Implementation of basic life support training for school children: Online education for potential instructors? Results of a cluster randomised, controlled, non-inferiority trial.

AIM OF THE STUDY: Comprehensive training of the population in basic life support (BLS) increases the chance of survival in cardiac arrest. To implement BLS trainings at schools a high number of instructors will be needed. This non-inferiority study investigated, if online education is effective to prepare instructors to teach BLS compared to face-to-face education. METHODS: A cluster randomised, controlled, single blinded study was performed in 2018 in Hamburg, Germany. A mixed group of potential instructors were allocated alternately to either the intervention or control group and participated in a four-hour instructor training. The instructor training of the control group was realised by trained educators. The intervention group participated in a self-regulated online training with hands-on training supported by peers. Instructors provided BLS training for high school students. The primary endpoint was a mean score in the BLS skills assessment of the students. The secondary endpoint was teaching effectiveness of the instructors. RESULTS: BLS assessments of 808 students of 46 classes, who were taught by 74 instructors could be analysed. The students trained by interventional instructors achieved 0.14 points less (95% CI: -0.27 to 0.56) compared to students trained by control instructors (9.34 vs. 9.48). The non-inferiority could not be confirmed. The teaching performance in the intervention group was better in some aspects compared to the control group. CONCLUSION: Integrating all results of this study, online education may be an effective alternative to prepare potential BLS instructors. Using free online courses, motivated persons can independently acquire necessary skills to become instructors and autonomously realise low cost BLS trainings at schools.

Implementation of Basic Life Support training in schools: a randomised controlled trial evaluating self-regulated learning as alternative training concept.

BACKGROUND: The Kids save lives statement recommends annual Basic Life Support (BLS) training for school children but the implementation is challenging. Trainings should be easy to realise and every BLS training should be as effective as possible to prepare learners for lifesaving actions. Preparedness implies skills and positive beliefs in the own capability (high self-efficacy). METHODS: This randomized controlled cluster study investigates, if self-regulated learning promotes self-efficacy and long-term retention of practical BLS skills. Students in the age of 12 years participated in a practical training in BLS and a scenario testing of skills. In the control group the practical training was instructor-led. In the intervention group the students self-regulated their learning processes and feedback was provided by the peer-group. The primary outcome self-efficacy for helping in cardiac arrest after the training and 9 months later was analysed using a multilevel mixed model. Means and pass-rates for BLS skills were secondary outcomes. RESULTS: Contrary to the assumptions, this study could not measure a higher self-efficacy for helping in cardiac arrest of the students participating in the intervention (n = 307 students) compared to the control group (n = 293 students) after training and at the follow-up (mean difference: 0.11 points, 95% CI: - 0.26 to 0.04, P = 0.135). The odds to pass all items of the BLS exam was not significantly different between the groups (OR 1.11, 95% CI: 0.81 to 1.52, p = 0.533). Self-regulated learning was associated with a higher performance of male students in the BLS exam (mean score: 7.35) compared to females of the intervention (female: 7.05) and compared to males of the control (7.06). CONCLUSION: This study could not resolve the question, if self-regulated learning in peer-groups improves self-efficacy for helping in cardiac arrest. Self-regulated learning is an effective alternative to instructor-led training in BLS skills training and may be feasible to realise for lay-persons. For male students self-regulated learning seems to be beneficial to support long-term retention of skills. TRIAL REGISTRATION: ISRCTN17334920, retrospectively registered 07.03.2019.

Basic life support training using shared mental models improves team performance of first responders on normal wards: A randomised controlled simulation trial.

INTRODUCTION: Survival of in-hospital cardiac arrest (IHCA) depends on fast and effective action of the first responding team. Not only technical skills, but professional teamwork is required. Observational studies and theoretical models suggest that shared mental models of members improve teamwork. This study investigated if a training on shared mental models, improves team performance in simulated in-hospital cardiac arrest. METHODS: On the background of an introduction of mandatory Basic Life Support (BLS) training for clinical staff a randomized controlled trial was performed to compare two training methods. Staff from clinical departments was randomised to receive either a conventional instructor led training (control group) or an interventional training (intervention group). The interventional training was based on self-directed learning of the group in order to develop shared mental models. Primary outcome were mean scores of the team assessment scale (TAS) and the hands-off time. Secondary outcome were mean scores for quality of BLS. RESULTS: Performance of 75 teams of the interventional and 66 of the control group was analysed. The hands-off time was significantly lower in the interventional group (5.42% vs. 8.85%, p = 0.029). Scores of the TAS and the overall BLS score were high and not significantly different between the groups. Hands-off time correlated significantly negative with all TAS items. CONCLUSION: BLS training for clinical staff which creates shared mental models reduces hands-off time in a simulated cardiac arrest scenario. Training methods establishing shared mental models of team members can be considered for effective team trainings without adding additional training time.