Pedagogical Implementation of Directive Feedback Manikins on Cardiopulmonary Resuscitation (CPR) Competencies: Expert Versus Peer Coaching.

BACKGROUND: Directive feedback manikins in resuscitation training evolved faster than the pedagogical evidence. Educators and learning systems must seek clarification on the efficacy of this technology to have evidence-based practices. This project explores directive feedback device use in cardiopulmonary resuscitation (CPR) education for laypersons. METHODS: A prospective nonrandomized-controlled design assessed two pedagogical approaches of directive feedback manikins in adult CPR lessons. The 230 participants were distributed between three groups: a control group without directive feedback manikins (no lights, NL), an expert coaching (EC) group with directive feedback and educator interpretation, and a peer coaching (PC) group with directive feedback, peer interpretation, and expert quality assurance. RESULTS: From the 25 courses observed, average compression depth (mm) did not differ between groups (p = .498), average compression rate (compressions: minute) significantly differed between groups (p = .004), and correct hand placement did not differ between groups (p = .249). A chi-square test showed no significant association between groups and CPR skill feedback, or between groups and "recommending the course to a friend or family member." The PC group was more likely to agree that they could "coach someone to do CPR skills" than the NL or EC. CONCLUSIONS: This study expands the knowledge base of directive feedback manikins in a pedagogical setting to improve CPR competencies. Training organizations may consider any of these practices effective, choosing those that align with desired outcomes. CPR educators need orientation to feedback devices as well as professional development on educational options for their use. Considerations for further research include technology costs, access, and cultural aspects of implementing these tools.

The Real Experience of Lay Responders Performing Cardiopulmonary Resuscitation: A Synthesis of Qualitative Evidence.

Objectives: To synthesize qualitative evidence on the experience of lay responders performing cardiopulmonary resuscitation (CPR). Methods: Qualitative evidence synthesis was performed using the Thomas and Harden method. The PubMed, Cochrane Library, Web of Science, OVID Medline, Embase, CINAHL, CNKI, and WanFang databases were systematically searched. The quality of the research was assessed by the Critical Assessment Skills Program Tool (CASP). Results: A total of 5,610 studies were identified, and 9 studies were included in the analysis. Four analytical themes were generated: emotional ambivalence before CPR, psychological tolerance during CPR, perceived experience after CPR, and enhancing psychological resilience. Conclusion: Lay responders face complicated psychological experience during CPR, which may be susceptible to psychological effects such as "loss aversion," "bystander effects" and "knowledge curse." In addition to the timely retraining of CPR, lay responders should be instructed to manage psychological distress and improve psychological resilience. More importantly, the psychological sequelae may be long-lasting, requiring ongoing psychological intervention and follow-up based on valuing transdisciplinarity across endeavours.

Survival and neurological outcome after bystander versus lay responder defibrillation in out-of-hospital cardiac arrest: A sub-study of the BOX trial.

BACKGROUND AND AIM: Bystander defibrillation is associated with increased survival with good neurological outcome after out-of-hospital cardiac arrest (OHCA). Dispatch of lay responders could increase defibrillation rates, however, survival with good neurological outcome in these remain unknown. The aim was to compare long-term survival with good neurological outcome in bystander versus lay responder defibrillated OHCAs. METHODS: This is a sub-study of the BOX trial, which included OHCA patients from two Danish tertiary cardiac intensive care units from March 2017 to December 2021. The main outcome was defined as 3-month survival with good neurological performance (Cerebral Performance Category of 1or 2, on a scale from 1 (good cerebral performance) to 5 (death or brain death)). For this study EMS witnessed OHCAs were excluded. RESULTS: Of the 715 patients, a lay responder arrived before EMS in 125 cases (16%). In total, 81 patients were defibrillated by a lay responder (11%), 69 patients by a bystander (10%) and 565 patients by the EMS staff (79%). The 3-month survival with good neurological outcome was 65% and 81% in the lay responder and bystander defibrillated groups, respectively (P = 0.03). CONCLUSION: In patients with OHCA, 3-month survival with good neurological outcome was higher in bystander defibrillated patients compared with lay responder defibrillated patients.

Tele-Instruction Tool for Multiple Lay Responders Providing Cardiopulmonary Resuscitation in Telehealth Emergency Dispatch Services: Mixed Methods Study.

BACKGROUND: Telephone-assisted cardiopulmonary resuscitation (T-CPR) has proven to be a crucial intervention in enhancing the ability of lay responders to perform cardiopulmonary resuscitation (CPR) during telehealth emergency services. While the majority of established T-CPR protocols primarily focus on guiding individual rescuers, there is a lack of emphasis on instructing and coordinating multiple lay responders to perform resuscitation collaboratively. OBJECTIVE: This study aimed to develop an innovative team-based tele-instruction tool to efficiently organize and instruct multiple lay responders on the CPR process and to evaluate the effectiveness and feasibility of the tool. METHODS: We used a mixed methods design in this study. We conducted a randomized controlled simulation trial to conduct the quantitative analysis. The intervention groups used the team-based tele-instruction tool for team resuscitation, while the control groups did not have access to the tool. Baseline resuscitation was performed during the initial phase (phase I test). Subsequently, all teams watched a team-based CPR education training video and finished a 3-person practice session with teaching followed by a posttraining test (phase II test). In the qualitative analysis, we randomly selected an individual from each team and 4 experts in emergency medical services to conduct semistructured interviews. The purpose of these interviews was to evaluate the effectiveness and feasibility of this tool. RESULTS: The team-based tele-instruction tool significantly improved the quality of chest compression in both phase I and phase II tests. The average compression rates were more appropriate in the intervention groups compared to the control groups (median 104.5, IQR 98.8-111.8 min-1 vs median 112, IQR 106-120.8 min-1; P=.04 in phase I and median 117.5, IQR 112.3-125 min-1 vs median 111, IQR 105.3-119 min-1; P=.03 in phase II). In the intervention group, there was a delay in the emergency response time compared to that in the control group (time to first chest compression: median 20, IQR 15-24.8 seconds vs median 25, IQR 20.5-40.3 seconds; P=.03; time to open the airway: median 48, IQR 36.3-62 seconds vs median 73.5, IQR 54.5-227.8 seconds; P=.01). However, this delay was partially mitigated after the phase II test. The qualitative results confirmed the compatibility and generalizability of the team-based tele-instruction tool, demonstrating its ability to effectively guide multiple lay responders through teamwork and effective communication with telecommunicators. CONCLUSIONS: The use of the team-based tele-instruction tool offers an effective solution to enhance the quality of chest compression among multiple lay responders. This tool facilitated the organization of resuscitation teams by dispatchers and enabled efficient cooperation. Further assessment of the widespread adoption and practical application of the team-based tele-instruction tools in real-life rescue scenarios within the telehealth emergency services system is warranted.

Characteristics and motivational factors for joining a lay responder system dispatch to out-of-hospital cardiac arrests.

BACKGROUND: There has been in increase in the use of systems for organizing lay responders for suspected out-of-hospital cardiac arrests (OHCAs) dispatch using smartphone-based technology. The purpose is to increase survival rates; however, such systems are dependent on people's commitment to becoming a lay responder. Knowledge about the characteristics of such volunteers and their motivational factors is lacking. Therefore, we explored characteristics and quantified the underlying motivational factors for joining a smartphone-based cardiopulmonary resuscitation (CPR) lay responder system. METHODS: In this descriptive cross-sectional study, 800 consecutively recruited lay responders in a smartphone-based mobile positioning first-responder system (SMS-lifesavers) were surveyed. Data on characteristics and motivational factors were collected, the latter through a modified version of the validated survey "Volunteer Motivation Inventory" (VMI). The statements in the VMI, ranked on a Likert scale (1-5), corresponded to(a) intrinsic (an inner belief of doing good for others) or (b) extrinsic (earning some kind of reward from the act) motivational factors. RESULTS: A total of 461 participants were included in the final analysis. Among respondents, 59% were women, 48% between 25 and 39 years of age, 37% worked within health care, and 66% had undergone post-secondary school. The most common way (44%) to learn about the lay responder system was from a CPR instructor. A majority (77%) had undergone CPR training at their workplace. In terms of motivation, where higher scores reflect greater importance to the participant, intrinsic factors scored highest, represented by the category values (mean 3.97) followed by extrinsic categories reciprocity (mean 3.88) and self-esteem (mean 3.22). CONCLUSION: This study indicates that motivation to join a first responder system mainly depends on intrinsic factors, i.e. an inner belief of doing good, but there are also extrinsic factors, such as earning some kind of reward from the act, to consider. Focusing information campaigns on intrinsic factors may be the most important factor for successful recruitment. When implementing a smartphone-based lay responder system, CPR instructors, as a main information source to potential lay responders, as well as the workplace, are crucial for successful recruitment.

Development, implementation, and evaluation of a lay responder disaster training package among school teachers in Angeles City, Philippines: using Witte's behavioral model.

OBJECTIVES: The aim of this study was to develop and implement a lay responder disaster training (LRDT) package with the intention to alter the perceived efficacy, perceived threat, and levels of fear among school teachers. STUDY DESIGN: The study used an intervention-based design, wherein we intervened by conducting an LRDT which aimed to affect the participants' responses as defined by Witte's behavioral model (WBM). METHODS: The LRDT package incorporated the usual disaster preparedness information but included the unexplored area of disaster first aid, which is lacking in most training currently being given. The entire LRDT was carried out for two consecutive days by an emergency medical services-accredited competency assessor. Preintervention and postintervention knowledge, level of fear, attitude, intentions, behavior, and a Risk Behavior Diagnosis Scale was assessed using a structured questionnaire based on the WBM. RESULTS: After conducting the LRDT as an intervention, the results show that there was a significant change in the knowledge, behavior, perceived threat, and level of fear among the participants. Other constructs, such as attitude, intentions, and perceived efficacy, were not statistically significant after the intervention. CONCLUSION: In conclusion, knowledge, behavior, and the perceived threat of the school teachers were significantly higher after the LRDT, and their level of fear was significantly lower. Based on these results, we can conclude that both the WBM questionnaire and the LRDT package showed potential in improving disaster risk reduction and management among school teachers in Angeles City, Philippines.

Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties.

BACKGROUND: To reduce fatal drug overdoses, two approaches many states have followed is to pass laws expanding naloxone access and Good Samaritan protections for lay persons with high likelihood to respond to an opioid overdose. Most prior research has examined attitudes and knowledge among lay responders in large metropolitan areas who actively use illicit substances. The present study addresses current gaps in knowledge related to this issue through an analysis of data collected from a broader group of lay responders who received naloxone kits from 20 local health departments across Indiana. METHODS: Postcard surveys were included inside naloxone kits distributed in 20 Indiana counties, for which 217 returned cards indicated the person completing it was a lay responder. The survey captured demographic information and experiences with overdose, including the use of 911 and knowledge about Good Samaritan protections. RESULTS: Few respondents had administered naloxone before, but approximately one third had witnessed a prior overdose and the majority knew someone who had died from one. Those who knew someone who had overdosed were more likely to have obtained naloxone for someone other than themselves. Also, persons with knowledge of Good Samaritan protections or who had previously used naloxone were significantly more likely to have indicated calling 911 at the scene of a previously witnessed overdose. Primary reasons for not calling 911 included fear of the police and the person who overdosed waking up on their own. CONCLUSIONS: Knowing someone who has had a fatal or non-fatal overdose appears to be a strong motivating factor for obtaining naloxone. Clarifying and strengthening Good Samaritan protections, educating lay persons about these protections, and working to improve police interactions with the public when they are called to an overdose scene are likely to improve implementation and outcomes of naloxone distribution and opioid-related Good Samaritan laws.

A smartphone application for dispatch of lay responders to out-of-hospital cardiac arrests.

BACKGROUND: Dispatch of lay volunteers trained in cardiopulmonary resuscitation (CPR) and equipped with automated external defibrillators (AEDs) may improve survival in cases of out-of-hospital cardiac arrest (OHCA). The aim of this study was to investigate the functionality and performance of a smartphone application for locating and alerting nearby trained laymen/women in cases of OHCA. METHODS: A system using a smartphone application activated by Emergency Dispatch Centres was used to locate and alert laymen/women to nearby suspected OHCAs. Lay responders were instructed either to perform CPR or collect a nearby AED. An online survey was carried out among the responders. RESULTS: From February to August 2016, the system was activated in 685 cases of suspected OHCA. Among these, 224 cases were Emergency Medical Services (EMSs)-treated OHCAs (33%). EMS-witnessed cases (n = 11) and cases with missing survey data (n = 15) were excluded. In the remaining 198 OHCAs, lay responders arrived at the scene in 116 cases (58%), and prior to EMSs in 51 cases (26%). An AED was attached in 17 cases (9%) and 4 (2%) were defibrillated. Lay responders performed CPR in 54 cases (27%). Median distance to the OHCA was 560 m (IQR 332-860 m), and 1280 m (IQR 748-1776 m) via AED pick-up. The survey-answering rate was 82%. CONCLUSION: A smartphone application can be used to alert CPR-trained lay volunteers to OHCAs for CPR. Further improvements are needed to shorten the time to defibrillation before EMS arrival.