First Aid -- CPR Training in Schools

While often associated with medical personnel and health care professionals, First Aid/CPR training is becoming more commonplace in non-medical settings, including the community, workplace, and schools. Within schools, the importance of First Aid and CPR knowledge can be examined both from the perspective of teachers and administration and from the perspective of students. Interestingly, while the approach to teacher First Aid/CPR certification has been driven by school and district regulations, student participation in First Aid/CPR programs has been largely an initiative of community health groups, such as the American Red Cross or the American Heart Association, acting in partnership with local schools and teachers. Even Congress has taken notice of the growing importance of First Aid/CPR knowledge among America's students.

Keywords American Heart Association; American Red Cross; Automated External Defibrillator (AED); Cardiopulmonary Resuscitation (CPR); First Aid; Physical Education; School Health Policies and Programs Study (SHIPPS)

Overview

Cardiopulmonary Resuscitation, or CPR, is defined as a method of artificial respiration utilizing a combination of mouth-to-mouth breathing and chest compressions. A life-saving technique, CPR is used to restore blood circulation and prevent brain damage in breathing-injured or cardiac arrest victims. First Aid is the immediate emergency care given to a victim whose injuries may range from minor to severe, and the purpose of first aid is to treat immediate symptoms to minimize injury and long-term effects.

While often associated with medical personnel and health care professionals, First Aid/CPR training is becoming more commonplace in non-medical settings, including the community, workplace, and schools. Within schools, the importance of First Aid and CPR knowledge can be examined both from the perspective of teachers and administration and from the perspective of students. Interestingly, while the approach to teacher First Aid/CPR certification has been driven by school and district regulations, student participation in First Aid/CPR programs has been largely an initiative of community health groups, such as the American Red Cross or the American Heart Association, acting in partnership with local schools and teachers. Even Congress has taken notice of the growing importance of First Aid/CPR knowledge among America's students.

Applications

First Aid/CPR among Education Providers

School Health Policies & Programs Study (SHIPPS)

In 1994, the Centers for Disease Control and Prevention (CDC) of the United States Department of Health and Human Services (HHS) conducted its first School Health Policies and Programs Study (SHIPPS). This study was an examination of school activities and policies in the areas of health education, physical education, health services, food service, and certain other school health policies. Six years later, CDC followed with a second SHIPPS, this one more comprehensive than the first and covering eight specific areas of school health:

• Health Education,

• Physical Education,

• Health Services,

• Mental Health and Social Services,

• Food Service

• School Policy and Environment,

• Faculty/Staff Health Promotion,

• Facility and Community Involvement (Burgeson, Wechsler, Brener, Young, & Spain, 2003).

Data was collected from the classroom, school, and district levels, and the study included both public and private school districts and elementary, middle, and high schools. Moreover, the survey drew geographically from all fifty states and Washington, D.C.

On the state and district levels, the SHIPPS survey found that more than half of the states participating in the survey provided either funding or other development resources to train physical education staff in first aid. On the school level, the data was similar, with greater than half of the number of physical education coordinators receiving some sort of training in first aid administration. Similarly, classroom-level data indicated that at least one half of physical education teachers received training in first aid and injury prevention.

Reporting on specific job descriptions within the area of physical education, the study provided additional data on First Aid/CPR certification. Among interscholastic sports coaches on the state level, for example, 40% of states require that coaches be officially certified in first aid, and an equal percent require CPR certification. On the district level, the percentages were slightly higher, with 44.4% of districts requiring first aid certification among coaches and 41.3% requiring CPR certification. Finally, on the school level, percentages were higher still, with 51.3% of schools requiring first aid certification of their head coaches and 45.6% requiring CPR certification (Burgeson, Wechsler, Brener, Young, & Spain, 2003).

Recommendations for School Athletic Personnel

In early 2007, a National Athletic Trainers' Association-sponsored task force issued new recommendations regarding emergency preparedness among school athletic personnel. Specifically, the task force recommended the following six action steps designed to address school response to instances of sudden cardiac emergencies that occur on the athletic field:

• "Schools or institutions sponsoring athletic events must have a structured emergency action plan

• "The emergency action plan should be developed through discussions with local emergency medical service (EMS) Personnel, school safety officials, onsite first responders, and school administrators.

• "The emergency action plan must be specific to the sporting venue and include emergency communication, personnel, equipment, and transportation to appropriate emergency facilities.

• "The emergency action plan should be practiced annually.

• "First responders should be trained and certified in cardiopulmonary resuscitation (CPR) and defibrillation.

• "Access to early defibrillation is essential, with a target time of less than 3 to 5 minutes from the time of collapse" (O'Riordan, 2007).

Dr. Jonathan Drezner of the University of Washington in Seattle described the importance of this increased preparation:

Our athletic trainers are very often the first responder, the first-line health professional caring for our athletes, but they are not always around because many high schools might have only one trainer. There is no way they can cover all the sports, or be at all the practices….The real people that we need to train to recognize cardiac arrest are the people that are there everyday: our coaches, our teammates, or the officials. They need to be able to recognize cardiac arrest and initiate steps that have been predetermined in the emergency action plan (cited in O'Riordan, 2007)

With good reason, the purpose for First Aid/CPR training and certification among school physical education coordinators, teachers, and coaches has been to ensure their ability to respond to incidents of injury or emergency among the children in their care. Equal attention and emphasis, however, has traditionally not been given to preparing students to respond in emergency situations both inside and outside the classroom. This fact is changing, though, as a result of interest and initiative among teachers, community groups, and policy makers.

First Aid/CPR & Student Education

In 2006, a twelve-year-old boy was with his parents and eight-year-old brother in the food court at a shopping center in Oregon when the younger boy began to choke on a chicken bone. The quick-thinking older brother knew exactly what to do. Without hesitation, he went to his brother and performed the Heimlich maneuver - a series of abdominal thrusts - until the food dislodged from his throat.

This boy was one of more than 2,400 students at Monroe Middle School in Oregon who, over the past 14 years, have learned First Aid and CPR through a program taught in conjunction with the American Red Cross. The class is instructed by the physical education and health teacher, and students learn basic and lifesaving techniques ranging from handling cuts and burns to administering chest compressions (Taylor, 2006).

To equip students with first-aid and CPR skills, community health groups such as the American Red Cross and American Heart Association (AHA) have launched school-focused initiatives aimed at increasing the number of students who are educated in these life-saving techniques.

American Heart Association (AHA)

The American Heart Association offers schools several emergency training options ranging from awareness programs to official course certifications. The AHA's credentialed courses include both CPR and automated external defibrillator, or AED, trainings. Long unavailable in general public areas, AEDs are small devices that analyze the heart rhythm of an emergency victim. If the analysis shows that a problem exists that may be alleviated by an electrical shock, the AED delivers that shock on-site to the victim. Increasingly, AEDs are becoming standard equipment in public places, such as supermarkets, health clubs, airports, and schools.

In addition to credentialed training courses, the AHA offers non-credentialed awareness options, entitled "Family and Friends (tm) CPR" and "Family and Friends (tm) CPR Anytime (tm)" (CPR Training Programs for Schools, 2007). These options are available for those who wish to learn the skills of CPR but do not require a course completion card. The Family and Friends program is a video- and instructor-led, classroom based training course which focuses on teaching CPR and choking assistance skills for treating adults, children, and infants. Because the course is designed for a group learning environment, it is ideal for school settings, and in such settings, the course may be led by a facilitator (Family and Friends CPR, 2007).

The Family and Friends CPR Anytime program makes instruction in the life-saving skills of CPR even more easily accessible. Designed as a self-directed course, the Anytime Personal Learning Program Kit provides instructional materials and an inflatable practice CPR manikin and promises to deliver the basics of CPR training in only 22 minutes. The American Heart Association offers both the Family and Friends CPR and the Family and Friends CPR Anytime non-credentialed program, as well as the CPR and AED credentialed courses as options for schools wanting to provide their students with access to CPR training (Family and Friends CPR Anytime Personal Learning Program, 2007).

American Red Cross

Like the American Heart Association, the American Red Cross also offers several programs designed for use in school settings. Chief among these is the Red Cross's First Aid/CPR/AED for Schools and the Community. This comprehensive course utilizes video instruction, live lectures, demonstrations, and hands-on practice and participation to teach participants how to respond to emergency situations including cardiac and breathing emergencies, shock, and physical injury.

In addition to offering trainings, the American Red Cross proactively seeks to involve both students and teachers in emergency preparedness activities and promotion. Through the Red Cross's Youth Services, teachers are invited to partner with the Red Cross and incorporate Red Cross training materials in their classrooms. These partnerships can extend beyond teaching CPR and First Aid and expose students to other disaster preparedness techniques, and because the Red Cross organizes its course curriculum following National Education Standards, teachers can easily incorporate the instructional material into their classrooms. Available topics range from water safety to babysitting, but include several levels of first aid training as well as CPR/AED instruction.

While official classroom settings offer valuable opportunities for students to learn First Aid and CPR, the American Red Cross also encourages extracurricular youth involvement emergency preparedness and response. To this end, the Red Cross has established programs for Elementary School, Middle School, and High School Red Cross Clubs. These clubs not only participate in Red Cross service projects but also prove to be valuable points of entry for young individuals to learn First Aid, CPR, and AED techniques that can save lives.

Legislative Initiatives

The push to require CPR instruction for school students is not new. Nearly 30 years ago, Gerald M. Dworkin (1979) wrote that of the 700,000 fatalities in the United States caused by a heart attack each year, approximately 350,000 occur outside of the hospital. Furthermore, an additional 100,000 individuals die each year from accidents including drowning, poisoning, electrocution, and suffocation. Dworkin notes that approximately 20% of these deaths could have been preventable if the victims had received prompt CPR attention (Dworkin, 1979).

In 1973, the National Academy of Sciences, National Research Council, and American Heart Association joined in sponsorship of a conference on "Standards for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC)" The results of this conference were published in 1974 by the Journal of the American Medical Association, and they outlined several recommendations made for teaching CPR in schools. Specifically, Dworkin notes the following:

• "All school children should be required to have annual training in artificial ventilation beginning in the fifth grade.

• "CPR training [should] be given to all eighth grade pupils" (Dworkin, 1979).

Additionally, Dworkin cites a 1977 Gallup poll in which 80% of respondents supported requiring CPR instruction prior to high school graduation. Bases for the support included:

• The school system represents an ideal setting to teach CPR skills;

• Schools reach a larger portion of the population than other organizations;

• Schools occupy a position of confidence within the community;

• Young students absorb and retain information often more easily than adults;

• Interest and motivation among young people to learn CPR may be greater than among adults; and

• Students trained in CPR will potentially have more years of opportunity to utilize their skill than do individuals who learn CPR as adults.

Approximately 53 million students ages 5 to 17 attend our nation's 117,500 elementary and secondary schools (Burgeson, Wechsler, Brener, Young, & Spain, 2003). As a result, the sheer number of students attending our nation's public schools offers a unique opportunity for organizations such as the Red Cross or the American Heart Association to provide lifesaving instruction to more students than they would most likely otherwise encounter.

To implement school-wide CPR training programs effectively, Dworkin encourages cooperation between schools and the Red Cross or American Heart Association. He indicates that this is particularly important in order both to assure alignment with national training standards and to achieve protection under the law. To address the issue of funding, Dworkin notes that the cost inherent in program implementation could be met through community efforts, corporate sponsorship, or even local and municipal equipment loans. For example, he writes that groups such as the PTA or other local service organizations would most likely be amenable to contributing either funds or physical equipment toward the trainings. To meet the need for qualified instructors, Dworkin suggests that schools select several teachers to be trained by the partnering organization, be it the Red Cross or the American Heart Association. Dworkin closes his piece on an anticipatory note by writing, "Hopefully in the near future, all communities, large and small, will include within their school curriculums the four R's instead of the traditional three: readin', 'ritin', 'rithmetic, and resuscitation!" (Dworkin, 1979).

Despite Dworkin's support, successful national legislative action did not come quickly on the heels of his urging. Nevertheless, his cause was not indefinitely forgotten. In May of 2000, Congresswoman Lois Capps of California and Congressman Mark Foley of Florida introduced the Teaching Children to Save Lives Act, a bill which would authorize $10 million in federal funds over a two year period for the purpose of supplying equipment and teacher education in order to begin training students in cardiopulmonary resuscitation (CPR). The bill was the result of teacher interest, as teachers had indicated they would like to provide this skill to their students, but local school districts lacked available funding to support the equipment and instructor training required.

The bill garnered the support of such organizations as the Red Cross, the American Heart Association, and the National Education Association, but although it passed the Senate, its fate in the House was less positive, and it died in committee. Nevertheless, individual states remain free to implement statewide requirements regarding First Aid/CPR training in schools, and in 2006, New York State passed a law requiring that CPR and AED instruction be provided by certified instructors in senior high school health classes. Cooperative initiatives, such as those mentioned above between schools and outside organizations, continue to yield positive results. As a case in point, in 2006, New Brunswick, New Jersey announced the School Safety Initiative. A partnership between the American Red Cross of Central New Jersey, the New Brunswick Public Schools, DCH Auto Group, and the New Jersey Coalition of Automotive Retailers, the School Safety Initiative will bring Red Cross training programs, including CPR and First Aid trainings, to an estimated 2,700 New Brunswick students during the first two years following the announcement.

Conclusion

Whether private initiative or public requirement, the inclusion of First Aid and CPR training and certification for students, teachers, coaches, and athletes remains a vital component of encouraging prompt and skilled response to breathing and other emergencies. By equipping teachers and students with the knowledge necessary to provide prompt attention to emergency victims, schools and organizations can continue to work hand-in-hand towards the mission of saving lives.

Terms & Concepts

American Heart Association: National organization whose stated mission is "to reduce disability and death from cardiovascular diseases and stroke."

American Red Cross: National emergency response organization founded in 1881. The Red Cross operates in six main areas: domestic disaster relief; community services for the needy; military support for service members and their families; collection and distribution of blood and blood products; health and safety educational programs; and international development and relief.

Automated External Defibrillator AED: A device that analyzes the heart rhythm of an emergency victim; if the analysis shows that a problem exists that may be alleviated by an electric shock, the AED delivers that shock on-site to the victim.

Cardiopulmonary Resuscitation (CPR): A method of artificial respiration utilizing a combination of mouth-to-mouth breathing and chest compressions; a life-saving technique, CPR is used to restore blood circulation and prevent brain damage in injured victims.

First Aid: Emergency care given immediately to an injured or sick individual, usually before professional medical care arrives or becomes available; first aid may be given for injuries and conditions that are life-threatening or for minor cuts, bruises, or other injuries.

Physical Education: Education that focuses on physical activity as a means of gaining skills. Physical education addresses the health and care of the human body and may include, among other things, athletics, hygiene, fitness, and nutrition.

School Health Policies and Programs Study SHIPPS: A survey conducted by the Centers for Disease Control and Prevention (CDC) of the US Department of Health and Human Services (HHS); the survey examined health programs and policies in classrooms, schools, states and districts across the county and in the District of Columbia.

Bibliography

American Heart Association (2007). CPR training programs for schools - Empowering students to save lives. Retrieved April 16, 2007, from http://www.americanheart.org/presenter.jhtml?identifier=3040460

American Heart Association. (2007). Family and friends CPR. Retrieved April 16, 2007, from http://www.americanheart.org/presenter.jhtml?identifier=3040458

American Heart Association. (2007). Family and friends CPR anytime. Retrieved April 16, 2007, from http://www.americanheart.org/presenter.jhtml?identifier=3033740

American Red Cross. (2007). Youth services: Educators introduction. Retrieved April 16, 2007, from http://www.redcross.org/services/youth/0,1082,0_397_,00.html

American Red Cross. (n.d.) For your community. Retrieved April 16, 2007, from http://www.redcross.org/services/hss/courses/community.html

Burgeson, C., Wechsler, H., Brener, N., Young, J., & Spain, C. (2003). Physical education and activity: Results from the school health policies and programs study 2000. The Journal of Physical Education, Recreation & Dance, 74 , 19. Retrieved April 13 2007, from http://www.questia.com/PM.qst?a=o&se=gglsc&d=5002513150

Curran, V., Fleet, L., Greene, M. An exploratory study of factors influencing resuscitation skills retention and performance among health providers. An exploratory study of factors influencing resuscitation skills retention and performance among health providers.Journal of Continuing Education in the Health Professions, 32, 126-133. Retrieved December 10, 2013, from Education Research Complete, EBSCOhost. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=77327049&site=ehost-live

DeMaria Jr, S., Bryson, E., Mooney, T., Silverstein, J., Reich, D., Bodian, C., & Levine, A. (2010). Adding emotional stressors to training in simulated cardiopulmonary arrest enhances participant performance.Medical Education, 44, 1006-1015. Retrieved December 10, 2013, from Education Research Complete, EBSCOhost. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=62366437&site=ehost-live

Dworkin, G. (1979). Teaching CPR in the schools. Retrieved April 16, 2007 from Lifesaving Resources http://www.lifesaving.com/issues/articles/35teaching_cpr.html

National Conference of State Legislators. (2007). State laws on heart attacks, cardiac arrest and defibrillators: Encouraging or requiring community access and use. Retrieved April 16, 2007, from http://www.ncsl.org/programs/health/aed.htm

O'Riordan, M. (2007). New guidelines for managing sudden cardiac arrest during school athletics. Retrieved April 16, 2007, from http://www.medscape.com/viewarticle/554918

Sack, J. (2000). CPR in the spotlight. Education Week, 19 , 22. Retrieved April 10, 2007 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=3309544&site=ehost-live

Schaefer, G. R., Esco, M. R., Gross, M., & Williford, H. N. (2010). Cardiopulmonary resuscitation and first aid certification among in-service physical education teachers. National Teacher Education Journal, 3, 153-163. Retrieved December 10, 2013, from Education Research Complete, EBSCOhost. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=57631673&site=ehost-live

Taylor, L. (2006, Feb. 16). An A in first aid: 12-year-old Kristian Tharop saves his brother from choking. The Register-Guard. Retrieved November 27, 2007, from http://rgweb.registerguard.com/news/2006/02/16/a1.saved.0216.p1.php?section=cityregion

Suggested Reading

Davis, R. (2007, Apr 2). School cardiac arrest plans urged. USA Today.

Red Cross gives kiss of life to first aid school initiative. (2007). Education, , 3. Retrieved Monday, April 16, 2007 from EBSCO Online Database Academic Search Premier. http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=24120366&site=ehost-live

Should public schools require coaches to be certified? (2003). The Journal of Physical Education, Recreation & Dance, 74 , 9. Retrieved April 16, 2007, from http://goliath.ecnext.com/coms2/gi_0199-2806989/Should-public-schools-require-coaches.html#abstract