said. “These are some of the most important skills medical providers can have. This transition to the American Red Cross ensures for us that providers have the right skills to be able to save patients.”

According to Douglas F. Kupas, MD, EMS and Emergency Room physician, and member of the National Association of State EMS Officials (NASEMSO), significant effort has been put into this program and major health care provider groups are beginning to use it. “Other places are adopting this as their training modality and I suspect that states and local medical directors to ensure competency and quality will turn to this program,” he said. “I think it’s a unique and quality approach that will add to the competency of providers that do resuscitation.”

The core role of the American Red Cross is to train healthcare professionals, according to Markenson. “This has been our mission for more than 100 years,” he said. “The new suite is a natural extension of that initiative to improve human life and reduce suffering.” RT


Phyllis Hanlon is a contributing writer to RT. For more information, contact [email protected]


References

  1. CPR Facts and Stats. American Heart Association Inc. Heart.org. https://cpr.heart.org/AHAECC/CPRAndECC/AboutCPRECC/CPRFactsAndStats/UCM_475748_CPR-Facts-and-Stats.jsp
  2. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm